FOCAL INFECTION AND THE SPECIAL SENSES



Congested and granular anterior pillars indicate deep-seated tonsillar infection. The small fibroid imbedded tonsil, even though the surface is free from evidence of disease, must always be looked upon with suspicion. Tonsils in which scar tissue formation has partially or wholly occluded the orifices of the crypts are particularly dangerous. Tenderness and enlargement of the superficial or deep cervical lymph glands are important signs in determining the presence of chronic tonsillar infection. Enlargement of the lymphatic gland at the angle of the jaw often spoken of as the “tonsillar gland,” is particularly suggestive of infection.

The determination of chronic middle ear or mastoid infection depends upon the history of the case, the results of visual otoscopic examination, and the roentgenographic findings. In the absence of chronic suppuration, enlarged lymph-nodes in the posterior cervical chain are indicative of chronic infection in this area.

In determining dental foci of infection, it is well to follow a routine method of diagnosis:.

1. Make a thorough clinical and visual examination to determine the presence of pyorrhea, ulcerations, suppurating sinuses, swellings, enlarged lymph-nodes.

2. Determine the response of each tooth to the faradic current.

3. Roentgenologic examination of each devitalized or suspicious tooth, but better X-ray all the teeth.

The blood picture is of real value in determining the presence of foci of infection. I feel that too frequently we fail to make use of the laboratory; perhaps because we may inconvenience our patient a little bit, but if we could only realize the kindness we are doing them, we would insist more often upon blood analysis as well as X-ray pictures.

Assuming that in the average adult we find a normal red count of 4,500,000 to 5,00,000 with hemoglobin 90 to 100 per cent. and a white count averaging 7500 with a range of from 6500 to 8500 and a differential of polymorphonuclear neutrophils 60 to 75 per cent., average 70 per cent.; small lymphocytes 20 per cent. (20- 25 per cent.), large lymphocytes 5 per cent., eosinophils 0.5 per cent., basophiles 0.1 to 0.5 per cent. and transitionals 4 per cent.

In acute focalization there is usually a polymorphonuclear neutrophilic leukocytosis associated with erythrocytic destruction. In persistent focalization of the sub-acute and chronic types there is usually a low color index with a moderate decrease in the erythrocytic count. The majority of cases show a moderate decrease in the hemoglobin even as low as 35 per cent. and a decrease in red cell count, one case of frontal sinus as low as 1,760,000.

A moderate increase in total white count rarely above 13,000, occasionally as high as 20,000, with a relative decrease in the per cent. of leucocytes average somewhere below 60 per cent,. with a relative increase of lymphocytes to about 38 per cent.; while the small lymphocytes show a greater increase relatively than the large.

One of the most frequent diseases complicating the diagnosis of focal infection is syphilis. This infection is often associated with focal infection, giving us a mixed infection. The blood picture in syphilis shows a slight leucocytosis rarely as high as 15,000, with a distinct lymphocytosis as high as 6.5per cent. Generally speaking, focal infections are unilateral, while syphilis is nearly always bilateral. The Wassermann reaction and other clinical findings well known to all of us aid in the differential diagnosis which I will not attempt to discuss at this time.

Treatment.

As regards treatment of the foci of teeth, tonsils, sinuses, etc., I feel that the modern dentist of today is in a situation to help our patients, and it behooves us to give this subject more attention, but at the same time we must ward against the unjustifiable removal of teeth without carefully weighing all the symptoms. Too many teeth have been sacrificed– but when disease warrants it, the sacrifice is amply repaid. Remove all dead teeth, dead roots, fixed bridges, whether abscessed or not.

It is well accepted fact as to the importance of tonsils as a point of entry for numerous organisms, and their removal will aid materially in controlling such disease. The complete removal is the only procedure. However, I would like to say a word of caution against the apparent wholesale removal of tonsils without due consideration of the consequences. Remember, that a patient “has tonsils” is not enough of an indication that they are the cause of infection. Careful study will have a tendency to prove or disprove them as the factor in focal infection.

In the correction of diet, pyorrhea and teeth, careful regulation of sugars, which is one of the important factors in fermentation, we have fundamentals upon which we can hope to eliminate some of the factors which cause disturbance of the alimentary tract. Dr. George Huston Bell of New York City is an ardent advocate of diet with other treatment. He divides food substances into two classes:.

1. Heavy starches — Bread of all kinds, potatoes, macaroni, corn, lima beans, rice, dry beans and sugar.

2. Heavy proteids– Meats of all kinds, fish, shell fish, chicken, duck, turkey, eggs and cheese.

A patient may pick only from list (1) heavy starches, for a singe meal with nothing else but fresh vegetables, salads, and fruits for desserts; or from the heavy proteid list, with the addition of fresh vegetables, salads, and fruit for desserts. This is done in order to prevent fermentation in the stomach and to prevent putrefaction in the intestines. The starches are digested in the mouth and intestines and if they are detained in the stomach with proteid food, the starches ferment and fight with the proteins.

So eat starches when they wont be delayed, since when meat is eaten, it causes a flow of gastric juice. In hyperchlorhydria, carbohydrate digestion is checked by hydrochloric acid and therefore interferes with the digestion of carbohydrates. For that reason, take heavy carbohydrates when heavy proteids are not eaten, so that they can get out of the stomach immediately.

In ear conditions, free drainage should be maintained by opening drumhead if necessary. Simple mastoid or radical mastoid operation should be performed when indicated. Local treatment maintained to keep ear clean and draining freely.

In eye conditions the treatment is simple. Remove focus of infection.

The question will no doubt arise as to the case where there is more than one focus of infection which should be removed. It is the consensus of opinion of the majority of authorities on the subject that where time and condition allows, foci should be removed in the following order: First, teeth and mouth, tonsils, sinuses, gall bladder, etc.

In cases where the pathology is caused by a focal infection associated with some other condition, for instance diseased tonsils with a gastric ulcer, it must be remembered that with the removal of the focus of infection ( the tonsils), the gastric ulcer will not cure itself. It is therefore very important to follow up the complete removal of the focus of infection with a conscientious indicated treatment, medical, hydrotherapy, corrective diet or whatever may be deemed advisable, until the patients entire body has been returned to a state of health.

Summary.

In conclusion, I will summarize by calling your attention to the importance of looking for a focus of infection as a causative agent in disease of the eye, ear, nose and throat.

First.– Find the focus of infection, (teeth, tonsils, sinuses, appendix, gall bladder, or wherever it may be).

Second.– Cure the disease by removing the cause (focus) in the quickest and safest manner.

Third.– Remove any contributing cause, and lastly dont forget the three Ts.

Teeth.

Tonsils.

Intestinal Toxemias.

C. Ivins William