TONSILLITIS  , acute inflammation of the tonsils, or

quinsy, due to the invasion of the tonsil, or tonsils, by septic micro-organisms which may have gained access through the mouth or by the blood-stream . Sometimes the attack comes on as the result of direct exposure to sewer gas, and it is not at all an uncommon affection of house surgeons, nurses and others who have to spend most of their time in a hospital . The association of quinsy with rheumatism may be the result of the infection of the tonsils by the micro-organisms or the toxins of that disease . Acute tonsillitis is very apt to run on to the formation of abscess . Quinsy may begin with a feeling of chilliness or with an attack of shivering . Then comes on a swelling in the throat with pain, tenderness and difficulty in swallowing . Indeed, if both tonsils are acutely inflamed it may be impossible to swallow even fluid and the breathing may be seriously embarrassed . The temperature may be raised several degrees . There is pain about the ear and about the jaw, and there is a swelling of the glands in the neck . The breath is offensive and the tongue is thickly coated . There may be some yellowish markings on the surface of the tonsil, but these differ from the patches of " false membrane " of diphtheria in that they can be easily brushed off by a swab, but often a true diagnosis can only be made by bacteriological examination . The treatment consists in giving a purgative, and in encouraging the patient to use an inhaler containing hot carbolized water .

Hot compresses also may be applied to the neck . As regards medicines, the most trustworthy are salicylic

acid, iron and quinine . As soon as abscess threatens, a slender-bladed knife should be thrust from before backward deeply into the swollen mass . And if, as most likely happens, matter then escapes, the patient's distress speedily ends . Convalescence having set in, a change of air and course of tonic treatment will be advisable . Chronic tonsillitis is often associated with adenoid vegetations at the back of the throat of tuberculous or delicate children, such children being spoken of as being " liable to sore throat." Chronic enlargement of the tonsils may seriously interfere with a child's general health and vigour and, should the condition not subside under general measures such as a stay at a bracing seaside place and the taking of cod-liver oil and iron, it will be well to treat the tonsils by operation . (E .