1748 DISEASES OF THE MOUTH, THROAT, AND STOMACH 



yellowish spots will be seen on the tonsils; these spots are in reality 

 the surface portion of granules contained in the crypts, and may be 

 extracted with more or less ease. These bodies when squashed 

 have a very offensive odour ; under the microscope they consist of 

 masses of Nocardia-like organisms at times, at other times masses 

 of leptothrix; in certain cases both Nocardial fungi and Leptothrix 

 are seen and various bacteria, and even protozoa such as amoebae 

 and flagellates The nocardia fungi are very difficult to grow. 

 After several years the masses in the crypts may become calcified, 

 and real calculi may be formed, which at times are the starting- 

 point of some very severe inflammation. 



Varieties of Tonsillonocardiasis. — Clinically the usual form is the 

 yellow or whitish type. A case observed by one of us was charac- 

 terized, however, by the presence of black granules, from which a 

 nocardia similar or identical to Nocardia nigra Caslellani, 19 12, was 

 grown. 



Tonsillar moniliomycosis. — Monihasis of the tonsils has been 

 described by Castellani. Three types may be distinguished: the 

 acute, the subacute, the chronic. The acute type is important, as 

 such cases have often been taken for diphtheria. The tonsils are 

 covered by creamy white patches, which at times extend to the 

 soft palate, the pharynx, and larynx. There is difficulty in swallow- 

 ing, and the patient may have some fever. Diphtheria is often 

 suspected, but the microscopical and cultural examination clears 

 the diagnosis at once. The fungus most commonly found in 

 Ceylon is Monilia tropicalis Castellani. Cases of mixed infections 

 of diphtheria and monihasis have occasionally been seen by us. 



In the subacute and chronic types of moniliasis the subjective 

 symptoms are often nil. The diagnosis is based on the microscopical 

 examination. The treatment consists in applications of glycerine 

 of borax and of carbolic acid. 



Tonsillar Oidiomycosis. — The condition is due to fungi of the 

 genus Oidium Link. Clinically the affection is very similar to 

 moniliasis, but in the case in which Oidium rotundatum Castellani 

 was found the patches were yellowish and not white. 



Tonsillar Hemisporomycosis. — In certain cases of tonsillitis in 

 Ceylon Castellani found a fungus which he had previously observed 

 in cases of bronchomycosis. He was doubtful about the classifica- 

 tion of the fungus, and at first placed it temporarily in the genus 

 Monilia, naming it Monilia rugosa Castellani, 1909. Recently Pinoy 

 has placed it in the genus Hemispora, the name of the fungus be- 

 coming Hemispora rugosa. 



The case in which the fungus was first observed had been suspected 

 by the house physician to be a case of diphtheria, as the patient 

 complained of great pain in swallowing. There was fever, the 

 submaxillary lymphatic glands were enlarged, and on examination 

 of the throat several greyish patches were seen on the left tonsil 

 and on the soft palate. At times, however, the patches are yellowish. 

 Under appropriate treatment they become smaller and smaller. 



