Notes on the Treatment of Tonsillitis.

Whilst preparing a pilot survey in the North Midlands (Sheffield) Faculty to study the position in regard to the treatment of acute tonsillitis, I had occasion to write to some of the ear, nose, throat and paediatric consultants in the faculty to ask for their views. In many instances their replies were extremely helpful, though somewhat conflicting, and this has led me to a further study of the literature on this subject. Broadly speaking, one can leave tonsillitis untreated in order to allow the child to develop immunity to further attacks, or one can use aspirin, sulphonamides, penicillin, other antibiotics, or bismuth, with apparently differing results. Some notes on the current opinions of the value ofsulphonamides, antibiotics and bismuth follow: Sulphonamnides Spencer Harrison (1954) in a personal communication, states that a notable number of authorities have failed to find evidence that sulphonamides accelerate recovery from a sore throat, though the value of these in preventing complications does not appear in the literature until more recently. He states: " It is really more important to protect from the consequences than accelerate recovery from a naturally brief illness." Amongst others he refers to Rhoads and Afremow (1940), and MacDonald and Watson (1951). Gray (1954) states that sulphonamides are better not used, as the tonsils become walled off from attack by the natural body defences, and from the sulphonamide itself. Sulphadiazine, in contradistinction to its relative ineffectiveness in the treatment of streptococcal infections, is often effective in preventing their occurrence; but the sulphonamides in general are ineffective in the prophylaxis of rheumatic fever. Cases occasionally occur, especially in children, in which the sulphonamide has masked a complication such as otitis media. Another unpleasant result of the use of sulphonamides which is sometimes seen, is what may be called " hang-fire tonsillitis," in which the condition improves up to a point and then remains stationary for a matter of days or weeks with a chronic sore throat and red swollen tonsils. The toxic and unpleasant side effects such as headache, malaise, nausea, vomiting, cyanosis, skin rashes, drug fever, haemolytic anaemia, agranulocytosis and renal disorders should be sufficient to discourage their routine use. Penicillin We should remember that patients usually recovered from acute tonsillitis before penicillin was available