PREVENTION OF FOLLICULAR TONSILLITIS.

BY A. S. MAXSON, M. D., OF MILTON JUNCTION.

Prevention of follicular tonsillitis is desirable in at least two classes of cases, those occurring during an epidemic, and also those where there are repeated attacks occurring from once a month to once a year.

Those occurring only during an epidemic can be prevented by a mild antiseptic throat-wash with or without the internal administration of benzoate of soda.

The chronic cases, which are subject to frequent and repeated attacks, are very annoying to the physician and damaging to the patient's health. Such was my experience until I discovered and applied a treatment that I have lately found was known and used by others, but is not mentioned in any literature I have access to. The treatment consists in destroying the contents of each follicle that is diseased in both tonsils. I think that the function of the follicle is not destroyed but the colonies of germs that make an abiding place in the follicles are destroyed.

My custom has been to take a doubled piece of silver wire, such as is used for sutures, and solder its free ends to a large wire, then dip the doubled silver loop into melted stick nitrate of silver so as to make a small bead on its end, after withdrawing it from the melted silver salt. The silver wire is then bent half an inch from its distal end so as to make an angle of 45°. This bead of caustic is inserted into a follicle The depth will vary from one-fourth to oneOne caustic bead will usually treat but one or two follicles. By means of several beads all the diseased follicles may be treated. This treatment is undertaken at any time

to its bottom.

half inch.

except when the tonsils are acutely inflamed.

It requires one or two treatments to effectually prevent its return. I have used this treatment for eight or ten years and found it entirely reliable. I know of no case that has not been given a very complete immunity even when subject to attacks every two to eight weeks before the treatment.

ACUTE LOBAR PNEUMONIA, ETIOLOGY AND PREVENTION.

BY G. A. HEIDNER, M. D., OF WEST BEND.

I wish, in this brief paper, to call your attention to some of the predisposing and exciting causes of acute lobar pneumonia, and offer a few suggestions, in the way of preventive measures, which should be recognized by the profession, and whose importance should be impressed upon the laity.

Pneumonia is one of the most widely distributed of all acute diseases; it is said to be unknown in the polar regions, but is found in every other climate. Apparently, altitude predis

poses to it both in hot and cold climates.

The amount of rainfall does not appear to have any marked influence. It prevails equally in cold and hot countries, but is said to be more prevalent in the southern than in the northern states on this continent. Although climate does not seem to materially alter the relative frequency of this disease, it is a well established fact that pneumonia is more prevalent in the winter and spring months than during any other season of the year. And this appears to be more especially true of the early spring time.

Most epidemics of pneumonia, as of all other catarrhal diseases, occur during the months of March, April and May; and it has been observed that whenever atmospheric conditions prevail, during other seasons of the year, which we are wont to find during the vernal equinox, this disease is quite apt to present an epidemic form.

This would teach us that different climates and seasons can only be considered etiologic factors in the production of this disease in so far as temperature and atmospheric conditions affect the health of the individual, and therefore must

be classed among the predisposing and not the exciting

causes.

The ill fed and poorly clothed are more liable to be affected than those surrounded by the comforts of life.

Density of population is also to be considered a predisposing factor, owing largely to the usual unsanitary conditions accompanying it.

Hirsch has said: "The amount of mean fluctuation in the mortality from pneumonia is in inverse ratio to the density of the population."

Sudden exposure to extremes of temperature and atmospheric changes, hardships of all kinds and severe injuries, especially those involving the chest, are frequently followed by an acute pneumonia. The less the inherent power of resistance to the pneumonia virus, the more predisposed is the individual; and this leads me directly up to the many systemic conditions which render an individual especially liable to this disease. Among these are found alcoholism, chronic organic diseases affecting the heart, kidneys and liver, protracted fevers, nervous diseases and all conditions of the system where there is a lack of proper elimination through the excretory organs. Age should not be forgotten in this con

nection.

While no period of life is exempt, infancy and old age are especially liable, and it is during these epochs that the fatality is greatest.

It is a recognized fact that one attack very strongly predisposes to another. Perhaps every physician present, of several years experience, has seen patients who have had two or more attacks of acute lobar pneumonia.

This is worthy of mention because it is an exception rather than the rule in acute infectious diseases.

In this age of microscopes and bacteriologists it would be strange indeed if no special work had been done in connection with this important malady.

And as it has been aptly said, "No disease can escape the bacteriologist in our age of research," so pneumonia has naturally fallen prey to his optical devices and a micrococcus lanceolatus is the result. I am not prepared either from clinical observation or experimental work, to prove that pneumonia is an infectious disease caused by the micrococcus lanceolatus, or its toxines; neither am I prepared to state authoritatively, that it is not an infectious disease caused by this said microbe. It has been demonstrated that in a large majority of cases of acute lobar pneumonia this microscopic organism can be found. It is also true that this same organism has been discovered in the buccal cavity of nearly 20 per cent. of healthy individuals examined. This microorganism has been found in meningitis, pleurisy and endocarditis independent of pneumonia. have no knowledge that it has ever been accused of causing. any of these diseases.

I

Although we have very good authority for saying that the diplococcus lanceolatus is one of the, if not the, prime exciting factor in the production of the morbid processes existing in this fatal disease, there still remains a doubt-and I think reasonably-whether it would be a safe conclusion, reasoning exclusively from these data, to attribute the disease to this organism alone, and classify it with diphtheria, scarlatina and others, as an acute specific infectious disease.

While there is still a doubt as to the exact etiologic relation existing between this diplococcus and the disease under consideration, and as the physical signs are so positive and distinct in a very large majority of cases of pneumonia, that a microscopic diagnosis is unnecessary, I will desist from further elucidating the microscopy and modes of propagation of this variously termed organism, but will leave that part of the subject to the gentlemen who have perhaps a more intimate acquaintance with this little fellow and will be anxious to tell you something of their personal experience with him.

While volumes have been written upon the infectious na