DISEASES OF THE TONSILS, PHARYNX, AND CESOPHAGUS The lymph-channels of this region run to the cervical glands situated around the jugular vein. The drainage of a considerable portion of the lymph-vessels from the nasopharynx is to the lateral pharyngeal glands, situated behind the tonsils, in the buccopharyngeal fascia, which are intimately con nected by numerous anastomoses with the deep glands of the neck. A certain number of these vessels pass the small retrapharyngeal glands. The remainder of the lymph-branches, run, by way of the lateral pharyn geal glands, behind the great vessels of the neck, directly to the deep cervical glands. The lymph-channels of the pharynx however, particu larly the faucial tonsils, have nothing to do with the lateral pharyngeal glands. They are distributed to the subrnaxillary glands, particularly those at the angle of the jaw, and from there to the superficial or deep cervical glands. All this is of diagnostic importance, because swelling of the pharyngeal and retropharyngeal glands, which are only palpable front within, points to disease of the nasopharynx; swelling of the sub maxillary glands to disease of the tonsils; while swelling of the cervical glands without involvement of the submaxillary glands, can only point to some nasopharyiageal condition.
The lingual tonsil really only develops after the age of puberty, and oceaonally has pathologjeal significance. On the other hand the develop ment of the other tonsils is often very rapid in childhood, and hyperplasia and diseases of the tonsils are so common that they make up a char acteristic part of the pathology of childhood. The fluidal tonsils, how ever, until about the second year, possess a well-known immunity, and only later on, when they become much enlarged, do they have the same patholmjeal importance that 18 peculiar to the lymphoid tissue of nasopharynx from earliest infancy. Pathological changes of this ring of lymphoid tissue extend during childhood to all its parts with the exception of the lingual tonsil. If pathological conditions of the faucial tonsils and the pharyngeal tonsil are treated as separate conditions, recurrences will take place. It is best to consider such disturbances coniointiv.