Study of the tonsils in a series of 375 school-boys. The tonsils were enlarged in G2 per cent.; they had caused symp toms in 33 per cent., and they produced gross disturbance of hearing in 27 per cent. The enlargement and the symp toms caused thereby were most marked between the sixth and ninth years. The percentages were much lower after the end of the ninth year. The children that progressed poorly in school were in over three-fourths of the instances those with enlargement of the tonsils. Wilbert (Deutsche med. Wochen., Feb. 5, 1903).
Treatment.—The best treatment is re moval of the major portion of the hy pertrophied gland either with the sillotome, galvanocautery-snare, or by galvanopuncture. Occasionally the op eration with the tonsillotome is followed by dangerous hmmorrhage. Care should be taken not to wound the anterior pillar of the fauces, as it contains a small artery, which, when wounded, gives rise to troublesome bleeding. When the pillars are adherent to the tonsils, they should be carefully separated from the tonsil by means of a probe, before erating. A tonsil may be removed by means of the galvanocautery-snare most as quickly and painlessly as with a tonsillotome and with little danger of hwmorrhage.
Scirrhous, or hard, tonsils should not be removed with the tonsillotome; owing to the hardness of the tissues surround ing the blood-vessels, a 'wounded artery cannot contract, and the hemorrhage is usually long continued and may be pro fuse and alarming.
Tonsillectomy, by which is understood the careful dissecting away of the whole gland, is to be preferred to tonsillotomy, which as commonly performed by the tonsillotome amputates only a portion of the diseased gland.
The contrasting of these two opera tions shows a distinct advantage in favor of tonsillectomy, as it absolutely pre vents recurrence of tonsillitis because of the removal of all of the diseased crypts with their contained bacteria. It liber ates the pillars and restores the action of the soft palate, with a corresponding im provement of voice. If the operation is perfectly done, a smooth surface is left, a result not reached by tonsillotomy. It is the only practical method in those tonsils where the surface is so soft that a firm hold cannot be obtained by a ton sillotome. In more than three hundred personal cases no untoward results have been met, only one requiring attention on account of limmorrhage. J. II. Coul
ter (Jour. Amer. Med. Assoc., Sept. 23, '99).
Should an artery be observed to spurt after an operation upon the tonsils, the bleeding-spot should be pierced with a tenaculum, by twisting which a sufficient amount of torsion can usually be made upon the tissue to stop the hemorrhage until more efficient methods can be de vised to control it.
In combating the severe haemorrhage that is sometimes the result of tonsil lotomy a purse-string suture may be placed about the base of the tonsil before the operation or inserted afterward if hmmorrhage is encountered. A heavy silk sterile suture is passed submucously with a curved needle and holder in four stitches about the tonsil and then tight ened. It can be readily inserted under eucaine B (10 per cent.) local anms thesia. Dawbarn (Med. News, May 20, '99).
Treatment by galvanopuncture is per formed in following manner: A small galvanocautery-knife is introduced, cold, into one of the crypts of the tonsils, and, being heated while in situ, is made to burn its way out.. Two or three such burns may be made at a sitting, and will be followed by considerable shrinking of the hypertrophied gland. From five to fifteen such operations are required to reduce the gland to satisfactory dimen sions.
In amygdalotomy dissecting the pala tine folds half-way off from the tonsil with a small electric cautery; then draw ing the tonsil forward and dissecting it out thoroughly to about one-half its ex tent, cutting this portion off, and treat ing the surface with a strong solution of silver nitrate is recommended. The other portion of the tonsil is to he removed in the same manner a week or ten days later. J. Homer Coulter (N. Y. Med. Jour., No. 93S, '96).
Hypertrophied tonsils may be gradu ally reduced to normal size by massage with the finger. The forefinger, pro tected by a rubber cot, should be intro duced as far as possible behind the ton sil, which should be rubbed fifteen to twenty times with the finger around it, and then up and down the same number of times. The massage, repeated about fourteen times, reduces even the most inflamed and swelled tonsils considerably. Kantorowicz (Deut. med. Zeit.. No. 63, '93).