CARE OF THE THROAT AND EAR. 797 



be prevented from returning to school until infection is no longer 

 possible, but other children of the same household should also be kept 

 at home. A few years ago a certain school in this city was rarely 

 without a case of diphtheria among its pupils for many months. I 

 am convinced that had the principal of the school or the parents in- 

 sisted upon the other children of the infected household remaining 

 at home, the spread in this direction would have been arrested and 

 much suffering avoided. 



When a patient has recovered from diphtheria, thorough dis- 

 infection is a most important measure. Unfortunately, however, 

 many persons consider it a hardship if articles which can not be dis- 

 infected are destroyed, and many will even use every endeavor to 

 prevent the representatives of the Board of Health from carrying out 

 their regulations. In this way the germ of the disease remains on the 

 premises, and under suitable conditions again finds another victim 

 in the household. To illustrate this, I recall an instance some years 

 ago in which I was called in consultation to see a most malignant case 

 of diphtheria. The little patient fortunately recovered, and the 

 premises were thoroughly disinfected, the parents being anxious to 

 avoid any repetition of the dreaded malady. Five months later, how- 

 ever, a younger child became ill, and was found to have diphtheria. 

 In view of the vigorous efforts which had been made to disinfect the 

 house thoroughly, and of the fact that the child could not have con- 

 tracted it elsewhere, not having left its home for several weeks, the 

 cause at first appeared a mystery. Careful inquiry, however, soon 

 elicited a fact which clearly explained the case. The first patient 

 had used a mouth-organ just before its illness, and when this was 

 abandoned, the toy was carelessly thrown on the top of a bookcase, 

 the nature of the child's illness at the time not being known. The 

 second child, just before its illness, had accidentally found this toy 

 and used it frequently. This experience explains the necessity of 

 disinfection in all its details, and also illustrates the tenacious char- 

 acter of the germ which produces this disease. 



Our knowledge of the specific cause of scarlet fever is not as com- 

 plete as that of diphtheria, but we have much useful information 

 which is of importance from a hygienic standpoint. As in diph- 

 theria, the specific poison is probably produced in the throat of the 

 patient, and may therefore be spread by the dried secretion from 

 the mouth and throat. The most common means of contagion, how- 

 ever, is the skin, which peels off in the later stage of the disease, 

 infection being produced by the inhalation into the nostrils of some 

 of the diseased particles. 



A predisposing factor which applies alike to diphtheria and all 

 other throat affections is the abnormal condition of the nose and 



