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

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ORIGINAL COMMUNICATIONS. 215<br />

a diseased faucial tonsil, and the brilliant evidence <strong>of</strong> a tubercular n<strong>at</strong>ure have also<br />

results obtained in the complete disappear- been obtained by McBride and Turner <strong>of</strong><br />

ance <strong>of</strong> these glandular enlargements after Edinburgh, Milligeu <strong>of</strong> Manchester, and<br />

the thorough removal <strong>of</strong> the tonsils, cannot<br />

but impress upon all the rel<strong>at</strong>ionship <strong>of</strong><br />

cause and effect. The question as to wh<strong>at</strong><br />

Brieger <strong>of</strong> Germany.<br />

An interesting observ<strong>at</strong>ion was th<strong>at</strong> <strong>of</strong><br />

Riethi, who found tubercle bacilli in six<br />

are enlarged and diseased tonsils will prob- out <strong>of</strong> a hundred hypertrophied tonsils reably<br />

never be settled as long as there remains<br />

so many different ideas on this submoved<br />

from<br />

tuberculosis.<br />

persons showing no signs <strong>of</strong><br />

He believes th<strong>at</strong> all hyperject<br />

among physicians. Lennox Browne trophied tonsils should be removed as early<br />

says th<strong>at</strong> all tonsils which project beyond<br />

the faucial pillows and many <strong>of</strong> those which<br />

as possible. Goodale <strong>of</strong> Boston, who has<br />

done more experimental work on the faucial<br />

do not, are foreign bodies in the thro<strong>at</strong> and<br />

should be removed. This probably is extreme,<br />

and yet in my own mind I think<br />

tonsils and nasopharyngeal adenoids than<br />

perhaps any other one man in this country,<br />

besides being an exceedingly capable and<br />

Browne is nearly correct. Logan Turner conserv<strong>at</strong>ive laryugologist, sums up wh<strong>at</strong><br />

says th<strong>at</strong> the presence <strong>of</strong> enlarged cervical would probably be accepted by most larynglands<br />

should make the removal <strong>of</strong> hyper- gologists as the present st<strong>at</strong>us <strong>of</strong> this untrophied<br />

tonsils imper<strong>at</strong>ive. G. B. Wood certain question. lie does not believe th<strong>at</strong><br />

has done considerable experimental work a cervical adenitis <strong>of</strong> tuberculous n<strong>at</strong>ure<br />

along this line and he concludes th<strong>at</strong> the can be removed by the removal <strong>of</strong> the tonsil,<br />

tubercle bacilli not only produce a tuberculous<br />

condition <strong>of</strong> the tonsil itself, but th<strong>at</strong><br />

because the tubercle bacilli have already<br />

penetr<strong>at</strong>ed into the lymph glands. Wh<strong>at</strong><br />

pass through the structure into the should be done under these circumstances<br />

According to this observer is to prevent further penetr<strong>at</strong>ion <strong>of</strong> more<br />

lymph<strong>at</strong>ic drainage <strong>of</strong> the faucial ton- bacilli into the lymph glands by extirp<strong>at</strong>ion<br />

1 they<br />

I lymph<strong>at</strong>ics.<br />

I "the<br />

I sils runs directly to the upper deep cervical <strong>of</strong> the tonsils and adenoids. In many in-<br />

1 glands,<br />

and these glands by a rich system stances there is enlargement <strong>of</strong> the glands<br />

<strong>of</strong> anastomosis, are connected by afferents I<br />

and efferents with practically all the lymph<br />

<strong>of</strong> a non-tuberculous n<strong>at</strong>ure in which re-<br />

moval <strong>of</strong> the tonsils brings a relief to the<br />

glands <strong>of</strong> the neck and head. The tonsillar glands.<br />

lymph gland just below posterior belly <strong>of</strong> Briefly summarized, it may be st<strong>at</strong>ed th<strong>at</strong><br />

the digastric muscle where it crosses the primary tuberculosis <strong>of</strong> the tonsils and adeauterior<br />

border <strong>of</strong> the sterno-cleido mastoid, noid tissne in the nasopharynx is rare, but<br />

Topographically this spot is loc<strong>at</strong>ed just as portals for the entrance <strong>of</strong> the tubercle<br />

behind and below the angle <strong>of</strong> the jaw." bacilli into the general system, especially<br />

According to this observer, nearly all tuber- into the cervical lymph<strong>at</strong>ic glands, is a<br />

cular adenitis <strong>of</strong> the neck have their origin question which as yet remains unsettled,<br />

through the tonsils. Cases pro and con have been reported which<br />

Strassman, Demochowski, Kruckmann would lead us to believe th<strong>at</strong> the tonsils<br />

and others, have demonstr<strong>at</strong>ed the exist- play no unimportant role in general sysence<br />

<strong>of</strong> tubercle in the faucial tonsils, and<br />

their observ<strong>at</strong>ions have been confirmed,<br />

Hugh Walsham has examined the faucial<br />

temic tuberculosis. During the last few<br />

years much has been written in reference to<br />

the rel<strong>at</strong>ionship between rheum<strong>at</strong>ism and<br />

tonsils removed postmortem from ,54 cases faucial tonsils. Such a rel<strong>at</strong>ionship is all<br />

<strong>of</strong> tuberculosis and found them tubercular most universally recognized, a fact which<br />

it). In his examin<strong>at</strong>ion <strong>of</strong> tonsils re- shows th<strong>at</strong> the internist and the laryngoloved<br />

from living persons his result was ogist must work together. Such accur<strong>at</strong>e<br />

neg<strong>at</strong>ive. Gourc examined'201 cases both clinical observers as Osier, Thayer, Solismicroscopically<br />

and by inocul<strong>at</strong>ion, and he Cohen recognize this rel<strong>at</strong>ionship and many<br />

also could find no trace <strong>of</strong> tubercle. On cases have been reported where the remov<strong>at</strong>he<br />

other hand, a most positive result has <strong>of</strong> the disea&ed and degener<strong>at</strong>ed tonsils<br />

been found by other observers. Fillet found have absolutely cured rheum<strong>at</strong>ic conditions<br />

evidences <strong>of</strong> tubercle in 7, hjc in naso- <strong>of</strong> the severest character. Ingalls says th<strong>at</strong><br />

pharyngeal adenoids. Lemoyez has published<br />

two cases where the adenoid tissue<br />

he is compelled to recognize the rel<strong>at</strong>ion-<br />

ship existing between the two diseases,<br />

removed was almost entirely tubercular, since in examining the redords <strong>of</strong> 100 cases<br />

Dieulafoy, after inocul<strong>at</strong>ing guinea pigs <strong>of</strong> tonsillitis without selection, he found<br />

with portions <strong>of</strong> adenoid tissue from 3.S th<strong>at</strong> 45% had, were having, or had immep<strong>at</strong>ients,<br />

obtained tubercle in 20%, and di<strong>at</strong>ely following, an <strong>at</strong>tack <strong>of</strong> rheum<strong>at</strong>ism,<br />

histological examin<strong>at</strong>ion by the same ob- Melville Hardie thus summarizes the pres-<br />

iserver revealed evidence <strong>of</strong> tubercle in 5, ent st<strong>at</strong>us as to our knowledge <strong>of</strong> the re-<br />

7%. Brindel obtained positive evidence in l<strong>at</strong>ionship between rheum<strong>at</strong>ism and tonsil-<br />

12.5%, and Gottstein in 12%. Positive lar affections, and from my own knowledge

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