Tonsillar disease in children / by James Carmichael.

Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: Tonsillar disease in children / by James Carmichael. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    draw a liard and fast line. Certain it is, that you have a simple form of patch confined to the tonsils alone, and clearing off within a few days or a week. On the other hand, you meet with cases where the patches are more adherent, and tend to spread over the adjacent mucous surfaces, the disease taking several weeks to run its course. Professor Henoch^ differentiates clinically between the simple forms of sore throat with exudation and the diphtheritic throat. He says certain anginas present a similarity to diphtheria. On the second day of the disease round yellowish-white patches, the size of a pin's head or larger, appear upon the tonsil; occasionally they are isolated, but often confluent, so that the tonsil appears covered with an irregular whitish-yellow mass, which looks sus- j)icious, but usually, he says, these patches leave no doubt of their benign nature, they are composed of purulent material secreted from the follicles, are loosely adherent, and easily detached. The yellowish colour of the patch is different from the gray or white colour of diphtheritic exudation. Cases occur not unfrequently in which judgment must be delayed for from twenty-four to thirty- six hours. Within this time simple catarrhal angina is either at a stand-still or subsiding, while diphtheria steadily increases in severity. I attach no importance to the fever and enlargement of the lymphatic glands, as they are common to both conditions. Microscopically you cannot arrive at a diagnosis, as bacteria are also found in both. Many cases of severe catarrhal angina are undoubtedly regarded as diphtheria by superficial observers, and this explains the fact that many physicians cure almost every case of diphtheria. Parenchymatous Tonsillitis is much less frequently met with than the other affections, and so with tonsillar abscess, which in young children is extremely rare. Why this should be the case we are unable to explain. Complicated Forms.—Of these I have already referred to the croupoiis variety, and have nothing further to add, except that under certain conditions, I believe this form of sore throat may take on diphtheritic action. Last year I had a little girl under my care in the Koyal Hospital for Sick Children, suffering from scarlatina. She had well-marked follicular tonsillitis with croupous exudation from the commencement of the disease. By the tenth day the patches had cleared off the right tonsil entirely; on the left one there still remained a very little patch, about the size of a small pea. On the twelfth day this tonsil became more swollen, and of a dark red colour, and diphtheritic ulceration rapidly spread from it to the soft palate, uvula, and nares, and also to the other tonsil. The child had a prolonged and tedious attack of diphtheria. I have seen other cases of a similar nature, going to prove that diphtheria may be, so to speak, grafted upon an ordinary sore throat. This occurs most 1 Diseases of Children, p. 286.