Vol. 60, 1909 - University of North Carolina at Chapel Hill

162 THE CHARLOTTE MEDICAL JOURNAL.
tween the first and the second injection in ing rise to the high-arched palate, are not
order that the patient show anaphylaxis or to be attributed to the blocking of the nasal
heightened susceptibility. Von Pirquet has air-way, but are rather to be thought of as
pointed out the great significance of this arising quite independently of the hitherto
reaction in its relation to immunity. Thus supposed cause. In the majority of cases
the tuberculin reaction is one of anaphy- of so-called "adenoids" there are also to be
laxis. noted the existence of a subnormal tem-
In the light of such knowledge physi- perature and lack of proper development
cians will necessarily look \ipon prophylac- of the body as indicated by weighing. The
tic injections of sera with considerable constancy of a subnormal temperature in
skepticism. Indeed the possibility of sub- these cases of nocturnal enuresis which are
sequent anaphylaxis would seem absolute- successfully treated with thyroid extract,
ly to contra-indicate this practice, although and its disappearance coincidently with the
serum inoculation must still be looked upon bedwetting, led Williams to infer that there
as one of the most valuable therapeutic might be a relationship between the subnormeasures.
The thing more important than mal temperature and the incontinence. Howprophylactic
inoculation is positive diag- ever.heprefers to account for both by the exnosis.
This first injection might possibly istence of thyroid insufficiency. It is interremove
the one chance in a subsequent in- esting to note the theory of the pathogenesis
jection. In the future we shall probably of the bone deformity in cases of adenoids,
have to rely for prophylaxis upon vaccines One of the most important functions of the
rather than upon serum. Vaccines are thyroid secretion is admittedly the fixing of
simply the dead bacteria in suspension in calcium salts in the tissues. Without a
non-proteid media. It is the serum, or sufficiency of the secretion the salts cannot
rather the proteids in the serum, that does be utilized, bone-formation is defective, and
the harm. the child's bones fail to grow hard, and, in
It will be some slight comfort to know the case of the palatine arch, they yield to
that when an animal has once reacted ana- external pressure in such a way as to conphylactically
to a given substance it may vert the arch from a Norman into a Gothic
develop a condition which prevents a subse- structure. This same relative absence of
quent reaction, that
has been developed.
is, antianaphylaxis calcium salts from the tissues, due to the
thyroid insufficiency, may likewise account
rt NEW THEORY CONGERNINO THE ETi- for the Occurrence of dental caries in such
OL.OGY OF ADENOIDS. children.
The prevalent belief that adenoids and In adults a lack of thyroid secretion is
nocturnal enuresis bear a genuine causal associated with a boggy, heavy developrelationship
has for years been calmly ac- ment of fat, which obese condition is oftencepted
by the majority of the profession, times very characteristic. Such a state is
Certainly the common association of the also seen in children, but is usually associtwo
has apparently given reason for the ated with complete absence of thyroid secreassumption
that bedwetting is, in some in- tion. When, however, the insufficiency in
stances, due to the existence of an excess infants and children falls short of complete
of adenoid tissue in the nasopharynx. The absence infantilism is produced, the subfact,
however, that the removal of the ade- jects of which are rarely corpulent. In this
noids affords a very uncertain cure for the way is the undersize of such children acenuresis
would seem to introduce a doubt counted for; whereas in the adult the thyas
to the relationship. A new and distinctly roid insufficiency shows itself chiefly by
original view has been advanced recently inadequate metabolism and the consequent
in the British Journal of Children's Diseases excessive deposit of fat; in the child the inby
Leonard Williams when he expressed sufficiency prevents the utilization of calthe
theory that the above mentioned idea cium salts, bone formation is defective and
as to the relation of adenoids to bedwetting the child fails to grow. Administration of
is erroneous, and that both are due to an thyroid extract to such children causes
insufficiency of the internal secretion of the them to gain in weight and size rapidly,
thyroid. Acting upon this belief he administered
thyroid extracts with results so uni-
Indeed the weight gives an index upon
which the extract administration may be
formly good that he is of the opinion that gauged. As long as there is a gain the
fully 80% of children who are said to suffer remedy is doing good, but as soon as there
from adenoid vegetations may be cured by is a definite fall the borderline of safety
purely medicinal means. The commonly has been crossed, and the drug should be
observed signs of adenoids such as are suspended. Another sign of intolerance of
noted in the typical facies; listless eye, snub the remedy, besides tachycardia, is the
nose, open mouth, rabbit teeth, malforma- occurrence of sudden and severe nasal
tion of the jaws—especially the upper giv- catarrh. Williams affirms that this is really