Anemia and hyperemia occur here just as elsewhere. Active hyperemia as a beginning of inflammation; passive, in chronic heart and lung disease, in which cases the veins may be distinctly varicose. Edema is found in connection with inflammation and ulceration and may be quite marked. Hemorrhage may occur in purpura and in severe infectious fevers, as well as being the result of direct injury. The blood may form quite a tumor between the layers of the soft palate.

Tonsillitis, or inflammation of the tonsil, may be either acute or chronic. Acute tonsillitis may be either symptomatic of various diseases or it may be a true local primary condition as a consequence of direct infection. It is known as catarrhal, lacunar or follicular, and phlegmonous. In the catarrhal the tonsils are somewhat reddened, usually as a part of a catarrhal pharyngitis. The lacunar or follicular form is characterized by the presence of many small yellowish-white spots over the surface of the tonsil. Each spot represents a follicle that has become filled with an exudate made up of degenerated epithelium, and bacteria, as staphylococci, streptococci, pneumococci, and tubercle bacilli. The exudate from the lacunae may extend over the surface of the tonsil, forming a covering that resembles diphtheritic pseudo-membrane. The exudate within the lacunae may become inspissated and calcify. If the infection passes through the bottom of the crypts into the deeper tissues phlegmonous tonsillitis may result, usually unilateral. In this there is abscess formation as well as round-cell infiltration. These collections of pus may discharge into the mouth, open into the larynx or even involve the large vessels of the neck, perforation of the internal carotid having occurred.

In chronic hypertrophic tonsillitis there is an increase in size of the tonsils, due not only to a hyperplasia of the connective-tissue septa and reticulum, but also to a hyperplasia of the lymphoid follicles. The tonsils may become so hypertrophic as to almost meet in the middle line, and by so doing cause obstruction to breathing and swallowing.

This form is frequently accompanied by marked disturbance of the general health and development. Is often found in children, and as a result they breathe with their mouths open; their digestion is often impaired and their mentality may be distinctly lessened.

Instead of the above hypertrophic form, the involvement may be confined to the lacunae, which are wider and deeper than normal. They become filled with an exudate that through decomposition can give rise to inflammatory processes in adjacent tissues.

Tonsillitis Leptothricia

Tonsillitis Leptothricia is caused by infection of the tonsils by the Leptothrix buccalis. It usually occurs in the poorly nourished, but may occur in a strong, well-nourished individual. Over the surface of the tonsil are numerous spots covered by a thick, dense, dry, whitish exudate that is composed of masses of threads of the leptothrix. It is firmly adherent to the crypts and is removed with difficulty. It usually involves other portions of the pharynx, but does not occasion much inflammation of the surrounding tissues. It tends to run a chronic course not yielding readily to treatment.

Tuberculosis of the tonsils is quite common. Is generally primary and involves the cervical lymph-nodes secondarily. From there it may by extension gain access to the lungs and occasion tuberculosis within them. It may also give rise to a secondary involvement of the intestines.

Syphilis of the tonsils may occur as a primary, secondary, or tertiary lesion.