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tonsils, inflammation, acute, attacks, common and consequence

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inflammation of the tonsils, or quinsy, is a frequent complaint of later childhood, but is comparatively rarely met with during the first few years of life. One of the peculiarities of the affection is its disposition to recur. A first attack leaves behind it a tendency to a second, and the same subject will be found to suffer from the disease again and again under the influence of . apparently trivial causes. A common consequence of these repeated attacks is a hypertrophied condition of the tonsils. This may be a source of great inconvenience, and may even have a serious ef fect upon the health and general development of the child.

The tonsils are often found to share in a general inflammation affecting the mucous membrane of the mouth and fauces, and in scarlatina and diphtheria they are almost invariably inflamed and swollen. The name " quinsy " is, however, applied to a special primary affection which appears to be something more than a mere local complaint. Acute tonsillitis has, indeed, been compared to croupous pneumonia—another disease which is no longer regarded as a purely local inflammation. In each of these forms of illness, we find general symptoms severe out of all proportion to the local lesion ; a rapid rise of temperature which often precedes the more special symptoms, and a critical fall ou the fifth or sixth day. In each dis ease, too, the attack appears to be due to very similar causes.

occasionally met with in young children, quinsy cannot be said to be common until about the eighth or ninth years. In all cases there is probably a special individual susceptibility rendering the patient more liable to be affected by cold and damp, which appear to be the ordinary causes of catarrh. Any influence which exercises a depressing effect upon the system will no doubt assist the action of these causes, and some observers are disposed to believe that in unfavourable subjects such depressing influences alone are capable of exciting the attack. There ap pears to be a distinct connection between tonsillitis and acute rheumatism. Quinsy is common in rheumatic subjects, and attacks of rheumatism are often preceded by acute inflammation of the tonsils. Indeed, so frequently

is this the case that quinsy has been looked upon as an early manifestation of the rheumatic tendency.

The inhalation of sewer gas is another common cause of tonsillitis. Inmates of houses where the waste-water pipes run directly into the soil pipe, or where the main soil-pipe is defective and leaks under the basement floor, are often subject to repeated attacks of quinsy, and also to a slower inflammation of the tonsils, which resists all treatment as long as the pa tient remains iu the vitiated atmosphere.

Chronic hypertrophy of the tonsils is not always the consequence of the acute form of the disease. In scrofulous children, enlargement of these glands may arise from a process of slow inflammation. The same thing is occasionally seen in children in whom no hereditary diathetic tendency can be discovered, and in families where the other members are strong and healthy. In these cases it will be generally found that the patient, if be bas not suffered from repeated attacks of the acute form of the disease, has been long exposed to insanitary or other depressing influences by which his development and general nutrition have sustained distinct injury. The child may have lived in a vitiated atmosphere, been overworked at school, or been subjected to other sources of depression which have reduced his strength and diminished his vital powers.

The chronic inflammation of the tonsils, which is the consequence of a cliathetic tendency, is seldom seen before the fifth or sixth year. When the hypertrophy occurs in children of healthier constitution, it often begins earlier, being found in infants under twelve or eighteen months old. It has been suggested by Robert, that in such young subjects the enlargement may be a consequence of teething, and it is possible that the change in the tonsils may have some connection with the general glandular activity which is known to prevail at this period of life.

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