APPENDIX I 



pected. If the discharge from the nose is only from one nostril, a foreign 

 body in the nose should be looked for. 



In cases of chronic nasal obstruction, as evinced by mouth-breath- 

 ing, snoring, continual post-nasal catarrh or recurring ear trouble, the 

 presence of an adenoid growth (third tonsil) should be suspected, and 

 the child referred for special examination and treatment. As a rule, 

 digital examination for adenoids should be made only by the operating 

 surgeon. Obviously large tonsils, recurring tonsilitis and enlargement 

 of the glands of the neck, suggest the advisability of referring the child 

 to the family physician as to the propriety of removing the tonsils. 



Recurring nose-bleed should be referred for special treatment. 



In cases of eczema about the nostrils, a cause may be sought in 

 pediculi capitis (head lice). 



In referring cases for treatment, school physicians, in addition to 

 the diagnosis, should state the symptoms upon which the diagnosis is 

 based, for the benefit of the family physician or specialist. 



V 



DISEASES OF THE SKIN 



Scabies (the Itch). A contagious skin disease, due to an animal 

 parasite which burrows in the skin, causing intense itching and scratch- 

 ing. The disease usually begins upon the hands and arms, spreading 

 over the whole body, but does not affect the face and scalp. Between 

 the fingers, on the front of the wrist, at the bend of the elbows and near 

 the arm-pits are favorite locations for the disease; but in persons of 

 cleanly habits the disease may not show at all upon the hands, and its 

 real nature is determined only after a most thorough and careful examina- 

 tion. There is a great variation in the extent and severity of this disease, 

 lack of personal care and cleanliness always favoring its development. 

 Scratching soon brings about an infection of the skin with some of the 

 pus-producing germs, and the disease is then accompanied by impetigo, 

 or a pus infection of the skin. 



At the present time itch is very common and widespread, and, 

 because of the great variation in its severity, mild cases have been mis- 

 taken for hives, eczema, etc., the real condition not being recognized, 

 and the disease spread in consequence. All children who are scratching 

 or have an irritation upon the skin should be examined for scabies. 



It is very important that all infected members of a family be treated 

 till cured, else the disease is passed back and forth from one to another. 

 It is also important that all underclothing, bedding, towels, etc., things 

 that come in contact with the body, be boiled when washed. 



All cases of scabies should be excluded from school until cured. 



