frightens the parents, though it seldom means anything serious. The child sits up in bed, frightened, and struggles for breath. It may clutch its throat with its hands as if something was tied round its neck. The lips may become slightly blue and the perspiration appears upon the child's brow. After some time,—it may be two or three hours,—the attack wears away and the child goes to sleep. Next morning it wakes up apparently well except for the croupy cough. The attack may repeat itself the next night and mildly on the third night.

Treatment.—The object of treatment during an acute attack, when the child is struggling for breath, is to relax quickly the spasm of the larynx which interferes with the breathing. The simplest way is to give the child a teaspoonful of the fresh syrup of ipecac. If the child does not vomit in fifteen minutes, give another teaspoonful and keep on giving it every fifteen minutes till the child vomits. One or two doses is usually enough, but it must be given till the child vomits.

If the attack comes suddenly during the night and there is no syrup of ipecac in the house, the physician should be sent for at once and informed that the child probably has croup, so he may know what to take with him. While waiting for the physician the mother should apply over the front of the neck (in the region of Adam's apple), hot applications. These are best made of flannel wrung out of quite hot water every two or three minutes: also a hot mustard foot bath. When the physician takes charge of the case he will also direct the treatment for the following day in order that the attack of the next night may be a very mild one, if it should came at all.

Children who have a tendency to frequent attacks of croup should receive the same attention as the children do who are subject to attacks of tonsilitis and acute catarrhal rhinitis.

SUMMARY:—

1st. Spasmodic Croup always requires prompt and efficient treatment.

2nd. It is called "false" croup, because "true" croup is always diphtheritic and is a very serious disease.

3rd. For that reason a physician should always be called because if it is "true" croup antitoxin must be given at once.

4th. Don't worry unnecessarily because, though "spasmodic croup" can make the child look exceedingly sick for a very short time, an uncomplicated case in a healthy child is seldom if ever dangerous.

TONSILITIS: ANGINA: "SORE THROAT"

This is one of the frequent diseases of childhood. We rarely see it in infants. It is caused by inhaling air which contains poisonous germs. These germs quickly develop when conditions are favorable. They lodge in the pores or follicles of the tonsils and set up an active inflammation. The tonsils swell up and the follicles exude a thick fluid which looks like curdled cream. This fluid sticks in the mouths of the follicles forming spots. If enough of this fluid is coming out, these spots join together forming patches, and the patches may join together forming membrane. This is why it is sometimes so difficult to tell whether the case is one of tonsilitis or diphtheria.

Conditions are favorable to the development of tonsilitis if the child is not in good health when he happens to inhale the infection, when the feet are wet or cold, or when the child is allowed out during inclement weather and it becomes chilled or numbed from cold, when the child has a cold in the head and a running nose, or when its stomach is out of order. Any condition in which the child should be carefully watched and tended to, rather than allowed further liberties, or risks, conduces to sore throat of some kind.

Some children have the disease a number of times; they seem to be predisposed toward a sore throat. These are children who have large tonsils or who are rheumatic. The tonsils should be removed in the one case, and the tendency to rheumatism should be the main treatment in the other case.

These children should be encouraged to cleanse the throat and nose morning and night with a warm salt solution (half a teaspoonful of ordinary table salt to three-quarters of a cup of warm water). This will help greatly to prevent these chronic sore throats.

Symptoms of Tonsilitis.—The disease begins suddenly. The child may have a chill or be seized with sudden vomiting or diarrhea. A very young infant may have a convulsion. The usual way is for the child to develop a fever quickly, to complain of being sick and tired. Muscular pains all over the body and a severe headache are constant symptoms. The fever is usually high from the beginning. The child will tell you its throat is sore, but there is as a rule very little pain in the throat. The little spots or patches can be seen on one or both tonsils. The general symptoms are more pronounced than the local throat symptoms. The amount of physical depression that is caused by a tonsilitis is out of all proportion to the seriousness of the disease.

Tonsilitis lasts three days usually. The throat symptoms may take a day or two longer to clear up, and the patients feel more or less weak for some time after all the symptoms have disappeared.

Tonsilitis is medically regarded as one of the mild diseases of childhood. It is, however, of very great importance because of its likeness to diphtheria, and inasmuch as a positive diagnosis must be promptly made, in the interest of the patient, it is given close attention and treated with considerable respect by the medical profession. The chief differences between the two diseases are as follows:

Tonsilitis begins abruptly with pronounced prostration and a high fever the first day. The patient feels distinctly sick all over. The second day the patient feels somewhat better, the fever is lower and the prostration and pain are not so marked. The third day he feels better still, and but for a little weakness would feel well. Diphtheria begins slowly and insidiously, with very little prostration and a very low fever the first day. The patient scarcely feels sick. The second day more prostration is present, the fever climbs upward a little more, and the patient begins to feel sick. On the third day the prostration is much more profound, the fever is higher, and all the evidences of a serious sickness are present. Two very different pictures: The one begins bad and ends easy, the other begins easy and may end bad.

The important fact, however, so far as the similarity of the two diseases is concerned, is, that we must make the diagnosis positive on the first or second day, because if we are dealing with a case of diphtheria we must give antitoxin at once. This is essential, because the efficacy of antitoxin is greatest when given early in the disease. By "early" we mean the first or second day of the disease. When antitoxin is given late (the third or fourth day of the disease) it is much less efficacious and must be given in relatively larger doses. The need, therefore, of a quick, positive diagnosis is a real one.

Another important element involved in a speedy diagnosis is, that we must not take any chances of infecting other children. So important are these conditions that it is the proper treatment to give antitoxin at once in every case of tonsilitis that in the slightest way resembles diphtheria. An examination of the throat contents,—a culture of which is taken during the first visit of the physician,—will, of course, reveal the true condition and dictate the future use of the antitoxin. Antitoxin is absolutely harmless when given to a patient who has no diphtheria. Every case of tonsilitis should be quarantined when there are other children in the house.

The local condition of the throat helps in the diagnosis: In tonsilitis (as the name implies) the disease