Tonsillitis

“ It is well known that tonsillitis is much more frequently produced by exposure to a draught which strikes the back or side of the head than by a current of air meeting one full in the face, or even by long-continued exposure to a storm in the open air. ”

“ Nature has created them for the elimination of impurities from the body. Acute, subacute and chronic tonsillitis accompanied by enlargement and cheesy decay of the tonsils means that these glands have been habitually congested with morbid matter and poisons, that they have had more work to do than they could properly attend to.
"These glandular structures constitute a valuable part of the drainage system of the organism. ”

“ The great danger is in the mild cases, in which the disease has perhaps not been suspected, and in which the child may be walking about and even going to school. Such patients are often a source of widespread infection. The careful attention given by mothers to the teeth and mouth of children is also an important factor. In children with recurring attacks of tonsillitis, in whom the tonsils are enlarged, the organs should be removed. Through these measures the incidence of the disease has been very greatly reduced. ”

“ In “relaxed throats” there is a chronic catarrhal state of the lining membrane, with some passive congestion. The tonsils are peculiarly liable to catarrhal attacks, as might a priori be expected by reason of their Cerberus-like function with regard to bacterial intruders. Still, acute attacks of tonsillitis appear on good evidence to be more common among individuals predisposed constitutionally to rheumatic manifestations. ”

“ Adenoids and enlarged tonsils are abnormal growths of lymphatic tissue in the nose and throat that make breathing difficult and inefficient, and that become breeding places for germs. The infection that they harbor leads frequently to colds, earache, deafness, tonsillitis, diphtheria, measles, scarlet fever. They obstruct the breathing and reduce the supply of oxygen, spoil the shape of the face, reduce the ability to think, and by their discomfort produce irritability and nervousness. They greatly interfere with the vitality. ”

“ Such infections most frequently occur in the tonsils, in the gums, and in the sinuses around the nose. Tonsillitis, acute or chronic, has been shown to be a menace to the heart. Acute streptococcie tonsillitis is a very frequent disease, and the patient generally, under proper treatment, quickly recovers. ”

“ Tonsillitis is more frequent in individuals with chronically diseased tonsils than in individuals in whom these glands are healthy. Such individuals, too, are more liable to recurrences; and such recurrences often follow very slight provocations.
Idiopathic tonsillitis is rare in infancy. At the period of eruption of the permanent teeth it is much more liable to occur than before that period, and the liability increases progressively until the second dentition has been completed. ”

“ Since 1915 there appears to have been a gradual increase. During the entire period there has been difficulty in distinguishing between the disease in 48question and other respiratory tract infections, particularly coryza, sore throat, tonsillitis, and bronchitis. Many of the local epidemics which appear probably to have been true influenza have had associated with them a high incidence of sore throats. We describe this as sore throat, rather than tonsillitis, because the clinician remarks that although the throat is sore there is little if any demonstrable inflammation of the tonsils. ”

“ Diphtheria is a disease much dreaded during childhood and adolescence. It may attack any age—even little babies are susceptible. It begins with a general feeling of heavy, drowsy lassitude with a sore throat. White spots appear on the tonsils which may resemble a simple follicular tonsillitis, while in a short time white patches spread over the throat and tonsils. ”

“ Tonsillitis in a more or less acute form, however, sometimes so mild as to be almost unnoticed, probably precedes most attacks of acute inflammatory rheumatism. Chronically diseased tonsils may not cause joint pains or acute fever, but they are certainly often the source of blood infection and later of cardiac inflammations. The probability of chronic inflammation and weakening of the heart muscle from such slow-going and continuous infection must be recognized, and the source of such infection removed. ”

“ At times, however, the membrane is soft and pliable, and is easily separated from the tissue; such cases are frequently diagnosticated as follicular tonsillitis. A bad cold is occasionally the only symptom of the disease. ”

“ When the superficial inflammatory process is a vesicular one, eventually sheathing the surface of the organ in whole or in part with a membranous envelope, it constitutes herpetic or membranous tonsillitis. ”

“ SYMPTOMATOLOGY, COURSE, DURATION, TERMINATIONS, COMPLICATIONS, AND SEQUELÆ.—The onset of tonsillitis, sometimes preceded by headache and general malaise, is often accompanied by a chill, pyrexia following within twenty-four hours. The temperature may reach 105° F., being at its maximum, as a rule, about the third day. It is rarely below 101° F. The pulse is accelerated to 120 beats per minute. Simultaneously with the constitutional symptoms local distress is usually manifested, but either set of disturbances may precede the other by several hours or by an entire day. ”

“ This can be counted on, however, only in cases where the tonsils are not of extreme size, and have not undergone frequent attacks of inflammation. Whenever the hearing is habitually dull, and the voice always thick, when cough is frequent, the nostrils narrow, the chest pigeon-breasted, and the child feeble and ill-thriven, removal of the tonsils is absolutely necessary. In cases where the question is doubtful, its decision must turn on whether the tonsils have often been inflamed. So long as their surface is smooth, and their substance soft and elastic, delay is permissible. ”

“ QUINSY.—This is an inflammation of the tonsils, or common inflammatory sore throat; commences with a slight feverish attack, with considerable pain and swelling of the tonsils, causing some difficulty in swallowing; as the attack advances, these symptoms become more intense, there is headache, thirst, a painful sense of tension, and acute darting pains in the ears. The attack is generally brought on by exposure to cold, and lasts from five to seven days, when it subsides naturally, or an abscess may form in tonsils and burst, or the tonsils may remain enlarged, the inflammation subsiding. ”

“ Drying clothes in a kitchen is an abomination and terrible to one subject to this disease or rheumatism. You can keep from having it so often by proper care. It is likely to return, and repeated attacks will cause permanently enlarged tonsils and they will become so diseased that they, will not only be annoying, but dangerous to health and life. You will go around with your mouth open, "talk through your nose." The tonsil must then be removed, also the adenoids in the throat, to enjoy proper mental and physical health. Enlarged tonsils with pus in them are a menace to anyone. ”

“ Chronic enlargement of the tonsils, as shown in Fig. 17, A A, is an exceedingly common affection. It is most common to those of a scrofulous habit. It rarely makes its appearance after the thirtieth year, unless it has been imperfectly cured. Both tonsils are generally, though unequally enlarged. A person affected with this disease is extremely liable to sore throat, and contracts it on the slightest exposure; the contraction of a cold, suppression of perspiration, or derangement of the digestive apparatus being sufficient to provoke inflammation. ”

“ There is fever, quick, full pulse, and dryness of the skin; the tongue is furred, and the breath offensive. The tonsils are intensely red, swollen, and painful, the pain often extending to the ear. Sometimes but one tonsil is affected, though generally both are involved. In severe cases the patient cannot lie down, in consequence of the difficulty of breathing.
Treatment. In the early stage of the disease, the spirit vapor-bath is invaluable. The sweating which it produces should be kept up by the use of the Compound Extract of Smart-weed in some diaphoretic infusion. ”

“ Inflammation of the tonsils with sensitive inirritated fever is a symptom only of contagious fever, whether attended with scarlet eruption, or with confluent small-pox, or otherwise. The matter of contagion is generally diffused, not dissolved in the air; and as this is breathed over the mucaginous surface of the tonsils, the contagious atoms are liable to be arrested by the tonsil; which therefore becomes the nest of the future disease, like the inflamed circle round the inoculated puncture of the arm in supposititious small-pox. ”

“ While healthy tonsils may serve some useful purpose even in the adult, it is almost universally conceded that the thoroughly bad and diseased tonsil is utterly useless to the body—only an open gateway for the entrance of infection.
BRONCHITIS
A very common disorder of early infancy and childhood is bronchitis—an inflammation of the bronchial tubes—accompanied by severe coughing. Its tendency to pass into pneumonia renders it a disease for skilled hands to treat—a disorder hardly safe for even the well-meaning mother to undertake to manage without medical advice and help. ”

“ Mouth breathing is the cause of many ills. As a result of this, the mucous membrane of the tongue, &c., becomes dry, micro-organisms multiply and the mouth becomes foul. Also from disease of the nose, the upper jaw, palate and teeth do not make proper progress in development. There is overgrowth of tonsils, and adenoids, with resulting deafness, and the child’s mental development suffers. An ordinary “sore throat” usually signifies acute catarrh of the fauces, and is of purely organismal origin, “catching cold” being only a secondary and minor cause. ”

“ As the rash fades, scaling of the skin begins in large flakes and continues from ten days to as many weeks, usually terminating by the end of the sixth to eighth week. One of the notable features is the appearance of the tongue, at first showing red points through a white coating, and after this has cleared away, in presenting a raspberry-like aspect. The throat is generally deep red, and the tonsils may be dotted over with white spots (see Tonsilitis) or covered with a whitish or gray membrane suggesting diphtheria, which occasionally complicates scarlet fever. ”

“ This interest has centered in part upon those two afflictions of childhood—adenoids and diseased tonsils,—or even tonsils that are merely enlarged. There is no doubt of the physical handicap borne by a child who is possessed of them. As a seat of inflammation, a source of infection, a hindrance to proper breathing,—in a multitude of ways they have seemed to deserve the verdict,—"Have them out." Many physicians, to be sure, have cautioned against the wholesale removal of tonsils, saying that tonsils which are large in early childhood very commonly are absorbed at an early age. ”

“ Exposure to cold and wet and to germ-laden air renders persons more liable to attacks. It is more likely to occur in young people, especially those who have already suffered from the disease and whose tonsils are chronically enlarged, and is most prevalent in this country in spring. The disease appears to be often associated with rheumatism. Tonsilitis begins much like grippe, with fever, headache, backache and pain in the limbs, sore throat, and pain in swallowing. ”

“ Of far graver, far-reaching and deeper significance are cases of infection in which life has doubtless been sacrificed by clinging to the lazy and stupefying delusion that the tonsil is the sole portal of poisoning. ”

“ Their cause is, as a rule, local disturbance in the mouth or throat, as decayed teeth, enlarged tonsils, cold in the head, catarrh, adenoids, or some form of infection of the mouth, or throat, or scalp. They occasionally accompany scarlet fever, diphtheria, measles, and influenza. They seldom suppurate.
Symptoms.—A swelling is noticed just below the angle of the jaw; it does not grow rapidly. There is a slight temperature and the child is more or less irritable. If the patient is an infant, the fever may be quite high and there may be considerable prostration. ”

“ In some instances the wind-pipe is primarily attacked, but when the disease affects this part of the throat it is generally a consequence of the extension of the membrane downward from the region of the tonsils. In the former case the diagnosis is somewhat difficult, as cultures taken from the throat may not show the presence of diphtheria bacilli, though material that is coughed up may contain myriads of the germs; in this phase of the disease interference with respiration is the symptom most to be feared. The mucous membrane of the nose, eyes, ears and generative organs, may be affected. ”

“ In chronic form there is general swelling of the tonsils with distension of follicles by above-mentioned putty-like masses, which are often calcareous. These are due to the proliferation of microbes, which find in these alveoli a most favourable field for their propagation. The affection usually ends in recovery, but may go on to grave local ulceration and general infection.
Treatment. Astringent antiseptics to buccal mucous membrane. Electuaries of honey or treacle and borax, sal ammoniac, chlorate or permanganate of potash and externally stimulating embrocations to the skin of the throat. ”

“ Personally, I should say that anæmia and malnutrition are the chief resulting evils, and that these conditions make us very vulnerable to infections. Sore-throat is certainly a drain disease, and thus a vulnerability to diphtheria is probably engendered. Puerperal disease of various kinds and rheumatic fever are among the diseases which have been attributed to sewer air, and it is probable that chronic enlargement of the tonsils and the surprising increase of adenoid growths in the pharynx and naso-pharynx are not without similar relationships. ”