Chap, viii.] THE PHARYNX. 117 



cases is probably due rather to an extension of tlie 

 hypertrophic process to the lining membrane of the 

 tube than to any pressure effects, since it is usually 

 not improved until some time after the tonsil has 

 been removed. The tonsil tissue is for the most part 

 collected around a number of recesses. The decom- 

 position of retained epithelial structures within those 

 recesses produces the foetid breath often noticed in 

 cases of enlarged tonsil, and probably incites the 

 attacks of inflammation to which such tonsils are 

 liable. 



The tonsil is very vascular, receiving blood from 

 the tonsillar and palatine branches of the facial 

 artery, from the descending palatine branch of the 

 internal maxillary, from the dorsalis linguse of the 

 lingual and from the ascending pharyngeal. Hence the 

 operation of removing the tonsil is often associated 

 with free bleeding. The internal carotid artery is close 

 to the pharynx, but is some way behind the gland 

 (Fig. 13). The vessel is, indeed, about four-fifths of 

 an inch posterior to that body, and is in comparatively 

 little danger of being wounded when the tonsil is ex- 

 cised. The internal jugular vein is a considerable 

 distance from the tonsil. Of important cervical struc- 

 tures, the nearest to the tonsil is the glosso-pharyngeal 

 nerve. The ascending pharyngeal artery is also in 

 close relation with it. Although of small size, bleed- 

 ing from this vessel has proved fatal, as the following 

 interesting case, reported by Mr. Morrant Baker, will 

 show : A man, aged 23, fell when drunk, and grazed 

 his throat with the end of a tobacco-pipe he was 

 smoking at the time. He thought nothing of the 

 accident. In two days he came to the hospital 

 with what appeared to be an acutely-inflamed tonsil. 

 The tonsil was punctured, but nothing escaped save a ' 

 little blood. Severe haemorrhages occurred from the 

 tonsil wound, and on the fourth day after the accident 



