Etiology

This is a disease of childhood. It is, however, not infrequently met with in grown people. An attack of this disease is supposed to be precipitated by wet and cold weather, and bad hygienic surroundings. The weather and surroundings will have little to do with bringing on a disease of this character until nutrition is very much impaired. Some of our leading writers declare that sewer gas is regarded as a common exciting cause. I agree in full that this is true, but I do not agree with them as to the location of the sewer. In all the cases that I have ever been called upon to treat, the sewer has been below the diaphragm. Unless there is a sewer there, the outside sewer--city drains, grease traps, etc.--will have little to do with developing the disease. According to our best authorities, one attack renders a patient more liable to subsequent attacks. Why? Because these patients will be treated for sewer-gas poisoning, instead of correcting the cess-pools under their diaphragms; and so long as they know nothing about proper living, and continue to generate sewer gas in their own stomachs and bowels, they will be subject to frequent attacks of this disease. The disease prevails more in the fall. Why? Because the first cold weather is accompanied by chilly winds. The throat already being sensitive from imprudent eating all summer, the cold air creates irritation. The patients put on heavy underwear just as soon as the weather turns cold, the body is over-heated, and they are thrown into a cold.

The cold is often repeated quite frequently during the fall and winter. There is nothing peculiarly wrong with the weather in the fall, so that anyone need be affected by it, indeed, it is usually delightful; but for years I have noticed that tonsilitis is a very common disease following within a week after the people start fires in their homes and put on their heavy underwear. It is worth while to know that after Thanksgiving, Christmas, New Year, and other feast-days, there is always an epidemic of tonsilitis, la grippe, colds, pneumonia, etc. Where conditions are favorable, diphtheria is developed, which is nothing more or less than a septic development or infection of ordinary tonsilitis. Most authorities look upon it as epidemic and contagious. It is so only in appearance, however; for people generally have much the same habits of eating, housing, clothing, etc., and there is nothing strange in the fact that all enervated people should be affected alike. When the habits of the people are analyzed, they will be found to live in much the same way; then it would be unnatural if physical agencies did not act on all alike.

Symptoms

Chill and fever, with aching all over, but particularly in the back and legs, are the symptoms with which this disease is ushered in. In children the temperature often runs to 105° F. Accompanying the disease there is always more or less gastritis; for the origin of the disease is gas poisoning from the gastro-intestinal canal.

The first symptoms may be a soreness in the throat; if not, this will come soon after the fever starts. On examination after the angina has commenced, the throat will be found intensely red, and the mucous membrance engorged, congested, and much swollen; the tongue is usually coated, and the breath very foul; the urine, as in all cases of fever, is highly colored and filled with mineral elements. Children frequently breathe very heavily, the pulse is quite rapid, and swallowing in some cases almost impossible. The fever is somewhat self-limited, usually lasting about a week. Then the patient will be almost well, unless there is a complication of quinsy setting in. That means that the tonsilar inflammation has extended to the soft palate, and an abscess will form. This form of tonsilitis is what is known as quinsy. It is an infection from an ordinary tonsilitis. The tonsils remain enlarged after this disease for quite a while, but will gradually shrink to their normal size, if the patient is properly fed; if not--if the patient continues the ordinary haphazard living--other attacks of tonsilitis will follow, a few weeks or months apart, until a time comes when the tonsils will be very much diseased. The constitutional derangement is great. Rheumatism will develop in some, and pulmonary tuberculosis in others.

Treatment

Inasmuch as tonsilitis always comes from gastro-intestinal fermentation, the first, last, and about the only consideration in the line of treatment should be given to clearing out the intestinal tract and fasting until the disease is controlled. Copious enemas should be given two or three times the first twenty-four hours, and after that every night before bedtime. Positively no food should be taken until the inflammation in the throat has entirely subsided, but all water desired may be taken. Then the eating should be confined to fruit for the first twenty-four hours; the second twenty-four hours, fruit moming and night, with a combination salad and cooked, non-starchy vegetables for the noon meal. The third day a little meat may be used if desired, or a soft-boiled egg, with a salad or a grapefruit. At the end of the fourth or fifth day, toasted bread and butter, with uncooked fruit, may be taken for breakfast; meat and salad, with cooked, non-starchy vegetables, for the second meal; and fruit for the third meal.