The diet must consist at first of milk and broth. When the of swallowing becomes great, strong meat essence should be given, and the strength may be supported, if the child appear very weak, by the brandy and-egg mixture, or port wine. In cases of the non-suppurative form of the disease, where, although the depre,ssion is great, febrile action is mod erate, and the inflammation is accompanied by shallow ulcers on the tongue and cheeks, chlorate of potash is very useful, and may he given in doses of five to ten grains every three or four hours. These cases also are greatly benefited by purgation, and Epsom salts with quinine form a good combi nation. A child of twelve years of age will take well two grains of quinine, with half a drachm of sulphate of magnesia, and five drops of dilute sul phuric acid, every six hours. This treatment cleans the loaded tongue, and improves all the symptoms with remarkable quickness. In young children, too, a glass of port wine, given quite at the beginning of the attack, seems often to have the power of preventing any further development of the com plaint.
In the chronic form of tonsillar enlargement, it is of extreme importance to improve the general nutrition of the child. It will be usually found on inquiry that he suffers from repeated attacks of gastric derangement. Our first care must be to improve the condition of the digestive organs by the means recommended elsewhere (see Gastric Catarrh). A broach flannel band age, to protect the stomach from chills, is here of extreme importance.
Usually, when the gastric mucous membrane has been restored to a healthy state, the general condition of the child improves, although the size of the tonsils has undergone no diminution. Cod-liver oil and iron wine, or qui nine and tonics generally, may be given to hasten the return of flesh and strength. A little alcohol, in the form of light claret, is very useful in these cases. As special internal treatment of the swollen tonsils, Mr. Lennox Browne speaks highly of the influence of a combination of sulphide of cal cium and iodoform (half a grain of each), given three times a day, in redu cing the size of the glands.
Of local measures, no doubt the best and most proceeding is excision. The tonsils having been removed, the tendency to catarrh in a great measure subsides ; the digestion improves ; the child begins to regain flesh and colour, and the congested state of the mucous membrane, which had been the source of so much discomfort and inconvenience, is at once relieved. The operation is a by no means painful one, and is followed by such immediate improvement that it should be recommended in every case. Often, however, the suggestion is not approved of by the parents,
and other means of reducing the size of the glands will have to be resorted to. The tonsils may be painted twice a day with a mixture of equal parts of tinct. iodi and liq. potassm ; or once a day with the pure fillet. iodi. Powdered alum may be applied according to Quinart's method, rubbing it into the gland vigorously with the finger ; or the throat may be brushed twice a day with glycerine of tannin. These applications are, however, of doubtful efficacy. I have used them myself, and seen them employed by others, but even if the size of the glands is reduced for a time by such means, the improvement is seldom a permanent one. Dr. Morel Macken zie speaks highly of a paste composed of equal parts of caustic. lime and soda with spirit. This is to be applied to different parts of the swollen surface once or twice a week. Other caustics, such as nitrate of silver, Vienna paste, and chloride of zinc (in the stick) have been used, and the galvano-cautery has also been employed. By the use of. these agents, small portions of the enlarged and toughened glands are destroyed on each ap plication ; but the size of the tonsils is but slowly reduced by this means —indeed, the patience of the child's relatives is usually exhausted before any definite results have been obtained. A more rapid method is that recommended by Dr. Gordon Holmes. A thin stick of nitrate of silver is pressed into the tonsillar crypts, and worked round for a few seconds. Small sloughs are thus formed, which are soon discharged. The process can be repeated every other day, and by this means, with little suffering to the child, for the operation is followed by but little external soreness of the throat, the size of the glands may be quickly and reduced. Another plan is to inject a solution of ergotin ( 3 j.—jss. to j.) with the hypodermic syringe into the enlarged tonsil. Three to five drops may be slowly introduced into the gland once or twice a week. The operation seems to cause some pain, and is so greatly dreaded by the child that it is difficult to persevere with it for long together. I have never seen a case where the glands have been appreciably diminished by this means.
French authors recommend sulphurous baths as efficacious in redu cing the size of the glands, but I cannot speak from my own experience of the value of this method of treatment.