The normal tonsil has a physiological function, probably protective to the or ganism. Being in itself often diseased, the physiological function of the tonsil is impaired, and, instead of being pro tective, it is the nidu• for the growth and distribution of pathogenic organ isms and their poisonous products into the system. Many grave and fatal gen eral infections have their origin in the tonsils. If the exanthemata, especially scarlatina, are of bacterial origin, the tonsil acts in part as port of entry. Acute articular rheumatism and the diseases often associated with it, undo carditis and chorea, in a great majority of cases are due to the action of at tenuated bacteria, their toxins or both entering the general system through a diseased tonsil. In rare cases of typhoid fever in which no intestinal ulcerations can be demonstrated, the similarity of the tonsillar tissue and Pet'er's patches suggests the portal of entry of the Eberth bacillus into the tonsil. Serofu losis is often associated with diseased tonsillar tissue, and the tubercle bacil lus very often enters the system via the tonsils. The tonsil is too little exam ined at necropsy, and much light might be shed on fevers of uncertain origins by bacteriological and histological ex amination of it. Julius Ullman (Med. News, Jan. 20, 1901).
Acute Pharyngitis.
Acute pharyngitis is an acute inflam mation of the mucous membrane and underlying structures of the pharynx.
Symptoms.—The constitutional symp toms are usually trifling: A feeling of lassitude with slight fever. The throat feels sore, dry, and stiff. These symp toms increase until pain, especially when deglutition is attempted, is quite severe. The cervical glands are often swelled and painful to the touch. The voice is gen erally husky; and a sensation, as of a foreign body in the throat, forces the patient to often hawk and expectorate.
Etiology and Pathology.—Acute phar yngitis is generally the result of exposure to wet and cold, especially in persons suffering from a rheumatic diathesis or from general debility. It may also be caused by traumatism or the presence of a foreign body in the pharynx.
The inflammation usually is not evenly distributed over the pharyngeal mucous membrane, the glandular elements al ways being most affected. Their secre tion is at first increased, but after a time decreased, becoming starchy and glue like in character. The tonsils are always involved, the inflammation being suffi ciently marked sometimes as to cause them to mask the inflammation of ad jacent structures.
Treatment.—A saline cathartic should be administered, in sufficient quantity to secure one or more free movements of the bowels. A solution of nitrate of silver, 1 or 2 drachms to the ounce of water, should be painted over the in flamed lateral walls of the pharynx once or twice a day. Care should be exercised not to touch the posterior wall, or the patient's suffering will be increased rather than diminished. It should be
borne in mind that, while the applica tion of a weak solution of nitrate of silver to the inflamed fauces is painful and acts as an irritant, the application of solu tions of the strength of 1 or 2 drachms to the ounce of water is not painful, and is immediately followed by a sensation of relief and comfort, and tends to mate rially shorten the course of the disease. The application of the silver solution should be followed by spraying the parts with an S-per-cent. solution of anti pyrine. A demulcent gargle or lozenge should also be prescribed for the patient's use. When acute pharyngitis is due to the presence of a foreign body, it should, of course, be at once removed, and the inflamed pharynx treated as ordinary acute pharyngitis. When the rheumatic diathesis exists, the administration of guaiac, either alone or combined with potassium iodide, will be found to yield most excellent results, while in gouty sore throat colchicum should be pre scribed.
Simple Chronic Pharyngitis.
Simple chronic pharyngitis is a chronic inflammation of the mucous membrane of the pharynx generally the result of chronic rhinitis. The disease is often complicated by inflammation of the fol licles of the mucous membrane, and is then called follicular pharyngitis.
Treatment. — It is all important to bring about a cure of the nasal disease to the presence of which the pharyngeal malady is due. After the primary nasal affection has been relieved simple chronic pharyngitis will often get well almost without treatment. During the treat ment of the nasal affection, however, applications should be made to the vault of the pharynx of glycerole of tannin, 40 grains to the ounce, or of a solution containing:— 1-; Iodine, 5 grains.
Potassium iodide, 15 grains. Glycerin, 1 fluidounce.
A tongue-depressor should be used to hold the tongue down, and the patient be requested to try to breathe through his nose in order to relax the palatine muscles. The application may then be made without difficulty by means of an aluminum applicator, the end of which has been wrapped with cotton and bent to a suitable curve. Should, however, the palate lie closely in contact with the pharyngeal wall, considerable force will be required to carry the end of the ap plicator into the post-nasal space, while most of the solution with which the cot ton on the end of the applicator has been saturated will be squeezed out and re main in the fauces. Applications made in such a manner irritate the parts mechanically and tend to increase the existing inflammation rather than to subdue it; and it is always best to desist from making an application to the phar yngeal vault under such circumstances.