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REMOVAL OF THE TONSILS.
1773 and of eosinophiles, and a marked shitting to the left of Arneth’s blood picture, which they therefore regard as of importance. Conversely they believe that changes in the opposite direction in any of the above factors in the blood count are favourable. Their observations upon pneumonia comrr,se 131 blood counts upon 40 cases, almost all of which were cases of lobar pneumonia, though a few examples of broncho-pneumonia were included. They findi, that leucocytosis occurs as frequently in fatal cases as in those which recover, and that this leucocytosis is due to an increase in the neutrophiles. When this increase in neutrophiles is excessive a very severe infection is indicated. Arneth’s differential count shows a constant shifting to the left in pneumonia, but appears to bear no relation to the clinical course of the disease. These results in pneumonia are somewhat in opposition to those of the earlier observers and require confirmation. Dr. Muller and Miss Reed’s paper is a useful study of an interesting question, and contains numerous references to the literature of the subject.
lymphocytes
AN AUTUMN VACATION
COURSE
IN
PARIS.
IT is officially announced by the Faculty of Medicine of the University of Paris that a vacation course on clinical practice and the application of laboratory methods to clinical diagnosis will be given at the Medical Clinic of the Hotel. Dieu under the direction of Professor A. Gilbert, commencing The course will comprise 28 lessons, and on Sept. 23rd. will occupy 14 days, a morning and an afternoon class being held daily. The students will receive individual instruction in the examination of patients, prescription writing, the management of apparatus, and laboratory methods, and will be allowed to take away the preparations made by them. With Professor Gilbert are associated in the course Dr. Herscher, Dr. Lippmann, Dr. Jomier, and Dr. Maurice Villaret, of the clinical department; Dr. Paul Descomps, of the department of pathological anatomy ; M. Deval, head of the chemical laboratory ; and in the specialties, Dr. Guilleminot, Dr. Durey, and Dr. Dausset. A certificate will be given at the completion of the course, which is open to foreign medical men. The fees are 100 francs, which should be sent by Post-office order to M. Deval, Chef de Laboratoire, Hôtel-Dieu, Paris.
and fourth branchial
pouches. All these bodies are produced by inbudding of the endothelial lining of the primitive pharynx. In a recent careful study in comparative anatomy Gordon Wilson, of Chicago, has shown that the tonsil secretes The r6le of the tonsils as or excretes into the pharynx. of infection Professor Mackenzie considers greatly portals exaggerated. He admits that they are so in certain cases, but to a less extent than the more abundant and receptive lymphatic structures of the nose and naso-pharynx. The tonsils are frequently held responsible for the results of morbid conditions situated elsewhere. If obstruction to to due adenoids be tonsils will often the removed, respiration take care of themselves. Even if they remain large and are causing no trouble they may be safely left, and as growth of the child proceeds they will become less conspicuous. The mere size of the tonsil Professor Mackenzie considers no indication for removal. A large tonsil does not necessarily mean a diseased one, nor does a small one mean a That the tonsil has one. some healthy important function is shown by its frequent growth after enucleation. Another point is that the tonsils play an important part in the mechanism of speech and song. They influence the action of the surrounding muscles On the other and modify the resonance of the mouth. hand, they may be so enlarged as to cripple both these functions, and then should certainly be removed. The changes in anatomical relations produced by tonsillectomy cannot be foretold, no matter how skilfully the operation is performed. The adhesions and contractions which sometimes follow, even in the best of hands, often ruin the singing voice. Professor Mackenzie shows that he would long hesitate before advising the operation in a great singer, or one depending on the voice for a livelihood. He considers that tonsillectomy is a dangerous operation which should be done only in a hospital or other place where there is every facility to meet the gravest emergency. It should be done only by a surgeon skilled in its performance, thoroughly equipped for every accident, and fully alive to the fatalities which have sometimes followed. He does not decry the many excellent measures which modern ingenuity has devised for operation on the tonsil when there are definite reasons for their application. -
-
REMOVAL OF THE TONSILS.
PRACTICAL INSTRUCTION AT THE BROMPTON HOSPITAL. IN the MccTyland Medical Journal for June Dr. John N. THE of bedside instruction has for long been in the of and Mackenzie, professor system laryngology rhinology Johns Hopkins University, inveighs against the indiscrimi- deemed one of the most valuable assets of medical educanate removal of the tonsils, which he attributes not only to tion in London, and it has been widely recognised as the mistaken views of the American profession but to insistent most satisfactory method of imparting technical knowledge demands of the laity. He points out that the functions of of the art of medicine. Recentlv an endeavour has been made the tonsils are at present unknown. Whether they are in some quarters to introduce in its place more formal portals of entrance or exit for infection, whether they pro- demonstrations in a theatre or lecture-room before larger tect the organism from disease or invite its entrance, audiences ; it has been argued in favour of this course whether the pathogenic bacteria sometimes found in them that bedside instruction lacks organisation, that there is much overlapping on the part of the teachers, and that are coming out or going in, whether they are manufacturers or storehouses of leucocytes, and whether their destruction there is no guarantee that the curriculum is commeans the removal of a battle-line against the passage of inprehensive. By way of experiment in the systematisafection from the throat to the neck cannot be stated. Until tion of clinical instruction the Brompton Hospital staff these questions are settled the final word on removal of thei has organised a short coarse of practical instruction on the tonsils cannot be said. Whatever its functions, the tonsll subject of pulmonary tuberculosis to be held during the first is not, as is generally believed, a lymphatic gland. Its fortnight in July;’it is hoped that the.best points of the two physiological integrity is important in childhood. It appears methods of teaching may thus be combined. The programme n the fourth month of embryonic life, attains maturity at is as far-reaching as possible for the time available, and an the end of the first year of infancy, and about puberty tends endeavour has been made to prevent overlapping by allotting to diminish in size. It does not develop as a lymphatic in advance the subjects for demonstration. Should the from a of gland plexus pre-existing lymph vessels in the experiment prove successful a longer and more elaborate mesothelium, but as an ingrowth of endothslinm from the course, including other subjects, may be organised. The second branchial poach, and therefore resembles the thymus subjects and times of the demonstrations are given in and thyroid, which originate respectively from the third our "Medical Diary." The programme opens on Monday,
lymphocytes
AN AUTUMN VACATION
COURSE
IN
PARIS.
IT is officially announced by the Faculty of Medicine of the University of Paris that a vacation course on clinical practice and the application of laboratory methods to clinical diagnosis will be given at the Medical Clinic of the Hotel. Dieu under the direction of Professor A. Gilbert, commencing The course will comprise 28 lessons, and on Sept. 23rd. will occupy 14 days, a morning and an afternoon class being held daily. The students will receive individual instruction in the examination of patients, prescription writing, the management of apparatus, and laboratory methods, and will be allowed to take away the preparations made by them. With Professor Gilbert are associated in the course Dr. Herscher, Dr. Lippmann, Dr. Jomier, and Dr. Maurice Villaret, of the clinical department; Dr. Paul Descomps, of the department of pathological anatomy ; M. Deval, head of the chemical laboratory ; and in the specialties, Dr. Guilleminot, Dr. Durey, and Dr. Dausset. A certificate will be given at the completion of the course, which is open to foreign medical men. The fees are 100 francs, which should be sent by Post-office order to M. Deval, Chef de Laboratoire, Hôtel-Dieu, Paris.
and fourth branchial
pouches. All these bodies are produced by inbudding of the endothelial lining of the primitive pharynx. In a recent careful study in comparative anatomy Gordon Wilson, of Chicago, has shown that the tonsil secretes The r6le of the tonsils as or excretes into the pharynx. of infection Professor Mackenzie considers greatly portals exaggerated. He admits that they are so in certain cases, but to a less extent than the more abundant and receptive lymphatic structures of the nose and naso-pharynx. The tonsils are frequently held responsible for the results of morbid conditions situated elsewhere. If obstruction to to due adenoids be tonsils will often the removed, respiration take care of themselves. Even if they remain large and are causing no trouble they may be safely left, and as growth of the child proceeds they will become less conspicuous. The mere size of the tonsil Professor Mackenzie considers no indication for removal. A large tonsil does not necessarily mean a diseased one, nor does a small one mean a That the tonsil has one. some healthy important function is shown by its frequent growth after enucleation. Another point is that the tonsils play an important part in the mechanism of speech and song. They influence the action of the surrounding muscles On the other and modify the resonance of the mouth. hand, they may be so enlarged as to cripple both these functions, and then should certainly be removed. The changes in anatomical relations produced by tonsillectomy cannot be foretold, no matter how skilfully the operation is performed. The adhesions and contractions which sometimes follow, even in the best of hands, often ruin the singing voice. Professor Mackenzie shows that he would long hesitate before advising the operation in a great singer, or one depending on the voice for a livelihood. He considers that tonsillectomy is a dangerous operation which should be done only in a hospital or other place where there is every facility to meet the gravest emergency. It should be done only by a surgeon skilled in its performance, thoroughly equipped for every accident, and fully alive to the fatalities which have sometimes followed. He does not decry the many excellent measures which modern ingenuity has devised for operation on the tonsil when there are definite reasons for their application. -
-
REMOVAL OF THE TONSILS.
PRACTICAL INSTRUCTION AT THE BROMPTON HOSPITAL. IN the MccTyland Medical Journal for June Dr. John N. THE of bedside instruction has for long been in the of and Mackenzie, professor system laryngology rhinology Johns Hopkins University, inveighs against the indiscrimi- deemed one of the most valuable assets of medical educanate removal of the tonsils, which he attributes not only to tion in London, and it has been widely recognised as the mistaken views of the American profession but to insistent most satisfactory method of imparting technical knowledge demands of the laity. He points out that the functions of of the art of medicine. Recentlv an endeavour has been made the tonsils are at present unknown. Whether they are in some quarters to introduce in its place more formal portals of entrance or exit for infection, whether they pro- demonstrations in a theatre or lecture-room before larger tect the organism from disease or invite its entrance, audiences ; it has been argued in favour of this course whether the pathogenic bacteria sometimes found in them that bedside instruction lacks organisation, that there is much overlapping on the part of the teachers, and that are coming out or going in, whether they are manufacturers or storehouses of leucocytes, and whether their destruction there is no guarantee that the curriculum is commeans the removal of a battle-line against the passage of inprehensive. By way of experiment in the systematisafection from the throat to the neck cannot be stated. Until tion of clinical instruction the Brompton Hospital staff these questions are settled the final word on removal of thei has organised a short coarse of practical instruction on the tonsils cannot be said. Whatever its functions, the tonsll subject of pulmonary tuberculosis to be held during the first is not, as is generally believed, a lymphatic gland. Its fortnight in July;’it is hoped that the.best points of the two physiological integrity is important in childhood. It appears methods of teaching may thus be combined. The programme n the fourth month of embryonic life, attains maturity at is as far-reaching as possible for the time available, and an the end of the first year of infancy, and about puberty tends endeavour has been made to prevent overlapping by allotting to diminish in size. It does not develop as a lymphatic in advance the subjects for demonstration. Should the from a of gland plexus pre-existing lymph vessels in the experiment prove successful a longer and more elaborate mesothelium, but as an ingrowth of endothslinm from the course, including other subjects, may be organised. The second branchial poach, and therefore resembles the thymus subjects and times of the demonstrations are given in and thyroid, which originate respectively from the third our "Medical Diary." The programme opens on Monday,