neck may afford relief. When an abscess is formed, it
should be opened by means of a fine-pointed pair of sinus forceps,
thrust through the soft palate at a point opposite the base of the
uvula, and in the line of the anterior pillar of the fauces. As those
who suffer from quinsy are liable to have attacks coming on
periodically, if the tonsils remain permanently enlarged they should
be removed between attacks.

#Hypertrophy of the tonsils# is most commonly met with in children
between five and ten years of age, and is often associated with
adenoid vegetations in the naso-pharynx and chronic thickening of the
pharyngeal mucous membrane.

The whole tonsil is enlarged, the mucous membrane thickened, and the
connective tissue more or less sclerosed. The crypts appear on the
surface as deep clefts or fissures, and the lymph follicles are
enlarged and prominent. Secretion accumulates in the crypts, and a
calculus may form from the deposit of lime salts. Sometimes food
particles lodge in the crypts, and they may collect and form
accumulations of considerable size, requiring the use of a scoop to
dislodge them.

_Clinical Features._--The hypertrophy is bilateral, but not always
symmetrical. Sometimes the tonsils project to such an extent as almost
to meet in the middle line; sometimes they scarcely pass beyond the
level of the pillars of the fauces. They are usually sessile, but
sometimes the base is so narrow as almost to form a pedicle. During
childhood they are usually soft and spongy, but when they persist into
adolescence or adult life they become firm and indurated. This
sclerotic change is due to the repeated attacks of catarrhal or
suppurative tonsillitis to which the patient is subject. The lymph
glands behind the angle of the jaw are frequently enlarged. Swallowing
is sometimes interfered with, and the patient is liable to attacks of
nausea and vomiting. Respiration is always more or less impeded; the
patient breathes through the open mouth, and snores loudly during
sleep; and the hindrance to respiration interferes with the
development of the chest. In some cases alarming suffocative attacks
occasionally supervene during sleep, but the difficulty in breathing
disappears as soon as the child is wakened. The voice is
characteristically thick and nasal, especially when adenoids are
present, and in many cases the patient has a vacant and stupid
expression. Hearing is often impaired from obstruction of the
Eustachia