348 CLINICAL APPLIED ANATOMY. 



in through the mouth may be highly charged with bacteria, and 

 these micro-organisms may pass directly on to the surface of 

 the tonsil, covered with its mucilaginous secretion. Few, if any, 

 of these micro-organisms are deposited in their passage through 

 the mouth. If they had passed over the mucous membrane of 

 the devious passages of the nose, few would have entered the 

 pharynx. Again, the passage of food through the fauces, guarded 

 laterally as it were by the tonsils, explains the liability for these 

 organs to meet with injury and infection. 



Kapid absorption occurs from the lymphoid tissue, and the 

 lymph carrying septic material passes to the glands of the 

 concatenate chain, and these filters arrest the progress of the 

 bacteria. Thus it happens that they are so frequently the site 

 of tuberculous infection. One of the highest of these glands, 

 lying immediately under cover of the angle of the jaw, when 

 enlarged in tonsillitis, has been sometimes mistaken for the 

 tonsil itself. 



The enlargement of the tonsil induced by acute inflammation 

 may seriously obstruct the entrance to the pharynx ; hence it is 

 that severe pain is caused by the act of deglutition, partly owing 

 to the movement of the pillars of the fauces and partly to the 

 pressure of the bolus of food upon the inflamed structures. 



The sensory nerve supply of the tonsil is derived from the 

 glosso-pharyngeal nerve, which runs downwards and forwards 

 just external to it. The tonsil and the posterior third of the 

 dorsum of the tongue are both supplied by the glosso-pharyngeal 

 nerve, which may explain the chronic furring of the tongue in 

 cases of chronic tonsillitis, but this is more likely to be due to 

 the mouth breathing. 



When acute tonsillitis terminates in suppuration, the purulent 

 matter should be evacuated. There is very little, if any, danger 

 of wounding any important vessel in this small operation. It is 

 generally stated that the internal carotid artery is not far 

 distant, but as a matter of fact even in children the amount of 

 space between the tonsil and the vessel is very appreciable, and 

 injury of this arterial trunk is very unlikely to occur unless the 



