In stubborn cases, it will often be necessary to recur again and again to the same remedies, notably to such remedies as Sulphur 30, Calcarea carb. C., Thuja 30, Sabina 30, Bacillinum 30 and C., before all the bars to cure are organically removed.
Sometimes Baryta carb.30 alone will rapidly reduce enlarged tonsils, but alone it does not often suffice.
Hepar sulphuris is a classic remedy in enlarged tonsils, and in some cases Silicea is the remedy.
Guaiacum, Phytolacca, Salix, and such anti-rheumatics come into play in the treatment of tonsils whose enlargements are of a rheumatic quality. There seems a disposition to regard the tonsils as the entrance door of the rheumatism into the organism. I am satisfied that this is entirely erroneous, and that, on the contrary, the organism endeavours to eliminate rheumatism from the organism by way of the tonsils, and it seems to me probable that it is when the tonsillary outlet is insufficient that rheumatic fever may result, not from without into the tonsils towards the centre, but from the organism out into the tonsils, to be cast away by the defecatory work of the tonsils.
The more I watch the behaviour of the tonsils, the more I am convinced that they are charged with an excretory, a defecatory function, and that they excrete things out from the organism, casting them out both at the time of swallowing food and also as a kind of lubricating trickle; such excretions pass with or without the food, down the oesophagus like corn down a shut.
Moreover, I think the bulk of the private troubles of the tonsils, i.e. their diseases, are vicarious for the mucous lining of the body.
I am satisfied from my observations that the tonsils are capable of sacrificing themselves on the altar of the economy by ulceration, till nearly or quite all the tonsillary tissues is gone.
The extension of phthisis to the organism from the tonsils from the exterior is practically a myth. I am quite prepared to grant that, given a strong disposition to the tubercular disease, a wounded tonsil might admit the phthisic virus, and the organism so become infected, but only through an actual lesion of continuity, just as it might be the case on any other person of the mucous sur-face of the body. I have frequently watched phthisis of the tonsils, as I believe, save the organism from death, by gathering and discharging over and over again-much the same as one may observe the organism operate in like manner through suppurating cervical or other glands. The cases I have in my mind appear at first as hyperaemia, and then there is a seemingly encapsuled mass, the containing membrane looking like fascia on the surface of the tonsil; it will take first one side and then another, and will repeat itself at intervals over a period of several years, and in the end terminate in the good health of the individual. Whether unaided nature would end by curing the organism with the aid of a series of tonsillary gatherings and dischargings I am unable to say, because I have treated all the cases I have observed with remedies, notably with Bacillinum in high dilution.
There is always some blood from these tonsillary gatherings when they burst, and they usually cause a certain amount of alarm. I have known experienced lung specialists greatly puzzled by these cases.
In conclusion, I will state as my opinion, based upon clinical facts as I see them in my daily work, that enlarged tonsils can be more or less readily cured by medicines withal the task is often tedious; and moreover, that the tonsils are important organs of the body, that have as one of their functions the preservation of the life and integrity of the individual.
And if this be so, it must be manifest that tonsils should not be cauterised or otherwise damaged by local applications, and that their total removal is an act of ignorant folly.
Some have regarded the tonsils as filters barring the entrance of disease into the economy; we will now shortly consider this question.
THE FILTER THEORY IN GLANDULAR FUNCTIONS.
In the Non-Surgical Treatment of Diseases of the Glands and Bones; with a Chapter on Scrofula London, James Epps & Co., Limited, 1894. by John H. Clarke, M.D., there is a portion (p.5) that I commandeer bodily for the purposes of this treatise. Commandeering seems to have a certain relationship to stealing whereas exchange is no robbery, and hence I give to the learned author of Diseases of the Glands and Bones, two chapters from any of my published prescribings in exchange for the here commandeered one chapter, and although Dr Clarke will be the loser, I trust he will for old friendship’s sake declare himself content.
Dr Clarke says (pp. 5-14):-
ANATOMY AND PHYSIOLOGY OF THE GLANDS.
In ordinary language a “gland” means a gland of the lymphatic system. It is in this sense that I use the term in the present treatise. Anatomically speaking, all the organs of the body which secrete definite fluids, such as the liver, the kidneys, the salivary glands, the sweat and sebaceous glands of the skin, and also some organ which have no known secretion, as the pineal and thyroid bodies, are glands. But when the word gland is used absolutely, it is the lymphatic glands which are understood to be meant.
The lymphatic glands are little bodies varying in size from a lentil to an almond, and are very widely distributed over the body. They are like so many “locks” on the system of lymph canals, which form a network of vessels spread over the whole of the soft tissues. The office of these vessels is to take up the used-up materials of the body, pass them on to the lymphatic glands, which so act on them as to make them again fit to be poured into the current of the blood.
In the ordinary course of events the glands are very well able to discharge their functions, but at times extra pressure is put upon them. When one has a gathered finger, instead of the ordinary amount of waste products of the part, there is a great increase and some of them are of a highly irritating character. In consequence of this we often find a red streak running up the arm from the injured finger to the armpit, and in the armpit one or more enlarged and painful glands. This means that the irritating matters are being dealt with by the glands. These may prove equal to the strain put on them, or they may inflame and suppurate themselves.
On dissection the lymphatic glands are found to consist of a capsule, and an internal portion composed of pouches communicating with each other, and richly supplied with blood- vessels and nerves. The pouches contain “a molecular fluid in which numerous nuclei and a few cells may be found in all stages of development”-(Burnett). There are lymphatic vessels leading into the glands and others leading away from the glands. The lymphatic vessels are provided with valves which only permit the fluid they contain to travel in one direction, away from the surface in the direction of the heart. Those vessels which enter a gland open into the lymph spaces of the outer portion of the gland; those which leave it are connected with the internal portion.
The distribution of the glands is very extensive. The chief localities in which they are found are the neck, the armpits, and the groins externally, and internally under the lining membrane of the abdominal cavity (peritoneum), and in the folds of it, where it forms the band of attachment for the bowels (mesentery), and in the chest along the larger bronchial tubes, at the root of the lungs, and at the base of the heart.
It will easily be understood that the functions of this system of glands and vessels is of very great importance. The apparently solid tissues of the body are in a constant state of flux, of building-up and of decay, and on the regular discharge of this process of interchange (Metabolism the scientific call it) the health of the body depends. It is one function of the lymphatics to take up the waste materials of the tissues and re- organise them, so far as they are capable of it, for the rebuilding of the same or other tissues. If they act too sluggishly the tissues become thick and unhealthy, and a state of obesity, either local or general, may result; if they act too energetically the opposite condition of wasting will ensue.
But they have another function of enormous importance in the economy. I have spoken of the familiar instance of glands inflaming in the armpit when there is inflammation of some part of the arm or hand. The lymphatics, therefore, not only deal with the waste of the body, they attack the products of diseased action, and, so far as they can, destroy the virus of disease.
I will not rest content with my own authority on this point. The Lancet of May 12, 1894, reports a discussion on a paper by Dr Walter Carr, entitled “The Starting-Points of Tubercular Disease in Children.” In the report of the discussion which followed I find the following:-
“Dr Routh pointed out the value of the lymphatic glands as a means of arresting the disease, in the same way that the poison of syphilis or of a dissection wound was arrested.”
“Dr Carr, in reply, said… he believed that the glands were usually infected near the primary source of infection near the primary source of infection. He had no doubt that the lymphatic glands did act as filters and arrested the disease.”
Closely allied with the lymphatics are the tonsils, which are looked upon by many surgeons as useless encumberances (from the patient’s point of view), liable to become enlarged from the slightest provocation, and good for nothing except for providing the surgeon with the work of cutting them out. But even in regard to the some authorities in the old sand are waking up to the fact that they may have been put where they are for some useful purpose, and not solely for the surgeon’s benefit. I quote the following from the Homoeopathic World of April 1893:-
In the Revue Homoeopathique Belge of December 1892, Dr Martiny adduces weighty reasons against excising or even cauterising the tonsils. He quotes from a work (Etudes Generales et Pratiques surla Phthisie) by Dr Pidoux, which was accorded by the Faculty of Medicine the prize of 10,000 fr. founded by Dr Lacaye, and in which facts were adduced to show that in phthisical patients the excision of the tonsils materially increased the predisposition to the disease. Says Pidoux:- “I act in regard to the follicular angina of phthisis as with hypertrophied tonsils, which I never excise, no more than I do the uvula in phthisics or in those who appear to me threatened with becoming such; as also with anal fistula, skin affections, pains, leucorrhoea, etc., etc.”
And further on he says:-
“Now it is quite certain hypertrophy of the tonsils is one of the most benign and most natural expressions of non-degenerate struma (des strumes non degenerees). It is often such with all the other characters of simple and nascent scrofula, in infants and strong adolescents, well formed, of healthy colour, with the aspect a little humid and full of juices. It must be feared, then that the violent suppression of this primitive affection may be followed, in a predisposed subject, with pulmonary manifestations of catarrhal pus and still more retrogressive ultimates.”
Dr Martiny adds that the above entirely agrees with his opinion. For a long time he has advised neither removal nor cauterisation of the tonsils; for he has discovered, on inquiring into the antecedents of consumptive patients, that a large number had formerly submitted to excision of the tonsils. For many years he has not met with a case of enlargement of tonsils that did not improve so much under treatment as to render their removal unnecessary.
Dr Martiny maintains that though nobody knows exactly what part the tonsils play as glands in the economy, this is no reason for concluding that they are useless; and that “to excise, to lacerate, to cauterise deeply an organ which exists normally in the human species and in a large number of animals,” has always appeared to him the reverse of prudent.”
I am sure my readers will thank me for enriching my pages with the foregoing, and what specially concerns me is Dr Clarke’s filter theory as bearing on my own theory here, that the organism in dealing with disease works from the centre towards the periphery. At first sight the two notions seem to contradict each other, but I submit that this is only apparently and not really so, for while the one function of the lymph vessels is to bring home to the blood what is fit, the other function is to arrest what is unfit, and this it does by swelling up the glands, whereupon the organism (beginning at said swelling) sets about extruding it towards the periphery and out of the economy. The organism sends the whole blood mass, good and bad alike, right out from the centre all over the body to the uttermost parts and particles; the lymph course will not return the bad, but blocks a gland therewith to prevent its return to the general circulation. Thus I apprehend it is with the tonsils, which are composed of coils; if a poison impinges on the tonsils and is taken up, it does not get very far in the coil till it is arrested and a block ensues-swelling then ensues, and the organism extrudes the poison by means of a gathering which then discharges its contents outside: for a gathered tonsil when it breaks and discharges does so outside and not inside, in as much as the inside of the gullet is outside of the economy. It is not always remembered that the inside of one’s intestinal canal is in reality outside the organism.
We all know that in the case of a quinsy when the gathering bursts there is not only local but also constitutional relief, and though the abscess burst in the night, unknown to the patient, and all the nasty discharge finds its way down the oesophagus into the stomach, no harm is done; the stomach must necessarily be endowed with no small amount of disinfecting power, for the patients suffer no harm, and soon call for food. The more I study the tonsils, the more I know of the organismic manifestations in them, the more I am impressed with their importance as vicars-general in pathological matters for the economy, in proof of which I adduce the fact that shapely normal tonsils are very rarely to be found in the adult, the reason being that during the upgrowing they have been sacrificed on the altar of the economy for its saving.
Hence it is that the pathological quality or qualities of a person can so often be read off, so to speak, like in a book, from the appearances of or on the tonsils.