TONSILLITIS AND LYMPHADENITIS 121 



inflammation, and from there, they or their products may 

 enter the general circulation and produce symptoms of a 

 general infection, or toxemia. Further, this condition may 

 appear during the course of some diseases, as distemper, 

 rabies, endocarditis, etc. 



Pathology.— The tonsils and the lymphatic tissues become 

 swollen, reddened, and later covered with a thick, tenacious 

 mucus. Vesicles are frequently formed, and in some instances 

 even membranous exudation, forming a pseudomembrane. 

 The lacunae of the tonsils become filled with a cheesy mass 

 of exudation, often becoming confluent, forming small 

 abscesses. The contents of the lacunse are composed of 

 epithelial debris and micrococci. In the chronic form, the 

 tonsils become hypertrophied due to a multiplication of the 

 glands mainly involving the lymphoid; or in some instances 

 the fibrous stroma is increased and the tonsils become hard 

 and swollen. 



Symptoms. — In the early stages the temperature is 

 elevated 102°-104° F., respirations and pulse accelerated. 

 When the glands become much enlarged, the patient breathes 

 with difficulty, holding the mouth open, producing a peculiar 

 snoring sound. Direct examination reveals the reddened 

 and enlarged tonsils. The cervical lymph glands are also 

 frequently enlarged from the infection. In severe cases the 

 tonsils become very much enlarged forming abscesses. 

 However, in the majority of cases the inflammation subsides 

 within a week, the temperature becomes normal, and the 

 local condition rapidly disappears. In the chronic form the 

 symptoms are milder and are usually overlooked. 



Prognosis.— In most cases favorable; depends somewhat 

 upon the cause. The course is rarely longer than one week 

 or ten days for the acute form, while the chronic form may 

 continue for several weeks. 



Treatment.— Locally the tonsils and the lymph tissues may 

 be treated with a 5 per cent, sodium bicarbonate solution. 

 Astringent and styptic preparations (iron, alum, zinc and 

 silver nitrate) may be found useful. Borax in glycerin 

 (2 per cent.) or thymol in glycerin (3 per cent.) can be used 

 as a deodorant when the mouth becomes offensive. Abscesses 



