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from the operation, and indeed the condition sought to be improved
by the operation is often aggravated. In the light of modern
research work in this department, these results are quite understandable.
This authoritative work has demonstrated the important
fact that "enlarged" and diseased tonsils and adenoids is not a
"local disease" per se—just confined to the tonsils—but the sequel
to a precedent infection or disease in the nasal sinuses, whose
lymphatic drainage is directly into the tonsillar lymph gland
system. The tonsils may, of course, be directly affected as well,
from direct local infection in the throat. The tonsils function as a
protective trap to prevent the free spread of infection into the
general system. They also serve in children the purpose of producing
an autogenous immunity and resistance to bacteriological
infections.
The complete extirpation of organs of such physiological
importance is a serious consideration, and the removal of tonsils
and adenoids alone, without adequate attention to the factors
involved in the production of their condition, is meaningless and
unscientific.
A very thorough examination is made of each case of "suspected"
tonsils and adenoids, both throat and nose, and a careful
account taken of the "history" of any previous throat or nasal
affections. Mere enlargement alone is not taken as an indication
for operation. A definite pathological "history" and condition
must be present, which is not likely to yield to conservative treatment,
before operation is advised.
Approved conservative methods of treatment in cases which,
according to other opinions, should be operated, have proved very
successful.
In this connection the Medical Officer of Health is developing
a scheme for the strict supervision of all school and pre-school
children with suspected tonsils and adenoids, with a view to
(a) an enquiry as to the possible exciting factors in their causation;
(b) the early detection and treatment of these factors; (c) the effect
of their treatment on the tonsils; and (d) the results of recent