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Tonsils and Adenoids 
 
 Treatment and Cure 
 
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Tonsils and Adenoids 
 
 Treatment and Cure 
 
 From the Standpoint of the Physician and Laryngologist 
 In Preference to that of the Surgeon and Laryngectomist 
 
 BY 
 RICHARD B. FAULKNER. M. D., (Columbia University) 
 
 THE BLANCHARD COMPANY, 
 PITTSBURGH, PA. 
 
COPYRIGHT 1915 
 BY 
 
 RICHARD B. FAULKNER, M. D. 
 
 THE BLANCHARD COMPANY 
 
CONTENTS. 
 
 Page 
 
 Treatment and cure i 
 
 ACUTE FOSSULITIS ( ACUTE TONSILLITIS) 3 
 
 Symptoms 3 
 
 Treatment 4 
 
 Chronic fossulitis (Chronic tonsillitis) 5 
 
 Symptoms S 
 
 Treatment 6 
 
 Secondary Diseases of the Tonsils 6 
 
 Symptoms 7 
 
 Treatment 7 
 
 Symptomatic Diseases of the Tonsils 7 
 
 Reflex Diseases OF THE tonsils 7 
 
 Symptoms 8 
 
 Treatment g 
 
 Mechanical Disorders of the Tonsils 9 
 
 Symptoms 9 
 
 Treatment lo 
 
 enlarged Tonsils n 
 
 Causes ii 
 
 Treatment 15 
 
 adenoids 15 
 
 Three Classes 15 
 
 Treatment 16 
 
 THE TONGUE TONSIL 18 
 
 Treatment 18 
 
 The Tubal tonsils 19 
 
 Treatment 19 
 
 QUINSY 19 
 
 Symptoms — 20 
 
 Abscesses 21 
 
 Treatment 22 
 
 Cancer 22 
 
 Sarcoma 22 
 
 Fibro-enchondroma 22 
 
 CYSTOMA 22 
 
 Lymphadenoma *2 
 
 PAPILLOMA 22 
 
 Lipoma 2a 
 
 ANGIOMA 22 
 
 Diphtheria 22 
 
 VINCENT'S Disease 22 
 
 Caution 2j 
 
 prescriptions 26 
 
 Zinc Versus Silver 30 
 
TREATMENT AND CURE . 
 
 Under the law of Hammurabi, King of Babylon, B. C. 
 2285-2242, surgeons who made mistakes had their hands 
 cut off. If that were the law now, many surgeons would 
 lose their hands. 
 
 Cehus, a famous physician, who lived B. C. 400, grew a 
 long, sharp, finger nail, with which he cut out tonsils, as you 
 would turn out an &gg from the shell. In the course of cen- 
 turies, the operation for the removal of tonsils was revived, 
 several times. It is again revived, in America. 
 
 To cure tonsils, or adenoids, it is necessary to know 
 what they are, what they do, and what deranges them. It 
 is a question of knowledge ; and with this as their guide, 
 surgeons would save their hands, even though the law of 
 Hammurabi were revived. 
 
 There are three sets of circulating channels in the 
 human body, arteries, veins and lymphatics. Through the 
 latter flozvs a fluid, called lymph, which protects the system 
 from germs and other harmful matter. The lymph fluid 
 contains a vast number of lymph cells, the duty of which is 
 to attack and destroy germs and other poisons. Attached 
 to the lymphatic canals are countless numbers of little 
 bodies, called adenoids (86*). These are divided, according 
 to size, into three classes. The largest are named tonsils, 
 the medium, lymph nodes, and the smallest, lymph nodules. 
 (87) They are filters. Germs and other harmful matter 
 w^hich in any way get into the lymphatic canals are carried 
 along until an adenoid is reached, and here they are depos- 
 ited and destroyed, while the lymph itself passes on. While 
 
 ♦Note. The figures in the body of the text refer to pages in 
 my book, on "The Tonsils and the Voice." The reader is ad- 
 vised, in every instance, to refer to the page indicated and 
 read what is there set forth. 
 
 1 
 
thus engaged in filtration, adenoids swell. The amount of 
 swelling is in direct proportion to the protective work they 
 are doing. There is no other reason for their enlarge- 
 ment. (88.) 
 
 There are six prominent tonsils. In the back of the 
 mouth there are three; one on each sidewall, named the 
 faucial, and one on the back of the tongue, named the 
 tongue tonsil. Behind the nasal passages there are three; 
 one attached to the roof, named the pharyngeal; and one 
 surrounding the orifice of each Eustachian tube, named the 
 tubal. These six, connected by lymphatic canals, are known 
 as Waldeyer's lymphatic ring. (9) Connected with this 
 ring, there is another, formed of smaller but similar bodies 
 {lymph nodes) and yet beyond this secondary ring, there 
 are countless thousands of still smaller bodies {lymph 
 nodules), scattered about in and underneath the lining mem- 
 branes of the mouth and the parts behind the nasal pass- 
 ages. (9, 87) 
 
 The faucial tonsils are quite separate and distinct from 
 the others that help to make up the Waldeyer ring. 12) 
 They are suspended in the center of a framework of 
 active and important muscles. They change in position con- 
 stantly in singing, speaking and swallowing. (15) They 
 change position rapidly and with great facility. (47) They 
 are covered and protected by a strong, tough capsule into 
 which muscular fibres are inserted. (13 Each one 
 of these tonsils consists of a small group of 
 lymph nodes, of an oblong shape. These are bound to- 
 gether; and as the tonsil rests in its natural position in the 
 back of the mouth, its surface presents irregular depres- 
 sions. The surface is covered over with the mucous mem- 
 brane that lines the mouth. This membrane dips down 
 into, and lines the depressions, pits, or trenches, formed by 
 the binding together of the nodes. The general appearance 
 
 2 
 
of the tonsillar surface is that of several oblong knobs, with 
 trenches between them. These little trenches are now called 
 fossitlae, by the Anatomical Society. These fossulae are 
 not bent, but are quite straight and simple. They do not 
 penetrate the tonsil. They are not "holcG" in the tonsil. 
 (37) The structure of these tonsils differs absolutely from 
 that of all other tonsils. Through their outer surface, they 
 absorb nothing. (13, 126) They have no facilities for ab- 
 sorption through their outer surface. The capsule, also, 
 prevents absorption. (124) In the interior of these tonsils, 
 there is a system of closed lymphatic canals (123), which 
 connects zvith the lining of the nose. There is also a direct 
 communication between the interiors of the two faucial 
 tonsils, by lymphatic canals. (17) 
 
 The faucial tonsils become diseased from six sources : 
 primary, by infection from the mouth ; secondary, from the 
 nose; symptomatic, from the blood; reflex, through the 
 nerves ; mechanical, by pressure ; and by nezv growths. 
 
 ACUTE FOSSULITIS: 
 
 erroneously called, acute tonsillitis. This is an inflammation 
 of the mucous membrane that covers the outer surface of 
 the tonsil and lines the fossulae. (29) It is caused by direct 
 infection from a filthy mouth, filthy teeth and gums, and 
 filthy nose. (29) Filthy matter (containing pus-producing 
 germs, the yellow and white micrococci, staphylococci and 
 streptococci) accumulates in the fossular trenches. 
 
 The disease is sometimes associated with secondary 
 trouble in the interior of the tonsil, carried from the nose 
 by way of the lymphatic canals. 
 
 Symptoms. The throat feels sore in swallowing, dry, 
 scratchy, with sometimes slight swelling and pain below 
 the angle of the jaw. One or several gray or yellow spots 
 appear on one or both tonsils; they are the open mouths 
 
of fossulae, filled with filthy matter. The tonsils are slightly 
 reddened, and sometimes moderately swollen. 
 
 In aggravated cases, the tonsils are considerably en- 
 larged, red, painful, and the entire back part of the mouth 
 is. inflamed, with painful swallowing, and the accumulation 
 of filthy, sticky, mucus. There is headache, backache, 
 slight rise in temperature, with general weakness. In 
 "brashy" children, the temperature will sometimes run high 
 suddenly, and then drop down just as quickly. The disease 
 lasts three to six days. 
 
 For details in diagnosis of primary afifections. I refer 
 readers to pages 273. 280, 281, 282 and 283, of my work on 
 "The Tonsils and The Voice." 
 
 Treatment. The filthy fossulae should be thoroughly 
 washed out, with a small syringe having a long, curved 
 nozzle, using the solution of borax (A*), followed by the 
 solution of resorcin (J) or of zinc (H). A wad of ab- 
 sorbent cotton, held in the grasp of long, curved forceps, 
 should be saturated with either the resorcin or zinc solution 
 applied and rubbed well into the fossulae and the surface 
 of the tonsil. The filthy matter is sometimes removed from 
 the fossulae by aero-suction with an air pump, made espe- 
 cially for this purpose. If any fossulae are plugged with 
 hardened matter, or contain pus, they should be opened, 
 cleansed and sterilized. (J) Rigid hygiene of the mouth 
 and nasal passages should be enforced, (306) and the gums 
 and necks of the teeth kept free from particles of decom- 
 posing food. The bowels should be regulated by dieting, 
 and in children by giving after each meal, one teaspoonful 
 of spiced syrup of rhubarb. The linings of the fossulae 
 and the surface of the tonsils should then be hardened by 
 galvano-cautery. 
 
 *Note. The capital letters in brackets in the text refer to 
 prescriptions at the end of this work. 
 
In aggravated cases (361), the filthy, slimy mouth 
 should be rinsed or sprayed with a saturated solution of 
 bicarbonate of soda (B), followed with the application of 
 guaiacol (K), and then with the application of suprarenal 
 extract (G). These measures, repeated once or twice daily, 
 will rapidly abate the condition. If improvement is not 
 prompt, then assist with the administration of iron (O). 
 When the bowels are constipated, and the tongue coated, at 
 the beginning of treatment a dose of solution of citrate of 
 magnesia acts well, or a dose of epsom salts. For severe 
 headache, with rise in temperature, five grains of acetanilide 
 may be given to an adult, once or tv/ice daily, until relieved. 
 For children, a half teaspoonful of spirit of Mindererus, in 
 a little water, every two or three hours. 
 
 CHRONIC FOSSULITIS: 
 
 also erroneously called chronic tonsillitis. This condition 
 is noted by the constant appearance of dirty gray or yellow 
 plugs hanging from the mouths of one or more fossulae. 
 When they are thrown out, they have both a foul odor and 
 taste. A filthy mouth, teeth, nose and the crowding of the 
 fossulae with filthy matter, prolongs the complaint. The 
 fossulae should be washed out, and sterilized daily, or with 
 sufficient frequency to keep them al)Solutcly clean. The 
 mouth and nose must be kept clean and constantly sterilized. 
 Good dentistry is of great value. 
 
 If the mucous membrane that covers the surface of the 
 tonsil and which acts as a lining for the fossulae becomes 
 easily inflamed, we have no right to say, as most doctors 
 do say, that the tonsil is a menace to the entire human 
 system, and that it should be cut out. Even if it were true 
 that the tonsil, on such account, is a constant danger to the 
 general health, we cannot conclude that, for such reason, 
 
 5 
 
it should be destroyed ; but that, upon the contrary, if we 
 should know of any human organ that becomes easily 
 affected, it should not be destroyed, but we should try to 
 protect it as much as possible against the danger of infec- 
 tion, which, in the case of the tonsil, is not so difficult to do. 
 The mucous membrane that lines the fossulae and covers 
 the surface of the tonsil should be hardened, and thus made 
 more resistant to infectious germs. The application of 
 galvano-cautery is the very best remedy with which to 
 harden the membrane. The proper applications are super- 
 ficial, painless, protective and preservative. They should 
 not be deep and destructive (362). By this method of gal- 
 vano-cautery, the tonsil is cured and not destroyed. (40, 
 361, 362). The general system should be hardened by regu- 
 lated exercise, good food, fresh air, etc. In all cases of 
 primary inflammation of the tonsil, the operation for re- 
 moval cannot be too strongly condemned. 
 
 SECONDARY DISEASES 
 
 affect the interior of the tonsils, and are caused by infectious 
 matter carried into them from a filthy nose, by way of the 
 lymphatic canals; (83) also from infections by way of the 
 blood (37) ; and also by infection from abscesses that occur 
 in the vicinity of the tonsil. (83, 284) 
 
 The researches of Menccr are here of great value (33, 
 2yy, 282, 283). They prove that just in that particular dis- 
 ease (articular rheumatism) wherein the entrance of germs 
 through the tonsil was considered assured, the infection 
 actually enters through adjoining tissues, through the count- 
 less thousands of lymphatic nodes and nodules of the neigh- 
 borhood, while the tonsils only become diseased secondarily 
 from the blood, or by way of the lymphatic canals leading 
 from the nose. Thus we see that rheumatism does not enter 
 
 6 
 
through the tonsils. (22) Most infections in the tonsil are 
 secondary, and mostly from the nose, (t,^, 7,y, 38) 
 
 Germs are always present in the nose in nasal catarrh, 
 during attacks of cold in the head, after nasal operations, 
 and in all babies and children who constantly sniffle. In 
 these cases, the tonsils are always infected, swollen, painful 
 and tender. (90) But these tonsils are not inflamed. Their 
 interiors are rarely inflamed; they rarely form pus. (143, 
 358) The swelling, pain and tenderness indicate the salu- 
 tary filter action of the tonsils. (90) There is always an 
 immediate improvement and prompt subsidence of the ton- 
 sillar condition after cleansing and sterilizing the nasal 
 passages. (307, 308, 309) Mop the nose at least twice 
 daily with cotton, saturated with solution (A). Rinse the 
 mouth with the same solution, and apply (H) or (J) to 
 the tonsils. 
 
 For acute cold in the head, cleanse and sterilize the nose 
 and mouth; apply ointment (C) or powder (F), and ad- 
 minister (N). Chronic nasal catarrh should be treated 
 and cured ; cleanliness is the first essential. 
 
 SYMPTOMATIC DISEASES 
 
 arise from infection of the blood, tuberculosis, scarlet fever, 
 rheumatism, etc. (81) They are called symptomatic to dis- 
 tinguish them from secondary affections, which latter may 
 be directly traced to another locality. 
 
 The treatment of the tonsil involves that of the general 
 complaint, with enforcement of cleanliness in the nose 
 and mouth and the application of antiseptics to the tonsil 
 (A. H. J.). 
 
 REFLEX DISEASES 
 
 are so frequent, so important and so little understood by 
 physicians, that it is deemed best to refer all readers to 
 
 7 
 
pag2 286 of my book for more detailed information. It 
 is not uncommon for the tonsils to become painful or swol- 
 len and painful, without apparent cause. Pain anywhere, 
 not associated with increased temperature, must be looked 
 upon as reflex. (290) It is common experience to see the 
 face swelled, the jaw set, the muscles of the pharynx con- 
 tracted, the masseter muscle pressing firmly against and 
 causing pain in the tonsil, with an inability to open widely 
 the mouth, and all as a reflex from an aching tooth. (290) 
 I have seen streams of pus pouring from the mouths 
 of the fossulae, associated as a reflex, in cases of erupting 
 molar teeth. In one case which I saw, very recently, of a 
 lady, aged twenty years, the left tonsil was greatly swollen, 
 the pain in it was excruciating, and streams of creamy pus 
 were pouring from the fossulae ; and at the same time, she 
 developed many most excruciatingly painful areas of reflex. 
 These areas were behind the left ear, over the sterno- 
 cleido-mastoid muscle in the neck, over the middle of the 
 left collar bone, over the rib region of the back, over the 
 pit of the stomach, and in the lower bowel. The muscles 
 were contracted and stood out like whip-cords in the neck, 
 over the collar bone, and as large as the index finger over 
 the stomach. Finger pressure over any one of these painful 
 areas brought tears and symptoms of fainting, with a most 
 vigorous protest. She was on the verge of collapse. In a 
 few hours, she cut a wisdom tooth, ivhereupon the tonsillay 
 trouble, with all of the xvonderful associated reflexes, imme- 
 diately disappeared. The treatment consisted in the appli- 
 cation of campho-phenique to the swollen gum, which gave 
 comfort by relieving the pressure of the tooth against the 
 gum. This was followed by the application of tincture of 
 lodme. I have seen other similar, but less severe, cases. 
 
 There are four periods in the development of the teeth, 
 when the tonsils become slightly enlarged, painful and 
 
 8 
 
tender, without inflammation, or evidence of suppuration. 
 These four periods correspond to the times when four 
 groups of molar teeth are in process of cutting through. 
 These periods are, with little variation, at two years, six, 
 twelve and seventeen. The enlargement of the tonsils coin- 
 cides definitely with these four periods, (no) In these 
 cases, there is no infection of either the interior, or the 
 outer surface of the tonsils. They are nerve reflexes. After 
 cutting the teeth, the tonsils immediately return to their 
 normal condition. Treatment with borax solution (A), 
 resorcin (J) and campho-phenique is sufficient. 
 
 After operation for the removal of tonsils, contractions 
 of the wounds take place, and extensive adhesions form, 
 leading to distortion of the parts, and over-stretching of 
 the muscles and mucous membranes, causing endless reflex 
 disorders. (292) For most of these contractions, distor- 
 tions and reflexes, there is no relief. Stomach and bowel 
 trouble, constipation, and intestinal worms, cause many 
 reflex disturbances of the tonsil. In all cases of reflex 
 disease of the tonsil, the source of the reflex should be 
 sought for and removed. Of course, in these cases, it would 
 be an unpardonable surgical blunder to remove the tonsil. 
 
 MECHANICAL DISORDERS 
 
 arise from mis-use of the voice, pressure from the cutting 
 of wisdom teeth, and pressure from the abscesses that form 
 in quinsy. Many voice users present the following symp- 
 toms : catarrh of the pharynx and larynx, with congested 
 mucous membranes ; arches of the palate swollen ; epiglottis 
 swollen and red ; vocal cords thickened and red ; lining of the 
 trachea congested ; ulcerations occur ; congestion in the 
 trachea extends upward into the nasal passages, involving 
 the Eustachian tubes and the middle ear in a general sub- 
 acute inflammation ; huskiness of the voice ; paralysis of the 
 
 9 
 
muscles of the larynx, and of the vocal cords; formation 
 of singer's nodes. The real cause of the above conditions 
 consists, not in a long continued use of the vocal organs, 
 but in a faulty luay of using them. The trouble is purely 
 functional. 
 
 In my work, pages 46 to 67, I have explained at length 
 the importance of the mechanical, acoustic and phonetic 
 functions of the to)isil. These functions, with their derange- 
 ments, have never before even been mentioned in the whole 
 range of medical literature. The science of voice mechan- 
 ism, and the phenomena of speech and song, do not belong 
 to the physician's art. But the voice profession points with 
 pride and justice to the scientific contributions of its masters 
 upon this subject. Garcia laid the foundation of scientific 
 laryngology. (184, 185, 186) And to the masters in his 
 profession we may wisely continue to appeal for instruction. 
 
 Mechanical afifections of the tonsil, associated wdth the 
 mis-use of the voice, are beyond the realm of the medical 
 profession. Maladies of the timbre, of the middle register, 
 of solidity, intensity, compass, agility, tremolo, the medium 
 out of balance, the transition missed, the vanished mezzo- 
 tone, are difficult problems. (299, 317, 319) These troubles 
 are not noted or described in medical books. Their remedy 
 requires the application of a correct method of voice pro- 
 duction. They tax to the limit the knowledge and experi- 
 ence of the voice teacher, for the slightest error in treatment 
 may injure the voice permanently. (301) 
 
 The voice mechanician and the expert laryngologist 
 may also be called into counsel. But the ordinary throat 
 specialist, and the laryngectomist — ever ready wath his 
 knife — never. To all whose voices are affected, I urge the 
 study of the chapters in my work, on pages 181 to 240, the 
 Si.Y Voice Questions, 241 to 271, and the Hygiene of the 
 Tonsils and of The Voice, 306 to 327. 
 
 10 
 
Voice users' tonsils require more consideration and less 
 treatment than those of other persons. There are no times 
 at which a voice user's throat requires surgical treatment, 
 with any assurance of improving the voice. Large tonsils 
 in elder professional singers should never be removed. (368) 
 Many voices are ruined by ignorant throat specialists. 
 
 Tonsils are sometimes swollen and painful from direct 
 pressure caused by the cutting of a wisdom tooth. They are 
 sometimes swollen and painful and even pushed out of their 
 natural position, by the direct pressure of the abscess that 
 forms in quinsy. Relief of pressure corrects the condition ; 
 and in the meantime, apply (A. K. J.) and campho-phenique. 
 
 ENLARGED TONSILS. 
 
 All medical authorities agree that tonsils are unusually 
 large in twenty per cent, of all persons between three and 
 eighteen years of age, and that after the latter age, they 
 naturally decrease in size. And the most eminent authorities 
 have also declared that children with large tonsils are gen- 
 erally very healthy, and that they are less easily affected by 
 diphtheria than children with smaller tonsils. (33) What 
 is the explanation of these facts? On pages 86 to 90, in 
 my book, I have shown that tonsils and adenoids are filters, 
 and that they always swell when actively engaged in the 
 process of filtration. On page 44, I have presented the 
 proof that the faucial tonsils do not absorb through their 
 surface; and on page 45, I have presented the further proofs 
 that they are infected through the blood, and that germs in 
 the nose are carried to the interior of these tonsils by zvay 
 of the lymphatic canals. Therefore, I oflFer the following 
 explanation as the proper cause of the enlargement of ton- 
 sils, between three and eighteen years of age. Before three 
 years, babies receive constant care from their mothers. They 
 are bathed regularly, and some eflfort is always made to 
 
keep their noses and mouths clean. After three years, the} 
 are able to walk about, and they no longer receive quite 
 the same care. As they grow older, they run more at largc- 
 and indulge more in play. They waste no time on their 
 toilet. Not until about sixteen to eighteen do they begin 
 to feel more pride in their personal appearance, take pattern 
 of the better groomed, and appreciate the value of a more 
 careful toilet, and of a cleaner nose. Hence, from three 
 to eighteen years is the most neglected period of life in 
 regard to the cleanliness of the nose. During the period 
 from three to eighteen years, the tonsils have more to filter 
 and they enlarge for the purpose of performing that duty. 
 Furthermore, those whose tonsils are enlarged during the 
 period designated are unusually healthy and less affected by 
 diphtheria, because their tonsils are actively engaged in 
 filtration and the consequent prevention of infection by 
 germs. 
 
 In natural breathing, the air goes in through the nose. 
 It is, therefore, a prime necessity to keep the nose clean. 
 A free and open filthy nose is a constant source of danger. 
 The air we breathe is full of filth. It carries the germs of 
 disease into all the breath passages. Thirty cubic inches 
 are inhaled with every ordinary breath; there are eighteen 
 breaths every minute, and 1080 every hour ; 540 cubic inches 
 of air are inhaled every minute, and 32,400 cubic inches 
 every hour. (307) And all this goes, or should go, in 
 through the nose. Wherever dust is raised, in the street, 
 m factories, in schools, in hospitals, in homes, we inhale 
 with the cloud large numbers of germs. (308) When we 
 consider that all of the dust, germs and filth contained in 
 this large volume of air are carried into the air passages 
 and deposited upon the lining membranes, and that none 
 comes out, it is not surprising that infections take place. 
 The dust in the air we breathe causes disease in all the 
 
 12 
 
breath passages. Disease of the air passages is chiefly a 
 question of dust (29) Among Arctic explorers, in the 
 regions of snow and ice, and the absence of dust, there is 
 no record of disease in the breath passages, no colds, no 
 laryngitis, no bronchitis, no pneumonia. Modern bacteri- 
 ology teaches us that wherever a specific germ is to be 
 found, the disease belongs to that germ. No matter what 
 part of the body is affected, if the germ of tuberculosis is 
 present, the disease is always tuberculosis. A knowledge of 
 this fact makes treatment surer, prevention more certain, 
 and mortality is greatly lessened. (82) I have shown that 
 the germ of cerebro-spinal meningitis enters the system 
 through the nose, by way of the pharyngeal tonsil (89) All 
 tonsils absorb through their outer surface, excepting the 
 faucial. Large tonsils are naturally very active tonsils ; 
 most highly protective. By their enlargement they some- 
 times cause embarrassment to breathing and swallowing, 
 but this is no reason for cutting them out. 
 
 It is exceedingly rare that enlargement of the tonsils 
 alone puts the life of the patient in such danger as to call 
 for surgical removal. In those cases where sore throat is 
 frequent, the patient is apt to bleed seriously if a cutting 
 operation is attempted, and he will become subject to fre- 
 quent sore throat thereafter. In these latter cases, where 
 inflammations before operation are frequent, it is best not 
 to operate, but to adopt other and safer methods of treat- 
 ment. It is of the most absolute importance to avoid cutting 
 operations upon infected tonsils. Here, galvano-puncture 
 gives good results; size decreases rapidly; inflammations 
 disappear. Before galvano-cautery, test the susceptibility 
 of the patient. Some throats re-act greatly under the 
 slightest cauterization. Under these conditions, begin with 
 very light points of galvano-cautery ; the condition of the 
 next three days will indicate the degree of susceptibility. 
 
 13 
 
During the galvano-cautery treatment, the tissues 
 should be touched, daily, or morning and evening, with a 
 concentrated solution of resorcin (I) ; the inflammation 
 thus will disappear rapidly, and the locality is thoroughly 
 antisepticised. During treatment with galvano-cautery or 
 resorcin, I always give, internally, syrup of iodide of iron, 
 ten drops after breakfast and supper, in a little water. The 
 tonsil may present numerous affected fossulae. These 
 should be freely exposed and galvano-cautery applied; but, 
 if there are contra-indications, such as inflammation, then 
 employ milder resorcin solution (J). Each fossula should 
 be washed out, and then swabbed with a wad of cotton, 
 saturated with resorcin solution. 
 
 Another successful method of treatmnit for infected 
 tonsils is that of systematic swabbing twice a day with 
 glycerite of tannin (L), for eight or ten days; and, at the 
 same time, maintaining thorough sterilization of the nose 
 with borax solution (A). Swabbing with tannin rapidly 
 shrinks the tonsil, and lessens the dangers of hemorrhage. 
 Shrinkage after tannin is sometimes so marked as to render 
 any surgical operation unnecessary. 
 
 The teeth of larger children should be cared for, and 
 diseased roots removed, to obtain a clean mouth. It is on 
 these conditions that complications are avoided. 
 
 If, at the time of a proposed cutting operation, the 
 tonsils are still inflamed, or the back of the mouth red and 
 covered with mucus, postpone the operation. In operating, 
 it is always best to leave the tonsil stumps in children, and 
 especially in those under four years of age. The deeper 
 part has not suffered as much as the superficial, and being 
 liberated from adhesion to the pillars, it can easily regain 
 its normal texture by subsequent medical treatment. 
 
 Beyond the age of seven or eight years, tonsils seldom 
 14 
 
embarrass by their size, but inflammations are frequent. 
 Here, all operations for removal are objectionable. 
 
 If the tonsil is large, smooth, without fossulae, the gal- 
 vano-cautery puncture is the remedy par excellence; efficient 
 and rapid. (350, 358, 359, 361, 362, 363, 364) 
 
 With a patient who bleeds easily, a cutting instrument 
 should never be employed. With a tuberculous patient, we 
 should always employ galvano-cautery and resorcin; never 
 the knife. 
 
 When one part of the tonsil is enlarged, that part alone 
 should be treated, 
 
 TREATMENT OF ADENOIDS. 
 
 Enlargement of the pharyngeal tonsil has received from 
 the untutored various names, as "adenoids," "adenoid 
 growths," "adenoid vegetations," etc. (89) 
 
 Besides the pharyngeal tonsil, there are thousands of 
 nodes and nodules in its neighborhood, that often swell in 
 unison with this tonsil. They are all filters. 
 
 Patients with adenoids are divided into three classes : 
 
 (95) 
 
 1. Those in whom the pharyngeal tonsil is hard and 
 very greatly enlarged. 
 
 This class forms hardly 8 per cent, of all patients. Re- 
 moval has rendered and will render great service. But 
 if obliged to repeat the operation several times, it becomes 
 necessary to institute the resorcin treatment (I) ; it is the 
 only way to render adenoids inactive. It removes all in- 
 flammation. 
 
 2. In the second class we include the patients in 
 whom the growths are soft, large and bleed readily tinder 
 the pressure of the finger ; there is an interruption in the 
 growth of the child, a deafness more or less persistent, and 
 
 15 
 
an inaptitude for work. These are readily cured by medical 
 treatJiiciit. The number of treatments varies with each 
 patient. 
 
 3. The third class comprises those who with slight 
 enlargement present in general only these symptoms, in- 
 terrmittent deafness, mouth partly open, snoring at night. 
 Resorcin will cause all symptoms to disappear. 
 
 Hospital patients are all comprised in the first class. 
 The treatment with resorcin is curative, medical, and 
 zvithout danger. With this treatment, relapses, ivhich are 
 so frequent after cutting operations, do not occur. It is 
 not a simple inflammation that is cured by this treatment; 
 if such v/ere the case, there would be relapses, but these do 
 not occur. 
 
 After ten or twelve treatments, one made each day, 
 or every alternate day, the enlargements diminish greatly 
 in volume and the patient is soon completely cured. 
 
 After the fourth or fifth treatment, the appearance of 
 a mild sore throat is sometimes noted, which is transi- 
 tory. The secretions should be removed, and we should 
 wait two or three days before resuming treatment. 
 
 After this treatment, the patient is less subject to at- 
 tacks of sore throat. 
 
 This treatment, exempt from all danger, renders great 
 service when the physician does not zvish to perform the 
 operation, or when the operation is impossible or danger- 
 ous. The treatment is perfectly applicable to children of all 
 ages. There is no pain, and the child offers no resistance; 
 inflammation does not follow; the patient can eat and drink 
 immediately after the treatment. No accidents nor unpleas- 
 ant incidents have ever happened. Resorcin is antiseptic and 
 without danger to the general health. 
 
 The resorcin employed is the chemically pure crys- 
 tals : the solution is made with pure water; 100 per cent. 
 
 16 
 
of each by weight ; and another sokition of half that strength 
 for infants. 
 
 A wad of absorbent cotton is saturated with the solu- 
 tion, then pressed against the lip of the vial upon with- 
 drawal, so that there will be no excess to flow over unde- 
 sired parts. The cotton is held firmly in the grasp of prop- 
 erly curved forceps, passed into the mouth and behind the 
 palate and pressed firmly upward against the adenoid en- 
 largement. The parts touched become immediately covered 
 with a white coating. 
 
 After the resorcin treatment, the child's spirits im- 
 prove, deafness diminishes, incontinence of urine disap- 
 pears, breathing is easier. The voice gains in timbre, and 
 it becomes often impossible to recognize in the robust, in- 
 telligent and lively child, the little, puny, idle and apathetic 
 child of several months before. It develops both mentally 
 and physically. 
 
 Resorcin treatment can tvell replace the surgical method 
 in over ninety-tzvo per cent, of all patients. No deaths, no 
 hemorrhages, no accidents of any kind are caused by resor- 
 cin treatment. It is easily given in the physician's office, 
 or at the patient's home. 
 
 The operation for adenoids should never be undertaken, 
 zvithout serious consideration. It should never be perform- 
 ed in cases that cause no symptoms; (92) never in patients 
 known as bleeders. 
 
 The results of operation ivill ahvays be disappointing 
 in cases that accompany nasal catarrh; with thickening of 
 the lining of the nasal passages; in cases of narrow nos- 
 trils, and mis-shaped nose; in cases of irregular teeth; in 
 deformity of the upper jatv; in deformity of the mouth 
 and palate; in cases of deafness, unth inflammation of the 
 middle ear and with thickening and hardening of the lin- 
 ings of the ear passages; in affections of the ear drum; and 
 
 17 
 
in all children with poor constitutions, improper or insuffi' 
 cient food, and had hygienic surroundings. 
 
 THE TONGUE TONSIL 
 
 is situated on the back of the tongue. Its usual appear- 
 ance is that of a group of scattered nodes. It is generally 
 unobserved except with the laryngeal mirror. The nodes 
 composing it are very active absorbents. It inflames, forms 
 abscesses, and enlarges, the same as other tonsils. It is 
 frequently troublesome, but being unseen, its troubles are 
 blamed on the faucial tonsil. When inflamed, the whole 
 base of the tongue sometimes swells, pains and becomes 
 tender on pressure, and both swallowing and speech are 
 difl^icult. Breathing is sometimes affected. Treatment is 
 the same as that which I have advised for the faucial ton- 
 sil. 
 
 Abscesses should be opened with the galvanic knife; it 
 has the advantages of thorough penetration, a free opening 
 
 and efficient drainage, with safety. 
 
 Lingual goitre is developed at the expense of an acces- 
 sory thyroid gland, and is usually accompanied by enlarge- 
 ment of the tongue tonsil. 
 
 In a patient referred to me for enlargement of this 
 tonsil, it had attained the size of an ordinary hen's tgg. It 
 pressed upon the epiglottis, and interfered with breathing, 
 speech and swallowing of food. I removed the growth 
 with the galvanic knife by cutting down through its cen- 
 ter, dividing it into two halves, and by then applying the 
 knife flat and cutting from each side towards the median 
 line. The result was entirely satisfactory. 
 
 The tongue tonsil is influenced by excesses in eating, 
 drinking and the mis-use of the voice. It frequently in- 
 flames and swells and is obscurely troublesome in aged peo- 
 
 18 
 
pie. Its neighborhood is a veritable trap for filth. It 
 sliould be cleansed and medicated just like the faucial tonsil. 
 
 THE TUBAL TONSILS 
 
 are situated in the passages behind the nose, and they sur- 
 round the orifices of the Eustachian tubes, which lead to the 
 ear. They enlarge, like other tonsils. In the neighborhood 
 of these tonsils there are countless nodes and nodules that 
 readily swell. The mucous membrane that lines the post- 
 nasal cavity is exquisitely sensitive ; any and all diseases that 
 obstruct the nasal passages lead to passive, non-inflamma- 
 tory swelling of this membrane, which, in turn, occludes or 
 partly closes the openings into the Eustachian tubes. This 
 passive, non-inflammatory sivelling is the most important 
 factor existing in the post-nasal cavity that leads to the pro- 
 duction of ear troubles, which latter are commonly and 
 wrongly ascribed to "adenoids." (92, 93) Massage of 
 the tubal tonsils, by means of the finger inserted behind 
 the palate, is mentioned only to be condemned. (94) 
 
 The treatment of the tubal tonsils should follow, with 
 exceeding care, along the same lines as already given for 
 the faucial and pharyngeal. 
 
 QUINSY 
 
 is an infection of the nodes and nodules embraced in the 
 secondary lymphatic ring (connected with Waldeyer's ring) 
 (9), and of the countless nodes and nodules connected with 
 the numerous lymphatic canals that extend still beyond the 
 
 secondary ring. 
 
 At this point, it will be of interest to recall the sus- 
 pended position of the faucial tonsil between the anterior 
 and posterior arches of the palate. (0pp. 9). Above the 
 
 19 
 
tonsil there is a triangular space, formed by the divergence 
 of the arches, and behind the anterior arch there is a de- 
 pression known as the supra tonsillar fossa. Below the ton- 
 sil is a deep pit, separating it from the tongue. Through- 
 out all this region, there is a superficial and a deep set of 
 lymphatic canals, nodes and nodules. Connected with 
 these there is another chain that extends down the neck 
 and under the sides of the tongue. These nodes and nodules 
 are energetic absorbers of infectious matter. Between the 
 faucial tonsils and the nodes and nodules that become in- 
 flamed in quinsy, there is no connection whatever, excepting 
 that when the latter swell they then press upon the tonsils. 
 When the nodes and nodules are inflamed, ignorant doctors 
 call the trouble tonsillitis. In quinsy, there is a rapid in- 
 fection of all those bodies. The infection is quickly follow- 
 ed by inflammation and an abscess in the neighborhood 
 of the tonsil ; above, in front, or below it. In most cases 
 the abscess forms above, at the upper border of the tonsil, 
 and often involves the soft palate. In rare instances, the 
 abscess forms behind the tonsil. Abscess of the tonsil it- 
 self, is rare, but when pus is found escaping from the ton- 
 sil, it usually makes its exit from a fossula. 
 
 Quinsy is rare in infancy, and disappears with advanc- 
 ing age. 
 
 Symptoms. Preliminary chill, febrile disturbance, and 
 feelings of depression. Pain in sv/allowing, rapidly in- 
 creasing in severity. Increased flow of saliva. Thick, 
 pasty coating on the tongue ; breath oflfensive ; loss of appe- 
 tite, and constipation. 
 
 Inspection shov/s palatine arch on the affected side 
 reddened, swollen, with a deep flush upon the lateral half 
 of the soft palate. Bulging of the faucial lining. The ton- 
 sil is pushed out of its natural position between the pala- 
 tine arches, by the inflamed and swollen condition of the 
 
 20 
 
parts behind it. The displaced tonsil may almost block the 
 entrance to the throat. The tonsil, itself, is sometimes red- 
 dened, but seldom much swollen, and careful observation 
 will show that it is not the center of disturbance. 
 
 The voice is thick and indistinct ; the glands in the 
 neck swollen ; and the neck is stiff and sore, while the 
 mouth can be only partially opened on account of pain. 
 
 The disease lasts five or ten days. When the abscess 
 forms, it is followed by quick relief. The abscess forms : 
 
 1. Most frequently behind the anterior arch of the 
 palate, above the tonsil. It bulges at the upper and inter- 
 nal edges of th^: anterior arch. The tonsil is pushed back 
 by the swelling betzveen it and the anterior arch. 
 
 2. The next most frequent seat of the abscess is limit- 
 ed to the back arch, which becomes rounder and smoother, 
 pushing the tonsil in front of it. In these cases, the anter- 
 ior arch remains absolutely healthy, and the tonsil only 
 slightly congested. 
 
 3. The external peritonsillar abscess is less common 
 than the preceding, and more serious. The parotid, sub- 
 maxillary, and occipital glands become rapidly affected. 
 The tonsil is pusJied into the middle line. The glands 
 in the neck are more swollen than in the preceding form. 
 Pus may escape through the pharyngeal aponeurosis. 
 
 4. The inferior abscess is situated below the tonsil, 
 betzveen it and the tongue tonsil, behind the anterior arch 
 towards its base. The tonsil is pushed upzvards against the 
 anterior arch. Pain in swallowing is early and severe. 
 The tongue becomes immovable. Infiltration takes place 
 in the lateral wall, even extending to the epiglottis and the 
 folds in the larynx. Pus gravitates and forms, a lateral 
 pharyngeal abscess, of exceptional gravity. 
 
 The abscess that forms in quinsy does not open into 
 the tonsil. Neither do abscesses in the tonsil open into 
 
 21 
 
the maxillo-pharyngeal space. The fibrous capsule of the 
 tonsil prevents it. 
 
 Treatment. Clean the nose and mouth with borax solu- 
 tion (A). Apply resorcin (I), followed by guaiacol (K), 
 and suprarenal extract (G). Give iron internally (O). 
 Rinse away accumulations of sticky mucus with soda 
 water (B). If bowels are constipated, begin treatment 
 wth solution of citrate of magnesia. If necessary to re- 
 lieve pain, give acetanilide, one five-grain tablet, repeated 
 in one hour if not relieved. No more than two or three 
 tablets in one day, and none at all if the heart is weak. 
 When the abscess forms, open it promptly. After the ab- 
 scess has opened, treat with great care, to avoid adhesions. 
 
 After cutting operations for the removal of tonsils, at- 
 tacks of quinsy are always more frequent. And they are 
 often accompanied by more or less permanent enlargement 
 of the glands (nodes and nodules) in the neck. (157, 162) 
 When permanently enlarged, the phosphorated oil (P) has 
 produced the best results. 
 
 Carcinoma (Cancer), sarcoma, fibro-enchondroma, 
 cystoma, lymphadenoma, papiloma, lipoma and angioma are 
 growths that usually require surgical attention. 
 
 Diphtheria requires anti-toxin. 
 
 Vincent's disease I have seen benefitted by radium and 
 the X-Ray. 
 
 22 
 
CAUTION! 
 
 The surgeon obtains no authority from the law to use 
 his knife. No law conveys to one person the right to cut 
 another. That's assault. Assault is punishable. The pa- 
 tient's permission is the surgeon's privilege. The surgeon's 
 honor is a pledge. The surgeon must be reasonable; the 
 law expects it ; and the patient should exact it. 
 
 The surgeon's art unrecognized by law, his operation 
 undefined, there is, therefore, no statutory requirement, no 
 explanation, no guide, no legal check nor statutory limit 
 to a surgeon's performance. 
 
 The law requires that the surgeon shall possess and use 
 reasonable skill, learning and care, and that he shall advise 
 against injudicious operations. 
 
 A leading throat specialist confessed to Professor 
 John N. Mackenzie, Johns Hopkins University, "That, al- 
 though holding views hostile to its performance, he was 
 forced to remove the tonsils from every patient, in order 
 to satisfy the popular craze and to save his practice from 
 destruction." There are many such cases. The same un- 
 lawful practice is in style all over our land. Mackenzie ex- 
 presses "the hope that not only the profession, hut that the 
 public shall demand that this senseless slaughter be stopped." 
 
 Under the fake theory that "tonsils are full of holes, 
 absorb germs, poison the blood, and cause rheumatism 
 and heart disease," the public has been scared into the false 
 belief that tonsils and adenoids have no right to exist; and 
 that in every instance they should be removed. 
 
 By whom has the public been scared? 
 
 The Metropolitan Life Insurance Company, New York, 
 advises removal ; illiterate doctors in the public schools 
 force operations upon children ; popular magazines, through 
 
 23 
 
mis-informed writers, advocate removal, and so does the 
 daily press, through ignorant commentators. 
 
 The slaughter is opposed at every leading university 
 in the ivorld, by such distinguished educational authorities, 
 as Professors A. Jacobi, Columbia; Henry L. Swain, Yale; 
 John N. Mackenzie, Johns Hopkins ; E. L. Shurly, Michi- 
 gan ; Charles P. Grayson, Pennsylvania ; Price-Brozvn, To- 
 ronto ; Vo7t Chiari and Von Schrottcr, Vienna ; Marage, 
 Castex and Lermoyes, the Sarbonne, Paris ; F.scat, Ton- 
 louse; Moure, Bordeaux ; Frankel, Von Levinstein and 
 Richard Lozuenberg, Berlin ; Brieger and Gorke, Breslau ; 
 Sir Felix Semon and Sir St. Clair Thomson, London ; 
 Massei, Naples ; Schmiegelozv, Copenhagen ; Earth, Leip- 
 sig; Von Baggen, The Hague. (379, 380) 
 
 The public deserves and should receive of our univer- 
 sities and of their experienced sons, plain statements of 
 facts, to guide and protect it, from an unskilled army of 
 operators. The public has a right and should demand to 
 be informed, as to operations that are proper and of the 
 many that are not. It should be plainly advised in favor 
 of treatment that is safe, sane and successful, and upon 
 the contrary, thoroughly warned against operations that 
 kill. 
 
 I am pleased with the cordial reception of my book 
 on "The Tonsils and The Voice," by expert laryngologists, 
 voice mechanicians, voice trainers and voice users, through- 
 out the world. 
 
 This work, on "Tonsils and Adenoids; Treatment 
 and Cure," is the result of many years of practical ex- 
 perience in the medical treatment of these organs, and from , 
 the standpoint of the physician and laryngologist, in pref-j 
 erence to that of the surgeon and laryngectomist. It is pub-| 
 lished with the object of furnishing to thoughtful and con-i 
 
 24 
 
servative physicians a medical treatment for affected ton- 
 sils and adenoids, which has already secured positive results, 
 and which can be depended upon to establish with those who 
 adopt it, a reasonable unity in professional proceeding. 
 
 If Dante were alive, he would undoubtedly add a tenth 
 cycle to his Inferno, deeper and hotter than the other nine, 
 to which he would consign surgeons who are willing to 
 shed your blood for the sake of a fee. 
 
 If what I have written, in my previous book and in 
 this one, will result in drawing the attention of the medical 
 profession and the great public to the surgical crimes that 
 are being committed, and lead to the abandonment of these 
 evil practices, mankind will be benefitted, my object will 
 have been attained, and I shall be highly gratified. 
 
 25 
 
PRESCRIPTIONS. 
 
 (A) ^ 
 
 Powdered Borax Grains 68 
 
 Essence of Peppermint Minims 20 
 
 Warm water One pint 
 
 A toilet requisite for the nose and mouth. A cleanser 
 and sterilizer. Saturate a wad of absorbent cotton with the 
 solution and carefully mop out the vestibule of the nose, 
 morning and evening, or more frequently, when necessary. 
 This method of keeping the nose clean is greatly preferred 
 to that of using atomizers and douches, as the latter serves 
 only to wash filthy matter farther in, and at the same time 
 leads to trouble in the ears and antrum. The solution is 
 also a very efficient gargle. 
 
 (B) I^ 
 
 Water Ounces 4 
 
 Bicarbonate Soda, enougli to saturate. 
 
 Essence of Peppermint ni. 5 
 
 Used as a gargle in quinsy, it dissolves sticky mucus, 
 and cleanses the throat of all foul secretions. 
 
 (C) R 
 
 Eucalyptus Oil (Binz) m. 10 
 
 Menthol ei"- » 
 
 Camphor g''- 4 
 
 Superfine White Vaseline oz i 
 
 Relieves irritation and swelling of the lining of the 
 nose, in children that sniffle and in acute colds. Apply a 
 small quantity inside of both nostrils morning and evening, 
 
 (D) R 
 
 White Precipitate g""- 3 
 
 Eucalyptus Oil (Binz) ">• ^° 
 
 Menthol g""- ' 
 
 Lanoline '^'^'^ ^ 
 
 Superfine White Vaselin* d"". 7 
 
 Relieves irritation of nasal linings, with discharge of 
 26 
 
mucus. Valuable in inflammation and obstruction of the 
 nasal passages in babies and older children. Apply in the 
 nose morning and evening. 
 
 (E; R 
 
 Lugol's Solution Iodine dr. i 
 
 Liquid Alboiene Benzoinated oz- 2 
 
 Shrinks swollen mucous membranes. Induces absorp- 
 tion of inflammatory thickening and relieves obstruction 
 to breathing through the nose. Apply to the swollen mem- 
 brane in the nose, on a wad of cotton, for five minutes, 
 every day. 
 
 (F) R 
 
 Dried Suprarenal Gland gr. 5 
 
 Menthol gr- 3 
 
 Camphor gr. 10 
 
 French Chalk gr. 3° 
 
 Powdered Acacia dr. 7 '-^ 
 
 For acute cold in the head ; apply in the nose, as a 
 snuff, or with the powder blov^er, once or twice daily. 
 
 (G) ^ 
 
 Drifd Suprarenal Gland gr. 10 
 
 Orthoform ( new) ... • ■ gr. 10 
 
 Powdered sugar dr. 3 
 
 Powdered Acacia dr. 5 
 
 Stops pain. Reduces swelling. Apply to the tonsils 
 with the powder blower, after galvano-cautery treatment. 
 Also in cases of quinsy, and other painful affections, once 
 or twice daily. 
 
 (H) R 
 
 Zinc Iodine ■ • gr. 20 
 
 Distilled water oz i 
 
 Astringent. Induces absorption of inflammatory pro- 
 ducts. Reduces thickness and heaviness of the linings of 
 
 27 
 
the throat, rendering them lighter and more elastic. Apply 
 to the membranes on a cotton swab, twice a day. Useful 
 in chronic inflammation of the throat. 
 
 (1) R 
 
 Resorcin, chemicallv pure, 
 
 Distilled water, of each, by weight dr. 2 
 
 Cures inflamed fossulae. Reduces enlargement of ton- 
 sils and adenoids. Saturate a small wad of absorbent cot- 
 ton with the solution, apply with suitable forceps, and press 
 tirmly against the affected parts. Be careful to press the 
 cotton wad, in withdrawing from the vial, against its lip, 
 to prevent supersaturation, so that there will be no excess 
 on the cotton to run over neighboring parts. Apply daily. 
 
 (J) R 
 
 Resorcin, chemically pure gr. 30 to 60 
 
 Distilled water dr. 2 
 
 Used for the same purposes as prescription I, but for| 
 milder effect. This solution, applied on cotton, is a pleasant 
 and powerful means of stopping nose-bleed. 
 
 (K) R 
 
 Guaiacol oz- 2 
 
 Oil Peppermint oz- ' 
 
 Olive Oil oz I 
 
 Stops pain. Apply on a cotton swab, or with a camel's 
 hair brush, once or twice daily, in quinsy, severe inflamma- 
 tion of the throat and inflamed gums. Follow by application 
 of prescription G. 
 
 (L) R I 
 
 Glycerite of Tannic Acid oz i 
 
 Shrinks swollen membranes. Apply on a cotton wad,; 
 or with a camel's hair brush, twice daily, to the back ofj 
 
 23 
 
the throat^ and to affected tonsils, to reduce congestion and 
 inflammation, before performing an operation. 
 (M) R 
 
 Camphor 
 
 Menthol 
 
 Chloral Hydrate 
 
 Oil Betula, of each dr. 2 
 
 Liniment. Apply to the outside of the throat. ReHeves 
 |3ain, inflammation of the larynx, and swollen glands. 
 
 :n) I^ 
 
 Ammonium Hypophosphite dr. i 
 
 Tincture Hyoscyamus dr. 3 
 
 Syrup Lactucarium, enough to make oz. 3 
 
 (Aubergier) 
 
 For acute cold in the head or throat. One teaspoonful, 
 n a little water, every two or three hours, for an adult. 
 
 O) R 
 
 Tincture Iron Chloride 
 
 Glycerine 
 
 Pure water, of each oz. 3 
 
 In severe attacks of quinsy, with suppuration, severe 
 )haryngitis, and badly inflamed tonsils, give an adult one 
 easpoonful in half a wineglassful of water, every two, 
 hree, or four hours. 
 
 Oleum Phosphoratum m. /^ 
 
 Syrup Acacia, 
 
 Mucilage Acacia, of each oz. 2 
 
 For chronic enlargement of the glands in the neck, 
 live to children, from six to twelve years of age, one-half 
 o one teaspoonful, in half a wineglassful of water, after 
 very meal. 
 
 29 
 
ZINC VERSUS SILVER. 
 
 Throughout my professional career, I have avoided the 
 us>? of nitrate of silver in the nose and throat. Silver 
 produces argyria. It thickens the mucous membranes to ] 
 which it is applied ; makes them heavy ; and causes cirrho- I 
 sis or hardening of the tissues, with chronic hoarseness,! 
 and eventually ruins the singing voice. I 
 
 Zinc Iodide I have used almost daily for over thirt) 
 years. It is an ideal astringent, resolvent, and antiseptic 
 It induces absorption of inflammatory deposits; relieve; 
 congestion and heaviness in the mucous membranes. li 
 renders the membranes lighter and more elastic, permittin| 
 more facile movement of the faucial, pharyngeal and laryn- 
 geal muscles, and tends to overcome the thickness, heavij 
 ness and ha/rdness that silver always produces. t 
 
 30 
 
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