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

216
THE CHARLOTTE MEDICAL JOURNAL.
of the literature on this subject, I think his appendix from the throat through the dideductions
are quite correct: gestive tract and he further observes that
1. It is undoubted that a certain number the micro-organisms which especially excite
of cases of acute rheumatism are preceded appendicitis, viz.: the influenza bacillus,
by angina, the proportion varying from .30 and the streptococci, are frequently the
to 80 per cent. cause of angina. This is certainly an in-
2. Both rheumatism and angina have teresting observation, and 1 trust that phymany
etiologic points in common, season sicians and surgeons will bear in mind the
of the year, cold, wet, fatigue, depression, possibility of such a relationship and that
vitiated air. all such authentic cases may be reported.
3. The connection of angina and rheum- I have myself known of several cases where
atism, though undoubted in a number of the removal of an appendix has been folcases,
is not yet clearly explained. lowed by a cessation in attacks of tonsillitis
4. The tonsil may be the port of entry of which previously had been quite frequent,
the rheumatism virus, and this even through As a resume of these important points I
the naked eye appearance of the throat can do no better than to give the conclugives
no indication of its being affected. sions of Uhlman published in 1901. These
5. The particular affection of the throat are:
which is associated with rheumatism has 1. That the normal tonsil has a physionot
yet been established. Apparently it is logic function, probably protective to the
not peritonsillar abscess. organism. (This is true if we knew what
6. Peritonsillar inflammation does not was the normal tonsil) but unfortunately
seem to be arrested by the administration this is far from being decided.
of anti-rheumatic remedies. Many cases 2. That being in itself diseased, the
of parenchymatous and lacunse tonsillitis physiologic function of the tonsil is im- |j
on the other hand are considerably benefited paired, and that instead of being protective ;
by the administration of salicine or the sali- it is the nidus for the grow'th and distribu-j
cylate of soda. That this action proves tion of pathogenic organisms and their pois-j
the rheumatic nature of the disease cannot onous products in the system. ]
yet be accepted. 3. That many grave and fatal general in- '
7. The question requires research in two fections have their origin in the tonsils,
directions: One is the differentiation of the 4. That if the exanthemata, particularly
various forms of angina, and ascertaining scarlatina, are of bacterial origin the tonsil
which one is associated with rheumatism; acts in part as a port of entry.
the other in further research to discover the 5. That acute articular rheumatism and
true nature of rheumatism. the diseases often associated with it, endo-
Besides tuberculosis and rheumatism, carditis and chorea in a great majority of
which seem to bear some decided relation- cases are due to the action of attenuated
ship to the tonsillar structure, other condi- bacteria, their toxins or both entering the
tions have been reported which also show system through a diseased tonsil,
some similarity. For instance, numerous 6. That in those rare cases of typhoid
cases have been reported where a diseased fever in which no intestinal lesions can be
condition of the tonsil has either produced demonstrated the similarity of the tonsillar
a septic infection or has been the gateway tissue and Pyers' patches suggest the tonsil
for the entrance of such septic organisms, as the portal of entry of the Eberth
Froelich has reported an interesting case bacillus,
in which a severe attack of follicular ton- 7. That scrofulosis is often associated
sillitis was followed by peritonitis and with diseased tonsillar tissue and that the
death. tubercle baccillus often enters the system
Jessen of Hamburg, has reported three via the tonsils,
very interesting cases where the general 8. That the tonsil is too little examined
history of the cases and bacteriological ex- at autopsy and as much light might be shed
amination showed almost with certainty on fevers of uncertain origin by its bacterithat
the infection entered the body through ologic aud histologic examination,
the tonsils. W. Lubinski records four cases It is unnecessary to speak of the relationwhere
there was an acute inflammation of ship existing between the lymph tissue in
the thyroid gland following an acute tonsil- the throat and the acute infectious diseases,
litis, and has been able to find only one such as measles, scarlet fever and diphother
case similar to these and this one by theria. The first symptoms of these dis-
Quervain. eases as manifested by some form of amyg-
H. Weber has found two cases where an dalitis is familiar to all, and needs no furangina
tonsillitis was followed by appendi- ther comment. The fact is certainly obvi-
citis. The author's explanation of this as- ous to all that enlarged and diseased tonsils
sociation is, that the irritant reaches the and adenoids add much to the gravity of