TONSILS, Diseases of.
In the common form of " Sore Throat," known as acute catarrhal pharyngitis, hospital sore throat, angina simplex, etc., the tonsils are more or less constantly involved, though the affection should be considered as a septic inflammation starting originally in the mucous membrane of the pharynx, and from thence invading the tonsils, uvula, palate, fauces and often the nasopharynx and even the larynx. The treatment of this condition has been already described under Pharyngitis.
The present article deals with the treatment of the various forms of tonsillitis, though these glands are seldom found to be involved alone, the inflammatory action usually extending to the mucous membrane covering other parts of the throat.
Acute Tonsillitis. —Various types of this affection have been described and named, the two most common being that recognised as acute catarrhal and acutejollicular tonsillitis, which may he regarded from the therapeutic standpoint as practically identical with acute pharyngitis. Either of these types may, however, pass into the more severe form of the sreppurative or parenchymatous tonsillitis or of the variety known as peritonsillitis. Hence at first sight the treatment of the various types of inflammatory sore throat and of tonsillitis appears to be as confusing a problem as are their diagnosis and pathology, but in practice this is not so difficult a question as it appears at first sight.
The first important point for realisation is to grasp the fact that all these types must be regarded as infectious, and isolation of the patient should he insisted upon as soon as the presence of the acute inflammation has declared itself. The nature or identity of the specific infection need not he considered, as probably there is no specific microbe, the infective process being multiple. Streptococcus pyogenes, various strains of staphy lococci, and whatever organisms produce acute rheumatism are often present together. As pointed out by Richards, the tonsils should be regarded as defensive organs, and if this view be realised, their function as a barrier to the introduction of septic organisms readily accounts for the accumulation of heterogeneous microbes in their crypts.
Acute Follicular importance of this type of tonsillitis rests in its liability to be mistaken for diphtheria. In every doubtful case the antidiplitheritic serum should be injected, as it cannot possibly do harm. Often it will be necessary to do this instead of waiting for a bacterial investigation.
Constitutional treatment is demanded in every severe case, and it is much more effectual in relieving the severe malaise than local applications to the throat.
Antipyrine seems to combine with or to neutralise the toxins of the micro-organisms which are absorbed from the tonsillar crypts. After its administration the high temperature, headache and back pains rapidly diminish. On the rheumatic theory of tonsillar inflammation, Salicylates are much employed; undoubtedly the Sodium Salt is a valuable drug, but its effects are not so reliable as those obtainable by antipyrine.
Small doses of the latter drug suffice to afford relief provided they are administered with sufficient frequency. For the fever and rapidity of the heart's action minute and frequent doses of Tincture of Aconite have long enjoyed a reputation; min. of the tincture may be given every 15 minutes for several hours. The following combination is very safe and efficacious: It . L ittrl..Iconili ilt viii.
gr. xxiv.
Caffein. Cit. gr. xvj.
.1(pue Misce.
Dial tttisltua. Cap!. lint al 5ss. (mini Nora.
It may he observed that the whole of the above mixture if swallowed in a single dose would probably do no harm; if administered in 2-0Z. doses three times a day very little benefit. if any. would be noticed; but when given in 2-oz. doses at short intervals very marked effects are produced.
This treatment is also applicable to the Epidemic form of tonsillitis which sometimes shows itself in certain districts, and in which marked enlargement of the cervical glands is present and sometimes cardiac com plications. Pruen in these cases employs an autogenous Vaccine and prolonged rest.