n 4 APPLIED ANATOMY. 



the tonsil. Below they extend a variable distance, necessitating depression of the 

 tongue with a spatula in order to make their lower limit accessible. They lie about 

 opposite the angles of the jaw on the superior constrictor muscle with the bucco- 

 pharyngeal fascia outside of the muscle. A knowledge of their structure is essential 

 to the proper treatment of their diseases. The tonsils are oval in shape and when 

 normal in size project but little beyond the pillars of the fauces. They are about 

 2.5 cm. long by i cm. wide and consist of about a dozen recesses or crypts formed 

 by the folding inward of the mucous membrane. From these crypts follicles extend. 

 The walls of the crypts contain adenoid tissue as well as mucous glands. The tonsil 

 is held together by connective tissue which is continuous with its capsule and the 

 submucous fibrous tissue of the pharynx. On this account while an enlarged tonsil 

 can at times be shelled out of its bed, especially its upper portion, at others it is 

 necessary to dissect or cut it out by means of a knife, scissors, or tonsillotome. 



The blood-vessels supplying the tonsil are five in number. They are: the 

 ascending pharyngeal branch of the external carotid, the ascending palatine and 

 tonsillar branches of $\e facial, the tonsillar branch of the dorsalis linguce^ and the 



FIG. 143. Point of puncture for tonsillar abscess. " If an imaginary horizontal line is drawn across the 

 base of the uvula, and another vertically along the anterior faucial pillar, they will intersect at a point overlying 

 the supratonsillar fossa. Just external to this is the best point for opening a quinsy." St. Clair Thomson, M.D., 

 Brit. M. J., March 25, 1905, p. 645. 



descending palatine branch of the internal maxillary. Ordinarily, these branches are 

 small, but sometimes some of them are large and may cause troublesome hemorrhage. 

 In inflammation of the tonsils, these vessels of course are larger than usual. 



The tonsils are subject to inflammation and tumors. Tumors are rare; they 

 grow inward and obstruct breathing and swallowing. Attempts are made to remove 

 them either by scraping, cutting," snaring, or burning them with the electrocautery 

 from the mouth; or they are sometimes removed through an external incision through 

 the neck. This latter is a very severe procedure on account of the depth of the 

 tonsil and the number of important structures which overlie it. 



Tonsillitis or quinsy is an inflammation of the tonsils which leads to the for- 

 mation of an abscess. In mild cases the crypts or lacunae are affected, forming a 

 follicitlar or lacunar tonsillitis. In this form epithelium and inflammatory matter are 

 poured into the follicles and distend them, often showing as white plugs protruding 

 from the mouth of the crypt. In its treatment, in addition to local applications, 

 surgeons enlarge the openings into the crypts with a small knife and scoop the con- 

 tents out with a sharp spoon. In severe cases, the whole substance of the tonsil 

 and even the connective tissue around it are involved in the inflammation, forming 

 a parenchymatous tonsillitis. It frequently proceeds to the formation of pus. When 

 this forms in the substance of the tonsil it may break into a follicle and discharge into 

 the throat. An abscess of the tonsil may become quite large, bulging toward the 



