Vol. 60, 1909 - University of North Carolina at Chapel Hill

214
THE CHARLOTTE MEDICAI, JOURNAL.
moment on the present theories in regard to closely resembling Pe5'ers' patches of the
these organs. In 1907 E. Barth published
in the Deutsch. Med. Woch. a very exsmall
intestine.
2. None of the theories thus far advanced
haustive article on this subject, and I shall to explain the functions of the tonsils are
take the liberty of quoting from the same conclusive.
as the most recent exhaustive contribution 3. The tonsils produce no physiologic
to the subject. Histologically the tonsils
consist of adenoid tissue, the same structure
secretion
4. The tonsils are not absorbing organs,
as exists in the naso pharynx and it must contrary to the later views as expressed by
be concluded that their function is similar
to the lymph glands. It is for this reason
Barth.
5. Tubercular tonsillitis is an uncommon
that they show a close resemblance to the condition.
Peyers' patches and solitary glands in the 6. There is no evidence to show that pulintestine.
monary tuberculosis ever results from ab-
The tonsils being placed in a superficial sorption of the tubercle bacilli from the
position at the level of the mucous mem- mouth through the tonsils,
brane at the beginning of the air and food 7. Rarefaction of the epithelium of the
passages, have been shown to have a con- tonsils affords a ready explanation of the
stant emigration of
mucous membrane.
leucocytes on to the
The presence, howway
in which the contagion of diphtheria
may gain entrance to the general circulaever,
of opening in the epithelium through tion in this disease.
which the lymphocytes might migrate, have Goodale of Boston, and Kayser of Bresnot
been entirely substantiated. One pe- lau, both have experimented and shown
culiarity about the tonsils is the presence of that the absorptive power of the tonsils is
fissures and folds, crypts, and lacuns.
The theory that the tonsils have some
very limited. Although a study of these
physiologic experiments shows many conpower
to aid the digestion and absorption flicting statements as to the function of the
of carbohydrates, has not yet been estab- tonsils, in fact leaving it an open question
lished. Some clinical investigations by as to whether or not they have any special
Lichtwitz and Sabrazes have shown an improvement
in the condition of the blood
function, the fact is nevertheless true that
clinical observation has shown many reafter
removal of hypertrophied tonsils. The lationships existing between diseases of the
theory of the protective action of the tonsils tonsils and other pathologic conditions of
is opposed by the fact that they are especi- the human body. Many clinical observers
ally liable to inflammation in consequence have reported authentic cases where varied
of infection and are often the source of a diseased conditions of the body had their
general infection. Barth says that inflam- origin through the portals of the tonsils and
mation of the tonsils is only in rare cases adenoid tissue in the nasopharynx. Tonsils
the result of an infection of the surface of which give rise to these various systemic
the tonsil, but arise more frequently by a conditions, or at least apparently so, are
secondary infection which reaches them seemingly just as active whether normal or
through the lymph channels. He illustrates abnormal in their appearance. Certainly
them by referring to a tonsillitis which the large flabby tonsil with numerous large
some times follows an operation in the secreting lacunae, or even the small friable
nasal cavities, even after the most thorough and degenerated tonsil, would be looked
asepsis, and this I have myself noted. The upon more as the starting point of various
infection here arises not from the surface of systemic aff'ection than those of a more
the tonsil, but from the wound in the nose healthful appearance.
through lymph channels. It seems, therefore, The importance of the faucial tonsils and
that the tonsils have the power of excreting adenoid tissue in the naso-pharynx as the
foreign substances which are brought to it gate of infection for chronic tubercular disby
the lymph stream, besides having some ease, has excited marked attention during
secreting powers of their own. There is a the last few years. While the results of the
great diversity of opinion among investi- various investigators in the field differ as to
gators as to the physiological and patho- the frequency of various forms of systemic
logical function of the tonsil; At variance tubercular trouble originating through this
to some of the views above expressed, is
the summary given by Hodenpyl at the
source, the possibility of such an occurrence
must certainly be considered. Clinical facts
close of his most exhaustive article published
a few vears ago on the physiological
t ^. r li. i •, rx , , .
function of the tonsil. He says that his
cannot always be substantiated by labora-
^^''y investigations and for this reason w&
must consider both sides of the question,
^^^j,,^ ,^^ j^^, f,,^ y^^,, laryngologistsj
investigations lead him to conclude: especially have noted the relationship bei
1. The tonsils are lymphoid structures tween the enlarged glands of the neck and
i