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THE TONSIL AND ITS USES 
 
 Vocal, Mechanic and Physiologic 
 
 BY 
 
 RICHARD B. FAULKNER, M. D. (Columbia University) 
 
 "The tonsil is an organ that must be respected" {Lermoyez) 
 
 "You have no right to destroy it" (yon Levinstein) 
 
 "It is absolutely necessary in the modulation of the singing 
 voice in crescendo and diminuendo" (Lamperti) 
 
 It is the sound-post in the mechanism of speech and 
 song {The Author) 
 
 THE BLANCHARD COMPANY 
 PITTSBURGH, PA. 
 
Author G, 
 
 MAY / 2 'tf 
 
 COPYRIGHT 1916 
 
 BY 
 
 RICHARD B. FAULKNER, M. D. 
 
 
 THE BLANCHARD COMPANY 
 
FOREWORD 
 
 The publication of my first book on this subject 
 "The Tonsils and The Voice" led to such wide 
 spread discussion of its contents, and to so many 
 requests for more specific data regarding the treatment 
 of tonsillar diseases without the knife, that in order to 
 meet this demand, I felt it my duty to issue the second 
 book, entitled "Tonsils and Adenoids: Treat- 
 ment and Cure". This second volume met with 
 a prompt and enthusiastic reception, and is amply 
 proving the position taken in the first volume, namely, 
 that the cutting of tonsils is Unnecessary in over 92 
 per cent, of all cases, and that these are curable b} 7, 
 safe and sane medical treatment. 
 
 The formulation of some original new views and 
 the desirability of emphasizing in concise form, the fact, 
 as set forth in my previous researches, that the tonsils 
 have uses and functions which must not be recklessly 
 interfered with, have led to the presentation of this 
 third volume on "The Tonsil and Its Uses; 
 Vocal, Mechanic and Physiologic." 
 
THE TONSIL AND ITS USES 
 Vocal, Mechanic and Physiologic 
 
 The two tonsils in the back of the mouth, one 
 
 on each side, are commonly called the tonsils. 
 
 Tne They are technically named the faucial tonsils, 
 
 tonsils on account of their location in that part of the 
 
 mouth known as the fauces. 
 
 The normal faucial tonsil is an organ that 
 represents a type. A unity of opinion regarding 
 Normal tne normal type is essential to an intelligent dis- 
 anatomy cussion of the organ. The anatomy and histol- 
 ogy of the normal type, from the author's studies, 
 are presented in detail, in his work upon "The 
 Tonsils and The Voice." 
 
 The faucial tonsils resemble the cartilages of 
 the larynx and trachea. But they are softer. 
 ^ n They change with age in character, size, shape 
 intimate an< ^ consistence, but never disappear. They give 
 part of a firmness to the walls of the pharynx. They 
 natural ser ve a purpose that hard, unyielding, osseous 
 throat formations would not serve. They are mobile 
 and compressible. They form an intimate part 
 of a natural throat and possess a normal his- 
 tologic structure. 
 
 The faucial tonsil has remarkable anatomical 
 characteristics, not possessed by any other organ. 
 Its external deep surface is encased in a firmly 
 adherent, strong, fibrous sheath. Nothing like 
 Remarka-this sheath surrounds any other lymphatic body. 
 ble So dense and tendinous and strongly adherent 
 charac- is this encasement that we may consider the 
 teristics organ as being practically armor-plated. Con- 
 tracting muscular fibres are inserted into the 
 sheath, derived from the superior constrictor 
 muscle of the pharynx. The sheath sometimes 
 sends fibrous outrunners along the walls of the 
 blood vessels that run through the body of the 
 
 5 
 
tonsil and into the folds of the mucosae. This 
 dense musculo-fibro-aponeurotic sheath with its 
 outrunners is too constant and definite to be 
 looked upon as an atavism, nor can it be viewed 
 as a simple anatomical accident. It is more rea- 
 sonably a result of evolution to meet some phy- 
 siologic demand. There must be strong phy- 
 siologic reasons for the existence of this pow- 
 erful anatomical contrivance. 
 
 What are they ? Why are muscular fibres from 
 the superior constrictor muscle inserted into the 
 aponeurotic sheath of the tonsil? Is the inser- 
 tion of these fibres in a soft and movable body 
 like the tonsil, designed to give freer action and 
 
 Equipped to facilitate some special play upon the part of 
 f or this muscle? Does the yielding tonsil serve 
 
 mechan- some function to the superior constrictor which 
 j Ca j insertion in a bone would not? And has the 
 
 service action of the superior constrictor led to the de- 
 velopment of the tonsil with its strong aponeu- 
 rotic sheath? For what purpose does the sheath 
 send fibrous outrunners along the walls of the 
 blood vessels and into the folds of the mucosae? 
 Is not the tonsil armed and equipped for mechani- 
 cal service? 
 
 The anatomical situation of the organ is re- 
 markable. It occupies a suspended position in 
 the very center of a framework of curious, active 
 and important muscles. The muscles of the 
 fauces attract attention when at rest, by the re- 
 markable bowed or arched appearance which 
 
 Remark- t | ie y assume. They straighten when they con- 
 able tract. Whenever an arched f aucial muscle 
 
 situation straightens, the tonsil is either pulled or pushed. 
 It is drawn inward toward the median line of 
 the mouth, by the palato-glossus muscle, which 
 curves outward while at rest. The palato-phar- 
 yngeous muscle, also, upon contracting and 
 straightening, draws the tonsil inward. The 
 tonsil is pressed toward the median line by the 
 
 6 
 
superior constrictor of the pharynx. If a mus- 
 cle embraces in its curve any yielding part, it 
 will, in its effort to draw itself straight, push 
 this yielding part out of its straightening way, 
 thus exerting a sidewise force, as well as that 
 lengthwise force which draws its points of at- 
 tachment nearer together. Even if the embraced 
 part is too firm to be actually displaced by the 
 sidewise push of a curved muscle, yet this will 
 be pushed upon and made more solid or dense. 
 There is an infinitely varied and ceaseless play 
 upon the faucial tonsils by the muscles of the 
 fauces, pharynx, larynx, mouth and jaw. 
 
 The faucial tonsil is a fulcrum for the mus- 
 cles of the pharynx. It is also a compressible 
 and movable fulcrum, thereby gaining greater 
 power. The faucial tonsil is a muscular com- 
 pensator, which supplies compensation by change 
 in its position, and by change in its pressure, and 
 by change in its shape when compressed. Also, 
 by its presence, it fills a cavity, which, if unoc- 
 cupied, would cripple compensation. Its an idler. 
 
 "Every sound of the voice," according to Man- 
 uel Garcia, i, (*) (London), "may assume an 
 infinite variety of shades. Each of these is a 
 timbre. The path of the sound being formed of 
 elastic and movable parts varies the dimensions 
 and forms in endless ways, and every modifica- 
 tion, even the slightest, has a corresponding and 
 definite influence on the voice." 
 
 Dr. Frank E. Miller, 2 (New York) says: 
 
 "There are seventy-four muscles and sixteen 
 nerves capable of influencing various points of 
 the vocal apparatus. The vocal tract of an ac- 
 complished singer is capable of some sixteen 
 thousand adjustments and re-adjustments. So 
 numerous are the adjustments in the shape of 
 the voice tract that Mara could make one hun- 
 
 (*) Note: The figures in the text refer to refer- 
 ences at the back of the book. 
 
Larynx 
 changes 
 in form 
 
 Tonsils 
 are 
 
 mechan- 
 ical 
 
 organs 
 
 Mechan- 
 ical 
 functions 
 
 dred changes in pitch between any two notes in 
 her voice, and as she had a compass of twenty- 
 one notes, she could produce no less than twenty- 
 one hundred changes in pitch within a range of 
 twenty-one notes." 
 
 "With the emission of each note," according 
 to Professor Mar age, 3 (Director of the Course 
 of Lectures at the Sorbonne), "the entire lar- 
 ynx, including the epiglottis, changes in form. 
 To each note corresponds a special form of the 
 entire organ. If to this is added the influence 
 of the supra-laryngeal resonators, we compre- 
 hend the diversity of the tracings which are ob- 
 tained for the same vowel. If the apparatus 
 (for inscribing vowel sounds) inscribed every- 
 thing, it is safe to say that there are no two 
 sounds absolutely the same." 
 
 That the faucial tonsil is a mechanical organ, 
 and plays an important role in the mechanism 
 of speech and song, is not to be doubt- 
 ed, but must, hereafter, be accepted as a 
 matter of fact. Its mechanical utility is readily 
 demonstrable, and as a mechanical organ of 
 unique importance the faucial tonsil commands 
 attention. 
 
 The tonsils assist in regulating the action of 
 the faucial pillars ; they support ; they modify ; 
 they give exactitude and perfection to the move- 
 ments of the pillars, unsurpassed in delicacy by 
 the fingers of an artist upon the strings of a vio- 
 lin. For the production of the artistic tone in 
 singing, the faucial tonsil is as necessary to the 
 support of the bowed muscles of the faucial arch 
 as the support of the bridge is to the strings of 
 the violin. Toneless is the violin without the 
 bridge. Artistically toneless is the faucial arch 
 without the faucial tonsils. They support the 
 tone by supporting the arch. They are an abso- 
 lute necessity in the support of the arch in 
 
 8 
 
the modulation of the voice in crescendo and 
 decrescendo. They soften the tone. 
 
 As muscular compensators, they help to shape 
 and re-shape the resonance cavities of the mouth, 
 and change, direct or interfere with, the course 
 of the vibrations of sound. They contribute to 
 altering the timbre of the voice. They give to 
 the timbre its personal quality, its charm, its 
 precious value. The colorings of the human voice 
 are as various and as marvelous as the crystals 
 of frost in winter time upon a pane of window 
 glass. These wonderful tints in vocal tone are 
 directly due to the mechanism which produces 
 them. 
 
 The presence of the faucial tonsil being essen- 
 tial as a factor in voice mechanism, its absence 
 necessarily interferes with the perfect action of 
 the mechanism. Its absence impairs and weakens 
 the mechanism. 
 
 The phonetic value of the faucial tonsil is 
 proved by the phonetic defects which always 
 follcnv after its removal. After its removal, 
 there is always a permanent loss in its personal 
 quality, and personal charm; always a loss of 
 sweetness in tone quality; the tone seems dis- 
 persed; it loses in clearness, exercise, color and 
 facility; it lacks the usual brilliancy of resonance; 
 crescendo and diminuendo are always affected 
 and most often impossible. 
 
 After removal, there is difficulty in assuming 
 the different shapes of the pharynx necessary in 
 singing, causing a hardness in quality and labor- 
 ious action; there is difficulty in supporting the 
 tone in different registers; the tone is weakened; 
 modulation difficult and sometimes impossible; 
 nasal tone common. 
 
 In accord with my personal observations, the 
 removal of the faucial tonsil lowers the voice; 
 tenors sometimes become baritones; sopranos 
 become mezzo-sopranos; the quality of tone 
 
 9 
 
throughout the range always becomes uneven, 
 and a mixed quality of tenor and baritone en- 
 sues ; support of the tone fails in certain regis- 
 ters, and an alteration in the compass occurs. 
 Tenors who sang high C have been lowered to an 
 A flat after removal of the tonsils. A clergy- 
 man sought my advice on account of an inabil- 
 ity to discourse for a longer period of time than 
 eight consecutive minutes at any one time, since 
 his tonsils were removed. He cannot sustain 
 the tone in public speaking. More than four 
 years have passed since the enucleation, and there 
 is no improvement. Another interesting case, 
 under my observation, is that of a military of- 
 ficer, who was compelled to resign from the serv- 
 ice on account of an inability to issue commands 
 to the troops, after his tonsils had been removed. 
 Five years have passed since they were removed, 
 and his voice is no better. 
 
 The mechanism that produces precious tone 
 is marvelously delicate, and finely poised. Its 
 
 Mp . preservation requires intelligence, education, and 
 ism eternal care. Speakers who shout, and singers 
 
 is delicate w ^ stram ' w ^ derange the mechanism. 
 
 andeasilv ^ oca l methods influence the faucial tonsils. 
 
 deranaed ^ ome methods enlarge them. And some me- 
 thods cause them to become painful. Tonsils 
 vary greatly in size among singers and speakers. 
 When Madame Cappiani complained about her 
 "red and big tonsils," her brother, Frederick 
 Young, dramatic tenor for years at the Royal 
 Large Court Opera in Munich, said that he had found 
 
 tonsils ac- in his career that all those prima donnas with 
 
 company extraordinary voices had big tonsils. 
 
 beautiful Mme. Cappiani, 4 (Milan) says: "The most 
 voices beautiful voices have large tonsils." 
 
 Dr. Neustacdter, 5, a medical school inspector 
 of New York, has reported that : "Among 8,00c 
 pupils examined, tonsils are slightly more preva- 
 lent among the best pupils. The best singert 
 
 10 
 
have 50 per cent, more tonsils than the poorest." 
 Professor Brieger, 6, (University of Breslau) 
 says : "People with enlarged tonsils are gener- 
 ally very healthy." 
 
 The size of the faucial tonsil is always the 
 direct result of some physiologic demand. Cause 
 Persons and effect are always proportionate. The exact 
 with size, in every instance, is related to, and deter- 
 enlarged mined by, the needs of the individual. What 
 tonsils power other than that of physiologic demand 
 are very can possibly determine the size of a natural ton- 
 healthy sil ? If the faucial tonsil is a phagocytic organ, 
 then an augmented phagocytosis will increase 
 its size. If it is a mechanical organ, invested 
 with muscular fibres, then the activity of these 
 fibres, together with the action upon the organ 
 of all the surrounding pharyngeal muscles, will 
 certainly enlarge it, as certainly as exercise en- 
 larges the blacksmith's arm. 
 
 The act of singing and public speaking con- 
 gests the tonsil, as well as manipulates it. Phon- 
 ation massages the tonsil. It is pulled, pushed 
 and compressed. May not a good singing or 
 speaking method, by giving the tonsils exercise, 
 lead to their healthy growth in size, as the natural 
 response to their activity? The vocal method of 
 singers and speakers, their habits of carefulness 
 Singing r carelessness in execution, and the general and 
 and continued environments under which they per- 
 speaking form, all have an undoubted bearing upon the 
 congest size and condition of the faucial tonsil. Does 
 :he tonsil not the size of the tonsil directly indicate the 
 physiologic requirement of the individual, and 
 also depend upon the specific vocal method em- 
 ployed in each and every case; and that one 
 method may cause a greater or lesser develop- 
 ment than another, and yet these various me- 
 thods be indicative of what is best for the dif- 
 ferent individuals? Therefore, if this is true, 
 then, who can say that the tonsil is ever too 
 
large, or too small, in the case of any particular 
 artist? 
 
 Professor Marage, 7, has shown that : 
 "In the experiments in rooms of the Troca- 
 dero, Chapel of the Sorbonne, Academy of Medi- 
 cine and Richelieu Amphitheatre, it is at once 
 seen that in ail these rooms bass voices have a 
 great disadvantage, since they must employ an 
 energy 7 to 16 times greater than a tenor voice: 
 the baritone voices are intermediate, while ap- 
 proaching much closer the tenor voice. A tenor 
 must expend four times more energy in the 
 Trocadero than in the Richelieu Amphitheatre ; 
 on the contrary, a bass voice is obliged, accord- 
 Energy ing to the room, to give an energy nine times 
 expended greater." 
 
 in singing May not singing or speaking constantly in 
 rooms and auditoriums with varying acoustic 
 qualities requiring the expenditure of varying 
 amounts of energy, influence the development 
 and size of the tonsils ? Some vocalists tire more 
 easily than others ; some vocalize with more ease, 
 and some with greater energy ; some with greater 
 power; some practice with regularity, and some 
 at irregular intervals ; all of these factors have 
 a bearing upon the voice mechanism, and, nec- 
 essarily, upon the character of the tonsils. 
 
 Dr. Raonlt, 8, (Nancy), in an excellent paper 
 on "Du Choix dn Procede pour V Ablation des 
 Amy gd ales," states that : 
 
 "The cicatrization of the operatory wound is 
 slow: it lasts from 10 to 12 days at the mini- 
 Healing of mum. While the scab is in place, the operated 
 wound surface is almost non-sensible, during the first 
 after half day; but then, as it begins to fall towards 
 removal the fifth or sixth day, it often becomes very pain- 
 ot tonsils ful and the pain sometimes lasts for four to 
 five days. Finally, at the moment of the fall of 
 the scab, secondary hemorrhages are not rare." 
 The experience of Raonlt is not exceptional. 
 
 12 
 
Pain and 
 hemorrh- 
 age after 
 
 removal 
 are due to 
 
 mechan- 
 ical 
 
 causes 
 
 Tonsils 
 are mech- 
 anical, 
 acoustic 
 
 and 
 
 phonetic 
 
 organs 
 
 Masini's 
 theory 
 
 I mention it for the purpose of suggesting that 
 both the pain and the frequent secondary hem- 
 orrhages that occur, after operations upon the 
 faucial tonsil, are sometimes due, partly or 
 wholly, to mechanical causes, to the manipulation 
 and massage of the organ by the muscles that 
 surround it. 
 
 The faucial tonsil is a mechanic .acoustic and 
 phonetic organ. This fact is not inconsistent 
 with the belief that the organ may have, also, 
 functions of a different nature; that it may pos- 
 sess physiologic and biologic functions, accord- 
 ing to some savants. 
 
 Masini, 9, (Genoa), "believes that the tonsil 
 has an inner secretion similar to that of the 
 suprarenal and other glands." He injected many 
 animals with the extract of tonsil, and produced 
 an increase of the arterial pressure. Scheier, 10 
 (Berlin) made analogous experiments by which 
 he produced a decrease in arterial pressure. 
 Pugnat, 11 (Brussels) repeated these experi- 
 ments, but could not produce either increase or 
 decrease in the arterial pressure. Masini, 
 Scheier and Pugnat had all three different re- 
 sults. Scheier and Pagnat disagreed with each 
 other, and they both disagreed with Masini. 
 There were three different results by three dif- 
 ferent experimenters. 
 
 Caldera, 12 (Turin), in his research, has re- 
 ported negative results following injection of 
 tonsillar extract into animals. 
 
 Masini has had the same results in many cases, 
 but Scheier and Pugnat having come to no con- 
 clusions, there is good reason why Masini's ex- 
 periments should be repeated, under the identi- 
 cal circumstances as to the strength, quantity and 
 freshness of the extract, as well as the exact 
 physical conditions of the subjects to be experi- 
 mented upon, as in the investigations conducted 
 by Masini himself. That the tonsil has, or has 
 
 13 
 
not, an internal secretion, is a question by no 
 means settled. May it not, possibly, have a 
 secretion, secondary or assistant to the other in- 
 ternal secretory glands ; a secretion which ceases 
 at about eighteen years of age? The fact that 
 the faucial tonsil is of unusually large size in 
 twenty per cent, of all persons from three to 
 eighteen years of age, that is, during the period 
 of the general growth of the body, is notewor- 
 thy and important. There must be some good 
 physiologic reason for the enlargement. 
 
 Professor Escat, 4 , (Toulouse) believes that 
 Escat's the tonsil secretes a principle useful in the devel- 
 theory opment of the system, and probably to the growth 
 of the skeleton. 
 
 Professor Brieger, 6, believes that the faucial 
 tonsil is a protective organ. He says : 
 
 "It can be proved that lymphocytes in lesser 
 or greater degree are always present in the epi- 
 thelium of the tonsils. We have to assume a 
 vehicle which carries the lymphocytes from the 
 adenoid tissue. The cause of the movement of 
 the lymphatic current is to be found," according 
 A protect- to p ro j essors Brieger, 13, and Goerke, 13 (Unl- 
 ive organ vers ity f Breslau), "in a difference of pressure 
 in the afferent lymphatic vessels and the free 
 surface. Increase of blood pressure increases 
 the force of the lymphatic current. Therefore, 
 if the blood pressure is increased, the lymphatic 
 juice flows stronger and quicker through the epi- 
 thelium, and carries along a larger amount of 
 lymphocytes out of the adenoid tissue." 
 
 Professor von Levinstein, 13 (University of 
 Berlin) says: 
 
 "Brieger assumes a current which permanent- 
 Brieger's ty flows through the whole organ from the in- 
 current s * f l e to the outside and which carries along more 
 theory or ^ ess lymphocytes. But nobody has seen this 
 current, and we are not entitled to see in the 
 
 14 
 
Closed 
 
 lymphatic 
 
 canals 
 
 Faulkner's 
 massage 
 theory 
 
 histologic picture of the tonsil a proof for the 
 existence of the current." 
 
 The blood supply to the faucial tonsil is scant. 
 It possesses no nerve of sensation. It is pecu- 
 liarly free of lymphatics, excepting a system of 
 closed lymphatic canals occupying the center of 
 the tonsil which do not open into the connective 
 tissue reticulum by stomata nor by gaping ex- 
 tremities. It has no known connection with 
 neighboring lymphatics, through its surface. The 
 sheath of the tonsil is not perforated by lympha- 
 tics, nerves or bloodvessels. 
 
 There is no proof that it has any absorptive 
 power. If it has no absorptive power, then, it 
 is not a menace to the system. 
 
 Must we admit, without proof, that a lymphatic 
 current flows through the faucial tonsil? Must 
 we assume this for the sake of science? 
 
 Admitting, only for the sake of argument, 
 that a lymphatic current does flow through the 
 faucial tonsil, as Professor Brieger, 13, claims, 
 is it necessary to assume that it is forced through 
 by the pressure of the blood? When we think 
 of the powerful musculo-fibro-aponeurotic 
 sheath that firmly envelopes the tonsil and which 
 sends fibrous outrunners along the walls of the 
 blood vessels that run through the body of the 
 organ and into the folds of the mucosae, and 
 then of the situation of the tonsil, amidst a frame- 
 work of active muscles, the author asks : 
 
 May not the transudation of lymphocytes and 
 phagocytes from the inside of the tonsil to its 
 epithelial surface, when these muscles are in 
 action, take place upon the same principle and 
 according to the same force in physics whereby 
 milk comes to the surface in the process of the 
 working of butter, and just as oil comes to the 
 surface in the manipulation of putty? May not 
 the appearance of lymphocytes and phagocytes 
 upon the surface of the tonsil be due entirely to 
 
 15 
 
Keep the 
 nose 
 clean 
 
 the mechanical massage of the organ, and not at 
 all due to any assumed lymphatic current, blood 
 pressure or physiologic action whatsoever? The 
 act of singing and public speaking congests the 
 tonsil, as well as manipulates it. Vocalization 
 massages the tonsil. It is pulled, pushed and 
 compressed. May not the central system of 
 closed lymphatic vessels by mechanical pressure, 
 such as occurs in vocalization, exude lymphocy- 
 tes? 
 
 Professor A. Jacobi, 28, with his accustomed 
 clinical acumen, emphasizes the fact that if there 
 were more care exercised in keeping the pas- 
 sages of the nose clean, so many operations on 
 the tonsils would probably not be necessary ; not 
 nearly so many as some gentlemen seem to 
 think. 
 
 Professor B. Fraenkel, 21, states that "if you 
 inject Chinese Tusch (black color) under the 
 lining of the nose of rabbits, dogs and 
 hogs, you can show in a short time these 
 color particles in the tonsils. After cer- 
 tain operations in the nose tonsillitis oc- 
 curs. If we try to understand these observa- 
 tions, we must assume that germs from the nose 
 have entered the tonsils; that the operation in 
 the nose has opened the door through which the 
 germs can advance by way of the lymphatic cir- 
 culation to affect the tonsils. This idea affords 
 for these infectious diseases another considera- 
 tion. We now cannot think any more that they 
 are caused by micro-organisms advancing 
 through the mouth." 
 
 Professor Goerke, 13, agrees with Jacobi and 
 Fraenkel, that "Infectious germs in the nose (af- 
 
 auaian.o ^ nasa i operations) can be transported by way 
 of the lymphatic vessels to the interior of the 
 tonsils and there produce local symptoms." 
 And Professor von Levinstein, 13, states that: 
 
 infections "Tonsils are frequently affected in a secondary 
 
 16 
 
 Germ3 
 from the 
 
 nose 
 enter the 
 
 tonsils 
 
 Goerke 
 sustains 
 
 Fraenkel 
 Tonsil 
 
are sec- way, after operations in the nose, by way of 
 mSms? the 'ymphatic canals. 
 
 Professor Poll, 29, has proved that the lym- 
 phatic regions of both nostrils are connected by 
 Nostrils lymph channels which surround the free edge of 
 are . c ^ n " the back of the nasal septum and at the front, 
 lyrmh though to a less degree, by vessels which pierce 
 channels the septal cartilages. These are newly acquired 
 
 facts in anatomy and are important. 
 Direct com- Professor von Lenart, 30, has proved the ex- 
 betweenth'e istence of a direct communication between the 
 tlfetonsu lining of the nose and the interior of the tonsil, 
 
 by way of lymph channels. 
 nlulScaSoii ^ e nas proved, also, the existence of a direct 
 between the communication, by way of lymph channels, be- 
 
 intenors of ' . J •> ■> l .' 
 
 both tonsils tzveen the interiors of the two iaucial tonsils. 
 
 Von Lenart has proved that the tonsil becomes 
 Von Lenart infected from the invasion of germs from the 
 Jacobi nose > by way °f the lymph channels. His data 
 Fraenkel prove the correctness of the statements of Jacobi, 
 and _ Fraenkel, von Levinstein, and others. He as- 
 Levir.stesn sures us that infectious material is carried from 
 the nose to the tonsil. 
 „ ., Von Lenart 's, 31, teaching confirms August 
 
 observa- Most's contention concerning the course of the 
 tions are lymph current in the nose and throat, which the 
 confirmed latter arrived at through his anatomical studies. 
 It therefore makes no difference as to how 
 clean you keep the oral surface that covers the 
 tonsil, septic material may pass from one tonsil 
 to the other, underneath the mucous membrane 
 Seotic ^ at nn es the mouth, by way of the lymph chan- 
 materlal nels. This fact gives us a very different under- 
 passes standing from the common and false idea that 
 under the j-he tonsils are full of holes, and that they are 
 infected from matter that collects in the oral 
 cavity and which, after having soaked through 
 the lining of the mouth then soaks into the ton- 
 sil which lies underneath. Such a physiologic 
 feat is impossible, 2J. 
 
 17 
 
Tonsils are filters, 27. In all cases, where 
 the tonsils are plainly visible, they can be seen 
 to enlarge during attacks of common cold (acute 
 inflammation) affecting the nasal passages. And 
 Tonsils in all such cases, after the nose has been cleansed 
 are filters and sterilized, 27, the tonsils will decrease in 
 size. This decrease is often noticeable within 
 an hour after cleansing and sterilizing. This 
 alternate increase and decrease in size, I have 
 observed in many cases. Tonsils filter filth that 
 accumulates in the nose, 39. 
 
 _ .. Tonsils are protective organs. They protect 
 
 are the general system from the invasion of germs. 
 protective They protect the system from the infections of 
 organs rheumatism, diphtheria, measles and other infec- 
 tious diseases. 
 When When actively engaged in the process of fit- 
 
 actively tration, tonsils always swell, and when thus en- 
 engaged, larged, ignorant persons erroneously believe that 
 they swell the enlargement is a sign of disease. But it 
 
 is only natural. 
 ^fh?°" S Professor Brieger, 32, states that : "Gener- 
 t ons jl sa 9 re ally, people who have enlarged tonsils are very 
 healthy healthy." 
 
 Children Professor Fraenkel, 21, 13, 27, states that: 
 
 with large "Children with large tonsils are less easily in- 
 
 ton easiiy e88 fected with diphtheria than children with small 
 
 infected tonsils." 
 
 _, ,_, Children with large tonsils are therefore best 
 
 Children , , r • r ° • ,. . - 
 
 with large protected from infectious diseases and from m- 
 ton best are vasion of filth of all kinds. Children with large 
 protected tonsils are always large, well grown and healthy. 
 
 27, 39- 
 
 The size of the tonsil, in children, is in direct 
 proportion to the amount of protection demand- 
 Protection. ec * ^ tne child. Subsequent involution, or de- 
 Immunity crease m slz e> is, as Professor Goerke 32, states, 
 "an expression of immunity against certain in- 
 fections, especially peculiar to childhood." 
 
 He also says, 33 : "The tonsils are protective 
 
 18 
 
regrow 
 
 Bad 
 
 results 
 
 after 
 
 removal 
 
 Diseased 
 tonsils are 
 not more 
 liable to 
 infection 
 
 organs. After removal, they regrow in all cases. 
 
 The regrowth, however, is not so large as the 
 
 After original tonsil. The same causes which led to 
 
 removal, the m " st enlargement, also lead to the new growth. 
 
 tonsils These regrowths occur more often than we think, 
 
 but we do not know about them. Patients don't 
 
 •talk about the return, because they don't want 
 
 to be operated on again." 
 
 The regrowth appears to be nature's protest 
 against removal. But adjacent structures injured 
 or destroyed in removal are not restored. 
 
 Professor Haymann, 34, says : "Operations 
 on the tonsils are looked on as being without 
 danger. However, bad results do occur. As a 
 rule, the habit of reporting bad results is not 
 often followed." 
 
 Professor Grober, 35, says: "Many authors 
 have considered diseased tonsils as more liable 
 to microbial infection than healthy ones. // that 
 is true, it has not been proven/' 
 
 Professor Hicguet, 36, wisely remarks that : 
 "It seems evident that the hypertrophied and 
 diseased tonsil could not come to the defense of 
 the system, while the normal tonsil could not be 
 a source of infection." 
 
 Professor Lermoyez, 37, says : "The normal 
 tonsil is an organ that must be respected. How 
 greatly w r ould the number of operations on the 
 respected tonsils diminish if only those which necessity 
 imposed were performed." 
 
 In conclusion : While the future may prove 
 new physiologic or biologic functions for the ton- 
 sil, it must be said that that surgeon who, at the 
 Author's present time, tears the tonsil from the throat 
 ;onclusion as though it were a trivial matter, will find that 
 its removal is always followed by an interference 
 with, and generally by a permanent destruction 
 of, values in the mechanism of the voice. 
 
 19 
 
The faucial tonsil is an integral part of a 
 
 Tonsil is natural throat, A VOX POSTIS, or "SOUND- 
 
 a VOX POST," in the mechanism of speech and song. It 
 
 POSTIS supplements a natural deficiency and completes the 
 
 original mechanism engaged in voice production. 
 
 Acting as a buffer organ in swallowing and as 
 
 a cushion, it protects from injury the internal 
 
 carotid artery and other delicate parts that lie 
 
 The tonsil underneath. After the tonsil is removed, this 
 
 protects important artery is permanently exposed to in- 
 
 the caret- j ur y m These mechanical facts are important. 
 
 id artery ^ na \ ^ j s a j so important to remember that the 
 
 process of swallowing food in aged people is 
 
 sometimes slow, choking and embarrassing. This 
 
 mechanical insufficiency is always more marked 
 
 when tonsils have been removed. 27. 
 
 The tonsil assists in supporting the muscles of 
 
 the palati?ie arch. It acts as a keystone. After 
 
 The tonsil * ts remova l> the pillars of the arch always sag, 
 
 supports usually from a quarter to a third of an inch, the 
 
 the palat- mechanism of the voice is damaged and the 
 
 ine arch quality of the voice is impaired. Even after the 
 
 extraction of a wisdom tooth, the arch often sags, 
 
 and the voice becomes badly affected. 
 
 Author's Based upon his studies concerning the me- 
 deduc- chanical utility of the faucial tonsil, the author 
 tions: is pleased to present the following deductions : 
 
 1. The faucial tonsil plays an important role 
 in the mechanism of voice production. 
 
 This conclusion is supported by the teachings 
 of Garcia, I, Signor Lamperti, 4, Mme. Cap- 
 piani, 4, Mme. Mott, 4, Mme. Clara Kathleen 
 Rogers, 4, Alexander Graham Bell, 14, Marage, 
 3, Moure, 4, (Bordeaux), Escat, 15 (Toulouse), 
 Van Bag gen, 4, and Dr. Frank E. Miller, 2. 
 
 2. The mis-use of the voice by an incorrect 
 method in singing or speaking acts in a mechani- 
 
 20 
 
cal way in causing enlargement, or disease, of 
 the tonsil. 
 
 This conclusion accords with the teachings 
 of Tosi, 1 6, Shakespeare, 4, Mme. Lilli Lehmann 
 4, Mme. Emma Seller, 17, Cast ex, 18 {Paris 
 and Van Bag gen, 19. 
 
 3. Tonsils enlarged, or diseased, through a 
 w T rong method of voice production, may be cured 
 by the institution of a correct method. 
 
 This conclusion is sustained by the teachings 
 of Tosi, 16, Shakespeare, 4, Mme. Lehmann, 4, 
 and Mme. Seiler, 20. 
 
 4. Tonsils that are swollen, tender and pain- 
 ful, caused by mis-use of the voice, will, in turn, 
 by their abnormal condition, hinder the proper 
 action of the voice mechanism, and this hindrance 
 will be relieved by the proper use of the voice. 
 
 This conclusion harmonizes with the teachings 
 of Garcia, 1, Shakespeare, 4, Mme. Lehmann, 4, 
 Mme. Seiler, 20. 
 
 5. Removal of the normal faucial tonsil in- 
 terferes with the natural mechanism of the voice. 
 
 The removal of the normal tonsil is strongly 
 condemned by Von Chiari, 4, (Vienna), Mar age, 
 
 3, Lermoyez, 4, (Paris), Escat, 15, Fraenkel, 21 
 (Berlin), Van Baggen, 4, Von Levinstein, 13, 
 (Berlin), Schmiegelow, 4 (Copenhagen), A. 
 Jacobi, 4, Sir Felix Semon, 4, 22, Richard Loew- 
 enberg, 4 ( Berlin ), Garcia, 1.27, Signor Lamberti, 
 
 4, Mme. Cappiani, 4, Mme. Lehmann, 4, Mme. 
 Mott, 4, Mme. Nordica, 4, Mme. Schumann- 
 Heink, 4, George Ferguson 4, Sir Charles Sant- 
 ley, 4, Jean De Reszke, 4, and David Bispham, 4. 
 
 6. The presence of the faucial tonsil being 
 essential as a factor in voice production, its ab- 
 sence necessarily interferes with the perfect ac- 
 tion of the mechanism. 
 
 7. The mere absence of the faucial tonsil im- 
 pairs and weakens — and the presence of adhe- 
 
 21 
 
sions, scars and contractions incidental to its 
 removal, interferes with — the mechanism of the 
 voice. Precious voices have the most delicate 
 mechanism — the more delicate, the more easily 
 it is thrown out of order. 
 
 This conclusion agrees with the experiences 
 of Sig. Sebastiani, 4, (Naples), and Loewen- 
 berg, 4. 
 
 8. The natural mechanism of the voice can 
 never be improved by surgical means. There are 
 no times at which a voice user's throat requires 
 radical treatment, or surgical operation .with any 
 assurance of improving the voice. 
 
 Surgeons who promise that cutting the tonsils 
 will enrich the voice, are promising just the con- 
 trary to the experiences of Garcia, 1, Mme. 
 Viardot-Garcia, 27, Lamperti, 4, Mme. Cappi- 
 ani, 4, Signor Marchesi, 23, Mme. Lehmann, 4, 
 Mme. Adelina Patti, 4, Mme. Nor die a, 4, Mme. 
 Schumann-Heink, 4, Mme. Von Klenner, 4, 
 Mme. Mott, 4, Signor Sebastiani, 4, Richard 
 Loewenberg, 4, and David Bispham, 4. 
 
 9. Beautiful voices accompany large tonsils. 
 "The most beautiful voices have large tonsils," 
 was the statement made to the author by Mme. 
 Cappiani, 4. And her brother, Frederic Young, 
 24, dramatic tenor of the Royal Court Opera, in 
 Munich, found that "all prima-donnas with ex- 
 traordinary voices had big tonsils." 
 
 Among 8,000 school children, examined by Dr. 
 Nenstaedtler, 5, of New York, "tonsils were 
 largest in the best pupils, and the best singers 
 had fifty per cent, more tonsils than the poorest." 
 
 10. Enlarged tonsils in experienced profes- 
 sional singers should never be removed. The 
 larger the tonsil the more it should be let alone. 
 This conclusion is in strict accord with the teach- 
 ings of Von Chiari, 4, 25, Mme. Lehmann, 4, 
 and John Howard, 26 (Boston). 
 
 22 
 
II. Persons who have large tonsils are gen- 
 erally very healthy. 
 
 The fact that twenty per cent, of all persons 
 between three and eighteen years of age have 
 unusually large tonsils is evidence that such 
 enlargement is not accidental. Mere size is no 
 indication of disease. A large tonsil in a 
 large mouth is normal : whether it is out of 
 proportion depends upon individual circum- 
 stances. Conversely, it may be normal in struc- 
 ture, and yet be too small to properly perform 
 its mechanical functions in speech and song. That 
 those persons who have large tonsils are gener- 
 ally very healthy, is the firm declaration of 
 Brieger, 6, Georke, 13, and Fraenkel, 21. 
 
 The foregoing deductions from the experi- 
 ence of the author, supported as they are by pre- 
 eminent authority, assure us that the faucial ton- 
 sils are natural organs, and that their existence, 
 Author s as we jj as ^heir variations in physical charac- 
 . ter, are due to physiologic demands. All the 
 deductions dj seases which have been attributed to their 
 presence, as a matter of course exist, but have 
 nothing to do with them. Stupidity, retarded 
 and impaired mental faculties, rheumatism, heart 
 disease, frog-face, pigeon-breast, and so forth, 
 require some other explanation than the pres- 
 ence of the tonsils. To the same degree that 
 we have gained in our knowledge of the anatomy 
 and functions of the tonsil, the organ has lost 
 its unmerited reputation as a cause of disease. 
 Nothing should more excite interest in and 
 Tonsils stimulate further study of the organ than the 
 must be var * e ty °f vocal and mechanical functions, which 
 respected ^ iave now been ascribed to it. Every new ray of 
 protected %^ thrown upon the subject serves more thor- 
 and oughly to confirm its mechanic, acoustic, and 
 preserved phonetic functions. The clinical and anatomic 
 studies of Jacobi, Fraenkel, Goerke, von Levin- 
 stein, Poli, von Lenart, Most, Brieger, Grober 
 
 23 
 
and Hicquet have firmly established its physio- 
 logic importance. Upon the facts presented in 
 this treatise, I trust that hereafter the vocal, me- 
 chanic, and physiologic functions will become 
 more clearly recognized and the tonsil more re- 
 spected, protected and preserved. 
 
 24 
 
REFERENCES. 
 
 1. Garcia, Manuel, Hints on Singing. E. Schuberth & Co., 
 New York, 1894. 
 
 2. Miller, Dr. Frank E. The Voice. E. Schirmer, New 
 York. 
 
 3. Marage, Professor: Etude des Vibrations Laryngien- 
 nes: Paris, Nov. 22, 1909. 
 
 4. Information personally communicated to the author. 
 
 5. Neustaedter, Dr. : Society of Medical Inspectors of the 
 City of New York, Dec. 4, 1908. 
 
 6. Brieger, Professor: Beitrage zur Pathologie der Rach- 
 enmandel. Archiv fur Laryngologie. Bd. 12, 1909, 
 Berlin. 
 
 7. Marage, Professor: La Portee de Certaines Voix et la 
 Travail developpe Pendant la Phonation. Paris, 1905, 
 1906. 
 
 8. R n oult, Dr. : Du Choix du Procede pour L' Ablation des 
 Amygdales. A Crepin-Leblond : Nancy, 1911. 
 
 9. Masini : The Internal Secretaion of the Tonsil. New 
 York Med. Jour. September, 1898. 
 
 10. Scheier: Zur Physiologie der Rachen und Gaumenman- 
 del. Berliner Laryngol. Gessellschaft, 1903. 
 
 11. Pugnat: Zur Physiologie der Mandeln. Belg. Oto- 
 Laryngol. Gesellsch. Brussels, 1903. 
 
 12. Caldera : Ricerche sulla fisiologia delle tonsille pala- 
 tine. Turin, 1913. 
 
 13. Von Levinstein, Professor : Kritisches zur Frage der 
 Funktion der Mandeln. Archiv fur Laryngologie. Bd. 
 23. 1 Heft. Berlin, 1909. 
 
 Also read : 
 
 Brieger, Professor : Beitrage zur Pathologie der Rachen- 
 
 Mandel. Archiv fur Laryngologie. Bd. 12, 1909. Berlin. 
 
 Also read : 
 
 Goerke, Professor: Kritische zur Phyiologie der Ton- 
 
 sillen. Archiv fur Laryngologie, Bd. 19, 1907. Berlin. 
 
 14. Bell, Professor : The Mechanism of Speech. New 
 York, 1908. 
 
 15. Bscat, Professor: Maladies du Pharynx. Mason et Cie: 
 Paris. 
 
 25 
 
16. Tosi: Observations on the Florid Song. 1723, 1743. 
 Reprinted from second edition by Wm. Reeves. Lon- 
 don, 1905. 
 
 17. Seller, Mme. Emma : The Voice in Speaking. Phila- 
 delphia : J. B. Uppincott, 1875. 
 
 18 Castcx, Professor: Maladies de la Voix. Paris, 1902. 
 
 19. Van Baggcn, Professor: New York Medical Record, 
 January 5, 1907. 
 
 20. Seller, Mme. Emma : The Voice in Singing. Phila- 
 delphia: H. B. Uppincott. 1887. 
 
 21. Fraenkel, Professor B. : Die Infektiosen Erkrankungen 
 des Rachens. Zeitschrift fur artzliche Fortbildung. 
 Berlin. 1910. 
 
 22. Semon, Sir Felix : Diseases of the Upper Air Passages 
 London: MacMillan & Co. 1902. 
 
 23. Marchesi, Signor Salvatore : A Vademecum. New 
 York: G. Schirmer. 1902. 
 
 24. Young, Frederic : Hints and Helps for Perfection in 
 Singing, by Mme. Cappiani. New York : Leo Feist. 
 
 25. Von Chiari, Professor O. : Die Krankheiten des Rach- 
 ens. Leipsic und Wien. 1903 
 
 26. Howard, Professor John : Physiology of Artistic Sing- 
 ing. Boston. 1886. 
 
 27. Faulkner, Dr. Richard B. : The Tonsils and the Voice in 
 Science, Surgery, Speech and Song. Pittsburgh : The 
 Blanchard Company. 1913. 
 
 28. Jacobi, Professor A. : The Medical Record. New York, 
 August 19, 1911. The Tonsil as a Portal of Microbic 
 and Toxic Invasion Archives of Pediatrics. New 
 York, July, 1906. Tonsils or General Lymph Apparatus 
 of the Pharynx — Which? Archives of Pediatrics, New 
 York. September, 1906. 
 
 29. Poll, Dr. : The Lymphatic Apparatus of the Nose and 
 Naso-Pharynx in its Relations to the Rest of the Body. 
 Third International Laryngo-Rhinological Congress. 
 Berlin. August and September, 1911. 
 
 30. Von Lenart, Professor: Archiv fur Laryngologie unj 
 Rhinologie. Band XXI. Heft 3, 1909. 
 
 31. Most, Professor August : The Topography of the Lymph 
 
 26 
 
vessel Apparatus of the Head and Throat in their Signi- 
 ficance for Surgery. Breslau. 1906. 
 
 32. Brieger, Professor O. : Zur Genese der Rachenmandel- 
 hyperplasie. Archiv fur Laryngologie. 12 Bd. 2 Heft. 
 
 33. Goerke, Professor : Die Involution der Rachenmandel : 
 Archiv fur Laryngologie, 16 Bd. 1 Heft. 
 
 34. Goerke, Professor : Ueber Recidive der Rachenmandel- 
 hyperplasie. Archiv fur Laryngologie. 12 Bd. 2 Heft. 
 
 35 Haymann, Professor : Ueber Blutengen nach Exsision 
 der Rachenmandel. Archiv fur Laryngologie. 21 Bd. 
 1 Heft. 
 
 36. Grober, Professor: Die Tonsillen als Eintrittspforten 
 fur Krankheitserregen, besonders fur den Tuberkel- 
 bazillus. Jena. 1905. 
 
 37. Hicguet, Professor: Fonctions et utilite de Tamyg- 
 dale Palatine. Etude de nhysio-pathologie de cet organe 
 
 La Presse Oto-Laryngologique. Beige. Brussels. No. 
 7, 1910 
 
 38. Lermoyez, Professor: Des Accidents Qui Arrivent a la 
 Suite Des Operations Intra-Nasales. Annales des Mala- 
 dies de l'oreille et de larynx. Paris, 1891. 
 
 39. Faulkner,Dr. Richard B.: Tonsils and Adenoids: Treat- 
 ment and Cure. Pittsburgh: The Blanchard Company. 
 1915. 
 
 27 
 
BY THE SAME AUTHOR. 
 
 The Treatment of Spasmodic Asthma. New York Medi- 
 cal Record, Sept. 25, 1880. 
 
 The Treatment of Asthma. New York Medical Record, 
 Feb. 10, 1883. 
 
 The Treatment of Pulmonary Consumption. New York 
 Medical Journal, Oct. 20, 1883. 
 
 An unusual effect of Ergot. New York Medical Journal, 
 June 14, 1884. 
 
 The Cure of Asthma. New York Medical Record, Jan. 
 24, 1885. 
 
 The Removal of Hair by Electrolysis. New York Medical 
 Record, July 20, 1889. 
 
 A Peculiar Growth of Hair on the Face. New York Medi- 
 cal Journal, Aug. 9, 1890. 
 
 Laryngitis in Vocalists. New York Medical Journal, 
 April 11, 1891. 
 
 Electro-Therapeutics in the Practice of Dermatology. The 
 Journal of Electro-Therapeutics, New York, Sept., 1891. 
 
 A collective Inquiry concerning Intubation. Philadelphia 
 Medical News, April 9, 1892. 
 
 Free Hydrochloric Acid — Is Its Absence from the Stom- 
 ach a Sign of Cancer? The Journal of the American Medi- 
 cal Association, March 2, 1895. 
 
 Why not Adhere to the United States Pharmacopeia? 
 American Medicine, April, 1907. 
 
 No Free Hydrochloric Acid in the Stomach. New York 
 Medical Journal, June 26, 1909. 
 
 Tonsil Research. Medical Record. New York, July 9, 
 1910. 
 
 Reflex Affections of the Tonsil. New York Medical Jour- 
 nal, August 5, 1911. 
 
 The Tonsils and The Voice, in Science, Surgery, Speech 
 and Song. The Blanchard Company, Pittsburgh, Pa., 1913. 
 
 Tonsils and Adenoids : Their Treatment and Cure. The 
 Blanchard Company, Pittsburgh, 1915. 
 
 29 
 
The Tonsils and The Voice 
 
 IN 
 
 Science, Surgery, Speech and Song 
 
 A RESEARCH STUDY 
 
 With Original Contributions from the 
 Highest Medical and Voice Authorities 
 
 By RICHARD B. FAULKNER, M, D. (Columbia University) 
 
 FOUR HUNDRED PAGES. ILLUSTRATED. TWO DOLLARS 
 
 THE LANCET (London): "Readers will feel indebted to 
 Dr. Faulkner. The method of treatment of the subject is cer- 
 tainly one sui generis, but specialists should be none the less 
 grateful foT so much information and such a gathering of famous 
 opinions." 
 
 MEDICAL RECORD (New York): "The author strikes a 
 timely note of conservatism, which it is to be hoped will reach 
 the ears of the many who are given to operate on every slight 
 pretext." 
 
 THE ETUDE (Philadelphia): "Dr. Faulkner's work is a 
 splendid testimony to the thoroughness of modern American 
 scholarship." 
 
 JOURNAL OF EDUCATION (Boston): "This is a work of 
 great merit, not only because of the patient research made by 
 the author, but also because of the original contributions pre- 
 sented from the highest medical and voice authorities of this 
 and other countries. As tonsils in the author's judgment have 
 so intimate a relation to the voice, he is averse to any ignorant 
 surgery in connection with these delicate organs. This work 
 embodies the results of long study and his conclusions are most 
 interesting." 
 
 SCIENTIFIC AMERICAN (New York): "Lamperti, Shakes- 
 peare, Nordica, Lehmann, Sir Charles Santley, and a host of 
 other teachers, singers, and physicians state in this work their 
 experiences and their positions. The anatomy and physiology 
 of the tonsil is lucidly dealt with; a chapter on the science of 
 the vocal art throws many sidelights upon important phases 
 of the subject; and some sane advice is embodied in the chapters 
 on hygiene of the faucial tonsil and the principles of treatment. 
 It is a work everyone should read, and one that vocalists will 
 find particularly beneficial." 
 
 THE BLANCHARD COMPANY, PITTSBURGH, PA. 
 
OtlSils and Adenoids 
 
 Treatment and Cure 
 
 From the standpoint of the Physician and Laryngologist 
 In preference to that of the Surgeon and Laryngectomist 
 
 By RICHARD B. FAULKNER, M. D. (Columbia University) 
 
 This work covers every disease of the tonsils and adenoids and 
 fits the details of treatment into every case. It is written by a physi- 
 cian of practical experience in the treatment of thousands of cases. 
 It is published with the object of furnishing a medical line of treat- 
 ment which has already secured positive curative results, and which 
 can be used at home or office, without the hospital and the knife. 
 It is written in plain English, and gives the author's prescriptions. 
 
 The book is small but practical; no words nor paper wasted; 
 no padding used for the publisher's benefit. 
 
 This book is a companion and key to the work on The Ton- 
 sils and The Voice. These two books form a scholarly presentation 
 of the knowledge of the world upon tonsils and adenoids ; broadly 
 educational; encyclopedic in character; international m scope. They 
 furnish technical information to voice mechanicians, voice teachers 
 and voice users ; aid the throat expert ; guide the family doctor ; 
 and teach the mother. They show to life insurance companies the 
 great value of the tonsil as a mechanical protection to the internal 
 and exteranal carotid arteries. They provide lawyers with the 
 strongest foundation for medical jurisprudence on the subject. 
 
 Those who have alread}' purchased The Tonsils aid The Voice, 
 have the privilege of buying the companion volume, Tonsils and 
 Adenoids: Treatment and Cure, for one dollar, 
 
 If you desire the books, order of the publishers promptly as 
 the edition is limited. 
 
 THE BLANCHARD COMPANY, PITTSBURGH, PA. 
 
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