The author recognizes nearly all diseases of the tonsil as being due to their size and consequent mechanical obstruction, or to chemical or bacteri ological changes going on in the crypts. The evils to health from hypertrophied tonsils of the fauces cannot always be separated from those arising from the whole adenoid ring-faucial pharyngeal and lingual tonsils, and the following table should be so understood: I. Evils due to reflex neuroses, affecting a. The ear, as tinnitus aurium, otolgia and deafness. The larynx, as in vomiting, gastralgia and dyspepsia. a. Upon the ears, resulting in imperfect ventillation of the middle ear, and giving rise to a large percentage of all ear diseases. b. Upon deglutition; a hinderance when the glands are very large. Adhesions high up interferes with the action of the levator and tensor palati muscles, and regurgitation of ingesta through the nose may result there from. c. Upon the voice. Injures the quality of the voice by changing the size and shape of the resonance cavities. d. Upon the respiratory function. Gives rise to mouth breathing. Dessicates the whole respiratory tract. The dry tongue impairs taste, the dry bronchi predisposes to cough. e. Upon body development. Impairs the growth of all the tissues, particularly that of the central nervous system. III. Evils due to the tonsils as absorbents. Furnish a most favorable site for the lodgment and absorption of infectious materials, thus predisposing to the infectious diseases, particularly diphtheria and the many forms of tonsillitis. IV. Evils due to the tonsils as auto-infectious bodies. The enlarged and open crypts form lodgment for food bacteria and cast-off epithelium. This mixed with saliva, at the mouth temperature, is soon a septic mass, which is later squeezed out of its lodgment by muscular contractions, and is swallowed. Such toxic dinner pills, plus the auto-infectious products of teeth, tongue, nose and naso-pharynx, undoubtedly form a frequent source of stomach and general disorders. The lung tissues may possibly become infected through the air passing constantly over the septic tonsils. The correction of two conditions will remedy the above evils. These are removal of the obstruction, and destruction or modification of the crypts, in which most of the above ill-effects originate. Both conditions do not always coexist. The most difficult cases to cure are those in which obstruction plays no part, but the gland is firmly adherent, has septic pockets, and is chronically inflamed. The difficulty of curing every variety of diseased tonsil has given rise to a multitude of methods, of which the following are chief: a. Systemic medication, hygienic measures, etc., are of value only in the young, whose tonsils are yet soft lymphoid masses, and in those with certain diathesis, as the tubercular, rheumatic or strumous. b. Application of astringents and pigments. These have the effect to relieve the inflammation existing in the tonsil. The reduction of the size of hypertrophied tonsils is scarcely noticeable, even after six months daily application of such means. c. Absorption of the glands by injecting solutions of carbolic acid, iodine, etc., into the tissues. The method is difficult, painful and useless. d. Partial destruction by silver nitrate, chromic or other acids, or ignipuncture. Methods of benefit, but not cure, and prove unsatisfactory. The points of local destruction leave pits that serve the same evil purposes as the original crypts. e. Ablation, by snare with cold or hot wire, by bistouary or tonsilotProperly performed cures the ailments arising in and from hypertrophied tonsils. The line of section should always be deeper than the bases of all the crypts. The author has examined patients who have had their tonsils removed, they say without benefit, or even been made worse. In all these cases the operator had taken a mere slice from the top, the bases of the crypt were left and the patient not benefited. Tonsillotomy in the nonadherent soft variety is a simple and safe surgical procedure. When the whole adenoid ring is cleared at the same time, its benefits are most striking. When a tonsil has adhesions such always should be broken up thoroughly. No instrument is made that can thoroughly catch up the gland till this is first done. The question of greatest safety following the use of snare, cold or hot, bistouary or tonsilotome is not settled. The latter instrument is the easiest to use, the most universally used, and is comparatively quite safe. If for any reason a hemorrhage should be greatly feared the snare should be used. An operator expecting to cure all classes of cases should have a good array of instruments. His judgment will then select the ones to suit each case. Printed instructions should be given patient, as to diet, quiet, etc., following throat operations. Conclusions drawn are: I. That the tonsil is practically a useless body, its function being readily performed by the abundance of similar tissues elsewhere in the body. 2. That when enlarged and consequently diseased, it is always a menace to health, and may predispose to fatal illness. 3. That it always requires treatment, on the same grounds that an irritated, infective tooth root should receive attention. 4. That in the treatment but two things need be accomplished. moval of any obstruction, and complete eradication of all crypts. Re 5. That these conditions are best met by ablation of the gland beyond the bottoms of the crypts. 6. And that little of a satisfactory nature to either patient or operator will have been accomplished by merely slicing off the top of any diseased tonsil. THE Whitley's Test for Albuminuria. BY J. D. WHITLEY, M. D., PETERSBURG, ILL. Read before the Brainard District Medical Society, at Jacksonville, Ill., October 28th, 1897. HERE are at present some seventeen tests for albumin in the urine known to the profession. The technique of these various chemical combinations are more or less complicated and not entirely satisfactory as to results obtained. Perhaps the oldest and best known test is by heat and nitric acid. The more modern and simpler one is the ferrocyanide test. The latter does not require heat but the addition of acetic acid is necessary, as follows: Put into a clean test tube 15 to 30 gtts of acetic acid, then add two or three times this amount of a one to twenty solution of potassium ferrocyanide. The urine is then added to two-thirds the depth of the tube. The resulting precipitate is albumen. The test which I wish to demonstrate to the society today commends itself on account of its simplicity, trustworthiness and its possessing sufficient delicacy for all practical purposes in routine work. This test gives no reaction with the urates, vegetable alkaloids nor mucin, but responds to all conditions of albumen in either acid or alkaline urine. It has no effect upon the normal constituents of urine except to preserve the specimen indefinitely by its well-known properties. The formula is as follows: Take of urine three parts by volume. Formaldehyde (40 per cent solution) I part by volume. Mix by gently shaking the tube, then set aside for reaction. Soon after the formaldehyde comes in contact with the urine a clouded or murky appearance will indicate the presence of albumin. In a few minutes this changes to a gray or whitish color, when the albumin begins, to separate and in time becomes precipitated. Should no discoloration occur within a few minutes after adding this reagent to the urine there is no albumen present, but any precipitate caused by this test is albumen and nothing but albumen. A curious fact has been noticed in reference to the formaldehyde test that where albuminous urine has been subjected to boiling and the test added instead of nitric acid, the separation of albumen is entirely prevented. BERND'S PHYSICIANS' REGISTER.-We take pleasure in calling the attention of our readers to Bernd's Physicians' Register, an announcement of which will be found on another page. The physician has never covered himself with glory when posing as a book-keeper, but Bernd's Registers have made it possible for his books to be as exact as those of the banker. The system is so simple and so absolutely convenient in every respect that it is natural that medical men who have adopted it should endorse it in almost extravagant terms. It is a system which will bear investigation. Investigation will convert you, doctor. The Reviewer's Table. Books, pamphlets, instruments, etc., for this department, should be sent to the Managing Editor, Saint Louis. PHYSICIANS Who are careful students of human nature have ever before them a vast field in which to study character. It is from this great field TRUE TO THEMSELVES: A Psychological Study. By some of the most sublime character studies are drawn. The physician novelist comes close to nature's heart when he depicts truths which burn. Dr. Skene, character as it is; his deductions, too, are who is reverenced by his students (the reviewer being one) for his exquisite depiction of clinical facts in medical instruction, uses the same logical method in unravelling the sociological problems ever before us. His descriptive writing is very much like that of his native countryman, Crockett, whose Stickett Minister has done so much good in this troubled world of ours. Skene dives beneath the apparent holier than thou blanket which serves to clothe much of theological hypocrisy into real life, and there shows how heart to heart true love cares little for the fickle barriers of caste and family precedent. While we doubt that there are many real Mrs. St. Clairs, yet we do believe that such theology, as used to bolster up her very fragile arguments, is too freely taught where the lines of caste are well drawn. Douglas is a great character. Jessie is a true character to be met with wherever true womanhood breathes the breath of life. Sir Ronald should have had more of his son's independence of character, but if he had this story would have been spoiled. The story is well told, and bears with it its mission, which is to preach. natural affinity, natural selection, true love, and the breaking down of the artificial barriers of society. F. P. N. THE malarial fevers have grown in importance since perfected laboratory methods have given access to the study of the organisms of the disease as LECTURES ON THE MALARIAL FEVERS, by WILL- formed in the blood. Dr. Thayer in these excellent lectures has exhaustively presented the latest studies of malaria, biological, pathological and clinical. It was long thought that clinical medicine was thoroughly familiar with malaria, but since Lavern opened the way for more exhaustive research, it has been found that but half had been told. Thayer gives us all that is now known concerning malaria, and his conservative, yet scientific, presentation of these facts, places his work among the classics of internal medicine. This volume is one of the most important medical publications of the year, and should be in the hands of every practitioner. F. P. N. DR. KLEMPERER'S work on Clinical Diagnosis is widely known, and all English readers will be rejoiced to find within their reach this very compre hensive but condensed manual, Its chapters deal with the inspection and examination of the patient, the diagnosis of the acute infectious diseases, diseases of the nervous system, digestive diseases, each under its special symptomatology, diseases of the respiratory apparatus, the heart and circulation. Two chapters are devoted to urine analysis and to the diseases of the kidneys. The four concluding chapters deal with the disturbances of metabolism, the diseases of the blood, the Roentgen rays as diagnostic aids, and animal and vegetable parasites, including such bacteria as are of clinical importance. No book so complete, short of a text-book of medicine, is before the American medical public. It has passed through seven editions in its original language (German) in as many years. The German school leads in clinical diagnosis, and this little work is an exquisite example of its methods. KLEMPERER'S CLINICAL DIAGNOSIS, by Dr. G. Klemperer. Professor at the University of Berlin; first American from the seventh and last German edition; authorized translation by NATHAN E. BRILL, A.M., M.D., Adjunct Attending Physician, Mt. Sinai Hospital, and Samuel M. BRICKER. A.M., M.D., Assistant Gynecologist, Mt. Sinai Hospital Dispensary, is announced for early publication by THE MACMILLAN COMPANY. WHILE there are many excellent text-books on medicine now before the profession, there is yet room for one more, providing, of course, that it is a A TEXT-BOOK OF THE PRACTICE OF MEDICINE. By JAMES M. ANDERS, M.D., Ph.D., LL.D., Professor of the Practice of Medicine and of Clinical Medicine in the Medico-Chirurgical College, Philadelphia; Attending Physician to the Medico-Chirurgical and Samaritan Hospitals, Philadelphia, etc. Illustrated. Philadelphia: W. B. SAUNDERS. 1898. good one. Anders' work is excellent and especially good for the medical student who wants facts boiled down, and ready for assimilation. This it seems is the feature of this work, it is concise; precise where it can be; elaborate when necessary, but withall stating in a method that can well be understood by the student, facts in diagnosis, differential diagnosis, symptoms and treatment. All of the modern methods of laboratory diagnosis are mentioned, differential diagnosis is full, by reason of excellent and original tables; treatment is modern and strictly clear, so that the student has at his command the essentials of all that time has found good, and all that modern medicine teaches is good. The physician will find this volume one of ready reference in diagnosis, symptoms and treatment it is especially to be commended to physicians who wish to find the distinctive teachings of practical medicine of today. F. P. N. "YOUTH AND HOME. "-A new home paper which is clean, bright and elevating in its every characteristic is the new Youth and Home, published at 127 Fifth Avenue, New York City. We are pleased to commend this paper to our readers. It is one of the few journals which does not depend on patent medicine advertisements for an existence. Its advertising pages are ciean. It is a paper the young people will enjoy. H. |