are cases in which death takes place not from the
severity of any local ailment, but from the intense depression of the
nervous system. There are other instances too, in which the case assumes
what is termed a malignant character; profuse discharge taking place
from the nostrils, swallowing being from the first exceedingly
difficult, membrane being deposited on the lips, behind the ears, or at
the edge of the bowel; death taking place in twenty-four or thirty-six
hours from the outset of the first serious symptoms, either in
convulsions, or from utter exhaustion.

But the very urgency of such cases must of necessity call for the
immediate assistance of the doctor; and my business throughout this book
is rather with those points which it is important for a mother to
notice, and those things which it behoves her to do.

What does diphtheria depend on? is a question more easily asked than
answered. The disease is contagious, as scarlatina is contagious, though
not to the same degree. I may add, it is not identical with scarlatina,
nor does the one disease protect from the other. It would, perhaps, be
too much to say that it is dependent on an unsanitary condition of a
town, a village, or a house, but there is no doubt but that, as is the
case with cholera, scarlet-fever, or typhus, unsanitary conditions
favour its spread, and increase its severity.

Being contagious, it is most important to keep cups, glasses, spoons,
towels, and bed-linen separate from those of other inmates of the house,
and to remove the patient from any room occupied by other children.
Great care too is to be observed, if anyone is standing over the child
during a fit of coughing, that none of the membrane which it spits up
enters the mouth; and, that if the child's breath is caught, the
attendant gargle immediately with a teaspoonful of Condy's fluid in a
tumbler of water.

In the next place, as the depression of the nervous system in some cases
of diphtheria is quite out of proportion to the local disease, and as
children who have not seemed very suffering, have yet been known to die
suddenly in an unexpected faint, it is of moment that the child remain
constantly in bed from the commencement of the attack till complete
convalescence. Nor, indeed, in serious cases is even this precaution
sufficient; but in such circumstances not only must the child not be
taken out of bed for any purpose, but it must even not be suddenly
raised in bed, from a re