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 is limited to the tonsils and on the
tonsils (one or both) do we find the spots or patches. In diphtheria, on
the other hand, the membrane is not limited to the tonsils, but may
cover every part of the throat and extend into the nose and mouth. In
tonsilitis it is spots or patches we see in the throat. In diphtheria it
is membrane we see always. The difficulty here again is that if we wait
till the diphtheritic membrane covers the whole throat, antitoxin will
not be of much use.

In diphtheria we have a characteristic odor, in tonsilitis we have no
charact