tonsils, and also the importance of taking care of the teeth even after the tonsils are taken out. There is unquestionably a swing against the promiscuous removal of tonsils, and I am sure that Dr. Kaiser's work, reported from year to year, is the leading factor in this tremendous revulsion of feeling from too frequent taking out of the tonsils to a proper aspect of the subject. In Cincinnati and vicinity there used to be large groups of children on whom tonsillectomies had been ordered based on the fact that visiting nurses had advised their removal. More care is now being exercised in determining which children should have these operations. Dr. W. H. Robey, Boston : In the Boston City Hospital for several years this problem has been attacked from a little different angle. The attempt has been made merely to stop acute rheumatic fever when all other medical measures have failed, such as rest and diet, and some brilliant results have resulted. In cases that were going on week in and week out with constant danger to the heart, in addition to a considerable economic loss both to the patient and to the hospital, the fever has been disregarded, no matter how high it was, no matter how red, tender and swollen the joints were, and the tonsils have been taken out, the disease sometimes being stopped in two or three days when all other measures had failed. Of course there is a risk, and nose and throat men hesitate about operating, particularly at this stage, but there have been no bad results. As a matter of fact, within the last year I have' seen two deaths from acute tonsillitis in patients who were not operated on. I believe that there has been too much delay and fear in taking out tonsils. I regard tonsillectomy as a major operation, and people who take out tonsils should be thoroughly trained in the procedure. One reason for failure, in my opinion, to get good results from tonsillectomy is that the tonsils are allowed to remain so long that they set up a tremendous amount of scar tissue and therefore the mucous membrane of the throat can never be returned to a normal con¬ dition ; furthermore, the infected tonsils set up foci of infection in other parts of the body, particularly the synovial membranes, and, lastly, certain cases of incomplete tonsillectomy leave a sufficient number of crypts which are just as dangerous to the patient as infected tonsils. This winter the brother of a young surgeon in Boston had' a recurrent acute rheumatism with intense pain. Nothing did him any good. Three nose and throat men saw him in consultation with his physician and finally one, under protest, decided to operate. In four days the man was over a rheumatism that had lasted ten weeks. I saw the brother recently and he said that the patient is perfectly well without any recurrence of rheumatic fever.Dr. Henry F. Helmholz, Rochester, Minn. : Dr. Kaiser's differentiation with regard to sore throats, which are usually an acute follicular tonsillitis, and colds is an important distinc¬ tion and one that should be of great significan...
