Chapter 11

CATCHING DISEASES, COLDS, DISEASED GLANDS

Deadly fevers, the plague, black death, cholera, malaria, smallpox, taught mankind invaluable lessons. Millions of human beings died before the mind of man devoted itself to preventing the diseases for which no sure cure had been found. Efforts to conquer these diseases were tardy because men were taught that some unseen power was punishing men and governments for their sins. The difference between the old and the new way is shown powerfully by a painting in the Liverpool Gallery entitled "The Plague." A mediæval village is strewn with the dead and dying. Bloated, spotted faces look into the eyes of ghouls as laces and jewelry are torn from bodies not yet cold. In the foreground a muscular giant, paragon of conscious virtue, clad like John the Baptist and Bible in hand, finds his way among his plague-stricken fellow-townsmen, urging them to turn from their sins. Modern efficiency learns of the first outbreak of the plague, isolates the patient, kills rats and their fleas which spread the disease, thoroughly cleanses or destroys, if necessary, all infected clothing, bedding, floors, and walls, and makes it possible for us to go on living for each other with a better chance of "bringing forth fruits worthy for repentance."

Where boards of health make it compulsory to report cases of sickness due to contagion, health records are a reliable index to "catching" diseases. But now that the chief infection is the kind that afflicts children, we can read the index before the outbreak that calls in a physician to diagnose the case. School examination shows which children have defects that welcome and encourage disease germs. It points to homes that cultivate germs, and consequently menace other homes. To locate children who have enlarged tonsils may prevent a diphtheria epidemic. To detect in September those who are undernourished, who have bad teeth, and who breathe through the mouth will help forecast winter's outbreaks of scarlet fever and measles. One dollar spent at this season in examination for soil hospitable to disease germs may save fifty dollars otherwise necessary for inspection and cure of contagious diseases.

It is harder at first to interest a community in medical examination than in medical inspection, because we are all afraid of "catching" diseases, while few of us know how they originate and how they can be prevented by correcting the unfavorable conditions which physical examination of school children will bring to light.

Courses in germ sociology are therefore of prime necessity. How do germs act? On what do they live? Why do they move from place to place? What causes them to become extinct? With few exceptions, germs migrate for the same reason as man,--search for food, love of conquest, and love of adventure. When there is plenty of food they multiply rapidly. Full of life, overflowing with vitality, they move out for new worlds to conquer. Like human beings, they will do their best to get away from a country that provides a scanty food supply. Like men and women, they starve if they cannot eat. Like boys and girls, they avoid enemies; the weak give way to the strong, the slow to the swift, the devitalized to the vitalized.

Human sociology imprisons, puts to death, deprives of opportunity to do evil, or reforms those who murder, steal, or slander. Germ sociology teaches us to do the same with injurious germs. We imprison them, we take away their food supply, we kill them outright, or we starve them slowly. They have a peculiar diet, being especially partial to decomposing vegetable and animal matter and to what human beings call dirt. By putting this diet out of their reach we make it impossible for them to propagate their kind. By placing poison within their reach or by forcing it upon them we can successfully eliminate them as enemies. As the president of Mexico restored order "by setting a thief to catch a thief," so modern science is setting germs to kill germs that harm crops and human stock. Of utmost consequence is it that the body's germ consumer--its pretorian guard--be always armed with vitality ready to vanquish every intruding hostile germ. If we are false to our guard, it will turn traitor and join invaders in attacking us. But here, as in dealing with evils that originate with human beings, an ounce of prevention is worth a ton of cure. The most effectual way to eliminate germ diseases is to remove the cause--the food supply of disease germs. The fact that many germs are plants, not animals, does not weaken the analogy, for weeds do not get a chance in well-tilled soil.

Perhaps the most notable recent example of government germ extermination is the triumph over the yellow-fever and malaria mosquito in Panama. When the French started to build a canal in Panama, the first thing they did was to build a hospital. The hospital was always full and the canal was given up. At the time the United States proposed to re-attempt the work, it was thought that it could not be done without great loss of life and without great labor difficulties. Instead of taking the sickness for granted and enlarging the French hospital, the chief medical inspector, Gorgas, took for granted that there need be no unusual sickness if proper preventive measures were taken. He knew what the French had not known, that the yellow-fever scourge depends for its terrors upon mosquitoes. Accordingly, with the aid of six thousand men and five million dollars he set about to starve out the few infected and infectious kinds of mosquito,--the yellow-fever or house mosquito and the malaria or meadow mosquito. He introduced waterworks and hydrants, paved the streets, drained the swamps and pools in which they breed, and instituted a weekly house-to-house inspection to prevent even so much as a pail of stagnant water offering harbor to these enemies. The grass of the meadows where the malaria mosquito breeds was cut short and kept short within three hundred feet of dwellers,--as far as the mosquito can fly. All ditches were disinfected with paraffin, and the natives were forced to observe sanitary laws. President Roosevelt, in his special message to Congress on the Panama Canal in 1906, stated that in the weekly house-to-house visit of the inspectors at the time he was in Panama but two mosquitoes were found. These were not of the dangerous type. As a consequence of this sanitary engineering there is very little sickness in Panama, the hospital is seldom one third full, and the canal is progressing very much faster than was expected. Panama, like Havana, is now safer than many American cities, because cleaner and less hospitable to disease germs.

Any place where numbers of people are accustomed to assemble favors the propagation of germs,--whether it be the meetinghouse, the townhall, the theater, or the school. Every teacher can be the sanitary engineer of her own schoolroom, school, or community by coöperating with the school doctor, the town board of health, family physicians, and mothers. Every teacher can exterminate disease by applying the very same principles to her schoolroom as Chief Medical Inspector Gorgas applied to Panama. Knowledge, disinfection, absolute cleanliness, education, and inspection are the essential steps. First she must know that "children's diseases" are not necessary. She should discountenance the old superstition that every child must run the gamut of children's diseases, that every child must sooner or later have whooping cough, measles, chicken pox, mumps, scarlet fever, just as they used to think yellow fever and cholera inevitable. The price of this terrible ignorance has been not only expense, loss of time, acquisition of permanent physical defects, and loss of vitality, but, for the majority of children, death before reaching five years of age. All these "catching" diseases are germ diseases, which disinfection can eliminate. The free use of strong yellow soap and disinfectants on the school floor, windows, benches, desks, blackboards, pencils, in the coat closets and toilets, plus the natural disinfectants, hot sun and oxygen, will prevent the schoolroom from being a source of danger. One or more of these germ-killing remedies must be constantly applied; cleansing deserves a larger part in every school budget.

Often country towns are as ignorant of the existence of germs and of the means of preventing the spread of disease as the woman in a small country town who used daily to astound the neighbors by the "shower of snow" she produced by shaking the bedding of her sick child out of the window. Their astonishment was soon changed to panic when that shower of snow resulted in a deadly epidemic of scarlet fever. Medical inspection of New York City's schools was begun after an epidemic of scarlet fever was traced to a popular boy who passed around among his schoolmates long rolls of skin from his fingers.

Much of the care exercised at school to prevent children's diseases is counteracted because children are exposed at home and in public places to contagion, where ignorance more often than carelessness is the cause of uncleanliness. By hygiene lessons, illustrating practically the proper methods of cleaning a room, much may be done to enlist school children in the battle against germs. Through the enthusiasm of the children as well as through visits to the homes parents may be instructed as to the danger of letting well children sleep with sick children; the wisdom of vaccination to prevent smallpox, of antitoxin to prevent serious diphtheria, of tuberculin tests to settle the question whether tuberculosis is present; why anything that gathers dust is dangerous unless cleansed and aired properly; and why bedding, furniture, floor coverings, and curtains that can be cleansed and aired are more beautiful and more safe than carpets, feather beds, upholstery, and curtains that are spoiled by water and sunshine; how to care for the tuberculous member of the family, etc. Anti-social acts may be prevented, such as carrying an infected child to the doctor in a public conveyance, thereby infecting numberless other people; sending infected linen to a common laundry; mailing a letter written by an infected person without first disinfecting it; sending a child with diphtheria to the store; returning to the dairy unscalded milk bottles from a sick room.

The daily inspection of school children for contagious diseases by the school physician has, where tried, been found to reduce considerably the amount of sickness in a town. Such inspection should be universally adopted. Moreover, the teacher should be conversant with the early symptoms of these diseases so that on the slightest suspicion the child may be sent home without waiting for the physician's call. Like the little girl who never stuttered except when she talked, school children and school-teachers are rarely frightened until too late to prevent trouble. The "easy" diseases such as measles, whooping cough, etc., cost our communities more than the more terrible diseases like typhoid and smallpox. During one typical week ending May 18, 630 new cases of measles were reported to one department of health. Obviously the nineteen deaths reported give no conception of the suffering, the cost, the anxiety caused by this preventable disease. The same may be said of diphtheria and croup, of which only thirty-two deaths are reported, but 306 cases of sickness. Yet no one to-day will send a child to sleep with a playmate so as to catch diphtheria and "be done with it."

The most strategic point of attack is almost universally unrecognized. That is the child's mouth. Here the germs find lodgment, here they find a culture medium--at the gateway of the human system. The mouth is never out of service and is almost never in a state of true cleanliness. Solid particles from the breath, saliva, food between the teeth, and other débris form a deposit on the teeth and decompose in a constant temperature of ninety-eight degrees Fahrenheit. In the normal mouth from eight to twenty years of age the teeth present from twenty to thirty square inches of dentate surface, constantly exposed to ever-changing, often inimical, conditions. This bacterially infected surface makes a fairly large garden plot. Every cavity adds to the germ-nourishing soil. Dental caries--tooth decay--is a disease hitherto almost universal from birth to death. Thus the air taken in through the mouth becomes a purveyor of its poisonous emanations and affects the lung tissues and the blood. Food and water carry hostile germs down into the stomach. Thence they may be carried into any organ or tissue, just as nourishment or poison is carried.

Moreover, the child with an unclean mouth not only infects and reinfects himself but scatters germs in the air whenever he sneezes or coughs. In a cold apartment where there is no appreciable current of air a person can scatter germs for a distance of more than twenty-two feet. Germs are also scattered through the air by means of salivary or mucous droplets. It is this fact that makes colds so dangerous.

TABLE VIII

=City of Manchester Education Committee=

=INFECTIOUS OR CONTAGIOUS DISEASES IN SCHOOLS INFORMATION FOR TEACHERS=

Four columns are omitted: (1) Interval between Exposure to Infection and the First Signs of the Disease; (2) Day from Onset of Illness on which Rash appears; (3) Period of Exclusion from School after Exposure to Infection; (4) Period of Exclusion from School of Person suffering from the Disease

+------------------------------+------------+------------------ DISEASE | PRINCIPAL SIGNS AND SYMPTOMS | Method of | REMARKS | | Infection | -----------+------------------------------+------------+------------------ Measles |_Begins like cold in the | |After effects |head_, with _feverishness, | |often severe. |running nose, inflamed and | |Period of greatest |watery eyes, and sneezing_; | |risk of infection |small crescentic groups of | Breath and |first three or |_mulberry-tinted spots_ appear| discharges |four days, before |about the third day; _rash | from nose |the rash appears. |first seen on forehead and | and mouth. |May have repeated |face_. The rash varies with | |attacks. Great |heat; may almost disappear if | |variation in type |the air is cold, and come out | |of disease. |again with warmth. | | -----------+------------------------------+------------+------------------ German |Illness usually slight. Onset | | Measles |sudden. _Rash often first | | |thing noticed;_ no cold in | Breath and | |head. Usually have | discharges |After effects |_feverishness_ and _sore | from nose |slight. |throat_, and the _eyes may | and mouth | |be inflamed. Rash_ something | | |between Measles and Scarlet | | |Fever, variable. | | -----------+------------------------------+------------+------------------ Chicken |Sometimes begins with | |When children Pox |feverishness, but is _usually | |return, examine |very mild_ and without sign | |head for |of fever. _Rash_ appears on | |overlooked spots. |second day as _small pimples_,| |All spots should |which in about a day become | |have disappeared |filled with _clear fluid_. | Breath and |before child |This fluid then becomes | crust of |returns. A mild |_matter_, and then the _spot | spots. |disease and |dries up_and _the crust falls | |seldom any after |off_. | |effects. | | | |May have _successive crops of | | |of rash_ until tenth day. | | -----------+------------------------------+------------+------------------ Whooping |_Begins like cold in the | |After effects Cough |head_, with _bronchitis_ and | |often very severe |_sore throat_, and a _cough_ | |and the disease |which is _worse at night_. | Breath and |causes great |Symptoms may at first be very | discharges |debility. Relapses |mild. Characteristic | from nose |are apt to occur. |_"whooping" cough_ develops | and mouth. |Second attack |in about a fortnight, and the | |rare. Specially |spasm of coughing often ends | |infectious for |with _vomiting_. | |first week or two. | | |If a child is sick | | |after a bout of | | |coughing, it is | | |most probably | | |suffering from | | |whooping cough. | | | | | |Great variation in | | |type of disease. -----------+------------------------------+------------+------------------ Mumps |Onset may be sudden, beginning| | |with sickness and fever, and | | |_pain about the angle of the | Breath and |Seldom leaves |jaw_. The _glands become | discharges |after effects. |swollen and tender_, and the | from nose |Very infectious. |_jaws stiff_, and the _saliva | and mouth. | |sticky_. | | -----------+------------------------------+------------+------------------ Scarlet |The _onset is usually sudden_,| Breath, |Dangerous both Fever or |with _headache, languor, | discharges |during attack and Scarlatina |feverishness, sore throat_, | from nose |from after effects. |and often the child is _sick_.| and mouth, |Great variation |Usually within twenty-four | particles |in type of disease. |hours the _rash_ appears, and | of skin, |Slight attacks |is _finely spotted, evenly | and |as infectious as |diffused_, and _bright red_. | discharges |severe ones. Many |The _rash_ is seen first on | from |mild cases not |the _neck and upper part of | suppuratory|diagnosed and many |chest_, and lasts three to | glands or |concealed. The |ten days, when it fades and | ears. Milk |peeling may last |the _skin peels in scales, | specially |six to eight weeks. |flakes_, or even _large | apt to |A second attack is |pieces_. The _tongue_ becomes | convey |rare. When scarlet |whitish, with bright red | infection. |fever is occurring |spots. The eyes are not watery| |in a school, all |or congested. | |cases of sore | | |throat should be | | |sent home. -----------+------------------------------+------------+------------------- Diphtheria |Onset insidious, may be rapid | Breath and |Very dangerous |or gradual. Typically _sore | discharges |both during attack |throat_, great weakness, and | from nose, |and from after |swelling of glands in the | mouth, and |effects. When |neck, about the angle of the | ears. |diphtheria is |jaw. The back of the throat, | |occurring in a |tonsils, or palate may show | |school all children |_patches_ like pieces of | |suffering from sore |yellowish-white kid. The most | |throat should be |pronounced symptom is great | |excluded. There is |debility and lassitude, and | |great variation of |there may be little else | |type, and mild |noticeable. There may be | |cases are often not |hardly any symptoms at all. | |recognized but are | | |as infectious as | | |severe cases. There | | |is no immunity from | | |further attacks. | | |Fact of existence | | |of disease | | |sometimes | | |concealed. -----------+------------------------------+------------+------------------- Influenza |_Begins with feverishness, | Breath and |Excessively |pain in head, back_, and | discharges |infectious. After |_limbs_, and usually _cold in | from nose |effects often very |the head_. | and mouth. |serious and | | |accompanied with | | |great prostration | | |and nervous | | |debility. -----------+------------------------------+------------+-------------- Smallpox |The illness is usually well | Breath, |Peculiarly |marked and the onset rather | all |infectious. When |sudden, with _feverishness, | discharges,|smallpox occurs in |severe backache, and | and |connection with a |sickness_. About third day | particles |school or with any |a _red rash_ of _shotlike | of skin |of the children's |pimples_, felt below the skin,| or scabs. |homes, an endeavor |and seen first about the | |should be made to |_face_ and _wrists. Spots | |have all persons |develop_ in _two days_, then | |over seven years |form _little blisters_, and | |of age |in other two days become | |revaccinated. |_yellowish_ and filled with | | |matter. _Scabs_ then form, | |Cases of modified |and these fall off about | |smallpox--in |the fourteenth day. | |vaccinated | | |persons--may be, | | |and often are, so | | |slight as to | | |escape detection. | | |Fact of existence | | |of disease may be | | |concealed. Mild | | |or modified | | |smallpox as | | |infectious as | | |severe type. -----------+------------------------------+------------+----------------- =In the following diseases only the affected child is excluded=

=Erysipelas.= Child should not | =Ringworm on Scalp.= Child should return till all swelling and | be excluded till cured. Very peeling of skin has disappeared. | difficult to cure and often takes | a very long time. =Ophthalmia.= Child should not | return till all traces have | =Phthisis= (=Consumption=). If in disappeared. | advanced stage and coughing much | _or spitting_, child should be =Scabies or Itch.= Child should be | excluded. (Infection from breath excluded until cured. | and dried spit floating in the air | as dust.) =Ringworm on Skin.= Child should be | excluded till cured. This takes | =Impetigo= (=Contagious Sore=). only a few days if properly | Child should be excluded until treated. | cured. A week or ten days should | suffice.

=A. BROWN RITCHIE=, _Medical Officer to Education Committee_.

Most people still think that colds are due to cold air or draughts rather than to a cold germ, which finds a body unequipped with resisting power, with its germ police off guard, exhausted from overwork, or disaffected and ready to turn traitor if the enemy seems stronger than our vitality. Sometimes it seems as if we contracted it from a sneezing fellow-passenger, sometimes from a draught from an open car window. An uninformed opponent of the theory that colds are a germ disease wrote the following letter last winter to a New York newspaper:

In addition to the Society for the Suppression of Noises there should be in this town a Society for the Suppression of "Fresh-Air" Fiends. The newspapers report an epidemic of pneumonia, grippe, and colds. It is almost entirely due to the fact that the average New Yorker is compelled to live, move, and have his being from daylight to midnight in a succession of draughts of cold air caused by the insanity of overfed male and female hogs, who, with blood almost bursting through their skins, demand "fresh air" in order to keep from suffocating. Everywhere a man goes, day or night, he is in a draught caused by the crazy ideas about fresh air.

Our wise ancestors, who as a rule lived much longer than we do, and had much better health, said:

"If the wind should blow through a hole, God have mercy on your soul."

After the correspondent has learned that our ancestors had more colds than we, had poorer health, and died twenty years younger, perhaps he will listen to proof that his unclean warm air weakens the body and makes it an easy prey to cold germs.

Many physicians preach and practice this fallacy as to fresh air and colds, but few physicians now deny that influenza is a germ disease or that a nose so irritated and so neglected as to secrete large quantities of mucus is a better place for breeding disease germs than a nose whose membranes are clean and not thus irritated.

Until medical specialists are agreed, and until they have definitely located the cold germ, we laymen must choose for ourselves a working theory. The weight of opinion at the present time declares that colds are due to germs. Strong membranes with good circulation and drainage provide poor food for germs. Congested membranes furnish proper conditions for propagation. The germ theory explains the spread of germs from the nose to the passages of the head, and from head to arteries and lungs.

A cold can always be charged to some one else. How many can be laid to our account? There is one right that is universally not recognized, and that is the right of protection from the germs showered in the air we breathe, over the food we eat, by the sneezes of our unfortunate neighbor at school, in the street car, at the restaurant. The chief danger of a cold is to our neighbor, not to ourselves. A cold which a strong person may throw off in a day or two may mean death to his tuberculous neighbor. Though for our own health "lying up for a mere cold" is an unnecessary bore, the failure to do so may deprive our neighbor of a right greater than the right to protection against scarlet fever or smallpox. Though formerly this statement would not have been true, rights change with conditions, and the fact that to-day the three most deadly diseases are pneumonia, tuberculosis, and diphtheria,--all diseases of the respiratory organs,--justifies the assertion that we have a right to protection against colds. The prevalence of colds, sore throats, irritated vocal cords, bad voices, catarrh, bronchitis, laryngitis, and asthma in America to-day demands summary measures. One can learn to sneeze into a handkerchief, not into a companion's face or into a room. School children can be taught to avoid handkerchiefs on which mucus has dried. In the far distant future we may be willing to use cheesecloth, and boil it or throw it away, or, like the Japanese, use soft paper handkerchiefs and burn them after using.

TABLE IX

DEATH RATE PER 10,000 POPULATION, PNEUMONIA AND BRONCHITIS FIVE-YEAR PERIOD, 1896-1900

England and Wales 22.70 Scotland 27.40 Stockholm 26.70 London 31.20 Berlin 16.10 Vienna 39.70 Christiania 21.30 Boston 30.60 Chicago 24.20 Philadelphia 25.10 New York City 36.60

One child with a cold can infect a whole class or family, thus depriving the class and family of the top of their vitality and efficiency without their consent. Because a person is thought a weakling who lies up for a "mere cold," one is inclined to wish that colds were as prostrating as typhoid, in which case there would be some hope of their extermination.

The exclusion of children with colds from school deserves trial as a check to children's diseases. Many of these "catching" diseases start with a cold in the head, as, for instance, measles, influenza, and whooping cough. The first symptom of mumps, diphtheria, and scarlet fever is a sore throat or swollen glands, which, because they commonly accompany a cold, are not at first distinguished from it.

The first step for the teacher or mother in reading the index for colds is to look into the coat closet for evidence of warm clothing and overshoes, then to note whether the children put them on when they go out for lunch or recess. Whether "cold" settles in the nasal passages, ear, or stomach depends upon which is the weak spot. Draughts, thin soles, wet soles, exposure when perspiring, may be the immediate cause of the nutritional or respiratory disturbances that give cold germs a foothold. Adenoids, diseased teeth, inflamed ears, may furnish the food supply. "There is no use treating children and sending them on fresh-air trips as long as they have nutritional and digestive disturbances due to bad teeth, or colds due to adenoids," said a physician when examining a party of children for a summer outing. The great preventive measure to be taken for catching diseases, colds, diseased glands,--in fact all germ diseases,--is the repeated cleansing of those portions of the human body in which germs may find lodgment,--the mouth, the nose, the eyes, and the ears.

In caring for young infants great pains is taken to cleanse all the orifices daily, but as soon as the child washes himself this practice is usually abandoned. Washing these gateways is far more important than washing the surface of the body through which germs could not possibly gain entrance into the system except through wounds. Oftentimes the douching of the nostrils with salt water will stop a cold at once. The mouth is the most important place of all, and the teacher should take care of her pupils' mouths first and foremost. As bad teeth, enlarged tonsils, and adenoids harbor germs and putrescent matter that vitiate every incoming and outgoing breath, these defects should be immediately corrected. Are we coming to a time when a thorough house-cleaning in the mouth of every child will take place before he enters the schoolroom, preferably in the presence of the teacher?

Two other "catching" diseases cause city schools a great deal of trouble,--trachoma and pediculosis (head lice). There are probably no two diseases more quickly transmitted from one person to another. Almost before their presence is known, all children of a school or all persons of a group have contracted them. When at college twenty men of my fraternity discovered almost at the same time that they had an infectious eye trouble; yet we thought we were using different towels and otherwise taking sanitary precautions. Last summer a Vassar graduate took a party of tenement children for a country picnic. She returned with head lice that required constant attention for weeks. What then may we expect of children who live in homes where there is neither water, time, nor privacy for bathing, where one towel must serve a family of six, where mothers work for wages away from home and see their children only before seven and after six?

Unfortunately for thousands of children, many parents still believe these troubles will be outgrown. Last summer a fresh-air agency in New York City arranged for several hundred school girls to go to a certain camp for ten days each. The only condition was that the heads should be free from lice and nits (eggs). From the list furnished by school-teachers--girls supposed to have been cured by school nurses--not one in five was accepted. A baby two weeks old, brought to Caroline Rest, had already begun to suffer from this easily preventable scourge. Of 1219 children examined in Edinburgh, Scotland, 909, or 69 per cent, had some skin disease, and 60 per cent had sores due to head lice. Even when neglect has caused the loss of hair and ugly sores on the head, mothers deceive themselves into believing that some other cause is responsible.

Trachoma, if neglected, not only impairs the health of the eye, but may cause blindness. Tears carry the germs from the eye to the face, where they are taken up on handkerchiefs, towels, and fingers and infect other eyes. Of late, thanks to school nurses and physicians and hygiene instruction, American cities have found relatively little trachoma except among recent immigrants. So dangerous is the germ and so insidious its methods of propagation, that a physician should be summoned at once at the first sign of inflammation. Conjunctivitis is due to a germ, and will spread unless checked. Since the board of health of New York City has instituted the systematic examination of the eyes of the children in the public schools, it has found fully one third affected with some form of conjunctivitis. Many of these cases are out-and-out trachoma, others acute conjunctivitis, and a larger proportion are "mild trachoma." This last form of the disease is found to a great extent among children who have adenoids. The adenoids should be regarded as a predisposing factor rather than a direct cause. Therefore sore eyes are given as one of the indexes of adenoids. When we consider that adenoids are made up of lymphoid material, and that trachoma follicles are made up of the same sort of tissue, it is not surprising that the two conditions are found in the same child. The catarrhal inflammation produced by adenoids in the nasal mucous membrane travels up the lachrymal duct and thus infects the conjunctiva by contiguity.

In preventing pediculosis and infection of the eye vigilance and cleanliness are indispensable. After the diseases are advanced, after the germ colonies have taken title, some antiseptic or germ killer more violent than water is needed,--kerosene for the hair or strong green oil soap; for the eye, only what a physician prescribes.