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R a d i u m 279
tonsil completely, and, when it is removed, that 50 per cent of the patients
still have chronic throat infections; that tonsillectomy simply allows
the bacteria lodging in the throat to drain into the cervical lymph
nodes and filter more rapidly down into the apex of the lung; that tonsillectomy
does this, or fails to do ;hat. In other words, we have followed
the general trend and quoted statistics and case reports ad nauseam,
neglecting our final and unanswerable argument—the pathologic
basis for our contentions. The general practitioner wants the fundamental
reason for any new treatment. A few brief fads will represent this
foundation on which we must stand. They may be grouped under: (1)
ihe anatomy and physiology of the tonsil; (2) the demonstrated and biologically
controllable effect of the roentgen ray on tonsillar tissue, and
(3) the pathologic conditions in which such a known effect, scientifically
produced, will remedy the condition present."
"The tonsil is essentially a mass of differentiated lymphatic tissue,
surrounded by a fibrous envelop, which holds it in position. The free
surface of the tonsil is covered by the mucous membrane epithelium
of the throat, this epithelium dipping into the substance of the tonsils
in several places, to form the familiar cypts. These crypts are formed
just as if one had taken a sharp pointed instrument and punched the
mucous membrane into the tonsil; there arc from ten to twenty of these
infoldings of the cpitheliium in each tonsil. Within the tonsil, there
arc two distinct kinds of cells: the main mass of ordinary lymphatic*
cells, and a number of small islands, called the germinal nodules, in
which the cells are more highly differentiated, actively dividing and
phagocytic, evidently designed to attack, destroy and digest invading
organisms. The network of lymph vessels enters the tonsil from the attached
side and the lymph flow is directed toward the free surface, so that
lymph and leukocytes arc being continually discharged on the free surface
of the tonsil and into the crypts. The crypts are lined with epithelium
similar to that on the free surface, except that it is thicker in the
crypts; this epithelium is everywhere seen to be invaded by leukocytes
and lymphatic cells, with germinal nodules protruding into the epithelium
in a number of places.'
'The tonsils guard the gateway to the respiratory tract and furnish
ihe first protection against bacterial invasion."
"The direction of ihe lymph flow in the tonsil and the discharge
of this protective lymph with phagocytic white cells on the surface of
the tonsil is the first defensive measure of the tonsil."
"The crvpts. lined with epithelium, are bacterial filters,the membrane
being thickened in the crypts and designed to hold back bacteria
Within these crvpts. the Ivmph and leukocytes supplied from within the
tonsil kill off tlie bacteria that invade these openings, the debris being
washed to the surface. If the destruction becomes rapid, or retention
within the crypts abnormal, the crypts narrow and till up with the familiar
plugs. * When bacteria penetrate the epithelium, they are met by
the phagocytes, which are one of the characteristics of tonsillar epithelium."
"The third function of disintegration, destruction and absorption of
bacteria within Ihe tonsil is a function that has been established within
recent years. Ihe histologic and anatomic structure of the tonsil, and
all the research work of the last few years, point directly to this function
as an important one. if not the paramount one. of the tonsil and other
lymphatic tissue of the throat. Whether this disintegration takes place