Treatment.—A thorough application of a solution of nitrate of silver of the strength of 1 or 2 drachms to the ounce of water frequently aborts the attack, if applied early. The silver lution should be painted upon the tonsils and adjacent inflamed mucous membrane by means of a swab of cotton and in croupous tonsillitis carried into the crypts after washing them out with peroxide of hydrogen by means of a modified Blake cannula. The relief experienced by the patient as the result of the application is almost instantaneous, and the appli cation should be repeated once or twice a day until all inflammatory symptoms have subsided. The nares and pharynx should be washed by means of a spray from an atomizer containing Dobell's so lution before making these applications, and a lozenge of guaiac and tannin may be prescribed for the patient's use in the intervals between the applications. It is best also to open the patient's bowels thoroughly at the commencement of an attack by means of small, frequently re peated doses of calomel. When these measures do not succeed in aborting the attack, but the fever and suffering of the patient are constantly increasing, aconite, in drop doses of the tincture every hour or every two hours, will give most excellent results.
At the onset of acute catarrhal tonsil litis a saline purgative should be adminis tered and the tonsils and pharynx should be sprayed or brushed every hour with a solution of:— Formalin, 15 to 20 minims.
Potass. chlor., 1 drachm. Liq. ferri chlor., 1 drachm.
Aquae nicotine pip., q. s. ad 4 ounces.
M. Sig.: Use as spray.
Early in the disease cold applied in ternally in the form of gargles or cracked ice in the mouth, and externally in the form of cold compress or ice-bag is of invaluable aid. The patient should drink frequently of equal portions of cold milk and Vichy. For the febrile condition antipyrine is to be administered, and in conjunction a capsule containing the fol lowing is given:— Fk Quinine hydrobromat., 1 grain.
Sodii benzoatis, 2 grains.
Salol, 5 grains.
M. et ft. cap. No. j.
Sig.: One every three hours.
If the inflammation extends to the deeper tissues, the tonsils and surround ing structures become cedematous and interfere with deglutition. Multiple punctures and scarifications are then in dicated in order to produce free bleeding, and at this stage heat applied internally, in the form of gargles and hot drinks, and externally, in the form of poultices and fomentation-, is indicated. J. H. Abrabiun (Jour. Allier. Med. Assoc., .1 uly 21, 1900).
The official tincture of iodine applied directly to inflamed and swollen tonsils recommended. The application is fol lowed by severe burning which lasts a couple of minutes, but which is relieved at the end of that time by gargling with plain water. Sixty-eight eases of acute
catarrhal and follicular tonsillitis were successfully treated by this method. I le lief from distressing symptoms was ob served within five minutes after the ap plication. Commonly the swelling and redness decreased rapidly. If used early in the disease it frequently aborts the in flammatory process. Samuel Floersheiin (New York Med. Jour., Oct. 5. 1901).
When pus has formed, the abscess should be opened by an incision through the anterior pillar at the upper portion of the tonsil, the so-called point of elec tion; or at any spot where the finger detects fluctuation. Even where no pus escapes from the incision, the bleeding affords a certain amount of relief. and may bring about resolution of the inflam mation.
In suppurative peritonsillitis after a thorough application of cocaine a thick stiff probe should be passed into the supratonsillar fossa. A slight pressure outward and slightly upward often suf fices to make a way through the soft ened wall of the abscess-cavity. If pus appears, a sinus forceps may be passed into the cavity and opened. It is well to repeat this latter procedure on two suc cessive days; in this way the pus can be thoroughly evacuated. Killian (Munch. med. \Voch., July 2S, '96).
In an attempt to abort peritonsillar abscess, a good dose of calomel is given, followed by a saline purge. The tonsil and surrounding pillars are painted thoroughly with a GO-grain solution of nitrate of silver, and this is repeated once daily. Hot gargles of vinegar and hot water, as hot as can be borne, should be begun early, and then hot fomenta tions applied externally. Salol and phenacetin always make the patient feel more comfortable. When abscess forms, it should be opened. Dunbar Roy (At lanta Med. and Surg. Jour., July, '93).
Hypertrophy.
There are two varieties of hypertrophy of the tonsils: the ordinary soft hyper trophy found in children and young adults, and the scirrhous, or hard, tonsil, which is characterized by an enormous increase of the connective tissue of the gland and a canalieularization of its blood-vessels.
Symptoms. — Generally there is more or less obstruction to breathing, the tient snoring during sleep. Articulation is impeded, and there may be some dif ficulty in swallowing, especially in the cases of young children. The crypts of the tonsil may become filled with cheesy masses, which, undergoing putrefaction, impart to the breath an offensive odor. Hypertrophied tonsils also interfere sometimes with the proper performance of the functions of the Eustachian tubes, and thus become a cause of aural catarrh and deafness.