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

The Charlotte Medical Journal
Vol. LX CHARLOTTE, N. C, OCTOBER, 1909. No. 4
A Pica lor the Early and Tborougb •
Re- famiHar tr, all K„t th^.
moval 'amiliar
ol
to all, Tonsils and Adenoids but there is
In
an anatomic
Cblldren.* torination above each faucial tonsil, which
By Dunbar Roy, M. D., Atlanta, Georgia. '" ^^^ ^^^^ ^^^^ years has received much at-
1. Anatomical— *^"^'°" o" account
Position
of its
and Structure
pathologic import-
'
2. Phvsiologic '" being
Function.
probably the starting point
f"'^^'
*°''
3. Pathologic
^'anous infections in
I^unction
and about the ton-
4.
^''^' Remote Effects
^^Pecially of peritonsillar
( 1 ) by Pathologic abscesses.
Ir-
Killian
voh'ement, (.2) by Mechanical
was one of the first
Obstruction.
men to call
attention
5. Rational
to this
Treatment.
anatomic formation from
the My only excuse
examination of
for bringing
105
a time-worn
anatomic preparations
subject and like this before our
100 living persons.
Medical Assoc
He found
ation is the fact of its importance to the \ '1 ^ immediately below the
,^'''f
specialist and ^°^^ of
general mucous
practitioner membrane,
alike which
^^"^'^""f
and also that I wish
^^^ upper part of the
to
tonsil
put myself on in front,
record ^°r'^
as favoring an early operation for tonsils ^ ^^P^^'°" >»^k
«[ This is the openand
adenoids, and this too onlv under a H^ '"'° f «lative y arge cavity lying in
general anesthetic. In the last few vears u^ ^"^f "^^'^^ *°"?'' '^'^"='^ '^ concealed by
the deleterious effect of enlarged or diseased ?^ ^of palate. Examination with a probe
tonsils and adenoids upon the general con- f °'^^ ^''^^^^'' P'^^'^^ ^^^ ^ '^e"^ ^^P^^ of
stitution of the individual has been univers- ,V"" / ^^^"^ was called by His
^.'t "f,"^
ally
^natonist,
recognized,
the
and supra-tonsillar
ils importance is in- ]^^ fossa and
creasing with every year of our medical L.l '11,^'"'' ''
'f"'^ \'' '^f''^"^^
advancement. It is impossible for me, in ^"'^Y •
^^ Prolonged down-
f ? f T^ the limited time at my disposal, to go t hor- '
f'^'" ^"' "l \^^, .^°"f °^ '' ^^y ^e
oughly into
^'-^J'^hedoutvvard
every
behind the
detail
palato-g
of this subject,
ossus
but
I shall try as far as possible to present some ^"!f/'fn T f , "r"" ^'^'-
possible to present "' some
''^'
crypt of the tonsil but a space above l'
important facts^as a practical
this
contribution
organ.
to the Enough
subject
has been
in question.
written to show
that it The has a distinct
anatomical anatomical
position
entity
and and
relationship
possesses
of
clinical
the faucial
significance. It
tonsils and adenoid may be-
tissure in
the nasopharynx
come
is no doubt j"""*! the \'"^ seat of suppuration which may
too familiar
to need
very imperfect
discussion, although manner and in
I shall speak
this way later on
give rise to
this point when
continuous throat irri-
discussing the obtation.structive
Patterson has
influence
found pyogenic or-
of these structures to
ganisms in
proper
great abundance
ventilation
in this
of the nose
space
and ears.
The
and believes it is
lymphoid
the point
ring
where the
in the throat now
ma-
has a
jority of tonsillar
definite infections arise. meaning to nearly My every own
physician,
observations
embracing
correspond
as
with this
it does
state-
the circle of Ivmphoid ment. In fact,
tissue
Killian known has
as
given
adenoid, up the
faucial, and lin-
ordinary incision
gual through the
tonsils.
soft
All of
palate in
this ring of tissue is
cases of peritonsillar
histologically abscess
the same,
d
being
opens
what
knowii
'^'"^ through the
as
supratonsillar
lymphoid fossa
tissue. On
by
account of
the prominem position and ease oframin If^ L?'.!.?'°^!l '"^.f^f„""^ .'"'^ *l^ ^^
scess ^'-cao
ation by uy this mis route.
fli(» fQii^i.,! juuie. t. „..;io i; f i
1 he question as to the
r'.^e^J^ m:^l Sl^nUon^lha^^ d^' th; Sjh^^^^L^y^t t^n^" ^iS adenoid T 'Z:"" T
tissue in the naso-pharvnx and the '! ^/'^°"sji a
'
, , T ) ,
of
lymphoid
.experimental work tissue has been
at the base of the tongue f^^V^^^.f. This, furthermore, was justifiable becfuse '"'' '^^ -'^'^
^.^^^ ' T'^^^.tT"''' r
the faucial tonsil, do produce more svstemic "' '^"^ °P1"'°."'
HZ T S
disturbances than '''''
possiblv do the rema Id r Ivmnhadc ti su'e Ch'i T''"""'"' l'
of the lymphoid ring, and for this reason L^ fP^'A". _''''"^,'^°*^ " '^^. "^so-pharynx
has receh-«f'^r/'r.^' r
their
"^ !"' '''?
nas "^T" bu^mo;resp;;i;n7;he"fauci;rt7„rir.'
received more attention from physiolo- tv.^ „.,, , r , .,
[""^t-"
-;K.a-d before the
'» t^^^ 'ght of the present day
n,eeti„g of the Georgia M...,cat
Association in Macon, Georgia, April "^"owledge, is still
20, 21, veiled m some obscurity.
"' '^^'
'
' It is for this reason that I shall speak for a