HOW PARASITIC AND PATHOGENIC BACTERIA REACH MAN 99 
cocci are almost invariably present, and streptococci, both hemolytic 
and non-hemolytic varieties, are very common. The tonsils, which 
are in very direct communication with the lymphatic system, are 
important atria of invasion, particularly for streptococci, and many 
cases of low-grade infections of the body appear to have originated 
from the passage of bacteria through the tonsils to the tissues of the 
body. The extent to which the normal tonsils destroy bacteria — 
their value in the non-specific initial defense of the body against 
bacterial invasi(m in other words— is not clearly established. Gener- 
ally speaking, however, the tonsils appear to bear the brunt of attack 
in certain diseases and they are of undoubted importance in shielding 
the body from invasion through the lymphatic tract by directly 
holding back these bacteria. The lymphatics of the jaws drain into 
the tonsils, hence infection through infected teeth should be borne 
in mind.^ The promiscuous removal of tonsils, particularly in the 
young, has no justification from available knowledge. The removal 
of diseased tonsils is quite a different matter.- 
Adenoids. —Vi\ot^ has studied the bacterial flora of adenoids, and 
has found potentially pathogenic bacteria in nearly every specimen 
examined. Normally these organisms appear to exist without harm 
to the host, but intercurrent infection or lowering of the normal resist- 
ance, may create conditions leading to secondary or terminal invasion. 
INCIDENX^E OF PATHOGENIC BACTERIA IN ADENOIDS, 
NASOPHARYNGEAL SWABS AND TONSILS. 
Organism 
I Adenoids, j Nasopharynx 
Number of i per cent. swabs, 
individuals. positive. per cent. 
Tonsils, 
per e^ent. 
positive. 
Str. hemolyticus . 
Str. viridans 
Pneumococcus 
Type II . . 
Type III . 
Type IV . . . 
B. influenzae (Pfeiffer) 
B. diphtherise 
Diphtheroid bacilli 
B. mucosus capsulatus 
Staphylococcus 
Mather's coccus . 
B. fusiformis . 
Gram-negative cocci 
103 
61.0 
25 
21 
103 
89.0 
21 
103 
65.0 
2.0 
10.3 
52.7 
115 
40.9 
25 
100 
12.0 
100 
30.0 
103 
14.0 
103 
60.0 
103 
17.0 
10 
20.0 
103 
79.0 
90.5 
95.0 
53.9 
12.0 
1 Duke: Oral Sepsis in its Relation to Systemic Disease, St. Louis, 1919. 
2 For an excellent discussion of the problem of tonsillectomy, based upon 1000 actual 
cases, see Crowe, Watkins and Rothholz: Bull. .Johns Hopkins Hosp., 1917, 28, 1. 
3 Proc. Inst. Med., Chicago, 1921, 3, 195. 
