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There is much to suggest that in rheumatism we have to deal only with a further stage in those catarrhal infections to which so much infantile ill-health is to be attributed, and that endocarditis and arthritis, when they arise, signalise the entry of these catarrhal, non-pyogenic organisms into the blood stream, overcoming at last the barrier of lymphoid tissue which has hypertrophied to oppose their passage.
The nervous system begins to readjust itself; but no longer having free outlet through the soft, lymphoid tissues of the uterus, the wave pressure meets with resistance and a choppy sea results. Vertigos, bilious attacks, and so forth are nothing more than reflex waves. The weakest organ of the individual is the one that generally suffers.
But that only raises the further question, What is a tonsil? And to that no answer can be given but Echo's. They are one of the conundrums of physiology. All we know of them is that they are not true glands, as they have neither duct nor secretion, but masses of simple embryonic tissue called lymphoid, which has a habit of grouping itself about the openings of disused canals.
On post-mortem examination the lesions found in these cases are: general hyperæmia of all the organs of the abdominal, thoracic, and cerebro-spinal cavities; marked leucocytosis, with destruction of red corpuscles, setting free hæmoglobin which lodges in the epithelial cells of the tubules of the kidneys; minute thrombi and extravasations throughout the tissues of the body; degeneration of the ganglion cells of the solar plexus; œdema and degeneration of the lymphoid tissue throughout the body; cloudy swelling of the liver and kidneys, and softening and enlargement of the spleen.
He was given during his disease to boasting and perpetual writing about elaborate real estate schemes and said he owned a $100,000 concern for the purpose. The case was clinically unusual in that the picture of a pseudoleukemia was presented, with demonstration at autopsy of great hyperplasia of retroperitoneal lymph nodes and grossly visible islands of lymphoid hyperplasia in liver and spleen.
This trickles down on both sides of the throat, and drains right into the open mouth of the Eustachian tube. Not only so, but these Eustachian tubes are the remains of the first gill-slits of embryonic life, and, like all other gill-slits, have a little mass of this same lymphoid or tonsilar tissue surrounding them.
Bacilli, whether inhaled or swallowed, are especially apt to lodge about the pharynx and pass to the pharyngeal lymphoid tissue and tonsils, and by way of the lymph vessels to the glands. The glands most frequently infected in this way are the cervical glands, and those within the cavity of the chest particularly the bronchial glands at the root of the lung.
It affects the septum of the nose and adjacent parts, firm, translucent, greyish nodules containing lymphoid and epithelioid cells appearing in the mucous membrane. These nodules subsequently break down in the centre, forming irregular ulcers, which are attended with profuse discharge, and marked inflammatory swelling.
We can hardly expect to prevent all development of adenoids by these prompt and painless stitches in time, for some children seem to be born peculiarly subject to them, either from the inheritance of a particular shape of nose and throat, "the family nose," as it has been called, or from some peculiar sponginess and liability to inflammation and enlargement of all these tonsilar or lymphoid "glands" and "kernels" of the body generally the old "lymphatic temperament."
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