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.
I have repeatedly carried out cures on these lines with the highest possible satisfaction.
Well, the gentleman in question at first consented to leave the so-called primary sore alone; but a neighbour of mine, a very high authority on venereal diseases, was horrified at my doctrine, and painted to the imagination of our patient fearful loss of tissue, and even destruction of the member; so patient, as I commonly find in such cases, insisted on the local sore being got rid of, which I refused to do; but I consented to watch and observe the case; and very instructive the purely observational role was. As soon as the primary sore had been compelled to heal up, there appeared on the right tonsil a sore that could not be distinguished from the ordinary hard chancre, and proved very rebellious to treatment-in fact it is still going
But syphilis does not lend itself so well to demonstrate my point, though my own mind is quite made up in regard to its phenomena and cure. I have thought that chronic tubercular processes might be better adapted for my purpose, so before we enter any further into questions that here concern us, we might with advantage inquire whether the mode of progress of certain tubercular processes is centrifugal or centripetal when we look at them in their clinical manifestations. In order to find out which way nature works I will take tuberculosis clinically, and by preference a few chronic cases, as more proof-affording than acute ones, for in chronic processes nature will generally be able to get her own way to a very large extent.
IN WHICH DIRECTIONS DOES NATURE WORK IN CHRONIC TUBERCULAR PROCESSES?
I wish at this place to determine whether we can find out how nature acts in chronic tubercular processes, viz., Whether we may regard the direction of the processes as from, or towards, the organismic centre?
It is needful to dwell a little, on the very threshold of this question on the element of time in regard to chronic cases.
CHRONIC TUBERCULAR PROCESSES.
Chronic disease needs chronic treatment.
I lately, read an account of a case of fatty degeneration of the heart having been cured in a few days. Last week a gentleman in good practice prescribed for a child with enlarged glands of the neck, and expressed the opinion that two or three weeks would see said glands completely cured. Incidentally my opinion was also sought, and I gave as my opinion that between two and three years would be required for their real cure, or perhaps even longer.
Remedies do not cure directly at all, but through the organic processes of nature. It is exceedingly difficult to fix the mind on the how and why of a given cure if of chronic nature, because after the medicinal stimulus has been given, we must bide a wee till nature mothers the action caused by the stimulus.
IS THE PHYSICIAN NATURE’S MASTER OR SERVANT?
Many have been the discussions in the history of medicine as to whether the physician should be the minister or master of nature; it seems to me that he should be both.
It occurs to me that the physician is in much the same position as a gardener, who, for instance, wants to grow apples. Only nature can grow apples; but then it is crab apples that she grows unaidedly, not edible apples. No gardener can grow apples or crabs of himself, that has to be done by nature herself organically. But although no gardener can grow either crabs or apples of himself, yet, guided by human wit and experience, the gardener can compel nature to grow apples of the finest sorts and varieties; he need not ask nature’s permission at all, he merely arranges nature’s forces so that she produces the apples required.
This, I take it, is the true position of the physician. It is only nature that can heal anything really, and yet nature cannot heal many things at all till the physician-gardener arranges her forces, so as to compel nature to grow apples in lieu of crabs; the physician’s position is like an apple grower’s further, in that nature requires time to grow apples; so also is it with nature’s healing ways, nature requires time; and any attempt to cure in less time than she needs for her organic processes results in failure-absolute failure.
The element time in the cure of disease is not sufficiently considered either by medical men or by their patients.
These remarks are introductory to a short consideration of the treatment of chronic tubercular processes by Bacillinum, etc., so as to find out the direction of nature’s way.
Whenever we have chronic ailments to cure, it is necessary to pause a wee bit and think, and we soon see that the duration of the treatment must be proportionate to the time required by nature to effect her organic processes, the sum of which makes up the cure.
It is commonly held that a tuberculously diseased part of an individual should be surgically got rid of, in order to prevent it from infecting the whole person, the idea being that the bacilli are the cause of the tuberculosis. The bacilli are the concomitants, and no doubt often the carriers of the virus which they very likely produce. Let us watch the behaviour of some chronic tubercular processes.
In October 1895 I received the following letter:- “10th October 1895.
“DEAR SIR,-To-morrow, Friday, I intend to bring my brother to you for advice. He has had two operations-removal of leg twenty years ago in consequence of a white swelling at knee, and at Christmas 1894, removal of one testicle in consequence of a swelling of a tuberculous nature. Since then it has attacked his other testicle, and another operation is advised; we seek your guidance in the matter,-Yours truly.”
Patient’s father died at sixty of tabes dorsalis, and his mother of apoplexy at forty-five. On examination, I found him in fairish condition, but very dusky; spits blood off and on for years; dulness under right clavicle; right leg amputated above knee; left testicle ablated, its position occupied by ill-healed scar; right testicle swelled, in its lower half solid, and on its outer surface three discharging fistular openings.
This gentleman’s medical advisers were of opinion that though the case was hopeless by reason of the process having already gravely affected the right lung, still they thought the removal of the remaining testicle might prolong life, in as much as the testicle was evidently teeming with bacilli which had already spread to the right lung.
Let us consider this case, which has many points of importance. Now, if the infection had spread from the circumference towards the centre, the reasoning would seem to be sound, but is that here the mode of progress?
It appears to me that a bacillary invasion may be from without inwards, but in most cases I think the individual becomes qualitatively, potentially tuberculous, and nature, so to speak, picks up the bacilli elements somewhere within the organism where found, and bundles them off, away from the central organs and parts to, or towards, the periphery.
This point is of the highest practical importance as bearing on treatment, for if the process is centrifugal, surgical interference may be quite useless, and even harmful; and so in the case of enlarged tonsils, which is the point I am driving at.
I have thought the matter out, after carefully watching many clinical cases, and I find the trend of vital processes to be from within outwards, and the peripheral manifestations are principally nature’s ways of turning the tubercular and other elements out of the economy, i.e., nature’s midden-outlets from the more important inside.
If any one will take the trouble to watch nature’s ways-say, in skin diseases-he will see that even where the first origin of the disease is by infection at a given point of the outside, the disease indeed at first marches inwards; but then in the within great battles are fought and many slain, whereupon the organism reacts centrifugally by carrying the dead and dejected inside the camp to a point at the periphery-i.e., she ejects them. I determined to act on this view, and began to regard and treat chronic cases dynamically from within.
This case-from October 1895 to the end of the year, all through 1897 and 1898-was treated steadily and persistently with infrequent doses of Bacil. 30, C., Tuberculinum test. 30, C., and some half-a-dozen other remedies, and at the moment at which I am writing, March 1900, patient is in good general health and spirits, and so he has been nearly all the time. At first his cough and blood-spitting lessened, and finally disappeared altogether; neither lung has any trace of active disease now for very long, but the place, where the left testicle used to be, opened and became fistulous, in even pace with the healing up of the right lung and the disappearance of the cough, and this is still somewhat flickeringly active here and there, thus conclusively proving that the left testicle was the midden of the economy, which being ablated and forcibly healed up, nature then chose the right lung as her next least harmful of fall pit. The surgeons who ablated the left testicle to save the organism have watched this case during all this time, urging for many months the terrible danger of delay in operating on the remaining testicle; and now that the patient has been well and sound of wind for very many months, they are of the same opinion still! Thus we see that a case of an admittedly tubercular nature, chronic, steadily progressing death-wards, was steadily left to itself surgically-dynamic doses of Bacillinum given at about eight-day intervals for several years, and the patient has slowly got well, and so remains; the healing processes taking place in the inverse order of their appearance.
The tubercular process in the right lung was the last to appear and the first to disappear, then followed the right testicle, and finally the points of severance of the left testis.
I have watched this in a certain number of other chronic tubercular cases, and with the same result. So long as the peripheral opening is free to discharge, patient’s life is safe, and if antibacillinic treatment be persevered in for many months, or several years, a genuine cure results. This is beautifully seen in fistula in ano, and in chronic tuberculosis of the tonsils.
Any close observer, if sufficiently patient can convince himself that in the common chronic tubercular processes having a peripheral manifestation, the natural course which nature follows is centrifugal.
Thus, only two days ago, a young lady, niece of Lord X., was sent to me for treatment. Eight years ago she developed a strumous gland in the right side of the neck, an inch and a half below the ear; said gland was very neatly excised. Six years ago another lump was found at the same spot, this lump was also equally neatly excised, and now there is an other lump come at the side of the very neat scar, evidently a gland. That the thing is constitutional is thus clearly manifest, and this is made the more certain by the fact that menstruations now occurs every fortnight, and the glands in the right groin are found to be indurated.
It therefore follows that the treatment should be from within, and the local peripheral tubercular processes are to be regarded as outlets, and not as inlets, where for the ordinary surgical treatment of such tubercular processes is wrong and harmful.
CHRONIC COUGH. TUBERCULAR DISEASE OF LEFT ELBOW.
A single gentleman, thirty-two years of age, came under my observation on March 14, 1899, telling me that he had tubercular disease of his left elbow joint these twelve years. Six operations had been performed on the part, in Germany, during these twelve years, with the view of eradicating the disease, and thus saving the constitution, and with it the patient’s life, but the seat of operation would never quite heal. Patient is well nourished, and I found his left elbow joint almost anchylosed, but an unhealing fistula exists at its side, from which mattery stuff is oozing. He is advised to have the whole joint excised, so as to be rid of the fistula. I advised, on the contrary, that internal treatment was the real thing to do. Patient consented, and placed himself frankly under my care for that purpose.
I began with a month of Bacill. C.
April 11.-Less discharge from the fistula.
May 8.-I notice that the cough is worst in the morning, and in my experience the exclusively morning cough is often vaccinosic, and moreover, I find patient was vaccinated as an infant, and again at twelve or thirteen for the second time. Ergo, Thuja 30 for a month in infrequent doses.
June 21.-The opening of the fistula is much dryer and shows a tendency to close.
July 25.-The fistula has healed, but only with a scab.
Rx Bacill. C.
August 22.-Well, save a very little morning cough.
Rx Thuja 30.
October.-He is quite well, and with friends in Germany.
April 5, 1900.-Remains quite well; no cough, and elbow has quite healed, and he has increased in weight.
From this case it seems to me that the nature of the ailment was vaccinosis implanted on tuberculosis, and that, moreover, the two existed side by side, each as a separate biosis, working from the centre towards and into the periphery.
CHRONIC STRUMOUS GONITIS.
A clergyman’s son, thirteen years of age, was carried into my consulting room on June 12, 1899.
Rather pale, big for his age well-grown, but his right knee had long been the seat of strumous disease. The knee three- fourths anchylosed, and at its side a sore place, whence came oozing matter from the diseased joint.
Leading surgeons, seeing no hope of a cure other than by operation, recommended resection, which was about to be performed. Patient had been troubled thus for a number of years, and all concerned were more than willing that an operations should put an end to the wretched thing.
At the end of four months, all the time under Bacill. 30, in infrequent doses, all discharge ceased, and in ten months from commencing the treatment, the knee was quite healed, and the lad in every respect in capital condition.
Movements are now being used to see if the amount of motion of the joint can be increased, which seems probable.
My point is, that the disease was of the constitution and from the centre to the outside, in which manner it was also cured.
Having now dwelt in a general manner on nature’s ways in chronic disease, how she works from the within towards the outside, and that time is of the essence of these workings, I will now proceed to my task and give some examples of cases of enlarged tonsils cured by medicines; they are not hear say cases, but such as I have seen and cured myself.
Cecil, aet. eight, was brought to me by his mother on May 20, 1897, for enormously enlarged tonsils, pains in stomach after food, snoring at night, with restless sleep, dull and stupid. He was nearly three years under me, and then discharged in excellent health. After one month under Thuja 30, my note is “vast improvement.” The improvement continued under Bacillinum. “He sleeps quietly and works better at school.”
He came to me a few times in 1898 and in 1899, and when his mother brought him to me for my final inspection, I had the great satisfaction of observing a fine healthy lad, with tonsils long since restored to their normal size and functions. The body has lost his stupid look and takes a good position at his school.
ENLARGED TONSILS AND ENURESIS CURED BY MEDICINES.
Whether the tonsils stand in any relationship of a peculiar nature with the root of the bladder or testicles has not been demonstrated.
Professor James used to teach that the ovaries and the tonsils have vital connections, and we know of the behaviour of the parotid glands and the testicles in cases of mumps. The parotid glands and the tonsils are certainly pretty near physiological relations as well as neighbours anatomically.
A lad of sixteen was brought to me on January 12, 1897, suffering from “he wets his bed sometimes, and his tonsils are enormous,” the right one being the larger. Many of his lymphatic glands are indurated, and he also suffers somewhat from eczema. He was discharged cured at the end of 1899, though his enuresis had long been well before them, and also his tonsils, but the eczema persisted till then, and in fact there are traces of it still.