ENLARGED TONSILS CURED BY MEDICINE J.C. BURNETT
IT is to some of us often a question of great interest and importance to determine, whether tonsils that have become enlarged should or should not be removed by operations. To start with, we may say that there are manifest advantages in operations for the removal of tonsils. It is soon over, and any benefit accruing therefrom is at once enjoyed by the sufferer; he can breathe better, more easily, and frequently soon takes on a healthier hue; and if his pigeon-breastedness is only of recent date, and costal ossification is not far enough advanced to amount to fixation of the ribs, the chest rounds out and great improvement in patients general condition is presently manifest. Again, swallowing is more easy, and all concerned feel happier in their minds when they reflect that in case of inflammations and swellings in the throat the chances of choking are much lessened. Moreover, there is a good deal of satisfaction in the feeling that the thing is over, the job is finished, and one can heave a sigh of relief, “Now that’s done with!”
But is it?
I fear not.
And before leaving the question of the advantages of a mechanical removal of the tonsils, I would also name the diminution of the aggregate quantity of mucoid tissue thereby effected, and which is sometimes seemingly advantageous, much as we observe that the removal of a portion of the thyroid will improve the general condition of the goitrous. But as a minus of either is manifestly, at least, as bad as a plus, it does not seem easy to determine how much to excise. Still granted that this happy middle-way can be struck, there is conceivably advantage to be derived from lopping off some tonsil tissue.
I take it, therefore, that the advantages to be derived from the operative treatment of enlarged tonsils are just stated.
On the other hand, there are certain unquestionable objections to an operative removal of the tonsils: there is the bleeding that occurs at times with occasional danger to life and the shock to the system and nerves.
Moreover, the administration of anaesthetics to delicate children is to be avoided, if any way possible. I have observed till after-effects there from over and over again. Then there is the question of the functions of the tonsils, one of which I believe is to subserve constitutional asepsis. The ever-ready way in which the tonsils show symptoms of sympathy with constitutional ailings leads me to infer that they are often of vast importance to the integrity of the organism. The tonsils are nature’s top-end out-post of the digestive tube, and as such are constantly at work to do outpost duty for the same. It is often stated that the tonsils, especially if enlarged, are a source of danger, as affording an inlet to germs of disease; many disease germs certainly do impinge upon enlarged tonsils-
“A very hotbed of infection” as was affirmed in my presence this very day. that is manifest; and some have maintained that that is the very reason why said tonsils should be got rid of in as much as said germs not only impinge upon the tonsils, but are said to actually penetrate into their parenchyma, there to thrive and multiply, and thence to poison the organism.
I am myself not aware that any real proofs have ever been given of the inward march of disease elements through the tonsils into the tissues. Many of the views held in regard to the mode of ex tension of diseases within the organism appear to be open to question to me to be open to question. Thus it is the fashion to regard the various tubercular manifestations as extending from the periphery centripetally, but this I very much doubt. In fact, it seems to me that on the contrary the tonsils are charged with the function of defending the organism and protecting it. I lately was treating a case of syphilis, the primarily lesion being on the right side of the glans. I tried to persuade the patient to leave the primary sore alone, so that it might be the last disease manifestation to disappear, for my experience teaches me that if the primary sore be maintained the inward march is much more mild, and less far-reaching-in fact, the constitutional disturbances are much more benign and of shorter duration. The idea that the primary lesion is in itself the disease is false; the real primary lesion is purely mechanical, and the so-called primary sore is really already a peripheral expression of the constitutional poisoning. Have we not had already the papule, the vesicle, and the pustule, before we get the Hunterian sore? How, then, can the chancre be really primary? The chancre is the sore resulting from the burst pock, which is now the peripheral expression of the poisoned organism, and, if allowed to do so, the organism, aided by remedies, quite overcomes the syphilis-disease, and the LAST expression of the disease is the disappearance of the sclerosis and the healing up of the sore that originally came from the burst pock.