CATARRHAL AND EXUDATIVE FORMS Angina, the acute disease of the lymphatic ring, is a part of a whole list of general infections. It represents the main lesion in scarlet fever and diphtheria, and it accompanies as a more or less important disturb ance the other acute exanthemata, and influenza, pneumonia, typhoid fever, etc. Angina must be considered of particular importance as being the portal of entry for articular rheumatism, and, as late investigations show, of epidemic cerebrospinal meningitis. Only idiopathic anginas will be considered.
is a well-known fact that many children are predisposed to "sore throat." Unimportant causes such as a "cold," or a voice strain are sometimes sufficient to cause ft disturbance in the pharynx. Or for many years the child will have recurring attacks of tonsillitis, which may come on so frequently that a serious condition is produced. This hereditary and family predisposition often does not disappear until after the age of puberty. It is often attributed to chronic throat conditions, which lead to acute exacerbations. It is claimed that infectious material may linger in the folds and crypts on the surface of the tonsil, particularly in the form of tonsillar concretions, made up of mucus, detritus and bacteria, which, every time conditions are favorable, is started into fresh activity.
Against this view of a localized predisposition, the argument may be advanced, that children with absolutely similar conditions of the pharynx, so far as their predisposition to attacks of angina is concerned, differ very materially, nor can any positive relation be traced betw-een such attacks and the hyperplastic condition of the tonsils, because many children with large tonsils remain entirely free from attacks of an,Ona, while many with only slightly- enlarged or practically- normal tonsils, are subject to repeated attacks. Much more weight must be attached to the theory of a general predisposition. We are forced to this conclu sion, because diatheses, described as lymphatic, scrofulous and rnore recently as exudative, with or without hyperplasia of the lymphatic apparatus make themselves apparent by an increasing susceptibility to bacterial invasion.
of the anginas of predisposed individuals are caused by auto-infection. There are how-ever many eases which must be attributed to infection from without, attacking predisposed as well as apparently immune individuals, whieh, in their way of extension, are entirely similar to the infectious diseases of childhood. It may be
said, that certain cases occur in epidemics in families and institutions. In such epidentics the disease must be transmitted from one person to the other, and there is probably a specific angina poison causing such cases which persists in certain regions like a iniasin„ In many insti tutions, hospitals and orphan asylums, nearly every new inmate as well as new internes in the hospitals, have an attack of this form of angina.
The streptococcus is the organism that usually causes tile disease. Other organisms such as the staphylococcus, pneumococcus, the coccus conglomeratus tStooss), mieroe.occus catarrhalis (Pfeiffer), etc., are also sometimes responsible for the infection. Alixed infections must also be considered. An etiological classification of the anginas according to the bacterial findings is not practicable. Generally speaking the strepto coccal diseases are the most severe, while the anginas caused by the staphylococcus and especially the pneumoeoccus are milder. General and local conditions may remain hidden. The clinical picture is the only reliable guide. According to this we must distinguish between catarrhal angina, follicular angina and lacuna!) angina. These forms have so much in (20111M011 in the symptomatology, that it is best to first consider them as It whole.
General Symptorns.—Tonsillitis (angina) beg,ins acutely, either as a general ffisturbance or as a symptom of disease of the upper air passages or the digestive tract. The early symptoms are usually con stitutional, because children do not. always complain of even 6evere local lesions. The invasion is usually like that of an infectious dis.ease. Young children look badly and are often irritable, while older children complain of lassitude, headache and chills. The temperature rises, aceording to the severity of the attack to 38° C. (100° F.) and even 40° C. (104° I.). Gastro-intestinal clisturbanees, vomiting and diarrhma are quite common. Young children sometimes have eonvulsious. Older children (although not always) eomplain of difficulty in swalloyving.