抄録
The patients with chronic febricular palatine tonsillitis (so-called tonsillar febricula) who were subjected to surgical treatment as in-patients at the Clinic of Otorhinolaryngology, Kyushu University Hospital, during the period of 1937 to 1951 amounted to 109 in number, including 52 male and 57 female. Palatine tonsillectomy crued the febricula in 78.9% of cases. The incidence of the condition was highest among 11 to 25-year-old persons. The subjective and objective symptoms, not much varied from those of chronic palatine tonsillitis, were marked and advanced. The diagnosis of the disease still remains difficult in many respects. The author is of the opinion that the hemographical findings may serve as an important criterion in the differentiation of this disease from chronic palatine tonsillitis. The disease is characterized by a slight increase in sedimentation rate, a decrease in the number of erythrocytes, an increase in that of leucocytes, a decrease in the amount of hemoglobin, an increase in the number of polynuclears, shift to the left of stab cells, an increase in the number of lymphocytes, an increase in that of basophils. The presence of one or more of these hemographical changes may safely be taken as an indication of the development of the disease. The subsidiary means of the diagnosis may comprise, among others, electrocardiographic search for myocardiac disturbance, alternate massaging of the right and the left palatine tonsil (for provocation of the focus), and confirmation of the presence or absence of fever type peculiar to the disease. Pathohistological examination of palatine tonsillitis in 80 tonsils in 40 of the above-mentioned 109 patients showed that this disease is attended, not only by the hitherto reported pathologic picture of chronic palatine tonsillitis, but also by some other conditions: pus accumulates and forms a pustuous cyst in the tonsillar fossa on one or either side: bust of the cyst produces inflammatory lesion in the lymphoid reticular tissue ; inflammation of epithelium in the fossa ; eosinophilic infiltration and reactive inflammation in the lymph follicles, and formation in the fossa of actinomycotic druse accompanied by remarkable wandering of neutrophils are seen as signs of systemic reaction. Such pictures of acute and subacute symptoms are to be seen at sametime. It thus appears that this disease is a condition of focal infection developing with the above-des-cribed inflammatory lesions as its primary foci and that the fibrila is a condition of mere secondary occurrence. In other words, this disease is caused by the absorption of the bacteria or bacterial toxin brought from the site of the inflammatory lesion and, possibly, also by the allergic reaction elecited by the bacteria or bacterial toxin acting as antigen. It therefore follow that the best treatment of this disease is total palatine tonsillectomy by which the original focus can be completely removed.
