There is perhaps no other organ of the body, diseases of which have
caused a greater variance of opinion relative to treatment than
the tonsils. There are those who believe that every hypertrophied,
atrophied, or infected tonsil together with its fellow of the opposite
side should be removed. There are also those who believe that no
tonsils, regardless of their pathology, should ever be removed. These
are the radicals and their views are not at all in keeping with present
day facts.
Those physicians and surgeons who have tried to arrive at some safe
conclusion on this subject, believe that there are certain methods of
non-surgical treatment which are effective in many cases and they also
believe that in other cases, tonsillectomy is imperative.
=Functions of the Tonsils.=—Many and varied functions for the tonsils
have been held by various theorists such as: the absorption of the
products of salivary digestion; the secretion of an amylolytic ferment;
that they are atavistic structures and therefore have no function;
that they eliminate systemic toxins; that they serve as culture tubes
for the production of vaccines; that they protect the deeper cervical
tissues from bacterial invasion; the theory of internal secretion and
a score of other theories which so far, have never been substantiated
by either clinical or experimental evidence.
The hematopoietic theory or the theory of blood formation has a rather
definite basis because such a function would be possible from the
histologic structure. The formation of small lymphocytes has been
attributed to tonsil tissue (Flemming) and this view has been generally
accepted. Some of the lymphocytes however, find their way through
the epithelial walls into the crypts and are discharged as “mucous
plugs”, while others are carried by the efferent lymphatics into the
circulatory system. In this respect, the tonsils, like other lymphoid
tissue, produce lymphocytes which are essential constituents of the
blood. This function is particularly marked during the growing period,
but this function is also highly developed in all lymph nodules during
this period, and in the growing child there is an abundance of such
tissue and thus it seems that the tonsils, while important to the
growing child, would not be at all indispensable structures.
Some physicians claim to have observed deficiencies in growth and
development of children whose tonsils had been removed during the first
ten or fifteen years of life, but this is not commonly accepted. The
tonsils have their greatest cellular activity during the growing period
and unless chronically hypertrophied they atrophy during adult life.