D. J. DAVIS 653 



the distribution of plasma cells in tonsils.' The results briefly were as follows: These 

 cells are not found in the fetus or the newborn. They make their appearance regu- 

 larly about the second or third week, and are always found thereafter. In children sev- 

 eral months old they are constantly found and usually in abundance. They remain 

 present throughout life and even to very old age (eighty-eight years). In pathologi- 

 cal states, and especially in hypertrophy, they are very numerous. They occur under 

 the epithelium of the crypts along the strands of connective tissue and clustered about 

 small blood vessels. 



In view of the role that these cells play in general pathological processes and since 

 they occur so regularly in the throat a short time after the entrance of bacteria, one is 

 led to suggest that their presence here indicates a chronic infective focus, where ab- 

 sorption of irritating products is constantly occurring. Aschoff has noted the same in 

 connection with the appendix. Along the entire gastro-intestinal canal, too, may be 

 observed large numbers of plasma cells under the mucosa and especially in the region 

 of lymphoid follicles. These facts are in harmony with the observations made by 

 Adami and others on the more or less constant penetration of the mucosa by organ- 

 isms and which they named "subinfection." No doubt, many bacteria are constantly 

 passing through the alimentary wall into the lymphatics and blood stream, there to 

 be disposed of in different ways. In the sense, therefore, that the term "subinfection" 

 has been used in connection with the condition of the so-called "normal tonsil," or in 

 the sense in which Aschoff uses the term "chronic inflammation" in the appendix, so 

 we may regard all throats as chronically inflamed a short time after birth. One 

 should, however, interpret such findings rationally, and when the terms are used as 

 above they should not necessarily convey the idea of a dangerous or serious patho- 

 logical state requiring surgical intervention. Nor should they be interpreted as a focus 

 of infection in the sense in which that term is now commonly used. 



HEMOLYTIC STREPTOCOCCI IN THE RESPIRATORY PASSAGES 



Some years ago, when the bacteriology of extirpated tonsils from certain cases of 

 chronic infection was being studied, a striking difference was noted between the sur- 

 face flora and the crypt flora of tonsils.^ On the surface, the predominant organisms 

 were of the streptococcus viridans type, whereas the predominant organisms in the 

 crypts of the same tonsil were, as a rule, hemolytic streptococci. The exceptions were 

 few. The difference was so striking that at first great significance was attributed to 

 this point, since the hemolytic varieties are so much more virulent, as a rule, than the 

 other varieties. Later it was found that most tonsils, regardless of the associated con- 

 dition, contained a similar flora. Hypertrophied tonsils, especially, but also others 

 that show no noteworthy pathology, revealed this distribution of streptococci on the 

 surface and in the crypts. Pilot'' in our laboratory also examined a series of tonsils 

 after removal, extirpated chiefly for hypertrophy, though many were normal in size, 

 and found on the surface hemolytic streptococci in 61 per cent. These organisms com- 

 prised usually less than 10 per cent of the total number of bacteria. In the same 

 throats from which these tonsils were removed, cultures taken just before extirpation 



' Davis, D. J.: /. Infect. Dis., 10, 142. 191 2. 



* Davis, D. J.: ibid., p. 148. 191 2. 3 Pilot, I.: ibid., 24, 386. 1919. 



