A Reference Hand-book For Nurses

GLOSSARY OF MATERIA MEDICA.

In the following Glossary will be found short definitions of many of the terms employed in the Dispensatory to designate the medical properties of the remedies; most of the words are commonly employed as nouns, and sometimes as adjectives.

• Absorbents.—Drugs used to produce absorption of exudates or diseased tissues.
• Abstergents.—Detergents (cleansing agents).
• Alteratives.—Medicines used to so modify nutrition as to overcome morbid processes.
• Analeptics.—Restorative medicines or food.
• Analgesics.—Medicines used to allay pain.
• Anaphrodisiacs.—Medicines used to allay sexual feeling.
• Anesthetics.—Medicines used to produce anesthesia or unconsciousness.
• Anodynes.—Medicines used to allay pain.
• Antacids.—Medicines used to neutralize acid in the stomach and intestines.
• Anthelmintics.—Medicines used to destroy intestinal worms.
• Antiarthritics.—Medicines used for the relief of gout.
• Antihydropics.—Medicines used for the relief of dropsy.
• Antilithics.—Medicines used for the relief of calculous affections.
• Antiperiodics.—Medicines used for the relief of malarial fevers.
• Antipyretics.—Medicines used for the reduction of bodily temperature in fevers.
• Antiseptics.—Substances which have the power of preventing putrefaction.
• Antispasmodics.—Medicines used for the relief of nervous
• irritability and minor spasms.
• Antisyphilitics.—Medicines used for the relief of syphilis.
• Antizymotics.—Substances which have the power of killing disease germs.
• Aperients.—Mild purgatives.
• Aphrodisiacs.—Substances used to increase sexual power or excitement.
• Aromatic Bitters.—Medicines which unite the properties of
• the aromatic and simple bitters.
• Aromatics.—Medicines characterized by a fragrant or spicy taste and odor,
• and stimulant to the gastro-intestinal mucous membrane.
• Astringents.—Medicines having the power of influencing vital
• contractility, thereby condensing tissues.
• Bitters, Simple.—Medicines which have a bitter taste andhave the power
• of stimulating the gastro-intestinal mucous membrane,
• without affecting the general system.
• Blisters.—Medicines which when locally applied cause inflammatory exudation
• of serum from the skin, and are used as revulsants.
• Calefacients.—Medicines used externally to cause a sense of warmth.
• Cardiac Depressants.—Medicines used to lower the heart’s action.
• Cardiac Stimulants.—Medicines used to increase the heart’s action.
• Carminatives.—Medicines containing a volatile oil used to excite intestinal
• peristalsis and provoke an expulsion of flatus.
• Cathartics.—Purgatives.
• Caustics.—Medicines used to destroy living tissues.
• Cholagogues.—Medicines which provoke a flow of bile.
• Constringents.—Astringents.
• Convulsants.—Medicines which cause convulsions.
• Correctives.—Medicines used to correct or render more pleasant
• the action of other remedies, especially purgatives.
• Corrigents.—Correctives.
• Demulcents.—Mucilaginous principles which are used in solution to
• soothe and protect irritated mucous membranes and other tissues.
• Deobstruents (obsolete and not very definite).—Medicines
• which overcome obstruction; aperients.
• Deodorants.—Substances which destroy or hide foul air.
• Depilatories.—Substances used to remove hair.
• Depressants.—Sedatives.
• Depressomotors.—Medicines which lessen motor activity.
• Depurants.—Medicines which act upon the emunctories so as
• to cause excretion and thereby purify the system.
• Detergents.—Medicines which cleanse wounds, ulcers, etc.
• Diaphoretics.—Medicines which produce sweating.
• Digestants.—Ferments and acids which have the power of
• aiding in the solution of food.
• Diluents.—Medicines which dilute secretions and excretions.
• Disinfectants.—Substances which have the power of destroying disease germs
• or the noxious properties of decaying organic matter.
• Diuretics.—Medicines which increase the secretion of urine.
• Drastics.—Purgatives which cause much irritation.
• Ecbolics.—Medicines which produce abortion.
• Eccoprotics or Ectoprotics.—Laxatives.
• Emetics.—Medicines which cause vomiting.
• Emmenagogues.—Medicines which stimulate menstruation.
• Emollients.—Substances used to mechanically soften and protect tissues.
• Epispatics.—Blisters.
• Errhines.—Medicines which increase the nasal secretions.
• Escharotics.—Caustics.
• Evacuants.—Medicines which evacuate; chiefly applied to purgatives.
• Excitants.—Stimulants.
• Excitomotors.—Medicines which increase motor activity.
• Expectorants.—Medicines which act upon the pulmonic mucous
• membrane and increase or alter its secretions.
• Febrifuges.—Medicines which dissipate fever.
• Galactagogues.—Medicines which increase the secretion of milk.
• Germicides.—Agents that destroy germs.
• Hemostatics.—Medicines which arrest hemorrhages.
• Hydragogues.—Purgatives which cause large watery discharges.
• Hypnotics.—Medicines which cause sleep.
• Laxatives.—Mild purgatives.
• Local Anesthetics.—Medicines which when applied locally destroy sensation.
• Mydriatics.—Medicines which cause mydriasis, or dilation of the pupil.
• Myotics.—Medicines which cause myosis, or contraction of the pupil.
• Narcotics.—Powerful anodyne hypnotics.
• Neurotics.—Medicines which act upon the nervous system.
• Nutriants.—Medicines which modify the nutritive processes.
• Nutrients.—Substances which nourish.
• Oxytocics.—Medicines which stimulate uterine contractions.
• Peristaltics.—Medicines which increase peristalsis.
• Prophylactics.—Medicines which prevent the taking or development of disease.
• Protectives.—Medicines which protect a part when applied to it.
• Ptyalagogues.—Sialagogues.
• Purgatives.—Medicines which produce copious discharges from the bowels.
• Refrigerants.—Medicines which lessen bodily temperature.
• Revulsants.—Medicines which by causing irritation draw nervous
• force and blood from a distant diseased part.
• Rubefacients.—Medicines which cause irritation and redness,
• and are used as revulsants.
• Sedatives.—Medicines which lower functional activity.
• Sialagogues.—Medicines which excite salivary glands to secretion.
• Somnifacients.—Soporifics.
• Soporifics.—Medicines which cause sleep.
• Sorbefacients.—Medicines which cause absorption.
• Specifics.—Medicines which have a direct curative influence
• on certain individual diseases.
• Stimulants.—Medicines which increase functional activity.
• Stomachics.—Stimulants to the stomach.
• Styptics.—Hemostatics.
• Sudorifics.—Medicines which produce sweating.
• Tenicides.—Medicines which kill the tapeworm.
• Tonics.—Medicines which permanently increase the systemic
• tone by stimulating nutrition.
• Vermicides.—Medicines which kill intestinal worms.
• Vermifuges.—Medicines which cause the expulsion of intestinal worms.
• Vesicatories.—Blisters.

ROMAN NUMERALS.

POPULAR AND OFFICIAL NAMES OF MEDICINAL PREPARATIONS.

WEIGHTS AND MEASURES. — TROY WEIGHT. — APOTHECARIES’ WEIGHT. — AVOIRDUPOIS WEIGHT. — DRY MEASURE. — LIQUID MEASURE. — TIME MEASURE. — CIRCULAR MEASURE. — LONG MEASURE. — CLOTH MEASURE. — MARINERS’ MEASURE. — MISCELLANEOUS. — SQUARE MEASURE. — NUMERICAL TABLE. — SIMPLE FRACTIONS. — METRIC SYSTEM. — METRIC MEASURES OF LENGTH DECREASING. — METRIC MEASURES OF LENGTH INCREASING. — APPROXIMATE EQUIVALENTS OF METRIC AND STANDARD MEASURES OF LENGTH. — METRIC WEIGHTS. — APPROXIMATE EQUIVALENTS OF METRIC AND APOTHECARIES’ WEIGHTS. — METRIC MEASURES OF CAPACITY. — APPROXIMATE EQUIVALENTS OF METRIC AND APOTHECARIES’ MEASURES OF CAPACITY. — APOTHECARIES OR TROY WEIGHT. — APOTHECARIES’ OR WINE MEASURE. — APPROXIMATE FLUID MEASURES.

TABLES FOR PERCENTAGE OF SOLUTIONS. — APOTHECARIES’ MEASURE. — METRIC MEASURE.

SOLUTIONS.

ACTION, USES, AND DOSES OF THE MOST IMPORTANT DRUGS.

Acetanilid.—This substance, a derivative of anilin, is used to lower temperature; to relieve headaches and neuralgic pains; and to allay spasm, as in chorea and whooping-cough.

Toxic doses cause lividity, cold sweats, ringing in the ears, and heart failure.

The dose is from 5 to 10 grains (0.3-0.6 gm.).

Arsenic.—Arsenic is used internally as a tonic in anemia, an alterative in chronic constitutional diseases, as a special remedy in chorea, and as an anti-malarial. Externally, it is occasionally used as a caustic.

Aconite.—This drug depresses the heart, slows the pulse, and lowers temperature. Externally, it causes numbness and anesthesia. Internally, it is employed chiefly as a heart sedative in hypertrophy of the heart, and as a febrifuge in acute febrile disease when the pulse is strong and rapid. Locally, it is sometimes employed in liniments in neuralgia and muscular rheumatism.

Aconite is a powerful poison, causing in overdoses tingling of the lips, tongue, and extremities, cold sweat, pallor, a feeble pulse, and collapse.

The dose of the tincture (Tinctura Aconiti) is from 1 to 5 minims (0.06-0.3 c.c.).

Alcohol.—In moderate cases alcohol stimulates the heart, favors digestion, and lessens tissue-waste. For these reasons it is a useful remedy in low fevers, like typhoid fever, diphtheria, and pneumonia. On account of its prompt action, it is a valuable circulatory stimulant in sudden heart failure. It has been recently recommended also as an antidote in carbolic-acid poisoning. Externally, it is used as a cleanser for the skin and as a stimulant application in the prevention of bed-sores.

Aloes.—This is cathartic and stimulant, and is given in chronic constipation, amenorrhea, and atonic dyspepsia. The laxative dose is from ½ to 2 grains; the purgative and emmenagogue dose is 2 to 5 grains.

Ammonia.—This is a gas employed medicinally in the form of a watery solution (water of ammonia) or an alcoholic solution (spirit of ammonia).

These preparations are used internally as heart stimulants, respiratory stimulants, gastric antacids, and externally as counterirritants. The dose of the Aromatic Spirit (Spiritus Ammoniæ Aromaticus) is from ½ to 1 dram (2-4 c.c.), well diluted. Large doses of ammonia preparations cause burning pain in the throat and abdomen, vomiting, purging, and collapse.

Antipyrin.—This drug has about the same action and uses as acetanilid, and may be given in the same dose.

Antitoxin of Diphtheria.—This is obtained from healthy horses which have been rendered artificially immune to diphtheria from having received a prolonged course of treatment with diphtheria toxin in doses gradually increased. The immunity is due to the formation in the blood of a substance which in some way counteracts the poison or toxin of the disease. This substance is known as the antitoxin. It exists in the serum of the blood, and so far has not been separated from it. The dose of the serum is measured in units, a unit being ten times the amount of antitoxin required to save the life of a guinea-pig which has been injected with 100 fatal doses of diphtheria toxin.

Antitoxin acts both as a curative and a preventive remedy. Since its introduction the mortality of diphtheria has been reduced more than one-half. The curative dose is from 2000 to 5000 units, to be repeated in from six to twelve hours, if necessary. The prophylactic dose is 500 units. The protection afforded is only temporary, lasting from two to three weeks.

The injections are sometimes followed by a rise of temperature, pain in the joints, or a cutaneous rash, but these symptoms are without serious significance.

Aspirin.—This is acetyl-salicylic acid and is used like sodium salicylate in rheumatism and pleurisy, and as an antipyretic and analgesic. Dose, 5 to 15 grains.

Atropin.—See Belladonna.

Belladonna.—This drug owes its activity to the alkaloid atropin. It is employed internally to stimulate the respiration; to stimulate the circulation; to allay local spasm, as in asthma and whooping-cough; to check excessive secretion, as in the night-sweats of phthisis; and to stimulate peristalsis in atonic constipation. Locally, it is employed in the form of solutions of atropin to dilate the pupil of the eye, and in the form of a liniment or plaster of belladonna as a sedative application in various inflammatory conditions. Toxic doses of belladonna cause dilatation of the pupils, dryness of the throat, quickening of the pulse and respiration, delirium, and a diffuse red rash resembling that of scarlatina.

The dose of atropin is from ¹/₁₅₀ to ¹/₅₀ grain (0.00043-0.0013 gm.); of the Tincture of Belladonna (Tinctura Belladonnæ), 5 to 20 minims (0.3-1.2 c.c.); of the Extract of Belladonna (Extractum Belladonnæ), ⅛ to ¼ grain (0.008-0.016 gm.).

Bismuth.—The insoluble preparations of the metal—subnitrate, subcarbonate, and subgallate—are used internally as mild antiseptics, sedatives, astringents, and antacids in various inflammatory diseases of the stomach and bowel. They are scarcely poisonous when taken internally in any amount. The usual dose of any one of the preparations named is from 5 to 30 grains (0.3-2 gm.) in dry powder or stirred in milk or water.

Bromids.—The salts of bromin in common use are the bromids of potassium, sodium, ammonium, and strontium. The action of these is very similar. They are especially useful as depressants to the central nervous system. They are employed to produce sleep, to check convulsions, and to relieve headache and neuralgic pain. Large doses depress the heart and respiration. The continued use of the bromids causes a condition known as bromism. This is characterized by fetor of the breath, a rash on the skin, languor, and somnolence. The dose of the bromin salts is from 10 to 60 grains (0.6-4 gm.).

Caffein.—This is an alkaloid obtained from coffee. It is a heart stimulant, respiratory stimulant, brain stimulant, and kidney stimulant (diuretic). The dose is from 1 to 5 grains (0.06-0.3 gm.).

Calomel.—See Mercury.

Carbolic Acid.—Externally, this acid is used in weak solutions (1 : 40 to 1 : 20) as an antiseptic, and in concentrated form as a caustic. Weak solutions are also employed to allay itching in skin diseases. Internally, carbolic acid is used as an antiseptic in dyspepsia and diarrhea. Applications of carbolic acid, even when dilute, should never be prolonged, as they are liable to cause gangrene. Poisoning by carbolic acid is characterized by white patches on the lips, the odor of the drug on the breath, burning pain in the abdomen, vomiting, purging, unconsciousness, and collapse. The dose is from ½ to 3 minims (0.03-0.2 c.c.).

Castor Oil.—This is an oil expressed from the seed of an East Indian plant. The seeds themselves are acrid poisons. It is a mild purgative, unloading the bowels very thoroughly in from four to six hours. It may be given in flexible capsules, in emulsion, or with equal parts of lemon-juice and glycerin. The dose is from ½ to 1 ounce (15-30 c.c.).

There are two simple methods of taking castor oil without producing nauseating effects. Have the patient wash out the mouth with water as hot as can be borne, then swallow the oil, and follow this by rinsing out the mouth well with hot water. The other method is to hold a piece of ice in the mouth long enough to chill the lining membrane, swallow the oil, and rinse the mouth with ice-water.

Chloral.—This substance is an active depressant of the brain and spinal cord. In large doses it also depresses the heart and respiration. It is employed to produce sleep and to check convulsions. The dose is from 10 to 30 grains (0.6-2 gm.) in some agreeable syrup.

Poisonous doses cause unconsciousness, embarrassed breathing, and collapse.

Chloralamid.—This is a comparatively safe and reliable hypnotic, producing sleep without causing much depression of the heart or disagreeable after-effects. The dose is from 10 to 30 grains (0.6-2 gm.), well diluted. Hot liquids decompose it.

Chloroform.—This substance is employed by inhalation as a general anesthetic, by the mouth as a sedative in colic, neuralgia of the stomach, and obstinate cough, and externally in the form of liniment as a counterirritant in muscular rheumatism, sprains, etc. As a general anesthetic it is more powerful than ether, more readily inhaled, but not so safe. Death from chloroform is usually the result of heart failure. The dose of Spirit of Chloroform (Spiritus Chloroformi) is from 5 to 30 minims (0.3-2 c.c.); of Chloroform-water (Aqua Chloroformi), 1 to 8 drams (4-30 c.c.).

Cinchona (Peruvian Bark).—This is the bark of an evergreen tree growing in the tropics. It owes its medicinal properties to quinin and cinchonin, especially the former. It is used as a general tonic, as a stomachic, as a febrifuge, and as an anti-malarial. Large doses cause ringing in the ears, headache, deafness, dimness of vision, convulsions, and coma. The dose of quinin and its salts is from 1 to 30 grains (0.06-2 gm.); of cinchonin, 1 to 30 grains (0.06-2 gm.); of the Compound Tincture of Cinchona (Huxham’s Tincture), 1 to 4 drams (4-15 c.c.).

Cocain.—This is the alkaloid of a shrub (coca) growing in South America. Applied to mucous membranes or raw surfaces, or injected under the skin, it blanches the part and produces anesthesia. Applied directly to the skin, however, it is without effect, as it is not absorbed from the unbroken skin. Internally, it is sometimes employed to stimulate the heart, to stimulate the respiration, and to allay vomiting. Its repeated use, even as a local remedy, is dangerous, in that it is prone to cause a habit, the symptoms of which are mental failure, loss of flesh and strength, anemia, and intense craving for the drug. The symptoms of acute cocain-poisoning are excitement, delirium, a rapid pulse, hurried breathing, convulsions, and coma. The dose of cocain is from ⅛ to ½ grain (0.008-0.03 gm.). As an anesthetic it is usually employed in from 2 to 4 per cent. solutions.

A 2½-grain tablet of cocain, dissolved in a teaspoonful of water, makes a 2 per cent. solution; a 4½-grain tablet, in the same amount of water makes a 4 per cent. solution; a 10½-grain tablet in a like amount furnishes a 10 per cent. solution. These percentages are not mathematically correct, but are sufficiently exact for any surgical purposes.

Cod-liver Oil.—This is more of a food than a medicine. It is preferable to other oils in being more readily digested. When well borne by the stomach, it is a valuable remedy in wasting diseases, especially phthisis. The dose is from 1 to 4 drams (4-15 c.c.). It may be given in emulsion, in flexible capsules, or pure, dropped in the froth of porter. It is best taken two hours after meals.

Creasote.—This is an oily substance obtained from the slow burning of beechwood. It is chiefly used internally as an antiseptic in dyspepsia and diarrhea, and as an expectorant in purulent bronchitis and phthisis. Large doses produce the same toxic effects as are observed in carbolic-acid poisoning. The dose is from 2 to 20 minims (0.1-1.2 c.c.) in capsules, in milk, or in some bitter tincture, like that of gentian. The dose of creasote carbonate (creosotal), which is free from the unpleasant odor and taste of pure creasote, is from 5 to 20 minims (0.3-1.2 c.c.).

Croton Oil (Oleum Tiglii).—This is an oil expressed from the seed of a small tree growing in Asia. Locally it is an active vesicant; internally it is a powerful purgative. Large doses cause severe inflammation of the stomach and bowels. The dose is from 1 to 2 drops (0.06-0.12 c.c.) in glycerin, olive oil, or bread-crumbs. A bland vehicle is necessary to prevent the vesicating effect of the drug on the throat. Diluted with from 2 to 4 parts of olive oil, and applied with friction, it is sometimes used as a counterirritant in inflammatory diseases of the chest.

Digitalis.—This is a powerful circulatory stimulant, strengthening the contractions of the heart, constricting the peripheral blood-vessels, and slowing the pulse. By increasing the blood-pressure in the kidneys it also increases the flow of urine. It is chiefly used as a stimulant in heart disease when there is failure of circulation, and as a diuretic in various forms of dropsy. The effects of the drug should be carefully watched; too large doses cause marked slowing and irregularity of the pulse, and a decrease rather than an increase in the urine. The dose of powdered digitalis leaves is from ½ to 2 grains (0.03-0.13 gm.); of the Tincture (Tinctura Digitalis), 5 to 20 minims (0.3-1.2 c.c.); of the infusion (infusum digitalis), 1 to 4 drams (4-15 c.c.); of digitalin, an important principle of the leaves, ¹/₁₀₀ to ¹/₆₀ grain (0.00065-0.001 gm.).

Ergot.—This is a fungus growing on rye. It is employed to contract the blood-vessels in internal hemorrhage and to stimulate the uterine contractions in the second stage of labor when post-partum hemorrhage is feared. Its use in the early stage of labor to hasten delivery is dangerous, since it may cause tetanic spasm of the uterus and asphyxiation of the child or even rupture of the uterus.

The dose of the Extract of Ergot (Extractum Ergotæ) is from 1 to 15 grains (0.065-1 gm.); of the Fluid Extract (Extractum Ergotæ Fluidum), ½ to 1 dram (2-4 c.c.); of the Wine (Vinum Ergotæ), 1 to 4 drams (4-15 c.c.); of ergotin, a concentrated extract, 2 to 5 grains (0.13-0.3 gm.). When given hypodermically abscess is likely to form, even under the most strict antiseptic precautions.

Ether.—Next to nitrous oxid, this is the safest of the general anesthetics, although it is not so readily inhaled as chloroform, and is more apt to produce unpleasant after-effects, such as nausea and vomiting. The latter may sometimes be relieved by the inhalation of hot vinegar fumes.

Death from ether is usually the result of asphyxia, and not, as in the case of chloroform, from heart failure. Internally, by the mouth or hypodermically, ether is sometimes used as a circulatory stimulant in sudden heart failure. Great care should be exercised in handling ether in the neighborhood of lighted gas-jets, as the vapor of the drug is highly inflammable. Ether should be stored in well-stoppered containers, in a cool place, remote from lights and fire.

The dose of ether as a circulatory stimulant is from 5 to 30 minims (0.3-2 c.c.) in ice-water or hypodermically.

Formaldehyd.—This gas is employed in the form of a 40 per cent. solution (formalin). It is used as an antiseptic, disinfectant, and deodorant. It is the best disinfectant for sick-rooms that we possess, although on account of its lack of penetrating power it can not be used for disinfecting bedding, stuffed furniture, carpets, books, etc. To be effective the gas must be generated from formalin in a special apparatus, or from paraform tablets heated over a suitable lamp. Attempts to vaporize solution of formaldehyd from an open vessel placed on a stove are unsuccessful, since this treatment converts most of the formaldehyd gas into crystals of paraform. Solutions of formalin—1 : 2000 to 1 : 500—are sometimes used for irrigating suppurating cavities and disinfecting instruments. A solution of 1 part of formalin to 20 parts of water makes a good disinfectant for stools, urine, and sputa.

Iodids.—The salts of iodin—potassium, sodium, ammonium iodid—resemble each other in their action and uses. They are used as alteratives in constitutional diseases, like chronic rheumatism and gout, as absorbents of exudates in chronic inflammatory diseases, and as eliminants in chronic mineral poisoning. Their continued use occasions a group of symptoms—frontal headache, nasal discharge, sore throat, and a cutaneous eruption—termed iodism. The dose is from 5 to 30 grains (0.3-2 gm.), well diluted, after meals.

Iodoform.—This drug owes its virtues to iodin, of which it contains about 50 per cent. When brought into contact with raw surfaces it exerts a mild anesthetic effect, liberates its iodin, and thereby acts as an antiseptic. When applied too freely it may be absorbed and cause toxic effects—headache, elevation of temperature, restlessness, a diffuse red rash on the face and limbs, delirium, stupor, and collapse. The unpleasant odor of the drug can be removed from the hands and from instruments by oil of turpentine.

Ipecac.—This drug is used as an emetic and expectorant. As an emetic it is safe, but somewhat slow in action. It is especially useful in the young and feeble, as it causes but little depression.

The dose of powdered ipecac, as an emetic, is from 20 to 30 grains (1.2-2 gm.); of the Syrup (Syrupus Ipecacuanhæ), as an expectorant, from 10-60 minims (0.6-4 c.c.); as an emetic, from 2 to 4 drams (8-15 c.c.); of the wine, as an expectorant, from 10 to 30 minims (0.6-1.8 c.c.); as an emetic, 1 dram (4 c.c.).

Iron. (Ferrum).—The various preparations of iron are employed as tonics and astringents. As tonics, they are especially indicated in simple anemia; as astringents they are employed locally in bleeding, and, internally, in diarrhea.

The dose of Reduced Iron (Ferrum Reductum) is from 1 to 5 grains (0.06-0.3 gm.); of the Pills of Iron Carbonate or Blaud’s Pills (Pilulæ Ferri Carbonatis), 1 to 3 pills; of the Tincture of Ferric Chlorid (Tinctura Ferri Chloridi), 5 to 10 minims (0.3-0.6 c.c.); of the Solution of Iron and Ammonium Acetate or Basham’s Mixture (Liquor Ferri et Ammonii Acetatis), 1 to 4 drams (4-15 c.c.); of the Sulphate of Iron (Ferri Sulphas), 1-3 grains (0.06-0.2 gm.); of the Syrup of Iodid of Iron (Syrupus Ferri Iodidi), 5 to 60 minims (0.3-4 c.c.). The Solution of Iron Subsulphate (Monsel’s solution) is used only as a hemostatic, and Iron Hydrate with Magnesia as an antidote in arsenic-poisoning. The dose of the latter is a tablespoonful every ten to fifteen minutes.

Lead.—The preparations of lead are used internally and externally as sedatives and astringents. Lead Acetate (Plumbi Acetas) is employed internally in diarrhea. The dose is from 1 to 3 grains (0.06-0.2 gm.), in pill form.

Magnesium Sulphate (Epsom Salt).—This salt is an excellent hydragogue cathartic, producing in the course of a few hours copious watery stools. It is also employed as an antidote in acute lead-poisoning and carbolic-acid poisoning.

To secure the most prompt and powerful cathartic effect the drug is best given before breakfast, in a single dose, and with but a small quantity of water. Dose, from 1 to 8 drams (4-31 gm.).

Magnesium Oxid (Magnesia).—This is a white, tasteless, and insoluble powder. It is a cathartic, but much milder in action than Epsom salt. Dose, from 10 to 60 grains (0.6-4 gm.).

Magnesium Citrate.—An effervescing solution of this drug is much used as an agreeable laxative. The dose is from 6 to 12 ounces (180-360 c.c.).

Mercury.—The most important preparations of this metal are calomel, blue mass, corrosive sublimate, oxid of mercury, iodid of mercury, nitrate of mercury, and ointment of mercury.

Nitroglycerin.—This drug is a depressant to the central nervous system, a heart stimulant, and a dilator of the peripheral blood-vessels. It is useful in certain local spasms (asthma), in heart failure, and in neuralgia of the heart. Owing to its action in dilating the vessels, it sometimes causes, even in small doses, headache, dizziness, and flushing of the face.

The dose of nitroglycerin is from ¹/₂₀₀ to ¹/₅₀ of a grain (0.0003-0.0013 gm.). The dose of the 1 per cent. alcoholic solution (Spiritus Glonoini) is from 1 to 5 minims (0.06-0.3 c.c.). The latter should be kept in well-stoppered bottles, in a cool place, remote from lights or fire.

Nux Vomica.—This is the seed of an East Indian tree. Its activity depends upon an alkaloid strychnin. It is a general stimulant, acting especially upon the spinal cord, respiratory center, heart, stomach, and intestine. It is employed in a great variety of affections in which there is deficient functional activity.

The limit of tolerance is indicated by restlessness, stiffness of the neck muscles, and jerking of the limbs. Toxic doses cause violent spasms closely resembling those of lock-jaw or tetanus. The convulsions of strychnin-poisoning, however, come and go, the muscles being completely relaxed in the intervals, and, moreover, they rarely involve the muscles of the jaw.

The dose of the Tincture of Nux Vomica (Tinctura Nucis Vomicæ) is from 5 to 20 minims (0.3-1.2 c.c.); of the Extract of Nux Vomica (Extractum Nucis Vomicæ), ⅙ to ¼ grain (0.01-0.016 gm.); of Strychnin Sulphate (Strychninæ Sulphas), ¹/₆₀ to ¹/₂₀ of a grain (0.001-0.003 gm.).

Opium.—This is the dried juice of a species of poppy growing in Asia. It contains several alkaloids, the chief of which are morphin and codein. From morphin are prepared artificially two alkaloids—apomorphin and heroin.

Paraldehyd.—This is an oily liquid, having a peculiar unpleasant odor and taste. It is used chiefly as a hypnotic. While comparatively safe and reliable, its disagreeable taste and persistent odor on the breath detract from its usefulness. The dose is from ½ to 1 dram (2-4 c.c.), in some pleasant vehicle.

Phenacetin.—This anilin derivative has properties very similar to those of acetanilid, and is used for the same purposes. Dose, 5 to 10 grains (0.3-0.6 gm.).

Physostigma.—This is the seed of a climbing plant growing in Africa. Its activities depend upon an alkaloid known as eserin or physostigmin. It depresses the spinal cord, stimulates the peristaltic movements of the bowel, and, when applied to the eye, contracts the pupil. It is employed to check certain convulsions (tetanus and strychnin-poisoning), to overcome atonic constipation, and, locally, to contract the pupils.

The dose of the Tincture of Physostigma (Tinctura Physostigmatis) is from 5 to 20 minims (0.3-1.2 c.c.); of the Extract of Physostigmatis (Extractum Physostigmatis), ¹/₁₂ to ⅙ of a grain (0.005-0.01 gm.); of eserin or physostigmin and its salts, ¹/₁₅₀ to ¹/₅₀ of a grain (0.0004-0.0013 gm.).

Pilocarpus, or Jaborandi.—This is the leaves of a South American plant. Its virtues depend entirely upon an alkaloid known as pilocarpin. The chief action of the drug is on the secretions—sweat, saliva, and urine—which it markedly increases. Large doses depress the circulation. Locally, in the eye, it contracts the pupil like eserin. It is mainly employed internally as a diaphoretic in Bright’s disease and dropsical conditions. The dose of the Fluid Extract (Extractum Pilocarpi Fluidum) is from 20 to 60 minims (1.5-4 c.c.); of pilocarpin and its salts, ⅛ to ½ grain (0.008-0.03 gm.). The latter are usually administered hypodermically.

Quinin.—See Cinchona.

Salicylates.—These salts are employed in medicine chiefly as antirheumatic remedies. Their manner of action, however, is unknown. They are also used, both internally and externally, to some extent as antiseptics. Large doses cause ringing in the ears, headache, deafness, nausea, and a greenish discoloration of the urine.

The dose of salicylic acid or its salts (ammonium, sodium, strontium) is from 5 to 20 grains (0.3-1.3 gm.); of Oil of Gaultheria (Methyl Salicylate), 5 to 20 minims (0.3-1.2 c.c.). These preparations should be given after meals, well diluted.

The following remedies have properties like the salicylates, but are less powerful and less irritant to the stomach: Salol, dose, 5 to 20 grains (0.3-1.3 gm.); salophen, 5 to 30 grains (0.3-2 gm.); aspirin, 5 to 20 grains (0.3-1.3 gm.).

Senna.—This is a purgative cholagogue and is used in the constipation of children and pregnant women. Dose, in substance, 5 to 20 grains; in fluidextract or tincture, 1 to 4 fluidrams.

Silver.—The most important salt of this metal is the nitrate. Locally, in concentrated form, the latter is a caustic; in dilute form it is a sedative, astringent, and antiseptic. Internally, in small doses, silver nitrate is useful as an astringent and antiseptic in inflammatory and ulcerative conditions of the stomach and bowel.

The prolonged use of the drug, even in small doses, is followed by a permanent grayish discoloration of the skin (argyria) from the precipitation of the metal in the tissues.

Toxic doses of silver nitrate cause burning pain in the abdomen, vomiting of white, curdy matter, and bloody purging.

The dose of silver nitrate is from ⅙ to ½ of a grain (0.01-0.3 gm.), usually in pill form.

Several combinations of metallic silver with albumin are much used as antiseptics and astringents in inflammatory diseases of mucous membranes. They have advantage over silver nitrate in being less irritating and in not being decomposed by the juices of the tissues. The most important of these organic compounds are protargol and argyrol. They are usually applied in solutions of from 1 to 10 per cent. A soluble form of metallic silver is also employed in the form of 15 per cent. ointment, known as Credé’s ointment. It is recommended as an antiseptic in various infectious diseases.

Spartein.—This is an alkaloid from the broom plant. It is used to some extent as a heart tonic and diuretic in doses of from ¼ to ½ grain (0.015-0.03 gm.).

Strophanthus.—This is the seed of a climbing plant growing in Africa. Its action very closely resembles that of digitalis, for which it is sometimes substituted. The dose of the tincture (Tinctura Strophanthi) is from 3 to 10 minims (0.2-0.6 c.c.).

Sulphonal.—This artificial compound is used almost entirely as a hypnotic. In single doses it is comparatively safe and reliable, but slow in its action. Languor, headache, and drowsiness not infrequently follow its use. The repeated administration of sulphonal over several days or weeks is distinctly dangerous, being often followed by chronic poisoning. The latter is marked by a red coloration of the urine, colicky pains, profound depression, weakness, and collapse.

The dose of sulphonal is from 10 to 30 grains (0.6-2 gm.). It is best given in hot tea or hot milk, one or two hours before bedtime.

Tannic Acid, Tannin.—This is employed externally as an astringent and styptic, and internally as an astringent in atonic diarrheas. It is used in the form of a gargle or in troches in relaxed conditions of the throat, in solution to prevent bed-sores, and in the form of ointment or suppositories for the relief of internal piles. Dose, 1 to 10 grains.

Trional.—This remedy resembles sulphonal in action, and is used for the same purpose. It may also be given in the same dose and manner as sulphonal.

Urotropin.—This compound, prepared by the action of ammonia on formaldehyd, is employed as a powerful urinary antiseptic in doses of from 3 to 5 grains (0.2-0.3 gm.). Large doses may cause pain in the bladder, frequent urination, and bloody urine.

Veratrum Viride.—This is the root of a North American herb. Its action resembles that of aconite in that it depresses the heart and slows the pulse. It is, however, more nauseating than aconite, and when locally applied does not cause numbness, tingling, and anesthesia. Large doses cause vomiting, muscular weakness, dizziness, sweating, failure of pulse, and collapse. It is used as a sedative in acute inflammatory diseases to subdue overaction of the heart.

The dose of the tincture of veratrum viride (tinctura veratri viridis) is from 1 to 5 minims (0.06-0.3 c.c.).

DOSAGE.

The following general rules will aid the student in remembering the safe dose of many important preparations:

1. Tinctures of very active drugs, such as opium, digitalis, belladonna, physostigma, nux vomica, gelsemium, arnica, and capsicum may be given in doses of from 5 to 20 minims (0.3-1.2 c.c.), except the tinctures of aconite, veratrum viride, iodin, and cantharides, the dose of which is from 1 to 5 minims (0.06-0.3 c.c.).

2. Tincture of less active drugs, such as gentian, calumba, krameria, quassia, valerian, cinchona, kino, may be given in doses of from ½ to 1 dram (2-4 c.c.).

3. Solid extracts of active drugs may be given in doses of from ⅙ to ¼ of a grain (0.01-0.016 gm.).

4. Solid extracts of less active drugs may be given in doses of from ½ to 5 grains (0.03-0.3 gm.) or more.

5. Dilute acids (hydrochloric, nitric, nitrohydrochloric, sulphuric) may be given in doses of from 5 to 20 minims (0.3-1.3 c.c.), except dilute hydrocyanic acid, the dose of which is from 1 to 5 minims (0.06-0.3 c.c.).

6. All medicated syrups, except the syrup of iodid of iron and the compound syrup of squill, may be given in doses of 1 to 2 drams (4-8 c.c.) or more.

7. All infusions may be given in doses of ½ to 1 ounce (15-30 c.c.) or more, except the infusion of digitalis, the dose of which is from 1 to 4 drams (4-15 c.c.).

8. All official mixtures may be given in doses of from 1 to 4 drams (4-15 c.c.).

9. All spirits may be given in doses up to 1 dram (4 c.c.), except the spirit of nitroglycerin (glonoin), the dose of which is from 1 to 5 minims (0.06-0.3 c.c.), the spirit of phosphorus, the dose of which is from 5 to 15 minims (0.3-1 c.c.), and the spirit of bitter almond, the dose of which is from 5 to 10 minims (0.3-0.6 c.c.).

10. All waters (aquæ) may be given in doses up to 1 ounce (30 c.c.), except aqua ammoniæ, aqua chlori, and aqua laurocerasi (cherry-laurel), the dose of which is about ½ dram (2 c.c.).

11. Volatile or essential oils may be given in doses up to 5 minims (0.3 c.c.) or more, except the oil of bitter almond, the dose of which is from ¼ to ½ minim (0.015-0.03 c.c.).

TO ASCERTAIN DOSES OF MEDICINE
FOR CHILDREN.

The following rule of Young is sufficiently accurate for most drugs: Add 12 to the age and divide by the age to get the denominator of the fraction, the numerator of which is 1. Thus, for a child of two years,

For children up to twelve months of age, Young’s rule may be worked out as follows: Add 144 to the age in months, which sum becomes the denominator of the fraction, the numerator of which is the child’s age. Thus, for a baby of eight months,

for a baby of six months,

The following table, based on Young’s rule, is sufficiently accurate in ordinary cases, and its use will avoid the necessity of mathematic calculations on the part of the physician:

Of powerful narcotics, such as opium, scarcely more than one-half of this proportion should be used. In the case of mild cathartics, however, two or even three times this proportion may be given.

THE DOSE OF DRUGS ADMINISTERED
SUBCUTANEOUSLY AND BY THE RECTUM.

The dose of a drug given hypodermically is usually about one-half the quantity given by the mouth, while twice as large a dose is generally given by the rectum as would be given by the mouth.

PROPER TIME TO TAKE MEDICINES.

Alkalis should be given before food. Iodin and iodids should be given on an empty stomach, when they rapidly diffuse into the blood. If given during digestion the acids and starch alter and weaken the digestion. Acids, as a rule, should be given between the digestive acts, because the mucous membrane of the stomach is in a favorable condition for the diffusion of the acids into the blood. Acids may be given before food when prescribed to check the excessive formation of the acids of the gastric juice. By giving it before meals you check the osmosis stomachward of the acid-forming materials. Irritating and dangerous drugs should be given directly after food, such as the salts of arsenic, copper, zinc, and iron, except where local conditions require their administration in small doses before food. Oxid and nitrate of silver should be given after process of digestion is ended; if given during food, chemic reactions destroy or impair their special attributes and defeat the object for which they were prescribed. Metallic salts, especially corrosive sublimate, also tannin and pure alcohol, impair the digestive power of the active principle of the gastric juice, so should appear in the stomach during its period of inactivity. Malt extracts, cod-liver oil, phosphates, etc., should be given with or directly after food, so that they may enter the blood with the products of digestion.

POISONS AND ANTIDOTES. — ANTIDOTES.

General Treatment.—Eliminate if possible by emetics, as zinc sulphate, 10 to 20 grains; copper sulphate, 5 grains; or hypodermic injection of apomorphin, ⅒ grain. Use stomach-pump or -tube where vomiting cannot be produced, observing great care if irritant poison has caused injury to tissues. In cardiac failure give stimulants. In narcosis keep patient awake. In threatened paralysis of respiratory movements use alternate hot and cold spray to chest, slapping, and artificial respiration. Ammonia, atropin, caffein, and strychnin are useful respiratory stimulants.

MISCELLANEOUS FORMULÆ. — SEMMOLA’S MIXTURE. — NORMAL SALT SOLUTION. — CARBOLIC ACID SOLUTION (5 PER CENT.). — 1: 20 SOLUTION GLYCERIN FORMALDEHYD. — SOLUTION (1: 1000) OF BICHLORID OF MERCURY (CORROSIVE SUBLIMATE). — ALKALINE SOLUTION OF CYANID OF MERCURY. — SATURATED BORIC OR BORACIC-ACID SOLUTION. — SOLUTION OF POTASSIUM PERMANGANATE. — IODIN SOLUTION. — SOLUTIONS OF FORMALDEHYD. — THIERSCH’S ANTISEPTIC SOLUTION. — HARRINGTON’S SOLUTION. — PICRIC ACID SOLUTION FOR BURNS. — CHLORID OF LIME SOLUTION. — SOLUTION FOR SORE NIPPLES. — NIPPLE OINTMENT. — ARISTOL OINTMENT FOR CRACKED NIPPLES. — SOOTHING LOTIONS FOR THE HANDS. — AN INUNCTION FOR THE HANDS WHEN THE SKIN IS DRY AND HARSH. — LASSAR’S PASTE FOR ECZEMATOUS SORES AND ULCERS. — UNNA’S PASTE. — CARRON OIL FOR BURNS. — BORATED VASELIN. — CARBOLATED VASELIN. — BORATED GLYCERIN. — FORTIFIED OIL. — SANITAS JELLY. — SALOL VASELIN FOR BURNS. — SWEATING OF THE FEET AND AXILLA. — ENEMAS FOR FLATULENCE. — GLYCERIN ENEMA. — OX-GALL ENEMA. — COMPOUND OX-GALL ENEMA. — SALINE ENEMA. — 1-2-3 ENEMA. — COMBINATION ENEMA. — STARCH-WATER ENEMA. — STIMULATING ENEMAS. — NOURISHING ENEMAS. — THE METHOD OF ADMINISTERING NUTRITIVE OR STIMULATING ENEMAS. — AMOUNTS TO BE GIVEN IN CLEANSING ENEMAS. — TEMPERATURE OF ENEMA FLUIDS. — MUSTARD PLASTER. — MUSTARD POULTICE. — FLAXSEED POULTICE. — ONION POULTICE. — TURPENTINE STUPES. — SPICE POULTICE. — CANTHARIDES BLISTER. — APPLICATIONS FOR PEDICULOSIS (LICE). — HAIR TONICS. — FOR MATTED HAIR.

Stock salt solution is kept for the purpose of making normal salt solution quickly and accurately. Use sodium chlorid (common salt) dried sufficiently to granulate.

Stock Salt Solution by Weight.

Normal salt solution should contain 90 grains of salt in 1 quart (1 L.) of water.

Normal Salt Solution.

Salt Solution.

The salt in this formula is added to prevent decomposition of the mercurial salt by the albuminous juices of the tissues.

Some surgeons recommend cyanid of mercury in solutions of 1: 1000 or 1: 2000 in place of the bichlorid of mercury. It is a powerful antiseptic that does not coagulate albumin, irritate the tissues, or attack metals.

Compressed tablets, each containing 7½ grains (0.48 gm.) of corrosive sublimate with tartaric acid, are also in common use. One of these added to 1 pint of water makes a solution of 1: 1000.

This solution may also be made by putting an excess of the crystals into the water, then sterilizing by boiling twenty minutes and straining through sterile cotton.

This substance is used in a solution of royal blue or purple color, which should be freshly made. Place a few crystals in a piece of sterile gauze, and suspend in sterile water of the required quantity and temperature until the right color is obtained.

This solution is made by adding to sterile water of the required temperature sufficient tincture of iodin to make the color of sherry wine. Add the iodin a few drops at a time, stirring until the sherry color is produced.

All the preparations on the market (formalin, formol, formolose, etc.) contain 40 per cent. of formaldehyd gas.

As the gas is the true germicidal principle, it is much the better plan, in stating the strength of dilute solutions of these preparations, to give the proportion of the gas present, and this is done in the formulæ below.

1 : 100 or 1 per cent. of True Formaldehyd Gas.

1 : 500 or ⅕ per cent. Solution of Formaldehyd.

Mix the salicylic acid with sufficient alcohol to dissolve it. Pour mixture into solution, and shake thoroughly.

1. Spirits camphor,		āā f℥j (30 c.c.);
Glycerin,
Tr. benzoin,
Alcohol (95 per cent.),		f℥v (150 c.c.).
2. Alcohol (95 per cent.)		āā f℥j (30 c.c.);
Glycerin,
Tr. benzoin,
Distilled extract of hamamelis		f℥ij (60 c.c.).
(witch-hazel),
3. Alcohol,		f℥ij (60 c.c.);
Glycerin,		f℥ij (60 c.c.);
Lemon juice,		f℥ss (15 c.c.);
Tr. myrrh,		f℥ss (15 c.c.).
4. Water,		Oj (500 c.c.);
Boric acid crystals,		ʒiij (12 gr.);
Gum tragacanth,		ʒij (8 gr.).
Allow mixture to stand 8 hours, then dissolve by boiling;
strain through cotton.
While stirring briskly add:
Alcohol (95 per cent.),		Oss (250 c.c.);
Glycerin,		Oss (250 c.c.);
Attar of roses,		ʒij (ad lib.).
Color with chlorophyl if desired.
5. Glycerin,		āā
Whisky,
Peroxid,

Dissolve gelatin in water and glycerin.
  Heat in a double boiler and stir in zinc oxid.

Lime-water,		Of each, equal parts.
Raw linseed oil,

Follow by 1 pint of warm water within five minutes to secure better result and to relieve fermentation that follows the injection.

Mix with sufficient cold water to make a thick paste; pour on boiling water until it becomes of the consistence of mucilage. From 10 to 30 minims (0.6-2 c.c.) of laudanum are often added to this enema.

Prepare the fluid and heat to between 100°-110° F. Pour the mixture into an enema pail or douche bag. To the tubing attach a large rubber catheter or small rectal tube by means of a glass nozzle. Place the patient on the left side with the knees flexed. Permit the fluid to flow through the tube to expel the air and then make pressure close to the point until ready to introduce it. Lubricate the catheter with vaselin or oil and insert gently eight or nine inches. Do not slip the catheter forward or backward unless absolutely necessary to encourage the fluid to flow, for it only increases the peristalsis and induces the patient to expel the contents which should be retained. Press the tube sufficiently to allow the solution to run very slowly, and occasionally make intermittent stoppage until it has all been given. Upon withdrawing the tube make digital pressure with a soft cloth against the anus for a minute or two. The use of an enema pail in place of a funnel insures more favorable results. Moreover, it is an easier and cleaner method and gives the advantage of having only the tube to take care of.

Slice a large onion and fry in lard or olive oil.

Place between layers of soft cloth. It should not be warmed over.

>Powdered cloves; powdered ginger; powdered cinnamon, of each from 1 to 2 teaspoonfuls; flour, a tablespoonful; whisky, enough to make a paste sufficiently soft to spread on flannel.

Use white vaselin freely each day. Untangle the ends and work gradually toward the scalp.

THERMOMETRY. — RULES FOR CONVERTING ONE SCALE INTO THE OTHER. — TABLE OF THERMOMETRIC EQUIVALENTS. — TO CONVERT THERMOMETER READINGS. — RULES OF TAKING TEMPERATURE. — TEMPERATURE OF WATER. — PULSE RATE. — RESPIRATIONS.

In the Fahrenheit scale there are 180 degrees between the melting-point of ice and the boiling-point of water. In the Centigrade scale there are 100 degrees between the freezing and boiling point of water.

URINE ANALYSIS. — TO TEST REACTION. — A SIMPLE AND RAPID TEST FOR ALBUMIN. — TO OBTAIN A 24-HOUR SPECIMEN OF URINE.

Normal urine is a clear, watery fluid, with an acid reaction and a specific gravity of from 1018 to 1020. It is composed of inorganic salts, organic constituents, together with some coloring and a small amount of mucus.

The most important of these inorganic salts are chlorid of sodium, phosphate of potassium, and the sulphates of calcium and magnesium. The inorganic constituents are chiefly urea, uric acid, and poisonous inorganic substances found in the body. The normal amount of urine voided by an adult weighing 160 pounds is from 40 to 70 ounces in twenty-four hours. The amount may be increased by drinking large quantities of fluid, especially water, and diminished by perspiration, emotion, and copious bowel movements.

Normal urine is aromatic. In health it may be faintly alkaline at certain times of the day. Urine passed in the morning has an acid reaction, a high specific gravity, and a dark color. After a hearty meal it may be turbid—perhaps alkaline, and of low specific gravity. Large quantities are pale, and vary with concentration. When just passed it is clear; then it collects a cloudy material made up of mucous corpuscles, which can be easily shaken up. Concentrated urine, when it cools, deposits a pinkish (brick-dust) precipitate. Gentle heat clears it up. When highly concentrated the crystals are red. When they collect and adhere together they become stones; if all precipitate on heating it is normal urine.

Alkaline urine throws down phosphates that are held in solution and clears up on addition of any acid; if urine is cold and acid in reaction, sediment, if present, may be urates, but is not phosphates; if urine is alkaline, they are normal phosphates.

Litmus-paper is used. Acid changes the blue to red. Alkaline changes red to blue. When urine does not affect litmus-paper it is said to be neutral.

Pus in urine is turbid or milky in appearance; after standing a while it settles down.

Albumin in urine is held in solution, and therefore cannot be seen.

Fill an ordinary test-tube half full of urine, and add a half dram or more of potassium ferrocyanid solution (1 to 20). After thoroughly mingling the urine and the reagent, add a few drops of acetic acid (50 per cent.); then pause for a half minute and note the change. If albumin be present it will come plainly into view within half a minute to a minute, in the form of white, milk-like opacity, diffused throughout the whole contents of the tube. The above method precipitates all modifications of albumin. On the other hand, it gives no reaction with phosphates, peptones, mucin, the alkaloids, urates, or the pure acids. The reaction that sometimes occurs on long standing between the acid and potassium ferrocyanid should not be mistaken for albumin. The albuminous reaction appears within half a minute or so, while the other occurs only after ten minutes to half an hour, and is mingled with more or less blue coloration.

Begin early in the morning. Throw away the first urination. Save all further urinations for the next twenty-four hours. For instance: Patient urinates at 6 a.m. This first urination is thrown away, or saved for an a.m. specimen if required and patient’s bladder is empty. Save all succeeding urinations for the next twenty-four hours, at the end of which time (6 a.m.) request the patient to urinate, and save the last urination also, to complete the specimen. This gives us twenty-four hours’ secretion.

The addition of solution of formaldehyd (fʒij) to a twenty-four hour specimen of urine will preserve it, and prevent fermentation before the analysis is made.

INFANT FEEDING. — CONSTITUENTS OF GOOD MOTHER’S MILK. — REGULATING THE COMPOSITION OF MOTHER’S MILK. — FORMULÆ FOR ARTIFICIAL FEEDING FOR BABIES. — AMOUNT OF FEEDINGS FOR INFANTS. — RULES FOR STERILIZING BOTTLES. — TO PASTEURIZE MILK. — TO STERILIZE MILK. — MODIFIED MILK. — SUGARS. — PROPRIETARY FOODS. — CARBOHYDRATE FORMULÆ. — FLOUR BALL. — BARLEY GRUEL. — RICE GRUEL AND OATMEAL GRUEL. — SKIMMED MILK — HOMOGENIZED MILK — WHEY. — RENNET TABLET FORMULA. — MILK ALBUMEN. — CHYMOGEN USED INSTEAD OF RENNET. — ALBUMEN-WATER. — LACTOSE SOLUTION. — PARTIALLY PEPTONIZED MILK. — COMPLETELY PEPTONIZED MILK. — BUTTERMILK. — BARLEY JELLY. — OAT-JELLY. — BEEF JUICE. — VEGETABLE SOUP FOR BABIES.

Reaction Alkaline.

Contains	3 to 4	per	cent.	of fat		Sp. gravity 1030.
“	6 to 7	“	“	of sugar
“	1 to 2	“	“	of proteids

The percentage of proteids     is increased by		Increased frequency of nursing;
		Increased liberality of nursing
		and insufficient exercise.
The percentage of fat   is increased by		Deficiency of proteid food;
		Excess of fatty foods and fasting.
The percentage of water		Increased fluid diets.
is increased by
The percentage of water		Saline cathartics and diminished   fluid diets.
is diminished by
Percentage of sugar and ash vary little.—Dr. Cotton.

				Age.
1.	Sugar of milk	℥j		From 3d to 14th day.
	Sterile water	℥xij
	Lime-water	℥ss
	Cream	℥ss
	Milk	℥ss
2.	Sugar of milk	℥j		From 2d week to 6th week.
	Sterile water	℥xij
	Lime-water	℥j
	Cream	℥j
	Milk	℥j
3.	Sugar of milk	℥j		From 6th week to 11th week.
	Sterile water	℥x
	Lime-water	℥j
	Cream	℥j
	Milk	℥j
4.	Sugar of milk	℥j		From 11th week to 5 months.
	Sterile water	℥viij
	Lime-water	℥ss
	Cream	℥j
	Milk	℥j
5.	Sugar of milk	℥j		From 5 months to 9 months.
	Sterile water	℥vij
	Lime-water	℥ss
	Cream	℥j
	Milk	℥ijss
6.	Granulated sugar	℥ss		From 9 months to 12 months.
	Sterile water	℥v
	Cream	℥j
	Milk[A]	℥jv

Age.	Twenty-four-hour amount.		Number of feedings, amouint and intervals.
1 week	10 to 12 ounces		10 feedings of 1 ounce
			at 2 hour intervals.
			8 feedings of 1½ ounces
			at 2½ hour intervals.
4 weeks	20 ounces		8 feedings of 2½ ounces
			at 2½ hour intervals.
			7 feedings of 3 ounces
			at 3 hour intervals.
4 months	32 ounces		7 feedings of 4½ ounces
			at 3 hour intervals.
6 months	36 to 40 ounces		6 feedings of 6 to 6½ ounces
			at 3 hour intervals.
9 months	48 ounces		6 feedings of 8 ounces
			at 3 hour intervals.
			5 feedings of 9½ ounces
			at 3 to 4 hour intervals.

Orange juice is not a necessary food unless milk is pasteurized or sterilized (boiled) and in case of constipation. Give 1 or 2 teaspoonfuls one hour before feeding. After nine months reduce amount of milk and increase amount of carbohydrates, such as starch gruels, flour ball, barley flour, oatmeal, and vegetable soup. Zwieback or dry toast may be placed in infant’s hand to teach it how to feed itself. Milk allowed in second year, 1 quart in twenty-four hours. Fruit juices may now be given and should form a part of the food after fifteen months of age. Vegetables, such as beets, spinach and carrots chopped fine and squeezed through colander, may be a part of the regular diet in four meals a day. A child two years old may have small quantities of fresh fish, tender chicken, or beefsteak. No green fruits should be given under four years of age. Eggs should be soft-boiled for two minutes or coddled four minutes, and then only one a day if it agrees with the child.

Boil bottles and nipples in 2 per cent. soda solution for five minutes, then in clear water for five minutes. Keep empty bottles and nipples not in use in sterile water or weak boric solution. Plug with raw cotton.

1. Place bottles in vessel of warm water. Heat to 147° F. Keep at that temperature thirty minutes. Take vessel off stove and cover with a heavy blanket. Then pour off hot water and fill vessel with cold water to cool the milk quickly.

2. Put milk in double boiler and raise to a temperature of 150° to 155° F. Let stand at this temperature for twenty to thirty minutes.

Pasteurizing milk does not kill the ferments in the milk, but it kills almost all bacteria except the spore-bearing bacteria, of which the gas bacillus is the most important.

Boil milk for five minutes and then prepare as for pasteurizing, keeping it at temperature of 147° F. for thirty minutes and cooling it by the same process as given for pasteurization.

Boiling milk kills all bacteria. It is said that heating of milk to this degree impairs its nutritive value.

Note.—Spores develop quickly in lukewarm milk, therefore the necessity of cooling it quickly and placing it in refrigerator.

Add water or other substances to cow’s milk to change it to agree with the digestion of the infant. Malted foods when mixed with water are deficient, and by adding milk or cream it becomes modified milk.

All mixtures should be cold when adding milk, and water sterilized when used as a diluent.

Note.—The natural food for the infant is human milk. The breast-fed babies are healthier, more vigorous, and more resistant to disease. (See Rickets and Scurvy.)

Lactose or milk-sugar is best for normal babies. It may split up in the intestines into acids and when it ferments is likely to be a laxative. Sucrose (cane-sugar) has no advantage over lactose, except that it is cheaper. Do not give sucrose if other sugars are on hand.

Maltose (malt-sugar) is expensive and is never given pure.

Dissolve all sugars in warm sterilized water. Malt extract is more laxative than other milk-sugar preparations. Malt extract should be brought to boiling-point only.

• Condensed and evaporated milks.
• Malted foods, containing starch.
• Starchy foods and various dry powders.
• Kindolac, a dried milk.
• Imperial Granum. Used in the same way as barley flour is prepared.
• Eskay’s Food, which is valueless unless mixed with cows’ milk.
• Mellin’s Food and Horlick’s Malted Milk.

The difference between Mellin’s and Horlick’s food is that Horlick’s Milk has as its basis a dried milk preparation containing maltose and dextrins. Use proprietary powders in the same way as oatmeal or flour barley.

Note.—Proprietary foods are only given to tide over a delayed feeding of mother’s milk.

Four cups of wheat flour; place in muslin bag; place in warm water and boil six hours. After taking out of bag, remove outer part; then break up in chunks, place in radiator or slow oven to dry out. Pulverize by grinding. May use it instead of sugar.

One tablespoonful barley flour; 1 quart of water.

Boil twenty to thirty minutes, then strain.

is prepared by removing the gravity cream or by a centrifuge.

is prepared by mixing olive oil and skimmed milk under great valvular pressure.

WHEY FOR SPECIAL INFANT FEEDING.

Add sodium bicarbonate, gr. x, to ½ pint of whey to render it alkaline, and sugar of milk, ʒj, to raise sugar to 6 per cent.

WHEY: ESSENCE OF PEPSIN FORMULÆ.

Measure milk in double boiler and raise to temperature of 98° or 100° F. Dissolve tablet in cold water, ℥ss to one tablet. Stir rennet through milk and let stand at same temperature for thirty or forty minutes. Cut into cubes and raise to temperature of 155° or 160° F. to stop the action of the rennet. Strain through gauze and put on ice. Do not use pressure in straining.

Boil milk two minutes. Cool to temperature 100° F. Add 60 grains of chymogen to the quart. Let stand until clabber forms. Then drain curds.

Add white of egg to cold boiled water and pinch of salt. Shake thoroughly or break with fork and strain through one thickness of gauze to remove froth.

Put milk and water into a bottle and add the peptonizing powder. Shake well and place bottle in warm water from 105° to 115° F., and leave about ten minutes at that temperature. Shake from time to time.

The process is exactly the same as the partially peptonized milk, except that it is continued for two hours, which is required for the conversion of all the proteins into peptones. For older children the bitter taste may be covered by lemon-juice and cane-sugar, one even teaspoonful of cane-sugar and two teaspoonfuls of lemon-juice being added to ℥iv of milk.

To 1 quart of fat-free milk add 8 ounces of sterile water. Crush tablet of lactic acid bacilli into the mixture; allow to stand for twenty-four hours at room temperature, then place on ice.

DIRECTIONS FOR MAKING BUTTERMILK
FROM LACTONE TABLETS.

Add hot water to milk; then salt; then the lactone tablet, well crushed. Stir well, cover with clean towel, and leave at ordinary room temperature. When the milk becomes thick and fermented set in ice-box for use. Before using heat the buttermilk until perfectly smooth.

Three tablespoonfuls of barley to 1 pint of water. Cook two hours.

I. Cut meat into one-inch cubes; broil slightly and press out juice with meat-press or lemon-squeezer.
One pound of meat will make 2 or 3 ounces of juice.

Serve warm or cold with a little salt.

Do not heat enough to coagulate albumen in juice.

II. Cold method:

• 1 handful of spinach;
• 1 beet;
• 2 carrots.

Chop fine and boil two hours in 1 quart of water.

Strain through gauze and add sterile water to make up deficiency to 1 quart.

TOOTHACHE: Its Forms, Diagnosis, and Treatment for Relief.

The sharp, paroxysmal, shooting pain which is caused by the application of cold, heat, sweets or sours, or by biting some substances into a cavity, is due to a live pulp, and the treatment is quite simple. Clean out the cavity as well as possible, then saturate a small pellet of cotton with oil of cloves, or one drop of carbolic acid, or a solution of cocaine hydrochlorate and clove oil. Place this in the cavity and add another pellet of cotton to prevent the solution from being washed out by saliva. Relief should be immediate, but if not, reapply within a few minutes.

The dull, throbbing pain, with swelling of the face and a sensation of elongation of the tooth, is caused by either a putrescent pulp or an imperfect root canal filling. There is infection; therefore, the first thing to do is to remove the pus.

Dental Treatment.—If there is a large cavity in the tooth, try to enter the root canals and remove the putrescent matter. If the face is badly swollen, make a digital examination, and over the root of the affected tooth you will find a spot about the center of the swelling where it seems to be spongy, appearing to hold the impress of the finger. Take a clean, sharp, cycle-shaped lancet, place on the spot, holding the patient’s head firm with your other arm for fear of his moving. Press the lancet firmly and directly through to the bone, then draw it out with a pulling motion so as to make a cut about an eighth of an inch or more. If this has been done properly, a creamy flow of pus should follow the lancet. Place the fingers on either side of the incision and massage toward incision. To relieve the pain, give hot foot-baths, cold applications to face (never hot), and some other sedative internally, such as remedies given for a headache. When a tooth is sore to percussion, so that the food cannot be masticated, but is without pain when left at rest, if there is no pain over the root of the tooth, it is best to give the tooth a rest, and apply counterirritants over the roots of the adjacent teeth.

This condition is called apical pericementitis, an inflammation of the layer of bone about the fangs of teeth. For relief, give hot foot-baths and pain remedies, as in abscessed tooth. A dead pulp in a tooth will form gas and cause the sensation of elongation and soreness. If the putrefaction is not removed, an abscess will result. At first there will be no soreness to pressure over the root, but on application of heat, such as drinking hot coffee, there will be pain, while cold water will temporarily remove it.

Dental Treatment.—Open the chamber and remove the putrescent pulp, being careful not to go beyond the apical foramen. Use a barbed broach, then wash out with peroxide of hydrogen on a thread of absorbent cotton wrapped smoothly about the broach. Do not push the instrument up into the canal very far for fear of sending some putrescent matter beyond the tooth. Then withdraw the broach and apply oil of cloves or carbolic acid, leaving the canal open and clean for the gas to escape. Hot foot-baths and headache remedies will relieve the pain.

Gum-boils are abscessed teeth, and may be deep-rooted or very superficial. The treatment is the same as given above. Hot applications are very often prescribed, but as an infection will always follow the line of least resistance, it can be readily understood why such a treatment should not be given. The abscess may gather in the cheek, necessitating lancing, which will leave a scar. Cold cloths will allay the infection and simplify the treatment to the gums alone. Teeth are withdrawn, leaving unsightly cavities, which could be avoided by a more deliberate treatment. Treat the abscess of the tooth the same as an abscess in any other part of the body, thereby saving the root of the tooth, if not the entire portion, which can be crowned and give a permanent good tooth.

Mastication is the most important part of the digestive system, and mastication cannot be done without good teeth. Therefore, it behooves everyone to preserve his own teeth and to give this benefit to others who may not have had dental treatment. There are dentists who will extract a tooth upon the patient’s request, and it is best to seek the most progressive and modern dental doctors for the preservation of the teeth to prevent the untimely loss of a tooth, which means also many times a preventive against other ailments affecting the digestive tract. A good dentist should be consulted at least once a year, although the teeth may appear sound and in good condition.

ERUPTION OF THE DECIDUOUS OR MILK-TEETH.

Lower central	incisors,	6 to  9	months.
Upper	“	8 “ 10	“
Lower lateral	“	15 “ 21	“		also first molars.
Canines,	“	16 “ 20	“
Second molars,	“	20 “ 24	“

Eruption of the deciduous teeth
(Frühwald and Westcott).

Twenty teeth in all: eight incisors, four on each jaw; four canines, two on each jaw; eight molars, four on each jaw.

NURSING IN ACUTE FEVERS. — TYPHOID OR ENTERIC FEVER. — PNEUMONIA. — SCARLET FEVER. — MEASLES. — DIPHTHERIA. — POLIOMYELITIS. — DISINFECTION OF FECES AND URINE.

Typhoid fever is an acute infectious disease, excited by the typhoid bacillus. It is most prevalent in the autumn, although it occurs at all seasons. The disease is not directly contagious, and can only be acquired by taking the special bacillus into the alimentary canal. This is usually accomplished through the medium of polluted water, milk contaminated with infected water, raw vegetables (celery, lettuce, water-cress) which have grown in infected soil, or raw shell-fish (oysters) taken from the beds of polluted streams. Occasionally physicians and nurses are infected directly in handling the patient or his clothing which has become soiled with his discharges.

The bacilli are contained in nearly all the secretions of the patients, especially in the stools and urine.

While the bacilli are widely distributed through tissues, the only characteristic lesions of the disease are in the glands of the intestines (Peyer’s patches), which in the first few days become red and swollen, about the beginning of the second week soft and pale, and in the third week ulcerated. If the patient survive, cicatrization usually begins in the fourth week.

Death may result from exhaustion, the result of the systemic poisoning, from perforation of the bowel by an ulcer, from intestinal hemorrhage, the result of erosion of a blood-vessel, or from some complication, like pneumonia.

Symptoms.—The initial symptoms, which may last a week or two before there is any fever, are headache, weakness, loss of appetite, nose-bleed, and perhaps slight diarrhea.

The fever rises gradually, reaching its maximum (104°-105° F.) in about a week; it remains stationary for one, two, or three weeks, and then falls, reaching the normal in another week, thus making the febrile period of the disease of four or five weeks’ duration. Throughout its course the evening temperature is apt to be two or three degrees higher than the morning temperature.

The abdominal symptoms consist of distention of the abdomen (tympanitis), pain and tenderness in the right iliac region, and often diarrhea.

Between the seventh and ninth days a rash usually appears on the abdomen, consisting of small rose-red spots. These come out in crops and disappear on pressure.

The pulse becomes rapid and feeble, and the heart sounds become weak and dull.

The respiratory symptoms include cough, hurried breathing, and slight expectoration.

Nervous symptoms are not always marked. In severe cases there may be delirium, stupor, twitching of the muscles, picking at the bed-clothes, and coma.

The face is dull and listless. The tongue is coated and tremulous. In severe cases it becomes dry, brown, and fissured, and sordes tend to collect upon the teeth.

Relapses are common. In some cases they are due to the too early use of solid food, to excitement, or to overexertion.

When typhoid fever is prevalent, the most reliable preventive measures consist in thorough boiling of all water and milk used for drinking purposes and the avoidance of uncooked vegetables, oysters, and shell-fish.

Management.—Unless otherwise directed take temperature, respiration, and pulse every three hours, in mouth or axilla, as desired. If for any reason a change is made in taking temperature, it should be noted on the chart. Note the effect of sponging or of bathing upon temperature and pulse. Note the character of pulse, and effect, if any, which stimulants have had upon it. Note the amount of cough, and the character and quantity of the expectoration; also any pain that may occur in the chest.

Note the amount of flatulence and the number and character of the stools; especially be on the lookout for blood or undigested food in the discharges.

Note carefully any abdominal pain, any increase in the distention, as these symptoms, with or without a rather abrupt fall in temperature, chills, and pinched features, are suggestive of perforation.

Treatment for Hemorrhage.—Stop all orders immediately, including diet. Elevate the foot of the bed. Give morphin sulphate, gr. ¼ (gm. 0.015), hypodermically, and apply an ice coil or iced compresses to the abdomen until the physician arrives.

Note the occurrence of vomiting and the character of vomit.

Be on the lookout for retention of urine, which is quite common. Note the amount of urine passed in a day and any abnormalities connected with its appearance.

Note the condition of the skin and tongue.

Note the amount of sleep, its character, whether quiet or restless and whether or not there have been delirium, stupor, or twitching of the muscles.

Note the exact amount and character of nourishment taken, and the time it was given; also the amount, time of administration, and effect of medicines and stimulants.

Cleanse the mouth and teeth frequently with some antiseptic wash, such as listerine, 1 part; water, 3 parts.

Bed-sores can nearly always be prevented by keeping the patient and bedding perfectly clean, the skin absolutely dry, and the bed-linen smooth. Changes of position are also important. Parts subjected to pressure and soiling should be washed at least twice daily with soap and water, thoroughly dried, gently rubbed with alcohol, and then dusted with a powder like the following:

If the skin be reddened and tender it may be painted with collodion and then dusted. When the part cannot be kept dry, it should be smeared with zinc ointment and powdered. In very prolonged cases it usually becomes necessary to use water- or air-pillows or water- or air-beds.

To disinfect the feces and urine, use a solution of chlorinated soda (Labarraque’s solution). Cover the urine and feces with the solution and leave the contents stand for an hour. Cleanse pan thoroughly and pour into it the Labarraque solution.

Pneumonia is a general infection, excited by a special organism—the pneumococcus—and manifested by a local inflammatory process in the lung and severe systemic disturbances.

Exposure to cold and lowered vitality from overwork, alcoholism, or some previous disease render persons liable to infection.

Symptoms.—These consist in a decided chill, pain in the side, fever rising rapidly to 104°-105° F., and lasting for five, seven, nine, or eleven days, and then rapidly falling; cough; tenacious bloody expectoration, shortness of breath, delirium and stupor, and physical signs indicating a solid condition of the affected lung.

In fatal cases death usually results from exhaustion, the result of the systemic poisoning, but occasionally it is due to a failure of the heart to propel the blood through the solid lung, to suffocation, or a complication, such as inflammation of the covering of the heart (pericarditis) or lining of the heart (endocarditis).

Management.—The room should be well ventilated, but free from drafts. The temperature should be maintained between 65° and 70° F. Cool water should be given freely. The points mentioned in connection with temperature, respiration, and pulse in dealing with typhoid fever are applicable here. Note the frequency of cough, the amount and character of expectoration, and whether the latter is raised readily or with difficulty. Note the occurrence of pain and its location; also amount of sleep, amount of nourishment, amount of urine, number of stools, etc., and the effect of sponging, of medicines, and of local applications. Clean the mouth and teeth at intervals, being extremely careful, however, in all manipulations not to tire or exhaust the patient.

Scarlet fever is an acute, highly contagious disease characterized by a sudden onset with chill, vomiting, or convulsions; a high fever of from a week to ten days’ duration; a very rapid pulse; severe sore throat; a bright red rash, appearing on the second day, lasting about a week, and followed by desquamation and a marked tendency to nephritis.

The most serious complications are nephritis, suppurative inflammation of the middle ear (otitis media), inflammation of the endocardium or pericardium, and pneumonia.

Scarlet fever, while contagious at all periods, is probably most so during the period of desquamation. The organism may cling to furniture, clothing, etc., and reproduce the disease after very long periods. The contagion may be carried by persons coming in contact with the sick, or the disease may be transmitted through the air of the sick-room or through clothing, utensils, etc., which have been used by the sick.

Prevention of contagion consists in isolating the patient; in disinfecting everything that has been in contact with him; in anointing the patient’s body with an antiseptic oil until desquamation is complete; and in thoroughly disinfecting the room after the patient’s removal.

Management.—Have the patient, if possible, in a large, airy room, preferably at the top of the house. Keep the temperature uniform and the room well ventilated. Wear a loose wrapper and cap, and leave these inside the room when obliged to leave it.

With cloths moistened with a 3 per cent. solution of carbolic acid wipe the floor, furniture, sills, door-knobs, mantelpiece, etc., once a day, but never dust or sweep. Thoroughly disinfect the secretions of the patient and all articles used by him before they leave the room.

Allow the patient no food except what has been ordered, which will usually be milk, koumiss, junket, fruit-juices, and gruels. Encourage the patient to drink water freely. Apply to the body, at least once a day, a bland ointment. Note temperature, respiration, pulse, stools, quantity of nourishment, sleep, and effect of baths and medicine as in typhoid fever. Note especially the quantity and appearance of the urine, and have a sample in a clean bottle ready each day for the physician’s examination.

Keep the nose and throat clean with mild antiseptic sprays or washes. Relieve pain in the throat, unless otherwise directed, with ice-poultices or hot-water compresses.

Measles is an acute contagious disease characterized by moderate fever of about a week’s duration; by an eruption on the skin, appearing on the third or fourth day as small red spots that soon coalesce into crescentic blotches, remain three or four days, and then disappear with a branny desquamation; and by catarrhal symptoms involving the eyes, nose, and bronchial tubes (conjunctivitis, coryza, and bronchitis). The most common complications of the disease are catarrhal pneumonia, inflammation of the gastro-intestinal tract, and inflammation of the middle ear.

Management.—The preventive measures described in connection with scarlet fever are applicable in measles. The room should be maintained at a temperature of 70° F., and should be moderately darkened. The bed should be so arranged that the face will be directed away from the light. Milk, broths, and gruels are suitable forms of nourishment. The temperature, pulse, respiration, hours of sleep, quantity of nourishment, amount of urine, and the effects of therapeutic measures should be carefully noted as in other fevers. Daily inunctions of the body with cold cream or olive oil are useful. Spraying the nose and throat with a mild antiseptic solution, and washing the eyes with boric acid solution (15 grains to the ounce of water) are usually ordered. Hot baths and hot drinks are indicated when the rash is delayed. Fever is generally controlled by sponging. Great care is necessary during convalescence to avert complications.

Diphtheria is an acute contagious disease characterized by moderate fever of an irregular type, and of from one to two weeks’ duration; by considerable weakness and prostration; and by the formation of a grayish or whitish false membrane upon the throat, nose, larynx, and adjacent parts. The exciting cause of disease is the bacillus of diphtheria, which is found chiefly in secretions of the affected mucous membrane. The constitutional symptoms are due to the absorption of a toxin produced by this bacillus.

Diphtheria involving the larynx is sometimes termed true croup or pseudomembranous croup. This form is characterized by irregular fever, hoarseness of the voice, croupy cough, and progressive difficulty in breathing. Death frequently results from suffocation, unless tracheotomy or intubation of the larynx be performed.

The chief complications of diphtheria are pneumonia, degeneration of the heart-muscle, inflammation of the middle ear, and paralysis the result of an inflammation of the nerves.

Preventive measures consist in isolation of the sick, the thorough disinfection of the bedroom, bedding, clothing, and all articles used by the sick, and the administration of an immunizing dose (500 units) of antitoxin (see page 25) to those who have already come in contact with the patient or who have otherwise been exposed to the contagion. The sick-room should be well ventilated and maintained at a temperature of 70° F. The atmosphere should be made moist by slaking lime in the room or by generating steam in a kettle. In membranous laryngitis treatment in a steam-moistened tent is desirable. On account of the tendency to sudden heart failure absolute quiet and rest are to be enjoined. The diet should consist of milk, unseasoned broths, koumiss, junket, and eggs.

The patient’s temperature, pulse, respiration, nourishment, urine, sleep, and bowel movements should be noted as in other fevers. Local applications of boric acid solution, hydrogen peroxid (1: 3), or normal salt solution are usually ordered; they should be made with utmost gentleness. Externally, ice-poultices or hot fomentations are useful in relieving soreness.

The utmost care should be exercised during convalescence to guard the patient against undue effort, as at this time sudden heart failure is especially liable to occur.

Poliomyelitis—Infantile Paralysis.—This disease occurs in all countries and was recognized more than a hundred years ago. The first of the great epidemics appeared in 1905, and it was then proved that the malady is a contagious disease. Peculiar facts connected with previous epidemics of poliomyelitis have made it appear possible that the disease when not spread directly from one person to another, like the most acute infectious diseases, may be dependent upon some intermediate agent, or perhaps upon some other host, or a living reservoir, or upon the combination of the two. If the disease is communicated by human contact, mild cases, abortive cases, and convalescents may carry the germs for years. A normal carrier is an individual who is not suffering from the disease and may carry the germs and transmit them to another without being the least suspected. Laboratory experiments would seem to show that the disease is passed directly from one affected human individual to another through immediate contact involving the transfer of the virus from the first person to the nasal passages of the second, and spread through the agency of dust or by various other means, a population other than human, one acting as an undercurrent and influencing the progress of the epidemic. There seems to be no relation between the sanitary conditions and the incidence of cases. Poliomyelitis is most prevalent during the warm months, even when it is not epidemic. Under the same conditions of temperature, rainfall, humidity, cloudiness, sunshine, wind, dust, etc., the outbreak will progress in one part of the city and subside in another. The course of the epidemic is not materially modified by weather conditions. No age, no sex, or race is exempt; the incidence is greater under five years of age, and the blonde children appear to be especially susceptible, while the colored race are rarely attacked, and the strongest children seem to be the greatest sufferers. That this disease can and often does end fatally has been clearly shown by the history of the past epidemics, and it has been frequently demonstrated by clinicians in various parts of the world that complete recovery from paralysis is not only possible but it is by no means uncommon.

Summary Results from Public School Reports.—1. A large number of children with poliomyelitis show pathologic conditions of the nose and throat, either diseased and hypertrophied tonsils and adenoids, or both.

2. A large number show marked hyperemia of the nasopharynx and throat, often resembling a scarlet or streptococcus throat.

3. Only a small percentage of cases previously operated for tonsils and adenoids were found to be affected with the disease, and in this group of cases the percentage of recovery was very much higher than in unoperated cases. The number of cases in this group is, of course, rather small to draw from it any definite conclusion, but it is at least suggestive. In another investigation of 1404 children in the public schools, made to determine whether any of them whose tonsils had been removed had been ill with poliomyelitis during the recent epidemic, a similar result was obtained. Of the 1404 children whose tonsils had been operated upon not one developed poliomyelitis during this epidemic, although in 18 instances cases developed in the family, and in 93 instances cases developed in the same house.

Poliomyelitis defined: Polio (gray), myel (marrow), itis (inflammation), meaning inflammation of the gray matter of the spinal cord.

Pathology of the disease: Infantile paralysis is a general infection, with lesions most marked in the central nervous system. Clinical manifestations exhibit a wide-spread and scattered motor paralysis or weakening. The large majority of all cases are of the central nervous system, but there are variations in which the symptoms are not of the usual kind.

Classification.—1. Non-paralytic or Abortive Type.—These are cases in which the nerve-cells are not sufficiently injured to produce paralysis; and those classed as meningitis cases, tuberculous meningitis without motor disturbances, often called encephalitic; in these cases the motor cortical areas are not involved, but there is evidence of disturbance of the sensorium.

2. Ataxic Type.—Here the motor cells are evidently not involved, but there is a lack of co-ordination—ataxia, nystagmus.

3. Cortical Type.—The upper motor neuron is here affected, with resulting spastic paralysis.

4. Ordinary Spinal or Subcortical Type.—Here the lower motor neuron is affected, with resulting flaccid paralysis; a manifestation of poliomyelitis difficult to classify is blindness. The most important symptoms of the disease may be described under the non-paralytic or abortive cases and those of ordinary spinal form.

Symptoms of Onset.—There is no typical onset for this disease. It is believed that there is an interval of from a few days to two weeks between the time of exposure and the appearance of symptoms. No one symptom or group of symptoms will always be found to identify it before the paralysis is apparent. Fever is the most constant of all symptoms; it varies a great deal; there may be much or there may be little. Vomiting occurs quite frequently, and in a child old enough to talk headache may be complained of. Sometimes there is considerable pain in the back. The child is often very drowsy and desires to be alone. Movements of any kind seem to cause pain, and muscle tenderness is plainly evident. Marked irritability and sweating are also often prominent features. Such symptoms may all appear suddenly following a day of great activity and good health. These symptoms may continue for from two to four days, when it is noticed that the child is unable to move a hand, an arm, a foot, or a leg. There may merely be a paralysis of one side of the face or only weakness in an arm or leg. In some mild cases it is occasionally hard to convince parents of the true nature of the disease. In some instances the first knowledge of a child’s indisposition is the discovery that it cannot walk or has difficulty in using an arm. Cases of this character are often attributed to “catching cold,” to going in bathing for too long, or perhaps a fall.

In the majority of cases temperature is down to normal within a week and there is seldom an extension of the paralysis after that time. In most instances all the paralysis which is going to occur is present at the time it is first noticed.

Within two weeks all the tenderness has usually left the muscles, which are now found to be soft and flabby from lack of use. No matter what extremity may be affected by the paralysis, there is one condition which is nearly always present in these cases. If the child’s shoulders are raised up from the bed, the head drops back almost as if on a string. The child is unable to keep its head in a line with the body, and if the head is raised and forcibly bent forward so as to cause the chin to touch the chest, marked pain results.

Treatment.—By the end of three weeks in favorable cases there may be some motion obtained by the patient in the limb which was paralyzed, or there may be evidence of threatened deformity. It is at this time and in the weeks and months to follow that so much depends upon treatment. The muscles of a leg or arm may waste away so as to make them useless if not promptly cared for. If contractions of muscles are not prevented, a club-foot, toe-drop, or some similar deformity may develop. Such deformities may be hastened by the pressure of the bed-clothes. At times it is well to put a wire cradle over the affected limbs. Well-padded splints seem to take the strain from unaffected muscles.

By some wonderful adaptation of nature there is a great effort to make other nerve channels take up the work of the destroyed cells, and hence the value of keeping the muscles artificially active by the use of massage and mild electric treatment. This treatment should be used early in the case, and then only with the advice and supervision of a competent physician.

The destruction of nerve-cells in the segment of the spinal cord is sometimes so extreme that a total paralysis of one or more extremities follows. This is a grave shock to the growing child, and it may be that all growth of that member will stop. The long bones will not lengthen. If one group of muscles remain active and unopposed in their action, deformity will follow. These deformities can be corrected by the orthopedic surgeon, and can usually be checked if the physician’s advice is sought.

Serum Treatment.—The serum injections were given even as long as thirty years ago. Intraspinal injection of an immune serum is effective when introduced in the preparalytic stage.

Prophylaxis.—The virus or germ of poliomyelitis is found in the nose, the mouth, and intestinal tract (it is also found in various other parts of the body). As house-flies may carry the virus after crawling over the person suffering from the disease, all insects are a dangerous asset to any household. Disinfection of secreta and excreta should be carried out. The mouth and nose should be disinfected.

Quarantine should be rigidly enforced, and all the necessary precautions taken to prevent the spread of a contagious, infectious disease.

Disinfect the feces and urine by mixing with each evacuation double its volume of 1 per cent. chlorid of lime solution or double its volume of 5 per cent. carbolic acid solution. Cover the vessel and allow it to stand for from one to two hours before emptying its contents into the closet.

Put all typhoid linens in cans used for that purpose only. Sprinkle with formalin and keep covered until sent to laundry.

N. B.—While performing work in which the hands come in contact with soiled linen and bed-pans, fill finger-nails with soap to keep them clean and to prevent them from acting as carriers of disease.

A WASHING FLUID FOR
SOILED CLOTHES.

Put in a stone jar and set it in the open air. Pour over it 1 gallon of boiling water. Use ½ cupful to a boiler of clothes and add ½ bar of soap. Soak clothes over night in cold water; then place clothes into the boiler and boil for twenty minutes. Plain pieces need very little rubbing. Rinse two or three times in clear water before hanging clothes out to dry.

INCUBATION PERIOD
AND QUARANTINE.

A constant period of incubation is not to be expected. In most instances, as will be seen from the following table, the difference between the maximum and the minimum period is not very great. It seems remarkable, however, that a disease should show such extremes as typhoid fever:

It is a peculiar fact that the diseases in which the period of incubation is shortest are those in which the infection persists the longest.

The period of quarantine must be guided largely by the period of incubation, hence the subject is an important one for a variety of reasons. The “Medical Magazine” (London) states that the period of quarantine should be at least a day longer than the maximum period of incubation for each disease. This is a very uncertain rule, however, for the patient should be free from all signs of illness, and especially from fever. The period of infection is very doubtful. It may be greatly prolonged by complications. This is especially true of small-pox, diphtheria, typhoid and scarlet fevers. The period during which a disease may be infectious cannot be stated definitely. It varies with different diseases, and must be determined according to the symptoms and character of the case. Measles, chicken-pox, and mumps lose the direct power of infection very early, and the infective principle does not remain active for a long period in the room in which the patient has been ill. Measles, mumps, and chicken-pox may be infectious in the earlier stages before becoming definite in character. Smallpox is not actually dangerous until the eruption appears.

THE CARE OF THE SKIN AND MOUTH IN FEVERS. — THE MOUTH.

By Harriet Higbee,
Graduate Illinois Training School for Nurses.

From the American Journal of Nursing.

The prevention and treatment of bed-sores have been and are frequently discussed in medical books and journals. But as it is a subject that often taxes the nurse’s ingenuity to the extreme, it can not be dwelt upon too frequently. Many preventive measures are familiar to us, as the soap and water bath for cleanliness, followed by rubbing with alcohol and dusting with boric-acid powder, or boric-acid powder and bismuth subnitrate in equal parts for dryness. The relief of pressure is most important. Make use of air-cushions, cotton-pads, pillows, water-bed and frequent change of position where that is possible. In addition to these, there are a few measures not generally used which after a thorough test have proved satisfactory. One is a simple inexpensive contrivance used to relieve pressure of heel, elbow, and ear. It is a pig’s bladder filled two-thirds full of either warm or cold water, as the case requires, tied securely, and placed under a cotton ring. The weight of the head or elbow rests on the ring and the tender point rests on the soft fluctuating mass. If the skin is inactive, as in paralysis, or there is frequent or constant moisture from perspiration or involuntary evacuations of urine or feces, the alcohol and boric acid, etc., are of very little value. They do not prevent the absorption of the moisture by the skin and its subsequent softness or excoriation, which is commonly followed by infection. In such cases the back should be washed with soap and water every six or eight hours, or after every involuntary evacuation, and thoroughly rubbed with a small amount of oil-substance, as camphorated oil or a mixture like the following:

Render out mutton tallow on the back part of the stove; do not brown it. Strain through a piece of muslin; add the olive oil and carbolic acid; set dish into cold water and beat its contents until set. This will make an ointment the consistence of vaseline, and it will keep indefinitely. If the skin needs a great deal of stimulation, camphorated oil or, better still, castor oil may be substituted for the olive oil in the above recipe.

When the skin becomes excoriated the part should be cleansed as mentioned before, not with soap and water, but with boric-acid solution, normal salt solution, or sterile water; then gently painted with oxide of zinc ointment made into liquid form by the addition of olive oil, castor oil, and balsam of Peru in equal parts, or castor oil alone, and covered with a clean cloth fastened on with a binder. Gentle massage may be used around the excoriated surface with excellent results.

The treatment of bed-sores is usually directed by the physician; but if it is left to the nurse, she will find the following method helpful. If there is necrotic tissue or suppuration present, she may irrigate the cavity once daily with peroxid of hydrogen, one glass syringeful, followed by normal salt solution, boric-acid solution, or sterile water. Then apply a hot boric-acid dressing, one inch thick, every four hours until wound is clean. If the stimulation of the tissues is needed, fill the cavity with a sterile dressing saturated with balsam of Peru and castor oil, equal parts bovinine, castor oil, or camphorated oil alone. When the depression is filled with granulation tissue, it can be treated as an excoriation.

The subject of the care of the mouth in fever nursing is equally as important as that of prevention of bed-sores. An unclean mouth is not only very unpleasant and often painful to the patient, but is a source of infection. The accumulation of food and mucus is a fertile field for the lodgement of bacteria. If this infected material is allowed to remain, it can easily spread to the middle ear and the mastoid cells, and cause abscesses or be carried by the food to the already overburdened alimentary tract to add to its infection. When the accumulation of sordes is profuse and persistent the patient’s mouth ought to be cleansed after every feeding. This may be done by wrapping a two-inch square piece of linen or gauze, saturated with the mouth-wash, around the little finger and wiping every portion of the cavity—not far enough on back of the tongue to provoke nausea. If it is necessary to clean the throat, a small swab may be employed. For thorough cleaning of the mouth several sponges are necessary. These may be received in a piece of paper and at once burned. While cleaning the mouth of a delirious patient the nurse for her own protection must place some hard substance between the patient’s teeth. A rubber cork is the best, but if that is not available, a fork-handle may be used. Its prongs must be carefully wrapped to avoid an accident. If the cork is used, the nurse must hold it in place to prevent its falling down the patient’s throat. There are numerous preparations used for cleaning the mouth, as:

The following three formulæ have been found excellent for special cases:

If the coating be of long standing, thick and dry, this solution may be applied with an applicator every five or ten minutes for one hour, and then the cleansing may be done with sponges. In these cases it is necessary to use a toothpick to gently loosen the sordes between the teeth.

For dry or fissured lips and tongue, and for anointing the baby’s nose, the following will be found useful:

In rare cases there is a persistent bleeding from the gums. The application, several times daily, of the following solution is effectual:

Mouth-Wash.

A solution of potassium chlorate and cinnamon water.

DISINFECTION OF ROOMS. — DISINFECTION IN PRIVATE NURSING.

Seal all crevices about doors and windows. Keep the room closed for twenty-four hours to allow dust to settle. At the end of this time vaporize in a lamp from fifty to sixty paraform tablets to each 1000 cubic feet of space or vaporize 1 pound of formaldehyd solution in a special apparatus designed for the purpose. If no special apparatus is obtainable, sprinkle sheets with the following solution, using a gallon of the mixture for a medium-sized room, and fill the room with steam:

The steam and glycerin prevent to some extent the conversion of the formaldehyd gas into paraform, which in itself is useless.

Another and more modern method is to pour 12 ounces of formaldehyd into a vessel and then add 4 ounces of crystals of potassium permanganate. Place the vessel in the room and leave the room closed for from four to six hours. To get rid of the fumes quickly after the disinfection is completed, sprinkle 4 ounces of ammonia on a sheet and leave the sheet in the room until the ammonia is evaporated.

Sulphate of copper solution is a very cheap disinfectant, and may be used to advantage in typhoid fever.

After this treatment again keep the room closed for four or five hours. Then wipe floor, walls, and woodwork with corrosive sublimate solution (1: 2000) or carbolic acid solution (3 per cent.).

In a private home (M. D. P., American Journal of Nursing) if contagion has taken the family by surprise and a room has not been especially prepared, leave in the room all the furniture and fittings in order that everything may be disinfected finally.

During the progress of the disease no blankets, coverings, etc., must ever be shaken from the windows. They can only be aired within the room, or rooms, occupied by the patient. Moist sheets hung outside the door leading to the rest of the house prevent the passage of dust from the sick-room. It is sufficient to keep them sprinkled with plain water, as the important thing is the moisture. However, a solution of carbolic acid may be used. They should be kept wet by some one on the clean side of the house. Soiled linen from the sick-room should be placed in a wash-boiler or metal can full of water, never taken to the laundry in a dry condition. Here also a weak solution of carbolic acid maybe used, or a very weak solution of soda. However, plain water will be sufficient. They should be boiled for at least half an hour. Patients’ dishes and silver should be kept in the room, and before returning to the house should be boiled.

All cleaning within the patient’s room during illness should be done with moist cloths, which should be put into paper bags and burnt.

Upon leaving the room the patient should receive an unusually thorough bath, hair and all, with tincture of green soap, a dilute alcohol rub, and finally a sponge-bath of bichlorid of mercury, 1: 2000 to 1: 4000, according to age.

The mode of disinfecting rooms is, generally, to use formaldehyd.

Before setting free formaldehyd in any form the nurse should put on rubber gloves, glasses, and a thick mouth and nose protector, as the fumes are very irritating. After leaving the room she should seal up the door and leave all over night, and then thoroughly air and house-clean on the morrow. Mattresses and pillows had better be steam-sterilized if there is any sterilizing plant in the town, or, in the country, made over and sunned thoroughly.

SURGICAL SUPPLIES. — TO STERILIZE INSTRUMENTS. — TO CLEAN INSTRUMENTS. — TO STERILIZE GLOVES. — TO DRY STERILE GLOVES. — TO CLEAN GLOVES. — TO STERILIZE SILK-WORM GUT OR SILK THREAD. — TO STERILIZE HORSE-HAIR. — TO STERILIZE CATGUT (FORMALDEHYD METHOD). — CHROMIC CATGUT. — TO STERILIZE LINEN THREAD. — TO PREPARE RUBBER TUBING. — TO PREPARE SIX YARDS OF IODOFORM GAUZE. — TO PREPARE IODOFORM GAUZE (GREEN-SOAP METHOD). — IODOFORM EMULSION. — TO PREPARE PROTECTIVE STRIPS. — TO PREPARE TINCTURE OF GREEN SOAP. — STERILIZING HAND-BRUSHES.

1. All instruments should be boiled for at least fifteen minutes in a 1 per cent soda solution. Wrap the blades of knives and scissors in cotton, put them in a separate towel, and in one corner stick the needles before folding it. Some surgeons prefer to have the latter simply washed and placed in absolute carbolic acid and then in alcohol for a few minutes. Water must boil before instruments are put in and the boiler must be kept closely covered.

2. In a German medical journal, published at Leipsic, Gerson corroborates his former assertions as to the efficacy of disinfection of instruments with tincture of soap, citing extensive bacteriologic tests in evidence. He wraps the blades in Brun’s cotton, impregnated with tincture of soap. The cotton protects them from the air and the tincture is an efficient disinfectant. The instruments are then ready for use at any moment. After using them he rubs them clean with cotton moistened with the same tincture, then wraps them in a fresh piece and lays them aside. No boiling or steaming is required, and the instruments are not harmed by the process. He recommends this method especially for military and other practice where steam disinfecting appliances are not available. He has found that instruments infected with pus, etc., and not even wiped off after having been used, proved perfectly sterile after a few days in the wet cotton wrapper. No colonies developed when they were rubbed on agar plates or soaked in bouillon.

To Arrange Instruments for the Convenience of the Operator.—Instruments for immediate use are laid in trays on a small movable table on the operator’s right hand. Instruments that may not be needed are kept in another tray. A separate tray is used for suturing material, needles, a pair of sharp-pointed scissors, and long forceps. Before placing instruments in the tray, dry with sterile towels.

First of all, the knives, scissors, and needles should be laid carefully aside and cleaned at once. Scrub all instruments in cold water to remove blood and pus, then in hot water with plenty of soap. Rinse thoroughly in hot water, then place in boiling water, take them out singly and dry; do not drain. Following pus cases all instruments must be boiled for at least fifteen minutes in 1 per cent. soda solution.

Examine carefully to see that they are in perfect condition. Select a pair, then wrap each one in a separate piece of gauze, fasten together, and boil at least 15 minutes in salt solution.

Cover a table with a sterile sheet. Prepare hands and person as for an operation, and draw on a pair of sterile gloves. Then dry gloves with sterile towel, and powder them inside with sterile powdered talcum.

Soak in cold water, then wash with green soap and hot water. Rinse and dry. If used in pus cases, boil 15 minutes before laying away.

Boil in sterile water 20 minutes and preserve in alcohol, 95 per cent., or first sterilize in steam sterilizer for 20 minutes, then boil in sterile water for 20 minutes and preserve in alcohol, 95 per cent.

1. Wash thoroughly in green soap and water. Rinse several times. Soak in ether 24 hours. Boil in sterile water 20 minutes. Preserve in alcohol, 95 per cent.

2. Soak in bichlorid solution 1: 1000 for 6 hours. Then boil 3 minutes in sterile water. Place in alcohol, 50 per cent.

Immerse in formaldehyd sol., 5 per cent., for 24 hours. Wash by soaking in sterile water for 24 hours, which must be changed every hour. Then boil in sterile water and basins about 10 minutes, according to size of the catgut. Lift out carefully, and place on a sterile towel until all moisture is absorbed. Prepare table, hands, and person as for an operation. Cut in required lengths, from 14 to 25 inches. Coil smoothly, and preserve in glass jars (which have been previously boiled for 20 minutes) containing the following solution:

Wind several yards of thread into coils. Boil for 30 minutes in a 1 per cent. solution of bicarbonate of soda. Wash in fresh cold water, and allow to stand in cold distilled water for 6 hours. Then boil in fresh water for 30 minutes. Place in absolute alcohol for 48 hours, then in a solution of Schering’s celloidin with equal parts of alcohol and ether. The mixture must stand for 12 hours, or until dissolved; keep tightly corked. When ready for use add 1 per cent. of sterile oleum ricini, and immerse thread for 48 hours. Then wind upon a frame to dry. This will require from 1 to 3 days. When dry, cut into lengths and coil or wind on glass slides. Boil for 1 hour in normal salt solution. Preserve in Chinesol solution, 1: 500.

To Sterilize Glycerin or Any Kind of Oil.—Place bottle uncorked in a vessel of boiling water for 2 hours.

Place different sizes in a deep dish of water. Add bicarbonate of soda to make a 10 per cent. solution. Let come to a boil over a slow fire, then with a stiff brush or cloth rub each piece well. This removes all sulphur, leaving a black surface. Rinse several times, then boil in clean water 15 minutes. Boil 15 minutes before immediate use.

Prepare the following solution:

Mix thoroughly, gradually add alcohol (95 per cent.), f℥iij, then very quickly, ether, f℥vij. Have gauze ready in desired lengths, and drop into solution. Press gauze uniformly to preserve evenness of color. Work rapidly. Prepare table, hands, and person as for an operation. Roll strips, and place in sterile glass jars.

To saturated boric-acid solution Oj, add green soap to make a good suds. Boil half an hour. To this add iodoform ℥j, then boil 15 minutes. When cool add carbolic acid (95 per cent.) ʒj, stir solution, dip gauze, and roll in strips. Keep in sterile glass jars.

Castile soap is a good substitute for green soap.

I. Nine parts sterile glycerin in 1 part of iodoform. Dissolve powder for eight hours in bichlorid solution (1: 500). Pour off solution and break up the iodoform after having rinsed it thoroughly in sterile water. Then mix with glycerin.

II. Iodoform, ℥j; sterile glycerin, ℥ix. Put the iodoform in a sterile basin. With a sterile spoon stir in glycerin, a few drops at a time, until a smooth paste has been made. Then add remainder of glycerin.

Scrub with green soap and rinse well in sterile water. Cut into strips. Disinfect in bichlorid (1: 500) for twenty-four hours. Keep in sterile water three hours. Then place in boric-acid solution. Put in normal salt solution when preparing for immediate use.

Prepare the following solution:

To prepare by cold process: Mix ingredients in a pitcher and stir briskly for a few minutes every hour until a solution is formed.

To prepare by warm process: Melt the soap over a slow fire; then remove it to a cool place and stir occasionally. Before it hardens add solutions and mix thoroughly.

Caution: Prepare where there is no danger of the ether igniting.

TO PREPARE A PATIENT FOR A SURGICAL OPERATION.

The preliminary preparations are of the greatest importance. The usual standing orders should be followed only when no directions have been given by the surgeon. When express directions for preparation are given by the surgeon, the usual standing orders must be disregarded. Caution in the use of cathartics can not be too strongly emphasized, for even a simple laxative at such a time may cost the patient’s life.

The usual standing orders are: For the previous day, liquid diet only. Give a cathartic, a bath, and a hair-wash during the afternoon, and flush the bowels thoroughly a few hours later. Surgical preparations should be completed before retiring time for the night.

Have room and all preparations ready before disturbing patient. Keep patient covered as much as possible. Protect table with a Kelly pad or a good substitute for same. Have at hand a drainage-pan and a bucket.

Shave field of operation.

Scrub with tincture of green soap and rinse with sterile water; then cleanse with ether, followed by alcohol, 70 per cent.

Put on dry sterile dressing (a towel), apply a suitable bandage and fasten securely.

Douches are given only by direction of the surgeon—sterile water preferred.

The final preparation is given in the operating-room a few minutes before the operation is begun, consisting of a heavy coating of tincture of iodin, applied by the surgeon in attendance.

Morning of Operation.—Have a specimen of urine ready for analysis. No food six hours before operation. If patient cannot urinate a few minutes before going to the operating-room, catheterize, with doctor’s permission. Remove false teeth, jewelry, and protect patient from the cold.

TO PREPARE A ROOM FOR A MAJOR OPERATION.

By Eveleen Harrison,
Graduate of the Post-Graduate Hospital,
New York.

From the American Journal of Nursing.

Of necessity this is far more extensive than the requirement of a minor operation, and should be commenced the day before if possible.

The selection of the room comes first, and as an abundance of clear light is more essential than anything else in an operating-room, let the choice of the room depend on that. When possible avoid using a room into which the sun will shine directly during the time of the operation; but in any case, take the room that gives the most light.

When the house is large enough to allow it, and your choice is not limited, use a room adjoining, or at least on the same floor as the one to be occupied afterward by the patient, and as near the bath-room as possible.

Sometimes it is necessary to use your patient’s bedroom, in which case the bed, after being prepared, should be pushed up in a corner out of the way.

All the furniture that it is possible to remove is taken out of the room; any large piece that has to remain should be covered completely with sheets fresh from the laundry. Carpets and curtains must be removed, unless the surgeon prefers to have them covered with moist sheets, and the room thoroughly cleaned, floor scrubbed, windows washed, etc.

As the surgeon will need all the light you can give him, cover only the lower panes of the window with thin muslin curtains, cheese-cloth, or—what will answer the purpose equally as well and is ready at hand—a thick lather of soap rubbed all over the panes and allowed to dry, thus shutting off the gaze of outsiders without excluding valuable light.

The temperature should be about 75° F. and the room well aired beforehand, as no window will be opened during the operation.

A list of articles usually required for a major operation is as follows:

• Bandages.
• One strong kitchen table.
• Four small tables.
• Three common chairs.
• One fountain syringe.
• Three large basins and pitchers.
• One small basin and pitcher.
• One piece of rubber sheeting for table.
• Two slop-jars or foot-tubs.
• One gallon of hot boiled water.
• One gallon of cold boiled water,
• and always keep a kettle of water
• boiling on the stove.
• Antiseptic solutions as ordered.
• Alcohol.
• Safety-pins.
• Green or synol soap.
• Absorbent cotton.
• Sterilized gauze.
• New wooden nail-brush.
• Two dozen towels,
• and plenty of clean soft cloths.

This list is an outline of the articles usually required; the surgeon will supplement what is necessary for each particular operation, but when a nurse is called upon to prepare for an operation in a private house, where the conveniences of the hospital are not at hand, she will be thankful to have ready a list of the things that are indispensable. I well remember my first operation outside the hospital, and how difficult I found it to construct a modern operating-room from the limitations of a small country house.

All supplies, when possible, should be on hand the night before the operation, and the room cleaned ready for work.

Facing the best light, and about five or six feet from the window, place the kitchen table, and cover it with a double blanket or comfortable, rubber sheeting, and a sheet fresh from the laundry, the whole pinned firmly at the four corners with safety-pins. Lay on the top a small single sheet, a blanket, and very small, firm pillow.

The little tables are to be arranged around the large one, leaving plenty of room to walk between. Cover them with sterilized sheets; if they have polished tops, first put on a piece of oilcloth or rubber sheeting to prevent damage. These tables are for the instruments, gauze, sponges, sterilized towels, and basin of solution for the surgeon’s hands.

A strong screw must be fastened in the wall near the window at the height of about seven feet to support the fountain syringe, which will be filled with whatever solution the surgeon requires for irrigating the wound.

One slop-jar stands at the side or end of the large table, the other beside the table that holds the basin of sponges.

The bureau (covered with a sheet) or the mantle-shelf will serve to hold the dressings and rubber gloves. A small stand or table will be needed by the doctor who gives the anesthetic for his hypodermic, clean towels, and ether or chloroform.

All the basins, towels, and pitchers to be used during the operation must be thoroughly washed in warm soap suds and then boiled for an hour, or—when that is not possible—allowed to stand all morning in a 1: 1000 bichlorid solution, and then rinsed off with sterilized water before using. Two of the basins are filled with sterilized water or salt solution for washing the sponges, another basin holds the wet sterilized towels, and the fourth the solution for the surgeon’s hands.

A small bowl is needed for the soft soap to wash off the part of the body to be operated on, also a small pitcher of 1: 2000 bichlorid and some alcohol.

In the bath-room arrange plenty of clean towels, a bowl of 1: 2000 bichlorid, and one containing alcohol, synol, or green soap, and a sterilized nail-brush for the surgeon’s hands. The surgeon will send instruments, sutures, and anesthetic.

You cannot err in having ready a good supply of sterilized water, as an emergency may arise in which a double quantity would be required. Clean the wash-boiler thoroughly, fill it almost to the top, and boil for half an hour. One boilerful must be prepared in time for the water to grow cold before the operation; it is then poured into pitchers that have been washed in warm soap suds, and rinsed off with the sterilized water. Cover the pitchers with sterilized towels or napkins.

It is of the utmost importance that everything should be in perfect readiness when the surgeon arrives. The nurse will do well to go over the list carefully, so that nothing may be missing.

TO PREPARE A ROOM FOR AN OPERATION. — AN EMERGENCY STEAM STERILIZER. — TO STERILIZE AN OBSTETRIC SET OR SMALL PACKAGES.

By Jessie McCallum,

Graduate Johns Hopkins School for Nurses.

From the American Journal of Nursing.

1. The room selected for the operation should be near the bath-room, as a porcelain tub filled with bichlorid solution of the strength of 1: 1000 makes an excellent arrangement for disinfecting the washbowls, pitchers, platters, plates, etc., which are to be used during the operation for the solutions, instruments, needles, and ligatures.

2. If the carpet cannot be removed, it may be protected with oilcloth, rubber sheeting, or newspapers, over which sheets can be pinned.

3. The windows can be frosted by rubbing sapolio on the inner surface, thus preventing any possible observation from the outside.

4. Two small tables placed together to form one of the required size, old blankets being used to make the tables of uniform height and also to furnish a comfortable surface for the patient, can be used for an operating-table, care being taken to cover the blankets with a bed-rubber or table oilcloth and a sheet, securely folded under, and tied to the table with muslin bandages.

5. A Kelly pad can be improvised by tightly rolling a blanket and covering it with a rubber sheet, two ends of which are to be pinned together and used to conduct the solutions into the foot-tub below.

6. An ironing-board or the leaf of an extension table, supported by two chairs, makes a good table for instruments or solution basins.

7. An ordinary clothes-boiler, one-third filled with water, can be used as a sterilizer, the instruments rolled in gauze, and the brushes and orange sticks (for the doctor’s hands) being immersed therein. The necessary dressings, towels, sheets, fountain syringe, etc., are sterilized by hanging them in a hammock or sling hung from the handles of the boiler. A kitchen fork, lengthened by securely fastening to it an iron spoon, makes a convenient utensil with which to remove the articles from the boiler.

8. An ordinary sheet folded over at the top makes an excellent gown for the operator, if the ends be carefully taken up under the arms, crossed in the back, and used as sleeves for the shoulders and upper part of the arm, the middle of the upper hem of the sheet being pinned to the collar in front.

9. Water boiled in the clothes-boiler or tea-kettles can be quickly cooled by placing pitchers of it, covered with sterile towels or cloths, in a dish-pan or foot-tub of cracked ice.

10. A kettle of water kept boiling during the operation is a great convenience.

11. Salt solution filtered into household preserving jars can be sterilized in the wash-boiler with the other articles.

12. A stretcher can be improvised by slipping two window-poles or broom-handles into the folds of a sheet folded the proper size and securely fastened with safety-pins.

13. The Trendelenburg position can be secured by using an ordinary kitchen chair comfortably padded with a rubber-covered pillow and sheet, the back of the chair being placed under the patient.

14. The patient can be put in the lithotomy position by placing under the knees a padded walking-stick, to the ends of which is fastened a sheet folded diagonally, and passed under the shoulders.

Take an ordinary wash-boiler. Make a crate of three light boards and a few slats to fit the interior. Boards should be about six inches high, to escape the water. The slats laid across will support all goods necessary for an operation. Pack parcels lengthwise to permit the full circulation of steam. Sterilize under full pressure of steam for one hour. Then take out and place on a table to dry.

Use a boiler or small kettle which has two handles. Make a hammock of strong muslin, tie corners to the handles and place packages in the sling suspended an inch or two above the boiling water. Cutting the muslin in a square and folding it on the bias gives more room, as the goods will stretch.

INSTRUMENTS TO USE FOR OPERATIVE CASES.

SURGICAL POSTURES.

Sims’s posture, anterior view.

Sims’s posture, posterior view.

Dorsal recumbent posture.

Dorsosacral posture, with leg-holder applied.

Knee-chest, or genupectoral, posture.

Walcher posture.

Trendelenburg posture.

Edebohls’s dorsal posture.

OPHTHALMIA. — PURULENT OPHTHALMIA — OPHTHALMIA NEONATORUM.

(SUPPURATIVE INFLAMMATION
OF THE CONJUNCTIVA).

By Cassius D. Wescott, M. D.,

Assistant Professor of Ophthalmology at
Rush Medical College, Chicago, Ill.

Purulent ophthalmia is caused by a specific germ, and is very contagious.

Local Treatment.—Irrigate with warm boric-acid solution or normal salt solution every hour. Anoint the edges of the lids with sterile vaselin to permit free drainage. Castor oil and glycerin, of each, equal parts; or borated vaselin may be used for the same purpose. Astringents and caustics, silver nitrate, etc., are usually applied by the doctor.

For an anodyne, atropin is principally employed, also cold or hot compresses; in the use of the latter care must be taken to prevent irritation of the skin that will show itself in a permanent livid hue.

In case of excessive swelling a leech may be applied, or the doctor may resort to scarification.

Medicines consist of cathartics, diuretics, diaphoretics, opiates, tonics.

General Treatment.—Frequent baths, plenty of fresh air. Temperature of the room should be uniform. Moderate and subdued light.

Diet should consist of nutritious food, liquid or soft, according to the condition of the patient.

The gravity of each case depends largely upon the extent to which the cornea is involved.

Treatment must, of course, be modified according to the virulence of the inflammation.

To Apply a Leech.—Leeches are applied to relieve congestion. Put one in a small vial with a mouth large enough for the leech to crawl through. Cleanse the patient’s temple, and with a sterile needle scratch the skin until the blood shows. Directly over this place the mouth of the vial. The leech will bite almost instantly, and will drop off when it is gorged. If the occasion requires the leech to be taken off before it is gorged, sprinkle a little salt on its head. Hemorrhage should not be checked unless profuse, in which case a piece of ice or alum applied to the spot will arrest the flow. If possible, the patient should be kept in ignorance of the application.

When the disease develops it will be manifested, as a rule, from three to five days after birth by redness of the eye and a slight discharge. It is the duty of the nurse, as well as of the accoucheur, to examine the eyes of the new-born babe each day during the lying-in period, and at the first sign of trouble, if discovered by the nurse, the attention of the physician should be directed to the matter. During the first two or three days after the disease begins there is usually little or no pus present, and comparatively little swelling of the lids, except in the most violent cases. During this so-called first stage the treatment should be that of an ordinary acute catarrhal conjunctivitis—viz.: iced compresses applied for an hour twice a day if the baby is well and strong; gentle flushing of the conjunctival sac with a warm saturated solution of boric acid. As soon as pus begins to form, the eyes must be cleansed more frequently—every hour during the day and every two hours during the night—and the edges of the lids should be kept constantly anointed with sterile vaselin to prevent their agglutination and the retention of the discharge. Drainage is indicated whenever there is suppuration, and if we can prevent the sticking together of the lids in this way, we allow free drainage and reduce the irritation which invariably results from retention of the discharges in these cases.

In all cases it will be noticed that after the discharge has been washed away from the everted lids there are strings or shreds of mucus in the folds of the conjunctiva. The nurse should endeavor at each cleansing to wash them out by continuous flushing and gentle manipulation of the lids. If she does not succeed in keeping the eyes free from these shreds the physician will remove them at least once a day.

If the conjunctiva of the globe becomes swollen and edematous and rolls up over the edge of the cornea, the nutrition of this precious membrane becomes threatened, and inflammation of the cornea, with ulceration or sloughing, is the cause of the blindness which follows this disease. At the slightest indication of haziness of its surface the iced compresses should be discontinued and hot fomentations resorted to. They may be applied every three hours for fifteen minutes each time. Great care and judgment are necessary in order that the heat be sufficient to be effective without burning the delicate skin of the lids and that it be continuous. The compresses should be changed at least every sixty seconds during their application. When the cornea becomes ulcerated great care must be used in the manipulation of the lids not to make pressure upon the eye-ball for fear of causing perforation. If the lids are slippery from the presence of vaselin or discharge, a single thickness of gauze or a little cotton held between the finger and the lid will be found a great help in opening the eye.

As the discharge of pus begins to diminish, which may not be for several weeks in bad cases, we may somewhat modify our treatment; the strong applications need not be quite so strong, and the cleansing need not be quite so frequent; but the most important item in the treatment of all these cases is the frequent thorough cleansing of the eyes, and if the cleansing is thoroughly done as above described each hour and the lids kept constantly anointed, in order to prevent accumulation of the irritating discharge, more frequent cleansing will not be necessary. Great care must also be exercised to prevent much crying by these little patients. They must be kept warm, regularly nursed or fed, and the slightest derangement of the alimentary canal must be attended to. If the cause of the crying cannot be ascertained and removed, it is wiser to soothe the baby with a simple anodyne than to permit the crying to go on.

It should not be necessary to point out the danger which lies in all things which come in contact with the discharge from these eyes.

Blennorrhea neonatorum is responsible for at least 25 per cent. of all the blindness in the world, and yet not one case in a hundred should result disastrously if skilfully and patiently managed.

EMERGENCIES. — HEMORRHAGES. — FRACTURES. — DISLOCATIONS. — SPRAINS. — BURNS AND SCALDS. — BURNS OF THE EYE. — INJURIES TO THE EYE. — SYNCOPE (FAINTING OR SWOONING). — HYSTERIA. — EPILEPSY. — DROWNING. — SUSPENDED ANIMATION FROM NOXIOUS GASES. — METHODS OF ARTIFICIAL RESPIRATION. — SUNSTROKE.

Hemorrhage from the arteries may be recognized by its bright red color and by the spurting jets by which the blood leaves the wound. Venous (from the veins) hemorrhages flow in a steady stream and are darker in color. Arterial hemorrhage may be checked by firm pressure over the side nearest the heart or above the wound. Venous hemorrhages may be checked by firm pressure on the side distant from the heart or below the wound. Large veins like the jugular should be compressed both above and below the wound because the vein may bleed from both ends. If possible, digital pressure should be made directly over the bleeding point.

Hemorrhage from the leg may be checked by firm pressure upon the femoral artery, in the middle of the groin at the top of the thigh.

Hemorrhage from the forearm by compression under the inner edge of the biceps against the humerus.

Hemorrhage from the upper arm by compression of the axillary artery against the humerus in the axilla.

Hemorrhage from the cheek by compression on the facial artery against the lower jaw just in front of the masseter muscle.

Flexing the limbs at the joints with a pad between them to make the compression secure and then binding the part may prove a successful method of arresting the flow of blood. A constrictor of rubber tubing twisted firmly around the limb is a ready appliance and a most successful way of checking a flow of blood from an injured limb. But it should not remain on longer than absolutely necessary or gangrene may result from complete stoppage of the circulation.

Wounds should be packed fully and evenly with some absorbent material. Applications of heat and cold are common methods of checking hemorrhages, heat being at all times preferable. Hot water poured on open wounds will encourage coagulation. Bleeding from an ulcer of the leg, which often results from varicose veins, should be stopped by firm pressure over the wound.

Hemorrhage from the Lungs.—A teaspoonful of salt taken internally may stop it. Place an ice-bag over the chest. Morphin, gr. ⅛-¼, may be given under the instructions of a physician. In all cases put patient in bed and enjoin complete rest until medical aid arrives.

Nose-bleed (Epistaxis).—First of all, position and rest should be attended to. The patient should not lie down unless very weak. The higher the head the better. Loosen clothing about the neck and thorax. Caution patient against coughing or sneezing. Holding the nostril tightly closed, with cold applications to the back of the neck, is sometimes successful. Insufflation of ice- or alum-water, or of tannic acid solution may induce coagulation. Profuse bleeding will require packing of the nostrils.

Compound Open Fracture.—The bone is broken and the wound extends from the seat of the fracture to the outside. Such wound may be caused by the injury itself, or may occur secondarily from the protrusion of pieces of bone through the skin.

A comminuted fracture is one in which the bone is broken into a number of fragments.

An Impacted Fracture.—The broken ends have been forcibly driven into one another, and are thus fixed.

Multiple Fracture.—The bone is fractured at different points, or when different adjoining bones are broken.

A complicated fracture is one associated with a serious injury to some important adjacent part—e.g., a large vessel.

A green stick or incomplete fracture occurs where the bone is soft and bends, and is only partially fractured; it is most frequent in children.

Symptoms of fractures are usually pain, loss of function, deformity (seen or felt by passing the fingers over the seat of pain), crepitus or the grating sound produced and felt on rubbing the broken ends against each other, abnormal mobility in the course of the bone, swelling, and discoloration.

The principal point is to keep the part immovable and in a position to give as little pain as possible. Support the limb with something stiff and padded with cotton or remnants of yielding material. Bandages can be made of handkerchiefs, strips of linen, ribbon, etc., to keep the splint firm.

For the forearm padded splints long enough to take in the hand from above the elbow should be applied. Tie firmly with bandages and suspend in a sling.

If the upper arm be fractured, bind it tightly to the side. For the thigh, the splints should extend from under the arm to the ankle and should be bound to the body and leg with long towels or sheets torn into strips. A splint made of blankets, rolled up tightly from both sides on broomsticks, allowing space for the limb to rest between the supports, is a good and ready appliance. Always make extension to prevent contractions of the muscles, as this would result in shortening the leg.

For a broken clavicle (collar-bone) bind the arm to the chest. Put the patient on the flat of his back with a small pad between the shoulder-blades. This will keep the broken ends in a normal position.

N. B.—In every case elevate and support the injured member on a pillow, keep in position and give complete rest until medical aid arrives.

Dislocation is a displacement of the joint. It may occur with a break of the limb, but usually results from a fall or strain.

There may be deformity and inability to move the injured part. Sometimes an abnormal projection is the first sign. If inflammation arises, apply cold applications. The only treatment a nurse may give is to keep the patient quiet and await skilled help.

There may be extreme pain, swelling, inflammation, discoloration, and inability to use the joint. Support and elevation of the limb is of the greatest importance. Use hot or cold applications to allay the inflammation and pain. Cover with a thin soft pad, and bandage evenly and firmly. A sprain should not be neglected, as it may cause future disease of the injured part.

For recent bruises cold applications are best. Give the patient complete rest, support and elevate the injured limb, apply cold or hot applications, and await skilled help.

In severe cases the constitutional treatment is of more importance than the application of local remedies. If the patient is in shock wrap him in warm blankets, and give him stimulants. In superficial cases where the skin is not broken powder with bicarbonate of soda (baking soda). A ready domestic application is sweet oil. Exclude the air at all times. When vesicles have been produced they should be punctured with a sharp instrument, and the serum gently evacuated with absorbent cotton. Apply soothing ointments or wet dressings. In case of severe burns of the body immerse the patient in a warm bath, keeping it at even temperature. Separating a layer of common white cotton wadding, and wrapping it about the injured part will allay the pain, and the cotton has the advantage of not adhering to the raw surface. Splints and bandages should be employed to prevent contractions.

For burns resulting from molten lead, strong alkalies, lime, or acids, flush freely with warm water or boric-acid solution, and anoint with pure vaselin or a few drops of castor oil. Do not rub the injured tissues. The applications should be made quickly and very gently. Put on cold compresses until medical aid arrives.

For surface injuries a drop of castor oil may be applied, and the eye kept closed for the day with a pad of wadding and a bandage.

Place the patient in a recumbent position. Loosen all clothing, and dash cold water on the face and chest. Spirits of ammonia or smelling salts should be used with caution, and not brought too near the nostrils. The pulse and general appearance will indicate if condition is serious. Give whisky and strychnin sulphate (¹/₃₀ gr.) hypodermically if necessary.

In hysteria the patient may be apparently unconscious; the body is normal to the touch, the pulse is full and regular, the color is natural, and if an attempt is made to raise the eyelid it will be met with resistance. Do not leave the patient alone, but do not disturb her until she recovers.

The attack comes on very suddenly. The patient utters a sharp cry, and falls to the ground. The muscles are rigid, the eyes staring, and there may be frothing at the mouth. The muscles soon relax, and there are twitchings of the whole body. The attack may last only a few minutes. Place the patient on his back with the head slightly elevated, and loosen all clothing. Put a wedge between the teeth, give him plenty of fresh air, and do not attempt to stop the movements.

Begin artificial respiration at once, then soon as possible remove or loosen all clothing about the back, chest, and abdomen. Free the throat and mouth from mucus and foreign substances. Secure the tongue with a dry cloth or handkerchief; keep it drawn forward and to one side, as this opens the windpipe. Then turn the patient face downward, allowing the abdomen to rest on a roll of goods. Make firm pressure on the back and on both sides of the thorax to evacuate the lungs. Envelop the body in warm blankets, apply heat to the feet, and stimulate with hypodermic of strychnin, whisky, and coffee.

Remove patient at once into the fresh air. Employ artificial respiration, apply heat, and stimulate hypodermically.

Sylvester’s Method.—Lay the patient upon his back; kneel above the head, take firm hold of the arms above the elbow, and move them horizontally—first away from the body, then over the head until the hands touch behind; pull them backward for a few seconds. This process expands the chest cavity, and the lungs are filled with air, inducing inspiration. Return the arms to the first position, and make strong pressure on the sides of the chest and epigastrium to expel the air and effect expiration. Movements should not be too rapid; they should be repeated about sixteen times a minute. In case of apparent want of success, persist in the treatment until it has been ascertained that the heart has ceased to beat.

Marshall Hall’s Method.—Roll the patient over on his breast, make gentle pressure on the back, then turn the body gently but completely on the side, and again make gentle pressure on the back. Repeat these movements fifteen times every minute.

Artificial respiration may be kept up for hours before the faintest symptoms of life are shown.

Two conditions result from exposure to excessive heat: thermic fever and heat exhaustion.

In thermic fever, after prodromal symptoms consisting of headache, nausea, and vomiting, there are stupor or coma, fever ranging from 105° to 110° F., flushing of the face, contraction of the pupils, a rapid, full pulse, and noisy respirations.

Management.—Pack the patient in ice, and rub with ice. Ice-water enemas may also be given. Bleeding and the subcutaneous administration of normal salt solution are sometimes efficacious.

In heat exhaustion consciousness is not lost; the skin is cold and moist; the respirations are shallow and rapid, but not noisy; and the pulse is feeble.

Management.—The patient should be covered with blankets and surrounded with hot bottles. Aromatic spirit of ammonia (30 minims), whisky, and black coffee are useful stimulants.

BATHS AND PACKS. — WARM PACK FOR PNEUMONIA PATIENTS. — COLD PACK TO REDUCE TEMPERATURE. — SPONGING TO REDUCE TEMPERATURE. — HOT PACKS TO INDUCE PERSPIRATION. — TUBBING. — ALCOHOL SWEAT.

Place under patient: First, blanket, then rubber sheet, covered with second blanket. Place small rubber piece, covered with the towel, under patient’s head. Third blanket put over patient. Leave patient on side while woolen blanket is wrung out of hot water. Place this blanket quickly under and about the patient, removing lower dry one at the same time. Leave feet out of wet blanket, wrapping them up dry, and use hot-water bottle if necessary. Cold compresses to head. Leave in pack 45 minutes. Wipe dry; give alcohol rub. Take temperature and pulse every half-hour after removing from pack.

Place under patient: First, blanket, then rubber sheet, covered with second blanket. Have blanket over patient with patient on side. Wring a cotton blanket or sheet out of warm water to wrap about patient, leaving feet out, covering them with a dry blanket, using hot-water bottle if necessary. Compress on head. Sprinkle with tepid water. Use friction. Turn patient once in midst of pack and iron back with ice, and again just before he is removed. Leave in 30 minutes. Change compresses frequently. Give plenty of water to drink. Have sea sponge to take up water. Leave patient between blankets; give alcohol rub. Take temperature and pulse half an hour after removing the pack.

Place patient between blankets. Rubber and towel under head. Towel across loins. Wash face and apply cold compress to head. Sponge chest, arms, legs, and back with warm water. Cool water and sponge chest. Apply cold compress across chest. Turn patient on side. Sponge arms, leaving upper part of body exposed. Fold blanket up and sponge back. Change compresses frequently. Give plenty of water to drink. Continue sponging from 20 to 30 minutes. Rub with alcohol and put patient to bed. Take pulse and temperature half-hour after sponging.

Place under patient: First, blanket, then rubber sheet, covered with the second blanket. Third blanket place over patient. Wrap feet up dry. Have patient on side. Wring fourth blanket out of hot water and place quickly about patient, bringing well up around neck and in between the arms. Wrap well about the legs. Bring under rubber sheet up about the neck well and place a long rubber sheet snugly over that. Wrap feet, then bring under blanket up over rubber sheet, and top blanket tucked over all, seeing that all folds of blankets are snug around the neck. Rubber and towel under head. Compress to head. Place sheet over patient not tucked in. Give hot drinks freely unless liquids are restricted. Take pulse before placing patient in pack and every 15 minutes while in. Leave patient in 45 minutes and then in dry blankets half an hour, Take out of pack, rub dry, and give alcohol rub.

Place under patient: One blanket covered with long rubber sheet, then with tubbing sheet, over which place muslin sheet widthwise. Place towel over loins. Bring sheet up around patient, tubbing sheet rolled in from sides and tied to the four corners of the bed. Use four pails of tepid water, gradually cool to 60° or 70° F. Apply friction most of the time. Compresses to head. Give water freely. Leave feet out of water. Turn patient and use friction on back once while in and before taking out. Take pulse frequently. Leave patient in pack 20 minutes. Turn patient and remove water with siphon and sea sponge. Lower patient, removing tubbing and wet sheet, leaving patient between blankets with hot-water can at feet. Take temperature half-hour after removal. Give alcohol rub and make bed.

Place under patient blanket covered with a long rubber sheet and then second blanket. Wrap shoulders in a blanket. Place folded blanket and small rubber sheet around the feet. Cover patient with blanket, and over that place long rubber sheet. Fold back upper rubber sheet blanket over patient and then one under patient. Place covered bricks on folds of lower blanket. Pour one tablespoonful of alcohol on hot bricks covered with outer edge of blanket, on which bricks rest, then with blanket over patient, folding it in between bricks and patient. Bring under rubber sheet up and upper one down. Tuck each rubber sheet and blanket well in about the neck. Bring folded blanket and short rubber sheet over feet, under the long rubber sheet. Arrange opposite side in like manner. Place over all 2 blankets and tuck in. Cover these with clean sheet, not tucked in. Rubber and towel under head. Apply the cold compress to head and change frequently. Give a hot drink unless contraindicated. Take patient’s pulse before placing in sweat and every 10 minutes while in. More often as condition of patient indicates. Leave in one hour. Do not expose patient while removing bricks and blankets. Leave one blanket under and two over patient for half an hour. Tuck blanket about patient, sheet over all. When removing these blankets dry patient and give alcohol rub.

MASSAGE—MECHANO-THERAPY.

Massage (meaning to knead or manipulate) is one of the oldest therapeutic measures employed for the relief of disease. It is probable that the Chinese used this method of treatment several thousand years ago. The Japanese and the Greeks and Romans also were ancient users of massage. To-day it is recognized as one of our most useful adjuvants in the treatment of a great many disorders. Unfortunately, like some other therapeutic measures, it has been misused for personal gain by unscrupulous parties to the great detriment of this form of treatment; because of this many physicians have hesitated to adopt its use extensively for fear of being classed with the army of quacks and charlatans who endeavor to guile the public with a pretended knowledge of massage. It not being possible for all nurses to become proficient in the art of massage while doing general nursing (as it requires time, patience, and a great deal of experience to succeed), massage has become somewhat specialized, and we find many nurses who devote their time and attention exclusively to this work. Yet all nurses should have a general knowledge of the physiologic effects of massage and how to give it. The best results are obtained only when massage is given under the direct supervision of a physician, as massage may influence the function of almost every organ and tissue of the body.

Some general rules may be given as to the hour and duration of each treatment. A great deal depends upon the nature of the disorder in each individual case. In the treatment of neurasthenic patients where insomnia is often a troublesome symptom, massage given one or two hours before the patient quiets down for the night frequently results in improved sleep. Again, other patients will do better to have the treatment one or two hours after the morning meal. Individual peculiarities must be considered always in giving massage. The room should be of such temperature that the patient when exposed will not feel chilly. Absolute quiet should be maintained during the treatment, and after the treatment the patient should remain quiet in a recumbent posture for an hour or two as the condition may require. The oft-used expression “that a masseur or masseuse possesses a great deal of electricity which is transferred during the treatment to the patient,” should find no place in the intelligent mind in considering the effects of massage. It is true that one operator by his method of administering massage may please a patient and accomplish more than another, but this is due only to the fact that one understands how it should be given, and the other does not.

All the different movements in massage may be classed under the following: First, stroking; second, friction; third, kneading; fourth, vibration; fifth, percussion; sixth, joint movements.

Stroking.—This procedure may be given with two or three fingers or the palmar surface of one or both hands. The movement should be gentle, and the contact made as lightly as possible. Stroking should be done always in one direction, and, as a rule, in the direction of the blood currents in the arteries. The physiologic effects when properly applied should be sedative, as the purpose should be to diminish the blood-supply to the part. It produces a certain effect upon the cutaneous nerves which is very quieting. It is often found useful when applied about the forehead for sleeplessness. Nervous headache may be relieved by the same procedure. Neuralgic pains and the vague, but nevertheless uncomfortable, sensations complained of by neurasthenic patients are often relieved by this measure.

Friction.—In this procedure the whole or part of the palmar surface of the hand is moved over the surface of the body with considerable pressure. The principal effect of friction is upon the superficial blood-vessels and the lymphatics. In the lower extremities the movement should be from below upward in the direction of the venous flow. The same may be said of the upper extremities. The thumb may be made to follow the course of the larger veins, in this manner stimulating the venous circulation. Some patients object to friction applied by the dry hand, in which case some lubricant may be used; pure vaselin, cocoa-butter, and talcum powder are among the best for this purpose. Friction should always be used in the beginning of massage, especially if the surface of the body is cold.

It is not the intention here to give minute instruction as to the methods of procedure with all the different parts of the body; only general instructions can be here given, and those requiring further information should consult text-books upon this subject.

Physiologic Effects of Friction.—First, reflex effects upon the vasomotor nerves producing dilatation of the peripheral blood-vessels with increased circulation, aiding the venous and lymphatic circulation. It is useful in all conditions accompanied by poor peripheral circulation. It not only stimulates the circulation, but aids materially in elimination and increased nutrition. It aids in the relief of general dropsy and hastens the absorption of inflammatory exudates resulting from sprains and various joint affections, etc.

Kneading.—Kneading is one of the most important procedures in massage. It consists in the alternate compression and relaxation of the tissues, the hand not being allowed to slip over the surface as in friction. It may be administered in various ways, such as rolling, wringing, and the use of the palm or fingers. Furthermore, it may be deep or superficial. Superficial kneading stimulates all the functions of the skin, increases superficial circulation in the blood-vessels and lymphatics. In deep kneading the object is to influence the deep-lying muscles, and care should be exercised in this procedure not to injure the large blood-vessels and nerves. Here a knowledge of anatomy is essential. In the beginning of deep kneading little pressure should be exercised until tolerance is established; then greater pressure may be exercised without discomfort to the patient. It is quite essential that each muscle group be gone over carefully and thoroughly, so that every muscle so far as possible shall be included in the treatment. The physiologic effect of deep kneading is a stimulation of the functions of the nerves, blood-vessels, lymphatics, and cellular metabolism of the muscles. It is of especial benefit to patients who are unable to take a sufficient amount of active exercise, such as those suffering from neurasthenia, rheumatism, chronic neuritis, locomotor ataxia, and from localized disturbances, such as fractures, sprains, etc.

Vibration.—This procedure consists of vibratory movements to the body of the patient through the hand of the operator. It may be given by using the palmar surfaces of the hand or the finger-tips. This procedure stimulates the superficial circulation and acts as a mild general stimulant. It may be used in conditions of poor circulation from any cause, but is contraindicated in conditions of hypersensitiveness.

Percussion.—This procedure consists of blows or taps with varying degrees of force. The tips of the fingers may be used, the two hands alternating, or the palmar or the ulnar surface of the hands may be used for the same purpose. In any case, the force should not be sufficient to bruise the tissues. The physiologic results of percussion are stimulation for functions of the skin and a marked effect upon the underlying structures, muscles, nerves, and blood-vessels. It is useful in such conditions as sciatica, inactivity of the liver, chronic constipation, poor circulation from various causes, and to produce reaction after a cold bath, etc.

Joint Movements.—Under this procedure we may mention flexion, extension, abduction, adduction, pronation, supination, circumduction, and stretching. The movements may be passive or resistive. In passive movements the exercise is almost entirely confined to the joint, the patient offering no muscular resistance. With the resistive movements a certain degree of muscular activity is enforced by the patient, thus not only exercising the joints, but the muscles connected with the joints. The physiologic effect of joint movements is to markedly stimulate all the parts about the joint, and is indicated in various joint disorders which may have resulted in the lessening of the normal movements of the part, as in rheumatism, gout, chronic synovitis, and the stiffness that follows immobilization of the joint in the treatment of sprains, fractures, etc. Care should be exercised in the beginning not to use too much force in the manipulation, otherwise the existing condition may be aggravated, and more harm result than good. Increased force may be exercised with each treatment, always bearing in mind the necessities of each case.

ELECTRICITY.

By Dr. James C. Gill,

Rush Medical College, Chicago, Ill.

Electricity is a useful and important therapeutic agent, and an understanding of its effect when applied to the human body is as essential as a knowledge of any other therapeutic measure. Too often the therapeutic use of electricity is committed to those having very little knowledge of it, and consequently good results are not obtained.

It is a great mistake to allow or advise patients to use electricity themselves; no greater mistake would be made or more harmful results follow if they were advised to go to the drug store, and help themselves to any drugs they might choose. Electricity should be administered by a physician, or under the directions of a physician by a nurse who has been thoroughly taught its use.

In medicine we have usually considered three different forms of electricity: First, Galvanism or Chemical Electricity; Second, Faradism or Induced Electricity; Third, Franklinic or Static Electricity. Now, we add a fourth and a very important one—namely, X-ray. A nurse should have a general knowledge of these different manifestations of electricity and their effect when applied to the body.

In electricity we have units of measurements as we do in weights and measures. For instance, the force that drives the current of electricity along, as we might express it, is called the electromotive force, and its unit of measurement is a volt. The resistance which the current must overcome is measured in ohms, and the strength of the current is measured in amperes, or, as we measure it in medical electricity, the thousandth part of an ampere, a milliampere.

Galvanic or chemic electricity has certain properties not obtainable in the other forms. Comparatively speaking, it is a current of considerable quantity, but low electromotive force. The galvanic current passes always from the positive to the negative pole. It possesses the power to decompose various compounds, such as water, the tissues of the body, etc. This is called the electrolytic action, and may be used to destroy certain tumors, for the removal of superfluous hair, etc. Again this current has the power to convey certain substances in solution into the tissues. This is called cataphoresis, and is used to produce local anesthesia by the use of cocain applied to the positive pole. This is one of the best methods we possess of obtaining local anesthesia.

The effect of iodin may be obtained by the use of a solution of potassium iodid, and the negative pole may be used to affect local swellings, etc. Muscular tissue may be made to contract by the application of the current, either when applied to the motor nerve supplying the muscle or when applied directly to the muscle. Upon sensory nerves the positive pole is sedative, and may be used to relieve pain in cases of neuralgias, etc. The negative pole is stimulating, and may be used in conditions requiring increased nutrition, etc.

In using galvanism a good battery and outfit are essential. First, it is necessary to have a milliampere meter, an instrument to measure the strength of current used. The quantity of electricity used should be measured the same as the quantity or dosage of drugs prescribed. Another essential instrument is the rheostat, by which the current strength may be gradually increased or decreased without interrupting the current. The electrodes which are attached to the poles of the battery may be metal, metal covered with sponge, cotton, etc., preferably cotton, which may be renewed with each application, thus avoiding the possibility of infection, always present in the use of a sponge-covered electrode, which cannot be changed with each application.

In the use of galvanism we may speak of two different methods. First, what is called cerebral galvanism, second general. By experimentation it has been clearly demonstrated that all the deeper tissues and organs of the body, such as the brain, spinal cord, liver, etc., may be influenced by galvanism. In cerebral galvanism the object is to influence the brain and spinal cord. In applying it to the head, a sponge or cotton-covered electrode 4-5” in diameter may be used. The positive electrode is applied to forehead, the negative at nape of neck, using a current of 5-10 milliamperes for from five to fifteen minutes, care being taken not to suddenly make or break the current, as this would produce a disagreeable shock to the patient. The circulation of the brain may be affected also by placing an electrode at the nape of the neck, and a smaller electrode (1-2” in diameter) passed up and down along the border of the sternocleidomastoideus muscle, using a current of 3-5 milliamperes. Galvanism used in this way is beneficial in such conditions as cerebral anemia, neurasthenia, insomnia, etc. In applying to the spine, one electrode may be used at the upper and the other at the lower part of the spine; or a large-sized electrode may be placed over the abdomen, and the other electrode moved up and down the spine without breaking or interrupting the current, the strength of which may be from 10-20 milliamperes, and the duration of each application varied to suit the condition of the patient. This treatment is indicated in such disorders as neurasthenia, infantile spinal paralysis, locomotor ataxia, etc.

General galvanization may be given by placing a large-sized electrode at the spine, over the abdomen, or at the soles of the feet, the other electrode, smaller in size, being passed over the entire surface of the body without interrupting the current, which may be from 5-8 milliamperes. This procedure will stimulate the peripheral circulation, elimination, and nutrition. The muscles may be exercised by using an interrupted current of sufficient strength only to cause contraction. General galvanization is very beneficial in such conditions as neurasthenia requiring the rest treatment, convalescence from various diseases, paralysis, multiple neuritis, etc. In the use of electricity it should be remembered that patients show idiosyncrasies as in the use of drugs, so that each case should be given the amount of electricity best suited to individual peculiarities. Unless this point be kept in mind, we will be surprised to find at times that the use of electricity aggravates the patient’s condition.

Faradism, or the induced current, is characterized by a high electromotive force and a low amperage or quantity. It is an interrupted current, and from the secondary coil it is an alternating current. It cannot be used like the galvanic for electrolytic-cataphoric purposes. Its effect upon the body is almost entirely mechanical; also unlike the galvanic, there is practically no polarity. It cannot be used to affect the deep-lying structures, such as the brain, spinal cord, etc. The current-strength is not measured by a milliampere meter. It will produce muscular contraction only through the motor nerve supplying the muscle. This is a point to be remembered. Its use is confined largely to exercising muscles and stimulating peripheral circulation, and is useful in such conditions as paralysis where the cause of the paralysis is in the brain (because where the lesion producing the paralysis is in the spinal cord or peripheral nerves the muscle will not contract when faradism is applied), and in convalescence and all conditions requiring exercise which cannot be obtained actively. In applying this form of electricity (if the object be to stimulate circulation), the strength of the current should be regulated to suit the feelings of the patient. The technic is practically the same as described above for general galvanization. If we wish to exercise the muscle, then that current should be used which is just strong enough to produce muscular contraction and no stronger, care being necessary not to over-stimulate and exhaust the muscle. As a means of muscular exercise only this current is preferable to galvanism, being easier of application and less likely to produce harm.

Franklinic, or static electricity, is seldom administered by a nurse unless in a hospital or in a physician’s office. The current is produced by machines of various makes, such as glass and mica. The plates vary in diameter from twenty inches to three feet or more, and in number from two to sixteen or more. Its current then generated is characterized by an enormously high electromotive force, but a very minute quantity or amperage. Unlike the other two forms of current described, its use does not necessitate the removal of clothing. It may be used by placing the patient on an insulated platform and charging him with this current of high electromotive force, which very markedly stimulates circulation; or it may be used by applying or drawing sparks directly from the patient’s body, in this manner producing counterirritation, stimulating circulation, relieving localized pains, etc. It has been found useful in such conditions as chorea, neurasthenia, muscular rheumatism, lumbago, chronic inflammation of nerves, etc.

Nurses probably will never be called upon to use the x-ray, but this most wonderful manifestation of electro-force has recently taken a prominent position as a diagnostic and therapeutic agent. Parts of the human body heretofore only revealed by the use of the knife or post mortem are now plainly discernible during life through the use of this force. The field of its therapeutic application is a large one, and disorders which have been considered incurable or difficult of cure by other means now yield readily to the x-ray.

FOOD CONSTITUENTS. — SOURCE AND USE OF CHIEF FOOD CONSTITUENTS.

The Wise Combination of Food.—In order that each meal may be planned to meet the needs of the body it is necessary that it contain protein, fat, carbohydrate, mineral matter, and water. Some flavor foods should enter into each meal.

Flavor is important because it stimulates the appetite and because it stimulates the flow of digestive fluids and thus aids digestion. Such foods are only injurious when they are used to excess. In that case the nerves which control the flow of digestive fluids are overstimulated and at last become weakened. Avoid the use of too many flavors at one meal.

Overuse of Carbohydrates.—If too much sugar and starch are eaten, fermentation may take place and interfere with digestion. Too much sugar and starch overworks the liver.

Because sweet foods have the quality of satisfying the appetite very readily they should not be taken to satisfy hunger, but should rather be eaten after sufficient body building and body regulating foods have been taken to meet the body’s need for such foods. The custom of serving the sweet food at the last of the meal is in harmony with this dietetic principle.

It is important that children should form sane habits of eating sweet foods. The practice of using large amounts of sugar on cereals, cooked fruits, and in beverages should be discouraged.

The overuse of sugar irritates the lining of the digestive tract. This is caused by the abstraction of water from the mucous lining. Sugar is one-sided in its value, consequently it is much wiser to obtain a high percentage of heat from foods which serve other purposes as well.

Protein Foods.—The first class of foods, the proteins, includes those which have tissue building for their chief purpose. They are essential for maintenance and for body growth, as they are the only source of nitrogen. Therefore they are necessary for the growing child and for the athlete in the development of strong, vigorous muscles. The more easily digested protein foods are advised for the tubercular patient whose muscles and tissues have become debilitated by disease.

Proteins are required by each individual, but in varying amounts, to suit age, occupation, condition of system, and climate. The value of a mixed protein diet is urged by the best authorities rather than the diet which contains but one protein food.

Overuse of Protein Foods.—It is true that a high percentage of illness is caused by an accumulation of wastes in the body. It is also true that protein foods leave a higher percentage of waste material in the body than any other class of foods. It follows, then, that an overuse of protein foods overworks the excretory organs and tends to weaken them. The weakened excretory organs are unable to take care of the waste products, and as a result the system is affected by poisonous wastes which are produced by putrefaction in the intestines. A person in this condition is more liable to have rheumatism, gout, kidney and liver diseases than one in normal condition.

A Short Study of Protein Foods

Milk contains a small amount of protein. In a glass of about 12 tablespoons of milk there is less than 1 tablespoon of protein.

Egg contains nearly as much protein as lean meat.

Value of Fruit and Vegetables.—Vegetables contain protein, starch, sugar, cellulose, mineral matter, water, and undetermined substances.

Fruits contain (chiefly) sugar, cellulose, mineral matter, and water.

Water removes wastes, lubricates tissues, aids in forming secretions, helps to equalize the temperature.

Acids help to maintain the alkalinity of the blood—stimulate the appetite.

• Mineral salts—
• Build bone.
• Help to make blood alkaline.
• Aid in digestion.
• Aid in excretion.
• Build red blood-cells.
• Build nerve tissue.
• Build cells.

Cellulose exercises muscular lining of digestive tract.

Note.—Good authority makes the statement that the housekeeper is wise who pays as much for milk, vegetables, and fruit as for meat, eggs, and fish.

Use of Eggs.—Eggs serve as a meat substitute.

Eggs require the addition of carbohydrates and some fruit or vegetables to form a well-planned meal.

Digestibility of Eggs.—Raw eggs are more easily digested when beaten. They are often prescribed when a nutritious, highly concentrated diet is desired, and in cases of tuberculosis, some forms of anemia, and various wasting diseases.

Effect of Heat.—Egg albumen begins to coagulate at 134° F. and becomes jelly-like at 160° F.

Preservation of Eggs.—1. Water-glass (Sodium Silicate).—Nine quarts of boiled water (cooled) to 1 quart of water-glass. Eggs will keep in this solution three and a half months.

Note.—A good grade of water-glass should be of the consistency of molasses. If heavier than this the water-glass should be diluted to the right consistency, as the eggs should sink.

Eggs may be added to the solution from day to day as gathered. Do not wash. If the nests are clean the eggs will not need washing. Keep in a stone jar in a cool place just above the freezing-point. Do not use the solution the second year. The water-glass may be obtained in the dry or liquid form, and dissolved in either hard or soft water.

2. Lime Solution.—Piece of lime size of lemon. Pour 1 gallon of boiling water over it. Let stand until cold. Add 1½ cups of salt.

3. Paper Wrapping.—Wrap perfectly fresh eggs in paper and keep in cool place. This is not as effective as Methods 1 and 2, but keeps eggs for a short time.

THE PREPARATION OF FOODS FOR THE SICK. — TO PEPTONIZE MILK. — PEPTONIZED BEEF. — PEPTONIZED OYSTERS. — GUM ARABIC WATER (ACACIA). — LIME WATER. — ARROWROOT WATER. — ALBUMIN WATER. — OATMEAL WATER. — BARLEY WATER. — RICE WATER. — TOAST WATER. — COFFEE. — WHITE-OF-EGG LEMONADE. — CREAM LEMONADE. — FLAXSEED LEMONADE. — MILK LEMONADE. — MILK PUNCH. — KUMISS. — BONNYCLABBER. — WINE WHEY. — JUNKET. — BEEF TEA. — BEEF JUICE. — BEEF EXTRACT. — CHICKEN AND VEAL EXTRACT. — SCRAPED BEEF SANDWICH. — CORNMEAL GRUEL. — CRACKER GRUEL. — OATMEAL GRUEL. — OYSTER BROTH. — SCALLOPED OYSTERS. — OYSTERS ON THE HALFSHELL. — TO BOIL CLAMS. — CLAM BROTH. — MAYONNAISE DRESSING. — COCOA. — CHOCOLATE. — CHOCOLATE SOUFFLE. — VANILLA CREAM SAUCE. — BAKED CUSTARD. — WINE JELLY. — LEMON JELLY. — PLAIN MILK SOUPS WITH VEGETABLES. — TO BONE A BIRD. — STUFFED BAKED POTATO. — FRIED CALF’S BRAINS. — BOILED MUTTON. — SOFT-BOILED EGG. — HARD-BOILED EGG. — POACHED EGG. — OMELET. — WATER WAFERS. — RICE. — RICE CREAM. — CREAM TOAST. — FRENCH OR EGG TOAST. — STEWED PRUNES. — EGG CREAM. — SPONGE PUDDING. — SAUCE FOR THE PUDDING. — ICE CREAM ROYAL. — ICE CREAM. — FROZEN CUSTARD. — SHERBET. — MILK SHERBET. — LEMON SHERBET. — ORANGE SHERBET. — STRAWBERRY SHERBET. — TAFFY. — BRAN BREAD FOR CONSTIPATION. — BRAN BISCUITS FOR CONSTIPATION. — VEGETABLE SOUP FOR BABIES. — BARLEY SOUP FOR BABIES. — FROZEN COCOA CREAM. — GINGER SNAPS. — CORN GRIDDLE CAKES. — BARLEY AND CORN MUFFINS. — JOHNNY CAKE. — BUCKWHEAT GEMS. — POTATO BISCUITS. — NUT BREAD. — CORN MEAL GINGERBREAD. — RICE AND OAT MUFFINS. — PAPER INDICATES OVEN’S HEAT. — VINEGAR PREVENTS COOKING SMELL. — SAUCES FOR MEAT.

Directions.—Place the contents of one of the vials into a well-cleaned quart bottle. Pour upon it a gill of cool water and shake the mixture thoroughly. Then add to the mixture a pint of fresh milk and place the bottle in a vessel containing water as hot as can be borne by the hand without discomfort. Let it stand, with occasional shaking, for ten to twenty minutes, or until it has acquired a slightly bitter taste, when it should be removed from the hot water and placed upon the ice or in a cool place, to check digestion and keep from spoiling. If it is not quickly cooled the digestion will continue and the milk become too bitter to be palatable.

Milk thus peptonized may be sweetened if the patient desires it. It may also be flavored with wine or rum as desirable.

Cold Process.—This consists in adding to the milk the peptonizing powder as above, using cool water and milk, and then placing the mixture upon ice without warming it at all.

N. B.—If it be found that the milk ferments after following the above directions, boil the milk first, let cool, and then peptonize. “The bacteria in uncooked milk cause fermentation when pepsin is added.”

To a quarter-pound of finely minced, raw lean beef add a half-pint of cold water; cook over a slow fire to boiling and boil for a few minutes, stirring constantly from the beginning. Pour off the liquor and set it aside; rub the meat to a paste and put it into a clean glass jar or bottle with the liquor and a half-pint of cold water; add

Shake all well together and stand in a warm place, about 110° to 115° F., for three hours, stirring or shaking occasionally, then boil quickly, strain, or clarify with white of egg in the usual manner; season to taste.

This final boiling is essential; if omitted, digestion will progress until the food is spoiled.

For the great majority of cases it is not necessary to strain the peptonized beef, for the portions remaining undissolved are so softened under the action of the extractum pancreatis that they are diffused in an almost impalpable condition—in a form readily susceptible to digestion in the body.

Chicken meat, alone or mixed with an equal portion of beef, may be prepared in the same way.

A cereal gruel of wheat, arrowroot, etc., may be incorporated with the beef, thus giving a food combination that is often highly desirable.

The gruel is prepared in the usual manner, the dry cereal mixed perfectly smooth with cold water and cooked slowly in a double boiler until gelatinized. Four ounces of this gruel may be added to the meat paste, liquor, water and peptonizing powder as directed above, and the further details of the process carried out just as with the beef alone.

The extractum pancreatis will at the same time digest both the meat and starch (of the gruel). The broth with the cereal is more agreeable than when made of meat alone.

The peptonized beef or peptonized beef and cereal may also be made into a jelly.

To a half-dozen large oysters with their juice add a half-pint of cold water; heat in a saucepan to boiling, and boil briskly for a few minutes; pour off the broth and set it aside.

Mince the oysters finely and reduce to a paste with a potato-masher in a wooden bowl; put in a glass jar with the broth and add:

Let the jar stand in hot water or in a warm place, where the temperature is not above 115° F., for an hour and a half. Then pour into a saucepan, stir in a half-pint of milk and heat slowly to boiling-point. Season to taste and serve hot.

The boiling is essential—to prevent further digestion and keep the broth from spoiling.

If heated gradually the milk will be sufficiently digested before the mixture boils.

The very small bits of oyster that remain undissolved may be strained out, or rejected in eating the soup, but are rarely unacceptable to the stomach.

Dissolve 1 ounce of gum arabic in 1 pint of boiling water; add 2 teaspoonfuls of sugar, a wine-glass of sherry or juice of 1 lemon. Good for poison cases.

Into 2 quarts of water place a lump of unslaked lime the size of an egg. After standing awhile, stir thoroughly and pour off the solution; add fresh water and keep covered.

Moisten 1 teaspoonful of arrowroot with cold water; smooth into a paste; add 1 pint of boiling water and boil five minutes, stirring continuously.

Beat lightly the white of 1 egg; stir into a glass of water; sweeten if permissible.

Teaspoonful of oatmeal to a quart of water. Boil down to a pint; then strain.

Wash in cold water 2 ounces of pearl barley. Boil five minutes; then drain. Pour on 2 quarts of boiling water and boil down to a quart. Flavor with thinly cut lemon rind; add sugar to taste. Strain only at patient’s request.

Wash 2 tablespoonfuls of cleaned rice; put in a granite saucepan with a quart of boiling water; simmer until the rice is softened and partially dissolved; strain; add salt. May be served either warm or cold.

Put into a pitcher 3 slices of dark brown toast; pour in a quart of boiling water and cover closely. When cold strain. Wine and sugar may be added.

1. Best mixture, 2 parts Java to 1 part Mocha. Grind roasted beans just before using. Fair strength, 1 tablespoonful of coffee to 1 pint of water. With the ground coffee, mix white of 1 egg and a little cold water. Pour over it boiling water; simmer five minutes and steep for ten minutes.

2. Scald a granite coffee-pot. Mix cup of coffee, 1 egg, half-cup of cold water; add 6 cups of boiling water and boil three minutes. Remove to the back of the stove and add a half-cup of cold water. Let settle for ten minutes.

The New York Medical Journal gives the following directions (by R. F. Leftwich) for the preparation of this beverage as a nutritive drink for febrile disorders: “Two lemons, the whites of 2 eggs, 1 pint of boiling water, loaf sugar to taste. The lemons must be peeled twice, the yellow rind alone being used, while the white layer is rejected. Place the sliced lemon and the yellow peel in a quart jug with 2 lumps of sugar; pour on them the boiling water and stir occasionally. When cooled to about the ordinary temperature of tea, strain off the lemons. Now insert an egg whisk, and when the lemonade is in full agitation add slowly the white of the egg and continue the whisking. While still hot strain through muslin, and serve when cold. The white of the egg will be found to impart a blandness which makes the addition of sugar almost unnecessary. This absence of sweetness is greatly appreciated in pyrexial cases, and has its obvious value for diabetics. For non-febrile cases with clean tongues more than 2 eggs may be used to the pint if desired. This drink is contraindicated only in cases of true Bright’s disease. It is very useful in the febrile diseases of childhood. It also possesses antiscorbutic properties which replace those lost from milk by boiling and sterilization. It is recommended as part of the diet in typhoid fever, forming a relief from the monotony of milk, and does not have the constipating and flatus-producing effects that lie in beaten-up eggs that include the yolk. The author states that the patient who takes plenty of this lemonade in addition to 4 pints of milk per day will emerge from the pyrexial period of typhoid fever in a much stronger condition than without its use.”

Fill bottom of glass with cracked ice. Beat white of 1 egg to stiff froth, and sugar to taste. To this add juice of 1 lemon, stirring all the time, and then add one half-cup of cream. This will make 2 glassfuls.

Tablespoonful of flaxseed, pint of water. Boil one hour, then add juice of 1 lemon. Strain, and sweeten to taste.

Tablespoonful of sugar, juice of 1 lemon, 2 tablespoonfuls of sherry, half-cup of milk, half-cup of water.

Cup of milk, 2 tablespoonfuls of brandy. Sweeten to taste. Grated nutmeg may be added.

Kumiss is an acid effervescing drink; contains a very small proportion of alcohol. It is much more easily digested than milk. The casein is so finely divided that lumps cannot be formed in the stomach and it is easily acted upon by the gastric secretion. In the United States it has been prepared from cows’ milk to which the ferment is added.

One tablespoonful of sugar in a quart of fresh milk. Dissolve one-fifth of a small cake of yeast in a little cold water, then stir it into the milk. Put the mixture into strong patent-stoppered bottles. Shake the bottles for one minute, then stand them on end in a refrigerator or other cool place. After three days place the bottles on their sides, and turn them occasionally. Five days will be required to perfect the fermentation.

This is sour milk in which the curd and whey are served in the same dish. Curd, whey, and junket is milk where coagulation has been brought about by the action of rennet.

Put 2 pints of milk into a saucepan, and place on fire. When about to boil add 2 wineglasses of sherry. Simmer fifteen minutes, skimming off the curds as they rise. Add a tablespoonful of sherry. Skim again, and strain through clean linen. If preferred, 2 tablespoonfuls of lemon juice may be used instead of wine.

Heat half-pint of fresh milk. Add teaspoonful of essence of pepsin. Stir enough to mix. Pour into custard cups, and let stand until firm. Serve plain or powder with sugar or nutmeg.

Free a pound of lean beef from fat, skin, etc. Chop up fine. Put into a pint of cold water to digest two hours. Simmer for three hours, but do not let boil. Make up for water lost by adding cold water. Press and strain. The best meats for beef-tea are the round and rump. Cold water draws out the albumin; boiling water coagulates it.

Cut thin, juicy meat into pieces one and one-half inches square; broil one and one-half minutes over a hot fire. Squeeze with a hot lemon squeezer; season with salt and pepper. May be added to milk or poured over toast.

Heat a select piece of round steak so that the juice may be freely pressed. Cut steak into pieces that will fit into a lemon squeezer, and squeeze juice into a cup. Set cup in a dish of warm water, which must not be allowed to boil. Season to taste. May be served on toast.

Make chicken broth from an old hen and cook down until it jellies.

Cook a neck of veal until broth jellies; cool, and skim off fat. As needed, use equal parts of each. The nourishment is in the veal and the chicken gives it flavor.

N. B.—The most delicate stomach can digest this.

From a piece of steak scrape all the fiber from the connective tissue with a knife. Season with salt and pepper. Serve spread between slices of buttered toast.

Mix 2 tablespoonfuls of cornmeal, tablespoonful of flour, teaspoonful of salt, teaspoonful of sugar, into a thin paste with a little cold water. Add quart of boiling water, and cook three hours. Add cup of milk, and serve.

Two tablespoonfuls of cracker crumbs rolled fine, teaspoonful of salt, teaspoonful of sugar, cup of boiling water, cup of boiling milk. Mix salt, sugar, and crumbs; add boiling water, then milk; simmer two minutes.

Two tablespoonfuls of rolled oats; teaspoonful of salt, teaspoonful of sugar, cup of boiling milk. Mix oatmeal, sugar, and salt; add boiling water; cook in a saucepan thirty minutes, or in a double boiler for two hours. Strain, and add hot milk. Bring to a boil, and serve hot.

Chop a dozen oysters fine; put into a saucepan with a cup of cold water. Bring to boiling-point; simmer five minutes, then strain and season. By adding milk three minutes before broth is taken from the fire it is made more palatable.

Clean oysters; roll crackers, and mix with melted butter. Sprinkle dish with crumbs, then place a layer of oysters, a layer of crumbs, another layer of oysters, and so on until all are used. Bake in a hot oven.

Wash the shells, and put them on hot coals or upon the top of a hot stove, or bake in a hot oven. Open the shells, taking care not to lose any of the liquor. Serve at once on hot plates with toast. Oysters may be steamed in the shells.

Wash the shells clean, and put the clams (the edges downward) in a kettle; pour about a quart of boiling water over them. Cover the pot, and set it over a brisk fire for forty-five minutes. The boiling water will open the shells quickly, and let out the sand. When done remove the black skin which covers the hard part, trim clean, and put into a stewpan. Add some of the liquor in which they were boiled, and a large piece of butter; pepper and salt to taste. Serve hot.

Take several large clams; scrub them clean, and boil in a cup of water. The broth is simply the juice of the clams with the water, boiled for a minute or two. As soon as the shells open the broth is done.

Yolks of 2 eggs, half-teaspoonful of salt, pinch of Cayenne pepper, 2 teaspoonfuls of mustard, and half-teaspoonful of powdered sugar. Mix the ingredients thoroughly, then drip in half-cup of olive oil, drop by drop, stirring all the time one way. When thick add a teaspoonful of lemon juice. When the dressing is thick and smooth add a tablespoonful of cream. Stir with a wooden spoon or paddle.

Cup of boiling water, cup of boiling milk, a teaspoonful of cocoa; sugar to taste.

Put one-third of a square of Baker’s chocolate with 1 cup of boiling water and a tablespoonful of sugar into a saucepan. Set the pan over the fire and stir, moving piece of chocolate through water until it is melted. Ready to serve when boiling-point is reached. If chocolate is allowed to boil, separation of the fat from the other ingredients takes place, rendering it indigestible. If sweet chocolate is used, dispense with sugar.

Half-pint of milk, 4 tablespoonfuls of boiled chocolate, 2 tablespoonfuls of sugar, 2 tablespoonfuls of flour, 4 eggs. Put milk in a double boiler; when hot, sieve the flour into it, gradually stirring all the time, and let it cook six minutes. Put the chocolate, sugar, and 2 tablespoonfuls of water on the fire until smooth and glossy, then stir into the boiler. Take from the fire, and add beaten yolks. When cool add the whites beaten to a stiff froth. Pour the batter into a buttered dish that will hold a quart. Set dish in hot water, and place in the oven for a few minutes. Serve with vanilla cream sauce.

Beat together 2 tablespoonfuls of butter, two-thirds cup of granulated sugar, 1 tablespoonful of vanilla; then gradually beat in 2 cups of whipped cream. Place bowl in a pan of hot water, and stir carefully for three minutes.

Milk 1 cup, 1 egg, pinch of salt, 1 tablespoonful of sugar. Heat milk in a double boiler, break into it a stick of cinnamon. Beat together egg, sugar, and salt; then pour hot milk over the mixture, stirring all the time. Pour into a bowl, set dish into a pan of hot water; bake until set.

A general rule for thickening: 3 eggs to the pint or 5 eggs to the quart.

Gelatin one-fourth of a box, one-fourth cup of boiling water, one-fourth cup of cold water, half-cup of sugar, half-square inch of cinnamon, a few cloves, and half-cup of sherry. Put gelatin and cold water in a dish for half an hour, then add boiling water with cloves and cinnamon; lastly, sugar and wine. Stir until sugar and gelatin are dissolved. Strain, and pour into a mould. Set on ice or in cold water.

Prepare the same as wine jelly, and substitute lemons for the spices.

One cup of vegetable pulp, 2 cups of hot milk, 1 teaspoonful of salt, ⅛ teaspoonful of pepper, 1 tablespoonful of butter, 1 tablespoonful of chopped parsley.

Wash vegetables and put through meat grinder. Cook in as little water as possible. Add the cooked vegetable pulp and seasonings to hot milk. Heat and serve.

Note.—String beans, celery, or carrots may be used. A beef cube may be added if desired. This soup may be varied by using a combination of vegetables and its nutritive value may be increased by the addition of a beaten egg yolk.

Shredded fish or clams may be substituted for the vegetables.

Select and dress a plump squab; cut off the head and feet and the wings at the first joint; singe, and with a sharp knife make an incision down the back and wings. Scrape away the bones without tearing the meat. Put into shape and broil between buttered paper.

Select a smooth potato; scrub well, and bake in a hot oven about fifty minutes. Cut one end partly off lengthwise; scrape out the potato into a dish; add pepper, salt, and butter. Refill the skin, place a bit of butter in the top, and brown in an oven.

Soak the brains for a few minutes in cold water, drain, cover with boiling salted water, and cook for three minutes. Drain again, lay in iced water until cold, and set in the ice to get firm. Cut into pieces the size of an oyster, dip in egg and slightly salted cracker crumbs, and fry to a golden brown. Serve very hot.

Wipe a leg of mutton with a damp cloth and put it into a large kettle with enough boiling water to cover it and bring to a boil, then cook slowly until done. After the boil is reached allow fifteen minutes for each pound of the meat. When nearly done add salt and pepper to taste and a small onion, a minced carrot, and a stalk of celery. Lift from liquor and lay on a heated platter. Serve with drawn butter or caper sauce.

Place egg in a vessel of boiling water, then withdraw at once to the back of the stove. Remove egg in nine minutes.

Boil slowly for one half-hour.

Pour hot water (or milk) into a saucepan, using salt-spoonful of salt to each cup of water. Bring to boiling-point. Break egg into a saucer and slip into the pan. Withdraw the pan to a cooler part of the stove and cook till white of egg is set.

Separate 3 eggs. Beat whites to a stiff froth; beat yolks. Heat half-cup of milk; to it add 1 teaspoonful of cornstarch or flour; then stir in the yolks and add lightly the whites of the eggs. Put a good-sized piece of butter into the frying-pan. When hot pour in the mixture, cover, and cook from five to seven minutes. When set, remove the cover, and place pan into the oven to brown the omelet. Serve on a hot platter.

BAKED-FLOUR PORRIDGE.

Pound of flour, packed lightly in a muslin cloth; place in boiling water; boil from six to eight hours. Cut off the outer portion and grate the hard one. Blend with a little milk; stir into boiling milk to desired thickness.

Quart of sifted flour; half-pint of cold water; teaspoonful of salt; mix thoroughly. Roll out thin, and cut into small cakes with a biscuit cutter. Put into a pan to bake in a hot oven.

Take desired quantity of rice and wash three times in cold water, rubbing rice carefully between the hands; then drain. Boil fresh water slowly. Put in the rice and cover vessel closely. Cook over a slow fire about twelve minutes, when grain should be perfect and separated; drain in a colander. When dry, put rice into the oven to heat.

Take 2 tablespoonfuls of cleaned rice, 2 cups of milk, salt-spoonful of salt, 2 tablespoonfuls of sugar, and cook in a double boiler until the grains of rice are soft; then press through a coarse strainer into a saucepan and return to the fire. Take 2 eggs, beat the whites and yolks separately, and add to the rice when it reaches the boiling-point, stirring mixture lightly for a few minutes; adding only the whites produces a white cream.

One pint of milk, 2 tablespoonfuls of butter, 2 tablespoonfuls of flour, half-teaspoonful of salt, half-teaspoonful of pepper. Put milk into a double boiler to heat. Put butter into a granite saucepan, and when it begins to bubble, slowly shake in the flour; then add hot milk, a small quantity at a time, and season with salt and pepper. Toast bread a rich brown and dip into salt water. Lay on a dish and pour sauce over it. Grated egg may be added.

Cup of milk or cream, 1 egg, 1 salt-spoonful of salt, 3 slices of bread. Beat the egg a few minutes and add milk and salt. In this mixture soak the bread until it is soft. Place in a buttered omelet-pan and fry slowly till golden brown. Put a piece of butter on each slice; turn and brown the other side. Powder each slice with cinnamon and sugar and place in a covered dish. Serve very hot.

Pound of prunes, half-pint of water, quarter-cup of sugar, juice of 1 lemon. Soak prunes in warm water for fifteen minutes; then wash and stew in a covered pan for two hours; add water as needed. When done, add the lemon juice.

Juice of half a lemon, 2 eggs, 2 tablespoonfuls of sugar. Separate yolks and whites; beat yolks with sugar until well mixed; add lemon juice and place bowl in a dish of hot water over the fire. Stir slowly until mixture begins to thicken; then add beaten whites and stir until the whole forms a thick cream. Remove from the fire, pour into dishes, and set aside to cool.

Half-pint of milk, half-cup of flour, half-cup of sugar. Boil together, stirring all the time. After taking from the stove, stir in 2 tablespoonfuls of butter. Beat 6 eggs separately. Put yolks into mixture; then add whites lightly. Pour into an earthen pudding-dish, set in a pan of hot water, and bake forty-five minutes.

Beat to a cream 2 tablespoonfuls of butter, 3 tablespoonfuls of sugar. When ready for the table, add a half-cup of boiling-water into which has been added 1 teaspoonful of cornstarch. Flavor as desired.

Tablespoonful of flour, 1½ cups of sugar, salt-spoonful of salt, pint of milk, 2 eggs, pint of sweet cream, tablespoonful of vanilla, half-teaspoonful of almond, half-cup of sherry, or quarter-cup of brandy. Mix the sugar, flour, and salt. Pour milk into a saucepan; when it reaches the boiling-point put in the mixture, stirring for a full minute. Beat the eggs very lightly, and slowly add the milk, stirring rapidly for a few minutes. Strain into a dish and set aside to cool. Add the cream and flavor before freezing.

Cup of sugar, teaspoonful of vanilla, tablespoonful of brandy, and 1 pint of scalded sweet cream. The whites of 2 eggs may be added.

Pint of milk, cup of sugar, 2 pinches of salt, yolks of 3 eggs, pint of milk or cream, and 1 ounce of wine or brandy.

In preparing gelatin sherbet, soak gelatin in cold water about thirty minutes; then pour over it boiling water and add the other ingredients. When sugar is dissolved, strain mixture and freeze.

Two cups of milk, 1 cup of sugar, 4 tablespoonfuls of lemon juice.

Dissolve the sugar in the lemon juice, add gradually to the milk, and freeze.

Pint of boiling water, cup of sugar, and juice of 2 lemons. Do not add the lemon juice until ready to freeze. May add gelatin.

Tablespoonful of gelatin, cup of boiling water, cup of sugar, juice of 4 oranges, juice of 1 lemon, and 1 ounce of brandy. May omit gelatin.

Pick and clean a pint of fresh strawberries; crush, add a quart of water, a sliced lemon, and a teaspoonful of orange-flower water. Let stand for a few hours. Put a pound of sugar in another dish. Strain the mixture through a coarse cloth into the sugar, and when it is all dissolved freeze or place on ice.

Pint of water, 3 cups of sugar, half-cup of vinegar, and a piece of butter. Boil; do not stir. When it will thread off, cool.

Bran flour, 1 quart; white flour, 1 pint; 1 teaspoonful of salt. Mix thoroughly. Dissolve 1 teaspoonful of baking soda in water, put in ½ cup of molasses, and stir the mixture into the flour. Add 1 pint of buttermilk. Bake in a moderate heated oven.

Four cups whole wheat bran, 2 cups graham flour, 1 teaspoonful of soda, 1 teaspoonful of salt, 1 cup molasses, 1 cup sour milk or water, ¾ cupful lard or butter, 1 cupful chopped figs. Spices to taste.

One handful of spinach, 1 beet, 2 carrots. Chop fine and boil two hours in one quart of water. Strain through gauze and add sterile water to make one quart of soup.

One tablespoon of barley flour to one quart of water. Boil twenty minutes.

(A hospital recipe).

One-half pound box cocoa, 4 cups of water, 3 cups of sugar. Boil three minutes until it stiffens. Put on ice.

A. To Prepare the Cocoa Syrup.—One-half pound of cocoa, 4 cups of water, 3 cups of sugar. Boil about three minutes until it stiffens. Put on ice.

B. Beat white and yolk of eggs separately and thoroughly. Sweeten whites to taste.

C. For the Beverage.—Pour ½ ounce of pure cream into a glass and 1 ounce of cocoa syrup. Add yolk and white of one egg, Beat thoroughly and cover with a dash of white. Drop a clot of cocoa syrup on the white and serve with a spoon. Ice cream may be served in it.

One pint of honey, 1 teaspoonful of ginger, and 1 teaspoonful of soda dissolved in a little water and two eggs. Mix all, then work in all the flour possible, roll very thin, and bake in a moderately hot oven.

One cup of corn flour, ½ cup of barley flour, ½ teaspoonful soda, ½ teaspoonful of baking powder, ½ teaspoonful of salt, 1 cup of thick sour milk, 1 egg.

Mix and sift dry ingredients. Add egg to sour milk. Combine mixtures. Beat well. Should be quite thin batter. May use ¾ cup of corn meal and ¾ cup of barley flour.

1¼ cups of corn meal or corn flour, ¾ cup of barley, 2 tablespoonfuls of syrup, 4 teaspoonfuls of baking powder, ½ teaspoonful of salt, 1 egg, 1 tablespoonful of fat (melted), 1 cup of milk.

Mix and sift dry ingredients, add fat and well-beaten egg to milk. Combine mixtures, beat well, and pour into greased muffin pans. Bake in hot oven twenty to twenty-five minutes. Amounts of corn and barley may be reversed if desired.

Two cups of corn meal, 2 tablespoonfuls of syrup, 2 tablespoonfuls of fat (melted), 1 teaspoonful of salt, ½ teaspoonful of soda, 1 egg, 1 cup of sour milk.

Mix dry ingredients, add the fat, syrup, and well-beaten egg to sour milk. Combine and bake in shallow pan.

Two cups of buckwheat flour, 1 teaspoonful of salt, ¼ teaspoonful of soda, 2 teaspoonfuls of baking powder, 1 tablespoonful of fat (melted), 1 egg, 1 cup of sour milk.

Mix and sift dry ingredients. Add the fat, syrup, and well-beaten egg to sour milk. Combine mixtures and beat well. Bake in well-greased muffin pans twenty to twenty-five minutes. Barley flour or meal may be substituted for part of the buckwheat.

Substitute mashed potatoes for one-third the flour in any biscuit recipe. Sift dry ingredients together, mix in fat and potatoes, then add liquid cautiously. On account of the moisture in the potatoes less liquid is needed to make a soft dough.

One egg, 1⅛ cups of sweet milk, ¼ cup of corn syrup, 2 teaspoonfuls of baking powder, ½ cup of nut meats, ½ teaspoonful of salt, 1⅓ cups of corn flour, ⅔ cup of barley flour.

Beat egg, add syrup, then milk and sifted dry ingredients and nuts. Pour in pan. Let rise twenty minutes. Bake in a moderate oven about thirty minutes. Equal amounts of corn flour and barley give good results.

One cup of corn meal, 1 cup of barley flour, 1 teaspoonful of soda, ¾ teaspoonful of salt, 2 teaspoonfuls of ginger, 1 teaspoonful of cinnamon, ¼ teaspoonful of cloves, 1 cup of molasses or syrup, 2 tablespoonfuls of fat, 1 cup of sour milk, 1 egg.

Sift together dry ingredients. Combine molasses, fat, egg, and milk. Add to dry mixture. Beat well. Bake in thin loaf or in muffin pans. Corn flour may be substituted for corn meal.

One egg, 2 tablespoonfuls of fat, 1 cup of liquid, 1 teaspoonful of salt, 1 cup of rice flour, 5 teaspoonfuls of baking powder, 1 cup of ground rolled oats.

Beat eggs, add fat and liquid. Sift together dry ingredients. Combine mixtures and bake in moderate oven.

To judge of an oven’s heat, try the oven every ten minutes with a piece of white paper. If too hot, the paper will blaze up or blacken. When the paper becomes dark brown, darker than ordinary meat, pie crust, the oven is fit for small pastry. When light brown, the color of nice pastry, it is ready for tarts. When the paper turns dark yellow you can bake bread, large meat pies, or pound cakes. If it is just tinged, the oven is fit for sponge cake and meringue.

When cooking by gas always place a tin of water in the oven. A bowl of vinegar and water placed beside the stove will prevent the smell of cooking from spreading through the house.

• With roast beef, grated horseradish.
• With roast veal, tomato or horseradish sauce.
• Roast mutton, currant jelly.
• Roast pork, apple sauce.
• Roast lamb, mint sauce.
• Roast turkey, chestnut dressing, cranberry jelly.
• Roast venison, black currant jelly or grape jelly.
• Roast goose, tart apple sauce.
• Roast quail, currant jelly, celery sauce.
• Roast canvasback duck, apple bread, black currant jelly.
• Roast chicken, bread sauce.
• Fried chicken, cream gravy, corn fritters.
• Roast duck, orange salad.
• Roast ptarmigan, bread sauce.
• Cold boiled tongue, sauce tartare or olives
• stuffed with peppers.
• Veal sausage, tomato sauce, grated parmesan cheese.
• Pork sausage, tart apple sauce or fried apples.
• Frizzled beef, horseradish.
• Pork croquettes, tomato sauce.
• Corned beef, mustard.
• Lobster cutlet, sauce tartare.
• Sweetbread cutlet, sauce bechamel.
• Reed birds, fried hominy, white celery.
• Cold boiled fish, sauce piquant.
• Broiled steak, maitre d’hotel butter or mushrooms.
• Tripe, fried bacon and apple rings.
• Broiled fresh mackerel, stewed gooseberries.
• Fresh salmon, cream sauce and green peas.
• Cream sauce with sweetbreads.
• Orange salad with roast chicken.
• Celery sauce with quail.
• Stuffed olives with fish balls.
• Horseradish sauce with boiled beef.
• Horseradish and fried onions with liver.
• French dressing with sardines.
• Mint sauce with lamb.
• Yorkshire pudding with roast beef.
• Hard-boiled eggs and parsley with boiled salmon.
• Cream gravy, strawberry preserves with fried chicken.
• Oyster dressing for turkey.
• Celery and onion dressing with roast duck.
• Tart grape jelly with canvasback duck.
• Currant jelly with roast goose.
• Cucumber catsup with corned beef.

FOOD AND NUTRITION IN DISEASE. — DIET-LIST. — DIABETIC DIET. — MOTOR TEST-MEAL. — EWALD’S TEST-BREAKFAST.

A physician, writing to the New York Medical Journal, says the chemical composition of the body is quite similar to the composition of the foods which nourish it. Protein, fats, carbohydrates, mineral salts, and water are the compounds we need in our foods, and they are found in flesh foods and vegetables. Protein, the most important element, is derived principally from meat, eggs, and milk. It is also furnished by some vegetables, as beans, peas, and the gluten of wheat; but in these it is mixed with too much extraneous matter, as husks, bulbs, woody fiber, etc., to be useful in the diet of the sick. Extractives, as beef-tea, are included in the nitrogen compounds, but they neither build tissue nor furnish energy; they are appetizers and stimulants. Animal and vegetable fats are useful; these are found in meat, fish, milk, eggs, some cereals, olives, and nuts. The carbohydrates include sugars, starches, cellulose, and the fibers of plants. Potatoes, sago, farina, and arrowroot are rich in them. Fats should be used with caution in disease, because they retard the formation of hydrochloric acid, which excites the pancreatic secretion, an important factor in digestion. Man can live better without a stomach than without a pancreas. Physicians realize that they must rely on diet rather than drugs to cure indigestion, as the food varies in its proportion of fat, protein, and carbohydrates; the digestive juices are poured out or repressed and altered in strength and quantity.

Milk is not an ideal food for the sick, too large a quantity being required, and the large curds it forms in the stomach often rendering digestion difficult. Boiled with rice it forms an excellent diet.

In acute diseases lasting from four to six weeks no great effort should be made at forced feeding. Thin soups, flooding the stomach with unnutritious fluids, should be avoided. It is unnatural to take food during physical or mental suffering. Appetite is wanting, and imperfect assimilation adds to the physician’s worries and the patient’s discomforts. When there is no appetite the digestive juices are absent. Feed a convalescent when, through conversation about some dainty dish, interest is aroused and saliva is secreted.

Typhoid diet, as soon as food is ordered, is as follows:

To the foregoing may be added for

Procedure.—Cook oatmeal 2 hours. When done, beat into it the melted butter. Then fold in the beaten whites of eggs.

OBSTETRICS. — SYMPTOMS OF PREGNANCY. — LABOR. — CARE OF THE OBSTETRIC PATIENT. — LYING-IN PERIOD. — CARE OF THE BABY. — OBSTETRIC SUPPLIES. — SUPPLIES FOR BABY BASKET. — BABY SLEEP.

Puberty.—This is the period of transformation from childhood to adolescence. There is a marked development of the throat and chest, the breasts become fuller, more rounded, and there is also an enlargement of the pelvis. These outward signs are combined with certain internal changes, affecting especially the ovaries and the uterus, that are described under the terms of ovulation and menstruation.

Ovulation.—The ovaries produce ova that are retained in cavities termed ovisacs (Graafian follicles), which are scattered throughout the ovary. Sometimes an ovisac contains more than one ovum, but usually each ovisac contains but one. When the ovary becomes functionally active, some of the ovisacs in the deeper part of the organ increase in size and develop toward the surface. From time to time one of these ovisacs, having continued to increase in size so as to form a projection on the surface of the ovary, actually bursts and sets free an ovum. This frequently occurs in association with menstruation, but may take place at other periods. While this development of the ovisac has been taking place there is a special flow of blood to the pelvic contents, and the fringe-like processes of the Fallopian tube become more closely applied, so that a cup is formed by the fimbriated extremity of the Fallopian tube, into which the ovum drops. Eventually the ovum reaches the cavity of the uterus, and, unless it becomes fertilized or impregnated, it is in due course cast off from the uterus in the menstrual discharge and perishes.

When the uterus has become the seat of a fertilized ovum there is no further ripening of ovisacs. After the escape of an ovum from the ovisac the follicle is filled with blood, and this takes part in the formation of a structure known as the corpus luteum, which is formed within the burst ovisac. The corpus luteum varies in its development according as the ovum becomes fertilized or not. If pregnancy takes place it remains to its close, but if the ovum is not fertilized it disappears in about three months. The ruptured ovisac always contains the elements of a corpus luteum, but its development depends on the fate of the ovum. Ovulation has been said to commence before menstruation; ovisacs may sometimes ripen and burst in childhood. Conception may take place before menstruation has set in.

Menstruation.—The blood is derived from the mucous membrane of the uterus (endometrium) and not from that of the cervix. The endometrium becomes swollen and thickened prior to the commencement of the flow, and the blood-vessels are distended. With the beginning of the flow this swelling gradually diminishes. A few superficial cells of the endometrium are usually cast off during menstruation, and this is regenerated during the interval between the periods. The mucous membrane of the uterus is thus never at rest until menstruation ceases for good.

Conception.—Fertilization of the ovum may occur anywhere in its course from the ovisac to the uterus, but ordinarily it takes place in the uterus. Certain changes take place in the uterus preparatory to the arrival of the fertilized ovum. The whole organ enlarges, it contains more blood than before; the mucous membrane becomes soft, spongy, thickens greatly, and is thrown into folds which are called the decidua vera.

Decidua Vera.—The part of the decidua vera to which the ovum becomes attached and where the placenta afterward forms is called the decidua serotina. The presence of the ovum acts as an irritant to the spot where it lodges, and active growth takes place. At the same time the ovum burrows into the mucosa and gradually becomes embedded. The vera closes over the ovum. The decidua vera is a mold of the interior of the uterus. The external surface is rough where it has been torn from the underlying tissues of the uterus, and the internal aspect which is in contact with the ovum is smooth. It is thickest at the third month; after this time the membrane becomes thinner and thinner, until by the end of pregnancy it is very thin. It is to a considerable extent expelled at labor and forms part of the membranes.

Ovum.—As the ovum develops the decidua reflexa expands until it fills the decidua vera at the end of the second month, and by the end of the third month it has intimately united with the decidua vera to form one membrane. Until these two membranes have coalesced the ovum is not free in the uterine cavity, but is enclosed in the decidua reflexa.

Pregnant Uterus.—As pregnancy proceeds the uterus ceases to be a pelvic organ; it becomes rounded, and after the sixth month gradually assumes an ovoid shape. At the end of the third month it has reached to the brim of the pelvis. By the sixth month it is level with the umbilicus, and by the ninth it has reached to the tip of the sternum. During the last fortnight the organ sinks a little, and this relieves to some extent the shortness of breath which has been caused by the pressure on the diaphragm.

Fetal Membranes.—Inside of the decidual membranes we find the chorion and amnion. Whereas the deciduæ are maternal structures, the chorion and the amnion are derived from the ovum. The chorion is the more external of the two fetal membranes; it early surrounds the ovum and throws out processes (villi) toward the decidua reflexa and serotina. These processes are at first formed equally all over the chorion, but those which lie in connection with the decidua serotina grow more rapidly in size and complexity, and remain to form the main part of the placenta. The membrane in which the fetus lies is the amnion. Contained within the amnion is more or less fluid, the liquor amnii, in which the fetus rests as in a water-bed. It permits free movements on the part of the fetus and protects it from violence from the outside; it equalizes the pressure on the uterine walls, preventing pressure on the cord and placenta; and during labor it assists in the dilation of the os uteri and lubricates the maternal passages. From it also the fetus derives its supply of water. Occasionally water may form between the three membranes, and during labor the chorion may rupture and not the amnion, and the waters between them be discharged. In like manner, water which has formed between the decidua and the chorion may come away. These, then, are two sources of fluid which may be discharged from the vagina in labor when the amnion is intact.

Umbilical Cord.—The organ by which the fetus is attached to the uterus is a whitish, glistening structure which springs from the fetus at the center of the abdomen, and passes to the internal aspect of the placenta. It contains two arteries and one vein surrounded by a gelatinous material (Wharton’s jelly), the whole being covered with a layer derived from the amnion. The vessels usually run tortuously in the cord, thus lessening the danger of compression, which might otherwise occur. This arrangement also tends to regulate and equalize the circulation of the blood through its vessels.

Placenta.—The “after-birth” is a spongy cavernous organ and has a circumference of from 20 to 24 inches. It is made up of two elements, fetal and maternal, chiefly the former. The fetal surface, to which the umbilical cord is attached, is formed by the amnion. External to the latter is the chorionic tissue, consisting mainly of finger-like processes of villi, many of which extend to the decidua. These villi are mostly vascularized. The vascular villus is made of a capillary loop, lying embedded in a connective tissue, the blood-vessels being derived from the umbilical vessels. The villi are surrounded by maternal blood, which circulates in the intervillous spaces. The maternal part is represented by the decidua serotina. Its surface is rough and irregular, being broken up into segments or cotyledons. It is made of two layers: (a) The deep or spongy layer, and (b) the compact, or layer to which the villi are attached. The decidua serotina contains large cavities or sinuses, which are formed by a dilation of the blood-vessels in the wall of the uterus. They communicate with the intervillous spaces of the placenta, and it is through the maternal blood circulating in them that nutriment is conveyed to the fetus through the medium of the villi. An interchange takes place between the fetal and maternal bloodstreams, though, of course, there is no direct continuity between them. The placenta thus has a two-fold function in acting both as an organ of circulation and of respiration. It is through the walls of the villi that this interchange of gases and fluids takes place; nourishment and oxygen passing through them to the fetus, and carbonic-acid gas and waste materials passing through them to the mother. There is no direct communication between the fetal and the maternal blood. The placenta, normally, is attached to the contractile part of the uterus, and on its separation the blood-vessels are closed by the contractions of the uterine wall. The placenta may be divided into two or more portions, or one or more of its cotyledons may be detached from the rest of the organ and have their own vascular supply. The importance of this lies in the fact that after the placenta is expelled these isolated masses may be left and give rise to hemorrhage or blood-poisoning.

Suppression of the Menses.—The cessation of the periods may be due to other causes, but it is usually the first indication of pregnancy. Conception may take place and menstruation yet continue. It usually occurs but once or twice, and then only where conception took place immediately before an expected period.

Morning Sickness.—Nausea and vomiting continued for any length of time is almost a certain sign of pregnancy. It may begin as soon as conception takes place and last for many months; sometimes it may occur toward the end of pregnancy, or occasionally not at all.

Salivation.—The excessive secretion of saliva often accompanies the morning sickness. The secretion is tenacious and difficult of expectoration. Heartburn, abnormal appetite, longing or loathing for particular articles of food, toothache and the like may be present.

Quickening.—The first feeling of fetal life felt by the mother is usually between the fourth and fifth months, but may be experienced occasionally as early as the third month, or be deferred until the sixth. Quickening occurs as soon as the uterus comes in contact with the abdominal wall. Improper elimination of the bowels, causing gastro-intestinal trouble, may produce movements not unlike this indication; therefore, this symptom is not reliable.

Enlargement of the Breasts.—The breasts grow larger toward the end of the second month. In some cases the enlargement is very marked, but in others there is scarcely any increase in size during the whole term of pregnancy.

Pigmentation.—Coloring of the skin takes place in different parts of the body. The face may show brownish spots. The skin darkens in the axilla and in the areola of the breasts. A dark line presents itself down the middle of the abdomen. The vagina takes on a violet tint, the cervix becomes purple, the various colors becoming more marked with the progress of pregnancy.

Changes in the Abdomen.—The abdomen grows larger gradually, and with it the gait and carriage of the woman change, to counterbalance the weight of the abdomen. It enlarges symmetrically unless the uterus is displaced by adhesions, or by a tumor in the uterus or external to it. The tearing of the under layer of the skin of the abdomen while distended produces streaks (stria), first pink and then white, which remain after the form resumes its natural shape; any other enlargement of the abdomen, especially when caused by a tumor, may produce the same result. The various conditions mistaken for pregnancy, due to changes in the abdomen, are fibroid in uterus; metritis; swelling of the tubes and ovaries, distended bladder, a pendulous belly; excessive fat; extra-uterine pregnancy; and inflammatory conditions, such as peritonitis. Pregnancy and any of the conditions named may coexist, and the former may be overlooked, while the latter is recognized.

Fetal Heartbeat.—The heart sounds are generally audible between the fourth and fifth months. The rate is from 120-140 a minute, being double that of the mother’s pulse. About midterm is heard the uterine souffle, a blowing sound, quite unlike the fetal heart, and its origin is the rushing of the blood through the enlarged and twisted arteries.

Ballottement.—In normal cases there is no pain on palpation. The uterine wall varies in consistence, being alternately soft and firm. The fetal parts may be felt through the abdominal wall in the late months.

Lightening.—In the last two weeks, especially in primiparæ, the child’s head sinks into the pelvis, and its body falls a little forward. The uterus sinks down and forward with the child. The waist-line lowers, the stomach region is flatter, the navel more prominent. The patient breathes easier, but does not walk as well.

Duration of Pregnancy.—Average time is 280 days; protracted, 314; a short term about 245 days. There is no positive period.

Prediction of the Date of Labor.—Count 9 calendar months from the beginning of the last menstruation and add 7 days. An error of 2 or 3 weeks, however, is possible. (See Table on page 178.)

Premonitory Symptoms of Labor.—(1) Lightening.—Dropping may be attended with slight pains similar to labor pains.

(2) False Pains.—These vary in nature and quality. They may be short and sharp, or long and continuous, or irregular. As a rule, they are marked by irregularity. They are mostly abdominal, rarely like true pains beginning in the sacral region and moving around to the region of the pubes. They may be caused by cramps in the abdominal wall, intestines, or in the distended bladder. They may be due to old inflammatory areas within the abdominal and pelvic cavities. They are frequent in cases in which there is marked bowel irregularity, and in conditions of over-fatigue. Some authors believe that they may be produced by irregular contractions of portions of the uterine wall. One important test is the condition of the uterine body during the pain. If there is no genuine contraction, the uterus will not become hard when pain is felt. This indication is not always reliable, however, since palpation may be unsatisfactory on account of the woman’s nervousness, her sensitiveness, or the thickness of the abdominal wall. If the cause be contractions of the uterus, partial hardening may be felt.

TABLE FOR CALCULATING THE PERIOD
OF UTERO-GESTATION.