Diseased Tonsils Research Articles

FUSOSPIROCHETAL ORGANISMS AND TONSILLITIS: BISMUTH THERAPY OF TONSILLITIS

Bacterial smears of mucopurulent material aspirated 1 from diseased tonsils frequently show considerable numbers of fusospirochetal organisms, while smears made from swabs of the same tonsils reveal only insignificant numbers of these organisms. What constitutes a significant number of these organisms is somewhat uncertain. The usual textbook picture of Vincent's angina calls for the presence of the organisms in predominant numbers in smears of material from tonsils presenting ulceration and membrane formation. I believe these diagnostic criteria are too exclusive, as I have encountered a great number of cases of follicular tonsillitis in which fusospirochetal organisms seemed to be the most important etiologic agent. Field, 2 likewise, observed that milder [fusospirochetal] infections than those manifested by ulceration and membrane may occur. This author also commented that grades of [fusospirochetal] infection in the throat and lungs, less severe than the usual textbook picture, are relatively frequent, and they are commonly not correctly diagnosed.

Report of the Secretary of Agriculture 1940

The work of the Farm Security Administration in providing medical care for their clients was developed because surveys in a Southern state revealed that 50 per cent of the borrowers who failed to keep up their payments were victims of bad health. A recent study of one hundred low income families in two Southeastern counties disclosed one thousand three hundred and seventy-three ailments among five hundred and seventy-five persons. The ailments included 132 cases of rickets among children, 31 cases of suspected tuberculosis, 14 cases of pellagra, 288 cases of diseased tonsils, three hundred and sixty individuals with defective teeth and one hundred and twenty-four with defective vision. The medical plans of the Farm Security Administration are supported by loans extended to the families and call for free choice of physician and the pooling of funds. Most families pay from $20 to $30 a year. They choose their doctor from

SIGNIFICANCE OF THE TONSILS IN THE DEVELOPMENT OF THE CHILD

During the last thirty years many significant facts have been ascertained relative to the growth and to the development of the child. Particular attention has been given to the status of the tonsils and adenoids as one of the factors that may influence the child's physical progress. In this period an increasing number of children have been classified as possessing hypertrophied or diseased tonsils resulting in the surgical treatment of the tonsils in nearly 50 per cent of urban children in the United States and England. This situation invites a survey of the tonsil problem and an evaluation of the tonsils as a factor in the child's development. It is of interest to note that in 1888 W. Franklin Chappell 5 surveyed 2,000 children in New York to determine the frequency of certain abnormal conditions of the tonsils. He concluded that 3 per cent of the children had tonsils sufficiently

Calcification of the Pericardium and within the Heart Muscle

During the past few years the literature has contained many reports of the roentgenologic demonstration of calcification of the heart valves which has been diagnosed, usually by fluoroscopic study, and later confirmed by properly made x-ray films. The reason for reporting this case is because of the extensive calcification present, and because it illustrates the fact that this calcification could easily have been overlooked, had one depended on the teleoroentgenogram for study of this heart and not availed himself of the fluoroscope. The principles of the Bucky grid are well understood—the moving grid does not register on a film. This holds true in studies of the heart, as, with cardiac pulsation, often massive deposits of calcium may be blurred and merged with the heart silhouette, thereby being overlooked (Fig. 1). The patient to be reported was admitted to Emory University Hospital with a complaint of “heart trouble” of 23 years' duration. He was 37 years of age. His past history indicated that at the age of eight he had puffiness about the eyes, a swelling of his ankles and extremities, and multiple inflamed joints which kept him in bed for several months. An abscessed tooth was removed, and he gradually improved. When 18 years old, he developed edema of the ankles and dyspnea on exertion. At first the symptoms were slight, but, as the years passed, they became progressively worse. One year ago the dyspnea was so severe he was confined to bed. He stopped smoking and, peculiarly, his pulse, which was 100 and regular, dropped to 60 and became irregular. He was digitalized for two weeks and returned to work. He has been taking digitalis for the past year. A month and a half ago he developed a massive edema and has been confined to bed. He was given five doses of salyrgan and the edema disappeared. He has lost considerable weight during the past two months and has a chronic cough. The physical examination, in brief, showed an inflammation of the eyes, chronically inflamed and diseased tonsils, chronic arthritis in multiple joints. Many râles were diffusely spread from the apex to the base of each lung. His heart was irregular, there was no pulse deficit, it appeared enlarged on percussion, the chest wall pulling in with each beat. There was a pronounced pulsus paradoxicus; there were no thrills; his blood pressure was 140∕80. His abdomen showed the liver margin 8 cm. down, with questionable liver pulse. He showed a markedly increased venous pressure. The intern's impression following history and physical examination was: (1) Congestive heart failure; (2) auricular fibrillation; (3) chronic tonsillitis; (4) adhesive pericarditis; and (5) chronic arthritis. The laboratory studies showed the Wassermann and Kahn tests to be negative. The sputum was purulent, containing many pus cells, but no acid fast bacteria.

Correcting Speech Defects

THE MOTHER Of a nine-year-old boy who stuttered called to see speech teacher in a public school recently. She was very anxious because clinic nurse had told her that the cause of Jack's stutter was masturbation and that if he continued to masturbate, he would eventually become insane. To be sure this was rather an unusual statement. The majority of nurses now recognize that stuttering, lisping, masturbation, and thumb sucking are all symptoms of emotional maladjustment and that whole child must be studied to determine cause. This article is concerned primarily with symptoms known as speech defects, most common of which are stuttering, lisping, letter substitution, oral inactivity, and delayed speech. Stuttering, lisping, and letter substitution are generally recognized by layman; first as halting or repetitive speech, lisping as substitution of th for s, sh, ch, and j, and letter substitution as when one says wed for red, tandy for candy. Oral inactivity is characterized by extreme indistinctness. Words are run together, sounds omitted and listener may say Why I can't understand one word that boy says. Too frequently delayed speech is not recognized early. If child does not talk in sentences at two years, parents should seek cause from doctor, speech specialist, or both. The parent feels sure that speech will develop and so, because he lacks technic for encouraging it, continues to wait or takes him to a doctor who says, Oh, he's alright, a perfect specimen-he will soon be talking too much. Many such cases of delayed speech are found in kindergarten and first grade still unable to express themselves intelligibly and so substituting undesirable behavior reactions for correct speech. The cause of these different speech defects is seldom understood by parent until it is fully explained by speech specialist. Grandparents and parents feel sure that heredity, diseased tonsils, teeth, or tongue-tie are responsible. Recent studies reveal fact that only Io per cent of speech defects are organic and that 90o per cent are functional, that is they are symptoms of an underlying emotional difficulty. Speech is not inherited but develops in response to a definite need. It is our way of getting along with people-adjustment to environment-and any break in rhythm of speech indicates a maladjustment or inability to meet situations in an easy, natural way. Speech is a very sensitive mechanism and emotional.disturbances are frequently cause of speech defect. The causes, numerous and varied, may best be illustrated with a few case studies.

Grouping of Hemolytic Streptococci Isolated in Puerto Rico.

While studying the biological properties of hemolytic streptococci isolated from different sources in this Island, we grouped 46 strains using the precipitin reaction described by Lancefield.1All extracts were first tested against group A serum. Those that gave a positive test were not tried against the other sera because cross reactions have never been observed with particular A antiserum.2 Those that gave a doubtful or a negative result were tested in the same B, C, D, E, F, G and H antisera.Out of 11 strains from diseased tonsils, 7 belonged to group A, 2 to group C and 2 remained unclassified. All the strains isolated from chronic discharging lesions of the face, from abscesses, from otitis media, from osteomyelitis and from the throat of patients with a diagnosis of scarlet fever were group A. Strains M6 and M7, isolated from the throat of cases of agranulocytic angina and rheumatoid arthritis respectively, remained unclassified, but they were not group A.Of 15 strains from cases of recurrent lymphan...

EXOSTOSIS OF THE EXTERNAL AUDITORY CANAL: Removal with the Electric Burr

A. G. was first seen by me in October, 1926, when he was 10 years of age. He had been referred for tonsillectomy, because of an attack of tonsillitis four months previously, which had been followed by an acute rheumatic attack and endocarditis. As long as he could remember, the left ear had felt clogged, especially on arising in the morning. Examination showed, in addition to badly diseased tonsils, a firm growth in the left external auditory canal, which was not bony in consistency. The diagnosis of a cartilaginous growth was made. This was about the size of a pea, and occluded about three quarters of the external canal. It arose from the posteroinferior part of the external canal. The tonsils were removed on October 30, and at the same time the growth in the external canal was removed. This was done easily with a curet. It proved

Progress in Otolaryngology: Summaries of the Bibliographic Material Available in the Field of Otolaryngology * TONSILS AND ADENOIDS

In reviewing the literature for 1931 on the tonsils and adenoids, I have selected only those papers which promote discussion and those which, according to my judgment, show the advances made in this particular field of otolaryngology. Most of the outstanding contributions have been directed to the study of the bacteriology, immunology and biochemistry of the tonsils. An extremely interesting and instructive series of reports by New and Childrey on tumors of the tonsil and pharynx represent the observations of a large collection of clinical and pathologic material. Instructive papers on retropharyngeal abscess were contributed by Lifschutz and by Woodward. GENERAL CONSIDERATIONS A review of the various factors involved in the tonsil problem convinced Burgers and Wolffheim that many factors are as yet not fully understood. Following a discussion of the bacteriology of the pharyngo-oral cavity, they stated that the bacteriology of healthy and of diseased tonsils as well as

RESULTS OF TONSILLECTOMY

Considerable evidence is at hand to convince one of the relationship of infected tonsils to disease in individual children. Removal of the tonsils and adenoids in such children has been followed by striking improvement in the child's general condition or by cessation of recurrent infection which had been attributed to the diseased tonsils. In spite of these outstanding favorable results following tonsillectomy, there still remains in the mind of the critical observer considerable doubt as to the value of this procedure in the great mass of children subjected to this operation. The popularity of this procedure is well known. In urban communities, approximately 50 per cent of the older children have had their tonsils and adenoids removed. No other medical procedure, with the exception of vaccination against smallpox and diphtheria, is as freely offered to the child as tonsillectomy. One is justified in the query Is this procedure wise and

THE INOPERABLE TONSIL: TREATMENT WITH RADIUM IN PREFERENCE TO OTHER NONOPERATIVE METHODS

After considerable observation of the use of nonoperative methods in the treatment of diseased tonsils, which for one reason or another cannot be removed surgically, I still prefer radium to all other measures. With the improved technic in the preparation and the application of the radon seeds, disease of the tonsils can be eliminated in from one to three months. Removable platinum seeds (radon seeds), each about 4 mm. long, are my choice. They have a screenage of 0.33 mm. thickness of platinum, which practically eliminates 98.5 per cent of the caustic beta rays. Each radon seed contains about 2.56 millicuries of radium emanation, but can be made to contain more or less emanation, as required. After the seed has been in situ for five or six days, it is removed by means of a silk thread attached to one end of the seed. At the end of this time,

EFFECT OF TONSILLECTOMY AND OF ADENOIDECTOMY ON DIPHTHERIA IMMUNITY

Tonsillectomy has been advocated not only to relieve symptoms referable to diseased tonsils themselves, but also as a means of protection against subsequent infections. The evidence concerning the protection that tonsillectomy may afford against diphtheria consists chiefly in statements by experienced clinicians that they have rarely observed this disease in children whose tonsils have been completely removed. In 1916, Tomlin¹of Indianapolis suggested that tonsillectomy might reduce the incidence of diphtheria by eliminating the portal of entry and also by reducing the number of bacilli carriers. In 1917, Boot²of Chicago observed that "there is no doubt that children who have had tonsillectomy done are less susceptible to diphtheria." In the same year, Perry³of St. Louis wrote as follows: "Our city doctors in charge of the isolation department tell me that they have never found a case of diphtheria in a patient who has had the

Tonsillectomy in the Prevention and Treatment of Rheumatism

In the organized attack on the rheumatic infection there is probably no more debated point than that of the efficacy of tonsillectomy. As portals of entry of the virus the tonsils are supposed to occupy first place, and hence it is only natural that one of the commonest procedures in the attempt not only to prevent the disease but also to hinder its progress, should consist intheirremoval. It must be admitted, however, that so far as the latter purpose is concerned the operation savours of locking the stable after the steed has been stolen. Statistics vary regarding the incidence of disease of the tonsils in examples of the rheumatic infection, but there is no doubt that in a goodly proportion of the patients abnormal tonsillar tissue is present and that a history of a previous tonsillitis is obtained. In a recent survey in London' the incidence of diseased tonsils in rheumatic children was said to be roughly 60 per cent. as against 50 per cent. in non-rheumatic children, whereas in a simultaneous enquiry carried out in Glasgow only 45 per cent. of the rheumatic and 40 per cent. of the non-rheumatic presented tonsillar abnormality. Disease of the tonsils is thus so widespread, not only among the non-rheumatic members of the class of society which provides the majority of our examples of rheumatism, but as we all know among the children of the better classes as well, in whom on the other hand, rheumatic fever is admittedly rare, that it is exceedingly difficult to assess the importance of this condition in the pathogenesis of the infection. Nevertheless it seems rational to remove a possible focus of infection and portal of entry, apart altogether from the effect of the operation on the general health, and it has been our custom to have the tonsils enucleated in all examples of the disease when there was any question of enlargement. The present communication is an analysis of our results in an attempt to appraise the value of this line of attack.

STUDIES IN ASTHMA

Current textbooks show that the diagnosis of eczema has been applied to a variety of skin conditions which depend on a number of causes. Recent progress has made it possible to remove many cases from the old classification of eczema by showing that the skin lesions depend on such local causes as chemical irritation, or on parasitic conditions, as ring worm or epidermophytosis. Eczema is becoming better defined. The local lesion frequently depends on some fundamental cause in the body as a whole, and is not necessarily a local disease of the skin itself. The more general causes include toxic, metabolic and allergic factors. Toxic causes include those in which the eczema depends on a well recognized focus of infection and clears when the bad teeth or diseased tonsils or constipation are treated. Under this heading, perhaps, may be grouped those children in whom eczema depends on a faulty digestion,

A NEW TECHNIC FOR THE LIGATION OF VESSELS IN TONSILLECTOMY

A decade or so ago, the operation universally practiced for the removal of enlarged and diseased tonsils was that properly called tonsillotomy, because it consisted of only partial removal of the organ. That this operation would prove a disappointment in failing to clear up either the local or the general infection is what might reasonably have been inferred from the consideration that the crypts in which the infective material is lodged extend through the whole depth of the tonsil to its enveloping capsule. There was therefore devised the operation of tonsillectomy or, as it is sometimes called, enucleation, which aims at the removal of the entire organ with its capsule. At the present time, any operation that falls in any degree short of this performance is looked on as a failure. Tonsillectomy is therefore a different undertaking from the old operation of tonsillotomy, and if properly done should be

A CLINICAL STUDY OF ENURESIS

A group of children suffering with enuresis was studied; 129 were boys and 123 girls. The observation covered a period of three years. The following factors to which enuresis is commonly ascribed were selected for study: Enlarged or diseased tonsils and adenoids. Eye strain. The male prepuce. A small meatus. Vaginitis. Pyelitis. Defective posture. Malnutrition. The neurotic constitution. The psychic factor and the role of discipline. Sex. CAUSATIVE FACTORS IN ENURESIS The Relation of Enlarged or Diseased Tonsils and Adenoids to Enuresis .—It was found that 116 of the children showed sufficient trouble with tonsils or adenoids to justify their classification as abnormal. In forty-nine of these, the tonsils and adenoids were removed for the purpose of curing the enuresis. This it seemed to do in one case. In one other case, the enuresis became considerably worse after the operation, and in the remaining forty-seven cases it did not seem

Relationship of diseased tonsils to goiter. Observations based upon a series of 9864 goiter cases : Bram, Israel, Philadelphia. Med. J. & Rec., April 6, 1927, cxxv, 442

Relationship of diseased tonsils to goiter. Observations based upon a series of 9864 goiter cases : Bram, Israel, Philadelphia. Med. J. & Rec., April 6, 1927, cxxv, 442

PARANASAL SINUSITIS IN INFANTS AND IN YOUNG CHILDREN

A large part of the work of the pediatrician concerns infections, even in the field of infant nutrition. A large proportion of these infections consist of, or result from, upper respiratory inflammation. For many years the importance of diseased tonsils and adenoids has been realized, both in their direct and indirect effects. That paranasal sinus infection is of equal importance is realized only incompletely. This is due to the more recent recognition of the role of sinus disease, and to the fact that the knowledge of its importance has not been disseminated sufficiently. That sinus disease occurs with considerable frequency in certain parts of this country has been shown by a number of observers. 1 The opinion is encountered that there is a tendency to overemphasize its importance in children, because it is a new idea and therefore a new panacea, and that it can only take its proper place

EFFECT OF REMOVAL OF ADENOIDS AND TONSILS ON THE MENTAL DEVELOPMENT OF THE CHILD

Some years ago, Dr. Roe, the laryngologist, called my attention to the depressing effect of adenoid growths on the mentality of children. Removal of adenoids and enlarged tonsils in dull or backward children almost invariably resulted in improvement in their school work. Indeed, this relationshiy between adenoids or enlarged tonsils and mental dulness has been generally recognized although the literature in reference to it is rather limited. Recently, in the city of Rochester, removal of tonsils and adenoids was undertaken on a large scale among the school children. About 1,500 operations were performed during 1919-1920. The further outcome of this experience was a general survey of the school children of the city, numbering about 50,000, including those attending parochial schools. Of this number, about 18,000 were found to be afflicted with diseased tonsils, adenoids or both. A clinic was established early in January, 1921, and the work was speedily begun.

PUBLIC HEALTH LEGISLATION

Inflammatidn of the Middle Ear in Scarlet Fever.-It was found that in a series of 100 consecutive cases of ear discharge in elementary school children the parents stated that it was the result of measles in 18 per cent of the cases and of scarlet fever in 19 per cent. It was found in regard to the age-incidence that although the greatest number of cases of scarlet fever were between five and ten years of age, the incidence of ear discharge varied from 15.4 per cent at the ages 0-5, which percentage was twice as high as in the five to ten age group and four times as high as in the remainiing groups. The incidence of scarlatinal ear discharge for all ages was 7.6 per cent. The chief indication for surgical relief in cases of infection of middle ear are (1) removal of the initial focus of infection, such as adenoids and diseased tonsils, and (2) paracentesis of the ear drum. The average duration of the ear discharge in 20 cases in a special ward with efficient means of examination and treatment, but without operation, was 32.4 days. In 50 cases treated by the removal of adenoids and with paracentesis when necessary the average duration was 15.8 days. The authors agree with other observers that scarlet fever does not cause a rapid destruction of the ear drum in the early stages of the disease if properly treated.-Scarlet Fever Otitis, E. H. R. Harriss and F. Brayshaw Gilhespy, The Lancet (April 26), 1924.

PUBLIC HEALTH LEGISLATION

PUBLIC HEALTH LEGISLATION Affiliation James A. Tobey CopyRight https://doi.org/10.2105/AJPH.14.4.374 Published Online: August 30, 2011