122 THE PHARYNX AND NASOPHARYNX anorexia and the development of changes in temperament, such as tantrums or bouts of crying for little reason. There is a lack of the usual vigour. CLINICAL FEATURES. Examination of the throat may reveal these white particles at the mouths of the crypts from which they may be easily removed, in contradistinction to those of keratosis pharyngis (p. 108). There is flushing of the margins of the palatoglossal arches, and the cervical glands are palpable. Pressure on the anterior pillars may squeeze fluid pus from the crypts. TREATMENT. The treatment is removal of the tonsils. Should there be contra-indications to surgery, such as haemophilia, severe diabetes, acute pulmonary tuberculosis, gross hypertension, advanced age, etc. conservative therapy with long-term antibiotics may be ordered, and the throat may be painted regularly with MandPs paint or a paint containing resorcin 0-3 g in 28-5 ml glycerine, or astringent gargles of hydrogen peroxide or ferric chloride may be prescribed. TUBERCULOSIS OF THE TONSIL Tuberculosis of the tonsil is now extremely rare in countries where the milk supply is controlled, and it presents no characteristic features. Attention is drawn to the tonsils by the diagnosis of tuberculous cervical glands. The tubercle bacilli in infected milk are presumed to reach the glands via the tonsils, which may or may not remain infected. There is no means of diagnos- ing this by clinical inspection, and the condition is discovered by histological examination after tonsillectomy. This is the more unfortunate because half of the tonsils so sectioned do not show evidence of tuberculosis. It is, however, sound surgical practice to remove the tonsils from children who have a tuberculous cervical adenitis rather than to leave potentially infected tonsils in situ. Full antituberculous therapy should be started when the diagnosis is made in the glands. CALCULUS OF THE TONSIL A calculus, or tonsillolith, may originate in the upper pole of the tonsil from calcification of cheesy food debris, and it may attain considerable size. It may be seen on the surface or detected with a probe. Sometimes the calculus is extruded spontaneously, or it may be removed with a probe. In many instances the tonsil must be removed, and this would be recommended if it were deemed septic. BONE AND CARTILAGE IN THE TONSIL Small islands of cartilage have occasionally been demonstrated in tonsils at microscopic examination, and they are thought to represent the remains of the first and second branchial arches. Enlarged styloidprocess is occasionally found in the tonsil and, although it usually causes no symptoms, it may give rise to pain radiating to the ear, The bony spine may be palpated with the finger or it may be demonstrated radiologically. It may be removed surgically with relief.