Translations. ADENOID TUMORS IN ADULTS.* BY DR. V. RAULIN. [Revue de Laryngologie d'Otologie et de Rhinologie.] Translated from the French by A. G. Sinclair, M.D., Professor of Diseases of the Eye, Ear and Throat, Memphis Hospital Medical College; Surgeon-in-Charge of the Eye and Ear Department of St. Joseph's Hospital, Memphis, Tenn. I desire to lay before you the conclusions of a work which I shall publish later on, with a view to complete the study of adenoid tumors. Hitherto attention has been given almost exclusively to adenoid vegetations of infancy, while those of the adult have been neglected to such a degree that evidently their existence and their frequency are comparatively unknown. This neglect arises on the one hand from the fact that at that period of life the symptoms of this affection are not so marked as in the infant, and consequently often pass unobserved if not attentively sought; and on the other hand from the prevalence of the belief that hypertrophy and inflammation of the follicles of the naso-pharyngeal cavity almost always disappear toward the age of 15 years, and that their persistence in adults is an exception of extreme rarity. The erroneousness of the second proposition is clearly established by numerous observations made in the clinic of M. Moure, which we shall publish hereafter. While not very frequent in adults this affection is far from being as rare as is commonly supposed. According to my experience it occurs as often as enlarged tonsils. Adenoid tumors in adults, and even in the aged, almost always date from childhood; the deformities observed in the bones of the head and throat are indisputable proofs of this, and we therefore believe that these lymphatic tumors rarely originate after adolescence. The reasons for the persistence of the hypertrophy of this adenoid tissue in persons of 40, 60 and even 70 years of age A Communication to the French Society of Otologists and Laryngologists, May, 1890. will we hope be furnished to us by the microscopic pathological anatomy of these tumors; we believe that they differ materially in their structure from those of childhood; macroscopically they have appeared to us to be distinguished from them by their firmness and the profuse hemorrhage which attends their ablation. Perhaps the normal evolution of these vegetations is disturbed or even arrested by the development of fibrous elements. Perhaps, under the influence of irritative causes, there occurs in the adenoid tissue of the nasopharyngeal cavity a change, such as is observed in a chronically inflamed lymphatic ganglion, which ends by becoming fibrous, and consequently incapable of retrogression. This opinion is only an hypothesis which the histological examination of the specimens which we have collected will help to confirm or refute. The adenoid tumors of adults present themselves most commonly in a manner quite different from those of childhood; in the latter they consist of a mass of small multiple tumors, formed in the majority of cases, by hypertrophy of all the groups of follicles in the naso-pharyngeal cavity. In the adult it is different; the hypertrophy en masse of all the follicular agglomerations of the naso-pharynx is exceptional. Sometimes the tumor is formed by the median group or pharyngeal tonsil, sometimes by that of the fossa of Rosenmuller, and especially by that of the orifice of the Eustachian tube, which extends to the middle third of the cartilaginous portion of this conduit, and constitutes what the Germans term the Tubenmandel-tube tonsil. I wish particularly to insist here upon the slight importance of the respiratory disturbances, which in infants are so great; they are less in adults for two reasons: the smaller volume of the tumor, and the large dimensions of the retro-nasal space. However, there are cases in which difficulty of respiration is observed. This is not due to an obliteration of the choanæ, for example by an hypertrophy of the median group, but to a complication to which I desire to ask your special attention, because it is also observed in infants. It is explained by a certain degree of stenosis of the nasal cavities proper, occasioned by swelling and increase of volume of the Schneiderian membrane. There occurs a pseudo-hypertrophic rhinitis, most marked upon the inferior turbinated bones. This condition is caused by passive congestion of the cavernous tissue, due to disturbance of the circulation engendered by the presence of the hypertrophied pharyngeal tonsil. This condition may be mistaken for true hypertrophic rhinitis, of which it presents all the symptoms except paleness, so much the more readily, because these two affections, adenoid vegetations and hypertrophic rhinitis, are alike entailments of the lymphatic temperament. It is therefore necessary to be on guard against this error of diagnosis which would lead to a more serious error in therapeusis, that of making galvanic cauterizations to reduce a pseudo-hypertrophy which would disappear totally after the ablation of the adenoid tumors. It is only under these circumstances that patients consult us for the nasal obstruction; in general it is for the nasopharygeal catarrh, and especially for the deafness (of which the tube tonsil is most commonly the cause.) I do not wish to enlarge here upon those two symptoms (sometimes the only ones) of adenoid vegetations in the adult; I would only emphasize the following antithesis: Whilst the first, the naso-pharyngeal catarrh, disappears in a short time after the ablation of the tumors, it is not so with the deafness, which, owing to chronic alterations in the middle ear, is not at all influenced, as in the infant, by the disappearance of the first cause. Regarding the deformities of the skeleton of the head and thorax, one often sees them in adults affected with vegetations, but from a diagnostic standpoint they have only a relative value, because they exist also in those who have had adenoid tumors in infancy, and have been relieved from them either by retrogression or operation. Dating from childhood, these osseous deformities are only the proofs of the obstruction of respiration which existed prior to the partial retrogression of vegetations which occupied the naso-pharynx. The only means of diagnosis is posterior rhinoscopic examination after thorough removal from the retro-nasal space of secretions which conceal the hypertrophied follicles. The treatment par excellence is scraping (raclage); ablation performed with the various adentomes is much more radical than that done with the forceps; with the latter it is difficult to grasp the more or less atrophied tumors in the vicinity of the hypertrophied follicular group. Miscellaneous Selections. Facts Bearing Upon the Propagation of Leprosy in Japan. 1. All Japanese use mosquito bars to inclose themselves in their sitting rooms after nightfall, and not merely for the purpose of protection from the insect's sting and annoying disturbance of sleep after retiring. 2. The Japanese do not drink uncooked water if possible to avoid it, as they consider it dangerous to health. 3. Leprosy first appears on the parts of the human body most exposed to insect-foraging-viz.: feet, hands and about the eyes and ears. 4. The Japanese in their intercourse with lepers or suspected persons carefully avoid touching their hands or faces. (No kissing ever occurs in Japan excepting in the marital embrace, not even between a mother and her child! Nor shaking of hands in salutation. If one were to offer to kiss a Japanese maiden, she would think she was going to be bitten!) 5. To drink water or eat food of lepers in Japan, or in their community or neighborhood is considered dangerous. 6. To even handle drinking-water or food of a leper is looked upon with suspicion. (There is an unknown relation acknowledged between food and drink and leprosy that is thought to be essential to contagion.) 7. The Japanese hesitate to eat or drink even pure food and water in contact with a leper. Husbands and wives have passed a test for leprosy. 8. Ancient Japanese "Ken" segregation of lepers exerts an acknowledged restraining influence on the spread and extension of the disease through permissibility of leper marriages, properly guarded as follows: No backward marriages allowed; children of lepers may marry children of lepers, and grandchildren marry grandchildren, thus unconsciously attenuating the virus and diminishing intermediatory-host function. Should leprosy attack a member of a family (not leprous) in Japan, that member at once (before outsiders can know of it) disappears to wander in "beggar" disguise to some distant place in the empire where he hides himself unknown, his associates being the despised race of "Etas" or curly headed negritoid hybrids, (the "pariahs" of Japan) or the Hinins ("not human ") executioners, and workers in hides. and leather, or other abhorrent and out-cast professions. This custom of self-immolation plays a very important part in spreading the disease in Japan, and serves to make inoperative the laws of leper segregation. It originated in order to prevent family ostracism, as no marriages are contracted with families of tainted blood. The wealthy and noble conceal their leper members in caves and mountain recesses or secluded buildings. All beggars for this reason are utterly outcasts, as they are suspected of leprosy; they can neither eat nor sleep in any man's house. A dish that is passed to a beggar in alms is afterward destroyed, and the vessel from which he drinks is never used again. Should he wash himself at a well or public watering-place, that water becomes polluted in public estimation, and thenceforth is shunned. Hence “beggars" and the despised races must use streams and rivers or pools, which other people consequently avoid. Some of the Japanese cominon people say that leprosy comes from India or southern China (which is quite right). Others that it originates from mixing foods, as eels and pumpkins! The word leprosy in Japanese is "Reibio," meaning "filth or rotting disease," or "Ten-keibio," meaning Heaven's punishment disease," or the "miraculous" disease, for they do not know in what manner it is contagious. |