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

ORIGINAL COMMUNICATIONS. 215
a diseased faucial tonsil, and the brilliant evidence of a tubercular nature have also
results obtained in the complete disappear- been obtained by McBride and Turner of
ance of these glandular enlargements after Edinburgh, Milligeu of Manchester, and
the thorough removal of the tonsils, cannot
but impress upon all the relationship of
cause and effect. The question as to what
Brieger of Germany.
An interesting observation was that of
Riethi, who found tubercle bacilli in six
are enlarged and diseased tonsils will prob- out of a hundred hypertrophied tonsils reably
never be settled as long as there remains
so many different ideas on this submoved
from
tuberculosis.
persons showing no signs of
He believes that all hyperject
among physicians. Lennox Browne trophied tonsils should be removed as early
says that all tonsils which project beyond
the faucial pillows and many of those which
as possible. Goodale of Boston, who has
done more experimental work on the faucial
do not, are foreign bodies in the throat and
should be removed. This probably is extreme,
and yet in my own mind I think
tonsils and nasopharyngeal adenoids than
perhaps any other one man in this country,
besides being an exceedingly capable and
Browne is nearly correct. Logan Turner conservative laryugologist, sums up what
says that the presence of enlarged cervical would probably be accepted by most larynglands
should make the removal of hyper- gologists as the present status of this untrophied
tonsils imperative. G. B. Wood certain question. lie does not believe that
has done considerable experimental work a cervical adenitis of tuberculous nature
along this line and he concludes that the can be removed by the removal of the tonsil,
tubercle bacilli not only produce a tuberculous
condition of the tonsil itself, but that
because the tubercle bacilli have already
penetrated into the lymph glands. What
pass through the structure into the should be done under these circumstances
According to this observer is to prevent further penetration of more
lymphatic drainage of the faucial ton- bacilli into the lymph glands by extirpation
1 they
I lymphatics.
I "the
I sils runs directly to the upper deep cervical of the tonsils and adenoids. In many in-
1 glands,
and these glands by a rich system stances there is enlargement of the glands
of anastomosis, are connected by afferents I
and efferents with practically all the lymph
of a non-tuberculous nature in which re-
moval of the tonsils brings a relief to the
glands of the neck and head. The tonsillar glands.
lymph gland just below posterior belly of Briefly summarized, it may be stated that
the digastric muscle where it crosses the primary tuberculosis of the tonsils and adeauterior
border of the sterno-cleido mastoid, noid tissne in the nasopharynx is rare, but
Topographically this spot is located just as portals for the entrance of the tubercle
behind and below the angle of the jaw." bacilli into the general system, especially
According to this observer, nearly all tuber- into the cervical lymphatic glands, is a
cular adenitis of the neck have their origin question which as yet remains unsettled,
through the tonsils. Cases pro and con have been reported which
Strassman, Demochowski, Kruckmann would lead us to believe that the tonsils
and others, have demonstrated the exist- play no unimportant role in general sysence
of tubercle in the faucial tonsils, and
their observations have been confirmed,
Hugh Walsham has examined the faucial
temic tuberculosis. During the last few
years much has been written in reference to
the relationship between rheumatism and
tonsils removed postmortem from ,54 cases faucial tonsils. Such a relationship is all
of tuberculosis and found them tubercular most universally recognized, a fact which
it). In his examination of tonsils re- shows that the internist and the laryngoloved
from living persons his result was ogist must work together. Such accurate
negative. Gourc examined'201 cases both clinical observers as Osier, Thayer, Solismicroscopically
and by inoculation, and he Cohen recognize this relationship and many
also could find no trace of tubercle. On cases have been reported where the removathe
other hand, a most positive result has of the disea&ed and degenerated tonsils
been found by other observers. Fillet found have absolutely cured rheumatic conditions
evidences of tubercle in 7, hjc in naso- of the severest character. Ingalls says that
pharyngeal adenoids. Lemoyez has published
two cases where the adenoid tissue
he is compelled to recognize the relation-
ship existing between the two diseases,
removed was almost entirely tubercular, since in examining the redords of 100 cases
Dieulafoy, after inoculating guinea pigs of tonsillitis without selection, he found
with portions of adenoid tissue from 3.S that 45% had, were having, or had immepatients,
obtained tubercle in 20%, and diately following, an attack of rheumatism,
histological examination by the same ob- Melville Hardie thus summarizes the pres-
iserver revealed evidence of tubercle in 5, ent status as to our knowledge of the re-
7%. Brindel obtained positive evidence in lationship between rheumatism and tonsil-
12.5%, and Gottstein in 12%. Positive lar affections, and from my own knowledge