APPENDIX I 



upon the physical condition of the children. Any hoarseness or any thick- 

 ness of the voice should cause an examination of the throat. If the tonsils 

 are enlarged, if the mucous membrane is congested, if there is swelling of 

 palate, a culture should be taken. These symptoms precede diphtheria. 



A child with positive cultures should be excluded from school until 

 two consecutive negative cultures at an interval of forty-eight hours 

 have been obtained. 



Scarlet Fever. If there is a sudden attack of vomiting, if there is 

 any redness of the throat, if the child complains of headache, if there 

 is an unexplained rise in temperature, the child should be isolated at 

 once. Any desquamation (peeling of the skin) should be looked upon 

 with suspicion. If there are any breaks at the finger tips, if on pressing 

 the pulp of the finger there is a white line at the juncture of the nail 

 with the pulp of the finger, particularly if this occurs in the majority 

 of the finger tips, the child should be excluded from the school. 



A child who has had scarlet fever should not return to school until 

 the process of desquamation has been entirely completed, and all dis- 

 charge from the nose and ears has ceased. 



Measles. Running from the nose and slight intolerance of light 

 may call for an examination of the mucous membrane of the mouth for 

 Koplik's sign. Koplik's sign, so called, is the presence on the lining 

 membrane of the mouth, near the molar teeth, of minute pearly white 

 blisters, without any inflammation around them. There may be only 

 two or three of these blisters, and they may easily escape detection if the 

 patient is not carefully examined in a good light. These blisters are 

 certain forerunners of an attack of measles. 



No child should return to school after an attack of measles until 

 the desquamation is entirely completed, and the child has recovered 

 from the intercurrent bronchitis. 



Mumps. Any swelling or tenderness in the region of the parotid 

 glands (situated behind the angle of the jaw) should be looked upon 

 with suspicion. It is important to notice any enlargement or swelling 

 about Steno's duct (inside the mouth, opposite the second upper molar 

 tooth), as this is a very frequent symptom of mumps. 



A child should be excluded from school until one week has elapsed 

 after the disappearance of all swelling and tenderness in the region of 

 the parotid glands. 



Wlooo-ping-cough . A persistent paroxysmal cough, frequently ac- 

 companied with vomiting, no matter whether there is any distinct whoop 

 or not, is indicative of whooping-cough. In cases of whooping-cough 

 of long standing, even if there has been no distinct whoop, an ulcer on 



