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i ■/■•



THE

NEW ENGLAND

Medical Gazette



ex (Wtont^C^ ^owcnat of
3^omoeo))At#ie (niebictne



THE GAZETTE ASSOCIATES
Editors



'Die Milde Maeht I»t Oroas"



Volume XL



BOSTON :

The Gazette Associates, 279 Dartmouth St.

1905



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INDEX

COMMUNICATIONS.

Anthrax. By William T. Hopkins, M.D 114

Antitoxin from a Homoeopathic Standpoint. By F. M. Pkulel-

ford, M.D 439

Avoidable Conditions Following Labor. By Eliza B. CahiU, M.D. 350

Basic Pulmonary Tuberculosis. By Herbert C. C.app, M.D. 343
Blakeslee, Arthur. Curative Results of the Massachusetts State

Hospitals in 1904 ....'.... 313
Blodgett, S. H. Urinary Indications for Surgical Interference. 300
Briggs, J. Enunons. E^ctopic Gestation . 145
Briggs, J. Emmons. Presidential Address to the Boston Homoe-
opathic Medical Society 193

Browne, Percy G. Difficulties in Eiarly Diagnosis of Phthbis 451

CahiU, Eliza B. Avoidable Conditions Following Labor. 350
Care of the Ear by the General Practitioner. By E. R. Johnson,

M.D 544

Care of the Eye by the General Practitioner, The. By John H.

Shaw 489

Care of the Nose and Throat by the General Practitioner, The.

By Winfred N. Emery, M.D 509

Chadwell, Orville R. Laboratory Suggestions. 250

Childs, Helen S. Gynmastics as a Therapeutic Agent . 353

Clapp, Herbert C. Basic Pulmonary Tuberculosis . 343
Curative Results of the Massachusetts State Hospitals in 1904.

By Arthur Blakeslee 313

Cystitis in the Female. By Horace Packard, M.D. 241
Difficulties in Early Diagnosis of Phthisis. By Percy G. Browne,

M.D 451

Earl, George H. Early Symptoms of Tubercular Lesions of the

Bones .......... 455

Eariy Symptoms of Tubercular Lesions of the Bones. By

George H. Earl, M.D 455

Ectopic Gestation. By J. Emmons Briggs, M.D. . 145
Emery, Winfred N. The Care of the Nose and Throat by the

General Practitioner ....... 509

Epilepsy: General Observations and Home Care. By Everett

Fkxxl, A.M., M.D 289

Exophthalmic Goitre: A Case. By N. R. Perkins, M.D. 206
Faucial Tonsil, The. By George B. Rice, M.D. .1, 67, 106



145 134

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Fisher, Edgar A. Some Factors Wliich Should Influence Our Di-
agnosis in Tumors of the Mammary Glands 308
Flood, Everett. Epilepsy: General Observations and Home

Care 289

Gas-Bacillus Infection in a Compound Fracture. By J. A.

O'Leary, M.D 97

Gay, Ellen H. The Hygiene of Puberty .... 17
Geoghegan, Wm. A. Idealism in Therapeutics 409
Gymnastics as a Therapeutic Agent. By Helen S. Childs, M.D. 353
Halsey, Frederick W. Presidential Address to the Massachu-
setts Surgical and Gynecological Society . .49
Halsey Frederick W. Procidentia Recti with Radical Opera-
tions for Relief 539

Homoeopathic Hospital of Rhode Island, The 267

Hooker, Edward B. The Scientific Spirit of Investigation. 397

Hopkins, William T. Anthrax 114

• Howard, Charles T. Variations in the Symp topis of Appendi-
citis. .......... 552

Hygiene of Puberty, The. By Ellen H. Gay, M.D. ... 17

Idealism in Therapeutics. By Wm. A. Geoghegan, M.D. 409

Johnson, E. R. Care of the Ear by the General Practitioner. 544

Laboratory Suggestions. By OrWlle R. Chadwell, M.D. . 250

Luscombe, J. Everett. Multiple or Diffuse Osteosarcomata 164

Manifestations of Syphilis in Childhood from the Standpoint
of a Nose and Throat Specialist. By Irving Townsend,

M.D 339

Multiple or Diffuse Osteosarcomata. By J. Everett Luscombe,

M.D 164

Need of More Preparation and Longer Convalescence in Some

Operative Cases. By Barbara T. Ring, M.D. ... 203
O'Leary, J. A. Gas-Bacillus Infection in a Compound Frac-
ture 97

Packard, Horace. Cystitis in the Female 241
Padelford, F. M. Antitoxin from a Homoeopathic Stand-
point 439

Perkins, N. R. Exophthalmic Goitre : A Case 206
Powers, A. Howard. Prostitution and Venereal Disea.s<jo . 559
Presidential Address to the Boston Homoeopathic Medical Soci-
ety. By J. Emmons Briggs, M.D 193

Presidential Address to the Massachusetts Surgical and Gyneco-
logical Society. By Frederick W. Halsey, M.D. . 49
Prostitution and Venereal Diseases. By A. Howard Powers, M.D. 559
Procidentia Recti with Radical Operations for Relief. By Fred-
erick W. Halsey, M. D ' . 540

Rehabilitation of the Family Doctor, The. By George H. Tal-
bot, M.D 260

Remedies in Some Diseases of Infancy and Childhood. By Mau-
rice W. Turner. M.D. . 10



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Report of the Medical Service at the Massachusetts Homoeo-
pathic Hospital, January to April, 1905. By Charles H.

Thomas. M.D 209

Rice, George B. The Faucial Tonsil 1, 67, 106

Ring, Barbara T. Need of More Preparation and Longer Con-
valescence in Some Operative Cases .... 203
Ruggles, Edwin P. The Use of the Pelvimeter in General Obstet-
rical Practice 356

Sanders, Orren B. Sexual Life and Sexual Hygiene . 499

Scientific Spuit of Investigation, The. By Edward B. Hooker,

M.D. 397

Sexual Life and Sexual Hygiene. By Orren B. Sanders, M.D. 499
Shall We Fraternize? By John J. Shaw, M.D. ... 103
Shaw, J. C. The Treatment of the Perineum and Vagina imme-
diately after Parturition 169

Shaw, John H. The Care of the Eye by the General Practi-
tioner. ......... 489

Shaw, John J. Shall We Fraternize? 103

Some Factors which should Influence Our Diagnosis in Tumors

• of the Manunarv Glands. By Edgar A. Fisher, M.D. 308

Southwick, George R. The Treatment of Mammary Cancer 59

Sutherland, John P. Why do People Die from Pneumonia? 389

Talbot, George H. The Rehabilitation of the Family Doctor . 260

Thomas, Charles H. Report of the Medical Service at the Mass-
achusetts Hospital, January to April, 1905 . 209
Townsend, Ir\ing. Manifestations of Syphilis in Childhood from

the Standpoint of a Nose and Throat Specialist . 339
Treatment of Mammary Cancer, The. By George R. South-
wick, M.D 59

Treatment of the Perineum and Vagina inmiediately after Partu-
rition, The. By J. C. Shaw, M.D 169

Turner, Maurice W. Remedies in Some Diseases of Infancy and

ChUdhood 10

Urinary Indications for Surgical Interference. By S. H. Blod-

gett, M.D 300

Use of the Pelvimeter in General Obstetrical Practice, The. By

Fxiwin P. Ruggles, M.D 356

Variations in the Symptoms of Appendicitis. By Charles T.

Howard, M.D. 552

Why Do Peopl9 Die from Pneumonia. By John P. Sutherland,

M.D 389

EDITORIALS.

Another Gold Medal 569

After Vacation 459

American Institute of HomcEopathv, The . Sixty-First Annual

Session ......... 365

Appeal, An 269



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Artificial Creation of Life, Tlie 424

Boston University School off Medicine. ..... 562

Brigham Hospital and the Needs of the Profession, The 317

Burrage Hospital, The . . * 378

Claims of the American Institute of Homoeopathy, The 21 1

Conrad Wesselhoeft, M.D 25

Dr. William L. Jackson 377

Hom(Popathy and the Address in Medicine at the Congress of Arts

and Sciences. ........ 118

Institute of Drug Proving, The 423

Laboratory Science ........ 84

Letter from Berlin ....... 215

Letter to the Editor 32,125,273,569

Meeting of the Massachusetts Homa?opathic Medical Society,

The 213

Nauheim, Again ......... 564

One Hundred and Fiftieth Anniversary of Hahnemann's Birth-
day 128

Open l^etter, An 83

Radio-Activity, Matter and Force 171

Remarkable Case of Self-Help, A 174

Superiority of the Homoeopathic Treatment of Diseases of the

Nervous System, Tlie ....... 515

What is Worth Doing is Worth Doing Well .... 566

SOCIETIES*

American Institute of Homoeopathy 132

Boston Homoeopathic Medical Society 33, 89, 129, 176, 220, 275, 322, 522,

571

Neighborhood Medical Club, The 133

Sixty-Fifth Annual Meeting of the Massachusetts Homoeopathic

Medical Society 227

BOOKS AND READING 41, 92, 286, 332, 461, 520, 582

COLLABORATOR'S DEPARTMENT 134, 181, 281, 323, 380, 428

ABSTRACTS FROM BOOKS AND JOURNALS. 42, 93, 141, 187,

238, 284, 431, 465, 530, 584

OBITUARY. f

Funeral of Dr. Conrad Wessclhcpft ..... 45

Dr. James H(»denberg ....... 426

Dr. Joseph W. Hayward. ....... 686

Dr. William I^avitt Jackson ...... 334

PERSONAL AND GENERAL ITEMS, 47, 94, 143, 191, 239, 288, 335,

386, 437, 485, 534, 587



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THE NEW ENGLAND

MEDICAL GAZETTE

No. I. JANUARY, 1905. Vol. XL.

ORIGINAL COMMUNICATIONS-



THE FAUCIAL TONSIL.

BY GEORGE B. RICE, M.D.» BOSTON, MASS.

[An elaboration of a paper read before the Massachusetts Homoeopathic Medical
Society, Oct. 12, 1904.)

A consideration of this subject has been undertaken for the
following reasons:

First. The function of the tonsil is so little understood
that a discussion of the different theories of physiologists on
the subject cannot but be of interest.

Second. The pathological changes are widely varying,
and a differential diagnosis of the diseased states is not always
easy.

Third. In the past few years the instruments for operation
on the diseased tonsil have greatly improved, and, therefore,
the methods of operating have changed.

Fourth. It is important that a differentiation should be
made between those cases amenable to cure by homoeopathic
medication, and those which must be treated by other methods.

By the faucial tonsil is meant that portion of Waldeyer's
ring which lies between the anterior and posterior faucial
pillars (see Fig. I). At birth the tonsil is partly or wholly
covered by a fold of mucous membrane, the plica triangularis,
reflected from the anterior faucial pillar. Above is the supra-
tonsilar fossa, and the gland is attached to the inner surface
of the subconstrictor muscles of the pharynx which separate



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2 . The New England Medical Gazette, Jan.,

it from the internal carotid and the ascending pharyngeal
artery. It arises from an invagination of the hypoblast in the
sinus tonsilaris; this diverticulum subdivides and lymphoid
tissue is formed in the primitive crypts. In the normal child
of healthy ancestry these formations of lymphoid tissue are
not to be seen on gross inspection of the throat, and they
gradually disappear as " an incident in the physiological life
history of the animal body'' approaching maturity.

Its normal structure consists of connective tissue in which
are imbedded lymphoid tissue cells. The gland is irregular
in shape, containing niunerous crypts, and presents puncture-
like blind orifices called follicles. The interior of these fol-
licles, according to a recent authority,^ is composed of endo-
thelial cells, but this is not a constant condition,' for, in quite
a large proportion of children, nothing more is found than a
small aggregation of lymphoid bodies covered by oral mucous
membrane, and containing no visible foUicles or crypts.

As had been intimated, the physiology of the tonsils is
imperfectly understood. Numerous theories have been
advanced regarding their function. Burnett' of London
says, "They are placed on either side of the fauces for the
primary purpose of llibricating the food as it passes down the
gullet, and, again, the tonsils lie at the top of the digestive
tube, and whenever certain parts or portions of the body have
to deal with something harmful, the same is passed along the
circulation to the tonsils to be cast out, and the tonsils thus
act vicariously for said parts from elsewhere." He further
states, "The tonsils are capable of curing phthisis by the
formation of series of abscesses each going through the.various
stages of heat, swelling and bursting, and that the tonsils are
capable of sacrificing themselves on the altar of the economy
by ulceration till nearly or quite all of the tonsilar tissue is
gone."

» Annal$ of Otology^ Rhinology and Laryngology, November, 1902, p. 694.

« Medical Review of Reviews, April 26, 1902.

3 ''Enlarfced Tonsils Cured by Medicine." By Dr.J.Compton Burnett, London, Eng.



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1905 The Faucial Tonsil. 3

These theories are quoted not because they deserve serious
consideration, but because they illustrate the extreme views
adopted by many of Dr. Burnett's particular school. It is
obvious that these theories are not the result of scientific
research or observation, but are simply vagaries of a fanciful
imaginati(m, founded upon a small basis of previously discov-
ered facts.

Wright* of New York^ one of our best authorities, says, that
while certain lymph nodes exist normally between the faucial
pillars, yet we cannot insist too strongly upon the correctness
of the view, that the tonsils are pathological when they can
be demonstrated clinically.

Fry^ asserts, that the tonsil is a retrograde structure and
has no function in man. Knight, in his recent book of " Dis-
eases of the Nose and Throat,'' states, that the function of the
normal tonsil is still a matter of speculation and that whatever
the function might be they would seem no longer capable of
exercising it when hyperplastic and diseased.

Ingalls^ suggests, thiat the structural relation of the tonsil
to the general lymphatic nodal bodies, makes it possible that
they may, like the so-called ductless glands, have an internal
secretion of their own.

Kyle* thinks the tonsil to be no more than a large lymphatic
gland and infers that it has a similar function.

Packard of Philadelphia, believes that investigation has
demonstrated that healthy tonsils can be invaded by micro-
organisms but that they can quickly rid themselves of these
sources of disturbance. This author thinks that their func-
tion is to offer a barrier to the entrance of micro-organisms
into the deeper tissues.

Two years ago, Bosworth^ stated before the New York
Academy of Medicine, that this mass with its lacunae traps,



« Jonathan Wright, New York Medical Journal, April 7, 1900.

* "Yearbook of Note and Throat," 1901.

s "Diseases of the Nose, Throat and Ear," p. &38.

* "Diseases of the Nose, Throat and Ear," p. 381.
■* Medical Revimo of Reviews, April 25, 1902.



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4 The New England Medical Gazette, Jan.,

should be considered a diseased body. He says, "Twenty
years ago I observed in a London Medical Society meeting,
that there are no tonsils in the healthy throat." This observa-
tion was received with jeers and laughter. After twenty
years of additional observation I am disposed to repeat the
same remark.

One could go on almost indefinitely quoting theories, but
the consensus of opinion seems to be as follows : The normal
tonsils are very small bodies of fibrous and connective tissue
and Ijmiphoid cells. They are capable of secreting mucous
from the membrane lining the crypts thus aiding, to a very
limited extent, in the lubrication of food. They have the
power of absorption of toxins and micro-organisms, and
probably^ do assist in the formation of lymph cells and their
distribution into the blood, that is, the function in this respect
is identical with that of lymphatic glands.

The tonsils are subject to many diseases and an attempt
will be made to enumerate most of them and to describe and
illustrate from practice some of the most interesting.

The acute inflammatory diseases are as follows: acute
superficial tonsilitis; cryptic, follicular or membranous
tonsilitis; rheumatic tonsilitis; herpetic tonsilitis; peritonsilar
abscess; suppurative tonsilitis.

The chronic affections are: hypertrophied tonsils; caseous
tonsilitis or chronic follicular tonsilitis (a condition where the
crypts are very much enlarged and become pockets for the
deposit of particles of food and* broken-down epithelial cells);
cholesteatomatous tonsilitis (perhaps identical with the first
named); chronic abscess of the tonsil; atrophy of the tonsil;
mycosis; keratosis.

Besides these affections we occasionally meet lipomatous
and papillomatous formations, as well as malignant growths,
both the epitheliomatous and sarcomatous variety. Tuber-
culosis and syphilitic chancre of the tonsil are exceedingly
rare, though the finding of the bacilh of the former disease
in the follicles and crypts is not uncommon.

' "Kirk'B Physiology" (nineteenth edition), p. 315.



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1905 The Faucial TonsiL S

Of the acute affections mentioned, the conditions caused
by the streptococcus and staphylococcus infection present
quite varying types, and should be further considered. The
most conmion forms of these manifestations are given by the
synonymous terms, membranous tonsilitis, fibrinous tonsil-
itis, benign fibrinous angina, pseudo-membranous tonsilitis,
acute follicular tonsilitis, and acute cryptic tonsilitis.

The disease is characterized by the formation of a distinct
membrane which is very similar to the diphtheritic membrane
in its early appearance. The most common form shows single
exudates forming over the mouths of the follicles. The
deposit is white or yellowish white, the tonsils are swollen,
and the mucous membrane is reddened. More rarely the
exudate takes on a membranous appearance due to coagu-
lation^ necrosis of the surface membrane of the tonsils as well
as of the lining of the foUicles. As a rule the membrane can
be readily dissolved with H,Oa and does not leave a bleeding
surface if forcibly removed. The infective process may
progress involving the deeper structures causing ulceration.
Some authorities^^ make two diseases, follicular tonsihtis
and membranous tonsilitis quite distinct, but from a clinical
and bacteriological viewpoint there is little difference between
them, the general symptoms depending upon the amount of
tissue involved and the absorption of toxins, and the vital
resistance of the patient. In the acute follicular form there
is usually more swelling and inflammation of the tonsils and
the general symptoms and discomfort are greater. Figs. II
and III give a general idea of the appearance of the throat
under the two conditions.

It should be noted in connection with streptococcus infec-
tion of the throat that occasionally the bacilli are exceedingly
virulent, and in the very old or young or when developing in
the throats of those whose vital forces are weak that profound



* Kyle, ** Diseases of the Nose and Throat" a904 edition), p. 395.

>Oninwald, ** Atlas of Nose, Mouth and Pharynx."

"Kyle.



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6 The New England Medical Gazette, Jan.,

and rapid toxemia may result. A case in point is the follow-
ing. The writer was called in consultation by Dr. M. of a
neighboring city. The patient, a gentleman of seventy years,
had two days previously complained of soreness of the throat,'
he had at the same time a severe chill followed by rise of
temperature and hoarseness. The swelling of the tissues
increased until swallowing was extremely difficult, involvement
of the lymphatics of the neck took place, and although respira-
tion was not noticeably impeded, yet it became very audible
to one in an adjoining room. Loss of strength was rapid,
heart's action progressively weak, and death occurred on the
afternoon of the third day from the initial chill. In this case
the laryngeal tissues were principally involved without mem-
branous formation.

Herpetic tonsilitis is not a common disease. It is associated
with lowered vitality, disordered digestion and a disturbed
state of the nervous system. In some cases the general health
is perfectly good, the herpetic manifestations being simply
an expression of nervous irritability of a functional character.
As found elsewhere in' the body\ two conditions are always
present, viz.^ the vesicle and the characteristic grouping of the
vesicles. If the throat is examined during the vesicular stage
the diagnosis is easy, but after the vesicle has broken down
and formed an ulcer the disease may be easily confused with
aptha', or mild follicular tonsilitis. The disease is sudden in
its onset, occasionally accompanied with chills and fever and a
burning, pricking, stinging pain. More often the general
symptoms are absent. The duration is uncertain. Lumbyez^
reports the disease affecting an old man of seventy-eight and
lasting two years. Usually the condition lasts but a few days.

Peritonsilar abscess; circumtonsilar abscess; quincy sore
throat are used synonymously.

For a common disease it is less understood by the general
practitioner than any affection of the throat with which he

' •' Walker'8 Dermatology."

2 Shirley, " Diseases of the Nose and Throat," p. 74.



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1905 The Faucial Tonsil, 7

comes in contact. It was for years, and is at present, thought
by many to be an abscess of the tonsil proper. For this
reason the tonsil was frequently incised, and as this rarely
gave relief, but on the contrary increased suffering, such
treatment quickly fell into disrepute.

As the name indicates, peritonsilar abscess is a disease of
the tissues surrounding the tonsil. Lenox Brown* in an
exhaustive study of the causation of the disease comes to the
conclusion that, ^* First, by the circumstances that in almost
all — if not all — of the patients who are attacked there exists
a strong predisposing factor in the shape of tonsilar hyper-
trophy — faucial, pharyngeal, and even lingual."

Second. That the epidemic is very apt to be regulated by
certain meteorological variations.

Third. So far from one attack conferring immunity against
a second, as is more or less the case in all infectious fevers —
iYifluenza perhaps excepted — each invasion of tonsilitis leaves



Online LibraryGiuseppe Marco Antonio Baretti Henry NeumanThe New England medical gazette → online text (page 1 of 52)