Often it will be advisable to puncture the great cedema of the mucous membrane over the uvula and soft palate where no evidence of suppura tion is visible, and where the acute septic inflammation extends to the opening of the larynx, oedema must be promptly met by scarifying the parts or by intubation or tracheotomy.
When the suppuration is peritonsillar the treatment is identical. Some surgeons restrict the term Quinsv to this type. and as the collection of pus is usually in the supratonsillar fossa and tends to invade the soft palate, the incision should be made through the latter close to the pillar of the fauces. When pus does not escape immediately after a deep incision the surgeon may wait before making another, as often the matter soon makes its way into the incision.
Ulcerative Tonsillitis is a rare condition. the so-called ulcerated sore throat " being usually due to severe follicular inflammation, the secretion blocking the follicles being commonly mistaken for ulcers. When well marked ulcers exist, some form of stomatitis, as the mercurial. is often present, and the patient is always a debilitated subject. The treatment is to be directed to the primary condition, and local agents used as for the follicular type. The ulcers should be freely swabbed with Hydrogen Peroxide, and if slow in healing a strong solution of Silver Nitrate may be brushed over each abrasion. Tuberculous ulceration is best attacked by the galvano-cauterv. Snail-track ulcers may be lightly touched with Pernitrate of Mercury solution after drying the surface with absorbent wool, or the entire tonsillar surface may be freely swabbed with Weak Tincture of Iodine.
Chronic Tonsillitis.—This shows itself usually as an enlargement of one or both tonsils, the result of repeated attacks of acute inflammation. Constitutional treatment is very disappointing. Iodides (Syr. Ferri Iod.), Cod-Liver Oil and other antiscrofulous remedies as fresh air. seaside residence, over-feeding, etc., may he tried when the enlargement is of a simple hypertrophic nature, but these agents generally fail and end in loss of time.
Local applications are equally futile; swabbing with Tincture of Iodine or painting with astringents as the Glvcerins of Tannin and Alum or Perchloride of Iron may be tried. One of the best routine applications will be the following applied with a large camel's-hair brush twice a day: Tincturce Lodi M71. 5iv. Glycerin. Aluminis Glycerin. Acid. Corbel. .5iv.
The application of the solid Nitrate of Silver. which should be thrust firmly into the crypts, is a very painful method of treatment. Chromic Acid and Trichloracetic Acid, used upon a fine probe covered with cotton wool and employed in a similar way, sometimes act very satisfactorily in bleeders where a cutting operation cannot be attempted. Oral sepsis should be invariably seen to. and all carious teeth must be removed.
Reduction of the enlargement may be effected by the galvano-cautery. The swollen gland haying been injected in several places with a few drops