When your President, Doctor Elijah S. Burdsall, first wrote, inviting me to participate in your meeting, he at the same time asked for the title of my paper, cautioning me to pick a subject that would be interesting to general practitioners. I picked the above title because I feel that focal infection is a most important subject in the practice of medicine today, and one that should be of very vital interest to every physician no matter what his field of medicine may be. The subject of focal infection has grown to be one of so vast a scope that it would be impossible to cover it intelligently in a single paper. Therefore, I will confine myself to focal infection in its relation to the eye, ear, nose and throat, dwelling chiefly upon etiology and diagnosis. I shall strive to deal with the usual rather than with the rare case.
First, let us consider the nasal tract. Nasal focalization, especially that of the non-suppurative variety, is far more prevalent than often considered by many specialists; probably due to the fact that tonsillar and dental infections are easier to detect. The extension of an acute inflammatory process into the accessory cells of the nose is the common occurrence in those nasal infections associated with systemic symptoms loosely called “gripe.”
Unfortunately, the natural drainage from the accessory sinuses is defective. The subsidence of the superficial nasal infection is frequently not accompanied by a similar subsidence within the accessory cells; especially is this true in cases where the swelling of the mucous membrane of the nose due to circulatory disturbances may completely obstruct natural drainage from the air cells.
Nasopharyngeal infection is common in children in the form of infected lymphoid tissue (adenoids). Primary tuberculosis of the adenoids was found in fourteen out of 100 cases by Crowe, who also states that at least 25 per cent. of children with adenoids have defined indication for their removal, the most common being otitis media. Sphenoid infection is commonly associated with adenoids and may persist through adult life. Etiologic nasal focus in acute systemic manifestations has is highest incidence in young adults.
In later life and in the more chronic forms of secondary manifestations, the relative incidence is lower. However, in bronchial asthma, in the recurring headaches of the migraine type or the “indurative or rheumatic” type, in recurring or chronically progressive eye infections, in chronic myositis and in certain cases of chronic arthritis; a chronic sinus focal infection has frequently been found to be the etiologic factor.
The types of organisms usually isolated from nasal focal infections are the members of the streptococcus-pneumococcus group, the diphtheroid organisms, the bacillus influenza, the micrococcus catarrhalis, and the staphylococcus.
Secondly– Foci of infection of the tonsils holds a very foremost place as an etiological site of focal infections. In childhood bacterial invasion of the tonsils is almost universal. The anatomical structure of the tonsil is such that retention of infection is predisposed because of imperfect drainage. Many tonsils may be diseased even though they appear to be innocent. Tonsillar stumps, although atrophied and scarred are frequently seats of chronic infection giving rise to many systemic symptoms.
Here again the infecting agents are generally of the streptococcus-pneumococcus group, including the streptococcus hemolyticus, streptococcus viridans, micrococcus catarrhalis, bacillus influenzae, the diphtheroid organisms and the bacillus tuberculosis. Entamoeba gingivalis has been found in several cases but more frequently where there is an existing pyorrhoea alveolaris.