Disinfect sponges immediately after using them. See page 2064

A patient with diphtheria should cough into a handkerchief, which should be immediately disinfected, or into a rag that can be burnt. See page 2064

Peptonizing milk for a delicate digestion. A very useful precaution in typhoid cases. See page 2062

Where cats and dogs are out of place - at nursery meals.

See page 2064

Cats or dogs should never be allowed in or upon children's beds. See page 2064 dainties, such as grapes or other fruit. The unbreakable rule should be that the patient eats nothing but what is ordered by the doctor.

Diphtheria

In nursing diphtheria, there are several important points for the nurse to attend to. The infection is spread by discharges from the nose and mouth, so the nurse has to guard her own health by not going unnecessarily close to the patient's mouth, and when she is at the bedside she should be very careful to keep her mouth shut, and breathe through the nose. The patient should be instructed to cough into a handkerchief, or piece of lint, and all linen rags or lint used for wiping away discharges should be burnt at once.

The disease is due to a germ which settles in the respiratory passages, and after a period of incubation, lasting a few days, the first symptoms-loss of appetite, headache, and sickness-appear. The patient complains of sore throat and pain on swallowing. On examining the mouth, patches of grey membrane, almost like wash-leather, can be seen on the throat, particularly the soft palate and the uvula. The early symptoms rather resemble scarlet fever, but in scarlet fever the throat is red and inflamed with no grey patches. The glands at the angle of the jaw are painful and swollen. The temperature and pulse are both raised, and if the inflammation spreads to the larynx, there is a croupy cough, and the expression of the face becomes anxious. The disease is most prevalent amongst children, and bronchitis and pneumonia are serious complications.

Another complication the nurse must look out for is paralysis. This may affect the nose and throat passages, causing a nasal condition of the voice and regurgitation of fluids through the nose. The paralysis may affect the limbs, with loss of power, or the heart, causing collapse.

So that one of the most important things for the nurse is to keep the patient lying flat in bed for some time after the symptoms have disappeared. He must be given nourishing liquid food. The doctor will order any medicines and stimulants. The room should be kept at about 65 degrees, well ventilated, without draughts. It may be necessary to use a steam-kettle, especially in cold weather, to keep the air moist and warm, while hot fomentations to the throat are necessary if the breathing is difficult and painful. If tracheotomy has been performed by the doctor, one of the nurse's duties is to keep the tube clean and in its place.

The operation of tracheotomy consists in inserting a silver tube into the trachea, and tying it in place with tapes. Inside this an inner tube, which can be removed for cleaning, is placed.

At the present time, the mortality from diphtheria has been very much reduced by the introduction of anti-toxin, to be used at the very beginning of the case. Anti-toxin is the serum of blood from a horse, which has been rendered immune from diphtheria by inoculating the animal several times with the poison of diphtheria. Contrary to the ideas spread by the anti-vivisec-tionists, the horse does not suffer from diphtheria, but venesection is performed, and some blood drawn off without any pain whatever. The blood serum which has been drawn off is injected by means of a special syringe into the tissues of the patient's body, and this acts as an antidote to the diphtheria bacillus in his system.