inflamed also. Occasionally there may be only one spot of
white on the tonsil. The swelling differs in degree; in some cases the
tonsils may be so swollen as almost to meet together, but there is no
danger of suffocation from obstruction of the throat, as occurs in
diphtheria and very rarely in quinsy. The characteristic appearance
then consists in large, red tonsils covered with white spots. The
spots represent discharge which fills in the depressions in the
tonsil. The fever lasts three days to a week, generally, and then
subsides together with the other symptoms.

With apparent tonsilitis there must always be kept in mind the
possibility of diphtheria, and, unfortunately, it is at times
impossible for the most acute physician to distinguish between these
two diseases by the appearances of the throat alone. In order to do so
it is necessary to rub off some of the discharge from the tonsils, and
examine, microscopically, the kind of germs contained therein. The
general points of difference are: in diphtheria the tonsils are
usually completely covered with a gray membrane. In the early stage,
or in mild cases of diphtheria, there may be only a spot on one
tonsil, but it is apt to be yellow in color, and is thicker than the
white spots in tonsilitis. These are the difficult cases. Ordinarily,
in diphtheria, not only are the tonsils covered with a grayish
membrane, but this soon extends to the surrounding parts of the
throat, whereas in tonsilitis the spots are always found on the tonsil
alone. The white spot can be readily wiped off with a little
absorbent cotton wound on a stick, in the case of tonsilitis, but in
diphtheria the membrane can be removed in this way only with
difficulty, and leaves underneath a rough, bleeding surface. The
breath is apt to have a bad odor in diphtheria, and the temperature is
lower (not much over 100 deg. F.) than in tonsilitis, when it is
frequently 101 deg. to 103 deg. F. Notwithstanding these points, it is never
safe for a layman to undertake the diagnosis when a physician's
services are obtainable. On the other hand, when this is not possible
and the patient's tonsils present the white, dotted appearance
described, especially if subject to similar attacks, one may be
reasonably sure that the case is tonsilitis.

=Treatment.=--The patient should be put to bed and kept apart from
children and young persons, and, if living among large numbers of
people, should be strictly quarantined.