Sometimes the surface of the tonsils becomes dotted with whitish specks, which are formed by material from small glands, and which give the idea of ulceration taking place, and some times suggest diphtheria, to the ash-coloured spots of which, however, they have no resem blance. See Plate XV.
Traces of acute sore-throat are often left in permanently enlarged tonsils, elongated uvula, &c., results which will be discussed imme diately.
Treatment.—At the outset a smart dose of opening medicine should be administered. Saline medicine is best, salts, seidlitz, or similar preparations. The person should remain in his room, and, indeed, in bed. To relieve the pain hot cloths or poultices may be applied outside, and the vapour of hot water, inhaled from a jug, will help to soothe. Sloppy food is taken most easily when the swelling is severe. Even liquids are often returned through the nostrils in such cases. As to medicines, it is doubtful how much benefit can be derived from them in ordinary cases. The guaiacum mixture of the British Pharmacopoeia is stron gly.recommended by some. It may be taken in doses of 1 to 3 table-spoon fuls thrice daily. The powder may also be em ployed, 20 to 30 grains, suspended in solution of gum, every six hours. At the very beginning an emetic of 20 to 30 grains of powdered ipecacuanha will help to shorten the attack. As for gargles, the tannic acid or alum and catechu gargle (see PRESCRIPTIONS—GARGLEs) will be found useful. The best way to use such appli cations, however, is in the form of a paint. A camel's-hair pencil should be dipped into the mixture, and, the mouth being opened as widely IS possible, the affected parts are painted. This nay be done often. The paint is most useful in mild cases. Anyone who has had an attack of 'ore-throat is always liable to another. He may know when it is coming on by a stinging in one tonsil, which is red and angry-looking. At this period if the paint be freely applied it may prevent any further advance. In very acute attacks, however, strongly astringent gargles are not advisable, and mild gargles, of warm water and milk, for example, are preferable, and still more the use of steam of hot water as mentioned.
If an abscess forms, the matter must escape, either by the abscess bursting or by it being opened. This latter should never be performed
by any but a surgeon, as a large artery passes close to the tonsil, and runs the risk of being wounded by a careless or ignorant hand. Deaths from this cause have been recorded. Indeed in every acute case the care of a surgeon ought, wherever possible, to be secured.
Chronic Enlargement of the Tonsils is a common result of inflammation. The tonsils are permanently swollen and hard, and project sometimes so far as to interfere with speech and swallowing. This condition is specially annoy ing to public speakers, teachers, and singers. The voice is thick and easily fatigued, and the pitch of the singing voice may be seriously lowered. Breathing is noisy, especially during sleep. Partial deafness, from thickening of the membrane of the tube passing up to the ear, is not unusual. The paints recommended above may be applied in such a case. Touching with solid nitrate of silver is not advisable. It tends rather to maintain the irritation. If the en largement is of any size, the only satisfactory treatment consists in the cutting out of the tonsils—not a painful operation—or in burning them with a hot iron—not painful either. Of course a surgeon only can perform such an operation. To weakly women and children cod-liver oil should be administered, and syrup iodide of iron in to I tea-spoonful doses.
The uvula, like the tonsils, may be perma nently enlarged and elongated. It may be so long as to rest on the tongue and occasion a tickling cough and tendency to vomit. A small piece should be snipped off with scissors.
Relaxed Throat, in which the mucous mem brane of the pharynx is thickened and produces a troublesome thick secretion, is the result of frequent alight colds. It is best treated by painting the back and sides of the throat with tannin and glycerine, or iron and glycerine (see PRESCRIPTIONS-GARGLES, &c.), or by the alum or chlorate-of-potash gargle. The frequent use of a spray-producer, with solutions as re commended for clergyman's sore-throat (p. 390), is valuable. Doses, thrice daily, of the iron and chlorate-of-potash mixture (see PRESCRIPTIONS) are also useful.