ADDITION TO THE REVISED EDITION OF 1880. 4.79 



ADDITION TO THE REVISED EDITION OF 1880. 



SECTION II. AFFECTIONS OF THE PHARYNX. 



1. P. 474. 



Some cases of suppurative tonsillitis seem analogous to acne 

 vulgaris ; as in this a plug of sebaceous matter forms, so in the 

 lacunae of the tonsils plugs of inspissated, cheesy, glandular secre- 

 tion collect (acne tonsillaris of Hicord). If now tonsillitis be de- 

 veloped by cold, the presence of these cheesy plugs induces suppu- 

 ration with formation of very bad-smelling pus. 



Usually the abscess does not embrace the whole tonsil, but 

 forms one or several circumscribed foci ; after opening of the ab- 

 scess the rest of the swelling undergoes resolution or remains as 

 chronic thickening. In some cases angina tonsillaris ends in reso- 

 lution, but we must bear in mind that the formation as well as the 

 opening of small abscesses, or of such as are on the back part of 

 the tonsils, may escape notice. 



Rarely a patient is lost from angina by the occurrence of O3dema 

 glottidis, or extension of the suppuration to the connective tissue 

 around the carotid artery, or sinking of the pus along the neck into 

 the thorax, or by occurrence of mortification and general blood- 

 poisoning. 



In the onset it is claimed that the disease may be arrested by 

 passing an instrument into the lacunae from which the cheesy plugs 

 project, and clearing them out. The tendency to relapses is best 

 overcome by repeatedly washing the neck with cold water, gargling 

 with ice-water, and, when the tonsils remain large, by excising them. 



