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CURATIVE MEDICINE.

PART XVI.

ART AND SCIENCE OF NURSING.

General Consideration.—There is no room to doubt that faithful, intelligent and efficient care of the sick is often responsible in large measure for recovery from attacks of severe illness and that the ministrations of a well-qualified nurse are second only in importance to skillful medical attendance. In fact there are diseases in which good nursing is more essential to the welfare of the patient than medicines, and in which these would be of little avail, unless accompanied by conscientious services of this character.

The Nurse is Doctor's Assistant.—The nurse is the physician's assistant, and he often depends, in forming his estimate of the condition and needs of his patient, largely upon the observation and judgment of the one who is in constant attendance on the case, who sees the changes which occur at different times of day or night, who notes the effect of this remedy or of that food, and who makes to him reports based upon what transpires during his absence.

What the Doctor Gains.—Thus he often gains valuable suggestions regarding the course and management of the case from what to the inexperienced and untrained might be considered a trivial symptom or a circumstance not worth repeating.

It is not the office of the nurse to discriminate between the important and unimportant features of a case, but to endeavor to give the medical attendant a faithful picture of the case as she has seen it, leaving it for him to weigh the evidence given, to form a just estimate of its value. On his departure the responsibility of the execution of his orders devolves upon her and until his return it is she who assumes the control of the case and gives directions.

THE SCIENCE OF NURSING.

The science of nursing is its theory—the mastery of its technical details—the knowledge of the subject which is acquired by observation, study and experience. This embraces information on such matters as the care of the patient, including moving, lifting, bathing, dressing, and attending to his wants and comfort; such details as relate particularly to the management of the case, as taking temperature, pulse and respiration, observing symptoms, administering medicines and applying external agents; the preparation and giving of food and drink; the care of the room, attention to the room, including its general cleanliness, order, disinfection, heat and ventilation; and the care of the bed, etc.

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THE ART OF NURSING.

The art of nursing on the contrary is its practice—the mode of application of the details learned. For a proper exercise of the art, there should be not merely a knowledge of the science but certain natural physical and mental endowments.

Like the poet, she who would successfully engage in the art of nursing must be born, not made. As in every line of employment, there are in this those who do not possess the requisite qualifications, and it is not infrequently the case that nursing devolves upon friends or relatives of the sick, who assume the duties, not because of any special fitness for the work, but because of sentiment or necessity. A brief consideration will be given to what some of these qualifications are, as a guide to those seeking such information.

QUALIFICATIONS OF THE NURSE.

Disposition.—Lamentable failure will inevitably attend the efforts of any one attempting to nurse, if she has not a suitable disposition. The qualities which constitute an ideal disposition for a nurse unfortunately are rarely all found in any one person. It will nevertheless be useful to consider some of the most important of them.

1. Amiability.—Essentially the product of a benevolent nature, this is a trait of prime importance. A spontaneous flow of kind acts and considerate attentions should characterize the nurse; whereas, irritability of temper and thoughtless and inconsiderate acts are so inexcusable as to at once disqualify her for her work. Therefore, she must naturally be kind in thought, word and deed.

2. Sympathy.—Sympathy with a patient's distress, without weak sentimentality is an outgrowth of this attitude of mind, which is of value to the nurse and of benefit to the patient, if not too freely exercised.

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3. Cheerfulness.—A bright and sunny disposition not only brings life, hope and cheer into the sick room, and thus aids in the favorable progress of the case, but sheds its influence through the entire household, lightening the burden of trouble from those who are in distress. The sick room is not the place for a gloomy or morose person.

4. Unselfishness.—Disregard for personal comfort and convenience and untiring devotion to the interests of the patient are demanded of the nurse. Hers should be largely a labor of love, in conformity with which, she should be willing to sacrifice herself in behalf of her patient.

5. Calmness.—A nurse with an excitable temperament, who is upset by trivial circumstances, and who cannot even in an extremity exhibit composure, will not tend to tranquilize a patient who is already in a state of nervous irritability. Cool judgment, calm demeanor, and, when not accompanied by hesitancy, deliberate action, will tend to inspire confidence in her intelligence and proficiency, a fact of no little importance in serious illness.

6. Patience.—The trying circumstances incident to the sick room and the exacting requirements of the patient, often call for the exercise of the most unbounded patience. Those who ordinarily are thoughtful and considerate are frequently, when sick, unreasonable in the extreme, and their demands for attentions, which are often unnecessary, become most exasperating.

7. Firmness.—It is desirable for the nurse to be sufficiently resolute to secure compliance with her instructions, but it is not needful to maintain, as is often done, a dogged and uncompromising attitude, and to be inmovable to appeal in non-essentials. Arbitrary refusal in such matters creates antagonism on the part of the patient, which more than counter-balances what has been gained by the nurse and which materially lessens her influence and usefulness.

8. Tact.—Not only in these matters but in her general deportment in the sick room is there opportunity for the exercise of tact. To divert the patient from an undesirable train of thought without making it apparent; to be discrete about the subject of conversation, neither unbosoming all her family affairs nor detailing the histories of all her previous cases; to avoid either depressing, exciting, tiresome or otherwise objectionable topics when reading is permissible; to regulate the matter of visitors without giving offense; in these and in manifold ways are shown the importance of having good, sound common sense, a quality unfortunately far too rare among those who engage in this art.

9. Observation.—The nurse should be a careful observer, able to notice differences in the condition of the patient, and to recognize at least in a measure the meaning of symptoms which she sees. Frequently it is left to her judgment to give more or less of a medicine prescribed, or to change one remedy for another, according to the condition of the patient, and a failure to correctly observe and properly interpret what is seen will work to the detriment of the patient.

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10. Physical Soundness.—The strain, physical and nervous, caused by untiring vigilance, loss of sleep, irregular meals, confinement to the sick room, and anxiety, are such as to make essential to the nurse an exceptionally sound, healthy body, endued with the power of endurance. In addition there should be good vision, good hearing and good sense of smell, all of these faculties being called into frequent requisition.

GENERAL CONDUCT IN THE SICK ROOM.

Personal Conduct.—Granted that a nurse has enough qualifications to make her an efficient nurse, there are still some details pertaining to her personal conduct in the sick room, and which are largely under her control, the observance or neglect of which will make the difference, often, between her being acceptable or not to her patients. Some of these are quite essential, while others may appear to be of little consequence, yet to those suffering from severe illness there are no trifles; mole-hills appear as mountains, and the insignificant become matters of great moment, and these very trifles often have much to do with the comfort and peace of mind of the one under the nurse's care.

Reference is had to such matters as dress, personal appearance and habits, movements, manner of speaking, touch, etc.

Clothing.—The outer clothing of the nurse should be of plain, modest color and preferably of wash material, an indispensable requirement in infectious cases. Starched clothing should not be so stiff as to make a constant rustling with every movement. The shoes should he noiseless.

Speech.—The nurse should endeavor to speak distinctly and evenly, though never abruptly nor in loud and rasping tones. Equally objectionable is it to whisper, as this almost invariably is annoying to the patient if he is awake. The voice should be cheerful and reassuring and calculated to inspire with hope and confidence. Very many questions of the patient must be answered adroitly, yet in such a manner as not to convey the impression that attempts are being made to conceal from him what he desires to know.

Touch.—The hands should be always warm, smooth and scrupulously clean and the nails well trimmed. A combination of gentleness and firmness is to be desired in handling and moving the patient, efforts of this sort being steady and deliberate, not sudden and jerking.

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Appearance.—General neatness of the hair and person should be strictly regarded. She who is careless of her appearance and tidiness will presumably be equally so of the one under her charge.

Manner.—If nurse is lacking in the ability to make herself acceptable to her patient she is confronted by an insuperable obstacle to success. This will depend almost wholly on her deportment in the sick room. An awkward, boisterous, bustling nurse will not compare favorably with one who quietly and unobtrusively accomplishes her tasks without confusion and noise. Nor, on the other hand, will the nurse who stealthily creeps around on tip-toe be likely to prove acceptable to her patient.

Study of Disposition.—A studious observance of the patient's disposition and a readily ascertainable knowledge of his likes and dislikes will soon enable the nurse to anticipate his wants, to scrupulously avoid that which is likely to annoy and to secure for him that which will give comfort and pleasure or bring repose of body or mind. It is this considerateness for the wishes and feelings of the patient which so often constitutes the difference between success and failure and the lack of which to a sensitive nature is a constant source of irritation and annoyance.

What a Nurse Should Avoid.—A nurse should not forget that a patient's progress toward recovery is retarded by such practices as the following: To rock incessantly in a squeaky chair; to sit and constantly tap with the foot or fingers; to noisily prepare for bed in the room after the patient is ready to sleep; to so time the administration of food and medicine, where this can be avoided, as to disturb the patient just as he has settled comfortably for a nap; to be continually asking whether he would like something done for him; to make unnecessary noise with dishes or papers; to allow the light to shine uncomfortably in his eyes; to hurry him with his meals; to shake his bed, and so forth.

OBSERVATION OF SYMPTOMS.

To intelligently observe the condition of the patient from time to time in order that she may make correct reports to the medical attendant is one of the most important duties of the nurse. Accordingly attention must be given to some of the symptoms which she will be expected to notice.

Temperature.—At stated times during the day, usually morning and night, it will be her duty in the large majority of cases to take and record the bodily temperature. A self-registering thermometer should be used, and after cleansing it the nurse should see that the column of mercury is as low as 96 degrees. If not, the thermometer should be firmly held by its upper end, with the arm raised and extended, and the thermometer swung downward with considerable force, care of course being taken to avoid striking it against anything. This process should be repeated as often as necessary, care being taken not to make the column of mercury go entirely into the bulb, or it will fail to be self-registering. The thermometer is usually held in the mouth, beneath the tongue, or in the armpit, five minutes being required to determine the temperature accurately in the latter place, while three minutes in the mouth is a sufficient time. If the arm-pit is selected it should be thoroughly dried and the thermometer held firmly in place by the arm being closely drawn to the side; if the mouth be chosen no cold drink should be given for at least ten minutes before and the lips should be kept tightly closed while the thermometer is in place. Care must also be exercised to prevent the thermometer being bitten, especially by children or by those who are at all irrational. With these the mouth had better not be chosen. The temperature normally is about 98-1/2 degrees, although it is usually slightly lowered during the early morning hours and slightly raised in the early evening. In case of depression it may fall one or two degrees; in fever it rarely rises more than about seven degrees, and even at this height the patient is usually in a perilous condition. Between 100 degrees and 103 degrees the fever may be said to be moderate; above 103 degrees high. The gravity of high temperature varies in different diseases; in inflammatory rheumatism and in hysteria for instance the temperature may reach 108 degrees or more and recovery still take place, while a temperature of 105 degrees in inflammation of the bowels would indicate great danger.

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The Pulse.—The pulse is usually felt at the wrist, over the radial artery, and coincides with the beating of the heart. If it cannot be distinctly counted at the wrist or over other large arteries, the hand may be placed over the heart. The average pulse rate in the adult is about seventy-two per minute, and in children from about one hundred to one hundred and twenty. In diseases it is occasionally slowed, though usually accelerated, reaching at times one hundred and fifty or more. Its character, which is often quite as important as its frequency, also varies considerably, being at times weak, compressible, irregular, intermittent, wiry, and so forth, or the reverse.

Respiration.—Normally the respiratory movements number about one-fourth the pulse beats. They are apt to be increased in disease, sometimes disproportionately so, the usual ratio between pulse and respiration not being maintained. It is important to observe not only its frequency but whether it is noisy, irregular, difficult, painful or otherwise abnormal.

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Cough.—If cough is present it should be noticed at what times it is worse, the frequency, duration and character of the paroxysms. If there is expectoration its features should be observed, its color, whether profuse or scanty, thick, tenaceous, frothy, bloody, and so forth.

Discharges.—The discharges of the patient should be noticed and any departure from the normal reported. The frequency, color, consistence and general characteristics of the movements should be known. The color, odor and quantity of urine, the character of sediments, if any are present, the frequency with which it is voided, and so forth, should be ascertained. In saving a specimen for examination that which has collected during the night is to be preferred. Incontinence of urine, or the inability to retain it; and retention, in which it cannot be voided, sometimes occur. Occasionally in retention the bladder becomes overdistended and the urine dribbles away, this condition simulating incontinence. The use of the catheter will be necessary in this as in the ordinary form of retention.

Miscellaneous Symptoms.—The condition of the tongue, whether it is clean, furred, coated, flabby, indented, and so forth, and whether it is protruded slowly or quickly; the skin, as to moisture, warmth, color and general appearance; the expression, whether wan, pinched, anxious, placid or otherwise; the eye, whether there is swelling of the lids, undue sensitiveness to light, alteration in color, or in the size of the pupils, and so forth; his general attitude and demeanor of the patient; the way he speaks, whether nervous, irritable, restless, rational; the amount and character of sleep; the extent and kind of delirium, if present; the sensations of the patient as described to the nurse; the location and character of pain—whether diminished or aggravated by pressure, whether constant or intermittent, stationary or movable.

HOW TO CARE FOR PATIENTS.

How to Make the Bed.—The mattress should be firm and the sheets large enough to permit them to be well tucked under its edges. The lower sheet may be kept in place more securely by pinning with large safety pins to the mattress. It is often desirable to protect the bed by placing under the patient a folded sheet, beneath which may be a piece of rubber sheeting or enamel cloth. When necessary to remove the "draw sheet," another, folded similarly, may be pinned to it and readily drawn into position as the first is drawn out. In changing the lower sheet with the least disturbance to the patient, the soiled one should be folded alternately backward and forward, something in the manner of the folds of a Japanese folding fan, lengthwise, beginning at the side farthest from the patient, until it reaches him. A clean sheet, folded in the same way, takes its place and can with little difficulty, especially if there is some assistance, be smoothly adjusted under the, patient as the soiled one is withdrawn. The upper sheet may be changed by folding it crosswise, tucking it in at the foot of the bed underneath the other clothes, and drawing it up into position, the soiled sheet being then drawn down to the foot and removed. Crumbs should be carefully kept from the bed and strict attention paid to having the lower sheet and the clothing underneath the patient absolutely smooth, not only in order to add to his comfort, but that in long continued illness the formation of bed-sores may be prevented.

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Bed-Sores.—If the patient is confined to the bed long, the parts subjected to pressure should receive special care by frequent bathing with alcohol. If there are indications of irritation from pressure, especially over the bony prominences, soothing applications such as zinc ointment or vaseline should also be used, or the parts may be protected and the process of repair assisted by applying flexile collodion or a piece of Johnson's Z. O. Mull plaster. It is much more difficult to cure bed-sores than it is to prevent their occurrence.

Changing Clothing.—In changing the clothing, the sleeves should first be removed from the patient. The clean garment is then laid face down on the patient, with the top toward his feet and the sleeves are put on his arms. Then as his head is slightly raised the soiled garment can be slipped over the head and the clean one put on at the same time. If, however the patient cannot be raised at all, the front of the garment must be ripped. Then as one sleeve is taken off the clean one replaces it, while the garment is gradually tucked under the shoulders and body, when the other sleeve may also be changed. A light wrap should always be at hand to throw around the patient's shoulders when he sits up in bed, for the sick are very susceptible to the change in temperature which occurs in being thus partially uncovered.

Bathing.—In bathing a patient, only a small portion of the surface should be done at a time, and this as much as possible should be done under the covers. A few tablespoonfuls of alcohol put into a small basin of water will not only facilitate the cleansing of the surface but will add to the comfort of the patient and help to reduce the temperature if fever exists. In all these cases the surface of the body should be sponged at frequent intervals.

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Bath Temperatures.—Cold baths, at a temperature of 40 degrees to 60 degrees Fahrenheit; tepid baths, from 85 degrees to 95 degrees; warm, baths, from 95 degrees to 100 degrees, and hot baths from 100 degrees to 106 degrees are employed for their therapeutic value, under the direction of the physician.

The Wet Pack.—The wet pack consists in wrapping the patient, in a sheet wrung out of cold water and covering with warm blankets or comfortables. When, after fifteen minutes to an hour have elapsed, these are removed, the body should be well dried with towels.

Sitz Baths.—Hip or sitz baths, foot baths, etc., are also employed. Russian baths consist in the application of steam to the surface of the body at a temperature of about 95 degrees, which is gradually raised to 110 degrees. In Turkish baths hot air instead of steam is used.

Temperature and Ventilation.—Except in warm weather the temperature of the room should be kept at about 70 degrees. In some diseases of respiration it is advantageous to have the temperature somewhat higher, and in all cases the atmosphere should be charged with moisture. If furnace heat is employed this may be accomplished by hanging in front of the register a cloth which is kept damp. A sick person should be supplied hourly with 2,000 cubic feet of fresh air. In other words he should be in a room twelve feet high and ten feet by sixteen or its equivalent, and the air in this should be renewed hourly. If a nurse also is in the room it should be proportionately larger or more freely ventilated.

Disinfection.—The employment of disinfectants materially aid in keeping the air of the apartment pure. Among the best to employ are preparations containing free chlorine, such as chlorinated lime, commonly known as chloride of lime, solution of chlorinated soda and Platt's Chlorides. These and the equally good preparations known as electrozone may be freely used in open vessels in the room and to place into the utensils used for receiving the discharges.

Disinfection of Clothing.—In disinfecting in infectious diseases, all washable clothing, sheets, and so forth, should be boiled in a covered boiler for a half hour, having been placed at once into the boiler in the room, or submerged in a disinfecting solution. Instead of handkerchiefs pieces of soft linen should be used and burned. All sweepings from the room, should likewise be burned and eating utensils be thoroughly disinfected with a solution of carbolic acid, a tablespoonful to the pint of water, or preferably boiled. After the termination of the illness the room should be subjected to the vapor of formaldehyde gas introduced through the keyhole of the door by means of appliances for the purpose, or what is less certain, to the fumes of burning sulphur.

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Sundry Suggestions.—A number of practical hints of a miscellaneous character and which cannot well be classified elsewhere are here given:

1. Where a choice can be made a bright sunny, airy room should be selected in which to nurse the sick. It should be remote from the rest of the house, if possible, so that noise may be excluded.

2. The room should be kept scrupulously clean and neat. Dust should be wiped up carefully from the furniture and the floor wiped with a damp cloth or carefully brushed with a pan and brush in such a way as to avoid raising a dust.

3. The patient should be kept as quiet as possible. It is often desirable to keep from him the knowledge of what is transpiring in the household.

4. In feeding never hurry the patient nor feed in too large mouthfuls. Prepare and serve food daintily, bringing only enough at once to tempt, not to pall the appetite. Liquids may be fed through a bent glass tube, a feeding cup, or preferably a glass with the lower lip elongated and bent at such an angle as to permit it to be tipped without spilling its contents while the patient is recumbent. It is often better to feed in small quantities and frequently than to give a large amount at longer intervals.

5. Visitors are to be admitted sparingly, if at all. Calls should be brief and should not be permitted to weary the patient. It is better to have one caller at a time, followed by a second, than to have both present at once.

6. Care should be taken not to jar the bed by knocking against it.

7. If fanning is desired it should be slow and gentle, not vigorous, and should be with a noiseless fan.

8. The nurse should not eat, dress or undress in the same room as the patient.

9. She should have daily an opportunity for an hour or more to be spent in the fresh air, and should not assume for any length of time both day and night duty.

10. In fevers water may be freely allowed, provided that too large an amount is not taken at one time.

11. Thirst is better relieved by sipping very hot water than by drinking cold water. Pieces of chipped ice are also often very acceptable.

12. For nausea and vomiting sips of very hot water or small pieces of chipped ice swallowed whole are serviceable. Mustard plasters to the pit of the stomach may also be advantageously employed.

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13. Small pieces of ice may be kept longer from melting by putting them into a piece of flannel shaped like a funnel and suspending this by means of a rubber band or piece of twine in a pitcher into which the water drips. Several layers of flannel should cover the top.

14. Chips of ice may readily be broken off by means of a straight pin, especially steel pins with large heads, as mourning pins, bonnet pins, and so forth.

15. Prepare for the reception of a patient seriously injured by having a warm bed with plenty of hot water bottles, and so forth, for applying artificial heat. If there is severe shock keep the head low, stimulate freely and rub the extremities briskly.

16. Attacks of fainting are to be treated by keeping the head low, giving plenty of fresh air, loosening the clothing about the neck and waist, sprinkling water on the face and administering ammonia or smelling salts cautiously by inhalation. When the patient can swallow aromatic spirits of ammonia, a half teaspoonful in water or whiskey, a tablespoonful may be given.

17. Heart failure is to be treated as shock.

18. Sprains, if treated at once by soaking in very hot water, will be relieved to a large extent of the pain and swelling.

19. Bleeding from the nose which cannot be checked by pressure and the application of cold may often be controlled by syringing with salt water. If this is ineffectual the nostril should have inserted into it a pledget of gauze (cheese-cloth) in the meshes of which is tannic acid or powdered alum. Or tannic acid mixed with brown sugar in equal proportions is useful as a local application.

20. Additional covering should always be accessible for use during the early morning hours when the patient's vitality is lowest.

21. Bed-pans should be warmed before using. They may be more readily placed in position if the upper surface is first lubricated with vaseline or oil.

ADMINISTRATION OF REMEDIES.

Internal Remedies.—Liquids, powders and pills and the modifications of the latter, tablets and capsules are the modes by which medicines are administered internally. As much as possible an array of medicines should not be on exhibition in the sick room. Any which in their administration require special care, such as poisons, should be kept in a place by themselves and some means adopted for distinguishing them by the sense of touch, such as a piece of ribbon tied about them.

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Pills and Powders.—To give pills, powders, etc., they should be placed as far back on the tongue as possible and a large swallow of water taken. Some powders are quite readily taken by floating them on a teaspoonful of water, others by mixing them into a paste with a few drops of water and placing on the tongue, a drink being taken to wash it down. Medicines in liquid form, unless specific directions to the contrary are given, had usually better be freely diluted. The mere addition of water does not usually diminish the efficacy of a drug, whereas when undiluted remedies are often too strong.

Measuring of Medicines.—Since spoons vary in size and drops differ according to the consistence of the liquid, droppers and graduated medicine glasses are better for measuring liquids. One teaspoonful should equal a drachm, two teaspoonfuls a dessertspoonful, two dessertspoonfuls a tablespoonful, two tablespoonfuls an ounce, two ounces a wineglassful, two wineglassfuls a teacupful, two teacupfuls a coffeecupful, and two coffeecupfuls a pint. In measuring liquids, the glass should be held perfectly even, on a level with the eye and the liquid slowly poured out from the bottle, on the side opposite the label, to prevent soiling the latter by drops rolling down the outside. If the medicine is measured by a spoon, it should be poured into a larger receptacle in order that it may not be spilled while administering it. In dropping from a bottle, the lip should be moistened in one spot with a drop of the liquid, and the side of the cork held against the moistened edge at an angle of about 45 degrees; if the bottle is carefully tilted its contents may be accurately dropped out.

EXTERNAL REMEDIES.

Poultices and Fomentations.—The effect of poultices is to soften and relax the tissues by the application of heat and moisture. In this way pain is relieved in many cases of inflammation, suppuration is prevented unless the process has gone too far, or if it is imminent or present it is hastened, and the healing of wounds and ulcerating surfaces promoted. If too long applied they do injury by lowering the tone of the parts.

Making and Applying Poultices.—Powdered slippery-elm bark, Indian meal or "mush," flaxseed meal, bread, or any similar substance which will retain the heat and moisture well, are employed. Hot water is gradually added to the material selected, until it is thick enough to stick to the wall if thrown against it. It is then spread quickly on a piece of thin material as muslin, to a thickness of about three-quarters of an inch, leaving a margin twice that wide. It is then covered by a similar piece of muslin, or preferably of thinner material, as cheese cloth and the edges turned over to prevent the contents spilling. The thinner side should be applied to the affected surface, over which a little glycerine has previously been rubbed to prevent sticking. The poultice should be covered by a piece of rubber or some water-proof material to aid in retaining the heat and moisture. A hot poultice should be ready to replace the one in use as soon as it begins to cool. If used on the trunk, care should be taken to prevent catching cold by permitting only the briefest possible exposure of the heated part while changing the poultices, and after they are discontinued a thin sheet of cotton or a light flannel cloth should be applied as a protective.

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Fomentations.—These are for the same purpose as poultices, but they require more frequent renewal as the heat is not retained as long. A flannel cloth is folded in half, laid on a towel which has two sticks tied to its ends to serve as handles, boiling water is then poured over it and the superfluous moisture expressed by twisting the towel. Or, the flannel, after being folded may be dipped into boiling water, laid between the folds of some thick absorbent material as Turkish toweling, and pressure as by means of a rolling pin applied to express the excessive moisture. It should then be quickly shaken out and applied to the desired surface with some impervious material, and a flannel or cotton layer to aid in retaining the heat and moisture.

Medicated Poultices.—Both poultices and fomentations may be medicated by the addition of antiseptics, laudanum, turpentine, and so forth, and materials having medicinal qualities, such as hops, poppy and digitalis may be used in poultice form for the relief of certain conditions by placing them in a bag, preferably flannel, and dipping into hot water, hot vinegar or hot alcohol.

Spiced Poultices.—Spice poultices or plasters are made in this way for mild counter-irritation in colic, and so forth, equal quantities of ginger, cayenne pepper, cinnamon and cloves being mixed together.

Pepper Plasters.—Pepper plasters are made of cayenne pepper the same way as spice plasters; or flour, pepper and water may be mixed together as an ordinary poultice, or to the white of an egg the pepper may be gradually added until of the proper consistence. The latter plan is said to have the merit of efficacy without causing much irritation and is useful in neuralgic affections.

Mustard Poultices.—These are made by mixing mustard flour with warm (not hot) water, and if desired adding a third or a half of wheat flour. The white of an egg may be advantageously added, or to relieve the burning the surface may be dusted after the poultice is removed, with a cooling powder, such as compound stearate of zinc with boric acid, or with menthol, or a soothing ointment such as cold cream, zinc ointment or vaseline. From fifteen to thirty minutes is a sufficient time to apply mustard poultices, the aim being merely to produce sufficient irritation, to thoroughly redden the skin. Never should a blister be allowed to form; as the resulting sore is very painful and slow to heal.

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Turpentine Fomentations.—These are called stupes, and are made by dipping flannel cloths into boiling water, as above directed, and sprinkling on the surface five or ten drops of turpentine; or in a half basin of hot water a teaspoonful of the turpentine may be placed. They are useful in cases of colic, being efficient in aiding to dispel the gas.

Blisters.—These are generally produced by the application of cantharides or Spanish fly in the form of a plaster or of cantharidal collodion. From two to eight hours usually elapse before the blister is produced, depending in the thinness of the skin, the strength of the plaster, and so forth. The surface selected should be washed and thoroughly dried before applying it. Occasionally it should be examined to see whether the desired effect lias been produced; if so the plaster should be carefully removed, and if any of it remains it should be cleaned with a little oil. If after twelve hours no blister has formed the plaster should be removed and the part poulticed, when a blister will usually form. In children, or in parts where the skin is very sensitive, it is well to do this as soon as the skin is well reddened. After the formation of a blister the serous contents are generally permitted to escape by snipping the lowest part with a pair of clean scissors. A dressing of vaseline or zinc ointment may then be applied.

Dry Cups.—These are used to produce counter-irritation. The most convenient form is a set of glasses of different sizes, provided with valves, and from which the air is exhausted after closely applying the cup to the surface of the body by means of a vacuum pump. Several of these may be placed in succession along side of each other. As the vacuum is produced the skin rises in the cup and the blood flows to the part. When it is desired to remove the cup, the skin may be pressed near the cup so as to admit the air beneath.

Cupping with a Tumbler.—In the absence of this cupping apparatus, a less convenient method is to use an ordinary thick glass tumbler; to hold it over a pledget of cotton, previously saturated with alcohol and ignited; after this has burned for a few moments it is quickly removed and extinguished and the glass containing rarified air is clapped on to the surface of the body, accomplishing the same result as described above.

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Wet Cups.—These are used for purposes of local blood letting in which, after dry cupping, the part is scarified with superficial incisions; the cups are sometimes replaced in order to promote the flow of blood. It is a practice which belongs, however, more to the domain of surgery than of nursing.

Lotions, Liniments and Ointments.—Lotions are remedies applied to the exterior of the body by simply painting, washing or mopping the surface. If they are intended to evaporate, so as to reduce heat and inflammation, they should be left with as little covering as possible.

Liniments.—These are external applications in which rubbing is employed, and are usually somewhat counter-irritant.

Ointments.—These are fatty substances applied either with or without rubbing.

Dry Heat.—This is used to impart warmth, restore suspended animation, relieve pain, as in cases of neuralgia and muscular rheumatism and in other affections. Appliances are now procurable for use in the home in which the affected part may be treated by air heated to a temperature of several hundred degrees. Hot water bags and bottles, hot stove lids, irons, bricks and plates, bags of salt, sand and ashes are common examples of the modes of applying heat. All these should be properly wrapped to prevent burning the patient. Where bottles or rubber bags are used the stoppers should be carefully fitted to prevent the possibility of leaking; the bag should be seamless lest the heat melt the cement and the patient be scalded, and it should only be half filled in order that it may conform more comfortably to the shape of the body.

Cold.—Cold is applied for the reduction of temperature, for the relief of inflammation and sometimes in the treatment of pain. Muslin cloths laid on ice, constantly renewed, cloths wrung out of ice water and rubber bags partially filled with small pieces of ice are the ordinary means of applying it. Coils of rubber tubing through which ice water is made to flow are also convenient. The same may be used for hot water. Ice bags should have between them and the surface of the skin a thin layer of flannel or other material. If folded in a napkin or other cloth they may be conveniently pinned to the clothing of the patient, or where applied to the head, to the pillow, to keep in position.

Miscellaneous Application of Remedies.—Remedies are also applied to the mucous surfaces by injection, suppositories, douches, inhalation, dusting, and so forth, by absorption through the skin into the general system; and by injection under the skin or into the deeper structures of the body. The utmost care should be observed to have all appliances used for these purposes scrupulously clean to avoid the danger of infection. Of these methods several must be more than mentioned.

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Enemata or Rectal Injections.—These are used for the purpose of securing movements from the bowels, to cleanse and medicate the lower part of the intestinal tract and to administer nourishment in cases where the stomach cannot be used. Large injections are sometimes used for their mechanical effect in helping to restore to its normal position an invaginated section of the bowel.

For the relief of constipation a teaspoonful of glycerine injected by means of a small piston syringe, preferably of glass with a soft rubber tip, will often cause a movement in the course of a few minutes, especially when the constipation is due to torpor of the lower portion of the bowel. When it is necessary to use larger quantities of liquid a bulb syringe or fountain syringe should be employed. All air should be expelled from the tube by filling it with water, the nozzle should be lubricated with soap and water, with vaseline or oil, and with the patient lying on the left side with knees bent and the bed amply protected, it should be inserted backward, upward, and to the left without force. After seeing that the orifice of the nozzle is not obstructed by a fold of mucous membrane or by foreign material the liquid should be allowed to slowly flow. If pain is produced the flow should be intermitted and resumed again after a few moments' rest. If haste is used expulsive efforts are likely to be excited and the injection not retained. One to three or more quarts may be used if care is exercised and the enema be retained ten or fifteen minutes. After the nozzle is withdrawn a folded towel may be pressed against the anus for a few minutes to aid in its retention. High injections are sometimes employed with a long tube, but should be administered by the medical attendant. The knee chest position is an aid in these cases.

Material of Injections.—Various materials are used for injection, the basis usually being water, hot, cold or tepid, plain or with the addition of such substances as turpentine, castor oil, soap, epsom salt, glycerine or oxgall—these, alone or in combination. For the relief of dysentery and diarrhoea injections of about two ounces of thin starch and thirty drops of laudanum repeated every two hours often act satisfactorily in controlling the pain and irritability. In the summer diarrhoea of infants there is often no more useful plan than to thoroughly irrigate the intestinal canal by means of a syringe and a soft catheter, with tepid or cold water, in each pint of which a teaspoonful of salt, and, if desired, some mild antiseptic are dissolved.

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Vaginal Douches.—These are administered with the patient on the back, the hips being well elevated. For the relief of congestion of the uterus it is usual to employ at least a gallon of water as hot as can be borne. When all but a quart has been used the remaining portion is often medicated with laudanum, glycerine, salt, alum, chlorate of potash or other remedies. Intra-uterine douches should be administered by the physician or under his immediate supervision.

Suppositories.—These are small masses, usually conical in shape, and composed of cocoa butter or some other material which will melt at the temperature of the body, and medicated. They are used for introduction into the rectum, vagina or uterus, and, except in the case of the last named, readily slip into position if lubricated with a little oil or vaseline.

FEEDING THE SICK.

Selecting Foods.—One of the important matters connected with nursing is the question of nourishment for the patient. While in most cases the physician will give directions in general as to the feeding, it will often devolve on the nurse to make selection for the patient of what she considers suitable, and not infrequently she will find it necessary to prepare the food herself. She must decide what combinations are appropriate, and what variety must be introduced, and when the patient tires of one food she must exercise her ingenuity often to the utmost to find a substitute. Food which is suitable in the morning, or at noon, is often improper to give at night, and what will agree under some circumstances will manifestly, under other conditions, be wholly inadmissible. As a usual thing it is better not to consult the patient about what his meal is to be, for if he is asked what he would like he will in all probability say that he would rather have nothing, and if told beforehand what he is to have, even if he has been wanting it, he will be apt to lose his desire for it.

The Patient Not to Judge.—Moreover a patient's inclinations are often not a safe guide, for he will be as likely as not to choose some article of diet altogether unsuitable. For instance, in convalescence from typhoid fever it is quite essential to exercise the utmost care in the matter of food for a considerable period of time, the ordinary diet being resumed only very gradually and tentatively, lest irritation and consequent relapse occur. But it is almost invariably the case that long before it would be permissible the patient has a strong desire for solid food, often of the kind which, would not be proper, and an inordinate appetite, which, to gratify would inevitably be detrimental.

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How the Nurse Should Judge.—Accordingly it is better to ascertain quietly and gradually the likes and dislikes of a patient, and what ordinarily agrees with him best, and with this knowledge to use one's judgment as to what to provide.

There are certain articles of diet, however, which are preëminently suitable for the sick, some under one set of circumstances, some under another. Among these are:

Milk.—The bland, unirritating nature of milk and the fact that it furnishes all the elements necessary to sustain life make it ordinarily a suitable article of diet for the sick, and unless contra-indicated it is quite usual to have it form the basis for the construction of a dietary, and for it to enter largely into the composition of the food selected. It is not infrequent indeed that it is used alone for many weeks at a time.

Administration of Milk.—If the taste is objectionable to the patient it may be disguised by flavoring with coffee or caramel. By feeding through a tube or straw the action of the saliva is secured, and by giving it slowly the formation of large curds, impenetrable by the gastric juice, is prevented. To counteract the tendency to biliousness, which occurs in many people from its use, it is customary to add a small pinch of bicarbonate of soda, or from a third to a half of lime water, soda water, apollinaris or vichy. At times it is more easily digested if boiled or scalded and diluted; In diarrhoea boiled milk often has a salutary effect.

Steady Milk Diet.—An exclusive milk diet is often resorted to in cases of heart, kidney and stomach diseases, and under these circumstances it is generally first skimmed. Dr. Thomas G. Morton is accustomed to having it administered every hour and a half from 7 A. M. to 10 P. M., beginning with three ounces or six tablespoonfuls, and increasing the amount one-half ounce with each dose until from two to six quarts are taken daily. This diet is continued for a month or six weeks, when a few easily digested articles are allowed, and a suitable dietary is gradually constructed. On a milk diet the patient at first feels weak, and soon develops a disgust for the milk, but this is usually overcome before a great while, and a desire is often established for a continuance of the milk even after convalescence. It is usually necessary to administer suitable laxatives to overcome the constipation which the milk causes.

Whey.—This is a watery, somewhat turbid, liquid resulting from the removal of the curd of milk after coagulation. It contains a fair proportion of the nutritive constituents of the milk, which may be increased by expressing as much of the fluid from the curd as possible. Sometimes it is used as a vehicle for the administration of other nutriment, as beef juice, yolk of egg, etc. The writer has used it to advantage by adding Mellin's Food in severe gastro-enteritis of children.

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Preparation of Whey.—Whey may be prepared in several ways. To a pint of lukewarm whole milk is added a teaspoonful of essence of pepsin, or of liquid rennet, and stirred only long enough to mix. After cooling and coagulation, the product is stirred with a fork, and the whey strained off. Or to a pint of boiling milk add two teaspoonfuls of lemon juice and strain. Wine whey is made by bringing to the boiling point a pint of milk and adding two wineglassfuls of Sherry wine. As it boils up again remove from the fire and strain.

Junket.—Make the same as the first formula for whey, with essence of pepsin or liquid rennet, but do not stir. Eat with sugar and cream. If desired, flavor with a little nutmeg and extract of vanilla. Tablets are furnished in the stores for the sake of convenience for making junket.

Buttermilk.—Fresh buttermilk can be used in many cases where milk disagrees, largely because of the formation of finely subdivided curds.

Koumiss.—For the same reason koumiss is often valuable under similar circumstances. Containing as it does carbonic acid gas it is grateful to the irritable stomach, while the small amount of alcohol present furnishes slight stimulation. To prepare it take an eighth of a cake of Fleishman's compressed yeast—fresh—and a tablespoonful of white sugar. Dissolve in a little warm water. Pour into a quart champagne bottle and fill to the base of the neck with fresh milk. Tie cork securely, lay on its side in a cool but not cold place for two or three days, shaking occasionally. If it is desired to hasten the process of fermentation, it may be kept for twelve hours at a temperature of about 70 degrees, although the slower method makes a smoother and pleasanter preparation. A champagne tap must be used to draw it off. Some prefer it when two days old, others when it is somewhat more acid in taste, at the age of three days. Kefyr and matzoon are similar to it.

Peptonized Milk.—To a pint of lukewarm milk diluted with one-fourth its bulk of water add fifteen grains of bicarbonate of soda and five grains of Fairchild's Extract of Pancreas. Keep in a warm place for twenty minutes. Then place against the ice to check further peptonization. This milk is partially predigested and can often be taken when milk cannot.

Sterilized Milk.—To sterilize milk without a special apparatus for the purpose it should be placed in infants' nursing bottles, which should be lightly corked with absorbent cotton. These should be placed in a kettle of cold water, with their bases kept from the bottom of the kettle by a folded towel or other contrivance. The water should be boiled for twenty minutes, the cotton removed and replaced by tightly-fitting corks and the bottles be allowed to cool gradually. Strictly speaking, milk thus prepared is "Pasteurized," the process of sterilization being simply a prolongation of this, for about twice the length of time. Pasteurized milk is more easily digested than sterilized milk. Both are used for feeding invalids and especially infants.

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Modified Milk.—This is a combination of milk, cream, water, lime-water and sugar of milk in such proportions as the age and strength of the infant for which it is prescribed seem to indicate. A useful and convenient way to employ this for home use is by means of the "materna" apparatus, which is a graduated glass presenting eight panels, each one being marked in such a way as to show how much of a particular constituent of the modified milk is to be used for a specified age.

There are also combinations of milk with other articles which will be considered among the miscellaneous formulas given later on.

Animal Broths.—These often form a suitable means of giving nourishment to the sick. Unless prepared with great care they do not contain the amount of nutrition for which they ordinarily receive credit, for if too high a heat is used the albuminous principles are coagulated and the virtues of the preparation decreased.

Beef Essence.—A piece of lean, juicy beef is minced and placed in a wide-mouthed jar, which is tightly corked and set in a kettle of cold water. This is then allowed to boil moderately for three or four hours, when the essence is expressed and seasoned. A tablespoonful may be given every two hours.

Beef Tea.—Cut in small pieces a pound of lean, juicy beef. Cover with cold water for an hour or more. Simmer gently for three hours at a temperature not above 160 degrees; strain and season. The finished product should measure one pint; if less, sufficient water may be added to equal that amount.

Beef Juice.—Pieces of lean, juicy beef the size of a walnut are toasted for a moment over a hot fire and the juice expressed by means of a lemon squeezer or a specially-designed press. Season with salt and give a tablespoonful every two hours either warm or mixed with pounded ice.

Scraped Beef.—Lean, raw meat is scraped fine and the pulp pressed through a coarse sieve. This may advantageously be added to the beef tea or beef essence.

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Mutton Broth.—Add two quarts of cold water to two pounds of lean mutton; boil very gently for two hours and season. A little barley or rice may be added. The broth should be allowed to cool and all the fat skimmed off.

Chicken Broth.—A chicken, or, if large, a half chicken, after being skinned and cut up, is boiled gently in a quart of water for an hour, seasoned and strained through a colander.

In cases where solid nourishment is permissible the following kinds of animal food are suitable:

Beef Steak.—A piece of thick, lean sirloin or tenderloin steak should be broiled quickly over a clear coal fire, the exterior only being cooked, while the interior is kept rare and juicy.

Lamb Chops.—Lean. rib or loin chops are suitable. They should be broiled until well done.

Chicken.—Tender chicken, carefully broiled, is a suitable food for the sick.

Squab.—Young pigeon or squab, broiled, is considered a delicacy and is nutritious and appetizing.

Sweet Breads.—In some cases these may be eaten and are highly appreciated. They should be parboiled and then carefully broiled, with a little butter rubbed over the surface.

Oysters.—When in season oysters taken raw are nourishing and easily digested. Cooked they are less digestible, though permissible in some cases.

Oyster Broth.—Slowly simmer for ten minutes a pint of oysters in a half pint each of water and milk; season to taste and strain.

Clam Broth.—Equal quantities of clam juice and boiling water are seasoned with salt. Clam juice and clam broth are often retained in great irritability of the stomach.

Eggs.—Beaten light these are most digestible. One of the most frequent ways of giving them is in the form of eggnog.

Eggnog.—The white and yolk of an egg are beaten separately, very light; they are now stirred together, sweetened and salted, and to these are added a small amount of brandy, sherry or port wine, a little nutmeg and an ounce of milk.

Boiled Eggs.—Cooked eggs should be soft, as the albumen or white is otherwise hard and indigestible. Boiled for three and a half minutes or less they are, however, suitable. It is still better to put them into boiling water, remove them from the stove and allow them to stand in the hot water for seven minutes.

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Powdered Yolk.—If eggs are boiled for an hour or more and cooled the yolks may be mashed into powder, which, with a little salt, is agreeable, nourishing and digestible. It may be taken plain or mixed with milk, whey or broth.

Egg Water.—In cases of extreme gastro-intestinal irritability the whites of two eggs stirred into a half pint of cold water, and sweetened or salted, may be given as a drink.

Vegetable Sick Foods.—Preëminent among the vegetable forms of aliment are the cereals, which in recent years have been so largely popularized by the introduction of scores of palatable, nutritious and digestible preparations. Many of these are already cooked, while others are predigested as well, so that they require little time or trouble in serving. A judicious selection from among these affords variety in taste and composition.

Wheat Foods.—These take the lead in nitrogenous constituents, followed closely by rye, barley, oats and corn; oats, corn and barley are richest in fats; rice contains chiefly starch; while oats contain the greatest amount of indigestible cellulose. This, however, in the finer preparations is largely removed. Of the wheat preparations, the following may be mentioned, rolled, cracked, crushed and granulated wheat, called by many names, according to where or by whom it is prepared, "vitos," "wheat germs," "germea," "wheatlet," "wheatena," "cream of wheat," "shredded wheat," and so forth. Gluten flour is supplied for the use of diabetics and those who cannot well take starch; and farina, a material similar to cornstarch, for the use by itself or in combination with other substances. From the other cereals, similar preparations to those made from wheat are manufactured.

Following are the formulae for preparing some of the foods in common use for the nourishment of the sick:

Milk Toast.—Remove the crust from two small slices of baker's bread, a day or two old; toast carefully, and cover with a half pint of scalded milk previously salted.

Boston Cream Toast.—Prepare as above, but thicken the milk with a heaping teaspoonful of flour mixed with the same amount of butter; these are to be carefully stirred into the hot milk and brought to boil.

Toast Water.—Cover well toasted, not burned, bread, with boiling water; set aside till cool, strain and salt or sweeten to taste.

Panada.—Cover split crackers or slices of toast with boiling water, (previously sprinkled with sugar, salt and, if desired, a little nutmeg. Simmer gently until the product is like jelly. Serve while warm.

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Flour Gruel.—Mix a tablespoonful of flour with enough milk to make a smooth paste; add a quart of boiling milk; boil for a half hour in a double boiler; salt.

Flour Ball.—Make a ball of a pint of flour which has been moistened with four tablespoonfuls of water; tie tightly in a cloth; dampen the outside of the cloth and sprinkle with flour; boil hard for ten hours. Remove the cloth and dry the ball for ten hours in an oven. Grate two teaspoonfuls of flour from the ball, mix into a paste with cold water and stir into a cup of boiling milk.

Farina Gruel.—Stir two tablespoonfuls of farina into a quart of water; boil until thick; add a pint of milk, salt and boil fifteen minutes longer. Serve with sugar and cream.

Arrow-Root Gruel.—Mix into a paste two teaspoonfuls of arrow-root with a little water; stir into a pint of boiling water or milk. Sweeten and boil for three minutes.

Oatmeal Gruel.—Boil two tablespoonfuls of oatmeal in a pint of water until smooth. Salt and strain.

Wine Jelly.—Pour two ounces of cold water on one-half ounce of granulated gelatine, and six ounces of sugar. Soak for fifteen minutes and stir into ten ounces of boiling water until dissolved. Add four ounces of sherry wine, strain through a jelly bag or coarse toweling and cool.

Iceland or Irish-Moss Jelly.—Thoroughly wash a handful of the moss and soak for one hour in a very little water. Stir into a quart of boiling water and simmer until it is dissolved. Sweeten and flavor, strain and cool. Serve with cream.

Flaxseed Tea.—Pour a quart of boiling water onto four tablespoonfuls of whole flaxseed and steep for three or four hours. The juice of two lemons may be added, and sugar if desired.

Barley Water.—Wash two ounces of barley; boil for five minutes and pour off the water. Add two quarts of water and boil down to a quart. Salt or sugar may be added. This is often employed to dilute milk.

Puree of Celery.—Cut into small pieces enough of the stalks of celery to fill a pint measure. Stew in a quart of water until tender. Salt, thicken with a little arrow-root and add a cup of milk. Boil for two or three minutes, stirring constantly.

Puree of Asparagus.—Proceed as for puree of celery, reserving the tips and discarding the stalks, after they are cooked.

Puree of Tapioca.—To a half pint of boiling water or milk, gradually stir in a tablespoonful of instantaneous tapioca. Add salt, and boil, with constant stirring until it begins to thicken.

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Milk and Albumen.—Shake in a bottle for five minutes the whites of two eggs and two ounces of lime-water; add a pint of milk, sugar and sherry wine to taste, and shake five minutes more. Give a wineglassful every two hours.

Cocoa.—Dissolve a teaspoonful of Phillip's Digestible Cocoa in a little cold milk. Add to this a coffee cupful of hot milk.

Predigested Foods.—Attention has already been directed to the peptonizing of milk; the same process may be applied to gruels made from oatmeal, or other cereals, and to beef tea, thus artificially digesting them before they are taken. Peptonized meat preparations have the disadvantage of a disagreeable odor and taste, but they are highly nutritious.

Extracts of Malt.—These are also employed in predigesting cereals, "maltine," "diastoid," "diastase" and "extract of malt" are some of the preparations which may be used in this connection. One of the successful applications of modern pharmaceutical skill is that exhibited in the manufacture of these artificially digested foods, many of which supply in concentrated form ready for absorption and assimilation the most important elements of nutrition.

We conclude with formulas for making the more important poultices, tinctures, ointments, syrups, and so forth, for some of which credit is given Drs. Warren and Thorndike.

POULTICES.

Mustard Poultice.—Stir a tablespoonful of ground mustard with water to make a paste. Spread on linen, cover with thin muslin, place on affected part. Renew if necessary.

Poke-Root Poultice.—Roast fresh poke-root until soft, pound it. Mix with cornmeal to consistency of poultice. Used on tumors to scatter them. Remove every four hours.

Charcoal Poultice.—Take bread and milk or Indian meal, make to consistency of poultice with water, stir in half a teacupful of pulverized charcoal. Good to clean ulcers and foul sores.

Slippery Elm Poultice.—Stir ground slippery elm bark in water to consistency of a thick paste. An excellent poultice for irritable sores.

Carrot Poultice.—Boil carrots until soft, mash them to a pulp, add lard or sweet oil sufficient to keep it from getting hard. Spread and apply. Excellent for offensive sores.

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Onion Poultice.—Made the same way as carrot poultice. Excellent for slow boils and stimulating to indolent sores.

Bread Poultice.—Put needed quantity of boiling water in basin. Throw in bread or cracker. When these have soaked up all they will, pour off water. Spread half-inch thick on cloth and apply.

Lobelia Poultice.—Take one ounce each of powdered lobelia and ground slippery elm bark. Stir into hot weak lye to poultice consistency. Excellent when applied to wounds, fistula, felon, boils, erysipelas, insect stings.

Arrow-Root Poultice.—Mix two tablespoonfuls of arrow-root with as much cold water as it will unite with. Add boiling water and stir till a thick paste is former.

Oatmeal Poultice.—Stir oatmeal slowly into hot water, boiling water while stirring, till poultice thickens is reached, that is till it will not run when spread on the rag.

Indian Meal Poultice.—Made same as oatmeal poultice.

Yeast Poultice.—Mix half pint yeast with one pound flaxseed meal to make thick paste. Stir constantly while heating.

Flaxseed Poultice.—Stir flaxseed into boiling water till thick paste is formed. Spread on linen and apply hot.

SYRUPS.

Simple Syrup.—Dissolve two and a half pounds of sugar in a pint of water. Dissolve sugar by heating, removing any scum. Strain while hot. The addition of any medicinal substance to a simple syrup makes a compound syrup.

Syrup of Squills.—Add two pounds of refined sugar to one pint of vinegar of squills, and proceed as in simple syrup.

Syrup of Seneka.—Mix four ounces of fluid extract of seneka with one pint of water. Dissolve in the liquid one pound of refined sugar and proceed as in simple syrup. Useful in colds and coughs, in frequent doses of one or two teaspoonfuls.

Syrup of Rhubarb.—Add to six pints of simple syrup, two-and-a-half ounces of crushed rhubarb, half ounce each of crushed cloves and cinnamon, two drachms of bruised nutmeg, two pints diluted alcohol. Evaporate liquid by a gentle heat, to a pint. Excellent for bowel complaint, in drachm doses every two hours till it operates.

Syrup of Lemons.—Boil for ten minutes a pint of lemon Juice, strain, add two pounds refined sugar and dissolve. When cold, add two-and-a-half fluid ounces of alcohol. A fine addition to drinks in fever cases and good to disguise the taste of medicines.

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Syrup of Citric Acid.—Add one pint of simple syrup to two drachms of powdered citric acid and four minims oil of lemons; add another pint of simple syrup and dissolve by gentle heat. An agreeable cooling addition to fever drinks.

Syrup of Ginger.—To a quart of simple syrup add two ounces of tincture of ginger. Evaporate the alcohol by gentle heat. Added to other medicines to improve flavor. Excellent to remove wind from stomach and as a stimulant.

Syrup of Garlic.—Slice and crush six ounces of fresh garlic, add one pint of acetic acid and two pounds of sugar. Macerate four days in glass vessel. Express and filter the liquor, till a pint has passed. Bottle. A teaspoonful will relieve bronchial affections in children under one year old. Larger doses according to years.

Syrup of Wild Cherry.—Steep two and a half pounds coarsely powdered wild cherry bark in a gallon of water. Strain and dissolve in it by heat as much sugar as will make thick syrup. A good tonic and excellent to mix with medicines for dyspepsia, consumption, and so forth.

TINCTURES.

Tincture of Snakeroot.—Steep for two weeks three ounces of crushed Virginia snakeroot in a quart of diluted alcohol. Express and filter. Good for low states of the system, in teaspoonful doses, three times a day.

Tincture of Rhubarb.—Add to a quart of diluted alcohol three ounces of crushed rhubarb and one ounce of crushed cardamom. Steep two weeks; express, filter and bottle.

Tincture of Opium.—Add to two pints of diluted alcohol two and a half ounces of opium. Steep for a fortnight; express, filter and bottle. This is the preparation known as laudanum. The dose should not exceed ten to twenty drops.

Tincture of Lobelia.—Add to a pint each of vinegar and alcohol four ounces of lobelia. Steep two weeks; draw off and filter. Dose as a nauseant, thirty to fifty drops.

Tincture of Cinnamon.—Add to one pint of diluted alcohol two and a half ounces of powdered cinnamon. Steep for two weeks; express and filter. Dose. two to four teaspoonfuls.

Cayenne Pepper Tincture.—Steep for two weeks an ounce of powdered cayenne pepper in two pints of diluted alcohol. Express, filter and bottle for use.

Tincture of Orange Peel.—Add to one quart of diluted alcohol four ounces of dried orange peel. Steep for a week; express, filter and bottle for use.

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Tincture of Cantharides.—Steep for a fortnight an ounce of crushed Spanish flies in two pints of diluted alcohol. Dose, twenty drops, three times a day.

Tincture of Valerian.—Steep for a fortnight four ounces of crushed valerian in a quart of aromatic spirits of ammonia. Express and filter. Used in nervous diseases in one- or two-drachm doses in sweetened water.

Tincture of Myrrh.—Steep for two weeks four ounces of crushed myrrh and two ounces of capsicum in four pints of alcohol. Express and filter. Good externally and as an occasional remedy for flatulence.

Tincture of Peruvian Bark.—Steep for two weeks twenty ounces of diluted alcohol, to which has been added two ounces of red bark, an ounce and a half of crushed orange peel, three drachms of Virginia snakeroot and one drachm of saffron. Express and filter. A stomach cordial, and good in low fevers. Dose, two to four drachms three times a day.

Tincture of Aconite.—Mix eight ounces of powdered aconite root with one pint of alcohol. Steep for a fortnight, stirring occasionally. Express and filter. Good in fevers and inflammations. Dose, three drops in water every hour or two.

Tincture of Saffron.—Steep for a fortnight one ounce of saffron in a pint of alcohol. Express and filter. Same proportions of castor and leptandria to alcohol, make their respective tinctures.

Camphor, oil of peppermint, oil of spearmint and asafetida, in proportions of two ounces each to a pint of alcohol and steeped and treated as in tincture of aconite, make their respective tinctures.

So cardamon, cochineal, colombo, ergot, galls, hemlock, cubebs, henbane, lobelia, poke, blood-root, squills, bittersweet and belladonna, in proportions of two ounces each to a pint of diluted alcohol, and steeped and treated as in cases of tincture of aconite, make their respective tinctures.

OINTMENTS.

Sulphur Ointment.—Melt half a pound of lard, and add one ounce sulphur, one drachm each of ammoniated mercury, benzoic acid, sulphuric acid and oil bergamot, and two drachms of nitrate of potassa. Stir constantly till cold. An excellent ointment for itch.

Pile Ointment.—Add to a quart of water three handfuls each of witch-hazel bark, oak bark and apple tree bark. Boil to a pint and strain. Add half a pound of lard, and simmer till water disappears. This forms an ointment valuable as a pile remedy.

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Tar Ointment.—Melt a pound of suet. Add the tar. Stir till cold Excellent ointment for scaly eruptions like scald head.

Spermaceti Ointment.—To a pint of olive oil add five ounces of spermaceti and fourteen of white wax. Melt together, stirring constantly. Good dressing for blisters and burns.

Simple Ointment.—Melt a pound of white wax with four pounds of lard. Let the heat be gentle, and stir till cold.

Poke Ointment.—Mix a drachm of extract of poke with one ounce of lard. Good for ulcers, itch, scald head, etc.

Oxide of Zinc Ointment.—Rub together half an ounce of oxide of zinc and three ounces of lard. Good for eruptions of skin and sore nipples.

Ointment of Galls.—Rub together six ounces lard, six drachms powdered galls and a drachm and a half of pulverized opium. Good for piles.

Belladonna Ointment.—Mix an ounce of lard with a drachm of extract of belladonna. Affords relief in neuralgia and painful tumors.

Ointment of Bayberry.—To half a pound of tallow add half a pound each of turpentine and bayberry, and four ounces of olive oil. Good application for scrofulous sores and ulcers.

Lead Ointment.—Add two and a half drachms of powdered acetate of lead to two ounces of white wax and four ounces of lard. Melt together, stirring till cold. Good for burns, scalds, ulcers and cuts.

PLASTERS.

Spiced Plaster.—Mix an ounce each of powdered ginger, cloves, cinnamon and black pepper with one drachm pulverized cayenne. Add a fluid ounce tincture of ginger and enough honey to make stiff poultice. A plaster of this applied to stomach stops nausea and vomiting.

Lead Plaster.—Melt one pound lead plaster, add two ounces each of linseed oil and tincture of opium, six ounces of oil of turpentine and eight ounces of oil of organum. Stir together till cold. Good for burns, chilblains, scalds, etc.

Capsicum Plaster.—Mix half pound resin and two ounces beeswax. Add a pint of spirit, in which two ounces of cayenne inclosed in bag has been steeped in gentle heat for two hours. Evaporate the spirit by gentle heat, add an ounce of powdered camphor. An excellent stimulating plaster.

Belladonna Plaster.—Melt three ounces of resin plaster and add an ounce and a half of extract of belladonna. An excellent application in neuralgia and rheumatism.

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Last Modified: Monday, 13-May-2013 15:31:47 EDT