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CONCERNING THE
ADENOID TISSUE OF THE PHARYNX AND
NASO-PHAEYNX.
By JOHN DUNN, M. D ,
RICHMOND, VA.
In the fall of 1890 Mr. S., aged twenty-sis, came to see me
about his throat. History as follows : Seven or eight years pre-
viously he had had "an acute attack of sore throat," for which
at the time he bad undergone the treatment usual in such cases,
including removal of part of the uvula. Since that time he had
never been free from a sense of discomfort in his throat, which,
often for months at a time, would remain acutely painful. The
pain was not referred to any one place in the throat, but the
" wliole throat was painful." During these years he had sub-
mitted to all kinds of treatment, including "having the skin
several times burned off his throat with caustic." removal of
part of the left tonsil with cautery, and all the anti-sore-throat
remedies of the pharmacopoeia, and without relief. Examination
at this time showed the mucous covering of the pillars of the
fauces, soft palate, uvula, tonsils, pharynx, and part of the naso-
pharynx to be fiery red. There was no swelling of the parts;
no exudation. Scattered over the pharyngeal wall were a few
so-called " enlai'ged follicles." The left tonsil had been in a
ragged manner destroyed by the application of tlie cautery,
which had also removed part of the posterior pillar of this side.
The right tonsil lay iiat against the posterior pillar of the right
side: tliis tonsil was enlarged, l)ut not enongh to protrude be-
yond the edge of the pillar ; its epithelial covering, like that Flurbiprofen 100mg of
the rest of the pharynx, was fiery red. I asked Mr. S. when
his throat hurt him. His reply, was: "It hurts all the time. It
aches. It has been this way for years." There was no nasal
complication, no upper pharyngeal complication, to account for
this state of affairs. There had been some rheumatism in lii.s
family, but not enough to make its existence a part of the family
history. In other respects Mr. S. was healthy. (I have since
then discovered that Mr. S.'s skin is exceptionally liable to in-
flammatory action after the apiilication of bichloride solutions
or of any similar api)lications.) I advised the removal of the
right tonsil, telling Mr. S. that there was a bare ))0ssibility that
it might be the cause of his throat trouble, though I could not
assure him that it was, or that its removal would afford him the
relief he sought, as I h.ad never seen a case similar to his (/. (.i
a case of apparently acute infiannuatioii of the coverings of the
pharynx, including the soft palate, uvula, and pillars of the
fauces, which acute inflamuiation at the same Flurbiprofen Sodium time was
chronic.)
lie declined to have the tonsil removed, saying that it gave
him no more pain than the rest of his throat. I then put Mr.
S. on antirrhemnatic remedies, including salicylate of sodium.
His throat got a little better after a time, probably as a result of
time and not of the medicines.
In October, 1891, Mr. S. returned to my office saying that
he could stand the pain in his throat no longer. If there was
any possibility of the tonsil being the cause of his trouble lie
wanted it removed ; something had to be done. Examination
of the fauces showed exactly the same condition that existed a
year before — the fiery redness of the mucous membrane. The
right tonsil seemed to have decreased somewhat within the past
twelve months, although it was still considerably hypertrophied.
Examination of this tonsil showed that it was firmly adherent
to, if indeed it had not been in part developed from, the outer
part of the posterior faucial pillar. With the aid of a snare and
a knife to loosen some of the adhesions, the tonsil was re-
moved. After a day or two the throat began Buy Flurbiprofen to lose its intiamed
appearance and Flurbiprofen Ibuprofen the pain in it to disappear. At the end of two
weeks Mr. S. said his throat felt better than it had for months.
There were, however, slight recurrences of the infiamraatory
condition of the mucous meinbi'.ane during these two weeks,
though of less seventy than the attacks had been prior to the
removal of the tonsil. Further treatment consisted in destroy-
ing with the cautery point the remains of the tonsil, wliich,
owing to their position and adhesions, could be removed thus
more easily than with a snare. Mr. S. also mentioned that, con-
comitantly with this sore throat, there comes a sore feeling in Flurbiprofen 100 Mg his
chest just beneath the sternum; this soreness lasts all the time
that the throat is inflamed, and seems to increase under exer-
cise or exposure. Furthermore, Mr. S. says that the hearing of
his right ear is not so acute as that of his left Examin.ation
showed some retraction of the drum-head on this side. Three
months after the removal of the tonsil Mr. S. says that the pain-
ful feeling in his throat has virtually disappeared ; his Flurbiprofen Ophthalmic throat,
however, still tires easily, though he has not now the same desper-
ate feeling in regard to it that he had when nothing he could do
would relieve the aching misery that once proceeded from it.
Although the foregoing ca.se at first glance bears onl}^
one point of interest — namely, a suggestion as to a reliition
between a hypertrophied tonsil and a chronic pharyngitis
wliich remains for years more or less acutely painful — fur-
ther consideration of its history brings up questions which,

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