Perforations  of  the  palate  arc  usually  caused  by  syphilis,  occasionally
by  traumatism  or  lupus.  If  the  local  disease  is  cured,  the  perforation  may  be
closed  by  a  plastic  operation,  although  in  most  syphilitic  cases  better  results
are  obtained  by  the  use  of  obturators.
Elongation  of  the  uvula  when  troublesome  may  be  remedied  by  removing
the  lower  jxtrtiun  with  scissors.
I


Suppurative  tonsillitis,  or  quinsy,  may  follow  exposure  to  cold  or  polluted
air.  Certain  individuals  arc  predis|xjsed  lo  attacks  of  this  character,  partic-
ularly during  adolescence.  The  tonsil,  the  fauces,  anil  the  soft  palate  arc
swollen  and  edematous,  causing  interference  with  breathing,  swallowing,  and
speaking.  There  are  pain  in  the  throat,  enlargement  of  the  cervical  glands,
and  marked  constitutional  symptoms.  Both  tonsils  may  be  involved,  and  the
patient  may  be  unable  to  open  the  mouth.  The  treaimrnt  in  the  initial  stage
is  an  ice  bag  cxtcmaily,  scarification  of  the  tonsil,  a  chlorate  of  potash  gargle.
i^^   ^^^^


Kic.  jiS.— lUinnie.)


^.r^^^^


Fio.  3J».— ( Binnic.l


Fio.  jjo.— (Binnie.)


and  symptomatic  internal  treatment.  \Vhen  pus  forms,  the  abscess  may  be
opened  with  a  sharp  fioinled  tenotome,  the  incision  being  parallel  with  the
anterior  pillar  of  the  fauces  and  directed  towards  the  middle  line.
Hypertrophy  of  the  tonsils  is  most  freciuent  in  children  and  indeed  may
be  congenital.  It  may  follow  re|x«tc(l  acute  attacks  of  inflammation  and  is
often  a  manifestation  of  a  tuberculous  diathesis.  It  is  usually  associated  with
adenoids  and  hence  presents  the  same  .symptoms  as  the  latter.  Caseous  and
calcareous  concretions  may  form  in  the  crypts  of  the  tonsils,  and  cysts  occa-
sionally develop  from  blocking  of  the  orifices  of  the  follicles.  The  trealmml
is  attention  to  the  general  health  and  removal  of  a  portion  of  the  gland.    Caus-


506


UPPER   DIOESTIVE  APPARATUS.
