528 THE DIGESTIVE SYSTEM. 



pharynx, and tonsils, may involve the mouth as well as the larynx and 

 trachea. (For details of the local lesion see page 259.) 



Tonsillitis. The tonsils may share in the inflammatory processes of the 

 pharynx or be independently affected. The structural characters of the 

 tonsils render them liable to infection and involve certain peculiarities in 

 the lesions. 1 



IN FOLLICULAR TONSILLITIS the swollen organ shows upon section an 

 increase in the number of the lymphoid cells of the nodules and an 

 hyperplasia of the endothelium of the reticuluin. These new-formed 

 and often exfoliated endothelial cells are similar to those found in the 

 lymph-nodes in general in the presence of bacterial or other toxic sub- 

 stances. There may be an increase in the cells of the stroma of the ton- 

 sil. The epithelial cells of the surface and the crypts may increase in 

 number and exfoliate. Epithelial cells and leucocytes and other forms 

 of exudate may gather in the crypts or over the surface of the tonsil, 

 forming white plugs or a whitish pellicle. * 



In EXUDATIVE TONSILLITIS (suppurative or phlegmonous tonsillitis, 

 quinsy) there are in addition to hyperplasia and catarrhal inflammation 

 oadeniatous swelling and suppuration often leading to abscess. 



Acute inflammation of the pharynx and tonsils is usually infectious 

 in character, and may be due to various forms of pyogeuic and other 

 organisms. Thus in tonsillitis and other forms of acute angina, the most 

 common micro-organisms concerned are Streptococcus and Staphylo- 

 coccus pyogenes, the pneumococcus, and the Micrococcus tetrageuus. 

 Many other forms have been isolated. 3 



In CHRONIC TONSILLITIS (the so-called hypertrophy of the tonsils) 

 there is hyperplasia of the lymph-nodules with increase in the fibrous 

 stroma. The mouths of the crypts may be occluded and distended with 

 exfoliated cells and cell detritus ; these may become calcified. 4 



Tuberculous Pharyngitis. Tuberculous inflammation of the pharynx 

 may be primary or secondary to tuberculous lesions elsewhere ; ulcers 

 may form and the tonsils may be involved. 



The hyperplasise of the pharyngeal mucosa in children, commonly 

 called "adenoids," have been found in a considerable number of cases to 

 be tuberculous. Whether in these instances the lesion is tuberculous in 

 origin or whether the hyperplastic tissue affords a portal of entry and 

 local vulnerability to infection by the tubercle bacillus is not yet clear. B 



1 Consult Dobrowolski, "Lymph Nodules of the Larynx, (Esophagus, etc.," Ziegler's 

 Beitrage z. path. Anat., Bd. xvi., p. 43, 1894. 



2 See Hodenpyl, "Anatomy and Physiology of the Faucial Tonsils," Am. Jour. Med. 

 Sciences, vol. ci., p. 257, 1891; also Packard, Philadelphia Med. Jour., vol. v., 1900, 

 pp. 914, 957. 



3 Consult for bacteriology of angina Lartigau, Philadelphia Med. Journal, vol. iii., 

 p. 899, 1899, bibliography; for a study of acute tonsillitis see Goodale, Jour. Boston 

 Soc. Med. Sciences, vol. hi., p. 63, 1899. 



4 For resume of tonsillar calculi with bibliography see Robinson, British Med. Jour., 

 1899, vol. i., p. 14. 



6 For a study of hyperplasia of the pharyngeal lymphoid tissue (adenoids) with 

 reference to primary tuberculosis of the pharyngeal tonsil see Lartigau and Nicoll, Am. 

 Jour. Med. Sc., vol. cxxiii., 1902, p. 1031, bibliography. 



Also for a study of the tonsils as portals of entry of tubercle bacilli see v. Scheiber, 



