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In reviewing the literature for 1931 on the tonsils and adenoids, I have selected only those papers which promote discussion and those which, according to my judgment, show the advances made in this particular field of otolaryngology. Most of the outstanding contributions have been directed to the study of the bacteriology, immunology and biochemistry of the tonsils. An extremely interesting and instructive series of reports by New and Childrey on tumors of the tonsil and pharynx represent the observations of a large collection of clinical and pathologic material. Instructive papers on retropharyngeal abscess were contributed by Lifschutz and by Woodward. GENERAL CONSIDERATIONSA review of the various factors involved in the tonsil problem convinced B\l=u"\rgers and Wolffheim that many factors are as yet not fully understood. Following a discussion of the bacteriology of the pharyngo-oral cavity, they stated that the bacteriology of healthy and of diseased tonsils as well as the question of the pathogenicity of the micro-organisms is still not fully understood. They considered it of great importance to detect a relationship between the various forms of tonsillitis and the micro-organisms that are found during these diseases in the coatings of the tonsils, in the lacunar secretions and in the tonsillar plugs. They thought that certain serologic reactions could serve as indicators for such correlations. Of the various methods of specific immunity tests, three were tried: dermoreaction, precipitation and phagocytosis. By intracutaneous vaccinations, analogous to the Dick test, only noncharacteristic, positive reactions were obtained, but these are probably only of an allergic nature and do not permit conclusions in regard to the specificity of the micro-organism. The precipitation reactions gave no indications of a definite regularity, and in their present form they therefore do not seem suitable for these purposes. In tests of the phagocytosis (opsonic action), the authors called attention to the fact that the leukocytes show a different behavior Downloaded From: http://archotol.jamanetwork.com/ by a Oakland University User on 05/31/2015
In reviewing the literature for 1931 on the tonsils and adenoids, I have selected only those papers which promote discussion and those which, according to my judgment, show the advances made in this particular field of otolaryngology. Most of the outstanding contributions have been directed to the study of the bacteriology, immunology and biochemistry of the tonsils. An extremely interesting and instructive series of reports by New and Childrey on tumors of the tonsil and pharynx represent the observations of a large collection of clinical and pathologic material. Instructive papers on retropharyngeal abscess were contributed by Lifschutz and by Woodward. GENERAL CONSIDERATIONSA review of the various factors involved in the tonsil problem convinced B\l=u"\rgers and Wolffheim that many factors are as yet not fully understood. Following a discussion of the bacteriology of the pharyngo-oral cavity, they stated that the bacteriology of healthy and of diseased tonsils as well as the question of the pathogenicity of the micro-organisms is still not fully understood. They considered it of great importance to detect a relationship between the various forms of tonsillitis and the micro-organisms that are found during these diseases in the coatings of the tonsils, in the lacunar secretions and in the tonsillar plugs. They thought that certain serologic reactions could serve as indicators for such correlations. Of the various methods of specific immunity tests, three were tried: dermoreaction, precipitation and phagocytosis. By intracutaneous vaccinations, analogous to the Dick test, only noncharacteristic, positive reactions were obtained, but these are probably only of an allergic nature and do not permit conclusions in regard to the specificity of the micro-organism. The precipitation reactions gave no indications of a definite regularity, and in their present form they therefore do not seem suitable for these purposes. In tests of the phagocytosis (opsonic action), the authors called attention to the fact that the leukocytes show a different behavior Downloaded From: http://archotol.jamanetwork.com/ by a Oakland University User on 05/31/2015
In a recent article in The Journal of the American Medical Association, Lichtenberg, Werner and Lueck1 questioned both the pathogenicity of the fusospirochetal organisms and the success of treatment with the arsenicals. After a number of years of experience with the disease in the laboratory and in the clinic, I have arrived at the conclusion diametrically opposed to that of Lichtenberg and his associates, that this group of anaerobic organisms has under certain conditions a primary pathogenicity, and that arsenical therapy is usually the most efficient treatment. In view of this difference of opinion, it seems advisable to review the evidence in favor of the pathogenicity of this group of organisms and to report some cases which illustrate the indications, dangers and limitations of arsenical therapy in fusospirochetal infections.In 1894, Veillon2 observed in necrotic, foul lesions of the throat the following mixture of organisms: cocci, Leptotriches vibriones, Spirochaeta denticola and fusiform bacilli. In December of the same year, Plaut3 described Spirochaeta dentium and Miller's bacillus in pseudodiphtheritic angina. Following Vincent's4 observations in 1896 and 1899, this type of infection was accepted as a clinical entity. The gradual development of knowledge of the disease has been reviewed in a recent monograph.5
Postoperative pulmonary complications, especially of the suppurative type, have been suspected of being induced by one or the other of two principal mechanisms, aspiration into the lower respiratory passages and vascular embolism. Many excellent studies have been made in an effort to substantiate or disprove one or the other of these modes of pathogenesis. One line of investigation has concerned itself with the demonstration of two types of aspiration and their sequelae\p=m-\(1)aspiration of secretions from the mouth, nose or pharynx or from all of them in anesthetized animals and in patients following operations on or adjoining the pharynx or on parts draining into the pharynx and (2) aspiration or insufflation of infective material in animals. The other line of investigation has concerned itself with the localization and sequelae of various septic emboli introduced into the venous circulation.
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