HYPERPLASIA 89 



of the opinion that there are more mouth breathers to 

 the acre in England than in any other country, while 

 Massei, in Naples, reports that he has seen only five 

 cases during the past fifteen years in which adenoidec- 

 tomy was indicated." (Crowe, Watkins and Rotholtz.) 

 Enlargement of the lymphoid tissues of the Peyer's 

 patches is often observed at autopsies in children. It is 

 not easy to speak of enlargement of the lymphoid 

 tissues in the wall of the appendix, as there is no 

 standard by which to reckon. 



Histologically, this overgrowth manifests itself 

 usually as a hyperplasia of the lymph nodules. It is 

 well known that lymph nodules are capable of increas- 

 ing in number as well as in size. 



The majority of tonsils and adenoids removed during 

 childhood show this structure. In the smaller pro- 

 portion — and these often at a later age — the enlarge- 

 ment is due to the presence of fibrous tissue, probably 

 the result of inflammation of pre-existing hyperplasia.* 

 * This hyperplasia is probably a protective reaction to 

 the insanitary condition of nose, mouth or throat. It 

 certainly follows suppurative processes in middle-ear 

 and nose. The hyperplasia is often initiated by the 

 specific fevers. 



In the unusual condition known as keratosis 

 pharyngis, the solitary nodules in the oropharynx are 

 chronically enlarged, and are marked on the surface 

 by white patches of adherent bacterial growth. 



The only harmful results of the hyperplasia are 

 mechanical. They are most marked in the pharynx, 

 the walls of which are fixed and unyielding. The en- 

 larged organs encroach upon and reduce the lumen, 

 thus interfering with the functions of respiration, de- 

 glutition and speech. The nasopharyngeal tonsil may 



* Messrs. Hett and Butterfielrl (1913) would probably disagree with 

 these statements. 



