t under five years of age. This
circumstance attaches special importance to sore-throat in young
children, since it will usually be found to betoken the approach of
scarlet fever, or of diphtheria, rather than the existence of simple
inflammation, or quinsey.

While this fact affords a reason for most scrupulous attention to every
case of sore-throat in children, and this in proportion to the tender
age of the child, needless alarm is sometimes caused by the appearance
on the inflamed tonsils of numerous white specks, which are at once
supposed to be diphtheritic. I have already pointed out the distinction
between the two conditions when speaking of diphtheria, but the matter
is so important that I will repeat what I then said. These spots are not
in the form of a uniform white patch or membrane, which, on being
removed, leaves the surface beneath red, raw, and often slightly
bleeding; but they are rather distinct circular spots, firmly adherent
to the tonsil, wiped off with difficulty, and evidently exuding from the
openings of little pits, blind pouches, or glands, with which the
surface of the tonsil is beset. I do not advise any parent to rest
satisfied with his or her judgment on this matter the first time that
they notice this appearance; but there are children with whom slight
sore-throat is always attended by this condition, and others in whom the
tonsils are habitually enlarged, and seldom free from these white spots
flecking their surface.

=Enlarged Tonsils.=--I have said that quinsey or acute inflammation of
the tonsils is unusual in early childhood; but a sort of chronic
inflammation of those glands which leads to their very considerable
enlargement is far from uncommon; and is sometimes the cause of very
serious discomfort. It is seldom traceable to any acute attack of
sore-throat, but usually comes on imperceptibly in children who are
feeble or out of health, or takes place slowly during the cutting of the
first set of grinding teeth; the irritation which that produces being in
some cases its only apparent exciting cause. Not seldom the enlargement
has become considerable before it attracts attention; one of the first
symptoms that indicate it being the loud snoring of the child during
sleep, who is compelled by the obstruction at the back of the nostrils
to breathe with its mouth open. The voice at the same time becomes
thick, and this and the snoring breathing are both greatly aggravated
when the chil