In scrofulous children, ulceration is very apt to occur. The ulcers are seated in the follicles. If isolated, they are small and circular, but when placed closely together, they are larger and irregular from junction of the borders of neighbouring sores. The uvula is elongated, and its surface is clotted over with enlarged glands.
Diagnosis.—The diagnosis of follicular pharyngitis presents no diffi culty. If the patient is brought on account of cough, examination of the chest usually reveals no sign of disease, while inspection of the throat dis covers the characteristic granular appearance of the pharynx.
Prognosis.— In children, the disease can usually be arrested by suitable treatment, but it may tend to recur afterwards from slight exposure. Follicular pharyngitis may be associated with phthisis, and, according to Dr. Horace Green, is sometimes a cause of it.
Treatment.—As children suffering from. this complaint are usually weakly and under-nourished, the general health must be first attended to, and the child will often be greatly benefited by cod-liver oil and tonics, such as iron and quinine. A little sound claret diluted with water may be given him with his dinner. In fact, the constitutional treatment recom mended in cases of strongly marked strumous diathesis is often required.
For a cure of the local disorder, local treatment is essential. In mild cases, a more healthy action of the pharyngeal mucous membrane may be induced by astringent applications, especially by brushing the throat two or three times daily with the glycerine of tannin, or with equal parts of strong perchloride of iron and glycerine. Dr. J. Sawyer speaks highly of
the local application of borax. A saturated solution should be sprayed into the throat for several minutes, three or four times in the day, at an interval after food. The extract of eucalyptus, in the form of a lozenge, is also serviceable when secretion is copious.
In more severe cases, it may be necessary tg destroy each follicle sep arately by a caustic or the galvanic cautery. The latter, which can be put cold into the throat and rapidly heated in situ, is no doubt the most con venient. Moreover, its action being instantaneous, the application is less painful than that of the more slowly-acting escharotic. If a caustic be used, nitrate of silver, properly employed, is one of the most successful. The throat must be first cleansed with a brush soaked in warm water ; then with a piece of lunar caustic, sharpened to a fine point, each enlarged follicle or ulcer must be touched separately. The number of follicles to be de stroyed at one visit must vary according to the sensitiveness of the child, and the distress produced by the application. On the first occasion, only one or two may be destroyed as a trial test.
Instead of the lunar caustic, other caustics, such as Dr. Morell Macken zie's "London paste," may be employed.