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sils have any value as a protective agent or other- wise, is Mirapex Er a much mooted question. However, I be- lieve the general tendency to-day is toward the be- lief that in infancy and early childhood, the tonsils play a very important role Mirapex Generic in warding off various infections. This is my personal belief, also, and therefore I have made it a general rule not to op- erate for this condition upon any child under the age of four years unless there is some special and defi- nite indication for doing so, such as chronic sup- puration of the ears, recurrent tonsillitis, hypertro- phied and suppurative glands of the neck, etc. R. H. Good 1 believes that the Cheap Mirapex tonsil has an im- munizing function early in life. Such a property of the tonsil is not easily proved ; but that it has apparently no function after the first few years is almost certain, as Good says ; for even the total removal of them, even so called healthy tonsils, has Generic Mirapex no deleterious effects on the child, and in many cases Pramipexole Mirapex the tonsils atrophy or diminish in size. That the tonsil evidently has some function in early childhood may readily be assumed because of certain anatomical, Mirapex Rls physiological, and pathological facts. Anatomically they are situated in such a po- sition in the throat that they are bound to act Mirapex 0.125 Mg as barriers to the entrance of pathogenic bacteria into deeper and more dangerous regions. Normally, slightly protruding from between the pillars of the fauces, the exposed surface comes in contact with all the secretions, air, and debris which may be taken in through the oral or nasopharyngeal cavi- Buy Mirapex Online ties. For a moment only, perhaps, the bacteria laden substance applies itself to these parts. But even such a short time is sufficient, in many in- stances, to allow the organisms to lodge there per- manently. This is readily proved by sections of *Read before the Harle 'R. H. Good: Early Im msil. Laryngoscope . .Tun Medical Association, March 6, 191 2. unization. the Essential Function Mirapex Price of the 1909. 56 HAYS: REMOVAL OF FAUCIAL TONSILS. [New York Medical Journal. diseased tonsils which show all sorts and varieties ol organisms. Two other important anatomical and hP-t. .logical points must here be taken into con- sideration, Mirapex Cost first, the cryptal arrangement of the mucosa which gives a What Is Mirapex large absorptive area, and, second the lymphoid structure of the organ which makes it admirably suited for the destruction of microorganisms. Physiologically, the tonsil has been proved to have a function, through Mirapex 1 Mg the painstaking investi- gations Mirapex Coupon of Wood, 2 of Philadelphia, and Jonathan Wright, 8 of New York. Both these investigators have" shown that the epithelium of the tonsil has the propertv of carrying foreign matter into the depths of the crypts and that such material in many instances traverses the cryptal lining, and that of- fending material is destroyed or absorbed by the numerous lymphocytes of the parenchyma. Such investigations have also shown the relation of the tonsil to the lvmphatics of the neck, particularly to the so called '"tonsillar gland," lying just anterior to the sternocleidomastoid muscle, below the angle of the jaw. This node is in direct communication Mirapex Coupons with the superficial and deep cervical glands which often become enlarged at the time of a tonsillar in- fection. Moreover, the removal of the offending tonsil in such cases will often assist in curing a sup- puration of these glands. This was sufficiently proved to me in the following case : A boy of Mirapex For Rls seven years had been in the Philanthropin Hospital, off and on, for two years, suffering from suppurative, tuberculous glands of the neck. Three operations for their removal had been performed, but there was still a large mass of glands on either side and a dirty purplish blue fistula on the right. I enu- cleated both tonsils thoroughly, and inside of two weeks the fistula had closed and the glands had sub- sided considerably. Pathologically, the function of the tonsil is proved purely in a negative way. Almost every tonsil which is removed has been found to be the seat of disease. In fact, a normal, healthy tonsil is a curi- osity. In the first few years of life, the injury they receive by constant reinfections predisposes the ma- jority of tonsils to a distinct hypertrophy of the glandular tissue. The majority of infants before the second year suffer more or less with inflamed cervical glands, Mirapex 0.25 Mg which are most prominent in con- nection with the teeth and the tonsils. As time goes on manv of these glandular inflammations subside, not always because the infection in the tonsil dis- appears, but because the organs having hypertro- phied, they are better able to take care of them- selves. However, there comes Generic For Mirapex a time when the ton- sils Mirapex Litigation become "worn out" and when they are so patho- logically altered that they Buy Mirapex can perform no physio- logical function. In such instances they are a dis- tinct menace and should be removed. My purpose in making these remarks is to show that apparently the tonsil has some function, and therefore should not be removed in the early years of life, unless it conforms to one of indications out- lined in the following pages:

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