10.04.2013 Views

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

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

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

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

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

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!