e chronically enlarged.

The _treatment_ is carried out on the same lines as for the catarrhal
form. In recurrent cases the tonsils should be removed.

#Acute Suppurative Tonsillitis and Peri-tonsillitis--Quinsy.#--This is
an acute suppurative inflammation of the tonsils and peritonsillar
tissue, due to infection with pyogenic bacteria. It affects the whole
substance of the tonsils, and the cellular tissue of the pillars of
the fauces, the soft palate, and the pharynx.

_Clinical Features._--The onset is usually sudden, and the affection
is ushered in by a rigor, high fever, and a feeling of malaise. There
is persistent thirst and dryness of the throat, and the patient has
the sensation of a foreign body being in the pharynx, with a constant
desire to swallow. Swallowing is extremely painful, the pain shooting
up to the ears, and the patient has difficulty in taking nourishment.
The saliva accumulates in the mouth; the voice is thick and nasal; and
the respiration impeded and noisy. If the patient can open the mouth
sufficiently to afford a view of the back of the throat (which,
however, is seldom the case), the inflamed parts are seen to be of a
dull reddish-violet colour. One tonsil is often more swollen than the
other, and the corresponding anterior pillar of the fauces more
prominent. The uvula is swollen and oedematous, and is deviated
towards the side on which there is least swelling. Suppuration occurs
in from three to seven days; in adults it is usually in the
peritonsillar tissue of the anterior pillar of the fauces, and extends
into the soft palate. In children the pus sometimes forms in the
substance of the tonsil. If left to burst, the abscess discharges
itself into the mouth, and the patient experiences instant relief. The
pus is always offensive, and if the abscess bursts during sleep, it
may enter the air-passages and cause septic pneumonia. The lymph
glands in the neck are usually enlarged and tender, and sometimes they
suppurate and give rise to a diffuse cellulitis. General infection of
the blood may follow, leading to metastatic invasion of different
tissues and organs, particularly one or other of the large joints.

_Treatment._--In the early stages soothing antiseptic gargles are
indicated. Later, when the patient is unable to gargle, the inhalation
of steam impregnated with the vapour of carbolic acid or friar's
balsam, and the application of hot fomentations or a large linseed
poultice to the