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or dead, are possessed by nearly all the body cells. These powers are in comparative abeyance, however,
in the specialised structures, but prominent in certain leucocytes or white corpuscles, and those
especially found in lymphatic structures. The normal tissues about the surfaces of the nasal and
mouth cavities are chieily exposed to noxious foreign elements, and the structures guarding the
lymphatic drainage from these areas are often liable to chronic enlargement. In individuals of robust
health the leucocytes have such vigorous power that these conditions of chronic inflammation do not
show ; in others of less vigorous stock or constantly in depressing surroundings chronic inflammatory
conditions present themselves. The tonsils on each side of the fauces are easily observed, but it is
found that in their case probably nearly all direct damage done is an event of early life and for most
cases determined by influences existing in infancy, as the proportion of children with tonsillar
enlargement remains steady during school life. Associated conditions and sequelae are developed in
the later years of childhood.

These tables can be summed in the following diagram :—
Diagram IV.
Further analysis of the cases with reference to caries of the teeth showed this to be somewhat
more common among children with enlarged tonsils, and showed also that the children with enlarged
tonsils had probably poorer nutrition than the others. The presence of such enlargement may from
mere mechanical obstruction hinder correct articulation ; this is noticed even in the pupil teachers ;
or the enlargement may cause increased efforts at breathing, resulting in mouth breathing. The accumulation
of decomposing secretions on the surface and in the crypts of the tonsils often lead to production
of offensive material, and the surface of the tonsil itself appears as a dangerous spot for the entrance
of various organisms leading, for instance, to rheumatism, scarlatina, diphtherial or other blood infections.
But it is rather as an indicator of other conditions in neighbouring tissues that enlarged tonsils
are generally useful. The lymphatic masses which are present about the upper part of the pharynx,
and the mucous tissues about the posterior ends especially of the turbinate bones, are liable to
become greatly hypertrophied, and sometimes cause much trouble from chronic irritation, whether
by substances in the air, or from want of proper drainage of the surfaces, from actual deformities
in development of the upper jaw, or even from want of development, due to the habit of mouth
breathing having become established at an early age. Mere catarrh is apt to set up mouth breathing.