CHAPTER XVI. 



Simple Enlargement or Hyperplasia of the 

 Subepithelial Lymphatic Glands. 



Chronic enlargement is an extremely common affec- 

 tion of the Subepithelial Lymphatic Glands, especially 

 in the first two decades of life. All these lymphoid 

 structures are liable to it — tonsils, adenoids, Peyer's 

 patches and vermiform appendix alike. The faucial 

 tonsils can be observed directly. The vast majority of 

 town-dwelling children in England probably have en- 

 largement of their tonsils for some period during child- 

 hood. During one year 57,809 Lancashire school 

 children were medically examined. Of these 2,591 

 (over 4 per cent.) were Jreported as suffering 

 from enlarged tonsils. The distinction between a 

 normal and an enlarged tonsil is, of course, quite an 

 arbitrary one. When the tongue is forcibly depressed 

 with a spatula the tonsils in any child bulge medial- 

 wards. Nevertheless, there can be little doubt that 

 in a considerable percentage of children the faucial 

 tonsils are sufficiently enlarged to project considerably 

 beyond the pillars of the fauces in the absence of retch- 

 ing and during quiet respiration. 



Enlargement of the nasopharyngeal tonsil usually 

 accompanies that of the faucial tonsil. The frequency 

 of these affections varies very much in different coun- 

 tries. They are uncommon in South China. ''The 

 Hebrew race is specially predisposed to this hyper- 

 plasia ; climate is also a predisposing factor. Osier is 



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