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Cervical gland tuberculosis: The case against surgery
July, 1937]
TUBERCULOUS ADENITIS
465
contrary being possibly the case. On the other hand, partial excision can only be justified if proved by results to be superior to other methods of treatment. Among the drawbacks to surgical intervention are: the high rate of local recurrence, to which reference has already been made, the permanent disfigurement resulting, the inconvenience of hospitalisation, especially if repeated, and the risk of paresis from nerve injury. Conservative treatment has none of these drawbacks, and the results produced arc believed by the writer to be in every way more satisfactory. His own routino methods for dealing with the disease, according to its clinical stages, are hased on comparative results obtained by different conservative measures in common use. In the early hyperplastic stage of the glands, syrup. ferri. iod. is given by mouth. When periadenitis, without softening. is present, tuberculin-preferably P.P.D.-is given by subcutaneous injection. The disease can usually be arrested when these methods arc adopted in the early stages. If a cold abscess has formed, either aspiration TIIO:\IPSON, n. c. Cervical Gland or incision with drainage is performed. Tuberculosis: The Case against Sur- Though treatment on these lines may gery. Brit. Med. JOllrll., 1936, ii, 584. have to be prolonged for months or Apart from the. practical difficulty of even years, it is almost always ambuensuring a complete extirpation of the latory. 1'he cosmetic results of what disease by radical excision of tuberculous might be termed natural cure, thongh glands-naked-eye appearances are not· often occurring under the worst possible infallible evidence of freedom from tnber- hygienic conditions, may be actually culosis--the frequent local recurrence superior to those of expert surgery. after operation shows that there is always the possibility of spread from ASBESTOSIS. the initial focus. Out of a total of 55 EGBETIT, D. S., and GEIGEn, A. J. radical operations among 44 patients observed hy the writer, 50 showed at Pulmonary Asbestosis and Carcinoma. some time or other a gross palpable Amer. Rev. 'l'ub., ID36, 34, 143. The case reported in this paper is local recurrence; while 18 out of 3G patients obse,rved immediately after apparently the first in which primary' operation had a persistent discharging carcinoma of the lung is described in sinus-presumptive evidence of residual association with pUlmonary asbestosis. infection. Nor is surgical extirpation, The patient, a man aged 41, was adeven if it were feasible, necessarily mitted to hospital with n. long history desirable. The immediate prognosis of of breathlessness and cough. and a more scrofula is good, and W. 1\1. Cumming recent disabling pain in the back. At pointed out (Tubercle, H133, 14, 259) the age of 23 he had entered an asbestos that surgical excision had no effect· in factory as weaver, and had continued at preventing the occurrence later of a pul- this occupation ever since. On admismonary lesion, or of determining n. more sion, clinical and X-ray examination benign type of pUlmonary lesioll,the showed II. pneumonokoniosis of both 30
At first the writers began by two injections weekly, but this latter appeared unnecessary, since occasionally patients who had been lost sight of, after one or two injections, came back cured. In cases where the glands are caseous, softened, or fistulised with periadenitis, more frequent injections are necessary, and individual glands, cut off from the lymphatic circulation, must be treated separately. Since October, 1933, the writers have treated 86 patients with tuberculous adenitis, including 77 in the cervical region, 4 in the axilla and 5 in the inguinal region. Some of these patients were cured in two months with four injections; others in six months with ten injections. In a certain number of cases the injections wem followed hy a course of ultra-violet ray treatment, and in others by intravenous injections of chlorophyll. The authors conclude by discussing the probable role in such cases of chlorophyll, divisible by saponification OL' by the action of diastase into two fractions: one with acid properties, water-soluble, and the other, phytol, insoluble in water but soluble in fat.
TUBERCULOUS ADENITIS
465
contrary being possibly the case. On the other hand, partial excision can only be justified if proved by results to be superior to other methods of treatment. Among the drawbacks to surgical intervention are: the high rate of local recurrence, to which reference has already been made, the permanent disfigurement resulting, the inconvenience of hospitalisation, especially if repeated, and the risk of paresis from nerve injury. Conservative treatment has none of these drawbacks, and the results produced arc believed by the writer to be in every way more satisfactory. His own routino methods for dealing with the disease, according to its clinical stages, are hased on comparative results obtained by different conservative measures in common use. In the early hyperplastic stage of the glands, syrup. ferri. iod. is given by mouth. When periadenitis, without softening. is present, tuberculin-preferably P.P.D.-is given by subcutaneous injection. The disease can usually be arrested when these methods arc adopted in the early stages. If a cold abscess has formed, either aspiration TIIO:\IPSON, n. c. Cervical Gland or incision with drainage is performed. Tuberculosis: The Case against Sur- Though treatment on these lines may gery. Brit. Med. JOllrll., 1936, ii, 584. have to be prolonged for months or Apart from the. practical difficulty of even years, it is almost always ambuensuring a complete extirpation of the latory. 1'he cosmetic results of what disease by radical excision of tuberculous might be termed natural cure, thongh glands-naked-eye appearances are not· often occurring under the worst possible infallible evidence of freedom from tnber- hygienic conditions, may be actually culosis--the frequent local recurrence superior to those of expert surgery. after operation shows that there is always the possibility of spread from ASBESTOSIS. the initial focus. Out of a total of 55 EGBETIT, D. S., and GEIGEn, A. J. radical operations among 44 patients observed hy the writer, 50 showed at Pulmonary Asbestosis and Carcinoma. some time or other a gross palpable Amer. Rev. 'l'ub., ID36, 34, 143. The case reported in this paper is local recurrence; while 18 out of 3G patients obse,rved immediately after apparently the first in which primary' operation had a persistent discharging carcinoma of the lung is described in sinus-presumptive evidence of residual association with pUlmonary asbestosis. infection. Nor is surgical extirpation, The patient, a man aged 41, was adeven if it were feasible, necessarily mitted to hospital with n. long history desirable. The immediate prognosis of of breathlessness and cough. and a more scrofula is good, and W. 1\1. Cumming recent disabling pain in the back. At pointed out (Tubercle, H133, 14, 259) the age of 23 he had entered an asbestos that surgical excision had no effect· in factory as weaver, and had continued at preventing the occurrence later of a pul- this occupation ever since. On admismonary lesion, or of determining n. more sion, clinical and X-ray examination benign type of pUlmonary lesioll,the showed II. pneumonokoniosis of both 30
At first the writers began by two injections weekly, but this latter appeared unnecessary, since occasionally patients who had been lost sight of, after one or two injections, came back cured. In cases where the glands are caseous, softened, or fistulised with periadenitis, more frequent injections are necessary, and individual glands, cut off from the lymphatic circulation, must be treated separately. Since October, 1933, the writers have treated 86 patients with tuberculous adenitis, including 77 in the cervical region, 4 in the axilla and 5 in the inguinal region. Some of these patients were cured in two months with four injections; others in six months with ten injections. In a certain number of cases the injections wem followed hy a course of ultra-violet ray treatment, and in others by intravenous injections of chlorophyll. The authors conclude by discussing the probable role in such cases of chlorophyll, divisible by saponification OL' by the action of diastase into two fractions: one with acid properties, water-soluble, and the other, phytol, insoluble in water but soluble in fat.