bowels being also freely opened by calomel, followed by castor oil or Epsom salts. Where the tendency to disease of the brain is very decided, after the application of leeches, blisters behind the ears, repeated as they heal up, will often prove serviceable. The slightest indication of an approaching attack of convulsions or spasms, should be carefully watched, and treated by its appropriate remedies. In the paralysis which occasionally attends dentition, Dr. Fliess recommends scarification of the gums, repeated cupping in the neighborhood of the origin of the brachial nerves, mild purgatives, and wrapping the affected limb in flannel. The application of stimulants to the paralyzed extremity, or even the use of electricity, he remarks, can produce no good effect. The dysuria, so common in cases of difficult dentition, is best assuaged by the free exhibition of some mild demulcent drink. If the pain be considerable, and there is nothing present to forbid its use, an opiate may be administered.1 'R.-Sulph. magnes. 3ij. ad 3iij. Solve in Or, Dose-a teaspoonful, to be repeated ac- R.-Hydrochlor. ammoniæ, 3j. Pulv. ipecacuanhæ, gr. iv. Opii, gr. ij.-M. f. ch. No. xv. One to be given once or twice in the course of the day, according to circumstances. CHAPTER II. DISEASES OF THE THROAT. 1. Tonsillitis. INFLAMMATION of the tonsils and veil of the palate is a frequent disease of the latter stage of infancy, and during the entire period of childhood. It seldom, however, assumes the decidedly acute character so common in the tonsillitis of adults. From a very early age, the tonsils are liable to a subacute form of inflammation, producing, in many cases, a very considerable enlargement of these parts, which often continues for a long period, changing the tone of the patient's voice, and impeding his breathing, deglutition, and hearing. Tonsillitis usually commences with a sense of pain or uneasiness in the throat, a huskiness of the voice, and a sense of chilliness and languor, quickly followed by more or less febrile reaction. The pain in the throat increasing, deglutition becomes more difficult, and a sense of heat or burning is often complained of in the pharynx. There is often considerable nausea, and in children at the breast, regurgitation of the milk, shortly after it is swallowed. In children a few years old, there is a frequent hawking and rejection of tough mucus. The throat being examined, the velum palati and pharynx are found to be increased in redness, and tumid; both the redness and intumescence being, often, more considerable on one side than on the other, while one or both tonsils are found to be swollen, and generally covered with a coat of thick, tough mucus, often of a dirty white color. In some cases, the soft palate and uvula present a dark red and oedematous appearance. The throat is tumid, and painful to the touch, externally. The tongue is covered with a white fur, through which the papillæ, enlarged and of a bright red hue, project--a thick pellicle of transparent mucus being spread over the whole. When, as is occasionally the case, the inflammation of the throat is complicated with gastric disease, the tongue is generally covered with a yellowish fur, and a sense of pain or heaviness is experienced over the eyes. The swelling of the tonsils is often very considerable, impeding respiration, often entirely preventing deglutition, rendering the voice indistinct and whispering, and the hearing obtuse. The disease, when properly treated, commonly terminates by resolution. We never recollect to have seen an instance of extensive suppuration in a child. A substance, somewhat resembling pus, is, however, occasionally seen adhering to the surface of both tonsils; and, in some cases, a slight, circumscribed, diphtheritic exudation. Very frequently, the redness and tumefaction of the velum and pharynx subside, while the enlargement of the tonsils continues. More frequently the symptoms, from the commencement of the attack, are of a much less marked character. The child, if at the breast, exhibits a difficulty and pain in swallowing, and throws up its milk soon after it is swallowed; the throat, externally, is somewhat swollen, and tender to the touch; and there is a peculiar huskiness of the cry. If the child is old enough, it complains of pain in the throat, increased at every attempt to swallow; the swelling of the throat externally is often very considerable; there is a difficulty of breathing, and a frequent hawking up of a thick, tenacious mucus. On examining the throat, a slightly increased redness of the palate is observed, with considerable and irregular enlargement of the tonsils, which present a kind of lobulated appearance, their surface being covered with a thick coating of tough mucus. This form of the disease is very generally complicated with disease of the alimentary canal; it is more common in children of a lymphatic, than in those of a sanguineous temperament and plethoric habit. The causes of tonsillitis are, in general, exposure to cold and dampness-sudden vicissitudes of atmospherical temperature-cold drinks, when the body is in a state of perspiration-and cold to the feet. It frequently exists simultaneously with the acute exanthemata. It is more prevalent in spring and the latter part of autumn, than in the middle of either summer or winter. The treatment of inflammation of the tonsils is very simple, and, if early commenced, a very prompt resolution of the inflammation may in general be effected. In slight cases, some rubefacient to the throat, externally,' followed by an emollient poultice; a purgative of a few grains of calomel, with a moderate dose of the sulphate of magnesia a few hours subsequently, and a warm pediluvium at bedtime, will frequently be sufficient to arrest the inflammation. 1 R.-Ol. olivæ, 3j. Aq. ammoniæ, 3ij. Sp. terebinth. 3j.-M. When, however, the inflammation of the throat is more considerable, a few leeches should be applied to the neck or behind the ears. Internally, minute doses of tartar emetic, either simply dissolved in water, or in a solution of sulphate of magnesia, should be given. R.-Aquæ puræ, Zij. ad iv. Tart. antimon. gr. j.-M. Dose, a teaspoonful every two or three hours. R.-Sulph. magnes. 3iv. Solve in Dose, the same. We have derived very great advantage, in cases of tonsillitis, from the use of a combination of the hydrochloride of ammonia, ipecacuanha, and calomel.* R.-Ammonia hydrochlor. gr. xxxvj. ad. 3j. Ipecacuanhæ, gr. ij.-iv. Calomel. gr. iij.—vj.—M. f. chart. No. xij. One of which is to be given every three hours. The hydrochloride of ammonia, in inflammation of the throat in children, is a favorite prescription with many of the continental physicians. Loeffler recommends it in tonsillitis, to be given internally, dissolved in water with the addition of the syrup of liquorice. Blisters to the throat are directed by most writers, when the inflammation of the tonsils is severe, and not quickly arrested by the other remedies employed. We have seldom seen much good result from the application of blisters to the throat in young children; nor any instance in which they were required, in the disease under consideration. If resorted to, they should be kept on only so long as to redden the skin, and on their removal, the part to which they were applied covered with an emollient poultice. If the child be at the breast, it is better not to allow it to suck until the inflammation of the throat is subdued. It sucks, in general, with so much avidity that a large quantity of milk is carried to the throat at one time, which is almost immediately afterwards discharged by regurgitation or vomiting. Its thirst may be assuaged by a few spoonfuls of cold water, rendered somewhat mucilaginous by an infusion of slippery elm bark or pith of sassafras, or by a mixture of milk and water, given occasionally. Older children should be debarred from all food, and allowed toast-water or some simple mucilaginous fluid as a drink. Patients affected with tonsillitis should be kept in a dry apartment, the air of which is of a moderate and equable temperature. When accompanied by disease of the alimentary canal, the latter should be treated by its appropriate remedies. The treatment of the subacute form of tonsillitis, which, according to our experience, is the one most frequently met with in children, differs in nothing from that of the acute form. Leeches to the throat will be occasionally required. The mixture of hydrochloride of ammonia, ipecacuanha, and calomel, will be found particularly advantageous in these cases. Angina Pharyngea Edematosa.-Dr. Wertheimer (Journ. für Kinderkrankheiten, Bd. xxxii.) calls attention to a variety of angina occurring in children, characterized by serous infiltration of the submucous tissue of the pharynx. The cases that he has seen occurred in children, the larger number being under ten months of age; the oldest being ten months old-the youngest seven weeks. A difficult and rattling respiration first calls attention to the disease. On examining the throat, large accumulations of loose, foamy mucus are seen attached to the isthmus and pharynx, on the removal of which, all the parts possessed of loose submucous tissue are found to be excessively swollen, especially the uvula and tonsils. The mucous membrane is pale, smooth, and, to the touch, soft and sticky. Dyspnoea, although considerable, does not become so urgent as in cedema of the glottis, croup, &c. Respiration is very noisy, and accompanied by an expiratory, snoring sound. The voice becomes changed, and the cry of the child is deficient in clearness, but is never hoarse, as in affections of the larynx, or suffocative, as in severe inflammatory affections of the lungs. Sucking and swallowing are difficult, but not painful. There is a frequent sense of choking. The child, finally, refuses all nourishment. There is not, usually, any fever present. In two of the author's patients, the course of the disease was acute-five to nine days; in other two cases, the course was chronic. They all recovered. The prognosis is, therefore, favorable; prolonged disturbance of nutrition is the most unfavorable feature. Dr. Wertheimer has found emetics to be especially useful in this disease. He prefers infusion of ipecacuanha with oxymel of squills. Sinapisms applied to the neck for a few minutes are sometimes desirable. When the affection assumes a chronic form, pencilling the parts with a solution of nitrate of silver will be found beneficial. 2.-Hypertrophy of the Tonsils in Children. In young children the tonsils are subject to a chronic enlargement, the effects of which are far more serious than the entire neglect which the affection has met with from medical writers would lead us to suspect. In many cases, there In many cases, there is no doubt that the enlargement is due to a subacute inflammation of the tonsils; in general, however, it would seem to be dependent simply upon the irritation of teething. It is commonly developed in children between six months and two years of age, thus coinciding with the most active period of dentition. In proof of the enlargement being due to the irritation of teething, Robert, who has examined the subject with some care (Bull. Gén. de Thérapeut., May, 1843), remarks that he has seen the evolution of the dens sapientia in the adult attended with similar inflammation and hypertrophy of the tonsils. The enlargement is always in both tonsils, and becomes, in many cases, very considerable. When of any extent it affects the voice, giving to it a peculiar nasal tone, and, by its pressure on the Eustachian tubes, it impairs in a great degree the sense of hearing. By forcing up the velum palati, it also interferes with the freedom of respiration, hence those affected with it sleep with their mouths open. There is a constant, troublesome, dry cough. The air in respiration being prevented from passing through the nares, causes the nose to remain undeveloped in breadth, giving to the anterior part of the face a thin and, as it were, pinched appearance. The most important result, however, of the enlargement of the tonsils. is a flattening of the chest, to which Dupuytren first directed attention. This flattening Robert supposes to be produced by the enlarged tonsils preventing a sufficient quantity of air from being admitted at each inspiration, to fully expand the chest, or to exert from within the lungs a pressure equivalent to that of the atmosphere without. The deformity once established, necessarily gives rise to dyspnoea, palpitation, and the usual results of interrupted respiration and circulation; hence the children in whom it exists are commonly pale, thin, and feeble. When enlargement is once established, the hypertrophied tonsils never diminish in size; their excision consequently is the only means by which the inconvenience and injury resulting from their presence are to be remedied. For diminishing the deformity of the chest, Robert suggests various plans and different forms of gymnastic exercises. The application to the enlarged tonsils of the iodide of zinc, is said recently to have the effect of causing their rapid absorption. The article is prepared by placing a clean plate of zinc over a jar or vial, and sprinkling iodine over it. In a short time the iodide is deposited in the vessel, in the form of a semi-fluid deliquescent substance. This is to be applied pure, to the surface of the enlarged tonsil, by means of a camel's hair pencil, or of a piece of sponge secured to a suitable handle. It is to be held on for a short time, and repeated every two or three days, until the object is accomplished. The application is followed by a pungent smarting, which lasts for twenty or thirty minutes, but by no other inconvenience. Dr. Goddard, of this city, we are informed by Dr. Parrish, in his annual Report on Surgery to the College of Physicians, has used the remedy extensively, and speaks very favorably of its effects. He has found it to possess the property of inducing a rapid absorption of the enlarged tonsil, by a sort of shrivelling process, without the formation of a slough. It does not, like the chloride of zinc, spread to the surrounding healthy structure, and hence may be used without the fear of injury from being swallowed. (Summary of the Trans. of the College of Physicians of Philadelphia, No. vii, page 191.) Professor Hess, of Copenhagen, states that he has employed compression, by means of the index finger applied to the indurated |