* 
The Anatomy and Physiology of the Faucial 
Tonsils with Reference to the Absorption 
of Infectious Material. 
I 
BY 
EUGENE HODENPYL, M.D., 
FIRST ASSISTANT IN PATHOLOGY IN TH+>G^4XEGE OF PHYSICIANS AND SURGEONS, 
NEW YORK. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
March, 1891. Extracted from 
The American Journal of the Medical Sciences for March, 1891. 
THE ANATOMY AND PHYSIOLOGY OF THE FAUCIAL TONSILS 
WITH REFERENCE TO THE ABSORPTION OF 
INFECTIOUS MATERIAL.1 
c (^( £ 
By Eugene Hodenpyl, M.D., 
FIRST ASSISTANT IN PATHOLOGY IN THE COLLEgK*W*PHYSICIANS AND SURGEONS, NEW 
Although very much has been said and written about the diseases 
of the tonsils, but little attention, comparatively, has been given to 
their normal structure and to the role which they play in the animal 
economy. 
The descriptions of their minute structure in most text-books of 
anatomy and histology, and even in special treatises on the throat and 
nose, are exceedingly meagre. This would account in part, at least, for 
the considerable diversity of opinion which exists concerning their path- 
ological conditions. We have little definite knowledge of their func- 
tions. Certain theories have been propounded, but none have been 
sufficiently conclusive as to have lead to any very general acceptance. 
In view of this these studies are presented. They have involved the 
examination of a large number of tonsils, both human and from some 
of the lower animals, i. e., dog, cat, rabbit, monkey, and raccoon ; and 
they include the results of a considerable number of original physio- 
logical experiments. 
The tonsils belong to the lymphatic apparatus; and in order to make 
the description of them more intelligible, it seems wise to review the 
structure of the better known lymphatic organs before describing the 
tonsils in detail. 
The structures of the lymphatic apparatus may be classified, on an 
anatomical basis, in three groups.2 
1. The simplest form of these structures are the minute masses, con- 
sisting of connective tissue, reticulum, or basement-substance, the 
meshes of which are filled with small spheroidal cells. These structures, 
1 Being the Alumni Prize Essay of the College of Physicians and Surgeons, New 
York, 1890. 
2 The spleen seems to belong more properly to the hsematopoetic rather than to the 
lymphatic system. 2 
HODENPYL, THE FAUCIAL TONSILS. 
which were first described by Arnold,' are found scattered in many of 
the viscera, i. e., lungs, liver, and kidneys. The reticulum is exceed- 
ingly fine and delicate, and is lined by endothelium. The spheroidal 
cells are about the size of or somewhat larger than leucocytes, and may 
contain one or more nuclei. The masses are not clearly outlined, but 
gradually merge into the surrounding tissues. 
2. Of more complex structure are certain nodules of lymphoid tissue 
occurring in the walls of the stomach and intestine, the so-called " soli- 
tary and agminated follicles or glands." Inasmuch as they are in no 
respect either follicles or glands, they are more properly called lymph 
nodules. The solitary nodules are little pear-shaped masses lying prin- 
cipally in the submucosa, and are composed of a reticular network, 
whose meshes are more closely arranged about the periphery. The 
meshes are lined with endothelium, and are filled with lymphoid cells. 
In the periphery is a rich network of bloodvessels and lymphatics. 
The bloodvessels send but a few branches into the more central portion 
of the nodule. They lie beneath the epithelium of the gut, through 
which lymphoid cells constantly pass. The epithelial covering is often- 
times thinned and excavated by pressure of the nodule upon it. Peyer's 
patches, or the agminated nodules, are aggregations of a number of 
these masses. 
3. The most complex of the lymphatic structures, so complex, indeed, 
as fairly to merit the term organs, are the lymph nodes, often incor- 
rectly called lymph glands. These are oval or irregular-shaped bodies, 
which interrupt the passage of lymph through the lymph vessels. They 
are surrounded by a fibrous tissue capsule, which furnishes numerous 
trabeculae to the interior. In the outer or cortical zone are a large 
number of lymph nodules furnished with cord-like anastomosing bodies, 
which ramify the inner or medullary portion, the lymph cords. The 
nodules and cords are composed of the same sort of tissue as are the 
lymph nodules of the intestine, except that their surfaces are covered 
by endothelium. Both are surrounded by a coarser reticular network 
containing a few lymphoid cells, the lymph sinuses. The bloodvessels, 
except the few branches supplying the connective tissue, ramify in the 
lymph cords and lymph nodules, while the lymph circulates in the 
lymph sinuses. 
The tonsil corresponds more nearly in structure with a Peyer's patch. 
Gross Anatomy of the Faucial Tonsils. 
The tonsils, two in number, are situated on either side of the mouth, 
between the anterior and posterior pillars of the fauces, and are more 
1 Virch. Arch., Bd. 80, 82, 83. HODENPYL, THE FAUCIAL TONSILS. 
3 
or less covered by folds of the mucous membrane. They are of a pinkish 
color and oval or almond-shaped. Their long axis, when the mouth is 
widely opened, is nearly vertical. When the mouth is closed they tend 
to approach one another, the long axis being more nearly horizontal. 
Externally they are covered by a layer of fibrous tissue derived from 
surrounding parts, and which serves as a partial investing sheath. They 
are covered by the superior constrictor muscle, which separates them 
from the internal carotid arteries. The internal or free surface projects 
into the cavity of the mouth; it is covered by stratified squamous epi- 
thelium, continuous with that of the mouth. In size the tonsils vary 
considerably at different ages, and in different persons of the same age. 
According to Sappey1 their average vertical measurement is from 20 to 
25 ram.; antero-posterior, 12 to 15 mm.; transverse, 10 to 12 mm. As 
a rule, they are relatively larger in childhood, as is the case with the 
rest of the lymphatic apparatus. 
They reach their maximum size in early adult life. They afterward 
tend to atrophy, and in old age may become almost entirely obliterated, 
or converted largely into fibrous tissue. 
They are composed, in general, of an aggregation of lymph nodules, 
separated from one another by diffuse lymphoid tissue, and arranged 
about a series of depressions from the surface, from eight to fifteen in 
number, the crypts. These crypts are lined by epithelium similar to 
that on the surface. 
Blood-supply.-The following arteries supply the tonsils: 
1. Branches from the dorsal artery of the tongue. 
2. Branches from the inferior palatine from the facial. 
3. Branches from the superior palatine from the internal maxillary. 
The veins empty into the internal jugular. The nerves are, princi- 
pally, from the glosso-pharyngeal; also branches from the pneumogastric, 
and possibly also from the spinal accessory (Balme).2 
The lymphatics will be considered in the description of the minute 
anatomy. 
Anomalies.-But few cases of malformation of the tonsils have been 
reported. They may be entirely absent (Salmuth3), or, but partially 
developed, as in a case reported by Gould,4 in which there was also 
faulty development of other organs. There may be an accessory tonsil 
(Jurasz5 and Claiborne6). 
1 Anatomie descriptive. 
2 De 1'Hypertrophie des Amygdaeles, Paris, 1888, p. 14. 
3 Handb. d. path. Anat., Halle. 
4 Brit. Med. Journ., Oct. 16, 1886. 
5 Monatschrift fur Ohrenh., 1885, No. 12. 
6 N. Y. Med. Journ., Feb. 8, 1890. 4 
HODENPYL, THE FAUCIAL TONSILS 
Drawing from a section of a normal tonsil from a child 
Fig. 1. HODENPYL, THE FAUCIAL TONSILS. 
5 
The development of the tonsils has been described by Kolliker1 and 
Bickel,2 and more recently exhaustive studies on the embryology of 
these structures, both human and in animals, have been made by Ret- 
terer.3 According to Ketterer, the tonsils develop both from the epiblast 
and the mesoblast; the lymphoid cells being formed from the epiblast, 
while the bloodvessels, lymphatics, and connective framework come from 
the mesoblast. 
They first begin to appear in man about the fourth month, and first 
consist of a collection of small spheroidal cells in the submucosa; at 
first the collection is diffuse, but gradually becomes more circumscribed. 
After a time the collection of cells becomes subdivided by numerous 
connective-tissue septa. 
At the fifth month depressions in the mucous membrane begin to 
appear. These are the crypts, and at first consist of solid plugs of cells 
dipping down into the submucosa and into the collection of lymphoid 
cells. Later these become hollow. In the early months the mucous 
membrane covering the tonsil has a distinct membrana propria, but 
toward the end of gestation this disappears. At term the tonsils are 
fully formed. 
Histology. 
The parts to be described are as follows: 
1. The reticulum or stroma. 
2. The cells. 
3. The bloodvessels, lymphatics, etc. 
4. The epithelium. 
1. The Reticulum.-The external or attached surface is covered by 
a layer of fibrous tissue derived from surrounding parts. From this 
partially investing sheath numerous septa are given off, dividing the 
tonsil into a series of intercommunicating chambers. The reticulum or 
framework in which the cells lie closely packed is of two kinds. A, 
that which is found in the nodules; and B, that which forms the stroma 
of the tissues between them. (Fig. 2.) The reticular tissue of the 
nodules is exceedingly fine and delicate. (Fig. 3.) The meshes are 
lined throughout by endothelium. About the centre the meshes are 
large and irregular, but toward the periphery they become somewhat 
coarser and more closely arranged, and finally become merged into the 
relatively coarser reticulum between the nodules. This form of re- 
ticulum contains no connective-tissue cells, and although it is usually 
1 Embryologie, 1882. 
2 Arch, fur path. Anat, und Phys., xcvii. p. 340. 
s Journ. de 1'anat. phys, etc., Paris, 1888, pp. 1-80; also Compt. rend. Soc. de Biol. 
Paris, 1886, pp. 536 and 581; also vol. iii. p. 27. 6 
HODENPYL, THE FAUCIAL TONSILS. 
Fig. 2. 
A drawing from a section of a normal tonsil from which the cells have been removed, showing the 
reticulum of two nodules. 
High-power drawing, showing the reticular tissue of a nodule. HODENPYL, THE FAUCIAL TONSILS. 
7 
described as being composed of connective tissue, it seems more properly 
to belong to a different variety of tissue. It may be called reticular 
tissue in contradistinction to the connective-tissue reticulum between 
the nodules. This last-mentioned form of reticulum differs from that 
just described, in that it is evidently derived from the fibrous-tissue 
septa. It is coarser and more closely arranged than the reticular tissue 
of the nodules, but the meshes are lined by endothelium. About the 
periphery the varieties merge into one another. 
2. The Cells.-Three varieties of lymphoid cells, which almost 
completely fill the reticular network, may be distinguished. (Fig. 4.) 
Fig. 4. 
The cells which occupy the reticular network. 
A. The majority of the cells are of a spheroidal or irregular shape 
from 5 to 8 in diameter, containing a single nucleus from 2 to 
4 p in diameter. The nuclei are either of a homogeneous or finely- 
granular character, and occasionally contain vacuoles. No distinct 
limiting cell-membrane can be detected. B. The cells of this group 
differ from those of the preceding, in that they are multinuclear. The 
nuclei vary in number from two to four in a single cell. These closely 
resemble leucocytes, and the relative number of the two varieties differs 
a good deal in different sections. As a rule, the mononuclear are vastly 
more abundant than the polynuclear cells. A large number of speci- 
mens were carefully examined with reference to cell-division in these 8 
HODENPYL, THE FAUCIAL TONSILS. 
cells; but none was observed in which karyokinetic figures could 
be satisfactorily demonstrated. Karyokinesis, in lymphoid cells, is 
still a much-disputed point among histologists. The studies of Baum- 
garten1 and Ribbert2 seem to confirm those of the writer. On the 
contrary, Flemming3 and his pupils Drews4 and Paulsen,5 Per- 
emschko,6 Lavodowski,7 Stohr,8 and others claim to have observed 
lymphoid cells in the process of indirect cell-division. C. Large, irreg- 
ular, flat nucleated cells are found in greater or less numbers in the 
reticular spaces. In these the protoplasm, which is surrounded by an 
investing membrane, is granular, the nuclei are relatively large, round, 
or oval, and sometimes contain nucleoli. The intra-nuclear network is 
distinct, and often karyokinetic figures can be made out. The origin 
of these cells was for a long time undetermined. It can no longer be 
doubted that they are derived from the endothelium lining the reticu- 
lum. Under normal conditions, but few such cells within the meshes 
are usually seen; but in diseased conditions, when increased desqua- 
mation of the endothelial lining takes place, they become especially 
numerous. (Fig. 5.) 
Fig. 5. 
High-power drawing showing the lymphoid cells and the reticular tissue. 
The reticulum forming the framework of the nodules is more closely 
packed with cells than is that which separates the nodules from one 
another. Such an arrangement gives to the nodules a denser appear- 
ance, but no difference could be detected in the character of the cells 
1 Zeitschr. f. klin. Med., Nos. ix. and x. 2 Ziegler's Beitrage, 1889, p. 185. 
3 Arch. f. Mik. Anat., Bd. 24. 4 Ibid., Bd. 24, p. 338. 
s Ibid., Bd. 24, p. 345. 3 Ibid., Bd. 17. 
7 Virch. Arch., xcvi. 
8 Ibid., xcvii.; also Ueber die Peripheren Lymphdriisen, Separat-abdruck aus den 
Sitzungsberichten in Wiirtzburg, 1883. HODENPYL, THE FAUCIAL TONSILS. 
9 
in the nodules from those between them. As was shown by serial sec- 
tions the nodules are arranged concentrically about the crypts. 
3. Bloodvessels (Fig. 6).-The larger trunks after entering the 
tonsil are surrounded by fibrous tissue sheets derived from the basal 
capsule. The fibrous tissue about the larger vessels would tend to 
interfere with their contraction and closure when cut; and this ana- 
tomical arrangement seems to afford an explanation for the haemorrhage 
which sometimes follows cutting operations involving removal of large 
Fig. 6. 
Drawing from an injected specimen showing the distribution of the bloodvessels. 
parts of the tonsil. The larger trunks rapidly divide into smaller 
branches, which ramify in the tissue between the nodules. As was 
shown by injected preparations, the nodules themselves are but scantily 
supplied with bloodvessels ; and these, as a rule, are principally confined 
to the periphery. Beneath the epithelium in the submucosa the blood 
is collected in small veins, whence it is returned to the larger veins at 
the base, and is finally emptied into branches of the internal jugular. 10 
HODENPYL, THE FAUCIAL TONSILS. 
Lymphatics.-Injections of colored gelatin or solutions of nitrate of 
silver show that the lymphatic network occupies the whole of the ton- 
sillar mass. The lymphatics constitute a series of closed canals in which 
the lymphoid cells lie, lined by endothelium, and probably they do not 
open into the reticular connective tissue, either by stomata or open 
extremities. 
From these lymph channels the lymph is collected by several lymph 
vessels, provided with valves at the base of the organ. These penetrate 
the basal capsule and connect with the lymphatics at the base of the 
tongue, which in turn finally enter the lymph nodes at the angle of the 
jaw, about at the level of the hyoid bone. 
Nerves.-The manner of termination of nerve-filaments in the tonsils 
could not be determined, since repeated attempts to demonstrate nerve- 
fibres in them failed in each instance. Aside from nerve-filaments sup- 
plying the sheaths of bloodvessels, the presence of nerve-fibres has not 
yet been demonstrated in the other lymphatic structures. 
4. Epithelium (Fig. 7).-The tonsil is covered on its free surface 
by stratified, squamous epithelium, continuous with that of the mouth. 
In the fully-developed tonsil there is no membrana propria separating 
the epithelial cells from the underlying tissue. It differs in appearance 
and arrangement in different parts. In places it presents a uniform 
layer of from eight to twelve cells in thickness, and is arranged in 
three layers; the cells of the outermost being flat and scale-like, those 
of the middle polygonal and " spined," while those of the inner layer 
are cuboidal in shape. In other parts, while the arrangement of the 
cells remains the same, the contour is made irregular by projections 
upward of the submucosa giving an appearance not unlike the rete 
Malpighii of the skin. 
Such is the usual arrangement of the epithelium of mucous mem- 
branes in general. The epithelium of the tonsils, however, and also 
that covering the solitary and agminated lymph nodules of the intestine, 
present still other appearances, the result of peculiar alterations in the 
cells themselves. In such situations, the epithelial cells are diminished 
in size and are very much altered in shape. The cells now become 
either cylindrical, irregular, spindle- or star-shaped, and many of them 
are furnished with long, branching processes, which are apparently con- 
tinuous with the underlying connective-tissue reticulum. Furthermore, 
little hollow cavities are found in the epithelial layer, usually near the 
surface. These cavities contain numbers of lymphoid cells and some- 
times are closed on all sides; but sometimes they are provided with 
minute channels leading to the surface, through which lymphoid cells 
may be seen to pass. 
This alteration, which Zawarykin1 calls a process of " rarefaction of 
1 Zawarykin: Anatom. Anzeiger, 1889, No. 15, p. 467. HODENPYL, THE FAUCIAL TONSILS. 
11 
the epithelium," seems to be the result of pressure from beneath upon 
the epithelial lining. It causes a great irregularity in the contour of the 
The epithelium covering the tonsil, showing emigration of lymphoid cells and rarefaction. 
The epithelium covering the tonsil, showing an advanced stage of rarefaction 
Fig. 7. 
Fig. 8. 
epithelial layer, which is also considerably diminished in thickness. In 
other parts, where these changes have advanced to a still greater degree, 12 
HODENPYL, THE FAUCIAL TONSILS. 
the epithelial covering is so thin as to be but one or two cells in thick- 
ness. (Fig. 8.) 
" Rarefaction of the epithelium " occurs in both healthy and diseased 
tonsils. Serial sections show it to be of very irregular distribution; and 
it has apparently no direct relation with the lymph nodules. As yet its 
physiological significance has not been made quite clear. It greatly 
facilitates the passage of lymphoid cells from the tonsil to the cavity of 
the mouth; and it has, I believe, an important bearing upon the ab- 
sorption of bacteria and their ptomaines, and in the production of certain 
of the acute infectious diseases. 
The crypts penetrate the substance of the tonsil, generally at right 
angles to the surface, but sometimes more obliquely. Their number 
varies from eight to fifteen in a single tonsil. Usually they are single, 
but they may divide into two or more branches. They vary in depth 
and in the size of their lumina, and are lined by stratified squamous 
epithelium. The contents of the crypts consist of emigrated lymphoid 
cells, desquamated epithelium, granular matter, cholesterine crystals, 
bacteria, and occasionally particles of food. 
In almost every section, a varying number of small spheroidal cells 
are found between the epithelial cells. As long ago as 1836 "emigra- 
tion of white blood-cells" was described by Valentin.1 Since then 
the process has been carefully studied by a great many observers. 
Stohr2 has studied this emigration of leucocytes more especially in the 
tonsils. In all cases, but more especially in tonsils of young persons, 
a large number of cells similar in structure to those found in the sub- 
stance of the organ, are continually finding their way through the 
epithelial covering to the surface or into the lumina of the crypts. 
It will be seen, from the above description of the faucial tonsils, that 
in structure and in the manner of distribution of the bloodvessels and 
lymphatics, they closely resemble the agminated lymph nodules or 
Peyer's patches of the small intestine. Except for the crypts, the struc- 
ture of the tonsils is, indeed, identical with that of a Peyer's patch. 
Comparative Anatomy.-The tonsils of those animals which were 
examined were found to be of an essentially similar structure as in the 
human variety ; but in the different species a good deal of difference 
was observed in their shape and gross appearance. 
In monkeys the tonsils differ but little, except in size, from those in 
man. In dogs, the tonsils are relatively large and spindle-shaped. The 
long diameter is about four times that of the transverse. The dog's 
tonsil is folded upon itself, so that it presents a deep fissure, on the sur- 
face, which extends from either extremity along the upper and outer 
1 Repertorium fur Anatomie und Physiologic, 1836, p. 283. 
2 Arch. f. Path. Anat, und Phys., xcviii. HODENPYL, THE FAUCIAL TONSILS. 
13 
aspect of the organ. Into this fissure most of the crypts empty ; the 
few remaining crypts empty on the free surface. 
The tonsils are but little encroached upon by the pillars of the fauces; 
and they are very thoroughly exposed to view when the mouth is opened 
and the tongue is forcibly drawn forward. Consequently, these animals 
are especially applicable for physiological experiments. 
In rabbits, the tonsils are hemispherical in shape and present a single 
crypt at the centre, about which the lymph nodules are arranged in 
rows. 
In cats the tonsils are pear-shaped, and lie in a pocket of fibrous 
tissue in which they are freely movable. Only a small part of the 
organ protrudes, through a small circular opening in the mucous mem- 
brane, into the mouth. 
Technique.-Specimens, for histological study, are better preserved 
when treated with corrosive sublimate solution, than are those which 
have been hardened, directly, in alcohol or in Muller's fluid. Any of 
the many formulae of sublimate solution may be employed, of which 
Lang's is, perhaps, the best, consisting of water 1000 c.c., corrosive 
sublimate 8 grm., hydric acetate 8 c.c. Small bits of perfectly fresh 
tissue are placed in this solution. After one hour they are washed in 
water, and hardened successively in 40 per cent., 60 per cent., 80 per 
cent., and in strong alcohol. By means of double imbedding in both 
celloidin and paraffine, exceedingly thin sections may be cut, which, 
provided all the sublimate has been removed, stain readily in any of the 
more commonly employed staining reagents. 
The reticulum is best studied in sections from which most of the cells 
have been removed. This may be accomplished in several ways. The 
most satisfactory way is to make frozen sections from specimens which 
have previously been hardened for from one to two hours in one-third 
alcohol. The sections are gently shaken in a test-tube of water, care 
being taken not to continue the shaking too long. The sections are 
stained on a slide and mounted on glycerin. The outlines of lymphoid 
cells are best preserved by teasing a bit of the fresh tonsil in a mixture 
of equal parts of osmic acid, 1 per cent., and normal salt solution. 
None of the methods of demonstrating the lymphatics of the tonsil 
are altogether satisfactory. Ranvier's1 method consists in injecting a 
small quantity of blue gelatin into the substance of the organ just 
beneath the epithelium, and allowing the specimen to cool before it is 
hardened in alcohol, and cut into sections. Solutions of nitrate of silver, 
1 : 500, are also recommended in place of the gelatin. While this 
method is applicable with the lymph nodes, in the case of the tonsil it 
has, thus far, always been the misfortune of the writer to puncture 
1 D'Histologie. Paris, 1875, p. 674. 14 
HODENPYL, THE FAUCIAL TONSILS. 
some of the smaller bloodvessels with the hypodermic needle, with the 
result of obtaining a mixed injection. The bloodvessels are easily in- 
jected with blue gelatin, artificially through the carotids; or a very 
good natural injection may be made by suspending the animal before it 
is killed, by the hind-legs, and hardening the tonsils immediately after 
they are removed, in strong alcohol. 
Physiology. 
As has been stated elsewhere, in this paper, our knowledge of the 
functions of the tonsils is largely theoretical, as nothing seems to have 
been done thus far by way of experimentation toward the solution of 
this problem. Indeed, the physiology of the other lymphatic structures, 
in spite of all the careful research which has been accorded them, is but 
little understood. 
The unsatisfactory state of our knowledge of the functions of the 
lymph nodes, for example, is well shown by this statement of Foster.1 
" Obviously here, as in the lymphatic follicles of the intestine, the ade- 
noid tissue or lymphatic substance is the seat of an interaction between 
the blood and the lymph : here the blood gives something to and takes 
something from the lymph, or, at least, is in some way changed ; here 
the lymph takes from and gives up to the blood. We may be confident 
that these changes take place, though our knowledge as to the exact 
nature of these changes is at present very limited." 
Studies in pathology indicate that the lymph nodes act as filters. 
Thus particles of pigment, bacteria, and cells from neoplasms, which 
have gained access to the lymph channels, are apt to be caught and 
held in the lymph nodes. 
The bronchial lymph nodes succeed, in most cases, in holding back 
from the general circulation the particles of inhaled pigment which 
may have been absorbed by the lungs. Living bacteria, or cells from 
neoplasms, which still have retained vital properties, when they become 
lodged in the lymph nodes may incite inflammation, or set up new- 
growths. 
It is almost certain that the lymph nodules of the intestines, espe- 
cially Peyer's patches, are concerned in the absorption of the products 
of digestion. A certain amount, though but an insignificant proportion 
of fats, at least, is absorbed by these bodies. (Schafer.2) 
The functions of the little masses of lymphoid tissue scattered about 
in the substance of the thoracic and abdominal viscera are totally 
unknown. 
The studies on the physiology of the tonsils, which I have made, 
1 Handbook of Physiology, London, 1889. 
2 Journ. Internal. Anat, und Histol., 1885, Bd. ii. p. 16. HODENPYL, THE FAUCIAL TONSILS. 
15 
were done, more especially, to determine their relations to some of the 
acute infectious diseases. Before entering upon a discussion of this 
subject, it will be necessary to consider some of the theories which have 
been advanced to explain the functions of these organs. 
Perhaps one of the oldest of these theories is, that the tonsils are 
secreting organs, furnishing a thick, viscid mucus which lubricates the 
bolus of food during the second part of the act of deglutition, and 
which also lubricates the back part of the mouth and pharynx. 
Such a theory is abundantly discredited on purely anatomical 
grounds. The secretion of mucus is furnished by the numerous 
mucous glands in the adjacent mucous membrane, and not by the ton- 
sils themselves. 
The old idea of Perrin, that the tonsils were concerned in the forma- 
tion of the voice, seems highly improbable. A connection between the 
tonsils and the organs of the genital apparatus has been suggested. 
This notion is more a popular one, and is without scientific foundation. 
More recently Hill,1 Spicer,2 and Kingston Fox,3 reasoning from 
analogy, have advanced the idea that the tonsils reabsorb the waste 
secretions of the mouth and pharynx. According to these authors, 
especially the digestive ferments of saliva are absorbed by the tonsils in 
order to prevent waste. Although this theory did, at first, seem plausi- 
ble, no attempt was made to strengthen it by actual demonstration. 
The physiological experiments which I shall describe later show 
Hill's theory of the functions of the tonsils to be wholly unsupported 
by facts. 
Recent observations have shown that pathogenic bacteria may be 
present in the mouths of healthy individuals, often in considerable 
numbers, and an intimate connection between the tonsils and some of 
the acute infectious diseases has long been supposed to exist. More- 
over, it was thought not to be unlikely that infection, in some cases, 
may take place through the tonsils. 
In order, if possible, to throw some light on this most important 
problem, I have endeavored to ascertain the amount of absorption 
which, under favorable conditions, may take place through the tonsils. 
Experiments were done on dogs and rabbits. In most cases the experi- 
ments were repeated, and as far as possible controls were made in each 
case. The experiments consisted in attempting to cause the tonsils to 
absorb various materials which could be afterward recognized, micro- 
scopically, in the tissues; and according to the nature of the materials 
used and the manner in which they were applied, the experiments may 
be divided into several groups. 
1 British Medical Journal, 1888, vol. ii. p. 615. 
2 Lancet, London, 1888, vol. ii. p. 805. 
. 3 Journal of Anatomy and Physiology, London, 1885-6, vol. xx p. 559. 16 
HODENPYL, THE FAUCIAL TONSILS. 
Landois states that under ordinary circumstances absorption from 
the mucous membrane of the mouth is very slight, although sufficient 
is absorbed to enable the sense of taste to be perceived, and applications 
of powerful drugs may be followed by systemic effects. I verified this 
statement by applying a solution of atropine to the mouth of a healthy 
person and watching its effect on the eyes. Although the solution em- 
ployed was a strong one, and the application continued thirty minutes, 
and the drug was distinctly tasted, no dilatation of the pupils followed. 
1. The tonsils of several animals, as well as the whole of their buccal 
cavities, were kept constantly smeared with olive oil, in one set of ex- 
periments ; in a second set, melted lard was used, and in still a third, 
lanolin. After from fifteen to thirty minutes the animals were killed, 
and the tonsils, together with portions of the tongue and pharyngeal 
wall of each animal, were hardened in osmic acid one per cent, and 
alcohol, and examined microscopically. The epithelial covering of the 
tonsils contained a few fine, black granules (fat droplets), generally 
near the surface. The granules seemed to be between the cells. There 
was no fat, either in the lymphoid cells, or lying free between them. 
Sections of the tongue and pharyngeal wTall from each animal showed a 
few fat globules in the superficial portions of the epithelial covering. 
2. Finely-powdered carmine, Berlin-blue, and emery powder sus- 
pended in water, were applied to the mouths and tonsils of dogs, in a 
similar manner as were the fats. 
Microscopical examination in each case failed to demonstrate the 
absorption of any of the insoluble material in the sections of the tonsils, 
tongue, or pharyngeal wall. 
3. Solutions of anilin colors in water, and in normal salt solution, 
salts of iron, and strong solutions of atropine, were kept in contact 
with the mucous membrane of the mouth and tonsils for from fifteen 
minutes to one hour. In none of the experiments in which colored 
solutions were employed did absorption, as was demonstrated by micro- 
scopical examination of frozen sections, take place. 
The tissues which were subjected to the action of ferrous sulphate 
were afterward placed in a solution of ferric cyanide of potassium. 
Sections of these specimens failed to show granules of Berlin-blue in the 
epithelium or in the deeper structures. The dogs to whose tonsils strong 
solutions of atropine were applied, showed no dilatation of the pupils 
after the application had been continued for one hour. 
4. Solutions of anilin colors and mixtures of insoluble carmine in 
water were injected beneath the mucous membrane in the neighborhood 
of the tonsils in different animals, which were killed one hour afterward. 
In neither case was the coloring matter taken up by the tonsils. 
5. A small quantity of a strong solution of atropine (one-sixth gr.) 
was injected into a dog's tonsil immediately beneath the mucous mem- HODENPYL, THE FAUCIAL TONSILS. 
17 
brane, care being taken that none of the fluid escaped into the oesopha- 
gus. Within a few minutes the pupils became widely dilated, and soon 
afterward the dog became very drowsy, and finally was unable to stand. 
6. Small quantities of both soluble and insoluble pigment were 
injected into the substance of dogs' tonsils, and the animals were killed 
one hour afterward. Upon examination the pigment was found to have 
collected in the spaces between the nodules, where the point of the needle 
was carried. It showed but little tendency to diffusion. None of the 
pigment had been gotten rid of by the surface or was found within the 
crypts. 
Summary of Absorption Experiments. 
The experiments just described were done with care, and, as far as 
possible, all sources of error were eliminated. The results seem to show 
that in healthy tonsils under ordinary conditions : 
1. Soluble or insoluble materials are not absorbed by the mucous 
membrane of the mouth, or pharynx, or by the tonsils, except to a very 
slight extent. 
2. It is the epithelial covering which prevents absorption taking place 
by the tonsils. Substances in solution which have found their way 
beneath the epithelium may be rapidly taken up by the lymphatics and 
carried into the general circulation. 
3. Soluble and insoluble foreign materials in the tissues in the imme- 
diate neighborhood of the tonsils are not readily and at once taken up 
by them. 
4. Soluble and insoluble foreign materials in the substance of the 
tonsils are not thrown off* by the surface; but may either remain in 
the tissues or may be carried off by the lymphatics to other parts of the 
body. 
Baumgarten has suggested that the tonsils might be the point of 
entrance of tubercle bacilli into the body ; that tubercle bacilli which 
may have been taken into the mouth may be absorbed by the tonsils, 
where they may result in the formation of miliary tubercles. From 
thence, Baumgarten supposes, infection may spread through the lym- 
phatics to the bronchial lymph nodes and finally to the lungs. In order 
to determine the relative frequency of tubercular lesions of the tonsils, 
and to ascertain the relationship, if any, of these structures to pulmo- 
nary phthisis, I have examined, microscopically, a large number of 
tonsils (nearly 200) for evidences of tubercular lesions. These tonsils 
were from persons of all ages ; and they include the tonsils from eighteen 
persons who died of pulmonary phthisis. In but one case out of the 
entire number examined were the tonsils tubercular. In this case they 
were removed from the body of a man who died of very general tuber- 
culosis. 18 
HODENPYL, THE FAUCIAL TONSILS. 
From the results of these examinations it would seem probable that: 
1. Tubercular tonsillitis is a rare affection. 
2. The tonsils are rarely, if ever, the site of primary inoculation in 
pulmonary tuberculosis. 
Whatever may be the physiological significance of rarefaction of the 
epithelium of the tonsils, it, together with a knowledge of the nature of 
the lesions of diphtheria of the tonsils, unquestionably affords a ready 
explanation of the way in which these structures become infected in 
this disease. We have seen that rarefaction of the epithelium is of 
constant occurrence in the tonsils; that as a result of this process parts 
of the epithelial covering are very considerably diminished in thickness, 
not infrequently so decidedly thinned as to be, in certain places, but one 
or two cells in thickness. Now, as a result of the presence of the con- 
tagium of diphtheria, which acts as an irritant to the cells, increased 
desquamation of the epithelial covering takes place. This prolifera- 
tion of the cells, as I have actually observed in sections of diphtheritic 
tonsils, may entirely denude the tonsil of its epithelial covering in 
places ; and the specific virus of the disease is thus brought into imme- 
diate contact with the lymphatics of the tonsils, from whence it is 
carried into the general circulation. 
Recapitulation. 
1. The tonsils are lymphoid structures closely resembling the Peyer's 
patches of the small intestine, consisting in general of a congeries of 
lymph nodules separated from one another by diffuse lymphoid tissue, 
which are arranged about several hollow depressions of the epithelial 
covering, the crypts. 
2. None of the theories thus far advanced to explain the functions of 
the tonsils are conclusive. 
3. The tonsils produce no physiological secretion. 
4. The tonsils are not absorbing organs. They neither absorb fluids 
or solid particles from the mouth under ordinary conditions, nor do 
they take up foreign materials from the tissues in their immediate 
neighborhood. 
5. Tubercular tonsillitis is an uncommon affection. 
6. There is no evidence to show that pulmonary tuberculosis ever 
results from absorption of tubercle bacilli from the mouth through the 
tonsils. 
7. Rarefaction of the epithelium of the tonsils affords a ready ex- 
planation of the way in which the contagium of diphtheria may gain 
entrance to the general circulation in this disease. 
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