Excerpt from The American Journal of the Medical Sciences, 1914, Vol. 148

Etiology. The ages of the patients varied from nine months to fourteen years. In three instances two members of a family were admitted, and in a fourth instance two cousins living in the same house. It was further observed that although only in a very few instances could a direct or indirect contact with a patient suffering from the disease be recorded, at any one time the majority of patients came from the same general locality in New York. Inquiries were made as to the prevalence of flies and other insects in the house, and subsequent to the communication of Rosenau2 on the conveyance of infection by the stable fly (stomoxys calcitrans), the proximity of the home to stables was in all cases inquired into. Neither the prevalence of insects nor the neighborhood of stables was found to be a usual occurrence. In many cases the parents suggested some slight accident or some dietary indiscretion as the cause of the condition, but in no case could a predisposing cause be ascertained.

In View of the possible importance of the nose and throat as the point of entrance of the infection, the tonsils were in all cases inspected.3 Simple inspection is unsatisfactory in estimating the size or condition of tonsils, but in 37 cases they were noted as somewhat enlarged and congested, in 18 cases as enlarged, and in 4 as slightly congested. In the remaining 31 they were noted as normal or were not examined, as occurred in two rapidly fatal cases. In the case of 8 children whose tonsils were noted as enlarged and congested, 21 other children in their families were examined, and of these in 16 the tonsils were noted as Showing no enlargement or congestion. In 15 cases the tonsils were enucleated, and on removal usually proved to be larger than inspection had led one to expect.

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