THERAPEUTIC BEARING 97 



the removal of tonsils and adenoids in the absence of 

 definite indications. 



Mindful both of tlheir probable physiological value 

 and also of the distinct, though not often serious, risks 

 of the operations for their removal, one may restrict 

 the indications for operation in a table as follows* : — 



Operation. Indications, 



(1) Partial Excision of the faucial Chronic interference with swallow- 



tonsils, ing or with speaking. 



(2) Enucleation of faucial tonsils. Where there is good reason to 



suspect the tonsil of containing a 

 chronic focus of infection ; for 

 example, in some cases with re- 

 peated attacks of septic sore 

 throats with tonsillar or periton- 

 sillar abscesses, or where there 

 are concretions in the tonsils. 



(3) Erasion of nasopharyngeal (A) Chronic obstruction to nasal 



tonsil. breathing. 



(B) Deafness, accompanied by a 

 very large mass in the naso- 

 pharynx with retraction of the 

 membrane which does not 

 yield to repeated politzerisation. 



The nasopharyngeal tonsil must be of very great size 

 to be responsible for blocking the tuba auditiva. Ob- 

 struction of the tuba auditiva is more usually due to 

 inflammation of the mucous membrane and swelling 

 of the lymphoid tissue about its orifice. That removal 

 of the latter can be accomplished by the blind use of 

 curette or finger is to my mind more than doubtful. 



(4) Appendicectomy. A probable diagnosis of appendi- 



citis. 



The indication given here is very vague. Probably 

 no one goes through life without an inflammation of 



* This table, for convenience, omits malignant disease, which is a 

 rare but perfectly legitimate indication for the removal when prac- 

 ticable of any of the subepithelial lymphatic glands which may be 



affected. 



G 



