The Room.—The rules which apply to dwelling rooms generally have a double importance in the case of the sickroom. The sanitation, ventilation, warming, and lighting, all demand extra care and attention. A southern aspect is preferable to any other; the room should be cheerful, spacious, and lofty, and subject to the invaluable effect of sunshine. It would be desirable for all houses, even of moderate size, to have some one corner suitable for a sickroom. If space admits of such a room being entirely isolated from the rest of the house, so much the better; but much may be done by securing two rooms opening into each other, with hot and cold water supply within easy reach, and a closet properly placed. When necessary, the room should be kept clean by dusting with a damp cloth, rubbing the floors in the same way.

Ordinarily, the chimney is the best ventilator, especially when the fire is burning, which increases the upward draught. Never stuff up chimneys: and except in very warm weather, always keep a fire in the sickroom. It is not always easy to maintain at the same time proper warmth and ventilation. But as a person is not liable to take cold when well covered up in bed, a little of the window may almost always be kept open, without fear of its doing harm, especially if a piece of fine gauze be gummed or tacked across the opening so as to break the force of the entering air. In ordinary sickness the best temperature is 62°-70° F. It should not be allowed to vary much, and as feeling is often deceptive, it is always advisable to keep a thermometer in the room.

For the removal of slops, the ordinary paraphernalia of the housemaid should be completely excluded from the sickroom, as both noisy and disgusting. All vessels when used, instead of being put under the bed, must be immediately removed and emptied outside, and brought back carefully rinsed, and, when necessary, deodorised with a little Condy’s fluid. Allow no confusion of medicine bottles, soiled glasses, spoons, and such matters about the room: those in immediate use should be kept arranged ready to hand; all others should be removed.

Even with the greatest care fires will burn down low, and it is necessary to have some means of restoration at hand. Few people know how valuable wine corks are for this purpose; they should always be saved, and a few kept in a corner of the coal basket. Orange and lemon peel likewise, when well dried, make capital fire revivers; and rather than that the fire in a sickroom should be allowed to go out, use a lump of white sugar or a sprinkling of brown, which will create in a moment a bright flame and revive the dying embers. Employ a pointed hard wooden stick instead of a poker; it makes so much less noise. Let a basket take the place of the coal-scuttle, and let its contents consist of fair-sized lumps, about as big as a French roll; a housemaid’s glove should be at hand to put these on with. This is the provision for the day. For the night small paper bags, such as fruiterers use, should be filled with about 1 lb. of small coal. This does not burn so fast or make so much flame as the lumps, whilst the feeding of the fire by these means divests the process of noise.

As little furniture as possible should encumber the room. No foot-stools, boxes, or baskets should be in the way, to be tripped over; no knick-knacks crowded on tables or mantelpieces to harbour dust, take up room, or tumble down with a crash. Various forms of sickroom furniture, adapted for confirmed invalids and serious surgical cases, are made by Alfred Carter, 97 Holborn Viaduct, and by Robinson and Sons, Ilkley, Yorkshire, whose catalogues will be worth getting.

Of carpets, the less the better; but if any are used, mere strips or rugs are best, as they are easily taken up and shaken, or cleaned. Curtains should be got rid of, especially if of woollen or stuff; cotton and linen should be used for any sofa or chair coverings.

Windows should be made to open easily from both top and bottom, whilst some contrivance is necessary to prevent any rattling noise from either window-frames or outer blinds. Venetian blinds, imperfect at the best, are quite unsuitable for a sickroom, being always noisy, and sure to admit alternate rays of light. Nothing wakes many people so quickly as light—a mere crevice unprotected is often enough. In the evening, be sure that the light of the lamp or candle does not fall in the patient’s eyes; there is nothing more distressing. Gas in a sick room is not healthy; a Queen’s reading-lamp, with a green shade, is pleasant for a stationary light, and a candle for moving about.

Real quiet is of paramount importance. Even “noiseless” crockery can now be obtained. The principle adopted is that of noiseless tyres to wheels, made of rubber, such tyres being fitted to the bottoms of the jugs, basins, &c.

One thing that would give great pleasure to many a bedridden sufferer is a looking-glass—sometimes two may, from the position of the bed, be necessary—fixed so as to reflect all the passers-by, or to show a patch of bright flower garden, bringing some of the outside life into the sickroom. Ferns growing beneath a bell glass, where they need no care or attention after they are once planted, may also be introduced. Plants in pots and cut flowers will occur to every one; it only remains to observe that growing plants, for their own sake as well as for the patient, should be moved out of the room at night, and that cut flowers from the side of a fever patient must be burnt in the room when they are dead, and not carried into any other part of the house.

The Nurse

The Nurse.—The Lancet insists that there is no more excuse for a nurse making a “guy” of herself than for her being decked out in vulgar finery, with her hair got up after an elaborate style which it would take her half the day to arrange. Print dresses of pretty pattern, or grey alpacas, according to season, with a light white cap, linen cuffs and collars, scrupulously white and clean, and a coloured neck ribbon, would be infinitely preferable to the black costumes of the sisterhoods. The heavy woollen dresses worn by some sisterhoods are not all that is desirable in a sanitary point of view. They do not “show dirt,” it is true; but it would be better if they did; and in their folds it is not impossible that germs of disease may be carried about. It may be laid down as a rule that nothing in a nurse’s dress that rustles, creaks, flaps, or catches can be in place. It is evident that this rule forbids silk dresses, stiff stays, trailing robes, and ornaments that are likely to throw things down. High heels are, of course, quite out of the question, as is any fashion which interferes with easy movement on the part of the nurse. Quietness, softness, usefulness are the points to be aimed at in the costume of a nurse; and if brightness can be given by a ribbon, the brightness may well be superadded. A nurse should wear no rings, and her nails should be kept cut very close. The sleeves of her dress should admit of being turned or rolled up above the elbow.

Never think any change in the patient’s manner or appearance too trifling to tell the doctor of it. Unimportant as you may deem it, it may be the very symptom he is watching for. Tell the doctor everything fully and truly, and above all, obey him implicitly. Never act against his orders, or tamper with them in any way. If you think any change in treatment judicious, ask his opinion first before trying it, but do not do things unknown to him. In this watchfulness and strict obedience lie the chief difference between professional and amateur nursing, and also too often the great advantage gained by employing the former over the latter. The several symptoms should be written down by the nurse from time to time on a slip of paper, always at hand, for the doctor.

Always save whatever has been vomited by a patient for the doctor to see, and be able to give information as to when the vomiting took place, whether directly after food or liquid had been taken, or not; notice whether there was much straining or retching before actual vomiting occurred, also if it was preceded by pain, and the situation of the pain. Remove the vomit from the room immediately.

In the case of coughing, observe whether it comes on in paroxysms, or is incessant; whether it is dry and hard, or moist and accompanied with expectoration; whether it is worse at any particular time, and is attended with pain. If there is expectoration, this should be kept for the doctor’s inspection. If blood is brought up, note whether it is coughed up, vomited, or brought up from the back of the throat or mouth; remark whether the expectoration adheres to the side of the spitting-cup, or flows easily.

The number of times the bowels are moved in the 24 hours must be noted, and whether the motion is attended with pain, griping, or straining; also the colour of the motion, and, if the patient passes worms, whether they are round or flat, tape, or small and thread-like. Note in what quantities urine is passed; also how often, whether with any discomfort or pain either before or after, its colour and consistence, and if there be any deposit, its colour also.

Do not forget to give messages of inquiry, as sick people think much of such kindnesses. Do not read letters out without reading them to yourself first; you may come upon some passage about the patient that you do not care to repeat, and your hesitation will make him anxious and uncomfortable. In convalescence books are often a difficulty, and require most careful choosing. Something not exciting, but thoroughly amusing, is generally the best thing—the lightest novel you can find. In any case, be careful not to read too long at a time; the strain of listening and attending is very tiring. In extreme weakness, when there is nothing to be done, say something from time to time to take off the sense of loneliness, but do not ask unnecessary questions or touch your patient—it is very tiring; and never at any time lean against the bed and shake it, and do not put anything heavy over the patient’s feet; the weight tires, and a hot bottle warms much more effectually.

Remember that the process of settling for the night takes a long time, and be sure to begin early. Some people sleep better in the first part of the night, and you should notice the hour at which the patient gets sleepy, and arrange accordingly; if kept awake long past that hour, a restless night will be the consequence. It is never wise to wake the patient, even to give medicine, except by the doctor’s orders. You should have a small tray arranged with all the things you are likely to want in the night, except medicines. By means of the judiciously-placed screen, anything that has to be brought in can be quietly handed over the top without a sound. Door-hinges and handles should be carefully eased and oiled.

Real quietude means the absence of all excitement, and it must be remembered that anything out of the common will tend to excite the mind of a sufferer. Do not, therefore, walk on tip toe, for this, in addition to its unusual elaboration of the gait, invariably causes a certain amount of creaking. Speak in low tones, but do not whisper. A whisper will often awake a sleeper who would not be disturbed by an ordinary conversation; and never say “hush!” Let your clothes and foot covering be of as noiseless and unobtrusive a character as possible, and instead of gliding and tottering about like a rickety ghost, do not hesitate to walk. If you have occasion to say anything in the room, say it so that the patient can hear it if he wishes, and do not let him be aware of your conspiring privately with the others, especially at the door. The door has much to answer for. If it be visible from the bed, people open it cautiously, put their heads in and slowly withdraw again. If, as is more frequently the case, it is screened by the bed curtains, mysterious openings and shuttings are heard, unattended with any apparent ingress or egress, and sotto voce colloquies going on outside. When you enter, do so honestly and at once. Do not spend 5 minutes in turning the handle, thereby producing a series of irritating little clicks, finally terminating in a big snap, with which the door flies open. If the latch be at all rusty, a handle that is slowly wound back in this way will often stick, and either require to be rattled back in position, or, if left as it is, may start back suddenly, after a time, of its own accord, with a report like a pistol shot.

A bracket or table on the landing or in an adjoining room, where one can keep a basin, water, and a cloth for washing cups, &c., can nearly always be managed; and even if one has to carry everything up and down stairs, the comfort to the patient of systematic, dainty cleanliness more than repays the trouble. Some nurses seem to think it enough to place anything used outside the sickroom door, trusting to a chance maid seeing it and carrying it off. But this proceeding often worries the patient most exceedingly. He or she lies there and fidgets over the chance of that stray cup being whisked over by a passing skirt, with an ominous clatter and smash; and though this probably does not happen, the expectation of it keeps the mind on tenter-hooks, and prevents needful rest.

Let visitors sit between the door and the patient, getting the benefit of the air and not between him and the fire, thus getting in the direct current of foul air rushing towards the fireplace; they should be well in sight of the patient, and never admitted at meal times. While talking to the patient it is better to sit by the side of the bed and as near the pillow as possible, so that you may converse easily, while your face and body are turned in the same direction as his. By this means you can make all necessary observation of his features without enforcing the arrest of his eyes on your own, which is so embarrassing and disagreeable to one lying in bed, and is almost unavoidable when facing him. Keep him in as comfortable a position as possible, by all means, but do not be too demonstrative in smoothing the pillows and little offices of that sort. Fidgety attentions will worry and do more harm than downright neglect.

The Bed.—The best kind of bed for the sick is a small iron bedstead, about 3½ ft. wide and not too high, with firm, level, spring mattress, and light warm covering, avoiding large heavy linen counterpanes, which, though oppressively weighty, give but little heat. It should be placed in such a position as will be most out of draughts, and at the same time convenient for the nurse in performing personal services for the patient. It must never have either side against a wall, nor be between the door and the fire. It is a point of some importance, especially in cases of long illness, to arrange the position of the bed so that the sick person can see the fire or look out of window. A second bed, or hammock, or stretcher on wheels, is often very useful for shifting the patient on to while airing and making the other bed.

Good bed-making is imperative in sickness, and nothing is a better test of a nurse’s capacity than the way she keeps her patient’s bed. Some nurses are eternally fidgeting till they work the unhappy invalid into a frenzy. Others, again, in their dread of disturbing him, let the patient toss everything to the wildest confusion, trusting to one grand and general clearing up to set matters right. A good nurse keeps things straight almost unconsciously, taking advantage of any chance the patient gives to smooth out the crumpled sheet, or tossed bed-clothes, with a strong even pull, or to replace a heated, crushed pillow with a fresh cool one (though careful that, if cool, it is not chilly). Remember when smoothing a sickbed never to jerk or twitch the clothes, and be always sure your attempts do not endanger anything that may be lying on the bed, and whose downfall would most certainly disturb and flurry the invalid. A wide bed in a measure is a substitute for having 2 beds, as considerable relief may be obtained by using alternate sides of the bed; moreover, you can cool one side when the patient is on the opposite side, by turning back the clothes so as to let the air reach the lower sheet. Bed linen should always, if possible, be exposed to the open air, in the sun and wind, before using, as this freshens it most effectually, whilst a drop or two of good lavender or rose water sprinkled on sheet and pillow-case add greatly to the pleasantness. The best way of making a bed so as to give the least possible disturbance to the sick person, and prevent bed sores, is laid down in these rules:—(1) Keep the sheet below the patient perfectly smooth; (2) wash the parts where the bone is prominent daily with soap and warm water, dry them well, rub them over with a little spirits of wine or whisky to harden the skin; (3) change the patient’s position frequently; (4) never let him lie on a blanket; a freshly-made bed, a good sponge over with vinegar and water, would often, after a restless, sleepless night, have the good effect of making the patient fall into a sound sleep. It is best to make a good lather with the soap, and not to use much water. Zinc-powder and boracic acid powder are often used to powder the back after the washing.

A very common torment of invalids is the weight of the bed clothes. They are heavy, but not warm. For the rich, blankets and eiderdown quilts are easily obtained; but for the poor, paper is far better than many more costly coverlids. It is by no means necessary to spend money on a paper blanket, though these are excellent; a few sheets of brown paper, or even newspapers, pasted together to the size of the bed, add greatly to the warmth and practically nothing to the weight. If it is not the beat possible covering, it is very good, and absolutely costless.

It is often necessary to change the sheets without disturbing the patient. This can be done either from side to side or from head to foot. The former method consists in loosely rolling up the soiled sheet sideways, from the side of the bed where there is most unoccupied space, until the roll can be pressed against the patient’s side. The clean sheet, previously loosely rolled up from side to side, is then unrolled over the uncovered part of the bed, until the clean roll lies by the side of the soiled one. The patient is now lifted over on to the clean sheet, the soiled sheet is taken away, and the spreading of the clean sheet is completed. The second plan is to roll up a clean sheet loosely from end to end. Beginning at the head of the bed, the soiled sheet is rolled down from underneath the bolster, and the clean sheet unrolled after it, and arranged in its place. The shoulders of the patient should then be raised a little, and the soiled sheet rolled down from under them, while the clean sheet is unrolled to follow it. The hips, and lastly the legs and feet, are to be gently raised one after another in a similar manner, the soiled sheet taken away at the foot of the bed, and the unrolling of the clean sheet completed.

With paralysed and other helpless patients, frequent washing or sponging is more necessary, and the draw-sheet becomes useful. This consists of a small sheet folded lengthwise 2 or 3 times, so that when placed beneath the patient it may reach from the middle of the back to the knees. One end of the folded sheet should be the part first used, the rest being loosely rolled up to within a few inches of the patient’s side. As the sheet becomes soiled, the unused portion is unrolled sufficiently for the soiled part to be drawn from under the sick person, and a clean part substituted. The soiled portion is rolled up as it is withdrawn, and secured by a safety-pin. A piece of waterproof sheeting or a strip of thin oil-cloth passed beneath the draw-sheet still further protects the bed.

Bedding and pillows should not be too soft, otherwise the patient is continually sinking into hollows, and becoming hot and restless in consequence. When a patient needs to be propped up, the greatest mistakes are made. Pillows are jammed and wedged in at the patient’s back till he is completely built in. A cheap and simple pillow which doctors strongly recommend as a support in such cases is made of chaff, or chopped straw, and stuffed hard. It is covered with any cheap material, and is shaped like a writing desk—that is to say, it is made to slope. It should be a little longer than an ordinary pillow, and should be 8-12 in. deep behind and 3-4 in. in front. Ordinary pillows (1 or 2) placed upon this as a basement make a capital back-rest for persons suffering, say, from bronchitis. Such a rest has many advantages: it does not give way, hence the patient no longer finds himself from time to time in a deep hole; it allows the arms and shoulders free movement; it is also cooler, and permits more frequent change of posture. In propping a patient up it should always be remembered that the back needs support as well as the head and shoulders.

A very great comfort to sick people, especially to those who have to be left much alone, is to be furnished with some simple arrangement by which they can raise themselves into the sitting posture and so maintain themselves with slight effort. This can be attained by fixing a length of strong webbing to the foot of the bed, and placing knots upon it at intervals, so as to enable it to be more readily and firmly grasped. A netted bed-rest, 3 yd. in length, is a very simple and useful contrivance; its main use is the same as that of the knotted webbing, but by allowing it to pass round the back of the invalid, and spreading it out, it makes an exceedingly pleasant bed-rest, fashioned on the principle of the hammock. A swing bed-rest has several advantages. It is very cool, and allows a free play of air on all sides of the patient, which is a very important advantage. It permits, moreover, considerable movement, and does away with the fatiguing restraint of keeping the body in one position. If the ventilation through the network be too great, or the weather be cold, a pillow can be placed against the patient’s back, within the rest. Instead of the rest being netted, it may be made of strong towelling, which will bear rougher usage. Its strength and serviceability will be increased by stitching here and there bands of webbing; and at each of its narrower ends strong broad tapes must be fastened, by which it can be secured to the foot of the bed. Such netted bed-rests can be had (5s. 6d. each) at the Depot for Ladies’ Work, 16, King Street, Manchester.

Bedridden patients, and those who are paralysed or otherwise reduced to a condition of great weakness, often complain that they are continually slipping down in the bed. Often a box or footstool is slipped in at the foot of the bed, that the patient’s feet may be pressed firmly against it to prevent slipping. But this cannot be long continued where the legs are weak, for the muscles become exhausted, the knees give way, and then the slipping goes on just as badly as ever. This can be prevented, if a little round pillow, 3-4 in. only in diameter, be fixed so that the patient, though lying down, as it were sits upon it. Such a pillow, to answer its purpose, must be tied in its position very securely, and this may be done by a piece of webbing attached to each end, and tied either to the head or sides of the bedstead.

Following is a way to make pillows with paper stuffing. Use any sort of paper, and tear all into small square or oblong pieces. Then roll each piece between the finger and thumb into a tiny spiral, exactly as if beginning to make round spills. It is very little trouble to do. It is a most suitable occupation for blindman’s holiday, or for people with weak eyesight; and the pillows, as may be supposed, are far more elastic than if made of the same paper, flat. Of course, it is most suitable for an under pillow, if one has a choice; but so long as there are so many unfortunate invalids without any pillows at all, the plan is worthy of remembrance.

A table to stand on the bed is very convenient for trays, &c. It can be bought ready made, and is not at all expensive, or a very little ingenuity is needed to make one. About 2 ft. long, hollowed out on one side, and 1 ft. broad, is a good size. The legs may be 6-7 in. high.

The bed can be refreshed and aired by raising and lowering the clothes so as to produce a fanning motion. To turn a pillow without fatiguing the patient, put the hollowed palm of one hand at the back of his head while with the other you quickly reverse the pillow and replace it. To lay a bed with a waterproof sheet for temporary use, first make the bed with a blanket beneath the under sheet, and then spread the waterproof, a blanket and another sheet, without tucking in. When done with, it is only necessary to draw out the waterproof with its blanket and sheet, leaving the patient on a fresh sheet. No amount of care will keep crumbs out of a sickbed; they catch in every fold and frill and pass up the sleeves, and demand a search after every meal in which bread figures. To avoid rucks in the under sheets, stretch it tight on the mattress and fasten it down with safety pins.

Sickroom accessories

Sickroom accessories.—These are of a varied character, and will be described under separate headings.

Poultices. Linseed.—The great art of poultice-making consists in applying it to the patient sufficiently hot, and, therefore, it is advisable to warm all the materials before beginning. Put the linseed (crushed or meal) before the fire or in the oven for 20 minutes to heat. Use by preference a tin bowl, and scald it with boiling water; then pour in as much boiling water as will be needed for the poultice, sprinkle in the hot linseed with one hand, and stir vigorously with a knife to the required thickness. To judge of this requires some practice. A poultice should be somewhat moister, if applied to an open wound, than if it is intended to relieve some internal pain; but in no case ought it to be sufficiently moist to stick in patches to the skin of the patient. The next step is to take a square of rag or paper ½ in. larger all round than the poultice is intended to be; spread the linseed on this about ½ in. thick, leaving the edges clear; fold the rag over on each side, and apply at once, covering with a pad of cotton wool and a layer of indiarubber or oil silk to keep the heat in. It is a good plan to oil the face of the poultice with a feather, as this effectually keeps it from sticking to the skin, even if it is not well mixed, and it is better than to put the poultice into a muslin. If, however, the muslin is preferred, on no account should a bag be made, for the poultice cools while it is being put in. A large piece of old linen, folded over at the back, like a parcel, keeps the linseed in, and makes at the same time a pad to cover it. Failing linseed meal, you can use either oatmeal or bran; if oatmeal, then boil it with the water like porridge. A poultice should be larger than appears absolutely necessary. It is intended to allay pain and inflammation, and as the pain probably extends beyond the inflamed part, a large poultice should be made to cover the inflamed part. Dr. Atkinson says that meal deprived of its oil is far better than that from which the oil has not been extracted. The latter does not retain its heat as long, and, unless covered by some fabric, is not so easily removed as the poultice made from the former. The exhausted meal takes up more water, and retains its heat longer. In making a poultice, the meal should be thoroughly stirred with a spoon while boiling water is gradually added, and when of proper (rather soft) consistence, should be spread on linen. The ability to bear the heat on the back of the hand is a good test of the degree to be used. The poultice should be applied directly to the skin, without intervening fabric, and be covered on the outside with good oiled-silk. A teaspoonful of laudanum may be sprinkled on the surface to increase its anodyne effects, or in place of water may be used a boiling infusion of camomile or poppy-heads. When the skin is inflamed, 3 grs. sulphate zinc or alum may be added to each oz. of water. A solution of 1-40 of carbolic acid may be used instead of simple water in the case of sloughing wounds. Once in 4 hours is a good rule to follow in changing poultices on the chest, the front and back being covered by separate poultices, and only one should be removed at a time. A fresh one should be ready when the change is made. Frequent changes are most grateful in cases of abdominal pain.

To relieve spasm, as in colic—intestinal, biliary, or renal; to relieve inflammation of the pleura (lining membrane of the chest), the lungs, the liver, or other organs, it is essential to apply the poultice as hot as possible, while protecting the skin from being scalded. In order to do this, a flannel bag should be prepared, a convenient size being 12 in. by 8; this should be closed at 3 edges and open at the fourth; one side of it should be 1-1½ in. longer than the other, and it is convenient also to have 4 tapes attached at the points which form the corners when the bag is closed, in order to keep the poultice in position. Besides this, another strip of flannel should be prepared of the same breadth as the length of the bag, and long enough to wrap round it once or oftener. Crushed linseed, bowl, and spoon should be got together, and the spoon and bowl thoroughly heated by means of boiling water; the poultice should then be made with perfectly boiling water, and rather soft. As soon as it is ready, it should be poured into the bag, previously warmed by holding it before the fire; the flap which is formed by the longest side of the bag should now be turned down and fastened in its place by a few long stitches with a needle and thread; it should then be quickly wrapped in the strip of flannel (also previously warmed), and fastened in situ, if necessary, by means of the tapes. It may be covered outside with a sheet of cotton wool. In this way the poultice may be applied boiling hot to the skin without burning; the 2 layers of flannel which are at first dry allow the heat to pass very gradually indeed to the skin; as the moisture of the poultice soaks through them they become better conductors, and the heat passes more quickly, but the increase is so gradual as not to cause any painful sensations whatever, but only one of soothing and comfort. The poultice also naturally keeps much longer hot, and the necessity for changing it arises much less frequently. The difference between the effect of a poultice made in the ordinary way and in the manner just described is sometimes exceedingly striking. It is, perhaps, less marked in cases of inflammation than in those of spasm.

Bread.—In a small and perfectly clean saucepan have a teacupful of boiling water. Add breadcrumbs, or the crumb of a stale loaf: 1½-2 oz. will be sufficient for this quantity of water, and let it soak over the fire for about 5 minutes. Then turn it into a piece of rag, and spread it of suitable size and evenly. This plan ensures its being hot.

Mustard.—If a mustard poultice is wanted it can be made in the same way as linseed, save by adding a certain proportion of dry mustard to the linseed. Some persons prefer to boil a little mustard in the water that is to be used. Dr. Tyson, of Philadelphia, recommends the addition of molasses to mustard in making plasters. This furnishes a mild persistent counter-irritant which can be worn for hours. Leaves of so-called “mustard paper” may be made as follows: The mustard must be deprived of all fatty matters; the adhesive agent must contain neither alcohol, resin, nor fatty matter; nor must it be of the nature of a plaster. Submit the mustard farina to strong pressure, and wash with sulphide of carbon or petroleum essence. Spread on paper an adhesive liquid formed of a solution of 4-5 parts caoutchouc in 100 parts mixed carbon sulphide and petroleum essence. Sprinkle over the freshly coated paper by means of a sieve, the prepared mustard. Pass between two rollers, and afterwards gently warm to promote volatilisation of the liquid solvents used. Cut to pattern as required.

Court Plaster.—This is generally bought. To make it, soak isinglass in a little warm water for 74 hours, then evaporate nearly all the water by gentle heat, dissolve the residue in a little proof spirits of wine, and strain the whole through a piece of open linen. The strained mass should be a stiff jelly when cool. Now stretch a piece of silk or sarcenet on a wooden frame, and fix it tight with tacks or pack-thread. Melt the jelly and apply it to the silk thinly and evenly, with a badger-hair brush. A second coating must be applied when the first has dried. When both are dry, apply over the whole surface 2 or 3 coatings of the balsam of Peru. Plaster thus made is very pliable and never breaks.

To make it without silk, mix enough collodion with castor oil to render it elastic when dry, the oil having profusely been rubbed with some zinc oxide. Into this mixture dip glass plates, and, after drying, redip and redry 2 or 3 times, or until a film of suitable thickness is obtained. Upon this paint the usual solution of isinglass to give it adhesiveness, and, after again drying, separate it from the glass.

Applying cold to the Head.—Take one fold of cotton or linen rag, soak it in cold water, the colder the better, squeeze dry and apply it as rapidly as possible. Do not take a large piece of cloth folded several times, and keep squeezing it in your hand till it is quite hot and then put on. One fold of cloth, the thinner the better, dipped often in the cold water and rapidly applied gives great relief in headaches, for example. If you can procure ice put a piece in the water. Ice is sometimes ordered to be kept constantly on the head; to keep it from melting, wrap it up in flannel, or put it in sawdust, and in a cool place. To break ice, use a large needle. Ice-bags can be bought for 3s.-4s., or it may be put in a bladder and applied to the part, or a bag may be made of guttapercha and chloroform. By putting a little chloroform along the edges and folding them over, you can make a very useful bag for ice; the ice should be broken in small pieces before being put in the bag, and be removed as soon as it melts.

Fomentations.—A very good, perhaps the best, plan is to put a piece of flannel, folded 4 or 5 times thick to the required size, into a potato-steamer over boiling water. In this way it soon becomes hot, and little or no wringing is necessary. Where a potato-steamer is not to be had, however, the following plan should be adopted. Take a strong towel or cloth, or a piece of ticking, and pin or tack a deep hem in each end. Into these run two short, strong sticks—anything will serve: a couple of iron spoons, and even a small poker, such as is called a “curate,” though this last is rather long for choice. Lay the towel, or “wringer,” as it is technically called, over a large basin, so that the sticks hang outside; place the folded flannel in the middle, and pour boiling water over. The flannel can easily be wrung dry by one pair of hands, and if it is not made by the bed side, it can be carried there without fear of cooling in the wringer. Sometimes opium or turpentine is to be added. The quantity of either to be used will be prescribed by the doctor, and it should be sprinkled on the side of the flannel that is to go next the skin, immediately before applying it to the patient. The flannel should be covered with wool and oil-silk, just as a poultice is covered. Fomentations are, in many cases, as efficacious as poultices, and they possess, besides, the advantage of being easier to make, and of costing practically nothing, since the flannels can be used repeatedly. For the very poor, the cost of linseed for poultices is often a serious item. There is no danger of scalding if the flannel is squeezed so dry that it cannot drip nor wet the palm of the hand.

Another plan is described as follows: Take your flannel folded to a required thickness and size, dampened quite perceptibly with water, but not enough to drip, and place it between the folds of a large newspaper, having the edges of the paper lap well over the cloth, so as to give no vent to the steam. Thus prepared, lay it on the stove or register, and in a moment steam is generated from the under surface, and has permeated the whole cloth, heating it to the required temperature.

Blisters.—Blisters and leeches should only be used under medical direction. Before the application of either, the part should be well washed with soap and warm water. Then, in the case of the blister, it has only to be slightly warmed before the fire and left on until “it rises,” and a good-sized vesicle has formed (which will usually be in about 8-10 hours), when the water must be let out by snipping the skin with the point of a sharp scissors—a perfectly painless operation—and the blistered surface dressed with spermaceti ointment spread on soft lint.

Leeches.—Leeches can generally be induced to bite by putting a few drops of milk or blood on the spots they are intended to take. They will usually fall off of themselves when filled, but if they remain on too long they must not be pulled off, but a little salt shaken on them, which will soon make them let go. Another simple and easy way of detaching leeches is to drop a few drops of camphor julep (mist. camph.) on the part, when they will soon relinquish their hold. The bleeding from their bites will also generally stop without interference. If it should continue to an undesirable degree, the nurse may nearly always stop it by making gentle pressure over the bite with her finger, or applying a little powdered alum or the muriated tincture of iron (tinctura ferri perchloridi). Never leave a patient for the night until all bleeding has completely ceased. The bleeding may be increased, when desired, by fomenting with warm water.

Enemas.—A nurse is often required to administer an enema or injection—which in many conditions of disease is a most valuable method of treatment. Be careful not to disturb or uncover the patient until quite certain that you have arranged ready to hand everything that will be required. Almost any variety of injection apparatus answers the purpose sufficiently well, but in using the rubber ones care must be taken to squeeze out all air from the bulb before commencing, else the air will be forced in by the first compression. The most convenient position for the patient is lying on the left side. Then the nozzle of the instrument, having been well greased and warmed, should be passed slowly and carefully into the bowel, the point being directed slightly backwards. On no account whatever must the least force be used. If there is any difficulty or pain in introducing the tube to the required distance, the nurse must wait for a minute or two, when, in all probability, the opposing muscle having become relaxed, it will pass in easily and without pain. The injection should then be given very slowly and quietly, and without any jerking or irregularity of motion, especially if it be desired that it should be long retained; it must be stopped immediately if the patient calls out that he can bear no more. Enemata are generally either nutrient or purgative; but occasionally other medicines are given in this way. The nutrient are of extreme value, as it sometimes happens that, when nourishment can be taken in no other way, sufficient may be supplied by this means to tide over the period of danger. A good nutritive enema may be made as follows: The yolks of 2 fresh eggs well battered in about ½ pint strong beef tea, or in 2 tablespoonfuls (half a canister) of Brand’s extract of beef, dissolved in warm milk. About ½ wineglassful port wine, or 1 tablespoonful brandy may be added in cases of extreme exhaustion. It should be given at about blood heat—100° F. An active purgative enema may be made with: 4 tablespoonfuls castor oil, 1 teaspoonful oil of turpentine, and about 1 pint well-strained gruel, or soap and water. An enema of plain soap and water often answers very well.

Clinical Thermometer.—In trifling ailments its use is for reference; in serious attacks it may give immediate warning that the physician is required; and even while the doctor is in attendance he often wishes observations regarding the temperature to be taken several times a day, in his absence, for his guidance and information. Following are a few illustrations of the uses to which the clinical thermometer may be put by any intelligent person. The natural temperature of the human body is 98·4°F. and the little arrow on the thermometer indicates this normal degree of heat, so that when the index rests at the arrow, the natural temperature is proved to be present. It is the variations above or below the arrow that mark the presence of disease.

The agony of colic is well known, but it is generally of little danger in the absence of inflammation. In peritonitis (inflammation of the bowels), the temperature runs quickly up to over 101° F.; in colic it scarcely rises more than a degree, if even thus far, above the natural temperature. A severe pain in the side causes pleurisy to be suspected. If the temperature is normal, there is no pleurisy, and the pain is probably neuralgic. Diarrhoea may continue for a few days, and the patient feels so out of sorts that typhoid fever seems to have set in; but all the specific forms, such as typhoid, typhus, scarlet fever, diphtheria, or measles, are accompanied by such an increase of body heat as will probably send up the record to 101° F., or possibly 3-4° higher. A child with persistent vomiting, sore throat, and high temperature will probably in a day or so show the rash of scarlet fever. In any case, when a temperature remains above 100-101° F. for more than 1-2 days, without obvious cause, the doctor should be consulted. If the child has disordered stomach or sustained a chill, the thermometer will record fever; but, after a purgative in the one case and a tepid or hot bath in the other, the increased heat will be found to be gone, and with it any alarm which may have been felt. In the course of an inflammation or fever, the friends can be informed by the medical man what degree of heat he expects, and should this be exceeded the doctor should be informed of the fact. Indeed the clinical thermometer is invaluable, especially to families at a distance from their medical adviser. It can be obtained from any instrument maker for 7s. 6d.-12s. 6d., or more. Its application is a very easy matter. The bulb containing the mercury should be placed in the mouth or arm-pit; care should be had in the last case that clothes do not intervene between the instrument and the arm, and that it is so placed in the arm-pit as to be completely surrounded by skin. The patient must then press the arm gently to the side so as to retain the instrument, and in 5 minutes the thermometer will show the body’s temperature.

Dollond, 1 Ludgate Hill, London, E.C., sells an improved Lens Clinical Thermometer. The importance of the “lens” front cannot be over estimated, for with such a thermometer there is no difficulty in reading off the temperature even in the dull light of a sickroom, for the thin thread of mercury is magnified quite twenty times its size. This thermometer is made with a contraction in the tube near the bulb, which prevents the mercury returning, until shaken down. The price of this thermometer is 7s. 6d.

W. H. Harling, 47 Finsbury Pavement, London, E.C., is the maker of an excellent clinical thermometer with lens front, which registers the temperature in the space of a single minute. It is furnished with a metal case having a bayonet fastening, and costs only 8s. 6d. The same maker supplies also ordinary clinical thermometers, in cases, at prices ranging from 3s. 6d. upwards. Other sickroom requisites are noticed on p. 1007.

When used to take the temperature of patients suffering from infectious disease, the thermometer should be disinfected by being washed in “Sanitas” or carbolic acid solution after each time of using. In taking the temperature under the tongue, the index should be “set” as directed, and the bulb should be placed as far back under the tongue as convenient and agreeable; the mouth should then be kept shut, and the patient should breathe through the nose: 3 minutes are sufficient for taking the tongue-temperature. In the arm-pit the thermometer should be left for 5 minutes and the fore-arm should be made to lie across the chest, so that the thermometer may thus be made to rest in a sheltered position.

Temperatures should be taken in ordinary cases at 8 A.M. and 8 P.M.; 2 o’clock is a convenient hour for a third observation. Variations in temperature occur in healthy persons, but such change does not usually amount to more than 2° or 3° F. What is to be regarded as deserving of attention under the ordinary circumstances of life is a fall below 97°, or a rise above 99·5°. In fevers, as a rule, the temperature does not rise above 106°; but in fever a heat of 108°, continuing even for a very short time, would be regarded as a most dangerous symptom. A very high or very low temperature must be looked upon as dangerous; should it be excessive either way, the case will probably prove fatal. A very sudden change is suspicious, and very frequently dangerous. In children, however, the presence of indigestible food in the intestinal canal may suffice to cause a rapid rise in the temperature. After the temperature has been stationary for some time, or has commenced to fall, a fresh rise may herald the advent of some complication, or the approach of a new disease. An unexpected fall may denote hÆmorrhage, exhausting diarrhoea, or the perforation of the peritoneum or pleura (lining membranes of the abdomen and chest). A considerable rise during the course of a disease which is not generally regarded as febrile—viz., in tetanus, epilepsy, and cholera—usually precedes death.

Making a Medical Coil.—Procure a well-seasoned walnut board about 21½ in. long, 3 in. wide, and ? in. thick. From this cut one length 12 in. long for the base board a, and 3 pieces 3 in. square (like b) for the coil heads; when cut, a fillet 8 in. long must be nailed or screwed on the two sides of the base board (as shown in a); these fillets should be ¼ in. square section. Corresponding square nicks must be cut of two of the square heads (as shown at x in c). All the woodwork when thus squared and finished should be soaked for ¼ hour in melted paraffin wax, and then rubbed dry while still warm.

Obtain a thin brass tube (known in the trade as “triblet tubing”) about ½ in. diameter, 4½ in. long; turn up a short plug and button to fit one end of this tube and serve as a handle (see d). This may be fastened to the tube by driving in 3 fine brass brads, and filing off the heads flush with the tube.

Cut up about 100 lengths of straight iron wire (best soft annealed) No. 22 gauge, say, about 4½ in. in length; fill the brass tube with them as tight as you can fit them; cut them all to the same length (they must protrude a little beyond the tube). Now draw out about 2 in. of the iron bundle and wrap it tightly round with twine, leaving about ½ in. free. Draw more out, and continue wrapping until you have wrapped to within ½ in. at each end of the bundle. Tie the string, and withdraw the bundle from the brass tube. Melt a little solder in a ladle, dip the ends of the iron bundle into soldering fluid (zinc dissolved in hydrochloric acid), and then at once into the melted solder. Allow the bundle to cool; file off the superfluous solder, so that the bundle will just enter freely into the tube. It should appear like e when the string has been removed.

The next operation is to make a good stout paper tube, also about 4½ in. in length, into which the brass tube d can slide easily. To make this, put a few turns soaped writing paper round the tube No. 1, then roll and glue seven turns of good stout brown paper, 4½ in. in length, round this writing paper, or else it will be difficult to draw out the tube. This paper tube f must be allowed to dry thoroughly while still on the brass tube d. When quite dry, it must be slipped off, the writing paper lining drawn out, and then it must be soaked for a few minutes in melted paraffin wax.

The iron bundle should also be allowed to stand in melted paraffin wax for some time, and then stood up to drain in a warm place. This will prevent rusting. When quite cold, all superfluous paraffin having been removed, a strip of brown paper, ½ in. wide, is rolled round one extremity of the iron bundle, until it is of such a diameter as to fit tightly into the paper tube f. This paper strip must be cut off at this point and glued tightly round the end of the iron bundle. The brass tube d is then slipped over the iron bundle until it just reaches the little paper collar just made. The brass tube and bundle together are pushed, button end first, into the paper tube f; and when the paper collar round the iron bundle is just about to enter the paper tube, it is to be well served with hot glue and forced into the tube. The whole must now be allowed to dry and set thoroughly.

Taking one of the 3 in. heads (the one which has not any nicks in the sides), bore a centre hole with a brace and centre bit, just large enough for the paper tube f, with its iron core, to fit tightly (see b). Putting a little thin good hot glue round the free extremity (the end opposite to that at which the brass enters), push it into the hole in the square head, until it projects about ? in. on the other side. This must be allowed to dry thoroughly before proceeding to the next operation.

Now proceed to wind the primary coil. To this end, take about ½ lb. No. 24 silk-covered copper wire, and wind it round the tube, as shown at g, from end to end, in continuous layers, taking care to put a sheet of paraffined paper between each layer, and also to baste each layer with melted paraffin wax before winding on another. About 4 layers will thus be got on, and an even number of layers must be aimed at, so as to get the 2 ends of the wire at the same extremity, and able to fasten them under the binding screw y. To effect this, before screwing down the said screws, the ends of the copper wire are stripped of their covering and wound once round the screw of the binder. Free ends of wire, at least 6 in. in length, must be left for attachments, &c. This is shown at h.

This primary coil, with its iron core, sliding brass tube regulator, &c. may now be fastened to the base board by means of 2 screws from underneath, as shown at i, at 4 in. from one end, and therefore 8 in. from the other. One of the free ends of the primary wire is brought to one of the binding screws v, while the other connects to the clapper z. A short piece of wire connects the platinum screw pillar w, to the other binding screw, which is not visible, as it is behind the platinum pillar. At this point it will be well to try the working of the primary coil. For this purpose, couple up the 2 binding screws on the base board with a good bichromate cell. Connect the two binding screws u in i, with the 2 brass handles intended for use. Screw up the platinum screw w till the clapper z begins to vibrate. Now hold the handles in your hand. As long as the brass tube j is entirely over the iron core, little or no sensation is perceptible. If an assistant pulls out the tube, little by little, the current will be found to increase in strength until the regulator tube is quite out.

The secondary coil now demands attention. A paper tube, precisely similar to b, but of such a size as to slide easily over the primary coil i is prepared, and paraffined. This must be cut exactly the length of the coil k, leaving the knob j projecting. The 2 square pieces of board in which the nicks were cut (c) must then have central holes cut in them to take this paper tube, and then glued, one at each end of the said tube, as shown. Two small binding screws are then to be inserted in the centre of the upper edge of each square. A bung is now placed in each end of the tube, and a ¼ in. iron rod pushed through both, to serve as an axle. This is then mounted on 2 standards, as shown at n; and beginning by attaching one end of the uncovered wire to the binding screw m, about ½ lb. No. 36 silk-covered copper wire is now carefully coiled on, being most diligent in avoiding kinks, breaks, or flaws of every description. Each layer must be paraffined and separated from its neighbour by paraffined paper. When the quantum of wire has been laid on, the finishing end is connected to the binding screw in n. The last coil should be covered with paraffined paper, and finally covered with a jacket of good silk velvet. The secondary coil is then complete, and may be slid in its place over the primary coil o. When it is quite over the primary, the secondary current will be at its strongest, if the metal tube regulator is drawn out; it will be weaker as the metal tube regulator is more and more inserted; or may be even more delicately regulated by sliding the secondary coil itself more or less over the primary. The secondary coil, while the primary is being excited with a freshly made pint bichromate, will give a ½ in. spark when the regulator is out and the secondary coil right over the primary. This will pass easily through a dozen persons. (S. R. Bottone.)

There are various other sickroom appliances demanded in special cases which do not require description here. Most may be had of such well-known firms as Salmon, Ody & Co., 292 Strand, and Savory and Moore, 143 New Bond Street.

Feeding patients

Feeding patients.—A nurse should bear in mind these two leading facts; that while in sickness there is usually a greatly increased tissue-waste, and consequently an increased necessity for nutriment, there is almost always a decreased appetite, or no appetite at all—often such a repugnance to food that, if left to himself, the patient would prefer taking none at all. Hence, although the medical attendant may decide what is the most suitable form of nourishment, on her devolves the more difficult task of inducing the sick person to take it. With this view, she must exercise all her ingenuity to tempt and encourage him, by bringing everything in the neatest possible form. On no pretext whatever should there be any cooking in the sickroom; nor should she take her own meals there; nor should any food be left standing near the patient. On the contrary, though his nutriment must be brought to him frequently—more frequently, of course, the less he can take each time—and punctually, it should only be in such quantity as he is likely to consume; and immediately that is done, everything in connection with food should be removed from sight and smell until the next time.

The nurse must devote much of her attention to the subject of diet, observing carefully the patient’s appetite, and attending carefully to the quantity of food and the effect of it. The sense of taste of many people is very acute when they are ill, and you must take care that the spoon in the arrowroot, which looks perfectly clean, does not taste to the patient of the soup for which it was used last. Eatables should not be kept in a sickroom: if you are obliged to have anything within reach, put it under a cover; a tumbler turned over does very well for biscuits or jelly, and for larger things a bell glass is useful; tin boxes, the next best thing, generally make a noise when they are opened. The water given to a sick person should not only be boiled and allowed to cool, but ought always to be filtered. It should frequently be changed, as it quickly absorbs the impurities with which the air of a sickroom is charged, and becomes injurious, if not dangerous to drink. In cases of faintness, where stimulants are not ordered, the patient should be made to sip some liquid slowly; the mere effort of sipping accelerates the action of the heart.

When solid foods cannot be taken, the best kinds are those which contain the most nourishing properties in the smallest and most easily digested form. Prominent among these is well-made beef tea: not the greasy watery broth which so often goes by that name, but nearly pure beef juice which has been slowly extracted, with the addition of little or no water, from fresh lean beef. A good substitute may be found in Bovril, which has the great advantage in an emergency of being immediately procurable at a chemist’s or grocer’s. Home made beef tea takes a long time to prepare properly, and even then it is deficient in staminal properties, whereas Bovril contains the entire nutritious constituents of pure beef, of which it takes 40 lb. to make 1 lb. of Bovril extract. Of equal value is milk; which, especially when combined with bread and butter, is very nourishing, and forms a most valuable article of sick diet. If it seems to disagree, or curdle on the stomach, it can generally be prevented doing so by the addition of about ?-¼ its bulk of lime-water. These may be varied by mutton broth, chicken or rabbit jelly, eggs in any form—plain, in custard, or in pudding with arrowroot and sago—and real turtle soup; which latter is, however, so terribly expensive as to be outside the reach of most people. Jellies made with gelatine, which contains scarcely any nutriment, are almost useless; and tea should be given only as an indulgence when specially wished for, and then it should be very weak, and with plenty of milk. All food given to the sick should be very fresh, of the best quality, and most carefully cooked.

Boiled Flour Gruel.—Where the illness has been long and tedious, and the strength reduced, the following will be found very useful: To prepare the flour, put into a basin as much as it will hold, pressed tightly down. Then tie a cloth over it, and allow it to boil hard for 6 hours. Then take off the cloth, and let the flour stand in the basin till next day, when remove the crust which will have formed, and put the remainder away in a covered jar. For use, mix 4 tablespoonfuls flour smoothly into a paste, then pour on it ½ pint boiling milk or water, and boil for 10 minutes, constantly stirring to avoid lumps. Brandy, sherry, lemon juice or cream may be added, according to taste. Gruel may also be made from baked flour, but it is not so easy of digestion.

Rice Gruel.—1 oz. each rice, sago, and pearl barley boiled in 3 pints water, which, in 2 hours, generally reduces it to 1 qt. Strain and flavour to taste. This forms a good nourishing diet, especially with the addition of a little isinglass.

Onion Posset or Gruel.—This has been found very efficacious for colds, and is made with Robinson’s groats with the addition only of an onion, which should have been previously boiled for 6 hours. The yolk of an egg well beaten is an improvement.

Chicken Broth.—The younger and fatter the birds are for this the better. It is made by immersing the legs, neck, and trunk of a fowl into just as much water as will cover them, and boiling gently for an hour. The white meat makes a delicious entrÉe if cut up finely and treated as a veal mince. Potato flour is useful for thickening in cases where boiled flour is not handy; but home-made things are always the best, as the ingredients are known.

Oyster Fritters.—Remove the beards, and put each oyster into a tablespoon, and fill with a batter made as follows: 1 oz. rice flour mixed with 2 tablespoonfuls water, 1 teaspoonful vinegar, and 2 salad oil, the yolk of an egg, and a little salt and pepper. Allow the batter to stand, and just before using, beat the white of an egg to a stiff froth, and mix with it. Fry the oysters covered with the batter in boiling fat, turn them, place them on blotting paper to drain; serve on a hot dish, and garnish with slices of lemon, and thin rolls of brown bread and butter alternately.

Potato Chops.—Mash nicely with a little milk, butter, pepper, and salt, any potatoes left from the day before, spread evenly over a boned loin chop previously sprinkled with finely chopped fried mint. Fry to a golden brown in boiling fat, then place it on blotting paper to remove the superfluous grease. Garnish with fresh mint and watercress.

Jellies and Creams.—The following recipes were published by Mary Hooper, in the Queen:—

When jellies and creams are ordered for sick people in families where there is not a good cook, they are usually obtained from the confectioner; but this is not at all in the interest of the invalid, and efforts should be made to provide his diet from the home kitchen. An idea prevails that it is very troublesome to make jelly. It is not at all necessary to clear the jelly through a bag for invalids, nor indeed for ordinary domestic use. By a little care in the use of citric acid, which is perfectly wholesome, a jelly nearly as bright as that which has been cleared with eggs may be produced. In some cases, jelly without wine is required for invalids, when coffee, cocoa, or Seville orange jelly will probably be useful. It is difficult to make these jellies palatable without making them sweet, and they will only keep a short time. If the doctor does not object, or where it is desirable to give stimulants in a disguised form, a very small quantity of absolute alcohol may be used, and it will obviate the last-named disadvantages.

Milk jellies, or creams, whenever they can be taken, are an excellent form of diet, and are very easily prepared by the following recipes. For those who require a quickly-made cream, “Nelson’s Blanc mange” will be found very useful; it merely requires to be dissolved in milk or water, and in a very short time is ready for use. This blanc mange is made of very rich milk, and tastes equal to that prepared at home with cream. The unflavoured blanc mange should, as a rule, be selected for invalids, as any home-made flavour can be added to it. These flavourings—lemon, Seville orange, almond and vanilla—are very easily prepared by infusing any of the three first-named in gin, the latter in brandy. As these are more digestible than any which can be bought, it is well worth while to take a little trouble in the matter. It is sometimes necessary to tempt the appetite of an invalid by a pretty looking dish, which is also nice and nourishing. Such a dish can be easily made by the recipe for Alexandra Cream.

Simple Jelly.—Soak 1 oz. gelatine in ½ pint cold water for 1 hour or more. It is an advantage to soak gelatine overnight when convenient, because it is then more easily dissolved. Boil 6 oz. lump sugar in 1 pint water, skimming it until clear; then throw in the soaked gelatine, let it boil slowly for 5 minutes, removing all scum as it rises. Dissolve in a basin ¼ oz. citric acid, in lump, in ½ gill boiling water, pour the jelly on to this, when more scum will rise, which should be carefully taken off. Now add 1 gill wine and a little lemon flavouring, and, when nearly cold, put the jelly into a mould. Lemon juice can be used instead of the citric acid, but the jelly will not then be so bright.

Cocoa Jelly.—Mix 1 dessertspoonful cocoa in ½ pint water, stir over the fire until it boils, sweeten it with ¼ lb. lump sugar, or according to the taste of the patient. Stir into it, whilst boiling, ½ oz. gelatine, soaked in ½ pint cold water for some hours, flavour with vanilla, and stir occasionally until the jelly begins to set.

Coffee Jelly.—Soak ½ oz. gelatine in ½ pint cold water, dissolve it in ½ pint very strong coffee, sweetened to taste. Extract of coffee can be used to flavour this jelly, and answers well.

Porter Jelly.—Procure a cow-heel (which should be thoroughly cleaned) and 2 calves’ feet; wash them in cold water, and put them into a pan with 5 pints water, and let them boil until the meat leaves the bones; strain the liquor through a hair sieve, and let it stand for one night in a cool place. Next morning put the stock into a pan with 1 lb. loaf sugar, ½ pint porter, the juice of 4 lemons with their rinds cut very thin, and the well-beaten whites of 8 eggs. Let all boil together till it rises to the top of the pan; then throw in a teacupful of cold water; then let it boil slowly about 20 minutes, at the expiration of which time add 1 wineglassful brandy. Boil 5 minutes longer, then lift the pan from the fire, and let it remain at the side of the fire, to keep hot. In about ½ hour the scum will collect in a lump, leaving the liquor quite clear. Run it into moulds.

Port Wine Jelly.—Take ½ pint port wine, 2 oz. isinglass, and ½ lb. white sugar candy. Let the ingredients be put together in a jar and stand for 6 hours; then put the jar into a saucepan of water, and as soon as it boils take it off the fire and strain through muslin; when cold it is fit for use.

Restorative Jelly.—Put into the jar in which the jelly is to be kept 2 oz. isinglass, 2 oz. white sugar candy, ½ oz. gum arabic, and ½ oz. nutmeg grated. Pour over them 1½ pint tent or port wine. Let it stand 12 hours, then set the jar in a saucepan of water, and let it simmer till all the ingredients are dissolved, stirring it occasionally. The jelly must not be strained. A piece the size of a nutmeg to be taken twice a day. If nutmeg is not liked, any other spice will do as well to flavour it.

Blanc Mange.—It is better, if possible, to soak the gelatine for this cream all night, because it will then dissolve in warm liquid, whereas if it is only lightly soaked, the milk must be boiling. Warm 3 gills milk or cream, and dissolve in it ½ oz. gelatine, previously soaked in ½ gill water. Sweeten to taste, and flavour with extract of vanilla. When nearly cold, stir into the blanc mange the whites of 2 or 3 eggs beaten to a strong froth. This blanc mange will be found light and nourishing in cases of great weakness.

Rice Cream.—(a) Boil 2 oz. fine rice in water for 5 minutes, strain it, and boil until tender in 1 qt. new milk. Rub the rice through a sieve to a pulp, and add to it any milk not absorbed in the boiling; ½ oz. gelatine to 1 pint rice and milk. The gelatine can be soaked and dissolved either in milk or water. Stir over the fire until mixed, sweeten and flavour to taste. Stir the cream occasionally until cold, then lightly mix in the whites of 2 eggs beaten to a strong froth; when on the point of setting put it into a mould.

(b) Make 1 pint milk or cream into custard with the yolk of an egg and 2 oz. sugar; then dissolve in it ½ oz. gelatine previously soaked. Mix with it 1 oz. rice which has been baked or boiled in milk until perfectly tender, flavour with vanilla, and add 1 teaspoonful brandy if liked. Rinse a mould with cold water, put the cream into it, and let it stand until firm enough to turn out.

Semolina Cream.—Soak 1 oz. semolina in 1 gill cold milk for an hour, boil it until soft in ½ pint milk. Dissolve ½ oz. gelatine, previously soaked in ½ gill water, in ½ pint boiling milk, sweeten it with 2 oz. lump sugar, flavour to taste, and when the cream is beginning to set, put it into a mould.

Alexandra Cream.—Make ½ pint rice cream (a) or blanc mange as directed in the foregoing recipes. Dissolve ½ pint Nelson’s port wine jelly (sherry can be used if preferred, but the colour is not so tempting), either adding water or claret, according to the directions given with the jelly. When both the cream and the jelly are on the point of setting, put first a layer of the latter into a mould, then of the former, and so on until all is used. (Mary Hooper.)

Beef Tea.—(a) Cut 1 lb. beefsteak into dice, rejecting all skin and fat. Put into a stewpan a bit of fresh butter the size of a bean, throw in the meat, and sprinkle over a small pinch of salt. Cover the stewpan closely, and set it on the range at a low heat to draw out the juices, which will take 20 minutes. Take care there is no approach to frying, as that would dry up the extract and destroy the character of the tea. About every 5 minutes during the process drain away the gravy as it comes; if the meat is fine and fresh there will be at least ? pint, and when all is drawn set it aside, either to use as extract of beef or to be added to the tea when finished. Now put to the meat 1 pint water, and let it boil gently for ½ hour. Pour the tea off, but do not strain it, as such nourishment as it contains lies in the thick portion. Of course if a patient is unable to take any solid this rule will not apply, and the tea must then be strained either through a linen or flannel bag. Having drained off the tea whilst still boiling hot, put into it the juices at first extracted, and having taken off every particle of fat it will be ready to serve.

(b) Cut the meat into small pieces, cover with water, and simmer an hour. If it is allowed, 2 or 3 peppercorns and a minced shallot—it is milder than onion—will be a nice addition to the tea.

(c) Cut the meat into very small pieces, and put it in a jar having a closely fitting lid, with cold water. The jar can be placed in the oven for 1-2 hours, according to the heat, or in a saucepan of water to boil for 1½ hour.

In all cases where it can be taken, beef tea should be slightly thickened, and especially when bread is refused. Boiled flour is best for this purpose; genuine arrowroot may also be used. The yolk of an egg beaten up in the broth-cup, and the tea poured boiling on to it, is excellent.

The meat from which beef tea has been prepared will make good stock, or be excellent if properly treated for the dinner of the family, who, be it remembered, have the chief of the nourishment in the fibre.

It is important in the preparation of beef tea to preserve the fine flavour of the meat, and to use such scrupulously clean vessels that no foreign taste can be imparted to it. The shin of beef should not be chosen for this purpose, for it gives more gelatine than juice. The best part is beefsteak or the neck; the first will yield the most gravy, and does not cost above 2d. per lb. more than the coarser portion of the ox.

The idea that beef tea should be boiled a long time in order to extract all the goodness of the meat is a mistaken one, for the gelatinous matter thus gained is of comparatively little value, whilst the delicate aroma of the tea is lost by long boiling.

Gruel.—Made as it should be, gruel is rarely disliked, and is more nourishing, and in many cases to be preferred to arrowroot—a thing most difficult to procure genuine, and very expensive. Made thin, as is customary, it is a comfort in sickness, is soothing to the stomach, and gives warmth to the body; made thick as a porridge it is the most nourishing of cereal foods. Robinson’s Embden groats, and Robinson’s patent groats, prepared by Keen, Robinson, and Bellville, are the only kinds of which gruel can be properly made. They are entirely free from the acrid flavour which is so disagreeable in inferior preparations of oatmeal, make a most nourishing and digestible gruel, with the advantage of being easily and rapidly served up—if made from the patent groats, the Embden takes longer—ten minutes only being required in the process of cooking. Robinson’s Embden groats were introduced about the year 1764 by Mr. Martin Robinson as an improvement upon the “whole gritts” then in use. In 1823 letters patent were taken out for a greater improvement known as Robinson’s Patent groats, now in use in all parts of the world. Take of the patent groats one tablespoonful, mix into a smooth paste of the consistence of cream with a wineglassful of cold water, pour this into a stewpan containing nearly a pint of boiling water or milk, stir the gruel on the fire while it boils for ten minutes; pour into a basin, add a pinch of salt and a little butter, or if more agreeable some sugar, and a small quantity of spirits if allowed. If made with water, milk or cream can be added afterwards.

A delicious substitute for gruel is made as follows: 1 oz. each rice, sago, and pearl barley; put 3 pints water, and boil gently for 3 hours, when the liquor should be reduced to 1 qt. Strain it in exactly the same manner as groat gruel, and flavour with wine, brandy, or anything else that may be suitable. If made a little thicker, say with 1½ oz. each ingredient to 3 pints water, a jelly will be produced, which may be eaten cold with sugar, fruit, syrups, or preserve.

Arrowroot.—(a) To make plain water arrowroot, with an Etna, put on ½ pint water to boil in the saucepan; mix, in a cup, 1 dessertspoonful arrowroot with a little water; pour the mixture into the boiling water, and cook it for 2-3 minutes, stirring all the time.

(b) Milk arrowroot is prepared exactly in the same manner. Some persons affirm that arrowroot should never be boiled, or it will lose its astringent qualities. In some particular cases, when strong astringents are needed, it should not be boiled, and should only have boiling water or milk poured upon it; but when the digestion is weak, it is better for the patient to take arrowroot cooked. Sifted sugar may be added according to taste; and in water arrowroot a little wine or brandy is generally given.

Pastry and Bread.—Any fat that is greatly heated decomposes, and gives rise to certain fatty acids that are sure to disagree with delicate persons. That is the reason why pastry and fried food are unfitted for invalids. Very plain pastry, made light with baking powder, is sometimes admissible; but a small egg or milk loaf with the inside taken out, and baked crisp and hot, is a much better substitute. Sponge cake is best of all cakes, because it is made without any butter. Bread should not be new, but may be baked crisp in the oven. Crust is often more digestible than crumb. A change in bread is easy to arrange; if it is only a change of shape, it is better than monotony. A French roll, loaves of baking powder bread, brown and white pulled bread, crisp biscuits, are easy to get in most places.

Puddings.—(a) Boil ½ pint milk with cinnamon, lemon, and bay leaves; add 2 oz. sugar, 1 oz. flour, a little salt, and 3 eggs; beat all together, and steam this custard in a plain mould or basin, previously spread inside with butter; when done firm and quite cold cut into square pieces and dip in frying batter; drop separately in boiling fat, and fry a light brown colour, and dish them up on a napkin. (b) 6 oz. finely-grated bread, 6 oz. currants, 6 oz. sugar, 6 eggs, 6 apples, some lemon peel and nutmeg; let it boil 3 hours. (c) Weight of 2 eggs in butter, which beat to a cream, same weight of flour, same of pounded white sugar, the grated rind and juice of 2 lemons; bake ½ hour in a small flat pie-dish, with a rim of paste round the edge, serve with sifted sugar on the top, and send up very hot. (d) ½ lb. best beef suet, ½ lb. grated breadcrumbs, ½ lb. beaten white sugar, 3 eggs, well beaten and strained; the grated rind and juice of a large lemon, stick a mould with raisins, pour in the mixture, boil 2 hours.

Treacle Posset.—Heat ½ pint milk in the saucepan, and when in the act of boiling, pour in 1 gill (¼ pint) treacle. The milk instantly curdles. It must be taken off the spirit lamp and allowed to stand for 10 minutes, and then strained through a piece of muslin to separate the curds. This must be drunk hot. White wine, whey, and lemon whey, are prepared in a similar manner, only substituting a glass of sherry in one case, and a glass of lemon juice in the other, for the treacle. All wheys must be strained before they are taken.

Restorative Soup.—Take 1 lb. newly-killed beef or fowl, mince it very fine, add 8 fl. oz. soft or distilled water, 4-6 drops pure hydrochloric acid, 30-60 gr. common salt, and stir well together. After 3 hours the whole is to be thrown on a common hair sieve, and the fluid allowed to pass through with slight pressure. On the flesh residue in the sieve pour slowly 2 oz. distilled water, and let it run through while squeezing the meat; there will be 10 oz. extract of meat, of which a wineglassful may be taken at pleasure. It must not be warmed to a greater extent than putting a bottle filled partially with it to stand in hot water. If the flavour be disagreeable, 1 wineglassful claret may be added to 1 teacupful.

Milk Toast.—Take 2 slices bread and toast well—that is, crisp. Take new milk or cream, also a bit of butter (varying according to toast required), and melt in a saucepan together. Then dip in the slices of toast, let them soak for a moment or two, lift on to a deep plate, and pour the remains of milk and butter on top. Serve very hot; add salt as required.

Hot Milk.—Milk that is heated to much above 100° F. loses, for a time, a degree of its sweetness and density; but no one fatigued by over-exertion of body or mind who has ever experienced the reviving influence of a tumbler of this beverage as hot as it can be sipped, will willingly forego a resort to it because of its having been rendered somewhat less acceptable to the palate. The promptness with which its cordial influence is felt is indeed surprising. Some portions seem to be digested and appropriated almost immediately; and many who fancy that they need alcoholic stimulants when exhausted by labour of brain or body will find in this simple draught an equivalent that will be as abundantly satisfying and more enduring in its effects.

Caudles.—The basis of all caudles is flour gruel, made either with water or milk, that made with milk being the most nutritious, while both are equally digestible. In cool weather a quantity of gruel may be made and kept in a cool place, and portions of it heated and used as required. When gruel enters largely into the diet, its acceptability to the patient will be augmented by varying the flavouring or spice used in its preparation. If, therefore, a quantity is made plain, it can be sweetened and variously flavoured as it is heated for immediate use.

Cold Wine Caudle (a nutritious, digestible, and slightly stimulating food, useful in all sickness where starch and wine are not objectionable).—Make a good gruel by mixing smoothly 1 tablespoonful flour with ½ pint cold milk or water, and stirring it into ½ pint boiling milk or water; add a level teaspoonful of salt, and let the gruel boil for 5 minutes, stirring it to prevent burning. To ½ pint cold gruel add 1 egg beaten to a froth, 1 glass of good wine, and sugar and nutmeg to suit the palate of the patient.

Hot Wine Caudle (preferably to cold caudle generally, and useful in the same physical condition indicated in the preceding recipe). Heat ½ pint gruel; beat the yolk of a raw egg to a cream with 2 tablespoonfuls pulverised sugar; beat the white of the egg to a stiff froth; when the gruel is boiling hot, quickly beat a glass of good sherry or Madeira wine into the egg yolk and sugar, stir the hot gruel into it, and then add the beaten white of the egg. Work very quickly, and serve the caudle hot.

Cream Caudle (an equally valuable food with the two preceding caudles, useful under similar physical conditions). To 1 pint gruel add 1 glass good wine, 1 gill sweet cream, 1 tablespoonful noyeau or any good cordial, and sugar to suit the patient’s taste. Use hot or cold, but preferably hot.

Digestive Foods.—Where the digestion is weak, as is generally the case in sickness, much benefit may be derived from partially digested foods. Maltose is a sugar which does not readily undergo acetous fermentation, and therefore will not give rise to acidity and dyspepsia. This is a great matter, as cane sugar added to stewed fruit and milk puddings readily undergoes acetous fermentation in many stomachs. The lÆvulose sugar of fruit, like maltose, readily undergoes alcoholic but not acetous fermentation. Maltose being less powerfully sweet than cane sugar, a greater quantity is necessary to sweeten the pudding. If the raw starch, semolina, sago, or tapioca be first put in the dish by itself, and placed in the oven for an hour (taking care not to have it burnt by the oven being too hot), not only are the starch cells cracked, but a certain conversion of the starch into dextrine takes place. If to this be then added an equal quantity of ground malt and some hot milk poured on, and the dish be allowed to stand a few minutes before being put into the oven again, the diastase of the malt acts upon the farina and converts it into dextrine and maltose. Dextrine and maltose being soluble, the pudding is very thin. Such a pudding is admirably adapted for invalids and dyspeptics, as requiring scarcely any digestion in the body. For those with whom ordinary milk puddings produce acidity, such a pudding is specially suitable. Ground malt may be added to fresh milk, and forms an admirable food in cases of acute disease. Baked flour perhaps goes better with meat broths, to which it gives a high food value. (Well-baked flour requires but a touch of saliva to render it soluble, and, added to meat broths and gravy soups, renders them very nutritive.) Malt, being sweet, goes better with milk, or apple-water, or tamarind-water, or lemonade, and gives us a food which being all but independent of the digestive act, can be most usefully employed in the sickroom. Beef-tea (which alone is scarcely a food) and milk-and-seltzerwater pall upon the palate of the sick person, who craves variety just as do healthy persons. The adoption of ground malt as a food will solve for us one or two knotty questions connected with feeding people when the digestive power is feeble. Drinks like lemonade, made with malt instead of cane sugar, would not only not go sour in the mouth and stomach, but would contain some phosphates and soluble albuminoids, and so form admirable beverages in feverish states. The many malt extracts now in the market are well adapted for such end. (Lancet.)

An excellent peptonising apparatus, for the predigestion of foods for the sickroom, is sold by Savory and Moore.

Drinks.—Orange-whey.—The juice of 1 orange to 1 pint of sweet milk. Heat slowly until curds form, strain and cool.

Egg-Lemonade.—White of 1 egg, 1 tablespoonful pulverised sugar, juice of 1 lemon, 1 goblet water. Beat together.

Sago-Milk.—3 tablespoons sago soaked in a cup of cold water one hour; add 3 cups boiling milk; sweeten and flavour to taste. Simmer slowly ½ hour. Eat warm.

Baked Milk.—Put ½ gal. milk in a jar, and tie it down with writing-paper. Let it stand in a moderate oven 8-10 hours. It will be like cream, and is very nutritious.

Punch without Liquor.—Take the juice of 6 oranges and 6 lemons, adding sugar to suit the taste. Put to this a quantity of pounded ice and some sliced pine-apple, pouring over it 2 qt. water. This is an agreeable summer beverage for anybody, sick or well.

Rice Water.—Wash 2 oz. best rice and boil it fast for ½ hour in 1 qt. water. Any flavouring may be added, or a small piece of stick cinnamon or shred lemon peel may be boiled with the rice, and sugar used according to circumstances. Lemonade made with rice water when cold is very nice and refreshing.

Gum Arabic Water.—Put into an earthenware jar 1 oz. finest picked gum with 2 oz. sugar candy and 1 pint water; set it in a saucepan of water, and stir occasionally until dissolved. This is very useful as a night drink for hectic cough, and will allay the tickling in the throat. It should be kept as hot as possible. The little French porcelain veilleuse is best adapted for this purpose.

Lemon Juice.—Few people know the value of lemon juice. A free use of lemon juice and sugar will always relieve a cough. Most people feel poorly in the spring, but if they would eat a lemon before breakfast every day for a week—with or without sugar, as they like—they would find it better than any medicine. Lemon juice, used according to this recipe, would sometimes cure consumption:—Put 1 doz. lemons into cold water and slowly bring to a boil; boil slowly until the lemons are soft, then squeeze until all the juice is extracted; add sugar to taste, and drink. In this way use 1 doz. lemons a day. If they cause pain, lessen the quantity and use only 5 or 6 a day until you are better, and then begin again with 1 doz. a day. After using 5 or 6 doz., the patient will begin to gain flesh and enjoy food. Hold on to the lemons, and still use them very freely for several weeks more. Another use for lemons is for a refreshing drink in summer, or in sickness at any time. Prepare as directed above and add water and sugar. But in order to have this keep well, after boiling the lemons, squeeze and strain carefully; then to every ½ pint juice add 1 lb. loaf or crushed sugar, boil and stir a few minutes more until the sugar is dissolved, skim carefully and bottle. You will get more juice from the lemons by boiling them, and the preparation keeps better.—Lancet.

Linseed Tea.—Take 3 tablespoonfuls linseed, about 1 pint water, and boil for 10 minutes. Strain off the water, put in a jug with 2 lemons, cut in thin slices; put also some brown sugar. A wineglassful of wine is an improvement. This has been found most nourishing for invalids.

Barley Water.—Barley water is an important article in the invalid’s dietary. Dr. Pye Chavasse, in his work entitled ‘Advice to a Mother,’ strongly recommends Robinson’s patent barley, prepared by Keen, Robinson, and Bellville, of London. Take of the patent barley one ounce mixed with a wineglass of cold water, pour this into a stewpan containing nearly one quart of boiling water, stir this over the fire while boiling for five minutes, then flavour with a small bit of lemon peel or cinnamon and sweeten according to taste. Equal quantities of milk and barley water make a very nourishing drink, especially useful in feverish cases. Barley water should not be mixed with milk or syrup before required for use, as in a warm atmosphere it undergoes changes, and sometimes slightly ferments.

Almond Milk (an exceedingly nutritious beverage, useful in most conditions of illness).—Pour 1 qt. boiling water upon ¼ lb. shelled almonds, and when the skins soften rub them off the kernels with a clean towel; pound the almonds thus blanched in a mortar, putting in 3 or 4 at a time, and adding 4 or 5 drops milk, as the almonds are being pounded, to prevent oiling—about 1 tablespoonful milk will be required for the ¼ lb. almonds; when the almonds are finely pounded, mix them with 1 pint milk, 2 tablespoonfuls sugar, a level teaspoonful salt, and the yellow rind of a lemon, and place the milk over the fire to boil; meantime, beat 3 eggs smoothly, and strain the almond milk into them, stirring the mixture as the milk is strained in; return it to the saucepan, and place it in another pan of hot water, over the fire, stirring it constantly until it begins to thicken; then remove it at once from the fire, strain it, and use it.

Barley Milk (a demulcent, refreshing, and nutritious beverage, useful in fevers and gastric inflammation).—Wash 4 oz. pearl barley in cold water until the water is clear; put it over the fire in a double kettle with 1 qt. milk and a level teaspoonful of salt, and boil it until the milk is reduced one half; then strain off the milk and sweeten to suit the taste of the patient. The barley may be used as food by adding to it a glass of wine and a little sugar.

Irish Moss Water (a bland, nutritious drink, excellent in feverish conditions and in colds).—Wash ½ oz. moss in plenty of cold water; then soak it for 10 minutes in 1 pint cold water; then add 2 pints cold water, 1 tablespoonful sugar, and 1 in. stick cinnamon to it, and boil it until it is about as thick as cream; strain it, add more sugar if it is desired, and use while warm. The yellow rind of a lemon may replace the cinnamon as flavouring.

Icelandic Moss Chocolate (a very nutritious drink, suitable for use when abundant nourishment is required).—Wash 1 oz. moss thoroughly in cold water; then put it over the fire to boil in 1 pint water. Grate 1 oz. chocolate fine, mix it with ½ cupful cold milk, stir it into 1 pint boiling milk, and boil it for 5 minutes; then add it to the boiling moss, strain them together, sweeten them to suit the taste of the patient, and use the beverage warm.

Imitation Kumys (Koumiss).—(a) Fill into a strong champagne bottle, good, fresh, unboiled cow’s milk to such a height that after the addition of 1 oz. granulated or powdered sugar, and after corking, there would still be left at least 1 in. of empty space below the cork. Before corking, add a piece of fresh compressed yeast, about the size of 2 peas, then cork and tie the cork firmly down. In place of compressed yeast, 1 teaspoonful good beer yeast may be taken. The contents of the bottle are well shaken, repeatedly, then the bottles are placed in the cellar, where they are turned up and down a few times during the day. From and after the fifth day the mixture is ready and may be drunk to about the twentieth day. It is best to prepare about 6 bottles full at a time, refilling each after it has been emptied and cleaned, so that the treatment, after being begun, may not be interrupted. On opening the bottles, the contents are very apt to foam over, hence the bottle should be opened while being held over a plate. It should never be opened where there may be any furniture or dresses about, which might be soiled by spattering. A good milk-wine or kumys should have a homogeneous appearance of the consistence of thin cream, should be effervescent when poured out, of an acidulous, agreeably vinous odour and taste, and should not be full of lumps, or taste like butter-milk. On first using kumys it produces loose bowels, but this effect soon passes off.

(b) 200 parts condensed milk, 2000 parts water, 2 parts lactic acid, 1 part citric acid, and 30 parts brandy are mixed and carbonated. Cork well and let it stand for 2 days in a warm room till it froths.

Administering Physic

Administering Physic.—Never allow a bottle of lotion for external use to stand beside a bottle of medicine to be taken internally. Keep them entirely separate, and keep all medicines in a place where children cannot by any possibility reach them. One further piece of advice, which is unfortunately but seldom attended to, is deserving of attention, namely, after an illness has terminated either in recovery or death, empty out all the medicine bottles, and on no account retain any of them for future use. Spoons differ very much in size, and it is not wise to trust to them in measuring medicines. It is best to get a medicine glass or spoon, either of which can be got at a chemist’s for a few pence. In giving sick people medicine there are 3 points which ought carefully to be remembered—namely, regularity, punctuality, and exactitude. Those intrusted with the administration of medicine to sick persons should always read the label of the bottle before administering the medicine. By doing so they will probably save themselves a lifelong reproach. An inhaler for taking medicated vapours in bronchial and catarrhal affections may be extemporised out of a pickle bottle fitted with a perforated cork and a bit of tube. A special apparatus (Dr. Felton’s) is sold at 7s. 6d. by Savory and Moore.

To mask the taste of cod-liver oil:—(a) Use Allan and Hanbury’s “perfected” oil. (b) Put a little salt in the mouth before taking the oil. (c) Add 30 drops sulphuric ether to the dose and take it quite cold. (d) Add a little iodoform and essence of anise; say 96 grm. oil, 20 c. grm. iodoform, 4 drops essence.

Quinine may be enclosed in gelatine capsules when otherwise refused. If in powder it is best mixed with a little milk.

Keep a separate measure and separate glass for administering such drugs as castor-oil, cod-liver oil, asafoetida, valerian, &c.

Pills should be placed well towards the gullet and washed down with a drink. Or they may be hidden in jam, or wrapped in rice paper, and then washed down. Powders may be mixed in jam, treacle, honey, milk, or water.

To remove the taste of nauseous medicines from the mouth chew a small piece of bread and spit it out.

The best times for administering medicines, according to the frequency with which they are ordered, are as follows:—

“Daily.”—At 9 A.M. or at bedtime.

“Night and morning.”—9 A.M. and bedtime.

“Twice-a-day.”—10 A.M. and 6 P.M.

“Three times a day.”—10 A.M., 2 P.M., 6 P.M.

“Every 4 hours.”—10 A.M., 2 P.M., 6 P.M., 10 P.M., 2 A.M., 6 A.M.

Never wake a patient to administer medicine or food unless ordered to do so.

To apportion doses according to age, reckon 21 years and upwards as adults requiring full dose; then 17 will take ¾, 14 will take ½, 7 will take ?, 4 will take ¼, 3 will take ?, and 2 years or under will take ? of the full dose.

Medicines are classified according to their general properties, the following being the chief:—

AnÆsthetics—produce insensibility to pain.
Anodynes—procure relief from pain.
Antiseptics—prevent putrefaction.
Antispasmodics—check spasms and cramps.
Caustics—destroy animal tissues by a kind of burning.
Collyrium—an eyewash.
Diaphoretics—induce perspiration.
Diuretics—increase the flow of urine.
Emetics—cause sickness (vomiting).
Expectorants—favour spitting.
Liniments—for rubbing in.
Narcotics—induce sleep.
Purgatives—cause very loose bowels.
Refrigerants—cooling.
Sedatives—calm the nerves.
Soporifics—induce sleep.
Styptics—arrest bleeding.
Tonics—increase the appetite and give a stimulus to the system.

The principal domestic remedies, with their doses (m. means minims, gr. grains, table. tablespoonful, tea. teaspoonful, dr. drams, oz. ounces, dess. dessertspoonful) and properties, are as follows:—

Aloes (compound decoction): 1-3 tablespoonfuls; pleasant purgative, useful in habitual constipation, and will often relieve headache.

Alum: 10-20 gr. in whooping cough and internal bleeding; 1 tea. (in treacle) as an emetic; 15 gr. in 10 oz. water as a collyrium; 60 gr. in 10 oz. water for gargles and injections; astringent (coddling the mouth) and styptic.

Ammonio-citrate of iron: 5-10 gr. in water; tonic.

Antimonial wine: 5-15 m. 3 times a day in bronchitis and fever, diaphoretic; 1 table. (for adults), emetic.

Aromatic chalk: 20 gr. in water checks diarrhoea.

Belladonna liniment (compound): externally applied on rag covered with waterproof for 12 hours as local remedy for rheumatism and lumbago; anodyne.

Bicarbonate of potash: 15-20 gr.; antacid; taken with lemon juice or citric acid as a cooling drink.

Bicarbonate of soda: 10-20 gr.; antacid; checks heartburn and stops diarrhoea.

Blue pill: 3-5 gr.; alterative; cures bilious attacks.

Borax: 1 in 24 parts water as a gargle for sore throat.

Calomel: 1-3 gr.; powerful purgative and alterative; taken for biliousness.

Camphor liniment (compound): stimulant liniment.

Carbonate magnesia: 5-30 gr. in milk; antacid, gentle aperient; useful for children.

Castor oil: ½ tea. (infants), 2 table. (adults), on milk, wine, or orange juice, or blended with glycerine or egg-yolk; most reliable aperient.

Chlorate potash: 10-20 gr., stimulant; 1 dr. with 4 dr. honey and 8 oz. water, gargle for sore throat; lozenges, overcomes effect of high altitudes on the respiratory system.

Chloric ether: 20-30 m. in water, cordial and antispasmodic; relieves cramp, violent cough, spasms, &c.

Chloroform: not to be inhaled or taken except in a doctor’s presence; sedative; applied to rheumatism, stings, and toothache as an anodyne.

Citrate of iron and quinine: 3-5 gr. in water; tonic and binding.

Citrate of magnesia (granular effervescent): 1 dess. in tumbler cold water; cooling aperient.

Cream of tartar: 20-60 gr., diuretic and cooling; ½ oz. in 1 qt. of water, fever drink.

Dover’s power: unfit for children; 5 gr. in wineglassful water, diaphoretic, checks diarrhoea and cures fresh colds; 3 gr. after meals prevents chest-ache.

Epsom salts: 1-4 dr. in water; purgative.

Essence of camphor: 30 m. in wineglassful water; exhilarating.

Essence of ginger: ½ tea. in wineglassful water; cordial stimulant, useful in chest-ache.

Essence of peppermint: 10-15 m. on sugar; exhilarating, warming and antispasmodic.

Extract of bark: 10-30 m. in wineglassful water; valuable tonic in neuralgia and fever.

Friar’s balsam: ½-1 dr. with sugar and egg-yolk, stimulating expectorant; applied on cuts.

Glycerine: may replace sugar for sweetening drinks and medicines; much used for softening the skin.

Goulard’s extract: 5 m. in wineglassful water as an eyewash; 1 in 40 of water, astringent, applied to bruises and sprains as a wash.

Gregory’s powder: 1 tea. in wineglassful water, cooling mild aperient.

Grey powder: 3-5 gr. (adult); aperient, acting on the liver.

Ipecacuanha powder: 15 gr. emetic.

Ditto wine: 10-20 m., expectorant for coughs; 1 table. (adults), repeated at 10 minutes intervals, emetic.

Jalapine: 2-6 gr., aperient for children.

Laudanum: 10-20 m., anodyne and soporific; with equal quantity opodeldoc, applied as an anodyne.

Lime-water: antacid; checks infantile diarrhoea; mixed with sweet oil affords great relief when applied to burns.

Liquorice powder (compound): 1 tea., mild aperient, best for piles.

Milk of sulphur: 1 tea. rubbed up with milk, gentle aperient and cooling, useful in rheumatism and piles.

Morphia bimeconate: 5 m. increasing every 3 hours; most valuable sedative and soporific; applied as an anodyne after the part has been reddened by compound camphor liniment.

Muriate (chloride) of ammonia: 10 gr. in wineglassful water, good expectorant in bronchitis; 1 oz. with 1 oz. alcohol and 10 oz. water; stimulant lotion for sprains.

Nitrate of silver: 2-4 gr. in 1 oz. water, lotion for sore nipples; 20 gr. in 1 oz. water, throat wash in diphtheria.

Nitre (saltpetre): 5 gr. in saline draught, cooling and diuretic for fever; ¼ oz. in ½ pint barley water, gargle for inflamed sore throat.

Nitric acid (dilute): 10 m. with 5 m. tincture of chiretta, 15 m. tincture of orange and 10 m. syrup in 1 wineglassful water, excellent between meal-times for convalescents.

Opodeldoc (soap liniment): excellent applied to bruises, stops swelling and discoloration.

Paregoric: 30-60 m., checks coughing.

Prepared chalk: 15-30 gr. repeated, with cinnamon and tincture of catechu, antacid and astringent for diarrhoea and cholera; made into a cream with water, cooling shield for burns.

Rhubarb: 1-5 gr., tonic to bowels; 10-20 gr., aperient followed by astringent.

Sal volatile: 30-60 m. in wineglassful camphor julep; antacid, antispasmodic, and exhilarating.

Santonine: 2-3 gr. on 3 alternate nights, followed by castor oil in the morning, expels threadworms from children.

Spirit of minderus: 15-20 m. in gruel at bedtime, excellent diaphoretic and cure for coryza (cold in the head); 20 m. in wineglassful water, eyewash; 1 table. in tumbler water, cooling lotion.

Spirit of nitre: 20-30 drops in wineglassful water, or 1 tea. in hot gruel at bedtime, diuretic and diaphoretic, for colds.

Sulphate of copper: 10-15 gr. in wineglassful water, rapid emetic in poisoning.

Sulphate of potash: 10-20 gr. with 10 gr. rhubarb and 15 gr. sugar in peppermint-water, mild aperient.

Sulphate of quinine: 1-5 gr. 2 or 3 times a day, tonic, useful in neuralgia, dyspepsia, weakness and fever.

Sulphate of zinc: 20 gr. in wineglassful water, emetic; 1 gr. in 1 oz. water, eyewash, astringent.

Sulphuric ether: ½-1 tea. in camphor julep, exhilarant.

Syrup of senna: 1 tea. (adults), mild aperient.

Tincture of arnica: with 4 times its bulk in hot water for fomenting bruises.

Tincture of chiretta: 10-30 m., tonic, useful in dyspepsia.

Tincture of colchicum: 10-20 m. at night after a light meal, diaphoretic, valuable in gout, rheumatism, and dropsy.

Tincture of henbane: 15-60 m., narcotic and anodyne.

Tincture of lavender (compound): 1 tea. with ½ tea. sal volatile in water, stimulant, antispasmodic, and exhilarant.

Tincture of quinine: 1-2 tea. in wineglassful water 2 or 3 times a day, tonic.

Tincture of rhubarb: 2-4 tea., cordial and purgative.

Tincture of squills: 1 tea. with wineglassful water, expectorant; take 1 dess. at short intervals to check coughing.

Tincture of steel: 5-15 m. in wineglassful water, tonic, astringent, and diuretic, good in weakness and dyspepsia.

Tincture of valerian: 1 tea. in camphor water, antispasmodic and stimulant, valuable in nervous headache.

Common Complaints.—Without making the least pretence to give such information as will enable the sick man to dispense with the services of the physician or surgeon, whose aid should be promptly sought, there are many matters which by careful study may enable the threatened attack to be warded off, and there are a variety of ailments and troubles which are not generally deemed of sufficient importance to be worth troubling a doctor about. It is these subjects which claim treatment here, and with which the following paragraphs will deal, leaving all special and serious diseases in hands which have been trained to the work.

Accidents and Emergencies

Accidents and Emergencies.—The first piece of advice to every one is to attend a series of lectures given every winter by the St. John’s Ambulance Association at very numerous centres all over the kingdom. This will convey an amount of knowledge and practical experience such as can never be attained by reading alone. Even Volunteers, who have gone through a course for the Army Hospital Corps, will do well to supplement it for every-day life with a course of St. John’s Ambulance lectures.

When you have not witnessed the occurrence of an accident, make some inquiry of the bystanders or patient as to its cause before taking any other steps, as this will often indicate what kind of injury is to be looked for. Never proceed to lift or remove a patient with broken limbs or bleeding wounds till the necessary bandaging and staunching have been done: let traffic be interrupted, if need be, rather than risk converting a simple hurt into a fatal one.

The ordinary accidents and emergencies of every-day life will now be dealt with in alphabetic order.

Bites and Stings.—These may be divided into two classes—those of insects and those of poisonous or rabid animals.

Of Insects.—First remove the sting (of a bee or wasp) by pressing a small key on the spot, whereby the sting is forced into the hollow barrel; then apply any of the following lotions:—(a) Rub the bite of mosquitoes with a solution of borax in ammonia. (b) When bitten by midges, the best applications are oil of camphor and laudanum, equal parts, applied on lint; or (c) 6 oz. Goulard water, ½ oz. laudanum, applied on lint. (d) ½ dr. extract of belladonna; ½ oz. glycerine; 3½ oz. water; to be well mixed, and made into a lotion. The parts to be washed with a small quantity—about a teaspoonful or two at a time. (e) Goulard water mixed with a little Eau de Cologne makes an excellent wash for the skin in case of gnat bites. (f) Keep an onion always at hand, and instantly when bitten squeeze or cut it, so that the juice should flow into the puncture, rubbing it gently over the place; its effects are equally efficacious in the sting of a wasp or bee, always provided the sting does not remain in the wound. (g) Ipecacuanha powder is very effective in allaying the pain caused by the sting of scorpion, hornet, and wasp, also mosquito and midge bites. For scorpion stings, &c., make a paste of the powder with a little water, and apply it to the wound in a patch about the size and thickness of a shilling. (h) In bee sting, first remove the sting as quickly as possible with a forceps or by scratching with a finger, but never with the thumb and forefinger, because this squeezes more of the poison into the wound. Next squeeze the wound until a drop of blood comes out, and rub the place as large as a florin with an aqueous or dilute alcoholic solution of salicylic acid. The effect is still better by injecting the salicylic acid into the wound with the hypodermic syringe. After this the spot is painted with collodion, to keep out the air. (i) Gnat bites, stings of wasps, bees, &c., may be cured by applying a tincture of minderus, laudanum, and Goulard water in equal parts. (j) Sweet oil, or camphorated spirit of wine, is a good thing to apply to bite of the mosquito. (k) One raw egg well beaten, ½ pint vinegar, ½ oz. spirit of turpentine, ¼ oz. spirit wine, ¼ oz. camphor; these ingredients to be well beaten together, then put in a bottle and shaken for 10 minutes, after which to be corked down tightly to exclude the air. In ½ hour it is fit for use. To be well rubbed in 2, 3, or 4 times a day. (l) The leaves of the common dock, bruised and well rubbed on the part affected, alleviate the pain. (m) For bee stings: after pulling out the stings, break some lettuce leaves close to the stalk, and apply the milk afterward. (n) Anything “strong,” in a popular sense, will generally suffice to decompose and destroy an organic poison if instantly applied. This is why the juice of an onion answers the purpose. Anything equally pungent would do as well. (Lancet.)

Poisonous bites.—There is great similarity in the immediate treatment desirable in the bite of snakes and mad dogs, the object being to prevent, as far as possible, the absorption of the poison by the blood. In the same category come any poisonous wound, as from arrows, &c. (a) Buckland recommends the following outlines:—(1) Suck the wound, if possible, most vigorously, taking care that there be no sores on the lips or in the mouth. In all cases before sucking fill the mouth with oil or salt and water if possible. (2) Apply, if you can, a cupping glass, or cut off the tip of a cow-horn, cut the bottom level, apply it over the wound, and exhaust the air by the mouth; when exhausted fill up the hole by means of a bit of wax or other material placed into the mouth before the operation of sucking is commenced. This is the mode adopted by the Kaffirs. (3) Wash the parts with hartshorn (ammonia). (4) Tie a ligature tightly above the wounded part. (5) Give doses of hartshorn and water as strong and as frequently repeated as the patient can bear them. (6) Send for the doctor as quickly as you can.

(b) Favourable results have followed using chloride of lime, a filtered solution of which was injected into the same place where the fatal virus (snakes’) had previously been introduced. In 17 trials made in succession, the poisoned animal survived without the slightest disturbance of its healthy condition.

(c) First tie a ligature above the part bitten. Then slightly cauterise with a lucifer match. Next swallow tumbler of raw brandy, to be repeated whenever the feeling of sinking comes on, till the liquor (which goes down like water) is tasted, and begins to affect the head. Meanwhile the patient is to be walked about by two men by force if he cannot do so alone or wants to lie down, which would be fatal. (Sir R. Burton.)

(d) Permanganate of potash may be added to the list of antidotes, as it is said to counteract very effectively the poison of serpents, when an equal quantity of filtered (1 per cent.) solution of permanganate of potash is injected 1-2 minutes after the poison.

(e) Probably a vapour bath immediately after being bitten by a venomous reptile or rabid dog will be found to prove one of the best remedies, the intense perspiration induced carrying off the poison. Excessive exercise following a poisonous bite generally effects a cure for this reason.

Bleeding.—Bleeding may result from a wound or from the bursting of a blood vessel, and may occur outwardly or inwardly. Bleeding from a wound may be arterial (coming from the arteries which carry the blood from the heart to the body and limbs), venous (coming from the veins which take the blood back to the heart), or capillary (coming from the capillaries which convey the blood to the extremities and surface of the body). In arterial bleeding, the blood is bright scarlet, and escapes in jerks, as if from a pump; this is highly dangerous. In venous bleeding, the blood is dark coloured, and flows away in an uninterrupted stream. In capillary bleeding, the blood leaks or oozes out. In some wounds all three kinds of bleeding will occur simultaneously. The foremost method of arresting external bleeding is by pressure, either on the wound itself or on the blood vessels feeding it, and in the case of a limb, it should be elevated above the body to retard the flow of blood towards the part. As the pressure is to be made on the vessels leading to the wound, it is obvious that in arterial bleeding the pressure must be between the heart and the wound, while in venous bleeding it must be beyond the wound.

The simplest and readiest way to apply pressure is by the fingers. But first of all some knowledge of anatomy and physiology is necessary to guide the operator where to press. Bleeding from the head and upper neck requires pressure to be exerted on the large artery which passes up beside the windpipe and just above the collar-bone, as in Fig. 110. The artery supplying the arm and hand runs down the inside of the upper arm almost in line with the coat seam, and should be pressed, as shown in Fig. 111. The artery feeding the leg and foot can be felt in the crease of the groin, just where the flesh of the thigh seems to meet the flesh of the abdomen, and this is the best spot to select in the case of a male patient; but in the case of a female, unless the injury were very high up the thigh, it would be more judicious perhaps to apply increased pressure around the leg about half-way between the hip and the knee. Pressure with the hands will not suffice to restrain severe bleeding for any length of time, and recourse must be had to a ligature.

The simplest and most available form of ligature is a pocket-handkerchief or neck-wrap, or any other article of attire long and strong enough to bind the limb. Fold the article necktie fashion, then place a smooth stone or anything serving as a firm pad on the artery, tie the handkerchief loosely, insert any available stick in the loop, and proceed to twist it as if wringing a towel until tight enough to stop the flow of blood, as in Fig. 111.

In the case of bleeding from an external wound or sore on the body, employ direct pressure over the bleeding point. If the bleeding is from the interior of the nose or other cavity, apply cold water or ice over the bleeding part or near it, and keep the patient perfectly quiet on the back, or let the patient stand erect with head well thrown back. Injection of hot water into the nostrils is very effective. When the bleeding is from a diseased surface or ulcer, and direct pressure does not stay it, a compress should be soaked in a strong solution of alum, or in steel-drops, and again applied over the point which is bleeding. Should the wound from which the blood is coming be large and gaping, you may stuff firmly into it a compress of some soft material large enough to fill the cavity; but this should always be avoided if possible, as it prevents the natural junction of the sides of the wound, and is very likely to introduce the germs of poison. In any case of bleeding the patient may become weak or may faint, but unless the blood is flowing actively, this is not necessarily a serious sign, and the quiet condition of the circulation during the faint often assists nature in staying the bleeding, by allowing the blood to clot, and so block up any wound in a blood-vessel. Unless the faint is prolonged, or the patient is losing much blood, it is better not to hasten to relieve the faint condition.

When blood is being coughed or vomited up in considerable quantities, ice or iced water or milk should be given, and the patient be allowed to breathe cool fresh air freely. If the blood is coming from the lungs, inhaling steam of turpentine and hot water mixed (2 tablespoonfuls turpentine to 1 qt. hot water) will often reduce the evil; apply cold wet cloths to the chest.

Broken bones.—Never move a patient with a broken bone till it has been suitably bandaged. Broken bones (fractured) are of three kinds—(a) simple fracture, when the bone is simply broken in one place; (b) compound fracture, when there is a wound in the flesh communicating with the broken ends of the bone; (c) comminuted fracture, when the bone is broken into pieces. The occurrence of a fracture may almost always be learned from the history of the accident, the patient having generally felt or heard the bone snap; other indications are deformity of the limb, such as shortening or bending, and on taking hold of the limb, you will find there is increased movability, and will hear and feel a peculiar grating caused by the broken ends of the bone rubbing against each other, called “crepitus”; also pain and loss of power in the limbs.

It is not imperatively necessary to do anything to a broken limb before the arrival of a doctor, except to keep it perfectly at rest, unless the patient must be moved; then, to prevent further mischief, the broken ends of the bone must be put in position and kept there. The first step is to pull the limb till the sinews and muscles stretch sufficiently to let the two ends of the bone meet each other. When this has been done, splints and bandages must be applied to keep the ends from shifting again.

The treatment of a broken bone then consists of (1) carefully removing or cutting away, if more convenient, any of the clothes which are compressing or hurting the injured parts; (2) very gently replacing the bones in their natural position and shape, as nearly as possible, and putting the part in a position which gives most ease to the patient; (3) applying some temporary splint or appliance, which will keep the broken bones from moving about and tearing the flesh, for which purpose you may use pieces of wood, stick, tin, pasteboard, wire, straw, or firmly folded cloth, taking care to pad the splints with some soft material, and not to apply them too tightly, while the splints may be tied by loops of rope, string, pockethandkerchiefs, pieces of cloth, or any kind of cord; (4) conveying the patient home or to a hospital, meanwhile examining the loops to see that they do not become too tight by rapid swelling of the part.

To get at a broken limb or rib, the clothing must be removed, and it is essential that this be done without injury to the patient. The simplest plan is to rip up the seams of such garments as are in the way. Boots must be cut off.

In a fracture of a leg bone, after setting the broken limb and putting it in splints, it should be bound to the sound leg at the knee and ankle, with rolled up coat for the sides and a piece of thin board or other substance for the front of the thigh. A broken arm, when in splints, requires the support of a sling, which may be made of a handkerchief fastened round the neck.

Bandaging can hardly be learned from a book—some practice is essential. Bandages are made of unbleached calico, flannel, linen, &c., and are used as supports to the different parts of the body, as means of applying pressure, for fixing splints, dressing, &c., and for allaying muscular action. The chief kinds are the roller and the triangular bandages.

Roller bandages commonly have the following dimensions: Finger, 1 yd. by ¾ in.; arm, 3-6 yd. by 2½ in.; leg, 6-8 yd. by 3 in.; chest, 8-12 yd. by 4-5 in.; head, 4-6 yd. by 2½ in. To roll one of these bandages, first fold one end 2 or 3 times, as tightly as you can, making it into a small roll; take hold of this by the fingers of both hands, both thumbs being placed on the top of it, the rest of the bandage being held by another person, who keeps it moderately strained; by alternate movement of the thumbs make the roll revolve on its own axis, the fingers at the same time holding it in position between the hands; fasten the end by a stitch or pin, to prevent unrolling.

Roller bandages are applied in 3 different ways: (1) simple spiral, (2) reverse or recurrent, (3) crucial or figure-of-8. When first applying the bandage, leave the end a little long, so that when the first turn is made, by laying this end under, and bandaging over it again, it is prevented from slipping. The application of the simple spiral is shown in Figs. 112, 113, each turn overlapping the preceding one to the extent of about ?rds the width of the bandage. This simple spiral is generally replaced by the reverse spiral, Fig. 114, which differs from it in that the bandage is turned back upon itself each time it is carried round the limb; it is not easily learnt, and requires practice before it can be done well; the thumb or forefinger of the hand not holding the bandage should be laid upon the limb at the point where the turn of the bandage is to be commenced, the other hand turning the bandage back upon itself. The crucial or figure-of-8 form is generally used at the joints, and always when going over the ankle-joint in bandaging from the foot up the leg. Carry the bandage over the upper part of the joint, then down, under, and across the lower part, and then up over the upper part again. Remember always to bandage from within outwards; commence from below and work upwards; let the pressure be evenly and uniformly applied, but not too lightly; avoid all wrinkles in your bandage; reverse or turn a bandage over always on the fleshy side, and not over a bone; fasten it with a few stitches.

The triangular bandage may well be represented in every-day life by an ordinary large pockethandkerchief folded from corner to corner. Its application is almost endless and simplicity itself. A few examples of the manner in which it may be used are shown in Figs. 115, a, b, c, d; it is fastened merely by tying the ends in a double knot.

Broken ribs are of common occurrence, and give rise to great pain, because every time the injured person breathes, the ribs, rising and falling, allow the broken ends to grate against each other. A temporary method of relieving this pain and keeping the broken ends in apposition, is to roll a wide flannel or calico bandage tightly round the chest 3 or 4 times.

Burns and Scalds.—(a) In all but very slight cases of burns and scalds, the patient should be seen by a doctor at once, as the constitutional symptoms consequent upon these accidents require skilled attention. With regard to the immediate local applications. The clothes having been most gently and cautiously removed (being cut in all places where they adhere to the burnt and scalded skin) and any blisters having been simply pricked, the surface should at once be covered with some unirritating substance which excludes the air and keeps up a good heat. For this purpose many things are advocated, such as flour, starch, a mixture of collodion and castor oil, and “carron oil” (equal parts lime-water and linseed oil). A smooth, thick layer of cotton wool should be laid over this, or failing that a blanket, but do not let the blanket touch any raw place without the intervention of a piece of fine linen rag soaked in oil, or it would stick, causing great pain when removed.

(b) Linen dipped in a solution of carbonate of soda or potash relieves the pain sooner than anything. The best form is a saturated solution of bicarbonated soda in either plain water or camphorated water; if applied speedily it is most effectual in immediately relieving the acute burning pain; and when the burn is only superficial, or not severe, removing all pain in the course of a very short time, and preventing the usual consequences—a painful blistering of the skin, separation of the epidermis, and perhaps more or less of suppuration. For this purpose, all that is necessary is to cut a piece of lint, or old soft rag, or even thick blotting-paper, of a size sufficient to cover the burned or scalded parts, and to keep it constantly well wetted with the soda lotion so as to prevent its drying. By this means, it usually happens that all pain ceases in ¼-½ hour. Where the main part of a limb, such as the hand and fore-arm or the foot and leg have been burned, it is best to plunge the part at once into a vessel filled with the soda lotion, and keep it there until the pain subsides.

(c) The matter given off from burnt surfaces soon emits a very offensive odour. Therefore it is wise to mix an antiseptic substance with the remedies—e.g. carbolic acid or thymol, which not only prevent the bad odour from the suppuration, but also tend to alleviate the suffering. It would be well to always keep ready mixed an ointment for burns containing 1 per cent. thymol.

(d) The free use of soft soap upon a fresh burn will remove the fire from the flesh in very little time. If the burn be severe, after relief from the pain, use linseed oil, and then sift upon it wheat flour. When this is dried hard, repeat the oil and flour until a complete covering is obtained. Let this dry until it falls off, and a new skin will be formed without a scar.

(e) Take ice well crushed or scraped, as dry as possible, into the finest division; then mix it with fresh lard until a broken paste is formed. The mass is put into a thin cambric bag, laid upon the burn or scald, and replaced as required. So long as the ice and lard are melting there is no pain from the burn; return of pain calls for the repetition of the remedy.

(f) Whether the skin is broken or not, apply soft cotton or linen rags, dipped in a solution of Epsom salts, 1 oz. to the pint of cold water, and lightly bound over the burnt part or parts, the bandages to be kept constantly moist with the solution, and never removed till a cure is effected, which will be in 2-3 hours to 2-3 days, according to the severity and extent of the burning. While this application in all cases gives instant relief from pain, it is especially useful in removing the tendency to collapse and nervous dread.

(g) Cover the place over at once with the preparation of chalk, called common kitchen whiting, mixed, either with sweet oil or water—oil is preferable—into a thick paste. Plaster it gently on with a brush or a feather about ? in., or more, thick; taking care, if possible, not to break the blister, or blisters. Then cover the part affected with a piece of flannel, to keep the moisture in, and damp the layer of whiting from time to time with oil or water. If kitchen whiting cannot be procured, use flour instead; and if neither can be had, then cover the scalds or burns with bits of rag dipped in sweet oil, and lay plenty of cotton wool outside them. Change the dressings only often enough to keep the places clean, and then wash them off with a weak solution of carbolic acid.

(h) A method in use in the public hospitals of the city of New York, known as “glue burn mixture” is composed as follows 7½ troy oz. white glue, 16 fl. oz. water, 1 fl. oz. glycerine, 2 fl. dr. carbolic acid. Soak the glue in the water until it is soft; then heat on a water-bath until melted; add the glycerine and carbolic acid, and continue heating until, in the intervals of stirring, a glossy, strong skin begins to form over the surface. When wanted for use, heat on a water-bath, and apply with a flat brush over the burned part. Pour the melted mass into small delf extract jars, cover with paraffin-paper and tin-foil before the lid is put on, and afterwards protect by paper pasted around the edge of the lid. In this manner, the mass may be preserved indefinitely.

(i) Saturate a soft piece of fabric with alcohol, lay it over the burn, then cover it with cotton or finely picked oakum: it will allay the pain. Subsequently disturb the dressing as little as possible; wet the dressing occasionally with alcohol. In burns from strong nitric acid, copious application of cold water, and even of such powerful bases as ammonia, potash, and lime in water, have no perceptible effect, except perhaps to increase the violence of the inflammation. But the effect of a dilute solution of sulphurous acid is astounding. In a very few minutes the blister will be reduced; the oxidising process of the acid will be completely arrested, the painful irritation removed, and in a short space of time the wound will heal. (A. Irving.)

In bad burns with lime, soap lye, or any caustic alkali, wash abundantly with water (do not rub), and then with weak vinegar or water containing a little sulphuric acid; finally apply oil as in ordinary burns.

(j) To recover a person in a state of insensibility from the effect of smoke, dash cold water in the face, or cold and hot water alternately. Should this fail, turn him on his face, with the arms folded under his forehead. Apply pressure along the back and ribs, and turn the body gradually on the side; then again slowly on the face, repeating the pressure on the back. Persevere with these alternate rolling movements about 16 times in a minute, until respiration is restored, A warm bath will now complete the recovery.

(k) In scalding by boiling water or steam, cold water should be plentifully poured over the person and cloths, and the patient then be carried carefully to a warm room, laid on the floor or carpet, or on a table, but not put into bed (as there it becomes difficult to attend further to the injuries), to await the doctor. If the patient complains of thirst, a warm, stimulating drink (such as tea) should be given, as after severe burning the temperature of the body is sure to fall. Children sometimes receive serious scalds of the mouth and throat by swallowing hot fluid or steam from a spout. Medical assistance should be obtained without delay, as an immediate operation may be required to prevent death from suffocation. Until the arrival of the doctor the patient should inhale warm vapour, to relieve the fits of choking; the best way to make a person inhale vapour is to construct a kind of tent of blankets around the patient, and allow the steam from a kettle, to puff into it.

Carrying injured persons. (a) By Bearers.—If no conveyance can be procured or improvised, you can transport an injured person a short distance by human bearers. If only one is available, and if the patient can stand up, let him place one arm round the neck of the bearer, bringing his hand on and in front of the opposite shoulder of the bearer. The bearer then places his arm behind the back of the patient and grasps his opposite hip, at the same time catching firmly hold of the hand of the patient placed on his shoulder with his other hand. Then by putting his hip behind the near hip of the patient much support is given, and, if necessary, the bearer can in this way lift him off the ground, and, as it were, carry him along. This is an admirable way of helping an invalid to walk up stairs. If the patient cannot stand, the only way in which one person can remove him is by getting him on his back; this is not practicable in a case of broken thigh (Fig. 116).

When 2 bearers are available, the patient may be carried several different ways:—(1) In a sitting position, by the bearers joining two of their hands underneath his thighs, close to the buttocks, while their other two hands are placed round his loins and clasped together. The patient, if able, can help to support himself by clasping the bearers round their necks. (2) By 2 of the bearers’ hands forming a seat and the other 2 arms a back support (Fig. 117). (3) By 3 of their hands forming a seat, while a back support is made by the remaining arm (Fig. 118). (4) A seat may be made with all 4 hands, and especially if the patient is able to sit up and help support himself by placing his arm over the shoulders of the bearers, he may be carried a long distance by this method. Fig. 119 shows another plan, and Fig. 120 indicates how the hands should grasp each other.

(b) By Stretcher.—To place an injured person on a stretcher and convey him properly requires 3 bearers, unless the distance be very great; 2 carry the stretcher, and a third attends to the patient, and changes place with one of the bearers if necessary. To lay a patient on it, put the foot of the stretcher at his head in a line with his body; 2 bearers then place themselves one at either side, join hands underneath the back and hips of the patient, raise him up, lift him backwards over the stretcher, and lower him on to it. The third bearer takes charge of the injured portion (limb or head), and steadies it with a hand on either side. The two bearers now take their places at the head and foot of the stretcher, lift it up, and carry it off; while the third walks at the side of it, as a safeguard to the patient. Observe the following rules in carrying a stretcher: (1) Carry it with the hands, or suspended by straps over the bearers’ shoulders, never place it on the shoulders, because the patient might fall off, or even die, without the bearer observing it. (2) Do not keep step, i.e. do not put the same foot forward, then the motion of the stretcher remains even. The pace must be short (about 20 in.) and without a spring; the knees must be rather bent, and the hips moved as little as possible. Jolting, hurrying, crossing ditches, &c., are to be avoided. Choose bearers of the same height, arrange the shoulder-straps so that the head may be carried a little higher than the feet.

Convulsions.—Till medical aid can be procured, put the child into a warm bath, in which you can bear your elbow. Sponge him well over, and put a sponge of cold water on his head.

Cuts and Wounds.—Wounds may be “incised” (made by a clean-cutting instrument), “punctured” (when the depth exceeds the breadth, as in stabs), “lacerated” (torn, and the lips of the wound irregular), and “contused” (effected by bruising). The chief points to be attended to are:—(a) Arrest the bleeding. (b) Remove all foreign bodies as soon as possible. (c) Bring the wounded parts in apposition, and keep them so, best done by means of strips of adhesive plaister, first applied to one side of the wound, and then secured to the other; these strips should not be too broad, and space must be left between the strips to allow any matter to escape; wounds too extensive to be kept together by plaister, must be stitched by a surgeon. For punctured and severely lacerated or contused wounds a surgeon should be sent for.

For washing a wound, to every pint of water add either 5 gr. corrosive sublimate or 2½ teaspoonfuls carbolic acid. If the acid is used, add 2 tablespoonfuls glycerine, to prevent its irritating the wound. If there is neither of these articles in the house, add 4 tablespoonfuls borax to the water. Wash the wound, close it, and apply a compress of a folded square of cotton or linen. Wet it in the solution used for washing the wound, and bandage down quickly and firmly. If the bleeding is profuse, a sponge dipped in very hot water and wrung out in cloth should be applied as quickly as possible. If this is not available, use ice, or cloths wrung out in ice water.

Wounds heal in two ways.—(a) Rapidly, by primary union without suppuration, and leaving only a very fine scar; this only when the sides of wound can be accurately brought together, are not displaced by bleeding or exudation of matter, and when the wound is left quiet, protected from outward injury, and kept perfectly free from impurity. (b) Slowly, with suppuration, and the formation of granulations, and leaving a large red scar, as when so much skin has been destroyed that the edges of the wound cannot be brought together, or so lacerated and bruised that life is destroyed in them, or separated by blood or exudation of matter, or if the injured parts have been disturbed, or the wound has not been properly cleaned and disinfected. Want of cleanliness leads to putrefaction and the formation of matter, which separates the sides of the wound.

Drowning, Choking, and Suffocation.—The fatal termination to be avoided in all these cases is suspension of breathing, hence they may be classed under one head.

Drowning.—This is perhaps the most common, and embraces in great measure the remedies adapted to the other forms of suffocation. The first step is to send immediately for medical assistance, blankets, and dry clothing; but proceed to treat the patient instantly on the spot, in the open air, with the face downward, whether on shore or afloat; exposing the face, neck, and chest to the wind, except in severe weather, and removing all tight clothing from the neck and chest, especially the braces.

The points to be aimed at are—immediately the restoration of breathing; and, after breathing is restored, promotion of warmth and circulation. Efforts to restore breathing must be commenced immediately and energetically, and persevered in for 1-2 hours, or until a doctor has pronounced life extinct. Efforts to promote warmth and circulation, beyond removing wet clothes and drying the skin, must not be made until the first appearance of natural breathing; for if circulation of the blood be induced before breathing has recommenced, the restoration to life will be endangered.

To restore breathing, place the patient on the floor or ground with the face downwards, and one of the arms under the forehead, in which position fluids can more readily escape at the mouth, and the tongue will loll out, leaving the entrance to the windpipe free. The tongue may be easily kept extended by simply passing a small rubber band round it and the chin. The mouth and nose must be thoroughly wiped and cleaned from obstructions.

If breathing has quite or almost failed, means must be used to restore it; if not, proceed at once to promote warmth. There are several ways of inciting suspended respiration. The best, as requiring only one person, is Silvester’s method, as follows: Place the apparently dead person flat on his back, raising his head and shoulders slightly by means of a folded article of dress. Standing behind him, grasp his arms just above the elbow, and draw them gently and steadily upwards over the head, keeping them in that position for 2 seconds; by this means the chest expands and air is drawn into the lungs (Fig. 121). Then carry the arms back again in the same way and press them gently and firmly against the sides of the chest for 2 seconds; by this means the air is pressed out of the lungs again (Fig. 122). These movements are repeated carefully and perseveringly, about 15 times in a minute, till natural respiration begins. The first evidence of this is a sudden flush of colour in the face.

121. Inspiration (Silvester). 122. Expiration (Silvester).