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April 1924


Author Affiliations


From the Department of Surgery of the Johns Hopkins University and Hospital.

Arch Intern Med (Chic). 1924;33(4):473-482. doi:10.1001/archinte.1924.00110280071007

"Do the tonsils show any peculiar anatomical structure or possess any specific physiology or undergo pathologic changes that would make them more liable to act as a gateway of infection than other structures in the body?"1 The histologic factors in chronic tonsillitis are: (1) loss of epithelium on the surface or in the crypts; (2) the presence of masses of keratinized epithelial cells in the crypts; (3) hyperplasia of endothelial cells; (4) accumulation of plasma cells, lymphocytes and leukocytes around the margin of the crypts; (5) evidence of hemorrhage in the parenchyma or in the lumen of the crypt; (6) the presence of polymorphonuclear cells and lymphocytes in the epithelium lining the crypts; (7) the presence of bacteria in the crypt epithelium and in the parenchyma of the tonsil (probably in lymph channels or blood vessels); (8) thickening of the capsule and increased fibrosis of the trabeculae. In every case

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