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to remove tonsils for asthma, only to find the condition unalleviated
and responding later to vaccine treatment. It is equally humiliating
to remove them for otalgia and to find, after that has failed, that a
dentist can remove the source of trouble in a few moments. Again
there is need for this process of elimination of other causes of the
disability before the tonsils are removed.
"Mental apathy, or Aprosexia, was a term given by Guye
of Amsterdam to a condition which he found alleviated by tonsillectomy.
Gawne, in Lancashire, last year investigated the
intelligence quotients of a hundred children with adenoids and a
hundred normal ones, and found them to be lower in the former
group. The condition of these children after operation has not
yet been investigated. On the other hand some observers deny
the existence of aprosexia as a clinical entity, and Glover, in 1932,
accepted the view that such defect as exists is due rather to the
nasal sinuses than to the tonsils and adenoids.
"Increased susceptibility to infectious diseases, which some
observers claim to have found associated with enlarged tonsils,
is not constantly so found by authorities on those diseases.
"Obstructive hypertrophy, reflex laryngeal spasm with respiratory
obstruction and new growths of the tonsil are indications with
which no one will quarrel.
"Cervical adenitis, however, though quoted by Moore, cannot
possibly be regarded as an indication sufficient in itself. If the
tonsils be regarded as a first line of defence against disease, the
glands are the second line. When, therefore, other possible sites
of sepsis are eliminated, cervical adenitis suggests either that the
tonsils are the sites of chronic sepsis or that they are failing to cope
adequately with invading organisms. In the former case operation
is indicated, but in the latter it will leave the patient worse off
than before, since the glands in question will continue to drain
the pharyngeal wall long after the tonsils are removed and will
continue to enlarge in any slight acute infection of that region.
So a difficult and important question has to be answered before we
act. Probably it is wisest to take adenitis into consideration only
when there are other signs or symptoms which support the idea
that the tonsil is a septic focus.