occur mainly in the retronasal and lacunar varieties.
(a) Parenchymatous tonsillitis, tonsillar and peritonsillar abscesses.— Occasionally a severe parenchymatous swelling develop in either one or both tonsils, and at times in the pharyngeal tonsil. .A.11 the throat symptoms become inuch aggravated, and there is a characteristic stiff ness of the jaws and head. The tonsils are intensely inflamed and swollen, with pain, and a high remitting fever. Inability to take nourish ment soon reduces the patient very much. Some of the cases abort, while others go on to the formation of ft peritonsillar abscess. After evacuation of the abscess, convalesence is rapidly established. The pus usually contains streptococci. This complication is more frequent in adults than in children.
(b) Lymphadenitis.—The regional glands at times remain much swollen, causing prolonged elevations in temperature. The submaxillary and cervical group of glands are involved, at times a single gland or group of glands, at other times several on one or both sides. In small children, the inflammatory process often jumps from one chain of glands to another. Under the name "glandular fever," Filatow and E. Pfeiffer have described a condition accompanied by fever, constitu tional symptoms, an inflamed pharynx and acute swelling of the upper posterior cervical glands, running a course similar to lyinphadenitis. Pain between the sternum and navel is sometimes present, and is attrib uted by Pfeiffer to an involvement of the mediastinal and mesenteric glands. Nephritis is an occasional complication. This condition cannot be considered a distinct entity. It is probably the result of a primary retronasal angina with slight local symptoms, but with a severe involve ment of the regional glands (llochsinger Zappert, Trautmann).
(e) Severe forms of otitis media are frequent complications of retro nasal angina, and it is in rare instances the starting point of a meningitis.
(d) Erythema and exanthems simulating scarlet fever are not uncommon.
(e) Catarrhal affections of the larynx, bronchial tubes and lungs also follow this variety of angina.
&condary Diseases.—In a certain percentage of angina eases, diseases of other organs follow, particularly "rheumatic" conditions: erythema nodosum and extidativum, purpura, swelling of the muscles, inflammation of the joints, inflammation of the enclocardium and other serous membranes and haunorrhag,ic nephritis. In particularly unfor tunate cases, the septic poison is taken into the system, causing septic or 1)3 uemic metastases. Attention has also been called to the. combina tion of angina and appendicitis.
onset of an angina 'nay simulate typhoid fever, pneumonia, meningitis, or an acute digestive disorder. If a routine examination of the throat is practiced in all diseases of children, mistakes of this kind in diagnosis will not be made. It is important to examine for swelling of the regional glands. From scarlet fever, a differential diagnosis may be made by the absence of the eruption and the course of the fever and the more diffuse redness of the pharynx. The redness of the throat is less, sharply defined in scarlet fever. Cases of angina with an accompanying erythema may be very confusing.
Scarlet fever may also occur without the eruption. Cases of laeunar angina are very common during epidemics of scarlet fever. The character of the exudate is different in lacunar angina from that in diphtheria, and it is confined to the tonsils. There are however, cases of diphtheria that simulate lacunar angina so closely that only a bacteriological ex amination will clear up the diagnosis.
so many anginas are infectious, it is advisable to isolate every case.
uncomplicated cases rest in bed, liquid diet, with proper applications to the neck (warm or ice in severe cases), when possible, gargles of chamomile tea, salt water and glycerin, water and lemon juice, or peroxide of hydrogen, one-half teaspoonful to one-half glass of w-ater, will be effective. Mercurial preparations may be given internally but are really unnecessary. In young children a 2 per cent. solution of potassium chlorate may be given internally. The much advertised angina lozenges give very little relief.
Local interference is only indicated for abscess formation. An early incision will shorten the attack materially. Fluctuation may be felt with the finger.
The incision when an abscess has formed is made in about the centre of the anterior faucial pillar, slightly beyond its border. Warm gargles may be used after the abscess is opened. Tbe removal of the tonsils, or incising the crypts for the purpose of preventing recurring attacks, are of doubtful value. A chronic or recurring inflammation of the lym phoid tissue in the nasopharynx, With eXCCSSiVe nasal secretion, may be practically cured by curettage of the nasopharynx and long-continued elevations in temperature checked. The removal of the faucial tonsils is not followed by such good results. If the pharyngeal tonsil is removed at the same time, the results might be better.
Much can be accomplished in the way of overcoming such suscepti bility to attacks, by diet anti climate. The so-called "hardening" process is useless.