Suppurative tonsilitis in scarlet fever is distinguished from ordinary diphtheria by its appearance, course, and consequences ; and it is usually regarded as a part manifestation of scarlet fever following it.
Chronic tonsilitic affections, unaccompanied by fever, consist either in a cornification of the surface of the tonsils, with a colonisation of white fungi, or in enlargement of the tonsils. The former condition is harmless, but the white patches are often mistaken for those of diphtheria. Enlarged tonsils are often due to some individual or family predisposition ; frequent inflamma tions are rarely the cause.
The belief of many lay persons that swellings situated at the back of the lower jaw, below the ear, are enlarged tonsils, is incorrect. These are usually swollen lymph-glands.
The treatment of simple follicular tonsilitis calls for the use of cold or hot compresses around the throat, the drinking of cold beverages (milk, lemonade, iced chocolate, etc.), and avoidance of solid or hot foods. The diet should consist preferably of milk, cream, raw or soft-boiled eggs, broths, etc. Gargling the throat with an alkaline antiseptic is pre-eminently of mechanical benefit and of germicidal value. Treatment of the fever by drugs, notably salicylates, improves the general condition, and sometimes produces sleep. In quinsy, or tonsilar abscess, it is essential to open the abscess as soon as possible.
Permanently enlarged tonsils should be operated upon if necessary. After the period of adult growth, the tonsils gradually become smaller ; and in advanced age they disappear entirely.
TRACHOMA.—See Granular Conjunctivitis, S.V. EYE, DISEASES OF.
TRICHINOSIS.—An infectious disease clue to a worm-like parasite, the Trichina spiralis. The disease was demonstrated in 186o by Zenker, and shortly after Virchow demonstrated the process of evolution of the parasite. The worm enters the human body through the eating of pork which contains the parasite. Since cooking destroys it, the chief source of contamination lies in raw or smoked pork. Swine are infected by eating the faces of trichinous persons, or by eating the flesh of infected rats.
The Trichina spiralis is observed in two forms, according to whether it appears in the intestinal canal or in the muscular tissue (see Fig. 424). When the encapsulated muscle-trichinae are swallowed, they get into the stomach, where the capsules are opened and the trichinae set free. These thereupon enter the intestine, where they are developed into full-grown worms, attaining a size of from to 4 of an inch. The embryos are
developed from eggs within the body of the female worm, and are born alive. A single trichina is supposed to bear more than r,000 young. Soon after birth, the embryos begin their wanderings through the intestinal wall, or through the lymphatic vessels of the intestine, into the body-tissues. They are prone to lodge in the muscles, rolled up as spirals, where they encapsulate, either singly or in groups, in lime-encrusted cysts (see Fig. 425). This encapsulation completes their development.
Trichinm lodge mostly in the muscles of the neck, larynx, diaphragm, and upper arm ; they are very resistant, and usually live as long as the person on whom they feed. In some cases trichin2e have been accidentally found at autopsies, their presence not having been suspected during the lifetime of the patient.
In most cases, however, the presence of trichina' gives rise to very pro nounced disease symptoms ; and they are often a direct cause of death. A few days after having eaten the infected pork, the patient generally complains of severe gastric and intestinal disturbances, such as nausea, vomiting, colicky pains, and usually diarrhoea. Later, a persistent constipation may set in. These symptoms are all due to the ravaging of the parasites in the intestinal tract, and are followed later by manifestations indicating the fact that the worms have penetrated the intestinal wall and begun their progress in the muscles. Gradually increasing pain, weariness, and stiffness are the chief early symptoms connected with their encapsulation in the muscles ; and these are later followed by various other manifestations, depending upon in which muscles the parasites have mainly lodged. Skin eruptions, profuse sweating, boils, soreness in the throat, and insomnia are among the later symptoms.
The treatment is entirely prophylactic, consisting in a thorough inspection of all meats, and in a strict prohibition against eating raw pork. Thanks to the more and more rigid enforcement of these rules in most civilised countries, the disease is now comparatively rare. Once the parasite has gained access to the human body, the physician is able to do little but alleviate the pain and other unpleasant symptoms, by giving warm baths, compresses, and internal remedies. It may sometimes be possible, if the trichime are discovered while yet in the intestinal canal, to prevent their invasion of the muscles by strong purges and tmnicides.