DISEASES OF THE THROAT The Tonsils.—This term is popularly applied to compact masses of lymphatic tissue situated between the anterior and posterior faucial pillars. Similar collections of lymphoid tissue are present in the nasopharynx and in the base of the tongue. The complete circle of this tissue is known as Waldeyer's Ring. It is present in all children and while it tends to undergo atrophy at puberty, this change often fails to take place.
The term adenoids implies an overgrowth of the lymphoid mass in the nasopharynx which is sufficient in degree to produce symptoms. In health the collections of lymphoid tissue comprising Waldeyer's Ring are supposed to act as a first line of defence against invasion of the body by pathogenic micro-organ isms. At the same time they offer an easy and open portal for infection. It is only necessary to mention the initial inflammation of the tonsils and their immediate regions which herald an attack of scarlet fever, measles, diphtheria, influenza (frequently) and acute rheumatic fever. But when the components of the lymphoid ring become the seat of a chronic infection, or act as foci of sepsis, their potency for evil is equal to or even greater than that of the paranasal sinuses already referred to.
In respect of mental disease at the New Jersey State Hospital (Trenton) the number of discharged patients increased from 37 to 85% after removal of oral and tonsillar infections (H. A. Cot ton, 1923) . It is often forgotten that a small septic tonsil—es pecially in adults—frequently causes more definite symptoms in distant organs or tissues than large and prominent tonsils which are often only a cause of local discomfort. The modern practice of "enucleation" or complete rather than partial removal of the tonsils is based on the facts which are briefly outlined above.
Both sarcomata and carcinomata are commonly met with. If left untreated they prove fatal, but if recognized and dealt with in their earlier stages they may be cured or afforded long periods of immunity from recurrence. Radio therapy alone or combined with less radical surgery than formerly, has produced equally good if not better results than extensive surgical procedures by themselves (see RADIUM THERAPY).
Under diathermy (see ELECTROTHERAPY) the operation is practically bloodless, the patient suffers no shock, scarring is slight and healing rapid. The coagulation by heat pre vents dissemination of the cancer cells into the surrounding tis sues which ordinary surgical manipulations may not be able to avoid. A dissection of the glands in the neck can be made before or after destruction of the primary growth.
Treatment by diathermy can only be carried out successfully when the growth is situated in readily accessible regions such as the mouth, soft palate, tonsillar regions, posterior wall of the pharynx and the epiglottis of the larynx. It is contra-indicated in the immediate neighbourhood of large blood-vessels, bone and cartilage. Hitherto "deep" X-ray therapy has not been success ful for malignant disease in the throat or larynx.
Larynx.—Tuberculosis of the larynx is prac tically always secondary to a primary infection of the lungs, and its treatment has improved pan passe with that of the pulmonary lesion. Frequent inspection of the larynx, and the recognition of the earliest signs and symptoms of tuberculous laryngitis, followed by prolonged functional rest of the voice, have cured many pa tients whose general health and resistance have been maintained or improved by sanatorium treatment. In these circumstances and if prolonged functional rest of the vocal cords fails to cure small or limited tuberculous lesions in the larynx, application of the galvano-cautery will often produce rapid healing. Severe surgical measures for the removal of infected laryngeal tissues are rarely called for. The value of tuberculin in the treatment of laryngeal tuberculosis is still a matter of opinion. For fuller information on this subject see "the Mitchell Lecture" by Sir St. Clair Thomson (Brit. Med. Journ. Nov. 8, 1924).
Here again the essential for successful treatment is early diagnosis. Any adult suffering from an altera tion of the normal speaking voice of more than a few weeks' dura tion should be examined by an expert laryngologist. The treatment of the disease in its early stages is surgical and aims at its com plete removal. The records of cure or many years of freedom from recurrence are probably better than those in any other re gion of the body.
Tilley, Diseases of the Nose and Throat (1919) Bibliography.-H. Tilley, Diseases of the Nose and Throat (1919) D. McKenzie, Diseases of the Throat, Nose and Ear
M. Mann, Text-Book of Tracheo-Bronchoscopy, Technical and
(1920) ; Sir St. C. Thomson, Diseases of the Nose and Throat (1921) ; C. G. Coakley, A Manual of Diseases of the Nose and Throat (1923) ; F. H. Tod, Diseases of the Ear (1926) .
