The Tonsils, Faucial, Lingual, and Pharyngeal; With Some Account of the Posterior and Lateral Pharyngeal Nodules

This historic book may have numerous typos, missing text or index. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. 1914. Not illustrated. Excerpt: ... crypts have been described (p. 63). What the general conditions may be that allow organisms, ordinarily kept at bay, to make a breach in the line of defence and enter the parenchyma of the tonsil, are but imperfectly understood. Possibly there may be changes in the cultural conditions in the crypts, which periodically increase the virulence of the organisms there; or, what is more likely, the defence itself is temporarily weakened. The deleterious action of bacterial toxins of the crypts on the epithelium has been assigned as a cause. It seems hardly probable, however, that this extremely attenuated tissue, at least as it is found in the tonsils of children, can be of any great importance in this regard; it is much more likely that vaso-motor changes in the lymphoid tissue itself, or temporary reduction in the antibacterial powers of the blood and lymph, are responsible for the invasion. Exposure to cold and wet is one of the most common means of bringing about this lowered resistance. The relation of the disease to rheumatism has been discussed (p. 71). It occurs at all seasons of the year but is much more common during the late winter and spring months than at any other time. It may be contagious, but probably only by very intimate contact. Pathology.--The tonsil is increased in size, due to diffuse proliferation of the cells of the parenchyma and to active hyperaemia of the organ. The crypts are filled with purulent exudate, consisting of exfoliated epithelium, polynuclear leucocytes, lymphocytes and bacteria. In the more severe cases the exudate is fibrinous. The most noticeable histological changes are to be seen in the follicles. Here increased proliferation, both of the lymphoblasts and of the endothelial cells of the reticulum, results in enlargement of ...