Acute catarrh of the nose and pharynx, such as is often induced by acute coryza, is unquestionably account able for the excessive development of the tissue in many instances. Undue opment may also be produced by septic disturbances of the lymphoid tissue. This accounts for their appearance as a sequel to exanthematous diseases after scarlet fever, measles, whooping-cough, etc., when the cause of the hypertrophy is traceable to the action of a pathogenic organism. The tubercle bacillus may find a soil in the hypertrophied tissues.
Specimens removed from a hundred patients carefully examined for histo logical evidence of tubercle, with the re sult that in 3 per cent. such evidence was found. Great numbers of other organisms were also found, not only lying upon the free surface of the hyper trophy, but also in the crypts. These are chiefly microeocci, though short ba cilli are also present in some of them. There is abundant evidence, therefore, of the presence of micro-organisms associ ated with the hypertrophy of the pharyn geal tonsil, and the dangers that may arise from this source should not be lost sight of in the clinical consideration of each individual case. P. McBride and A. Logan Turner (Edinburgh Med. Jour., May, '97).
From examination of 212 cases of ade noid vegetations, the conclusion reached that there is no bactericidal property in the secretion of the glands, and probably none in the nasal mucus. Latent lacuna/. encysted adenoiditis is a rarity. As re gards the bacilli, 25 examinations dis closed none; 37 streptocoeci, but never pure; 60 staphylococci, pure, and 69 associated with other micro-organisms; other forms of cocci, 41 pure and 54 associated; pneumococci, 3; leptothriK buccalis, 1 pure and 1 associated; and a short bacillus not taking Gram's stain in 1 case. There was hypertrophy of the tonsils in 17 eases; tlibereulosis, collateral in 30, hereditary in 18, and personal in 17, but Ko.-It's bacillus was never detected in the vegetations. Goure (Thi/se de Paris, No. 175, '97).
While adenoids consist essentially of hyperplastic pharyngeal lymphoid tissue, the epithelium and fibrous-tissue changes are inconstant, variable, and independ ent of the age of the patient. The new formed fibrous tissue is largely perivas cular in distribution. It may occasion ally be one of the factors in the process of disappearance of the adenoid. The hyperplastie pharyngeal tonsil often contains micro-organisms, and these are mainly pyococcic forms. The bacteria
for the most part lie near the surface; and the infection usually occurs from the surfaee, with or without demonstra ble lesion of the epithelium. Primary tuberculosis of adenoids is probably more common than most previous studies show. Sixteen per cent. of the writer's series contained tubercle bacilli. 10 per cent. with characteristic lesions of tubercidosis. The tubercle bacilli were present in small numbers. The lesions in primary tuberculosis of the adenoid are generally close to the epi thelial surface and focal in eliaracier. Occasionally they may be found in the deeper parts of I he pharyngeal lyinphniil tissue. The pharyngeal tonsil may bo portal of entry for tlw tubercle howilln. and other micro-organisms in looalized or general infectious. A. .1. Lariigau and -Matthias Nicoll, Jr. (Amer. Jour. Med. Seienees. June. 1902).
Influenza is ofl on responsible for post nasal adenoid hypertrophy. The growth sometimes, as a result of congestion and inflammatory infiltration, becomes mar not confined to the period at or after puberty, but occurs also hi very young children, and is, therefore, independent of the age of the patient. P. _McBride and A. Logan Turner (Edinburgh Med. Jour., Apr., '97).
Whether operated upon or not, the retrogression of the lymphoid material, while frequently leaving the surface smooth, usually leaves behind in the stroma, a superabundance of fibrous tis sue, and possibly some epithelial meta plasia of the surface, which are liable to interfere with the proper functions of the vascular and glandular organs of the pharynx—resulting in post-nasal catarrh. Another form of cieatricial sequel of ade noids is Tornwaldt's disease, resulting from the inflammatory agglutination of the surfaces of the lymphoid folds of the pharyngeal tonsil one to the other, leav ing closed cavities erroneously called cysts. Jonathan Wright (Brooklyn Med. Jour., July, 1900).
Prognosis. — The prognosis of post nasal adenoid growths from the point of treatment is, in the majority, of cases satisfactory. But, when the disease is allowed to remain unrelieved and pur sue a natural course, the consequences incident to these growths are sometimes so far-reaching that they cannot be paired either by Natnre's process or the physician's aid.