Transcriber’s Notes:

  Underscores “_” before and after a word or phrase indicate _italics_
    in the original text.
  Equal signs “=” before and after a word or phrase indicate =bold=
    in the original text.
  Small capitals have been converted to SOLID capitals.
  Illustrations have been moved so they do not break up paragraphs.
  Antiquated spellings have been preserved.
  Typographical and punctuation errors have been silently corrected.
  The “ADDITIONAL NOTES” section, pages 211 to 226 have been removed as
    they serve no function in an ebook.




                  A REFERENCE HAND-BOOK FOR NURSES

                                 BY
                        AMANDA K. BECK, R. N.

         Graduate of the Illinois Training School for Nurses

                       FOURTH EDITION, REVISED
                       PHILADELPHIA AND LONDON
                       W. B. SAUNDERS COMPANY
                                1919

      Copyright, 1905, by W. B. Saunders and Company. Reprinted
      August, 1905, July, 1906, June, 1907, and January, 1908.
      Revised, reprinted, and recopyrighted August, 1908. Reprinted
      March, 1909, February, 1910, July, 1910, March, 1911, February,
      1912, and August, 1912. Revised, reprinted, and recopyrighted
      February, 1913. Reprinted October, 1913, May, 1914, November,
      1914, January, 1915, May, 1915, September, 1915, June, 1916,
      January, 1917, July, 1917, November, 1917, April, 1918, and
      August, 1918. Revised, reprinted, and recopyrighted March, 1919

             Copyright, 1919, by W. B. Saunders Company

                         PRINTED IN AMERICA

                              PRESS OF
                       W. B. SAUNDERS COMPANY
                            PHILADELPHIA

                                 TO
                           ISABEL McISAAC

    For many years Superintendent of the Illinois Training School
                       for Nurses, of Chicago

                               AND TO
                            IDORA C. ROSE

            Formerly her Assistant and now her Successor

                THIS BOOK IS AFFECTIONATELY INSCRIBED




PREFACE TO THE FOURTH EDITION.


In the present edition of this work a few new subjects have been added
and the text has been somewhat altered in order that certain recent
advances and changes might be noted and brought into daily service.
I have not been unmindful, however, of the fact that to be of the
greatest possible use to our profession this volume must remain small
and compact.

I hear frequently that this Handbook is valued by my fellow-workers and
that it is to many of them a daily help and companion. This is a source
of great pleasure to me, and I hope that this new edition will be found
more useful even than any of its predecessors.

                                            A. K. BECK, R. N.
    CHICAGO, ILL.,
         _March, 1919_.




PREFACE.


As a probationer doing class and hospital work and as a graduate
trained nurse I took notes of all the various formulæ, directions,
etc., that might at some time be useful to me in the pursuit of
my duties. My class work was productive of many valuable items of
information; these and such other items as I gathered in the course of
my hospital work and while on private duty, and others which were the
result of my own experience and observation, I kept in a memorandum
book which soon became indispensable to me, and which I used until the
leaves became worn and fell apart. I rewrote this memorandum book three
times, and the task of its fourth rewriting made me wish that I had its
contents in a form more easily preserved. The inspiration followed that
my notes in book form would be of general use to most nurses and of
some use to many physicians. This little volume is the result.

To my own notes, all of which have been submitted to competent
authorities for criticism, I have added several articles by eminent
physicians and superintending nurses, which tend to round out the
usefulness of the book. I have kept in mind, however, my original
intention of producing a hand-book of convenient size for quick
reference.

To the authors of these articles, to the friendly critics to whom my
notes were submitted, and to the kind friends who encouraged me in this
work, I extend my sincere thanks.

    AMANDA K. BECK, R. N.




REFERENCE HAND-BOOK FOR NURSES.


ABBREVIATIONS.


    ABBREVIATION.           LATIN.             ENGLISH.

    =āā=                   Ana                 Of each.
    =A. c.=                Ante cibum          Before meals.
    =Ad.=, =Add.=          Adde                Let there be added.
    =Ad lib.=              Ad libitum          At pleasure.
    =Adv.=                 Adversum            Against.
    =Alt. dieb.=           Alternis diebus     Every other day.
    =Alt. hor.=            Alternis horis      Every other hour.
    =Aq.=                  Aqua                Water.
    =Aq. astr.=            Aqua astricta       Ice.
    =Aq. bull.=            Aqua bulliens       Boiling water.
    =Aq. dest.=            Aqua destillata     Distilled water.
    =Aq. ferv.=            Aqua fervens        Hot water.
    =Aq. font.=            Aqua fontana        Spring water.
    =Aq. mar.=             Aqua marina         Sea-water.
    =Aq. tep.=             Aqua tepida         Tepid water.

    =Ba.=                  Barium              Barium.
    =B. A.=                Balneum arenæ       Sand-bath.
    =Bib.=                 Bibe                Drink.
    =B. i. d.= or =B. d.=  Bis in die          Twice daily.
    =B. M.=                Balneum maris       Sea-water bath.
    =Bull.=                Bulliat             Let it boil.
    =B. V.=                Balneum vaporis     Vapor-bath.

    =C.=                   Conguis             Gallon.
    =c.=                   Cum                 With.
    =Cap.=                 Capsular            A capsule.
    =C.c.=                 Centimeter cubicum  Cubic centimeter.
    =Cerat.=               Ceratum             A cerate.
    =Chart.=               Chartula            A small paper.
    =C. M.=                Cras mane           Tomorrow morning.
    =C. N.=                Cras nocte          Tomorrow night.
    =Col.=                 Cola                Strain.
    =Colet.=               Coletur             Let it be strained.
    =Collyr.=              Collyrium           An eye-wash.
    =Comp.=                Compositus          Compound.
    =Cong.=                Congius             A gallon.
    =Cons.=                Conserva            Keep.
    =Coq.=                 Coque               Boil.
    =Crast.=               Crastinus           For tomorrow.
    =C. V.=                Cras vespere        Tomorrow evening.

    =D.=                   Da                  Let it be given.
    =Decoct.=              Decoctum            Decoction.
    =Def.=                 Defæcatio           Defecation.
    =Dieb. alt.=           Diebus alternis     On alternate days.
    =Dieb. tert.=          Diebus tertiis      Every third day.
    =Dil.=                 Dilue               Dissolve.
    =Dilut.=               Dilutus             Dilute.
    =Dim.=                 Dimidius            One-half.
    =Disp.=                Dispensa            Dispense.
    =Divid.=               Dividendus          To be divided.
    =D. P.=                Directione propria  With a proper direction.
    =Dr.=, =ʒ=             Drachma             A dram.

    =Emuls.=               Emulsum             Emulsion.
    =En.=, =Enem.=         Enema               A rectal injection.
    =Et.=                  Et                  And.
    =Exhib.=               Exhibeatur          Let it be given.
    =Ext.=                 Extractum           An extract.
    =Ext. fl.=             Extractum fluidum   Fluidextract.

    =F.=, =Ft.=            Fiat                Make.
    =Filt.=                Filtra              Filter.
    =Fl.=                  Fluidum             Fluid.
    =F. m.=                Fiat mistura        Make a mixture.

    =Garg.=                Gargarisma          A gargle.
    =Gm.=                  Gramma              A gram.
    =Gr.=                  Granum              A grain.
    =Gtt.=                 Gutta               A drop.

    =H.=                   Hora                An hour.
    =Hor. decub.=          Hora decubitus      At bedtime.
    =H. s.=                Hora somni          At bedtime.

    =Id.=                  Idem                The same.
    =I. e.=                Id est              That is.
    =Ind.=                 In dies             Daily.
    =Infus.=               Infusum             Infusion.

    =L.=                   Liter               A liter.
    =Lb., lb.=             Libra               A pound.
    =Lin.=                 Linimentum          A liniment.
    =Liq.=                 Liquor              A solution.
    =Lot.=                 Lotio               A lotion.

    =M.=                   Misce               Mix.
    =M.=, =♍︎=           Minimum             A minim.
    =Mas.=                 Massa               A pill mass.
    =Mist.=                Mistura             A mixture.

    =N. b.=                Nota bene           Note well or take
                                                 particular notice.
    =No.=                  Numerus             Number.
    =Noct.=                Nocte               At night.

    =O.=                   Octarius            A pint.
    =O. m.=                Omni mane           Every morning.
    =Omn. hor.=            Omni hora           Every hour.
    =Omn. noct.=           Omni nocte          Every night.
    =Ov.=                  Ovum                Egg.

    =P. C.=                Post cibum          After meals.
    =Pil.=                 Pilula              A pill.
    =Præp.=                Præparatus          Prepared.
    =P. r. n.=             Pro re nata         When necessary.
    =Pulv.=                Pulvis              A powder.

    =Q.=                   Quaque              Every.
    =Q. i. d.= or =Q. d.=  Quatuor in die      Four times a day.
    =Q. l.=                Quantum libet       As much as you choose.
    =Q. p.=                Quantum placeat     At will.
    =Qq. hor.=             Quaqua hora         Every hour.
    =Q. s.=                Quantum sufficit    A sufficient quantity.
    =Q. v.=                Quantum vis         As much as you like.

    =℞=                    Recipe              Take.
    =Rep.=                 Repetatur           Let it be repeated.

    =S.=                   Sine                Without.
    =Scrup.=, =℈=          Scrupulum           A scruple.
    =Sig.=                 Signa               Mark or sign.
    =Sing.=                Singulorum          Of each.
    =Solv.=                Solve               Dissolve.
    =S. O. S.=             Si opus sit         If necessary.
    =Spt.=                 Spiritus            Spirit.
    =Ss.=                  Semis               A half.
    =Stat.=                Statim              Immediately.
    =Su.=                  Sumet               Let him take.
    =Syr.=                 Syrupus             Syrup.

    =T. i. d.= or =T. d.=  Ter in die          Three times a day.
    =Tinct.= or =Tr.=      Tinctura            A tincture.
    =Trit.=                Tritura             Triturate.
    =Troch.=               Trochiscus          A lozenge.

    =Ult. præs.=           Ultimum præscriptus Last prescribed.
    =Unc.=, =℥=            Uncia               An ounce.
    =Ung.=                 Unguentum           An ointment.
    =U. S. P.=                               United States Pharmacopœia.
    =Ut. dict.=            Ut dictum           As directed.
    =Utend.=               Utendus             To be used.

    =Vehic.=               Vehiculum           A vehicle.
    =Vel=                  Vel                 Or.
    =Vin.=                 Vinum               Wine.
    =Vitel. ovi=           Vitellus ovi        Yolk of egg.
    =Viz.=                 Videlicet           Namely.
    =Vs.=                  Venæsectio          Venesection.




GLOSSARY OF MATERIA MEDICA.


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

    =Absorbents.=—Drugs used to produce absorption of exudates
            or diseased tissues.
    =Abstergents.=—Detergents (cleansing agents).
    =Alteratives.=—Medicines used to so modify nutrition as to
            overcome morbid processes.
    =Analeptics.=—Restorative medicines or food.
    =Analgesics.=—Medicines used to allay pain.
    =Anaphrodisiacs.=—Medicines used to allay sexual feeling.
    =Anesthetics.=—Medicines used to produce anesthesia
            or unconsciousness.
    =Anodynes.=—Medicines used to allay pain.
    =Antacids.=—Medicines used to neutralize acid in the stomach
            and intestines.
    =Anthelmintics.=—Medicines used to destroy intestinal worms.
    =Antiarthritics.=—Medicines used for the relief of gout.
    =Antihydropics.=—Medicines used for the relief of dropsy.
    =Antilithics.=—Medicines used for the relief of calculous
            affections.
    =Antiperiodics.=—Medicines used for the relief of malarial
            fevers.
    =Antipyretics.=—Medicines used for the reduction of bodily
            temperature in fevers.
    =Antiseptics.=—Substances which have the power of preventing
            putrefaction.
    =Antispasmodics.=—Medicines used for the relief of nervous
            irritability and minor spasms.
    =Antisyphilitics.=—Medicines used for the relief of syphilis.
    =Antizymotics.=—Substances which have the power of killing
            disease germs.
    =Aperients.=—Mild purgatives.
    =Aphrodisiacs.=—Substances used to increase sexual power
            or excitement.
    =Aromatic Bitters.=—Medicines which unite the properties of
            the aromatic and simple bitters.
    =Aromatics.=—Medicines characterized by a fragrant or spicy
            taste and odor, and stimulant to the gastro-intestinal
            mucous membrane.
    =Astringents.=—Medicines having the power of influencing vital
            contractility, thereby condensing tissues.

    =Bitters, Simple.=—Medicines which have a bitter taste and
            have the power of stimulating the gastro-intestinal mucous
            membrane, without affecting the general system.
    =Blisters.=—Medicines which when locally applied cause
            inflammatory exudation of serum from the skin, and are used
            as revulsants.

    =Calefacients.=—Medicines used externally to cause a sense
            of warmth.
    =Cardiac Depressants.=—Medicines used to lower the heart’s
            action.
    =Cardiac Stimulants.=—Medicines used to increase the heart’s
            action.
    =Carminatives.=—Medicines containing a volatile oil used to
            excite intestinal peristalsis and provoke an expulsion
            of flatus.
    =Cathartics.=—Purgatives.
    =Caustics.=—Medicines used to destroy living tissues.
    =Cholagogues.=—Medicines which provoke a flow of bile.
    =Constringents.=—Astringents.
    =Convulsants.=—Medicines which cause convulsions.
    =Correctives.=—Medicines used to correct or render more
            pleasant the action of other remedies, especially
            purgatives.
    =Corrigents.=—Correctives.

    =Demulcents.=—Mucilaginous principles which are used in
            solution to soothe and protect irritated mucous
            membranes and other tissues.
    =Deobstruents= (obsolete and not very definite).—Medicines
            which overcome obstruction; aperients.
    =Deodorants.=—Substances which destroy or hide foul air.
    =Depilatories.=—Substances used to remove hair.
    =Depressants.=—Sedatives.
    =Depressomotors.=—Medicines which lessen motor activity.
    =Depurants.=—Medicines which act upon the emunctories so as
            to cause excretion and thereby purify the system.
    =Detergents.=—Medicines which cleanse wounds, ulcers, etc.
    =Diaphoretics.=—Medicines which produce sweating.
    =Digestants.=—Ferments and acids which have the power of
            aiding in the solution of food.
    =Diluents.=—Medicines which dilute secretions and excretions.
    =Disinfectants.=—Substances which have the power of destroying
            disease germs or the noxious properties of decaying
            organic matter.
    =Diuretics.=—Medicines which increase the secretion of urine.
    =Drastics.=—Purgatives which cause much irritation.

    =Ecbolics.=—Medicines which produce abortion.
    =Eccoprotics or Ectoprotics.=—Laxatives.
    =Emetics.=—Medicines which cause vomiting.
    =Emmenagogues.=—Medicines which stimulate menstruation.
    =Emollients.=—Substances used to mechanically soften and
            protect tissues.
    =Epispatics.=—Blisters.
    =Errhines.=—Medicines which increase the nasal secretions.
    =Escharotics.=—Caustics.
    =Evacuants.=—Medicines which evacuate; chiefly applied to
            purgatives.
    =Excitants.=—Stimulants.
    =Excitomotors.=—Medicines which increase motor activity.
    =Expectorants.=—Medicines which act upon the pulmonic mucous
            membrane and increase or alter its secretions.

    =Febrifuges.=—Medicines which dissipate fever.

    =Galactagogues.=—Medicines which increase the secretion
            of milk.
    =Germicides.=—Agents that destroy germs.

    =Hemostatics=.—Medicines which arrest hemorrhages.
    =Hydragogues.=—Purgatives which cause large watery discharges.
    =Hypnotics.=—Medicines which cause sleep.

    =Laxatives.=—Mild purgatives.
    =Local Anesthetics.=—Medicines which when applied locally
            destroy sensation.

    =Mydriatics.=—Medicines which cause mydriasis, or dilation
            of the pupil.
    =Myotics.=—Medicines which cause myosis, or contraction
            of the pupil.

    =Narcotics.=—Powerful anodyne hypnotics.
    =Neurotics.=—Medicines which act upon the nervous system.
    =Nutriants.=—Medicines which modify the nutritive processes.
    =Nutrients.=—Substances which nourish.

    =Oxytocics.=—Medicines which stimulate uterine contractions.

    =Peristaltics.=—Medicines which increase peristalsis.
    =Prophylactics.=—Medicines which prevent the taking or
            development of disease.
    =Protectives.=—Medicines which protect a part when applied
            to it.
    =Ptyalagogues.=—Sialagogues.
    =Purgatives.=—Medicines which produce copious discharges from
            the bowels.

    =Refrigerants.=—Medicines which lessen bodily temperature.
    =Revulsants.=—Medicines which by causing irritation draw
            nervous force and blood from a distant diseased part.
    =Rubefacients.=—Medicines which cause irritation and redness,
            and are used as revulsants.

    =Sedatives.=—Medicines which lower functional activity.
    =Sialagogues.=—Medicines which excite salivary glands to
            secretion.
    =Somnifacients.=—Soporifics.
    =Soporifics.=—Medicines which cause sleep.
    =Sorbefacients.=—Medicines which cause absorption.
    =Specifics.=—Medicines which have a direct curative influence
            on certain individual diseases.
    =Stimulants.=—Medicines which increase functional activity.
    =Stomachics.=—Stimulants to the stomach.
    =Styptics.=—Hemostatics.
    =Sudorifics.=—Medicines which produce sweating.

    =Tenicides.=—Medicines which kill the tapeworm.
    =Tonics.=—Medicines which permanently increase the systemic
            tone by stimulating nutrition.

    =Vermicides.=—Medicines which kill intestinal worms.
    =Vermifuges.=—Medicines which cause the expulsion of
            intestinal worms.
    =Vesicatories.=—Blisters.




ROMAN NUMERALS.


        I—   1
       II—   2
      III—   3
       IV—   4
        V—   5
       VI—   6
      VII—   7
     VIII—   8
       IX—   9
        X—  10
       XI—  11
      XII—  12
     XIII—  13
      XIV—  14
       XV—  15
      XVI—  16
     XVII—  17
    XVIII—  18
      XIX—  19
       XX—  20
      XXX—  30
       XL—  40
        L—  50
       LX—  60
      LXX—  70
     LXXX—  80
       XC—  90
        C— 100
        D— 500
        M—1000




POPULAR AND OFFICIAL NAMES OF MEDICINAL PREPARATIONS.


    =Baking soda=       Sodium bicarbonate.      Sodii bicarbonas.
    =Basham’s mixture=  Solution of iron and     Liquor ferri et
                              ammonium acetate.      ammonii acetatis.
    =Blaud’s pills=     Pills of iron carbonate. Pilulæ ferri
                                                        carbonatis.
    =Blue mass= or      Mass of mercury.         Massa hydrargyri.
       =blue pill=.
    =Blue ointment=     Ointment of mercury.     Unguentum hydrargyri.
    =Borax=             Sodium borate.           Sodii boras.
    =Brown mixture=     Compound licorice        Mistura glycyrrhizæ
                                mixture.                compositæ.
    =Calomel=           Mild chlorid of mercury. Hydrargyri chloridum
                                                        mite.
    =Castor oil=                                 Oleum ricini.
    =Cod-liver oil=                              Oleum morrhuæ.
    =Corrosive=         Corrosive chlorid of     Hydrargyri chloridum
       =sublimate.=        mercury.                corrosivum.
    =Cream-of-tartar=   Potassium bitartrate.    Potassii bitartras.
    =Croton oil=                                 Oleum tiglii.
    =Dover’s powder=    Powder of ipecac and     Pulvis ipecacuanhæ
                                opium.                  et opii.
    =Epsom salt=        Magnesium sulphate.      Magnesii sulphas.
    =Fowler’s solution= Solution of potassium    Liquor potassii
                               arsenite.                arsenitis.
    =Glauber’s salt=    Sodium sulphate.         Sodii sulphas.
    =Gum Arabic=                                 Acacia.
    =Heroin=            Diethylmorphin
                                hydrochlorid.
    =Hive syrup=        Compound syrup of        Syrupus scillæ
                                squills.              compositus.
    =Hoffmann’s=        Compound spirit of       Spiritus ætheris
       =anodyne.=          ether.                  compositus.
    =Huxham’s=          Compound tincture of     Tinctura cinchonæ
        =tincture.=        cinchona.               compositæ.
    =Jaborandi=                                  Pilocarpus.
    =Lady Webster’s=    Pill of aloes and        Pilula aloes et
       =pill.=             mastic.                 mastiches.
    =Laudanum=          Tincture of opium.       Tinctura opii.
    =Licorice powder=   Compound licorice        Pulvis glycyrrhizæ
                                powder.               compositus.
    =Lugol’s solution=  Compound solution of     Liquor iodi compositus.
                                iodin.
    =Magendie’s=        Solution of morphin      Liquor morphinæ
       =solution.=         sulphate.               sulphatis.
    =Male fern=         Filix mas.               Aspidium.
    =Muriatic acid=     Hydrochloric acid.       Acidum hydrochloricum.
    =Mustard=                                    Sinapis.
    =Nitroglycerin=                              Glonoin.
    =Oil of=            Oil of gaultheriæ.       Oleum gaultheriæ.
       =wintergreen=
    =Paregoric=         Camphorated tincture     Tinctura opii
                                of opium.               camphorata.
    =Phenol=            Carbolic acid.           Acidum carbolicum.
    =Prussic acid=      Hydrocyanic acid.        Acidum hydrocyanicum.
    =Rochelle salt=     Sodium and potassium     Sodii et potassii
                                tartrate.               tartras.
    =Salt=              Common salt, sodium      Sodii chloridum.
                                chlorid.
    =Seidlitz powder=   Compound effervescing    Pulvis effervescens
                                powder.                 compositus.
    =Sweet spirit=      Spirit of nitrous ether. Spiritus ætheris
       =of niter.=                                 nitrosi.
    =Tartar emetic=     Antimony and potassium   Antimonii et potassii
                                tartrate.               tartras.
    =Washing soda=      Sodium carbonate.        Sodii carbonas.
    =Witch-hazel=                                Hamamelis.




WEIGHTS AND MEASURES.


            TROY WEIGHT.
        24 grains =  1 dwt.
        20 dwts.  =  1 ounce.
        12 ounces =  1 pound.

    Used for weighing gold, silver, and jewels.

         APOTHECARIES’ WEIGHT.
        20 grains  =  1 scruple.
        3 scruples =  1 dram.
        8 drams    =  1 ounce.
        12 ounces  =  1 pound.

    The ounce and pound in this are the same as in Troy weight.

          AVOIRDUPOIS WEIGHT.
        27¹¹/₃₂ grains =  1 dram.
        16 drams       =  1 ounce.
        16 ounces      =  1 pound.
        25 pounds      =  1 quarter.
        4 quarters     =  1 cwt.
        2000 lbs.      =  1 short ton.
        2240 lbs.      =  1 long ton.

             DRY MEASURE.
        2 pints    =  1 quart.
        8 quarts   =  1 peck.
        4 pecks    =  1 bushel.
        36 bushels =  1 chaldron.

           LIQUID MEASURE.
        4 gills     =  1 pint.
        2 pints     =  1 quart.
        4 quarts    =  1 gallon.
        31⅓ gallons =  1 barrel.
        2 barrels   =  1 hogshead.

            TIME MEASURE.
        60 seconds =  1 minute.
        60 minutes =  1 hour.
        24 hours   =  1 day.
        7 days     =  1 week.
        28, 29, 30, or 31 days = 1 calendar month
              (30 days         = 1 month in computing interest).
        365 days   =  1 year.
        366 days   =  1 leap year.

          CIRCULAR MEASURE.
        60 seconds  =  1 minute.
        60 minutes  =  1 degree.
        30 degrees  =  1 sign.
        90 degrees  =  1 quadrant.
        4 quadrants =  12 signs, or 360 degrees = 1 circle.

           LONG MEASURE.
        12 inches  =  1 foot.
        3 feet     =  1 yard.
        5½ yards   =  1 rod.
        40 rods    =  1 furlong.
        8 furlongs =  1 statute mile.
        3 miles    =  1 league.

           CLOTH MEASURE.
        2¼ inches  =  1 nail.
        4 nails    =  1 quarter.
        4 quarters =  1 yard.

          MARINERS’ MEASURE.
        6 feet       =  1 fathom.
        20 fathoms   =  1 cable length.
        7½ ca. lgth. =  1 mile.
        5280 feet    =  1 stat. mile.
        6085 feet    =  1 naut. mile.

           MISCELLANEOUS.
        3 inches   =  1 palm.
        4 inches   =  1 hand.
        6 inches   =  1 span.
        18 inches  =  1 cubit.
        21.8 in.   =  1 Bible cubit.
        2½ feet    =  1 military pace.

           SQUARE MEASURE.
        144 sq. in.   =  1 sq. ft.
        9 sq. feet    =  1 sq. yd.
        36¼ sq. yds.  =  1 sq. rod.
        40 sq. rods   =  1 rood.
        4 roods       =  1 acre.
        640 acres     =  1 sq. mile.

                NUMERICAL TABLE.
        12 things                =  1 dozen.
        12 dozen                 =  1 gross.
        12 gross                 =  1 great gross.
        20 things                =  1 score.
        24 sheets                =  1 quire.
        20 quires, or 480 sheets =  1 ream.

              SIMPLE FRACTIONS.
        ⁶/₁₀ of 15 = 6 × 15 ÷ 10 = 9
        ³/₁₀ of 15 = 3 × 15 ÷ 10 = 4⁵/₁₀
        ³/₁₀ of 60 = 3 × 60 ÷ 10 = 18
        ⁶/₁₀ of 60 = 6 × 60 ÷ 10 = 36


           METRIC SYSTEM.
        Meter = Unit of length.
        Gram  = Unit of weight.
        Liter = Unit of capacity.

           METRIC MEASURES OF LENGTH DECREASING.
        Decimeter (dm.)  = one-tenth,      .1, or ¹/₁₀ of a meter.
        Centimeter (cm.) = one-hundredth,  .01, or ¹/₁₀₀ of a meter.
        Millimeter (mm.) = one-thousandth, .001, or ¹/₁₀₀₀ of a meter.

        METRIC MEASURES OF LENGTH INCREASING.
        Decameter (Dm.)  =    10 meters.
        Hectometer (Hm.) =   100 meters.
        Kilometer (Km.)  =  1000 meters.

           APPROXIMATE EQUIVALENTS OF METRIC
            AND STANDARD MEASURES OF LENGTH.
        1 meter                  =        39.37 inches.
        1 centimeter             =            ⅖ inch.
        5 centimeters            =            2 inches.
        30.5 centimeters         =           12   “
        1 millimeter             =          ¹/₂₅ inch.
        25 millimeters           =            1   “

                    METRIC WEIGHTS.
        1 gram (Gm.)      = weight of 1 cubic centimeter of water.
        1 decigram (dg.)  = one-tenth, 0.1, or ¹/₁₀ of a gram.
        1 centigram (cg.) = one-hundredth, 0.01, or ¹/₁₀₀ of a gram.
        1 milligram (mg.) = one-thousandth, 0.001, or ¹/₁₀₀₀ of a gram.
        1 Decagram (Dg.)  =   10 grams.
        1 Hectogram (Hg.) =  100 grams.
        1 Kilogram (Kg.)  = 1000 grams.


APPROXIMATE EQUIVALENTS OF METRIC AND APOTHECARIES’ WEIGHTS.

      0.001 gram     =     ¹/₆₄   grain.
      0.002  “       =     ¹/₃₂     “
      0.008  “       =     ¹/₈      “
      0.01   “       =     ¹/₆      “
      0.065  “       =        1     “
      0.1    “       =        1.5 grains.
      0.2    “       =        3     “
      0.5    “       =        7.7   “
      1.0    “       =       15.4   “
     10.0  grams     =      154     “
    100.0    “       =     1543     “
     ¹/₁₀₀ grain     =     0.00065 gram.
     ¹/₅₀    “       =     0.0013   “
     ¹/₃₀    “       =     0.002    “
     ¹/₂₀    “       =     0.003    “
     ¹/₁₀    “       =     0.0065   “
     ¹/₈     “       =     0.008    “
     ¹/₄     “       =     0.016    “
     ¹/₂     “       =     0.03     “
     1       “       =     0.065    “
    10       “       =     0.65     “
    15       “       =     1.0      “


METRIC MEASURES OF CAPACITY.

    1 liter (l.)       = the measure of 1000 grams of water.
    1 deciliter  (dl.) = ¹/₁₀ or 0.1 of a liter, or 100
                              cubic centimeters.
    1 centiliter (cl.) = ¹/₁₀₀ or 0.01 of a liter, or 10
                              cubic centimeters.
    1 milliliter (ml.) = ¹/₁₀₀₀ or 0.001 of a liter, or 1
                              cubic centimeter (c.c.).
    1 decaliter  (Dl.) = 10 liters.
    1 hectoliter (Hl.) = 100 liters.


APPROXIMATE EQUIVALENTS OF METRIC AND APOTHECARIES’ MEASURES OF
CAPACITY.

       1 liter       =   2   pints.
    1000 c.c.        =   2   pints.
     100 c.c.        =   3.4 fluidounces.
      30 c.c.        =   1   fluidounce.
      10 c.c.        =   2.7 fluidrams.
       1 c.c.        =  16   minims.
       1 minim       =  0.06 c.c.
      10 minims      =  0.6  c.c.
      20 minims      =  1.25 c.c.
      30 minims      =  2.0  c.c.
       1 fluidram    =  3.75 c.c.
       2 fluidrams   =   7.5 c.c.
       1 fluidounce  =  30.0 c.c.
      16 fluidounces = 474   c.c.


APOTHECARIES OR TROY WEIGHT.

    20 grains (gr.) = 1 scruple (℈).
     3 scruples (℈) = 1 dram (ʒ).
     8 drams (ʒ)    = 1 ounce (℥).
    12 ounces (℥)   = 1 pound (lb.).

       APOTHECARIES’ OR WINE MEASURE.
    60 minims (m.)      = 1 fluidram (fʒ).
     8 fluidrams (fʒ)   = 1 fluidounce (f℥).
    16 fluidounces (f℥) = 1 pint (O).
    8 pints (O).        = 1 gallon (Cong.).

       APPROXIMATE FLUID MEASURES.
    1 teaspoonful     = 1 fluidram, or fʒj.
    1 dessertspoonful = 2 fluidrams, or fʒij.
    1 tablespoonful   = 4 fluidrams, or fʒiv.
    1 wineglassful    = 2 fluidounces, or f℥ij.
    1 teacupful       = 4 fluidounces, or fʒiv.




TABLES FOR PERCENTAGE OF SOLUTIONS.

The following tables are sufficiently correct for practical purposes:

                       APOTHECARIES’ MEASURE.

    +-----------------------+-------------------+-------------------+
    |                       |   For 1 ounce.    |   For 1 pint.     |
    +-----------------------+-------------------+-------------------+
    |                       |                   |                   |
    | 1 per cent. (1 : 100) |  5 M. or 5 grains |75 M. or 75 grains |
    | 2    “      (1 : 50)  | 10  “   10   “    |     2½ drams      |
    | 3    “      (1 : 33)  | 15  “   15   “    |     3¾   “        |
    | 4    “      (1 : 25)  | 19  “   19   “    |     5    “        |
    | 5    “      (1 : 20)  | 24  “   24   “    |     6½   “        |
    |10    “      (1 : 10)  | 48  “   48   “    |    13    “        |
    +-----------------------+-------------------+-------------------+
    |                       |    For 1 quart.   |  For 1 gallon.    |
    +-----------------------+-------------------+-------------------+
    |                       |                   |                   |
    | 1 per cent. (1 : 100) |      2½ drams     |10 drams           |
    | 2    “      (1 : 50)  |      5   “        | 2½ ounces         |
    | 3    “      (1 : 33)  |      7½  “        | 3 oz. and 6 drams |
    | 4    “      (1 : 25)  |      10  “        | 5 ounces          |
    | 5    “      (1 : 20)  |      13  “        | 6 oz. and 4 drams |
    |10    “      (1 : 10)  |      26  “        |13 ounces          |
    +-----------------------+-------------------+-------------------+

                        METRIC MEASURE.
    +-----------------------+------------------+------------------+
    |                       |     30 C.c.      |     500 C.c.     |
    +-----------------------+------------------+------------------+
    | 1 per cent (1 : 100)  |   0.30 gram      |    5.00 grams    |
    | 2    “     (1 : 50)   |   0.60   “       |   10.00   “      |
    | 3    “     (1 : 33)   |   0.90   “       |   15.00   “      |
    | 4    “     (1 : 25)   |   1.20 grams     |   20.00   “      |
    | 5    “     (1 : 20)   |   1.50   “       |   25.00   “      |
    |10    “     (1 : 10)   |   3.00   “       |   50.00   “      |
    +-----------------------+------------------+------------------+
    |                       |     1000 C.c.    |     4 liters.    |
    +-----------------------+------------------+------------------+
    | 1 per cent (1 : 100)  |    10.00 grams   |   40.00 grams    |
    | 2    “     (1 : 50)   |    20.00   “     |   80.00   “      |
    | 3    “     (1 : 33)   |    30.00   “     |  120.00   “      |
    | 4    “     (1 : 25)   |    40.00   “     |  160.00   “      |
    | 5    “     (1 : 20)   |    50.00   “     |  200.00   “      |
    |10    “     (1 : 10)   |   100.00   “     |  400.00   “      |
    +-----------------------+------------------+------------------+




SOLUTIONS.


TO MAKE A 1: 500 SOLUTION.

            Add   1 gr. or   1 m. to 1 ounce of water.
            Add  15   “     15  “    1 pint     “
            Add  30   “     30  “    1 quart    “
            Add 120   “    120  “    1 gallon   “

    To make 1 : 1000 sol. take 1 part of 1.500 sol. and 1 part water.
    To make 1 : 2000     “     1    “    1.500    “     3 parts water.
    To make 1 : 4000     “     1    “    1.500    “     7     “
    To make 1 : 5000     “     1    “    1.500    “     9     “

To make a 1: 500 solution of formaldehyd add 38 minims of formalin (a
40 per cent. solution of formaldehyd) to 1 pint of water.


A HANDY SOLUTION TABLE WITH DOMESTIC MEASURES.

        SOLUTION.            DOMESTIC MEASURE.

    1 : 1000               1  teaspoon to gallon.
      ⅒ of 1 per cent.   15   drops to quart.
    1 : 500                2  teaspoons to gallon.
      ⅕ of 1 per cent.    30  drops to quart.
    1 : 200                5  teaspoons to gallon.
      ½ of 1 per cent.     1¼ teaspoons to quart.
    1 : 100                2½ teaspoons to quart.
      1 per cent.          1¼ teaspoons to pint.
    1 : 50                 5  teaspoons to quart.
      2 per cent.          2½ teaspoons to pint.
    1 : 25                 2½ tablespoons to quart.
      4 per cent.          5  teaspoons to pint.
    1 : 20                 3  tablespoons to quart.
      5 per cent.          1½ tablespoons to pint.


TO PREPARE A 1: 500 SOLUTION.

There are 7680 m. in 1 pint of solution (water); therefore we divide
7680 by 500 as follows:

    500)7680(15⅗ m. to 1 pint of solution (water).
        500
        ————
        2680
        2500
        ————
         1800
         1500
         ————
          300, or ⅗ of a m.

N.B.—Divide the number of m. in 1 pint by the strength of the solution,
and then divide the result by the percentage of original strength of
the article.

When original strength of solution is less than 100 per cent., as, for
example, formaldehyd, which is 40 per cent., divide the quotient above
resulting by the percentage of strength—viz.:

    40)1536(38⅖ m. to 1 pint of solution (water).
       120
       ———
        336
        320
        ———
         ¹⁶/₄₀ = ⅖.

To get a ¹/₁₀₀ of a grain dose of any drug out of a solution of 60
minims containing ¹/₃₂ of a grain of that drug, compute as follows:

    ³²/₃₂ or 1 grain = 32 × 60, or 1920 m.
    ¹/₁₀₀ = ¹/₁₀₀ of 1920 m.
                     100)1920(19⅕ m.
                         100
                         ———
                          920
                          900
                          ———
                           20, or ⅕ m.

RULE.—Multiply the quantity of the solution on hand in minims by a
number indicating the fractional amount of the drug therein contained,
and divide by a number indicating the fractional amount of the drug
desired.

    In  20 parts of solution we have    1 part of carbolic acid.
    In   1 part        “       “   ¹/₂₀    “            “
    In 100 parts       “       “    100 × ¹/₂₀ = 5 pt.  “
    So that ¹/₂₀ solution is a 5 per cent. carbolic acid solution.

        40 parts contain    1 part of carbolic acid.
         1 part contains ¹/₄₀  “           “
       100 parts contain 100 × ¹/₄₀ = 2½ parts of carbolic acid.
    So that ¹/₄₀ solution is a 2½ per cent. carbolic acid solution.




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


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

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

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

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

          The indications of its too free use are puffiness under
        the eyes, or griping pains in the abdomen, with diarrhea.

          Toxic doses cause abdominal pain, vomiting, purging,
        swelling of the face, and collapse.

          Preparations of arsenic should be given after meals. The
        _dose_ of _arsenous acid_ is from ¹/₄₀ to ¹/₂₀
        grain (0.0016-0.0032 gm.); of _Fowler’s Solution_
        (Liquor Potassii Arsenitis), 1 minim (0.06 c.c.), very
        gradually increased to 10 minims (0.6 c.c.).

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

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

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

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

          _Preparations._—_Wines_ are produced by the
        spontaneous fermentation of fruits. The strongest are
        port, Madeira, and sherry, each of which contains about
        20 per cent. of alcohol. The _dose_ is from 4 to 8
        drams (15-30 c.c.). The weakest wines are the clarets
        and Rhine wines, which contain about 8 per cent. of
        alcohol. The _dose_ of these is from 1 to 2 ounces
        (30-60 c.c.).

          _Champagne_ is prepared by adding sugar to an
        ordinary wine, and allowing the mixture to ferment in
        corked bottles, the carbon dioxid thus being retained.
        It contains from 10 to 12 per cent. of alcohol. The
        _dose_ is from 1 to 2 ounces (30-60 c.c.).

          _Whisky_ is made by subjecting fermented grains
        to distillation. _Rum_ is made by distilling
        fermented molasses. _Gin_ is prepared by distilling
        fermented grain and adding oil of juniper berries to the
        distillate.

          _Brandy_ is a spirit produced by the distillation
        of a wine.

          Whisky, rum, gin, and brandy contain from 40 to 50 per
        cent. of alcohol. The _dose_ of each is from 1 to 4
        drams (4-15 c.c.).

          _Beer_, _ale_, and _porter_ are made from
        an infusion of malt—that is, fermented barley, flavored
        with hops. They each contain from 4 to 6 per cent. of
        alcohol.

          In large doses alcohol in any form causes mental
        excitement, delirium, loss of co-ordination, and finally
        stupor and coma. Death may result from paralysis of the
        heart or respiration.

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

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

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

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

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

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

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

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

    =Atropin.=—See _Belladonna_.

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

          The _dose_ of _atropin_ is from ¹/₁₅₀ to ¹/₅₀
        grain (0.00043-0.0013 gm.); of the _Tincture of
        Belladonna_ (Tinctura Belladonnæ), 5 to 20 minims
        (0.3-1.2 c.c.); of the _Extract of Belladonna_
        (Extractum Belladonnæ), ⅛ to ¼ grain (0.008-0.016 gm.).

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

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

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

    =Calomel.=—See _Mercury_.

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

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

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

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

          Poisonous doses cause unconsciousness, embarrassed
        breathing, and collapse.

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

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

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

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

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

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

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

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

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

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

          The _dose_ of the _Extract of Ergot_ (Extractum
        Ergotæ) is from 1 to 15 grains (0.065-1 gm.); of the
        _Fluid Extract_ (Extractum Ergotæ Fluidum), ½ to 1
        dram (2-4 c.c.); of the _Wine_ (Vinum Ergotæ), 1 to
        4 drams (4-15 c.c.); of _ergotin_, a concentrated
        extract, 2 to 5 grains (0.13-0.3 gm.). When given
        hypodermically abscess is likely to form, even under the
        most strict antiseptic precautions.

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

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

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

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

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

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

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

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

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

          The _dose_ of _Reduced Iron_ (Ferrum Reductum)
        is from 1 to 5 grains (0.06-0.3 gm.); of the _Pills
        of Iron Carbonate_ or _Blaud’s Pills_ (Pilulæ
        Ferri Carbonatis), 1 to 3 pills; of the _Tincture
        of Ferric Chlorid_ (Tinctura Ferri Chloridi), 5 to
        10 minims (0.3-0.6 c.c.); of the _Solution of Iron
        and Ammonium Acetate_ or _Basham’s Mixture_
        (Liquor Ferri et Ammonii Acetatis), 1 to 4 drams (4-15
        c.c.); of the _Sulphate of Iron_ (Ferri Sulphas),
        1-3 grains (0.06-0.2 gm.); of the Syrup of _Iodid of
        Iron_ (Syrupus Ferri Iodidi), 5 to 60 minims
        (0.3-4 c.c.). The _Solution of Iron Subsulphate_
        (Monsel’s solution) is used only as a hemostatic, and
        _Iron Hydrate with Magnesia_ as an antidote in
        arsenic-poisoning. The _dose_ of the latter is a
        tablespoonful every ten to fifteen minutes.


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

          The _Solution_ of _Lead Subacetate_ (Liquor Plumbi
        Subacetatis) is employed externally. Diluted with from 5
        to 6 parts of water it is used as a sedative application
        in ivy-poisoning and erysipelas.

          The _Dilute Solution_ of _Lead Subacetate_
        (Liquor Plumbi Subacetatis Dilutus) is known as
        _lead-water_, and is chiefly employed in making the
        sedative preparation known as lead-water and laudanum.
        As usually dispensed it contains 1 dram (4 c.c.) of
        laudanum and 4 drams (15 c.c.) of lead-water to 2 ounces
        (60 c.c.) of water.

    _Acute lead-poisoning_ is characterized by a burning
        pain in the abdomen, a metallic taste in the mouth,
        vomiting, purging, coma, and collapse.

    _Chronic lead-poisoning_ is characterized by anemia,
        intestinal colic, constipation, a blue line on the
        gums (deposit of lead sulphide), and paralysis of the
        forearms (wrist-drop).

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

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

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

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

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

          _Calomel_ (Hydrargyri Chloridi Mite).—This
        preparation is employed internally as a cathartic and
        gastric sedative, and externally as a stimulating and
        antiseptic dusting-powder. As a cathartic its best
        effect is secured by giving it in _doses_ of from
        ⅒ to ⅙ grain (0.006-0.01 gm.) every half-hour or hour,
        until a grain has been taken. In this way the whole
        amount ingested is absorbed. When large doses are
        employed much of the drug escapes absorption.

          _Blue Mass_ or _Blue Pill_ (Massa
        Hydrargyri).—This is a mixture of mercury, glycerin,
        honey, and licorice. Its action is much like that of
        calomel.

          _Corrosive Sublimate_ or _Bichlorid of
        Mercury_ (Hydrargyri Chloridum Corrosivum).—Although
        irritant, toxic, and destructive to instruments, no
        other drug has supplanted this salt as an antiseptic
        for use in general surgery. The following are the
        strengths of the solutions usually employed for various
        purposes: for the skin, 1 : 1000 to 1 : 500; for wounds,
        1 : 10,000 to 1 : 2000; for cavities of the body, 1
        : 20,000 to 1 : 5000. Corrosive sublimate is not a
        good disinfectant for stools, sputa, etc., as it forms
        an impenetrable coagulum on the outside of the mass.
        Internally, corrosive sublimate is used as an alterative
        in constitutional diseases in _doses_ of ¹/₆₀ to
        ¹/₁₂ of a grain (0.001-0.005 gm.).

          _Oxid of Mercury._—This appears in two
        forms—yellow oxid and red oxid. Both preparations are
        employed externally in the form of ointments for their
        alterative properties.

          _Iodid of Mercury._—This salt occurs in two forms:
        Red Iodid or Biniodid (Hydrargyri Iodidum Rubrum) and
        Yellow or Green Iodid (Hydrargyri Iodidum Flavum). The
        first is an irritating preparation, somewhat resembling
        corrosive sublimate in its action; the latter is
        comparatively unirritating, and is much used internally
        as an alterative. The _dose_ of the _red
        iodid_ is from ¹/₆₀ to ¹/₁₂ grain (0.001-0.005 gm.);
        of the _yellow_ or _green iodid_, ¹/₁₀ to ½ grain
        (0.006-0.03 gm.).

          _Nitrate of Mercury._—This preparation is used in
        the form of a solution (Liquor Hydrargyri Nitratis) as a
        powerful caustic.

          _Ointment of Mercury_, or _Blue Ointment_
        (Unguentum Hydrargyri).—This is an ointment of metallic
        mercury. It is used as a stimulant and absorbent
        application in chronic inflammatory swellings, as a
        parasiticide in certain skin diseases, and by inunction
        in syphilis. When used for the latter purpose about a
        dram (4 gm.) should be rubbed in the axilla, groin, or
        inner surface of the arm or thigh daily, a different
        region being selected each time, so as to avoid
        irritation of the skin.

          _Mercurial Poisoning._—Patients taking mercury
        continuously, even in small doses, should be
        carefully watched, as symptoms of _ptyalism_ or
        _salivation_ sometimes arise very speedily. This
        condition is manifested by fetor of the breath, soreness
        of the teeth when the jaws are brought together,
        increased flow of saliva, redness and swelling of the
        gums, and finally by ulceration of the tissues, loss
        of the teeth, and necrosis of the jaw bones. On the
        slightest evidence of these symptoms the drug should
        be suspended, and the mouth washed out frequently with
        a solution of hydrogen peroxid (1 : 4) or of potassium
        chlorate (1 dram to 8 ounces of water).

          The ingestion of a single large _dose_ of an
        irritant salt of mercury, such as the bichlorid or
        biniodid, gives rise to severe burning pain in the
        abdomen, vomiting, bloody purging, and collapse.

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

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

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

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

          The _dose_ of the _Tincture of Nux Vomica_
        (Tinctura Nucis Vomicæ) is from 5 to 20 minims (0.3-1.2
        c.c.); of the _Extract of Nux Vomica_ (Extractum
        Nucis Vomicæ), ⅙ to ¼ grain (0.01-0.016 gm.); of
        _Strychnin Sulphate_ (Strychninæ Sulphas), ¹/₆₀ to
        ¹/₂₀ of a grain (0.001-0.003 gm.).

    =Opium.=—This is the dried juice of a species
        of poppy growing in Asia. It contains several
        alkaloids, the chief of which are _morphin_ and
        _codein_. From morphin are prepared artificially
        two alkaloids—_apomorphin_ and _heroin_.

          Opium depresses the brain, depresses the respiration,
        stimulates the heart slightly, lessens the peristaltic
        movements of the bowel, and diminishes all secretions,
        except the sweat. It is employed to induce sleep, to
        relieve pain, to allay cough, to check diarrhea, and to
        promote perspiration.

          _Opium-poisoning_ is marked by three stages: the
        _first_ stage is short and characterized by mental
        exhilaration; in the _second_ stage the pupils
        are greatly contracted (pin-point), the respirations
        are slow, the pulse is slow and full, and there is
        deep stupor. In the _third_ stage the patient can
        no longer be aroused (coma), the respiration becomes
        shallow and irregular, the pulse becomes rapid and weak,
        the pupils finally dilate, and the patient dies from
        failure of the respiration.

          Even after small doses of opium many patients suffer from
        headache and nausea. Children are much more sensitive
        to its action than adults. Morphin resembles opium in
        action, but is more powerful, less nauseating, and less
        constipating. Codein is less powerful as a hypnotic and
        less depressing than morphin.

          The _dose_ of _opium_ is from ½ to 1 grain
        (0.03-0.65 gm.); of the _Extract of Opium_
        (Extractum Opii), ⅛ to ½ grain (0.008-0.03 gm.);
        of the _Tincture of Opium_ or _Laudanum_
        (Tinctura Opii), 10 to 20 minims (0.6-1.2 c.c.); of the
        _Camphorated Tincture of Opium_ or _Paregoric_
        (Tinctura Opii Camphorata), ½ to 4 drams (2-15 c.c.);
        of _Dover’s Powder_ (Pulvis Ipecacuanhæ et opii),
        5 to 10 grains (0.3-0.6 gm.); of _morphin_ and its
        salts (sulphate, hydrochlorate, etc.), ⅛ to ½ grain
        (0.008-0.03 gm.), and of _codein_, ½ to 1 grain
        (0.03-0.06 gm.).

    _Heroin_ is chiefly used to allay cough. The _dose_
        is from ¹/₁₂ to ⅛ of a grain (0.005-0.008 gm.).

    _Apomorphin_ is employed as an emetic and as an
        expectorant in bronchitis. The _dose_ as an emetic
        is from ⅒ to ⅙ of a grain (0.006-0.01 gm.), always
        hypodermically; the _dose_ as an expectorant is
        from ¹/₂₀ to ¹/₁₀of a grain (0.003-0.006 gm.), always by
        the mouth.

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

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

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

    The _dose_ of the _Tincture of Physostigma_
        (Tinctura Physostigmatis) is from 5 to 20 minims
        (0.3-1.2 c.c.); of the _Extract of Physostigmatis_
        (Extractum Physostigmatis), ¹/₁₂ to ⅙ of a grain
        (0.005-0.01 gm.); of _eserin_ or _physostigmin_
        and its salts, ¹/₁₅₀ to ¹/₅₀ of a grain (0.0004-0.0013 gm.).

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

    =Quinin.=—See _Cinchona_.

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

          The _dose_ of _salicylic acid_ or its salts
        (ammonium, sodium, strontium) is from 5 to 20 grains
        (0.3-1.3 gm.); of _Oil of Gaultheria_ (Methyl
        Salicylate), 5 to 20 minims (0.3-1.2 c.c.). These
        preparations should be given after meals, well diluted.

          The following remedies have properties like the salicylates,
        but are less powerful and less irritant to the stomach:
        _Salol_, _dose_, 5 to 20 grains (0.3-1.3 gm.);
        _salophen_, 5 to 30 grains (0.3-2 gm.); _aspirin_,
        5 to 20 grains (0.3-1.3 gm.).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

          The _dose_ of the _tincture of veratrum viride_
        (tinctura veratri viridis) is from 1 to 5 minims
        (0.06-0.3 c.c.).




DOSAGE.


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

1. Tinctures of very active drugs, such as opium, digitalis,
belladonna, physostigma, nux vomica, gelsemium, arnica, and capsicum
may be given in _doses_ of from 5 to 20 minims (0.3-1.2 c.c.),
except the _tinctures of aconite_, _veratrum viride_, _iodin_, and
_cantharides_, the _dose_ of which is from 1 to 5 minims (0.06-0.3
c.c.).

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

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

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

5. Dilute acids (hydrochloric, nitric, nitrohydrochloric, sulphuric)
may be given in _doses_ of from 5 to 20 minims (0.3-1.3 c.c.), except
_dilute hydrocyanic acid_, the _dose_ of which is from 1 to 5 minims
(0.06-0.3 c.c.).

6. All medicated syrups, except the _syrup of iodid of iron_ and the
_compound syrup of squill_, may be given in _doses_ of 1 to 2 drams
(4-8 c.c.) or more.

7. All infusions may be given in _doses_ of ½ to 1 ounce (15-30 c.c.)
or more, except the _infusion of digitalis_, the _dose_ of which is
from 1 to 4 drams (4-15 c.c.).

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

9. All spirits may be given in _doses_ up to 1 dram (4 c.c.), except
the _spirit of nitroglycerin_ (glonoin), the _dose_ of which is from 1
to 5 minims (0.06-0.3 c.c.), the _spirit of phosphorus_, the _dose_ of
which is from 5 to 15 minims (0.3-1 c.c.), and the _spirit of bitter
almond_, the _dose_ of which is from 5 to 10 minims (0.3-0.6 c.c.).

10. All _waters_ (aquæ) may be given in _doses_ up to 1 ounce (30
c.c.), except _aqua ammoniæ_, _aqua chlori_, and _aqua laurocerasi_
(cherry-laurel), the _dose_ of which is about ½ dram (2 c.c.).

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


TO ASCERTAIN DOSES OF MEDICINE FOR CHILDREN.

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

    2 + 12
    ——— = 7, and the dose is ⅐ of that for an adult.
      2

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

       8       8
    ——— = ——, or ¹/₁₉ of an adult’s dose;
    8 + 144   152

for a baby of six months,

       6       6
    ——— = ——, or ¹/₂₅ of an adult’s dose.
    6 + 144   150

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

    Child aged one month      ¹/₁₄₅ of an adult’s dose.
      “    “   two months     ¹/₇₃      “    “      “
      “    “   three months   ¹/₄₉      “    “      “
      “    “   four months    ¹/₃₇      “    “      “
      “    “   five months    ¹/₃₀      “    “      “
      “    “   six months     ¹/₂₅      “    “      “
      “    “   seven months   ¹/₂₂      “    “      “
      “    “   eight months   ¹/₁₉      “    “      “
      “    “   nine months    ¹/₁₇      “    “      “
      “    “   ten months     ¹/₁₅      “    “      “
      “    “   eleven months  ¹/₁₄      “    “      “
      “    “   twelve months  ¹/₁₃      “    “      “
      “    “   two years      ¹/₇       “    “      “
      “    “   three years    ¹/₅       “    “      “
      “    “   four years     ¹/₄       “    “      “
      “    “   five years     ⁵/₁₇      “    “      “
      “    “   six years      ¹/₃       “    “      “
      “    “   seven years    ⁷/₁₉      “    “      “
      “    “   eight years    ²/₃       “    “      “
      “    “   nine years     ³/₇       “    “      “
      “    “   ten years      ⁵/₁₁      “    “      “
      “    “   eleven years   ¹/₂       “    “      “
      “    “   twelve years   ¹/₂       “    “      “

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


THE DOSE OF DRUGS ADMINISTERED SUBCUTANEOUSLY AND BY THE RECTUM.

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


PROPER TIME TO TAKE MEDICINES.

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




POISONS AND ANTIDOTES.


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

    =Acetanilid.=—Emetic; rest in recumbent position;
        stimulants—ammonia and strychnin; artificial
        respiration; oxygen inhalations; external heat.

    =Acid, Carbolic.=—Alcohol or Epsom salt as an
        antidote. Three or four ounces of diluted alcohol,
        followed by lavage with a solution of Epsom salt;
        external heat; demulcents; stimulants hypodermically.

    =Acid, Hydrocyanic.=—Fresh air; artificial
        respiration; oxygen inhalations; ammonia by inhalation
        and by intravenous injection.

    =Acid, Oxalic.=—Chalk or lime as an antidote;
        demulcents, like oil or egg-albumin.

    =Acids, Mineral.=—Chalk, magnesia, soap, or
        white-wash from wall to neutralize poison; demulcent
        drinks—bland oils or egg-white; stimulants
        hypodermically.

    =Aconite.=—Recumbent position; empty stomach with
        pump with patient flat on back; external heat;
        stimulants—alcohol, ammonia, strychnin—hypodermically.

    =Ammonia.=—Vinegar with lemon-juice to neutralize the
        poison; white of egg or oil to allay irritation.

    =Anilin Dyes.=—Give plenty of warm water to induce
        emesis; place patient in recumbent position; loosen
        clothing and permit free circulation of fresh air.

    =Antimony (Tartar Emetic).=—Tannic acid as an
        antidote; use stomach-pump; external heat; stimulants.

    =Antipyrin.=—Same as Acetanilid.

    =Arsenic.=—Stomach-pump or an emetic; freshly
        precipitated ferric hydrate (tablespoonful every ten
        minutes) made by adding magnesia to any iron solution;
        demulcents—oil or egg-albumin.

    =Atropin.=—Same as Belladonna.

    =Belladonna.=—Emetic or stomach-pump; tannic acid as
        an antidote; cold to head; enema of warm black coffee.

    =Camphor.=—Empty the stomach; apply a hot-water bag to
        the abdomen, and stimulate the patient if necessary.

    =Cantharides.=—Emetic or stomach-pump; egg-white;
        mucilaginous drinks in abundance; _avoid all oily
        substances_.

    =Chloroform.=—Withdrawal of drug; lowering of head;
        pulling tongue forward; artificial respiration;
        stimulants—strychnin, digitalis, ammonia.

    =Cocain.=—Empty the stomach by means of the
        stomach-pump or an emetic. Stimulate patient and
        administer artificial respiration.

    =Colchicum.=—Stomach-pump or emetic; external heat;
        white of egg; stimulants; opium for pain.

    =Copper Sulphate.=—Yellow prussiate of potassium,
        soap, or magnesia; milk and albumin freely; opium for
        pain.

    =Corrosive Sublimate.=—White of egg freely; milk;
        emetic or stomach-pump; opium for pain.

    =Creosote.=—Same as Carbolic acid.

    =Croton Oil.=—Emetic; mucilaginous drinks; opium.

    =Cyanide of Potassium.=—Same as Hydrocyanic acid.

    =Digitalis.=—Recumbent position; stomach-pump with
        patient recumbent; external heat; tannic acid.

    =Elaterium.=—Emetic; external heat; demulcents; opium.

    =Ergot.=—Empty stomach; copious drafts of warm water,
        coffee, or tea; quick purgative (croton oil); place
        patient in recumbent position; give hot sponge-bath and
        apply friction to the body.

    =Gas, Illuminating.=—Fresh air; artificial
        respiration; oxygen inhalations; injections of ammonia
        and strychnin.

    =Iodin.=—Starch-paste as an antidote; emetic; external
        heat; demulcents; opium.

    =Lead Salts.=—Epsom salt as antidote; emetic; milk or
        egg-white.

    =Lobelia.=—External heat; tannic acid; stomach-pump;
        stimulants.

    =Matches.=—Same as Phosphorus.

    =Morphin.=—Same as Opium.

    =Mushroom, poisonous (Toad-stools).=—Emetics; atropin
        (¹/₁₀₀ gr.) hypodermically; castor oil; stimulants.

    =Nux Vomica.=—Same as Strychnin.

    =Opium.=—Stomach-pump or emetic; repeated lavage;
        black coffee enema; potassium permanganate (5 gr.) in
        tumblerful of water, or tannic acid as an antidote; keep
        patient awake with cold affusions or electric brush;
        artificial respiration; respiratory stimulants—atropin,
        ammonia, strychnin, cocain, caffein.

    =Phenacetin.=—Same as Acetanilid.

    =Phosphorus.=—Copper sulphate as an emetic; dilute
        peroxid of hydrogen or potassium permanganate as an
        antidote; Epsom salt as a purge; _avoid all oils and
        fatty substances_.

    =Potassa or Soda (Lye).=—Vinegar or lemon-juice as an
        antidote; oils or egg-white; opium.

    =Ptomain Poisoning.=—Empty the stomach by means of the
        stomach-pump or by an emetic. Apply a hot-water bag to
        the abdomen. Give opium or morphin to allay the pain and
        check diarrhea. Give a large dose of castor oil.

    =Rat Poison.=—This usually contains arsenic or
        phosphorus (q. v.).

    =Silver Nitrate.=—Solution of common salt as antidote;
        emetic; demulcent drinks. Silver nitrate stains on the
        skin may be whitened and their removal much expedited
        by the application of a solution made according to the
        following formula:

                  Mercury bichlorid,      gr. v;
                  Ammonium chlorid,       gr. v;
                  Aqua,                   ʒij.

    =Stramonium.=—Same as Belladonna.

    =Strychnin.=—Absolute quiet; if convulsions have
        begun, do not use stomach-pump unless the patient first
        be etherized; tannic acid as antidote; inhalations of
        chloroform or amyl nitrite for convulsions; potassium
        bromid (ʒj) and chloral (gr. xxx) by mouth or rectum.

    =Tobacco.=—Emetic; external heat; stimulants.


ANTIDOTES.

    1. =Albumen, Egg-white.=—Dissolve 4 egg-whites in 1
        quart of warm water.

    2. =Milk, Fatty Oils, Mucilaginous
        Substances.=—Substitutes for albumen.

    3. =Castile Soap.=—Dissolve in plenty of water;
        substitute for albumen.

    4. =Tannic Acid, Coffee, Tea.=—To precipitate various
        alkaloids.

    5. =Vinegar, Diluted Mineral Acids.=—To neutralize
        alkalies and alkaline salts.

    6. =Emetics.=—(1) Zinc sulphate, grs. v-xv, repeated
        twice if necessary at fifteen-minute intervals, or until
        emesis is produced. (2) Mustard, ʒj-iv, stirred to a
        cream with warm water. (3) Ipecac, gr. xv; repeat if
        necessary in fifteen minutes. (4) Tartar emetic, gr. ½,
        in sweetened water for children.

      _Note._—In all poison cases loosen clothing
      instantly and permit free circulation of fresh air;
      protect body with warm blankets; do not use pump or give
      emetics if acid has been taken in concentrated form;
      secure necessary drugs so that medication may be given
      at once upon direction of physician in charge.




MISCELLANEOUS FORMULÆ.


SEMMOLA’S MIXTURE.

    Sodium iodid,             gr. xv;
    Sodium phosphate,         gr. xxx;
    Sodium chlorid,           gr. cx;
    Aqua,                     ℥xxxvj.

A diuretic and laxative mixture.


NORMAL SALT SOLUTION.

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


Stock Salt Solution by Weight.

        Sodium chlorid,         ℥jss (47 gm.);
        Water,                 f℥viij (237 c.c.).

    Boil in a closed vessel fifteen minutes.
    When cold make up with sterile water to f℥j-viij.
    Strain through sterile cotton into a sterile bottle,
    and keep tightly corked.

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


Normal Salt Solution.

    Stock salt solution,     f℥j (30 c.c.);
    Sterile water,            Oij (1 L.).


Salt Solution.

    Distilled water,             Oiv;
    Purified salt,               ℥xij.


CARBOLIC ACID SOLUTION (5 PER CENT.).

    Cold sterile water,             gal. j;
    Carbolic acid (95 per cent.),   ℥iv.


1: 20 SOLUTION GLYCERIN FORMALDEHYD.

    Sterile glycerin,            ℥viss (23 c.c.);
    Solution formaldehyd,        Oj (500 c.c.).


SOLUTION (1: 1000) OF BICHLORID OF MERCURY (CORROSIVE SUBLIMATE).

    Mercury bichlorid or
      corrosive sublimate,       gr. xv (1 gm.);
    Common salt,                 gr. xv (1 gm.);
    Sterile water,               Oij (1 L.).

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


ALKALINE SOLUTION OF CYANID OF MERCURY.

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

      Mercury cyanid, gr. viiss (0.5 gm.);
      Sodium borate,  gr. xv (1 gm.).
    These tablets are made to correspond to bichlorid tablets.

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


SATURATED BORIC OR BORACIC-ACID SOLUTION.

    Boric acid crystals,         ℥jss (47 gm.);
    Hot sterile water,           Oij (1 L.).

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


SOLUTION OF POTASSIUM PERMANGANATE.

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


IODIN SOLUTION.

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


SOLUTIONS OF FORMALDEHYD.

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

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

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

        Solution of formaldehyd,     fʒvj (23 c.c.);
        Cold sterile water,          Oij (1000 c.c.).
    This solution is approximately equivalent to

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

    Solution of formaldehyd,     ♏︎xxxviij (2.3 c.c.);
    Cold sterile water,          Oj (500 c.c.)


THIERSCH’S ANTISEPTIC SOLUTION.

        Saturated boric acid solution,  Oj (500 c.c.);
        Sterile water,                  Oj (500 c.c.);
        Salicylic acid,                 gr. lxxv (5 gm.).

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


HARRINGTON’S SOLUTION.

    Bichlorid of mercury,        gr. xxxij;
    Hydrochloric acid,           2400 c.c.;
    Distilled water,             12,000 c.c.;
    Alcohol (95 per cent.),      25,600 c.c.


PICRIC ACID SOLUTION FOR BURNS.

    Picric acid crystals,        gr. xx (1.3 gm.);
    Alcohol (95 per cent.),      fʒij (8 c.c.);
    Cold sterile water,          f℥viij (250 c.c.).


CHLORID OF LIME SOLUTION.

    Chlorid of lime,             ℥v (160 gm.);
    Water,                       Oviij (4 L.).


SOLUTION FOR SORE NIPPLES.

    1. Glycerin,                  f℥ss (15 c.c.);
       Boric solution,            f℥ss (15 c.c.);
       Alcohol (95 per cent.),    f℥ss (15 c.c.);
       Tannic acid,               gr. xx (1.3 gm.).

    2. Compound tincture of benzoin, f℥j (30 c.c.).
       Apply with a cotton swab or camel’s hair brush.


NIPPLE OINTMENT.

        Sulphur sub.,              gr. x;
        Acid tannic,               ʒj;
        Borax pulv.,               ℈j;
        Syrup simp.,               ℥j;
        Glycerini,                 ℥ss.
    Wash off before nursing.


ARISTOL OINTMENT FOR CRACKED NIPPLES.

    Aristol,                   gr. xxv (1.6 gm.);
    Vaselin,                   ℥j (30 gm.).


SOOTHING LOTIONS FOR THE HANDS.

    1. Spirits camphor,          }
       Glycerin,                 } āā f℥j (30 c.c.);
       Tr. benzoin,              }
       Alcohol (95 per cent.),        f℥v (150 c.c.).

    2. Alcohol (95 per cent.)    }
       Glycerin,                 } āā f℥j (30 c.c.);
       Tr. benzoin,              }
       Distilled extract of hamamelis
         (witch-hazel),               f℥ij (60 c.c.).

    3. Alcohol,                       f℥ij (60 c.c.);
       Glycerin,                      f℥ij (60 c.c.);
       Lemon juice,                   f℥ss (15 c.c.);
       Tr. myrrh,                     f℥ss (15 c.c.).

    4. Water,                         Oj (500 c.c.);
       Boric acid crystals,           ʒiij (12 gr.);
       Gum tragacanth,                ʒij (8 gr.).

    Allow mixture to stand 8 hours, then dissolve by boiling;
    strain through cotton.

    While stirring briskly add:

       Alcohol (95 per cent.),        Oss (250 c.c.);
       Glycerin,                      Oss (250 c.c.);
       Attar of roses,                ʒij (ad lib.).
       Color with chlorophyl if desired.

    5. Glycerin,    }
       Whisky,      } āā
       Peroxid,     }


AN INUNCTION FOR THE HANDS WHEN THE SKIN IS DRY AND HARSH.

    Lanolin,    ℥iij (90 c.c.);
    Olive oil,  ℥j (30 c.c.).

LASSAR’S PASTE FOR ECZEMATOUS SORES AND ULCERS.

    Salicylic acid,       gr. x (0.65 gm.);
    Pulverized starch,    ʒij (8 gm.);
    Zinc oxid,            ʒij (8 gm.);
    Vaselin,              ℥ss (16 gm.).


UNNA’S PASTE.

    Zinc oxid powd.,      ½ pound;
    Sheet gelatin,        ½ pound;
    Glycerin,             ℥xiv;
    Water,                ℥xx;
    Salicylic acid powd., gr. xvj.

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


CARRON OIL FOR BURNS.

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


BORATED VASELIN.

    Boric acid,      gr. xx (1.3 gm.);
    Sterile vaselin, ℥j (30 gm.).

Mix thoroughly; do not heat.


CARBOLATED VASELIN.

    Carbolic acid (95 per cent.), ♏︎v (0.3 c.c.);
    Sterile vaselin,              ℥j (30 gm.).


BORATED GLYCERIN.

    Boric acid,       ʒiss (6 gm.);
    Sterile glycerin, f℥ij (60 c.c.).


FORTIFIED OIL.

    Croton oil, ♍︎j;
    Castor oil, ♍︎j-xiv.


SANITAS JELLY.

    Vaselin, ℥j (30 gm.);
    Sanitas, gtt. iv.


SALOL VASELIN FOR BURNS.

    Salol,                         gr. xx (1.3 gm.);
    Sterile vaselin,               ℥j (30 gm.).


SWEATING OF THE FEET AND AXILLA.

    Solution of formaldehyd,      fʒss (2 c.c.);
    Water,                        f℥vij (210 c.c.).

    One application is usually sufficient. Further applications
    should be made with great caution.


ENEMAS FOR FLATULENCE.

    1. White of 1 egg (beaten),
       Oil of turpentine (add drop by
         drop),                      fʒj (4 c.c.);
       Olive oil,                    f℥j (30 c.c.);
       Warm water,                    Oj  (500 c.c.).

    2. White of 1 egg (beaten),
       Glycerin,                     f℥ij (60 c.c.);
       Oil of turpentine (add drop by
         drop),                      fʒij (8 c.c.);
       Warm water,                    Oj (500 c.c.).

    3. Warm water,                    qt. j;
       Yeast,                         ½ cake.
       Mix thoroughly.

    4. Hot water,                     qt. j;
       Pulv. alum,                    ℥j (by measure).

    5. Molasses,                      ℥viij;
       Milk,                          ℥viij.

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

    6. Milk of asafetida,             ℥j;
       Warm water,                    Oj.


GLYCERIN ENEMA.

    Glycerin,                  ℥j-iv (30-120 c.c.);
    Warm soapy water,          ℥j-iv (30-120 c.c.).


OX-GALL ENEMA.

    Ox-gall,                    ℥ss (15 gm.);
    Warm water,                 Oij (1 L.).


COMPOUND OX-GALL ENEMA.

    Ox-gall,                    ʒj (4 gm.);
    Castor oil,                f℥iv (118 c.c.);
    White of 2 eggs,
    Warm water,                 Oj (500 c.c.).


SALINE ENEMA.

    Magnesium sulphate (Epsom
      salt),                       ℥j (30 gm.);
    Hot water, sufficient to dissolve.


1-2-3 ENEMA.

    Magnesium sulphate,         ℥j (30 gm.);
    Glycerin,                  f℥ij (60 c.c.);
    Hot water,                 f℥iij (90 c.c.).


COMBINATION ENEMA.

    Turpentine,                 ʒj;
    Olive oil,                  ℥j;
    White of one egg;
    Tr. asafetida,              ʒj; or
    Milk of asafetida,          ℥j.

    Beat egg well and with olive oil make an emulsion of the
    turpentine.


STARCH-WATER ENEMA.

         Starch,                ℥j (30 gm.).

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


STIMULATING ENEMAS.

    1. Black coffee,               ℥viij;
       Whisky,                     ℥j.

    2. Hot N. S. S.,               ℥viij;
       Whisky,                     ℥j.

    3. Black coffee,               ℥viij; or
       Hot N. S. S.,               ℥xij;
       Without whisky.


NOURISHING ENEMAS.

    1. Malted milk,                   ℥ss (15 gm.);
       Somatose,                      ʒj (4 gm.);
       Water,                        f℥iv (118 c.c.);
       Sodium chlorid,                gr. xx (1.3 gm.);
       White of 1 egg,
       Add peptonized milk or brandy, p. r. n.

    2. Peptonized milk,               f℥x (300 c.c.);
       White of 2 eggs,
       Alcohol (95 per cent.),        fʒij (8 c.c.);
       Pinch of salt.


THE METHOD OF ADMINISTERING NUTRITIVE OR STIMULATING ENEMAS.

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


AMOUNTS TO BE GIVEN IN CLEANSING ENEMAS.

    Adults,          Oj-iv;
    Children,        ℥viij-xvj;
    Infants,         ℥ij.


TEMPERATURE OF ENEMA FLUIDS.

    Nutritive enema,          100° F.
    Stimulating enema,        116° F.
    Cleansing enema,          100° F.


MUSTARD PLASTER.

    Mustard,                    1 tablespoonful;
    Flour,                      3 tablespoonfuls;
    Glycerin,                   1 tablespoonful;
    Baking soda
      (dissolved in hot water), 1 teaspoonful.

Beat well and spread between two layers of muslin or soft linen. Apply
from 15 to 30 minutes.


MUSTARD POULTICE.

    Mustard,             2 parts;
    Ground flaxseed,     4   “
    Hot water,           a sufficient quantity.


FLAXSEED POULTICE.

    Ground flaxseed,     ½ cupful;
    Olive oil,           2 teaspoonfuls.

Add enough boiling water to make a thick paste. Cook for a few minutes,
and beat thoroughly.


ONION POULTICE.

Slice a large onion and fry in lard or olive oil. Place between layers
of soft cloth. It should not be warmed over.


TURPENTINE STUPES.

    1. Add 3 teaspoonfuls of oil of turpentine to 1 pint of
       boiling water. Immerse the flannel and stir. Remove the
       flannel, wring it out in a twisted towel until it no
       longer drips. Anoint the skin with olive oil, and then
       apply fomentation until it causes some discomfort or
       redness. If allowed to remain too long, it will blister
       the skin.

    2. Oil of turpentine,    1 part;
       Olive oil,            7 parts.

Apply with applicator or soft cloth every 4 or 6 hours, and
fomentations p. r. n.


SPICE POULTICE.

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


CANTHARIDES BLISTER.

Cantharides is used for this purpose, either as a plaster or in liquid
form; that is, in the form of vesicating collodion. Its most frequent
use is as a plaster, rarely over one and a half inches square. Scrub
the parts well with soap and water, and dry and rub with a soft cloth
until the skin is red, then apply the plaster and bandage lightly,
so there may be plenty of room for the formation of the blister.
Vesication is produced generally within four to eight hours; if it
is not, the plaster should be removed and the operation completed by
applying a poultice. Great care should be exercised when blistering
patients suffering from kidney affections. Cantharides is an acute
irritant, and not infrequently causes strangury or acute nephritis.
When the cantharidal collodion is used the space to be covered is
outlined with oil to prevent spreading; the collodion is applied with
a camel’s hair brush or other applicator, and covered with a layer of
soft lint and oil silk.

_Dressing the Blister._—Puncture the lower part of the bleb; absorb the
fluid with a piece of soft cotton; anoint with pure vaselin, and apply
a soft dressing. Bandage lightly.

Sometimes it is desirable to have the fluid reabsorbed into the system,
in which case precautions must be taken to prevent the blister from
rupturing.


APPLICATIONS FOR PEDICULOSIS (LICE).

    1. Pulverized larkspur seed,      ℥j (30 gm.);

    2. Pulverized sabadilla seed,     ℥j (30 gm.);
       Boiling water,                 Oj (500 c.c.).

    One application of these infusions is usually sufficient.

    3. Kerosene oil is a cheap and excellent application; it
       also removes dandruff: Rub lightly upon the scalp for
       one or two nights and follow in the morning by a shampoo
       of soap and water. To destroy the nits apply hot vinegar
       every other day.

    4. Wash hair and scalp thoroughly with a good soap, then
       saturate hair with hot vinegar and tie up securely.
       Repeat for a few days.

HAIR TONICS.

    1. Resorcin,                     gr. xlviij (3 gm.);
       Glycerin,                    fʒij (8 c.c.);
       Alcohol (50 per cent.),      f℥ij (60 c.c.).

       Rub into the scalp each night.

    2. Tincture of cantharides, fʒij (8 c.c.); Tincture of nux
       vomica, f℥ss (15 c.c.); Tincture of capsicum, fʒj (4
       c.c.); Bay rum, f℥ij (60 c.c.). Rub into the scalp at
       night.

    3. Tincture of cantharides, fʒij (8 c.c.); Quinin
       bisulphate, gr. xx (1.3 gm.); Bay rum, f℥iv (120 c.c.);
       Rain-water or distilled water, f℥iv (120 c.c.). Rub into
       the scalp each night.


FOR MATTED HAIR.

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




THERMOMETRY.


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


RULES FOR CONVERTING ONE SCALE INTO THE OTHER.

To convert Fahrenheit degrees into those of Centigrade: Subtract 32,
multiply by 5, and divide by 9. For example:

    104° F. - 32° = 72; 72 × ⁵/₉ = 40° C.

To reduce Centigrade degrees into those of Fahrenheit: Multiply by 9,
divide by 5, and add 32. For instance:

    40° C. × ⁹/₅ = 72 + 32 = 104° F.


TABLE OF THERMOMETRIC EQUIVALENTS.

    36° Centigrade  96.8° Fahrenheit.
    37°      “      98.6°    “
    38°      “     100.2°    “
    39°      “     102.2°    “
    40°      “     104.0°    “
    41°      “     105.8°    “
    42°      “     107.6°    “


TO CONVERT THERMOMETER READINGS.

A correspondent of the “Lancet” (London) offers a new alternative
method of converting degrees Centigrade into degrees Fahrenheit,
which may be found easier to perform mentally than the usual method,
because the factors can be more easily retained in the memory. This
method consists of multiplying the centigrade figures by 2, deducting
one-tenth of the product, and adding 32.

    Example (_a_), 30° C.= 86° F.
    Method: 30 × 2 = 60. 60 - 6 = 54. 54 + 32 = 86.

    Example (_b_), 37° C. = 98.6° F.
    Method: 37 × 2 = 74. 74 - 7.4 = 66.6. 66.6 + 32 = 98.6.

    Example (_c_), 40° C. = 104° F.
    Method: 40 × 2 = 80. 80 - 8 = 72. 72 + 32 = 104.


RULES OF TAKING TEMPERATURE.

    Per mouth.—Retain thermometer from  1  to  3 minutes.
     “  rectum    “         “        “   3  “   5   “
     “  axilla    “         “        “  10  “  15   “
    Temperature per rectum is ½° F. higher than per mouth.
        “        “  axilla is ¹/₁₀° to ³/₁₀° F. lower than per mouth.


TEMPERATURE OF WATER.

    Cold signifies a temperature below 65° F.
    Cool    “            “       between 65° F. and 80° F.
    Tepid   “            “          “    80°    “   90° “
    Warm or neutral      “          “    90°    “  100° “
    Hot                                 100°    “ above.
    Very hot or very cold indicates extremes of temperature.


PULSE RATE.

    Six to twelve months          105-115.
    Two to six years               90-105.
    Seven to ten years             80- 90.
    Eleven to fourteen years       75- 85.
    Adults                         60- 78.


RESPIRATIONS.

    Two months to two years                 35 per minute.
    Two months to six years                 23  “    “
    Six months to twelve years              20  “    “
    Twelve months to fifteen years          18  “    “
    Fifteen months to twenty-one years   16-18  “    “




URINE ANALYSIS.


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

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

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

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


TO TEST REACTION.

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

_Pus in urine_ is turbid or milky in appearance; after standing a while
it settles down.

_Albumin in urine_ is held in solution, and therefore cannot be seen.


A SIMPLE AND RAPID TEST FOR ALBUMIN.

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


TO OBTAIN A 24-HOUR SPECIMEN OF URINE.

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

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




INFANT FEEDING.

    1. If the bowel movements are curdy, we may take it as an
       indication of an excess of proteids.

    2. Sour vomiting often indicates too much fat.

    3. Stools that are very watery but without curds may result
       from too much sugar or too much fat.

    4. Vomiting of hard, curdy masses may indicate too much
       proteids.

    5. Should the child seem to do well on its food in every way
       except that it does not gain in weight, it may be that
       the sugar is too low.

    6. Vomiting may mean that the child has eaten too much.

    7. Breast milk is the best infant food.

    8. No artificial food can or should be trusted which does
       not contain the essentials of breast-milk—viz., fat,
       proteids, and sugar.

    9. The elements named are to be found only in milk, cows’
       milk being the only one available for general use.

    10. Cows’ milk must be modified, because it does not contain
       the same proportions of the elements named.

CONSTITUENTS OF GOOD MOTHER’S MILK.

Reaction Alkaline.

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

Inorganic materials ¹/₁₀ to ²/₁₀ of 1 per cent.

Average percentage, 12 per cent. of solids to 88 per cent. of water.


REGULATING THE COMPOSITION OF MOTHER’S MILK.

    The percentage of proteids { Increased frequency of nursing;
      is increased by          { Increased liberality of nursing
                               {   and insufficient exercise.

    The percentage of fat is   { Deficiency of proteid food;
      increased by             { Excess of fatty foods and fasting.

    The percentage of water }    Increased fluid diets.
      is increased by       }

    The percentage of water }    Saline cathartics and diminished
      is diminished by      }      fluid diets.

        Percentage of sugar and ash vary little.—DR. COTTON.


FORMULÆ FOR ARTIFICIAL FEEDING FOR BABIES.

                                          Age.

    1. Sugar of milk    ℥j    }
       Sterile water    ℥xij  }
       Lime-water       ℥ss   } From 3d to 14th day.
       Cream            ℥ss   }
       Milk             ℥ss   }

    2. Sugar of milk    ℥j    }
       Sterile water    ℥xij  }
       Lime-water       ℥j    } From 2d week to 6th week.
       Cream            ℥j    }
       Milk             ℥j    }

    3. Sugar of milk    ℥j    }
       Sterile water    ℥x    }
       Lime-water       ℥j    } From 6th week to 11th week.
       Cream            ℥j    }
       Milk             ℥j    }

    4. Sugar of milk    ℥j    }
       Sterile water    ℥viij }
       Lime-water       ℥ss   } From 11th week to 5 months.
       Cream            ℥j    }
       Milk             ℥j    }

    5. Sugar of milk    ℥j    }
       Sterile water    ℥vij  }
       Lime-water       ℥ss   }  From 5 months to 9 months.
       Cream            ℥j    }
       Milk             ℥ijss }

    6. Granulated sugar ℥ss   }
       Sterile water    ℥v    } From 9 months to 12 months.
       Cream            ℥j    }
       Milk[A]          ℥jv   }

[A] It is sometimes desirable to substitute whey for milk and water.


AMOUNT OF FEEDINGS FOR INFANTS.

              Twenty-four-hour      Number of feedings,
      Age.        amount.          amount and intervals.

                                 { 10 feedings of 1 ounce at 2
                                 {   hour intervals.
    1 week     10 to 12 ounces   { 8 feedings of 1½ ounces at
                                 {   2½ hour intervals.

                                 { 8 feedings of 2½ ounces at
                                 {   2½ hour intervals.
    4 weeks    20 ounces         { 7 feedings of 3 ounces at
                                 {   3 hour intervals.

                                 { 7 feedings of 4½ ounces at
    4 months   32 ounces         {   3 hour intervals.

                                 { 6 feedings of 6 to 6½ ounces
    6 months   36 to 40 ounces   {   at 3 hour intervals.

                                 { 6 feedings of 8 ounces at
                                 {   3 hour intervals.
    9 months   48 ounces         { 5 feedings of 9½ ounces at
                                 {   3 to 4 hour intervals.


First twenty-four hours—Infant should receive only water, and after
that water to be given only between feedings, 1 to 2 ounces every four
hours.

Water may be sweetened with saccharin.

Normal infant may feed every three or four hours and only one feeding
during night.

After eight months old, no feeding after 10 P. M.

Three months’ child may take 5 ounces at one feeding.

Six months’ child may take 7 ounces at one feeding.

Nine months’ child may take 9 ounces at one feeding.

The child should consume the contents of a bottle in twenty minutes.

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


RULES FOR STERILIZING BOTTLES.

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


TO PASTEURIZE MILK.

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

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

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


TO STERILIZE MILK.

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

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

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


MODIFIED MILK.

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

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

_Note._—The natural food for the infant is human milk. The breast-fed
babies are healthier, more vigorous, and more resistant to disease.
(See _Rickets and Scurvy_.)


SUGARS.

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

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

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


PROPRIETARY FOODS.

Condensed and evaporated milks.

Malted foods, containing starch.

Starchy foods and various dry powders.

Kindolac, a dried milk.

Imperial Granum. Used in the same way as barley flour is prepared.

Eskay’s Food, which is valueless unless mixed with cows’ milk.

Mellin’s Food and Horlick’s Malted Milk.

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

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


CARBOHYDRATE FORMULÆ.

    Horlick’s food,    11 teaspoonfuls
    Dextrimaltose,     10      “
    Mellin’s Food,     11      “
    Milk-sugar,         9      “
    Barley flour,      15      “
    Flour ball,        12      “

Dissolve carbohydrates in sterilized water before adding milk. All
mixtures should be cold when adding milk.


FLOUR BALL.

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


BARLEY GRUEL.

One tablespoonful barley flour; 1 quart of water. Boil twenty to thirty
minutes, then strain.


RICE GRUEL AND OATMEAL GRUEL.

Prepare the same as barley gruel.

_Note._—The flours thus made are very good carbohydrate foods. Gruels
from this kind of flour settle on standing. To prevent this, add
barley, oat, or wheat gruel flour before cooking. In using starch, boil
solution one hour.


SKIMMED MILK

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


HOMOGENIZED MILK

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


WHEY.

    1.—Boil 1 quart of milk; add 2 teaspoonfuls of rennet. Keep
        at temperature of 103° F. for thirty minutes. Strain
        through sterile cloth. To secure a fine soft curd add ½
        teaspoonful of chymogen; allow to drain one hour. Sodium
        citrate softens casein curd.

WHEY FOR SPECIAL INFANT FEEDING.

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

WHEY: ESSENCE OF PEPSIN FORMULÆ.

    2.—1 pint skimmed milk;
        2 teaspoonfuls essence of pepsin or rennet.

Let milk in double boiler heat to a temperature of 105° F.; add
pepsin; stir for a moment and let stand at same temperature for
thirty-five minutes. Cut into cubes and raise temperature to 155° or
160° F. to stop action of the rennet or pepsin. Then strain through
several thicknesses of gauze and put on ice. Do not use pressure while
straining.


RENNET TABLET FORMULA.

    Milk,                               1 pint;
    Rennet or junket tablet No. 1,      gr. j.

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


MILK ALBUMEN.

         Milk,                          1 quart;
         Chymogen,                      1 dram;
         Buttermilk,                    1 pint.

      I. Boil milk for five minutes.
     II. Cool to temperature of 100° to 105° F.
    III. Add chymogen (dissolved in ℥j of cold water) and let
         stand for one hour at temperature of 100° to 105° F.
     IV. Let drain through cheese-cloth for one and a half hours,
         and then throw out the whey.
      V. Press the curd through the colander twice, adding the
         buttermilk as the curd is pressed through.
     VI. Make up the quart by adding sterile water.

When the food is to be given to the baby, heat only enough to take off
the chill, as more vigorous heating will cause the curd to clump at the
bottom of the bottle in large curds.

If there is any clumping, shake the bottle well before giving to the
baby.

Never put the baby directly from a milk diet to a milk-albumen diet,
but give one intervening feeding of barley water before giving
milk-albumen diet.


CHYMOGEN USED INSTEAD OF RENNET.

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


ALBUMEN-WATER.

    White of one egg;
    Water,                  ℥viij;
    Pinch of salt.

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


LACTOSE SOLUTION.

To each ounce of milk-sugar add 1½ ounces of water (boiled). Heat until
all the sugar is dissolved. Filter, put in a sterile bottle, plug with
sterile absorbent cotton, and put on ice.

Use ℥iss for every ounce of sugar ordered. Subtract this amount from
the total amount of water ordered.


PARTIALLY PEPTONIZED MILK.

    Milk,                   Oj;
    Water,                  ℥ij;
    Peptonizing powder,     1 tube.

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


COMPLETELY PEPTONIZED MILK.

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


BUTTERMILK.

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


DIRECTIONS FOR MAKING BUTTERMILK FROM LACTONE TABLETS.

    Fresh skimmed milk,           1  quart;
    Hot water,                    1½ to 2 cupsful;
    Salt,                          ½ teaspoonful;
    Lactone tablet,               1.

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


BARLEY JELLY.

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


OAT-JELLY.

Oat flour, 2½ tablespoonfuls to 1 pint of water. Cook four hours and
strain.

Oatmeal, prepare same as oat flour.

For a feeding, dilute with baby’s milk; season with a little salt. Do
not use sugar, then the child will not acquire the taste for sweetened
cereals.

_Note._—To cook cereals use a fireless cooker.


BEEF JUICE.

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

Serve warm or cold with a little salt.

Do not heat enough to coagulate albumen in juice.

II. Cold method:

    Finely chopped beef,          1 lb.;
    Water,                        ℥viij.

Put in covered jar; allow to stand on ice from six to twelve hours;
then squeeze out by twisting in coarse muslin.

Season with salt and serve as above.

This contains a smaller amount of extractives.

It may be served with sherry wine or celery salt.

If added to milk in the proportion of 2 or 3 tablespoonfuls to the
feeding, the taste will not be noticed. The milk should not be heated
over 100° F., as the albumen will coagulate.

No. I. contains twice the amount of extractives as No. II. If the
stronger juice is desired, No. II. may be made by adding only ℥iv of
water instead of ℥viij.


VEGETABLE SOUP FOR BABIES.

    1 handful of spinach;
    1 beet;
    2 carrots.

Chop fine and boil two hours in 1 quart of water. Strain through gauze
and add sterile water to make up deficiency to 1 quart.




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


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

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

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

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

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

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

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




ERUPTION OF THE DECIDUOUS OR MILK-TEETH.


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

[Illustration: Eruption of the deciduous teeth (Frühwald and Westcott).]

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

Permanent teeth:

    First molars coming back of baby molars, 6    years.
    Centrals,                                7      “
    Laterals,                                8      “
    First bicuspid,                          9      “
    Second    “                             10      “
    Canines,                                11-12   “
    Second molars,                          12-13   “
    Third    “     or wisdom teeth,         17-21   “




NURSING IN ACUTE FEVERS.


TYPHOID OR ENTERIC FEVER.

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

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

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

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

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

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

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

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

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

The _respiratory symptoms_ include cough, hurried breathing, and slight
expectoration.

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

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

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

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

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

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

Note carefully any _abdominal pain_, any _increase in the distention_,
as these symptoms, with or without a rather abrupt _fall in
temperature_, _chills_, and _pinched features_, are suggestive of
perforation.

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

Note the occurrence of _vomiting_ and the character of vomit.

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

Note the condition of the _skin_ and _tongue_.

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

Note the exact amount and character of _nourishment_ taken, and the
time it was given; also the amount, time of administration, and effect
of _medicines_ and _stimulants_.

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

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

    Boric acid,   1 part;
    Starch,       1  “
    Zinc oxid,    1  “

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

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


PNEUMONIA.

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

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

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

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

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


SCARLET FEVER.

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

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

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

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

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

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

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

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


MEASLES.

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

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


DIPHTHERIA.

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

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

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

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

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

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


POLIOMYELITIS.

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

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

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

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

Poliomyelitis defined: _Polio_ (gray), _myel_ (marrow), _itis_
(inflammation), meaning inflammation of the gray matter of the spinal
cord.

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

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

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

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

4. _Ordinary Spinal or Subcortical Type._—Here the lower motor neuron
is affected, with resulting flaccid paralysis; a manifestation of
poliomyelitis difficult to classify is blindness. The most important
symptoms of the disease may be described under the _non-paralytic_ or
_abortive_ cases and those of _ordinary spinal form_.

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

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

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

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

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

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

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

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

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


DISINFECTION OF FECES AND URINE.

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

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

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


A WASHING FLUID FOR SOILED CLOTHES.

    One can of lye,           10 cents;
    Lump of ammonia,           5   “
    Salts of tartar,           5   “

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


INCUBATION PERIOD AND QUARANTINE.

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

                          Normal.   Maximum.   Minimum.
    Variola               12 days.   14 days.   9 days.
    Varicella             14  “      19  “     13  “
    Measles               10  “      14  “      4  “
    Rubella               18  “      21  “      8  “
    Scarlatina             2  “       7  “      1 day.
    Influenza              3  “       5  “      1  “
    Diphtheria             2  “       7  “      2 days.
    Typhoid fever         12  “      23  “      5  “
    Mumps                 19  “      25  “     12  “

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

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




THE CARE OF THE SKIN AND MOUTH IN FEVERS.

BY HARRIET HIGBEE, Graduate Illinois Training School for Nurses.

_From the American Journal of Nursing._


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

    Mutton tallow,                      ℥j;
    Olive oil,                         f℥j;
    Carbolic acid, 95 per cent.,        ♏︎j.

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

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

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


THE MOUTH.

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

    1. Listerin,                     f℥j;
       Water,                        f℥ij.

           _Dobell’s Solution._
    2. Borax,                         ʒss;
       Sodium bicarbonate,            ʒiv;
       Listerin,                     fʒj;
       Carbolic acid, 95 per cent.,   ♏︎viij;
       Warm water,                   f℥x.

    3. Boric-acid solution,          f℥j;
       Alcohol,                      fʒss;
       Glycerin,                     fʒj;
       Tincture of myrrh,            f♏︎j.

    4. Glycerin,
       Water, of each,               f℥ss.

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

_For Mucus-coated Mouth._

    1. Sodium bicarbonate,         gr. x;
       Glycerin,                   fʒij;
       Water, enough to make,      f℥ij.

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

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

    2. Lanolin,
       Vaselin, of each,              ℥j;
       Oil of gaultheria,             ♏︎xxx.
         Apply small quantity several times daily.

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

    3. Tincture of myrrh,             ♏︎xxx;
       Water,                        f℥j.

_Mouth-Wash._

A solution of potassium chlorate and cinnamon water.




DISINFECTION OF ROOMS.


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

    Formaldehyd sol.,        4 parts;
    Glycerin,                1 part;
    Water,                   2 parts.

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

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

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

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


DISINFECTION IN PRIVATE NURSING.

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

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

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

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

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

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




SURGICAL SUPPLIES.


TO STERILIZE INSTRUMENTS.

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

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

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


TO CLEAN INSTRUMENTS.

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


TO STERILIZE GLOVES.

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


TO DRY STERILE GLOVES.

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


TO CLEAN GLOVES.

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


TO STERILIZE SILK-WORM GUT OR SILK THREAD.

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


TO STERILIZE HORSE-HAIR.

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

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


TO STERILIZE CATGUT (FORMALDEHYD METHOD).

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

    Corrosive sublimate,          1 part;
    Boiled glycerin,            200 parts;
    Alcohol, 95 per cent.,     1000   “  .


CHROMIC CATGUT.

    1. Soak in ether 1 to 2 weeks, according to size.

    2. Wind on glass spools.

    3. Soak in chromic acid solution, 5 gr. to 1 pint water, 3 to 6
       hours, according to size.

    4. Dry in sun 3 days.

    5. Boil in 95 per cent. alcohol 1 hour, under 15 pounds pressure,
       in autoclave.

    Use Mason fruit jars.
    Do not screw the top down when in sterilizer.

TO STERILIZE LINEN THREAD.

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

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


TO PREPARE RUBBER TUBING.

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


TO PREPARE SIX YARDS OF IODOFORM GAUZE.

Prepare the following solution:

    Sterile iodoform,        ℥iij;
    Sterile glycerin,        ℥iij.

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


TO PREPARE IODOFORM GAUZE (GREEN-SOAP METHOD).

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

Castile soap is a good substitute for green soap.


IODOFORM EMULSION.

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

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


TO PREPARE PROTECTIVE STRIPS.

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


TO PREPARE TINCTURE OF GREEN SOAP.

    Green soap,                3 parts;
    Alcohol, 95 per cent.,     2   “  ;
    Ether,                     1 part.

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

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

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


STERILIZING HAND-BRUSHES.

1. Clean with green soap and water; rinse thoroughly.

2. Place in saturated oxalic solution for 30 minutes.

3. Place in sterile water 30 minutes.

4. Change water twice.

5. Keep dry.




TO PREPARE A PATIENT FOR A SURGICAL OPERATION.


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

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

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

Shave field of operation.

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

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

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

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

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




TO PREPARE A ROOM FOR A MAJOR OPERATION.

BY EVELEEN HARRISON, Graduate of the Post-Graduate Hospital, New York.

_From the American Journal of Nursing._


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




TO PREPARE A ROOM FOR AN OPERATION.


BY JESSIE MCCALLUM,

Graduate Johns Hopkins School for Nurses.

_From the American Journal of Nursing._

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

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

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

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

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

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

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

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

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

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

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

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

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

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


AN EMERGENCY STEAM STERILIZER.

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


TO STERILIZE AN OBSTETRIC SET OR SMALL PACKAGES.

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




INSTRUMENTS TO USE FOR OPERATIVE CASES.


CURETMENT SET.

    1 pair scissors.                  1 uterine probe, long.
    2 forceps, 8-inch.                4    “    curets, sharp and dull.
    2 tissue forceps, long.           6 hemostats, 6-inch.
    1 placenta forceps, Barrett’s.    2 tenacula.
    1 uterine dressing forceps.       2 volsella.
    3    “    sounds.                 1 Sims’ speculum.
    1    “    dilator.                1 retractor, deep and broad.
    1    “    douche point.


HERNIA SET.

    2 pairs scissors.         6 hemostats, 4-inch.
    2 scalpels.              18     “      6- “
    2 pairs tissue forceps.   3     “      8- “
    1 grooved director.       1 needle-holder.
    1 Kocher     “            2 perineum needles.
    1 Fenger     “            Suturing material and needles.
    1 probe.
    2 pairs retractors, sharp and dull.


AMPUTATION SET.

    2 pairs scissors.          6 hemostats, 4-inch.
    1 scalpel.                18    “       6- “
    2 pairs tissue forceps.    2    “       8- “
    1 bone saw.                2 curets.
    1 cutting forceps.         2 periosteotomes, long and short.
    1 holding    “             1 bone elevator.
    2 bone-holding forceps.    2 probes.
    1 lion jaw.                1 hammer.
    1 rongeur.                 2 chisels.
    1 grooved director.        1 needle-holder.
    1 Kocher     “             Needles and suturing material.
    2 pairs retractors,
         sharp and dull.


LAPAROTOMY SET.

    1 pair scissors, curved.            2 pairs retractors, broad.
    1  “     “       straight.          2   “       “       narrow.
    2 scalpels.                         6 hemostats, 4-inch.
    2 pairs tissue forceps.            18  “         6- “
    1 grooved director.                 3   “        8- “
    1 Kocher     “                      2   “      curved, 8-in.
    1 Fenger     “                      2 tenacula.
    1 probe.                            2 volsella.
    2 pairs retractors, superficial.    2 perineum needles.
    2   “       “       sharp.          1 needle-holder.
    2   “       “       dull.           Needles and suturing material.
    2   “       “       deep.


GALL-STONE SET.

    1 laparotomy set.       2 gall-stone scoops.
    1 lithotomy forceps.    Aspirating syringe and needle.
    1 long probe.           2 bone curets.


SKIN-GRAFT SET.

    1 scalpel.                      2 curets.
    1 pair scissors.                3 hemostats, 8-inch.
    1 tissue forceps, plain.        6    “       6-  “
    1    “      “     rat-tooth.    2 razors.
    1 Fenger director.


SKULL FRACTURE SET.

    1 pair scissors, straight.         18 hemostats, 6-inch.
    1  “      “      curved.            6    “       4- “
    2 scalpels.                         4    “       8- “
    1 bone-holding forceps.             3 bone curets.
    1 bone-cutting    “                 2 gouges.
    1 probe, long.                      2 periosteotomes.
    1   “    short.                     1 rongeur.
    1 Fenger grooved director.          1 lion jaw.
    1 Kocher grooved director.          2 trephines.
    2 retractors, superficial, sharp.   1 deVilbiss.
    2 retractors, superficial, dull.    1 hammer.
    2 chisels.                          2 aneurism needles.
    1 aspirating syringe.               1 bone elevator.
    1      “     needle.                2 pair tissue forceps.
    Needle-holder and needles.          1 ether mask.


HEMORRHOID SET.

    2 pair scissors.           1 grooved director.
    2 knives.                  6 hemostats, 6-inch.
    1 clamp.                   2   “        8- “
    2 retractors.              2   “        “T.“
    2 tooth tissue forceps.    1 bone curet.
    1 plain   “      “         1 rectal dilator.
    1 probe.                   Cautery.


PROSTATECTOMY SET.

                1 laparotomy set, suprapubic.
                1 hernia set, perineal.

                    Add to either set:

    6 sounds, graduated sizes.    6 filiform bougies.
    2 metal catheters.            1 rubber catheter, size 16.
    2 grooved staves.             1   “       “       “   18.


SURGICAL SETS FOR STRANGULATED HERNIA, GASTRO-ENTEROSTOMY, GUNSHOTS,
ETC.

    1 laparotomy set.             4 intestinal clamps.
                    2 Murphy buttons.


TUBERCULOUS GLAND AND GOITER SETS.

    1 hernia set                  2 aneurism needles..
    6 hemostats, 6-inch.          1 ether mask.


WIRING OF BONE.

    1 amputation set.    4 drills.
    2 drill-holders.     Wire or plates and screws.


SURGICAL SETS FOR VARICOSE VEINS, VARICOCELE, HYDROCELE.

    1 hernia set.




SURGICAL POSTURES.


[Illustration: Sims’s posture, anterior view.]

[Illustration: Sims’s posture, posterior view.]

[Illustration: Dorsal recumbent posture.]

[Illustration: Dorsosacral posture, with leg-holder applied.]

[Illustration: Knee-chest, or genupectoral, posture.]

[Illustration: Walcher posture.]

[Illustration: Trendelenburg posture.]

[Illustration: Edebohls’s dorsal posture.]




OPHTHALMIA.

PURULENT OPHTHALMIA (SUPPURATIVE INFLAMMATION OF THE CONJUNCTIVA).


BY CASSIUS D. WESCOTT, M. D.,

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

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

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

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

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

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

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

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

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

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

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


OPHTHALMIA NEONATORUM.

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

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

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

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

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

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




EMERGENCIES.


HEMORRHAGES.

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

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

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

Hemorrhage from the _upper arm_ by compression of the axillary artery
against the humerus in the axilla.

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

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

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

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

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


FRACTURES.

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

_A comminuted fracture_ is one in which the bone is broken into a
number of fragments.

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

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

_A complicated fracture_ is one associated with a serious injury to
some important adjacent part—_e.g._, a large vessel.

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

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

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

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

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

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

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


DISLOCATIONS.

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

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


SPRAINS.

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

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


BURNS AND SCALDS.

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


BURNS OF THE EYE.

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


INJURIES TO THE EYE.

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


SYNCOPE (FAINTING OR SWOONING).

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


HYSTERIA.

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


EPILEPSY.

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


DROWNING.

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


SUSPENDED ANIMATION FROM NOXIOUS GASES.

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


METHODS OF ARTIFICIAL RESPIRATION.

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

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

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


SUNSTROKE.

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

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

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

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

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




BATHS AND PACKS.


WARM PACK FOR PNEUMONIA PATIENTS.

        Articles needed:
    4 blankets.                     Foot-tub for hot water.
    1 rubber and towel for head.    Basin and ice.
    1 long rubber sheet.            2 compresses for head.

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


COLD PACK TO REDUCE TEMPERATURE.

       Articles needed:
    1 long rubber sheet.    Foot-tub.
    3 blankets.             Pitcher or sprinkler.
    Basin of ice.           Rubber and towel for head.
    2 compresses for head.

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


SPONGING TO REDUCE TEMPERATURE.

       Articles needed:
    2 blankets.                   Basin of ice.
    3 towels.                     Basin of warm water.
    Rubber and towel for head.    Compresses or ice-cap for head.

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


HOT PACKS TO INDUCE PERSPIRATION.

    Articles needed:
    4 blankets.               1 sheet.
    2 long rubber sheets.     Basin of ice.
    1 short  “    sheet.      Foot-tub of hot water.
    Rubber piece for head.    Old woolen blanket.
    2 towels.                 2 compresses.

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


TUBBING.

Articles needed:

    1 long rubber sheet.        1 sea sponge.
    2 blankets.                 2 pails.
    1 tubbing sheet.            Basin of ice.
    1 towel.                    Siphon.
    2 compresses or ice-cap.    Piece of rubber tubing.
    1 bath towel.

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


ALCOHOL SWEAT.

    Articles needed:
    6 old blankets.           8 hot bricks in bags
    1 piece of old blanket.       (woolen preferred),
    2 long rubber sheets.          12 × 12 inches.
    1 short   “   sheet.      Basin of ice.
    1 piece   “   for head.   2 compresses.
    1 towel.                  Alcohol.
    1 sheet.                  Hot drink.

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




MASSAGE—MECHANO-THERAPY.


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

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

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

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

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

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

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

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

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

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

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




ELECTRICITY.


BY DR. JAMES C. GILL,

Rush Medical College, Chicago, Ill.

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

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

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

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

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

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

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

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

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

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

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

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




FOOD CONSTITUENTS.


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

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


SOURCE AND USE OF CHIEF FOOD CONSTITUENTS.

                                          Chief functions in the body.

                  { Meats                       {
                  { Fish                        { Build tissues.
                  { Eggs                        {
      I.          { Milk                        {
    Protein       { Cheese                      { Repair daily waste
                  { Peas                        {   of tissue.
                  { Beans                       { Give heat energy.
                  { Gluten in flour             {

                  { Butter                      {
                  { Cream                       { Give heat energy.
                  { Fat of meats                {
      II.         { Cheese                      {
     Fats         { Oil in nuts                 {
                  { Olive oil                   {
                  { Egg yolk                    {
                  { Corn oil                    { Produce fat.
                  { Seed oils                   {

                  {            { Cane           {
                  {            { Beet           { Give heat energy.
                  {            { Maple          {
                  { Sugars     { Malt           {
                  {            { Sugar of milk  {
                  {            { Sugar of fruit {
                  {                             {
      III.        {            { Cereals        {
    Carbohydrates {            { Flours         {
                  {            { Peas, Beans    {
                  { Starches   { Corn           {
                  {            { Potatoes       {
                  {            { Some other     { Produce fat.
                  {            {   vegetables   {
                  {
                  { Celluloses { Vegetables     } Give bulk.
                  {            { Fruits         }
                  {                             { Aid in formation of
                  { Fruit acids                 {   bone.
                  {                             { Enter into composition
                  {                             {   of every living
                  {                             {   cell and body
                  {                             {   liquids.
                  {                             { Useful in the blood
                  {                             {   (carrier of body’s
                  {                             {   oxygen).
                  {                             { Necessary to maintain
                  {                             {   osmotic pressure.
      IV.         {                             { Govern contraction
    Mineral       {                             {   of muscles,
    salts         {                             {   including those
                  {                             {   of the heart.
                  {                             { Help to maintain
                  {                             {   neutrality of the
                  {                             {   blood (increase
                  {                             {          alkalinity).
                  {                             { Assist in digestion.
                  {                             { Assist in the removal
                  {                             {  of waste.
                  {                             { Unite with harmful
                  {                             {   products found in
                  { Vegetables                  {   body and render
                  {                             {   them harmless.

                  {                             { Solvent for food.
                  { In all vegetables           { Carries food to
                  {                             {   blood.
      V.          {                             { Carries off waste.
    Water         {                             { Helps to regulate
                  {                             {   temperature.
                  { In all animal foods         { Aids digestion.
                  {                             { Aids tissue building.

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

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

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

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

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

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

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


A SHORT STUDY OF PROTEIN FOODS

    Some common forms.                Some sources.

      Albumen                           Eggs
      Casein                            Milk
      Myosin, fibrin, and elastin       Meat
      Gluten                            Wheat
      Tuberin                           Potato
      Legumin                           Peas and beans
      Excelsin                          Brazil nuts
      Zein                              Corn

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

_Egg_ contains nearly as much protein as lean meat.

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

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

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

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

_Mineral salts_—

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

_Cellulose_ exercises muscular lining of digestive tract.

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

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

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

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

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

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

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

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

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

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




THE PREPARATION OF FOODS FOR THE SICK.


TO PEPTONIZE MILK.

    1. Pepsin,                grs. xx;
       Cold water,            ℥iv;
       Milk,                  Oj.

    2. Pancreatin,            grs. v;
       Soda bicarbonate,      grs. xv.

    3. Peptonizing powder,    grs. xx;
       Warm water,            ℥j;
       Milk,                  Oj.

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

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

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

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


PEPTONIZED BEEF.

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

    Extractum pancreatis,        20 grs.;
    Soda bicarbonate,            15 grs.
        Mixed thoroughly into one powder.

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

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

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

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

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

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

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

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


PEPTONIZED OYSTERS.

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

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

    Extractum pancreatis,          15 grs.;
    Soda bicarbonate,              15 grs.
        Mixed thoroughly into one powder.

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

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

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

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


GUM ARABIC WATER (ACACIA).

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


LIME WATER.

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


ARROWROOT WATER.

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


ALBUMIN WATER.

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


OATMEAL WATER.

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


BARLEY WATER.

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


RICE WATER.

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


TOAST WATER.

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


COFFEE.

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

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


WHITE-OF-EGG LEMONADE.

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


CREAM LEMONADE.

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


FLAXSEED LEMONADE.

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


MILK LEMONADE.

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


MILK PUNCH.

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


KUMISS.

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

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


BONNYCLABBER.

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


WINE WHEY.

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


JUNKET.

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


BEEF TEA.

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


BEEF JUICE.

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


BEEF EXTRACT.

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


CHICKEN AND VEAL EXTRACT.

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

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

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


SCRAPED BEEF SANDWICH.

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


CORNMEAL GRUEL.

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


CRACKER GRUEL.

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


OATMEAL GRUEL.

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


OYSTER BROTH.

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


SCALLOPED OYSTERS.

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


OYSTERS ON THE HALFSHELL.

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


TO BOIL CLAMS.

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


CLAM BROTH.

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


MAYONNAISE DRESSING.

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


COCOA.

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


CHOCOLATE.

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


CHOCOLATE SOUFFLE.

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


VANILLA CREAM SAUCE.

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


BAKED CUSTARD.

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

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


WINE JELLY.

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


LEMON JELLY.

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


PLAIN MILK SOUPS WITH VEGETABLES.

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

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

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

Shredded fish or clams may be substituted for the vegetables.


TO BONE A BIRD.

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


STUFFED BAKED POTATO.

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


FRIED CALF’S BRAINS.

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


BOILED MUTTON.

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


SOFT-BOILED EGG.

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


HARD-BOILED EGG.

Boil slowly for one half-hour.


POACHED EGG.

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


OMELET.

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


BAKED-FLOUR PORRIDGE.

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


WATER WAFERS.

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


RICE.

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


RICE CREAM.

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


CREAM TOAST.

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


FRENCH OR EGG TOAST.

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


STEWED PRUNES.

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


EGG CREAM.

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


SPONGE PUDDING.

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


SAUCE FOR THE PUDDING.

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


ICE CREAM ROYAL.

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


ICE CREAM.

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


FROZEN CUSTARD.

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


SHERBET.

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


MILK SHERBET.

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

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


LEMON SHERBET.

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


ORANGE SHERBET.

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


STRAWBERRY SHERBET.

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


TAFFY.

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


BRAN BREAD FOR CONSTIPATION.

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


BRAN BISCUITS FOR CONSTIPATION.

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


VEGETABLE SOUP FOR BABIES.

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


BARLEY SOUP FOR BABIES.

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


FROZEN COCOA CREAM.

(A hospital recipe).

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

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

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

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


GINGER SNAPS.

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


CORN GRIDDLE CAKES.

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

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


BARLEY AND CORN MUFFINS.

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

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


JOHNNY CAKE.

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

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


BUCKWHEAT GEMS.

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

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


POTATO BISCUITS.

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


NUT BREAD.

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

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


CORN MEAL GINGERBREAD.

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

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


RICE AND OAT MUFFINS.

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

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


PAPER INDICATES OVEN’S HEAT.

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


VINEGAR PREVENTS COOKING SMELL.

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


SAUCES FOR MEAT.

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




FOOD AND NUTRITION IN DISEASE.


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

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

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


DIET-LIST.

      =Liquid diet= consists of:
    Water of all kinds.    Cocoa.
    Ginger ale.            Kumiss.
    Lemonade.              Buttermilk.
    Orangeade.             Milk punch.
    Albumin water.         Malted milk.
    Broths.                Milk.
    Tea.                   Cream.
    Coffee.                Egg-nog.

       =Soft diet= consists of:
               Liquids of all kinds.
               Soups (vegetable and strained).
    Milk toast.              Soft-boiled eggs.
    Gravy  “                 Oysters.
    Bread without crusts.    Baked apple.
    Cereals.                 Apple sauce.
    Custard.                 Stewed fruits (no seeds).
    Rice.                    Mashed potato.
    Ice cream.               Baked     “
    Milk puddings.           Purées and milk.
    Plain   “                Toast.
               Soft-poached eggs.

       =Light diet= consists of soft diet, including:
    Whitefish.         Quail.
    Codfish.           Sweetbreads.
    Finnan haddock.    Chicken.
    Bacon.             Chops.
    Scraped-beef.      Steak.
    Squab.             Vegetables only when ordered.

    =Typhoid diet=, as soon as food is ordered, is as follows:
    _First week_—
        Coffee for breakfast.
        Tea for dinner.
        Cereals (well cooked and strained).
        Eggs lightly boiled.
        Poached eggs and soft toast.
        Broths (chicken, oyster, and meat).
    Scraped-beef.           Custards.
    Bread without crust.    Ice cream.
    Milk toast.             Orange-juice.
          A glass of milk, t. i. d.
    To the foregoing may be added for
    _Second week_—
        Dry toast.       Chicken.
        Baked potato.    Whitefish.
        Baked apples.    Rice.
        Asparagus.       Farinaceous puddings.
        Chops.           Milk soup.
        Steak.           Purées.
    No vegetables, pastry, or raw fruits are allowed.
    _Liquid_—
         1. Milk,                  3 parts;
            Lime-water,            1 part.
         2. Albumen-water.
         3. Clear chicken or beef broth may be given
             three times in 24 hours.


DIABETIC DIET.

    White of eight eggs;
    Dry oatmeal,                 ℥xij (by weight);
    Butter,                      ℥viij-x.

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


MOTOR TEST-MEAL.

    A. White meat of chicken or fish.
    B. Coarse vegetables.
    C. Jam seeds (raisins or currants).
    D. Potatoes.
    E. Tea.
    F. Two slices of bread.


EWALD’S TEST-BREAKFAST.

    A. 2 shredded wheat biscuits, or 2 slices of bread.
    B. 1½ glasses of water.




OBSTETRICS.


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

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

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

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

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

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

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

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

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

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

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


SYMPTOMS OF PREGNANCY.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TABLE FOR CALCULATING THE PERIOD OF UTERO-GESTATION.

    ----------+--------------------------------------------------------------------------------------------+-------
    January   | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31|
    OCTOBER   | 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7|NOV.
    ----------+--------------------------------------------------------------------------------------------+-------
    February  | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28         |
    NOVEMBER  | 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5         |DEC.
    ----------+--------------------------------------------------------------------------------------------+-------
    March     | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31|
    DECEMBER  | 6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5|JAN.
    ----------+--------------------------------------------------------------------------------------------+-------
    April     | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30   |
    JANUARY   | 6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4   |FEB.
    ----------+--------------------------------------------------------------------------------------------+-------
    May       | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31|
    FEBRUARY  | 5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28  1  2  3  4  5  6  7|MAR.
    ----------+--------------------------------------------------------------------------------------------+-------
    June      | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30   |
    MARCH     | 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6   |APRIL.
    ----------+--------------------------------------------------------------------------------------------+-------
    July      | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31|
    APRIL     | 7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7|MAY.
    ----------+--------------------------------------------------------------------------------------------+-------
    August    | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31|
    MAY       | 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7|JUNE.
    ----------+--------------------------------------------------------------------------------------------+-------
    September | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30   |
    JUNE      | 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7   |JULY.
    ----------+--------------------------------------------------------------------------------------------+-------
    October   | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31|
    JULY      | 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7|AUG.
    ----------+--------------------------------------------------------------------------------------------+-------
    November  | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30   |
    AUGUST    | 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6   |SEPT.
    ----------+--------------------------------------------------------------------------------------------+-------
    December  | 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31|
    SEPTEMBER | 7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7|OCT.
    ----------+--------------------------------------------------------------------------------------------+-------

EXPLANATION.—Find in top line the date of menstruation, the figure
below will indicate the date when confinement may be expected, _i.e._,
if date of menstruation is June 1st, confinement may be expected on
March 8th, or one day earlier if leap year. (Dr. ELY.)

(3) _True Pains._—The contractions of the uterus as they become
stronger, in the great majority of cases, cause the woman pain.
For this reason “true pains” is used synonymously with “uterine
contractions.” With their appearance the woman becomes restless, likes
to sit down, to bend forward and to press on the sacrum. “True pains”
are felt in the sacral region, gradually moving around toward the
pubes. They begin slowly, increase in intensity, and slowly pass away.
The pains are involuntary, and the woman tries to complain or cry out.
Differences in this largely depend upon the nervous temperament of the
patient, though they are also related to variations in the physical
factors. “True pains” must be distinguished from “false pains.”

(4) _The Show._—Within twenty-four hours before labor really begins
there is a discharge from the vagina of thick mucus, more or less
stained with blood. This is called the “show,” and is the plug of mucus
which fills the cervical canal during pregnancy. Sometimes the show is
absent or appears after labor has been in progress for awhile. If there
is much pure blood with the discharge it is unusual, and the physician
should be notified.


LABOR.

=First Stage.=—The first stage extends from the time of the labor
pains to the complete dilatation of the os uteri. It may come on very
slowly or act quickly. Slow dilatation occurs normally in a woman over
thirty years of age; and it may be due to inflammatory conditions or
appear in cases where the membranes lining the uterus are adherent. On
examining the vagina there is found a bulging (which is a main factor
in dilatation of the cervix) and a discharge of mucus tinged with
blood. The dilatation increases until it is 4 in. across, and the bag
of membranes bulges like a saucer. In abnormal cases it comes down into
the vagina in the shape of a tube. When the os is fully dilated the
membranes rupture, a rush of water escapes down the vagina, and the
first stage of labor is ended. Not all of the water comes away, for the
head comes down and acts as a plug. It is very important for the nurse
to recognize the true rupture and not mistake it for incontinence of
urine.

=Second Stage.=—This comprises the period from the time of complete
dilatation of the cervix to the end of the expulsion of the child. The
patient has some relief after the first stage, and when the second
stage comes on she holds her breath and contracts the abdominal muscles
as much as she can in making expulsive efforts. The pains become of
longer duration and more frequent; and upon examining the vagina the
head is found down, the tissues bulge, the rectum becomes stretched,
the majora and minora separate, and then, while the pain is on, there
is some change in the position of the head as it recedes and advances
again. Nature brings it slowly, for if the head plunged down it might
produce complete laceration of the perineum. If the head is delayed
too long there is swelling of the scalp. The most painful period is
when the head passes the perineum. Then there comes a marked change in
the position of the fetus, and it lies in that position for some time;
following, comes a rotation to one side, the shoulders turn, and birth
occurs. The cord is still in the vagina, and the third stage begins
with a flushing of amnii fluid. The placenta is still in place in the
uterus. The child may cry, and the pulsation may continue in the cord
for as long as fifteen minutes, but ordinarily for about five minutes,
while a new circulation is established in the infant and more blood is
drawn from the placenta.

=Third Stage.=—The patient has a rest for some minutes. Then the
contractions of the uterus continue until the membranes and placenta
are expelled. The pains begin again; the uterus is smaller, firm,
yet will recoil; it is rounded, and the fundus lies even with the
umbilicus. If the fundus is above the umbilicus something is wrong.
Painful contractions of the uterus follow and cause a squeezing off of
the placenta. There is a flow of blood, the placenta follows, passes
out of the vagina, dragging the membranes after it. The fundus sinks,
and the uterus, hard, contracted and firm, lies in the pelvis. In some
cases it becomes soft, rises up and then relaxes. If it becomes too
soft, the relaxation which follows may induce hemorrhage. The uterus
should be carefully massaged until it hardens.

=Period of Labor.=—Fourteen hours is a normal range. First stage
usually lasts about twelve hours; second stage about one hour, and the
third stage from fifteen to thirty minutes.

=Complications of Labor.=—Labor may be brought on by extreme mental
anxiety. The child may be born without any actual pain. It may be
expelled while the patient has an evacuation of the bowels, especially
if the bowel movement has been induced by enemata or a purgative.
Children may be born without the usual progression of labor, yet with
all normal conditions present. In cases where the mother dies during
labor the uterus continues to contract until the child is born about
fifteen minutes later. The child in such cases is sometimes saved by a
Cesarean section.


CARE OF THE OBSTETRIC PATIENT.

=Diet.=—Diet should be regulated and consist of light, nutritious and
predigested foods. Milk should be prepared in various ways palatable to
the patient. Wine and fruits and vegetables in season may be included.
For malnutritious patients, malt and beef extracts may be added.
Starches prepared in fat, and rich pastries should be avoided.

=Elimination.=—The bowels must move regularly, and laxatives may be
given if necessary. Alkalies should be given before bedtime, and
effervescent powders in the morning. Enemata should not be resorted to
unless absolutely necessary, as the sudden expulsion of the contents
may produce abortion. The kidneys may be regulated by giving simple
diuretics; plenty of pure water is the best. The condition of the
kidneys is a most important factor in pregnancy. The urine should be
clear and of sufficient quantity. Meats should be eaten but sparingly,
as they over-produce albumin.

=Baths.=—Daily bathing in tepid water is very essential to encourage
the elimination through the skin and to promote cleanliness. A cold
sponge is stimulating and very agreeable to some patients.

=Exercise.=—Exercise should be moderate. Light work about the home may
be encouraged, care being had to avoid over-lifting, over-reaching,
etc. Walking should be insisted upon, to maintain correct carriage and
posture of the body. Outdoor enjoyments may be had if indulged in with
discretion. Tiredness may be overcome by the patient lying down on an
incline, the head lower than the body, thereby relieving all tension
of the muscles and nerves. Any recumbent position for comfort is
beneficial.

=Breasts and Nipples.=—Plenty of room should be given to permit full
growth and to encourage the nipples to prominence. Their inversion or
depression may be remedied by massage and manipulation. No alcohol
or other strongly astringent washes should be used. The nipples must
not be hardened, but should be kept soft and pliable; cocoa-butter or
other healing ointments may be applied. Cracks and fissures not only
render nursing difficult or impossible, but may lead to mastitis and
subsequent abscess formations. There should be perfect cleanliness, to
promote pure secretion and prevent sepsis.

=Pelvic Organs.=—Pelvic organs do not, under normal conditions, require
douches. The normal vagina cleanses itself, and a hot douche may induce
abortion.


LYING-IN PERIOD.

=Confinement Room.=—A quiet room should be selected, in which there
has been no recent sickness and which is not in proximity to any
sewerage. The room should be well ventilated, with no draughts, and
at a temperature from 65°-75° F. The furnishings should be plain and
few as possible. They should consist of a table or two, a few chairs,
and a narrow iron bed of medium height. If the bedspring is soft,
a few boards may be placed under it to make it firm. If the patient
is to be delivered in bed, it should be made up as follows: (1) Long
rubber sheet; (2) long muslin sheet; (3) rubber draw-sheet; (4) muslin
draw-sheet; (5) a large pad, 3 ft. square and 3 in. thick. All sheets
should be fastened with large safety-pins, and the pad left free to
draw the patient to either side, if the bed is of the low-and-wide
variety commonly used in many homes. The ideal way is to deliver the
patient on a settee, or on two tables, covered with a small mattress;
the physicians and nurses have less work to do and they work to a
better advantage. Moreover, when the patient is carried from the table
to her clean, warm bed she gets immediate comfort and avoids the usual
disturbance and uncleanliness attending the clearing away of soiled
linen, etc.

=Preparatory Treatment for Patient.=—The patient should have a warm
bath, and the genitals should be scrubbed thoroughly with soap and
water. Shaving the parts is much to be desired if the patient has no
objection, then an antiseptic pad should be applied. The nurse must
be sure the bladder is empty; it is very important that a dribbling
from an over-distended bladder should not be mistaken for frequent
urinations; this is to prevent the danger of ruptured bladder from the
constant pressure of a contracting uterus; also a distended bladder
makes labor hard by interfering with the passage of the head.

=During the First Stage.=—The patient may be out of bed and encouraged
to take exercise. She should not walk about too freely before the head
is engaged, lest this induce a malpresentation or malposition. The
patient’s crying should not be prevented, and she should be told not to
press down. She may have a cup of hot water or tea, but no stimulant,
as an anesthetic may become necessary.

=During the Second Stage.=—All clothing should be removed but the
night-dress. Pin the gown up under the arm, put on perineal drawers,
and a sheet around the body, then place the patient in bed. The pain in
the back may be relieved by pressure over the sacrum, and the patient
should be encouraged to hold her breath. The nurse should now use
tact to quiet the patient, having hitherto managed, if possible, to
encourage calmness. For cramps in the limbs, the muscles may be moved
and firm pressure applied. A handkerchief bound tightly around the
affected part may relieve it. A sheet may be tied to either side of the
bed, for the patient to grasp, and a block placed at the foot of the
bed for a brace for her feet.

=Patient After Labor.=—The soiled skin should be gently and quickly
bathed with warm solution, the vulva and perineum carefully cleansed
and an antiseptic pad applied. The binder should be pinned firmly
about and below the hips, allowing freedom over the upper part of
the abdomen. If there is any anxiety that the uterus may relax after
kneading it, a tightly folded towel may be placed over the fundus, and
kept in position by the binder. A vaginal douche is never given without
orders from the physician. External douches of lysol, 1 or 2 per cent.,
are given three or four times daily until the lochia becomes scant.
The patient should be watched during the first few hours for symptoms
of hemorrhage. The room should be kept quiet and dark, and light, warm
covering be used on the bed. The patient may have a cup of hot water or
milk to induce sleep and relieve thirst.

=Diet.=—During the first twelve hours the patient should be kept on
liquid diet. On the second day, butter toast, milk toast, oyster stew,
and chocolate may be added. On the third day, if the bowels move
freely, soups, with rice or barley, and cereal foods may be given.
Stewed fruits (omitting those strongly acid) may be included. After the
fourth day, fresh fish, a chop, chicken, and pigeon may be given. Even
after ordinary diet is ordered, heavy meats and rich pastry should be
avoided for a while.

=Bowels.=—The bowels are usually constipated for the first few days.
A dose of castor oil may be given, to be followed in six hours by a
saline enema. The patient should be encouraged to drink freely of pure
water, to secure proper elimination of the kidneys. If the patient can
not urinate, after the different methods to produce urination have been
tried, she may be catheterized. The urine should be measured for some
days to ascertain if the quantity is sufficient.

=Colostrum.=—The first secretion in the breasts contains no
nourishment, but is a laxative for the child. The baby should be put to
the nipple as soon as the mother has had some sleep and feels rested.
Nursing assists the uterine contractions, preventing hemorrhage from
the torn placental vessels and cleansing the organs from secretions
still being discharged at intervals.

=Breast and Nipples.=—The nipples should be cleansed after each nursing
with warm boric solution. If they are cracked and sore a lubricating
ointment should be applied and a nipple shield should be used. If the
breasts become distended they should be massaged gently every two or
three hours, and they may be pumped if necessary. In this state the
patient must not have regular liquid diet, and the bowels must be kept
freely open with saline laxatives. A compressed binder is comforting
and beneficial. If the child, for some reason, does not nurse, the
secretion may be dried by an application of belladonna in the form of a
plaster, permitting the nipples to protrude through an opening cut into
the center of it. The belladonna ointment is good but very unclean.
Atropin may be given internally.

=Conditions During which the Child Should Not Nurse.=—Depressed or
cracked nipples; inflammation of the breasts; poor health of the
mother; marked anemia; kidney or heart disease; nervous or general
febrile afflictions; tuberculosis; syphilis.

_Menstruation._—If the return flow of the menses occur during the
nursing period the milk becomes impure, and the child may suffer from
the effects of it. If menstruation takes place normally and the child
does not become ill, it is because the mother is strong and can endure
the drain upon her system with no other bad result than losing flesh.
In such a case it is best to wean the baby, especially after it is nine
months old.


CARE OF THE BABY.

=Upon Birth.=—As soon as the eyes are cared for, by flushing them with
warm boric solution (the physician may use Credé’s method—1 to 2 per
cent. nitrate of silver solution, followed by weak salt solution), the
baby should be wrapped in a warm, soft, sterile cloth (cotton flannel),
and placed in a warm crib until the mother has been attended to. After
that the baby should be anointed with warm olive oil, especially in
the groin, axilla, in the folds of the neck and behind the ears. The
nurse should then wash and sterilize her hands to dress the cord.
Apply alcohol, 95 per cent., and then boric acid powder or any other
antiseptic dressing the physician may order; it may be kept in place
by a thin flannel binder, going around the abdomen but once and be
fastened in the back (not too tightly) by sewing it together. Pins
of any kind should be used only where absolutely necessary. The baby
should be dressed in as few garments as possible.

=Bathing.=—Until the umbilicus is healed the child should not be put
in the full bath. The face, hands, and head may be sponged daily with
tepid water. Gently massaging the body every day with warm olive oil,
and rubbing with a soft towel, will not only keep the baby clean, but
prove beneficial. The genitals should be washed well once daily and
sponged after each evacuation of the bowels. During the first few weeks
a little oil rubbed into the parts is better than powder; in most
cases powder will dry the skin too quickly and rub off the delicate
epithelium.

=General Care of the Baby.=—The eyes, the mouth, and navel should be
given the usual daily attention. The bowels, if constipated, should be
encouraged by small doses of castor oil given with a medicine dropper.
If the urinations are not clear and of sufficient quantity the baby
may have warm water, about 1 oz. at a time, three or four times daily.
Leave the infant with the mother _only_ during the nursing period.

=Nursing the Baby.=—Practical experience is daily upsetting the theory
that a set of rules and regulations can be laid down and followed for
the nursing of all babies; that nursing must be done at certain hours
and after certain intervals. While babies are alike in nearly every
respect, speaking physiologically, there are only a few who can be
awakened at regular intervals to be nursed by the mother or fed by the
bottle. Some babies can not be awakened sufficiently for nursing, even
after four or five hours’ sleep. Others will nurse for twenty minutes
(the rules say it should not be longer than ten minutes) at two- or
three-hour intervals during the day and then sleep all night.

Of course, where the child can be fed regularly, this helps the mother
to regulate her own habits, and is comforting to all concerned.
Therefore, nurses should not lack in determination to encourage such
a system. But no such regularity should be insisted upon where both
baby and mother suffer during the interval when nursing is denied;
the former, hungry and crying lustily, and the mother under a nervous
strain that is harmful to both. Let there be no hard-and-fast rules.
Babies who feed as often as they feel like it (being allowed proper,
though not necessarily long, intervals for digestion) generally suffer
no ill effects and are healthy and strong. Mother’s milk, the natural
feeding, should always be given, rather than any artificial food, when
the supply is sufficient and good.


OBSTETRIC SUPPLIES.

    =Solutions:=
      Antiseptic solutions.
      Normal salt solution.
      Spiritus frumenti.
      Fluid extract of ergot.
      Plenty of sterile water (hot and cold).

    =Articles:=
      Rubber sheeting.
      Plain roll of absorbent cotton.
      Abdominal binders.
      Vessel to receive placenta.
      Large drainage-pan.
      Large- and medium-sized safety-pins.

    =Sterilized Accessories:=
      One half-dozen sheets.
      One dozen towels.
      One night gown.
      One doctor’s gown.
      Accouchement pad.
      Two dozen vulva pads.
      Receiving pad for baby.
      Maternity leggings.
      Gauze sponges.
      Cotton pledgets.
      Applicators.
      Tape for the cord.
      Rubber and glass catheters.
      Douche points.
      Douche bag.
      Vaselin.


SUPPLIES FOR BABY BASKET.

    Blunt-pointed scissors.
    Needle, thread and thimble.
    Medium-sized and small safety-pins.
    Rectal and bath thermometer.
    Bar of pure mild soap.
    Jar of pure olive oil.
    Wide-mouthed bottle of alcohol, 95 per cent.
    Wide-mouthed bottle of boric solution.
    Sterile gauze to dress the navel.
    Sterile applicators.
    Two slips.
    Two shirts.
    Abdominal binders.
    Diapers and old soft cloths.


BABY SLEEP.

A young baby sleeps eighteen hours out of twenty-four. At six months
of age a baby sleeps about sixteen hours. A one-year-old child sleeps
about fourteen hours, and at two years of age at least twelve hours.
Daytime naps should be continued as long as possible.




FETAL CIRCULATION.


_From Kimber’s Anatomy._

The peculiarities of the fetal circulation, leaving details aside,
are: the direct communication between the two auricles of the heart,
through an opening called the foramen ovale; the communication between
the pulmonary artery and descending portion of the arch of the aorta,
by means of a tube called the ductus arteriosus; and the communication
between the placenta and the fetus, by means of the umbilical cord.

The arterial blood for the nutrition of the fetus is carried from the
placenta along the umbilical cord by the umbilical vein. Entering the
fetus at the umbilicus, the blood passes upward to the liver and is
conveyed into the inferior vena cava in two different ways. The larger
quantity first enters the liver, and, alone or in conjunction with the
blood from the portal vein, ramifies through the liver before entering
the inferior vena cava, by means of the hepatic veins. The smaller
quantity of blood passes directly from the umbilical vein into the
inferior vena cava, by a tube called the ductus venosus.

In the inferior vena cava the blood from the placenta becomes mixed
with the blood returning from the lower extremities of the fetus. It
enters the right auricle and, guided by a valve—the Eustachian valve,
passes through the foramen ovale into the left auricle. In the left
auricle it unites with a small quantity of blood returned from the
lungs by the pulmonary veins. From the left auricle the blood passes
into the left ventricle and is distributed by the aorta almost entirely
to the upper extremities by the superior vena cava, the blood enters
the right auricle, and, passing over the Eustachian valve, descends
into the right ventricle, and from the right ventricle into the
pulmonary artery. As the lungs in the fetus are solid, they require
very little blood, and the greater part of the blood passes through
the ductus arteriosus into the descending aorta, where, mixing with
the blood delivered to the aorta by the left ventricle, it descends to
supply the lower extremities of the fetus, the chief portions of this
blood, however, being carried back to the placenta by the two umbilical
arteries.

[Illustration: Diagrammatic view of the fetal circulation (Dorland).]

From this description of the fetal circulation it will be seen:

1. That the placenta serves the double purpose of a respiratory and
nutritive organ, receiving the venous blood from the fetus, and
returning it again charged with oxygen and additional nutritive
material.

2. That the greater part of the blood traverses the liver before
entering the inferior vena cava; hence the large size of this organ at
birth.

3. That the blood from the placenta passes almost directly into the
arch of the aorta and is distributed by its branches to the head and
upper extremities; hence the large size and perfect development of
those parts at birth.

4. That the blood in the descending aorta is chiefly derived from that
which has already circulated in the upper extremities and, mixed with
only a small quantity from the left ventricle, is distributed to the
lower extremities; hence the small size and imperfect development of
these parts at birth.




NURSING IN DISEASES OF CHILDREN.


=Spasmodic Croup.=—Spasmodic croup is due to a sudden closure of the
glottis.

_Causes._—Exposure to a cold, damp atmosphere, indigestion, or
irritation of the throat. There may be some hoarseness a few hours
preceding the attack and the child awakens suddenly in the paroxysm of
the sharp croup cough, experiences difficulty in breathing and has the
cyanotic appearance so terrifying to the mother, but which need give no
cause for serious alarm.

_Treatment._—Apply hot compresses about the throat. If the attack is
severe give an emetic—one dram of salt or mustard in one-half cup of
warm water, and repeat in twenty minutes if necessary; an enema of warm
water should be given and steam inhalation resorted to. Keep the child
in an even temperature, restrict diet for a few days, and keep bowels
active.

=Parotitis (Mumps).=—An infectious disease characterized by
inflammation of the parotid glands. Incubation is from two to three
weeks.

_Symptoms._—The disease comes on with a mild chill, pain below the ear
and swelling of the glands. There is great discomfort and the tension
is very disagreeable.

_Treatment._—Keep patient in bed during the height of the disease. Give
liquid and soft diet. Bowels should be opened freely. No medicine is
required unless fever is high. Apply cold compresses to the affected
part, though, if preferred, hot ones may be used. A pad of cotton with
oiled silk is the best application. In cases of extreme redness or
tenderness of the glands, leeches may be applied. In cases of delirium
use the ice-cap. For orchitis, lubricate the parts with camphorated oil
and support with a soft cotton pad.

Duration of disease, from seven to ten days.

=Whooping-Cough.=—An infectious disease, beginning with catarrh of
the air-passages, like an ordinary cold. The short expiratory coughs
following each other in rapid succession and the period of drawing a
long breath give rise to the whoop characterizing pertussis.

_Incubation._—A week to ten days.

_Treatment._—Isolate patient and if attack is severe put him in bed.
Fresh air is the most essential element. If the cough is distressing,
ipecacuanha wine and paregoric may be given. During convalescence the
child should be watched carefully, as at this period bronchopneumonia
and tuberculosis are apt to develop. Change of air is advisable.
Tonics and cod-liver oil should be employed. The diet should be easily
digestible, nourishing food. After each paroxysm and after the child
has recovered from the exhaustion it produces give nourishment. There
will be a partial if not complete absorption of the food before another
attack. Duration of the disease from six to twelve weeks.

=Colic.=—_Causes._—Constipation, indigestible foods, flatus,
overfeeding, improper foods and exposure to cold.

_Symptoms._—Child cries out very suddenly and sharply. There is a
convulsive movement of the extremities, the hands are tightly closed,
abdomen is tense.

_Treatment._—Gentle pressure and massage with warm oil over the abdomen
and a few doses of hot or peppermint water will expel the gas. Burnt
brandy is good. The simple warm enema is a common remedy. Wrap warm
flannels around the lower parts of the body and keep the hands warm.

=Diarrhea.=—Frequent loose evacuations without tenesmus.

_Causes._—Impure water or food; irritating secretions poured into the
bowels; bottled milk.

Diet should be restricted to cereal and albumin water. Flush the bowels
very gently with warm water.

=Dysentery.=—_Symptoms._—Fever, tenesmus and frequent small mucous,
bloody stools. Treat as diarrhea. Keep child warm, especially about the
abdomen.

=Cholera Infantum (Summer Complaint).=—_Symptoms._—Fever, intense
thirst, continuous vomiting, and purging of the bowels. Stools
soon become watery and pale-green in color, and the child has all
appearances of complete prostration.

_Treatment._—Stomach washing and intestinal irrigation carefully given.
Restrict diet to barley water containing a few drops of brandy and give
hourly for a few days.

=Rickets.=—A disease of infants, characterized by impaired nutrition of
the entire body and alteration of growing bones.

_Causes._—Not positively known. Heredity may be a predisposing factor.
Another theory given is want of sunlight, impure air, prolonged
lactation, and suckling. As it is a constitutional disease it is almost
certain to be due to a disturbance of nutrition. _It is much less found
in the breast-fed than in the artificially fed and more common when the
artificial feeding is bad than when it is properly given._

=Scurvy= is a constitutional disease of metabolism _due to a faulty
diet_. Probably the absence of some constituents in the nature of
vitamins. _Scurvy and rickets are two distinct diseases_, and yet both
may be due to _impure, improper infant feedings_.

_Three General Symptoms of Great Importance._—First, a diffuse soreness
of the body, so that the child cries when an attempt is made to move
it; second, slight fever; third, profuse sweating. Deformities may
often be prevented if, in the early stages, constant care is taken that
the child is properly held.

=Thrush.=—_Aphthæ._—Small white, furry mouth ulcers developing during
the first and second year of infancy.

_Cause._—Lack of cleanliness in the care of the mouth, especially after
feeding with bottled milk. The patches are tenacious, grow larger,
until sometimes they involve the entire gastro-intestinal tract,
resulting in acute indigestion and bowel disorders.

The first symptom is usually some evidence of painful distress in the
infant’s efforts to nurse; fever, diarrhea and vomiting occur and the
trouble may become acute.

_Treatment._—Absolute sterile cleanliness in the preparation and
administering of the patient’s food. The mouth must be cleansed with
warm boric acid solution after every feeding. The patches should be
touched gently with the same solution, and the lips anointed with a
soothing lotion.

=Convulsions.=—The principal predisposing causes are infancy conditions
affecting the nutrition of the brain and hereditary influences. The
brain grows more during the first year than in later life, and this
rapidity of growth is in itself an important predisposing cause of
functional derangement. After infancy attacks of convulsions are much
less frequent, and after seven years they are relatively rare. Death
may take place from a single attack in very young infants, especially
those who are rachitic.

Convulsions may be thought to indicate the onset of some acute disease
when they occur in a child over two years old, and when they come on
suddenly or with only slight premonition in a child previously well;
but the most important point is that they are accompanied by a high
temperature—104°-106° F. Acute meningitis is the only other condition
likely to produce these symptoms. Whether the convulsions mark the
onset of lobar pneumonia, scarlet fever, malaria, or some other disease
can be determined only by carefully watching the patient’s symptoms for
24 or 36 hours.

In convulsions depending upon some disorder of the alimentary tract,
we may get a history of chronic constipation or improper feeding,
and in nursing infants, sometimes of passion or intoxication in the
wet-nurse. Convulsions are so frequently due to digestive derangement
that the condition of these organs should be one of the first things
to be looked into. Examination of the urine should never be omitted
in any case of convulsions of doubtful origin, even where no dropsy
is present. This, both in infants and older children, is too often
overlooked. In all cases of convulsions of doubtful or obscure origin
occurring in infants, rickets should be suspected as the underlying
cause, and the child carefully examined for other evidences of that
disease.

_Treatment._—Cold should be applied to the head, best by means of an
ice-cap or cold cloths, and dry heat and counterirritation to the
surface of the body and extremities.

_The Mustard Pack._—The child is stripped and laid upon a blanket,
and the trunk is surrounded by a large towel or sheet saturated with
mustard water. This is made as follows: 1 tablespoonful of mustard,
1 quart of water. In this the towel is dipped and, while dripping,
wound around the entire body. The patient should then be rolled in the
blanket. This pack may be continued for 10 or 15 minutes; at the end of
which time there will usually be a very decided redness of the whole
body. It may be repeated, according to indications. Where it is desired
to produce general counterirritation, the mustard pack is not quite
as efficient as the mustard bath, but it has the advantage in causing
much less disturbance to the patient. The mustard pack is useful in
the conditions of collapse, or of great prostration from any cause
whatever, in convulsions, and in cerebral or pulmonary congestion. The
degree to which the counterirritant of the skin should be carried will
depend upon the condition of the pulse and the cyanosis. The feet may
be placed in mustard water while the child lies in its crib (Holt).




A FEW NOTES ON MEDICAL DISEASES.


RHEUMATISM.

A constitutional disease, characterized by fever, inflammation in and
around the joints, occurring in succession, and a great tendency to
induce the condition of endocarditis or pericarditis.

=Cause.=—Usually exposure to cold—chilling of the body—damp atmosphere.

=Treatment.=—Rest in bed is important. The bedding should be yielding,
and the patient wear loose flannel night-clothes. Sleeping between
blankets promotes perspiration, increases the activity of the skin,
prevents exposure to cold and may reduce the liability to heart
trouble. Change bed-clothing frequently.

_Diet._—Should be easily digested food. Milk is the most suitable.
Dilute with alkaline or mineral water. Barley- or oatmeal-water and
lemonade may be given. Broths and soups may be substituted for milk at
times. Regular feedings every two hours until patient convalesces.


GOUT.

Gout is characterized by sudden attacks of severe pain in the smaller
joints, especially that of the big toe. There is a gradual deposit of
urate of sodium in and about the joints, and presence of uric acid in
the blood.

=Causes.=—Intemperate living, excess in drinking wines and liquors,
overindulgence in rich foods, change of climate.

=Treatment.=—Proper elimination. Free use of all kinds of mineral
waters, abstention from alcoholic drinks and moderation in eating.
Exercise by walking and living in the open air may counteract any
hereditary tendency to the disease. Cold baths, followed by massage,
may be given to the sthenic patient, while the warm and tepid bath
should be substituted for the asthenic type. Protect the body from
exposure to cold. Flannel underwear should be worn.

_Diet._—Milk for liquid—no coffee or tea. Vegetables and fruit,
excepting bananas, strawberries, tomatoes, oranges, lemons; fish,
oysters and soup in small quantities; no fresh meat should be allowed
for a time. Avoid hot breads, pastry of all kinds, spices and eggs.


DIABETES MELLITUS.

A disorder of nutrition, characterized by an accumulation of sugar in
the blood, and excreted in the urine. The amount of urine is greatly
increased, accompanied by progressive loss of flesh and strength.

=Treatment.=—Regulate diet, exercise and mode of living. A warm bath
every other day and a Turkish bath every two weeks are very beneficial.

_Diet._—Avoid sugar, starch and all liquors. Patient may eat soups
without vegetables and flour; fish of all kinds; meats and fats cooked
in any way except with flour; gluten bread. Of vegetables—lettuce,
cucumbers, spinach, tomatoes, onions, celery, radishes, cauliflower,
cabbage, egg-plant. Of desserts—custard, nuts, acid fruits, ice
cream without sugar. Of drinks—coffee, tea and buttermilk, lemonade,
beef-tea, chicken broth, and egg-nog.

Fluid diet must be moderate, and sugar and flour must not be used in
any form.


BRIGHT’S DISEASE.

(Acute Nephritis; Inflammation of the Kidneys.)

=Due= to the action of cold or toxic agents upon the kidneys.

_Causes._—Cold, poisons of specific fevers, toxic agents, pregnancy,
blows and injuries of the back, lesions of the skin as in burns or in
chronic skin diseases.

=Symptoms.=—Fever, pain in the back over the kidneys, nausea, vomiting,
frequent desire to urinate, puffiness of the face, swelling of the
ankles, extreme pallor of the skin, shortness of the breath, with the
general appearance of complete exhaustion. The urine is very scanty and
highly colored.

=Treatment.=—Rest in bed until all symptoms disappear. To promote
activity of the skin and kidneys, alcohol or steam sweats should be
given daily. To eliminate and purge the bowels give saline cathartics;
and alkaline mineral waters may be used freely.

_Diet._—Buttermilk, gruels made of barley or arrowroot, or oatmeal
water; animal broths and oysters; substitute cream-of-tartar lemonade
or plain lemonade for tea or coffee. Pure milk should be taken freely.


UREMIA.

Uremia occasionally develops during the course of acute or chronic
Bright’s disease and other maladies, the result of the retention or
accumulation in the blood of an excrementitious material, supposed to
be urea, the flow of urine being either normal, lessened, or increased.


TREATMENT FOR TUBERCULOSIS.

Fresh air and sunshine, a rest in bed from one to three months, and
proper food are the three vital points of importance. Do not give too
many baths.

=Diet= should consist of starch foods—60 per cent. Stale bread and
crackers may be prepared in variety. Give albuminoids and tender meats.
Milk and eggs should be given about six times a day.


FOR PATIENT IN SITTING POSITION.

A contrivance easily made and very useful in nursing cases where the
patient is to be kept in the semirecumbent or sitting position, as,
for instance, in pneumonia, or in operations on the upper abdomen, is
arranged by taking a broomstick with the broom part sawed off. Wrap
around this stick a blanket, large pillow, or something to make it
resemble a knee bolster. Place this under the knees of the patient,
and to each end of the broomstick attach a stout cord, which may be
securely tied to the bed-posts at the head of the bed. This will add
to the comfort of the patient in preventing the constant sliding down
which is so difficult to prevent. It will also save the nurse a great
deal of tugging and lifting.




MISCELLANEUOS NOTES AND REMEDIES.


COLDS.

This was one of the subjects of discussion at one of the meetings of
the New York State Medical Association.

One physician thought that cold was only a predisposing factor in
these cases, microbes being the chief element in the affection. At the
beginning of an ordinary cold in the head the serous flow was an effort
of nature to relieve the congestion and eliminate the infection, hence
it should not be interfered with at this stage.

Another doctor said that while cold was a separate disease in the minds
of the laity, to physicians it always meant a condition secondary to
something else. A person with nasal polypi, for example, would complain
of almost constant stuffiness of the nose; one with an enlarged lingual
tonsil became hoarse after very slight use of the voice in singing.

Dr. —— —— ——, of New York, took up the treatment of colds. He thought
some colds in the head are communicable, and that isolation might
sometimes be a useful protective measure. Cod-liver oil was a good
preventive for those who were in the habit of constantly catching
cold. If the temperature was over 100° F., he insisted on the patient
staying in bed, or at least in the house. A moderate dose of quinin and
Dover’s powder at night, followed in the morning by a laxative, would
cut short some colds. A hot mustard foot-bath increased the comfort
of the patient. Rhinitis tablets were effectual if taken early, but
persons susceptible to belladonna should be careful in using them. The
alkaline treatment was often satisfactory—one dram of bicarbonate of
soda in half a glass of water, with a few drops of lemon juice. Camphor
internally and by inhalation often yielded good results. He was not a
great believer in local treatment, though admitting that irrigation
with saline solution was often useful. It was, however, dangerous
except in skilful hands. When colds showed a tendency to recur, he
advocated tincture chlorid of iron in large doses for two or three
days, also cod-liver oil, quinin, or the vegetable bitters. Sometimes
change of climate was the only cure.

=Cold a Germ Disease.=—Walsh, in the _Medical News_, says a very
striking indication that cold is due to _microbic invasion_ is to
be found in the fact that the process is nearly always accompanied
by _fever_. A distinct period of incubation can be traced, and the
efficient cause of the illness is commonly farther off than the patient
imagines. The treatment advised when fever and chilliness occur is the
use of calomel and hot drinks, especially cream-of-tartar lemonade,
which acts as a diuretic as well as a laxative. A diaphoretic at the
beginning of the affection will always give the patient comfort and may
unload the system of enough depressed toxic material to enable it to
react and bring about the abortion of a cold.

Other medical men objected to calling everything an infection. A common
cold, they thought, was nothing else than the effect of the lowered
temperature on the human system. The dry air of houses caused a chronic
postnasal catarrh, which at times increased. To overcome susceptibility
to catching cold, overdressing should be avoided and cold baths taken.


TREATMENT OF HYPERIDROSIS.

In sweating of the feet a single application of diluted formaldehyd
will bring about permanent relief. For the axilla, use 10 drops of
formaldehyd to 2 ounces of water.


TREATMENT OF ERYSIPELAS.

Apply a thick layer of white vaselin twice a day. Protect with linen
and gauze bandages.


TO DISTINGUISH CHICKEN FROM SMALLPOX.

If the vesicle in chicken-pox is pricked with a needle, its contents
can be completely evacuated and the cell will collapse; whereas, in
small-pox the vesicle can be pricked twenty times and it will be
impossible to empty it.


TREATMENT OF FELON.

A felon _may sometimes be_ aborted by the application of pure alcohol
under exclusion of air. Cover the phalanx with a thin layer of
absorbent cotton saturated with alcohol; over this put on a rubber
finger-stall. In severe cases the tissues should be deeply incised.


TREATMENT OF BOILS.

Apply hot dressings; incise if necessary. The application of pure
alcohol dressings and a plug of cotton saturated in the same solution
and inserted in the wound promotes rapid healing.


TO DISLODGE AN INSECT FROM THE EAR.

Saturate a piece of cotton-wool in salt and vinegar. Fill the ear with
it. Have patient lie on the ear and give firm pressure with the hand.
The insect may be found on the cotton when the plug is taken out. Oil
may be used as a substitute.[B]

[B] Foreign bodies in the ear usually cause far less trouble and harm
than does the attempt to remove them by anyone not expert.


RELIEF FOR EARACHE.

Make a small funnel of paper, and saturate a ball of cotton with
chloroform; drop it into the funnel. Place the funnel in the ear,
draw a long breath and then blow the breath into the large end of the
funnel; the fumes of the chloroform are thus carried into the ear, and
all pain ceases at once. No doubt, heat is the best remedy of all.


RELIEF FROM FLIES AND MOSQUITOES.

Pour into an atomizer half a teaspoonful of lavender oil. Add to this
as much alcohol as will make a saturated solution. Use as a spray.
Sweet clover hung about the room will banish flies and mosquitoes. The
drier the clover becomes the more effectual it is.




A BIT OF ANATOMY.


The entire adult skeleton consists of 200 distinct bones, as follows:

    The spine or vertebral column
        (sacrum and coccyx included)     26
    Cranium                               8
    Face                                 14
    Os hyoids, sternum and ribs          26
    Upper extremities                    64
    Lower extremities                    62
                                        ———
                                        200

The patellæ are included as separate bones; the smaller sesamoid bones
and the ossicula auditus are not counted. The teeth belong to the
tegumentary system.


BLOOD-CORPUSCLES.

The average number of red blood-corpuscles per cubic millimeter is
about 5,000,000 for men, and somewhat less for women. The number is
much increased in people who live in altitudes of about 8000 feet or
more. The greatest decrease occurs in anemia, when they may number
less than 1,000,000, and in leukemia, when there may be not more than
2,000,000.

The average number of white blood-corpuscles per cubic millimeter
varies from 5000 to 10,000. The number is usually decreased in anemia,
and much increased in leukemia, when they may number 500,000 per cubic
millimeter.

Blood should contain 100 per cent. hemoglobin. Hospital patients seldom
have this amount. Patients are not considered safe for operation who
have less than 50 per cent., and can not live long if they have 10 per
cent. or less.

[Illustration: The skeleton.]

[Illustration: The principal arteries and veins of the body (Morrow).]

[Illustration: Abdominal regions.]

[Illustration: General scheme of the digestive tract, with the chief
glands opening into it (Raymond).]

[Illustration: Position of the thoracic and abdominal organs, front
view (Morrow)]

[Illustration: Position of the thoracic and abdominal organs, rear view
(Morrow).]

[Illustration: _A_, Recurrent bandage of the head; _B_, anterior
figure-of-eight bandage of the chest.]

[Illustration: Ascending spica bandage of groin.]

[Illustration: Bandage of the knee.]

[Illustration: Finger bandage.]

[Illustration: Double spica of groin.]

[Illustration: Ascending spica of shoulder.]

[Illustration: Figure-of-eight bandage of forearm.]

[Illustration: Spica bandage of thumb.]

[Illustration: Spica bandage of ankle.]




INDEX.


    A 1 : 500 solution, 21
    Abbreviations, 9
    Abdomen, changes in, in pregnancy, 176
    Abdominal organs, view of, 207, 208
        regions, 206
    Accessories, surgical, 106
    Acetanilid, action, uses, and dose of, 23
        poisoning, 45
    Acid, carbolic, poisoning by, 45
        hydrocyanic, poisoning by, 45
        oxalic, poisoning by, 45
        tannic, action, uses, and dose of, 40
        as antidote, 48
    Acids, fruit and vegetable, value of, 145
        mineral, diluted, as antidotes, 48
        time to take, 43
    Aconite, action, uses, and dose of, 23
        poisoning, 45
    Action, uses, and doses of important drugs, 23
    Acute fevers, nursing in, 79
    After-birth, 174
    Albumin as antidote, 48
        in urine, test for, 63
        water, how to make, 71, 150
    Alcohol, action, uses, and dose of, 23
        sweat, 130
    Alkalies, time to take, 43
    Alkaline solution of cyanid of mercury, 50
        urine, 62
    Aloes, action, uses, and dose of, 24
    Ammonia, action, uses, and dose of, 24
        poisoning by, 45
    Amputation, instruments for, 111
    Analysis of urine, 62
    Anatomy, a bit of, 203
    Anilin dyes, poisoning by, 45
    Antidotes, 48
    Antimony poisoning, antidotes in, 46
    Antipyrin, action, uses, and dose of, 25
        poisoning, antidotes for, 46
    Antitoxin of diphtheria, 25
    Aphthæ, nursing in, 194
    Apical pericementitis, 75
    Apomorphin, 36, 37
    Apothecaries’ measure, table of percentage solutions in, 20
        weight, table of, 17
    Argyrol, 39
    Aristol ointment, 52
    Arm, fracture of, 123
        hemorrhage from, 121
    Arrowroot water, how to make, 149
    Arsenic, action, uses, and dose of, 23
        poisoning, antidotes for, 46
    Arsenous acid, 23
    Arteries of body, illustration of, 205
    Artificial feeding of infants, formulæ for, 65
        respiration, 126
    Asphyxia from ether, 30
    Aspirin, action, uses, and dose of, 25, 38
    Atropin, action, uses, and dose of, 25
        poisoning, antidotes for, 46
    Avoirdupois weight, table of, 17
    Axilla, sweating of, formula for, 54

    Baby, care of, 186
        feeding, artificial, 65
        nursing, 186
        sleep, 188
    Baby basket, supplies for, 186
    Baked custard, how to make, 156
    Baked-flour porridge, how to make, 159
    Ballottement, 177
    Bandages, 209, 210
    Barley and corn muffins, 163
        gruel, 69
        jelly, 72
        soup, 162
        water, 150
    Bathing the baby, 186
    Baths, 128
        in pregnancy, 182
    Bed-sores, treatment of, 94
    Beef extract, how to make, 153
        juice, how to make, 153
        peptonized, 148
    Beef-tea, how to make, 153
    Belladonna, action and uses of, 26
        poisoning, antidotes for, 46
    Bichlorid of mercury, 34
        1 : 1000 solution of, 50
    Bird, how to bone, 157
    Bismuth, action and uses of, 26
    Bleeding from gums, treatment of, 96
    Blister, cantharides, 57
    Blood-corpuscles, 203
    Blue mass, 34
        ointment, 35
    Boils, treatment of, 202
    Bones of body, classification of, 203, 204
    Boning a bird, 157
    Bonnyclabber, 152
    Borated glycerin, formula for, 53
        vaselin, formula for, 53
    Boric acid solution, 50
    Bottles, sterilizing, 67
    Bowels after labor, 184
        care of, in pregnancy, 181
    Bran biscuit, recipe for, 162
        bread, recipe for, 162
    Brandy, action and uses of, 24
    Bread, nut, 164
    Breasts, care of, after labor, 185
        in pregnancy, 182
        enlargement of, 176
    Bright’s disease, 198
    Bromids, action and uses of, 26
    Broth, clam, how to make, 155
        oyster, how to make, 154
    Buckwheat gems, 164
    Burns, carron oil for, 53
        of the eye, 124
        picric acid solution for, 51
        salol vaselin for, 54
        treatment of, 124
    Buttermilk, 71
        from lactone tablets, 72

    Caffein, action and uses of, 27
    Calf’s brains, fried, 158
    Calomel, action and uses of, 27, 33
    Camphor, poisoning by, 46
    Cantharides blister, how to prepare, 57
        poisoning, antidotes for, 46
    Carbohydrate formulæ for infant feeding, 69
    Carbohydrates, 142
        overuse of, 143
    Carbolated vaselin, 53
    Carbolic acid, action and uses of, 27
        poisoning by, 45
        solution, 49
    Carron oil for burns, 53
    Castile soap as an antidote, 48
    Castor oil, action and uses of, 27
    Catgut, chromic, 101
        sterilization of, 101
    Cellulose, value of, 145
    Champagne, use of, 24
    Cheek, hemorrhage from, 121
    Chicken and veal extract, 153
    Chicken-pox, how to distinguish, from small-pox, 201
    Children, diseases of, nursing in, 192
        dosage for, 42
    Chloral, action and uses of, 27
    Chloralamid, action and uses of, 27
    Chlorid of lime solution, 51
    Chloroform, action and uses of, 28
        poisoning, antidotes for, 46
    Chocolate, how to make, 155
        soufflé, how to make, 156
    Cholera infantum, nursing in, 194
    Chromic catgut, 101
    Chymogen, use of, 71
    Cinchona, action and uses of, 28
    Circulation, fetal, 189
    Clam broth, how to make, 155
    Clams, how to boil, 155
    Clavicle, fracture of, 123
    Clothes, soiled, washing fluid for, 91
    Cocain, action and uses of, 28
        poisoning by, 46
    Cocoa, how to make, 155
        cream, frozen, recipe for, 163
    Codein, 36
    Cod-liver oil, action and uses of, 29
    Coffee as antidote, 48
        how to make, 150
    Colchicum poisoning, 46
    Cold pack, 128
    Colds, treatment of, 200
    Colic, nursing in, 193
    Collar-bone, fracture of, 123
    Colostrum, 185
    Combination enema, 55
    Comminuted fracture, 122
    Compound fracture, 122
    Conception, 172
    Confinement room, care of, 182
        table for calculating date of, 178
    Convulsions, nursing in, 195
    Cooking smells, how to prevent, 165
    Copper sulphate, poisoning by, 46
    Cord, umbilical, 174
    Corn and barley muffins, 163
        griddle cakes, 163
    Cornmeal gingerbread, 165
        gruel, how to make, 154
    Corrosive sublimate, 1 : 1000 solution of, 50
        action and uses of, 34
        poisoning by, 46
    Cracked nipples, aristol ointment for, 52
    Cream, egg, 160
        ice, how to make, 161
        lemonade, how to make, 151
        rice, 159
        toast, how to make, 159
    Creasote, action and uses of, 29
        poisoning by, 46
    Credé’s ointment, 39
    Croton oil, action and uses of, 29
        poisoning, treatment of, 46
    Croup, spasmodic, nursing in, 192
    Curetment, instruments for, 111
    Custard, baked, how to make, 156
        frozen, how to make, 161
    Cyanid of mercury, alkaline solution, 50
        of potassium poisoning, antidotes, for 46

    Decidua vera, 172
    Dental treatment, 74
    Diabetes mellitus, 198
    Diabetic porridge, 170
    Diarrhea, nursing in, 193
    Diet after labor, 184
        for obstetric patient, 181
        in disease, 168
        typhoid, 170
    Digestibility of eggs, 145
    Digestive tract, scheme of, 206
    Digitalin, 30
    Digitalis, action and uses of, 29
        poisoning, antidotes for, 46
    Diphtheria antitoxin, 25
        nursing in, 85
    Disinfection in private nursing, 97
        of feces, 82, 90
        of rooms, 97
        of urine, 82, 90
    Dislocations, 123
    Dobell’s solution, 95
    Dosage for children, rule for ascertaining, 42
        general rules for, 41
        hypodermic, 43
        rectal, 43
    Dosage, subcutaneous 43
    Doses, action, and uses of
        most important drugs, 23
    Drowning, treatment in, 125
    Drugs, action, uses, and doses of, 23
    Dry measure, table of, 17
    Dysentery, nursing in, 193

    Ear, insect in, removal of, 202
    Earache, relief of, 202
    Eczematous sores, Lassar’s paste for, 53
    Edebohls’ posture, 116
    Egg cream, 160
        toast, how to make, 160
    Eggs, digestibility of, 145
        poached, 158
        preservation of, 146
        soft-boiled, 158
        uses of, 145
    Egg-white as antidote, 48
    Elaterium poisoning, antidotes for, 46
    Electricity, 137
    Emergencies, 121
        burns, 124
        dislocations, 123
        drowning, 125
        epilepsy, 125
        eye-injuries, 124, 125
        fainting, 125
        fractures, 122
        hemorrhages, 121
        hysteria, 125
        scalds, 124
        sprains, 124
        sunstroke, 126
    Emergencies, suspended animation from noxious gases, 126
    Emetics as antidotes, 48
    Emulsion, iodoform, 102
    Enema, 1, 2, 3, formula for, 55
        combination, 55
        for flatulence, 54
        glycerin, formula for, 54
        nourishing, formula for, 55
        ox-gall, formula for, 54
        saline, formula for, 55
        starch-water, 55
        stimulating, method of administering, 55
        turpentine, formula for, 54
    Enteric fever, nursing in, 79
    Epilepsy, treatment of, 125
    Epistaxis, 122
    Epsom salt, action and uses of, 33
    Ergot, action and uses of, 30
      poisoning by, 46
    Ergotin, 30
    Eruption of teeth, 77
    Erysipelas, treatment of, 201
    Eserin, 37, 38
    Ether, action and uses of, 30
    Ewald’s test-breakfast, 170
    Exercise in pregnancy, 182
    Extract, beef, how to make, 153
    Eye, burns of, 124
      injuries of, 125

    Fainting, treatment of, 125
    False pains, 177
    Faradization, 140
    Fats, 142
    Fatty oils as antidote, 48
    Feces, disinfection of, 82, 90
    Feeding, infant, 64, 68
        of infants, amount of, 66
        artificial, formulæ for, 65
    Feet, sweating, formula for, 54
    Felon, treatment of, 202
    Fetal circulation, 189
        heart-beat, 176
        membranes, 173
    Fever, scarlet, nursing in, 83
        typhoid, nursing in, 79
    Fevers, care of skin and mouth in, 93
        incubation period, 91
        nursing in, 79
        reduction of, by cold pack, 128
           by sponging, 129
    Finger-nails, care of, in handling infectious material, 91
    Flatulence, enema for, 54
    Flaxseed poultice, formula for, 57
    Flies, relief from, 202
    Flour ball, formula for, 69
    Food and nutrition in disease, 168
        constituents, source and use of, 142
        in disease, 168
        wise combinations of, 142
    Foods for sick, preparation of, 147
    Foods, proprietary, for infant feeding, 68
    Formaldehyde, action and uses of, 31
        disinfection by, 97
        glycerin, 49
        solutions of, 51
    Formalin, 31
    Formulæ, miscellaneous, 49
    Fortified oil, 53
    Fowler’s solution, 23
    Fractures, 122
    French toast, how to make, 160
    Friction in massage, 133
    Frozen cocoa cream, 163
        custard, how to make, 161
    Fruit, value of, 145

    Gall-stone operation, instruments for, 112
    Galvanization, 139
    Gas, illuminating, poisoning by, 47
    Gases, noxious, suspended animation from, 126
    Gauze, iodoform, preparation of, 102
    Genupectoral posture, 115
    Gin, 24
    Gingerbread, cornmeal, 165
    Ginger-snaps, recipe for, 163
    Glossary of materia medica, 13
    Gloves, cleaning of, 100
        sterile, drying of, 100
        sterilization of, 100
    Glycerin, borated, formula for, 53
    Glycerin enema, formula for, 54
        formaldehyde, 1 : 20 solution, 49
        sterilization of, 102
    Goiter operation, instruments for, 113
    Gout, 197
    Green soap, tincture of, 103
    Greenstick fracture, 122
    Gum-arabic water, how to make, 149
    Gum-boils, treatment of, 75
    Gums, bleeding from, treatment of, 96
    Gynecologic postures, 114-116

    Hair, matted, 59
        tonics, formulæ for, 58
    Hand-brushes, how to sterilize, 103
    Hands, inunctions for, 53
        soothing lotions for, 52
    Harrington’s solution, 51
    Heartbeat, fetal, 176
    Heat exhaustion, treatment of, 127
        of oven, how to estimate, 163
    Hemorrhage in typhoid fever, treatment of, 81
    Hemorrhages, treatment of, 121
    Hemorrhoid operation, instruments for, 113
    Hernia operation, instruments for, 113
    Heroin, 36, 37
    Homogenized milk, 69
    Horse-hair, sterilization of, 100
    Hot pack, 129
    Hydrocyanic acid, poisoning by, 45
    Hyperidrosis, treatment of, 201
    Hypodermic dosage, 43
    Hysteria, treatment of, 125

    Ice cream, how to make, 161
        royal, 161
    Impacted fracture, 122
    Incubation period of acute fevers, 91
    Infant feeding, 64, 68
        amount, 66
        artificial, formulæ for, 65
        sugars in, 68
    Infantile paralysis, 86
        classification, 88
        pathology, 88
        prophylaxis, 90
        quarantine in, 90
        summary results from public school reports, 87
        symptoms of onset, 88
        treatment, 89
        serum, 90
    Infectious disease, nursing in, 79
        quarantine for, 91
    Insect in ear, how to dislodge, 202
    Instruments, arrangement of, for operator, 99
        cleaning of, 100
        for operative cases, 111
        sterilization of, 99
    Inunction for dry hands, 53
    Iodids, action and uses of, 31
    Iodin poisoning, antidotes for, 47
        solution, 51
    Iodoform, action and uses of, 31
        emulsion, 102
        gauze, 102
           preparation of, 102
    Ipecac, action and uses of, 32
    Iron, action and uses of, 32

    Jaborandi, action and uses of, 38
    Jelly, lemon, how to make, 157
        Sanitas, 53
        wine, how to make, 156
    Johnny cake, 164
    Joint movements, 135
    Juice, beef, how to make, 153
    Junket, how to make, 153

    Kelly pad, improvised, 100
    Kneading in massage, 134
    Knee-chest posture, 115
    Kumiss, how to make, 155

    Labor, 179
        after-treatment of patient in, 184
        complications of, 181
    Labor, diet after, 184
        nursing in, 182
        prediction of date of, 177
        premonitory signs of, 177
        preparatory treatment of
        patient in, 183
    Lactose solution, 71
        tablets for making buttermilk, 72
    Laparotomy, instruments for, 112
    Lassar’s paste, formula for, 53
    Lead, action and uses of, 32
        poisoning, 33
        salts, poisoning by, 47
    Leech, to apply, 117
    Leg, fracture of, 123
        hemorrhage from, 122
    Lemon jelly, how to make, 157
        sherbet, how to make, 161
    Lemonade, cream, how to make, 151
        white-of-egg, how to make, 150
    Lice, applications for, 58
    Light diet, 169
    Lightening, 177
    Lime-water, how to make, 149
    Linen thread, sterilization of, 101
    Lips, dry and fissured, treatment of, 96
    Liquid diet, 169
        measure, 17
    Lobelia poisoning, antidotes for, 47
    Lungs, hemorrhage from, 122
    Lye poisoning, antidotes for, 47
    Lying-in period, 182

    Magnesium citrate, use of, 33
        oxid, uses of, 33
        sulphate, uses of, 33
    Marshall Hall’s method of artificial respiration, 126
    Massage, 132
    Matches, poisoning by, 47
    Materia medica, glossary of, 13
    Matted hair, 59
    Mayonnaise dressing, how to make, 155
    Measles, nursing in 84
    Measures, 17
    Mechanotherapy, 132
    Medicinal preparations, popular and official names of, 16
    Medicines, proper time to take, 43
    Membranes, fetal, 173
    Menses, suppression of, 175
    Menstruation, 175
    Mercury, action and uses of, 33
        poisoning, antidotes for, 35
    Metric weights and measures, table of, 18, 19, 21
    Milk, 145
        albumin, 70
        as antidote, 48
        homogenized, 69
    Milk, how to peptonize, 147
        to sterilize, 67
        modified, 68
        mothers’, constituents of, 64
           regulating composition of, 64
        pasteurizing of, 67
        peptonized, 71
        punch, how to make, 152
        sherbet, 161
        skimmed, 69
        soup with vegetables, 157
        teeth, eruption of, 77

    Mineral acids, diluted, as antidotes, 48
        poisoning by, antidotes for, 45
        salts, 143
        value of, 145
    Modified milk, 68
    Morning sickness, 175
    Morphin poisoning, antidotes for, 36, 47
    Mosquitoes, relief from, 202
    Mother’s milk, constituents of, 64
          regulating the composition of, 64
    Mouth and skin in fevers, care of, 93
        wash, 96
    Mucilaginous substances as antidotes, 48
    Mucus-coated mouth, formula for, 96
    Muffins, barley and corn, 163
        rice and oats, 165
    Multiple fracture, 122
    Mumps, nursing in, 192
    Mushroom poisoning, antidotes for, 47
    Mustard pack, 196
        plaster, formula for, 56
        poultice, formula for, 57
    Mutton, boiled, 158

    Nephritis, 198
    Nipple ointment, 52
    Nipples, care of, after labor, 185
        in pregnancy, 182
        cracked, aristol ointment for, 52
        sore, solution for, 52
    Nitrate of silver, poisoning by, 47
        stains, 47
        time to take, 43
    Nitroglycerin, action and uses of, 35
    Normal salt solution, formula for, 49
        urine, 62
    Nose-bleed, 122
    Nourishing enema, formula for, 55
    Numerals, Roman, 15
    Nursing child, conditions under which it should not nurse, 185
        in acute fevers, 79
        in diphtheria, 85
        in measles, 84
        in pneumonia, 82
        in scarlet fever, 83
        the baby, 187
    Nut bread, 164
    Nutrition in disease, 168
    Nutritive enema, 55
        method of administering, 56
    Nux vomica, action and uses of, 36
        poisoning, 47

    Oat and rice muffins, 165
        jelly, 72
    Oatmeal gruel, 69
        water, how to make, 150
    Obstetric nursing, 181
        patient, care of, 181
        set, sterilization of, 110
        supplies, 187
    Obstetrics, 171
    Oil, fortified, 53
    Ointment, aristol, 52
        nipple, 52
    Omelet, how to make, 158
    Onion poultice, 57
    Operation, how to prepare patient for, 104
        room for, 108
        major, preparation of room for, 105
    Ophthalmia, 117
      neonatorum, treatment of, 118
    Opium, action and uses of, 36
        poisoning, 36
        antidotes for, 47
    Orange sherbet, how to make, 162
    Oven, heat of, how to estimate, 163
    Ovulation, 171
    Ovum, 173
    Oxalic acid poisoning, antidotes for, 45
    Ox-gall enema, formula for, 54
    Oyster broth, how to make, 154
    Oysters on half-shell, 155
        peptonized, 149
        scalloped, 154

    Pack, cold, 128
        hot, 129
        warm, 128
    Paraldehyd, 37
    Paralysis, infantile, 86, See _Poliomyelitis_.
    Parotitis, nursing in, 192
    Paste, Lassar’s, formula for, 53
        Unna’s, 53
    Pasteurizing of milk, 67
    Patient, how to prepare, for surgical operation, 104
    Pediculosis, applications for, 58
    Peptonization of milk, 71, 147
    Peptonized beef, formula for, 148
        oysters, 149
    Percentage solutions, tables for, 20
    Percussion in massage, 135
    Pericementitis, 75
    Perspiration, induction of, by hot packs, 129
    Peruvian bark, action and uses of, 28
    Phenacetin, action and uses of, 37
        poisoning, antidotes for, 47
    Phosphorus poisoning, antidotes for, 47
    Physostigma, action and uses of, 37
    Picric acid solution, formula for, 51
    Pigmentation in pregnancy, 176
    Pilocarpus, action and uses of, 38
    Placenta, 174
    Plaster, mustard, formula for, 56
    Pneumonia, nursing in, 82
        warm pack for, 128
    Poached eggs, 158
    Poisoning, mercurial, 35
    Poisons and antidotes, 45
    Poliomyelitis, 86
        classification, 88
        pathology, 88
        prophylaxis in, 90
        quarantine in, 90
        summary results from public school reports, 87
        symptoms of onset, 88
        treatment, 89
        serum, 90
    Popular and official names of medicinal preparations, 16
    Porridge, baked-flour, 159
        for diabetics, 170
    Postures, gynecologic, 114-116
        surgical, 114-116
    Potassium permanganate solution, 50
        poisoning, antidotes for, 47
    Potato biscuits, 164
        stuffed baked, how to make, 157
    Poultice, flaxseed, formula for, 57
        mustard, formula for, 57
        onion, formula for, 57
        spice, formula for, 57
    Pregnancy, baths in, 182
        care of bowels in, 181
        diet in, 181
        duration of, 177
        exercise in, 182
        symptoms of, 175
        table for calculating, 178
    Pregnant uterus, 173
    Preservation of eggs, 146
    Private nursing, disinfection in, 97
    Proprietary foods for infant feeding, 68
    Prostatectomy, instruments for, 113
    Protargol, 39
    Protective strips, how to prepare, 103
    Protein foods, 144, 145
        overuse of, 144
    Proteins, 142
    Prunes, stewed, 160
    Ptomain poisoning, 47
    Ptyalism, 35
    Puberty, 171
    Pudding, sauce for, 160
        sponge, how to make, 160
    Pulse-rate, 61
    Punch, milk, how to make, 152
    Pus in urine, 63

    Quarantine, 91
    Quickening, 175
    Quinin, 38

    Rat poison, antidotes for, 47
    Reaction of urine, testing of, 62
    Rectal dosage, 43
    Rennet tablet formula, 70
    Respiration, artificial, 126
        rate of, 61
    Rheumatism, 197
    Rice and oat muffins, 165
        cream, how to prepare, 159
        gruel, 69
        water, how to make, 150
    Rickets, nursing in, 194
    Roman numerals, 15
    Room for major operation, how to prepare, 105
        for operation, how to prepare, 108
        in confinement cases, 182
    Rooms, disinfection of, 97
    Rubber tubing, how to prepare, 102
    Rum, 24

    Salicylates, action and uses of, 38
    Saline enema, formula for, 55
    Salivation, 35, 175
    Salol, 38
    Salol vaselin, formula for, 54
    Salophen, 38
    Salt solution, normal, formula for, 49
        sterilization of, 109
    Sandwich, scraped-beef, 154
    Sanitas jelly, formula for, 53
    Sauce for pudding, how to make, 160
    Sauces for meat, list of, 166
    Scalds, treatment of, 124
    Scalloped oysters, how to make, 154
    Scarlet fever, nursing in, 83
    Scraped-beef sandwich, 154
    Scurvy, nursing in, 194
    Semmola’s mixture, formula for, 49
    Senna, action, uses, and dose of, 39
    Sherbet, how to make, 161
        lemon, how to make, 161
        milk, 161
        orange, how to make, 162
        strawberry, how to make, 162
    Show, 179
    Sick, preparation of foods for, 147
    Sickness, morning, 175
    Silk thread, sterilization of, 100
    Silk-worm gut, sterilization of, 100
    Silver, action and uses of, 39
        nitrate poisoning, antidotes for, 47
        stains, removal of, 47
        time to take, 43
    Sims’ posture, 114
    Sitting position of patient, contrivance for, 199
    Skeleton, bones of, 203, 204
    Skimmed milk, 69
    Skin and mouth in fevers, care of, 93
    Skin-grafting, instruments for, 112
    Sleep, baby, 188
    Soda poisoning, antidotes for, 47
    Soft diet, 169
    Soft-boiled eggs, 158
    Solution, boric acid, 50
        carbolic acid, 49
        cyanid of mercury, 50
        Dobell’s, 95
        for sore nipples, 52
        Harrington’s, 51
        iodin, 51
        of chlorid of lime, 51
        of potassium permanganate, 50
        picric acid, 51
        Thiersch’s antiseptic, 51
    Solutions, handy table of, 21
        obstetric, 187
        of formaldehyd, 51
        of various strengths, how to make, 21
    Soothing lotions for the hands, 52
    Spartein, action and uses of, 39
    Spasmodic croup, nursing in, 192
    Spice poultice, 57
    Splints, improvised, 123
    Sponge pudding, how to make, 160
    Sponging to reduce temperature, 129
    Sprains, care of, 124
    Squab, how to bone, 157
    Starch-water enema, formula for, 55
    Static electricity, 140
    Steam sterilizer, improvised, 109
    Sterilization of instruments, 99
    Sterilizer, improvised, 108 109
    Sterilizing bottles, 67
        catgut, 101
        gloves, 100
        glycerin, 102
        hand-brushes, 103
        horse-hair, 100
        linen thread, 101
        of milk, 67
        of obstetric set, 110
        of silk thread, 100
        of silk-worm gut, 100
        of small packages, 110
    Stewed prunes, 160
    Stimulating enema, method of administering, 56
    Stramonium poisoning, antidotes for, 48
    Strawberry sherbet, how to make, 162
    Stroking in massage, 133
    Strophanthus, action and uses of, 39
    Strychnin, action and uses of, 36
    Strychnin poisoning, antidotes for, 48
    Stuffed baked potato, how to prepare, 157
    Stupe, turpentine, 57
    Subcutaneous dosage, 43
    Sugars in infant feeding, 68
    Sulphonal, action and uses of, 39
    Summer complaint, nursing in, 194
    Sunstroke, treatment of, 126
    Supplies for major operation, 106
        obstetric, 187
        surgical, 99
    Suppression of menses, 175
    Surgical operation, how to prepare patient for, 104
        postures, 114-116
        supplies, 99
    Suspended animation from noxious gases, 126
    Sweat, alcohol, 130
    Sweating of feet and axilla, formula for, 54
    Swooning, treatment of, 125
    Sylvester’s method of artificial respiration, 126
    Syncope, treatment of, 125

    Taffy, how to make, 162
    Tannic acid, action, uses and dose of, 40
        as antidote, 48
    Tannin, action, uses and dose of, 40
    Tea as antidote, 48
        beef-, how to make, 153
    Teeth, eruption of, 77
        pain in, treatment of, 74
    Temperature of water, 61
        reduction of, by cold pack, 128
        by sponging, 129
        rules for taking, 61
    Test meals, 170
    Thermic fever, treatment of, 126
    Thermometric equivalents, table of, 60
    Thermometry, 60
    Thiersch’s solution, formula for, 51
    Thrush, nursing in, 194
    Time measure, 17
    Tincture of digitalis, 30
        of green soap, preparation of, 103
    Toad-stool poisoning, antidotes for, 47
    Toast, cream, how to make, 159
        egg, how to make, 160
        French, how to make, 160
        water, how to make, 150
    Tobacco poisoning, antidote for, 48
    Toothache, diagnosis and treatment of, 74
    Trendelenburg position, 116
        improved, 109
    Trional, action and uses of, 40
    True pains, 179
    Tubbing, 130
    Tuberculosis, treatment for, 199
    Tubing, rubber, how to prepare, 102
    Turpentine enema, formula for, 54
        stupes, 57
    Typhoid diet, 170
      fever, hemorrhage in, 81
        management of, 80
        nursing in, 79
        symptoms of, 79

    Ulcers, Lassar’s paste for, 53
    Umbilical cord, 174
    Unna’s paste, 53
    Uremia, 199
    Urine, albumin in, 63
        analysis, 62
        disinfection of, 82, 90
        pus in, 63
        reaction of, testing, 62
        twenty-four-hour specimens of, 63
    Urotropin, action and uses of, 40
    Uses of eggs, 145
    Uterus, pregnant, 173

    Value of fruits and vegetables, 145
    Vanilla cream sauce, how to make, 156
    Vaselin, borated, formula for, 53
        carbolated, 53
    Vaselin, salol, formula for, 54
    Vegetable soup for babies, 73
    Vegetables, value of, 145
        with milk soup, 157
    Veins of body, illustration of, 205
    Veratrum viride, action and uses of, 40
    Vibration in massage, 135
    Vinegar as antidote, 48

    Walcher’s posture, 115
    Warm pack, 128
    Washing fluid for soiled clothes, 91
    Water, 143
        temperature of, 61
        value of, 145
    Weights and measures, 17
    Whey for babies, how to make, 69, 70
        wine, how to make, 152
    Whisky, 24
    White-of-egg lemonade, how to make, 150,
    Whooping-cough, nursing in, 192
    Wine jelly, how to make, 156
        whey, how to make, 152
    Wines, 24
    Wounds, care of, 121

    Young’s rule for dosage of children, 42




Books for Nurses


Published by Saunders

Our books are revised frequently, so that the editions you find here
may not be the latest. Write us about any books in which you are
interested.

STONEY’S NURSING

This work gives you clear, definite instructions how best to meet all
emergencies—medical and surgical; how to improvise things needed in
the sick-room. There are chapters on _the nurse_—her responsibilities,
duties, deportment, etc.; on _the sick-room_—its preparation, care,
hygiene, etc.; on _nursing medical cases_—observations of patient,
bodily care, relief of functional disturbances, administration of
medicines, general and local applications; on _obstetric cases_—signs
of pregnancy, disorders of pregnancy, conduct of labor, care of mother
and child, cesarean section, etc.; on _gynecologic nursing_—preparation
for operation, after-care, sequelæ, surgical disinfection, accidents
and emergencies, nursing in infectious diseases, nursing of sick
children, etc.

    =Fifth Edition—Published August, 1916.=
    By EMILY A. M. STONEY. Revised by LUCY CORNELIA CATLIN,
    R.N.                                 Cloth, $1.75 net.

GOODNOW’S WAR NURSING

This _complete_ text-book shows the inexperienced nurse how to care
for a ward of wounded men from arrival to dismissal; it introduces the
auxiliary war nurse to _actual conditions_, and shows her how they are
best met. It is the ideal text-book on this important branch of the
service.

    By MINNIE GOODNOW, R. N., _War Nurse in France_.
    Cloth, $1.50 net.            =Published December, 1917=

STONEY’S SURGICAL TECHNIC

The first part of this work deals with bacteriology, antiseptics,
disinfectants, deodorants, including the theory of _antitoxins_. The
second part is devoted to a careful treatment of surgical technic.
An important chapter is that giving you the list of instruments
and supplies needed for the various operations—_illustrated_. The
chapter on _bandaging_ covers 20 pages, illustrated with _33 clear
line-drawings_. Preparation of _artificial foods_ for infants and the
exact formulas for antiseptic gauze dressing, etc., are given.

    =4th Edition—October, 1916.=
    By EMILY A. M. STONEY.      Cloth, $1.75 net.

LEWIS’ ANATOMY and PHYSIOLOGY

This work gives you the regions of the body, the internal organs, their
names, locations, functions, and the relation each bears to life.
The final chapter takes up repair and waste, nutrition, animal heat,
perspiration, and the power that supports and preserves health. At the
end of each chapter is a list of selected _review questions_, of great
help in self-examination. Throughout the book the _application_ of
anatomy and physiology to actual nursing is emphasized. There are 161
illustrations. Those showing the arteries, veins, and nerves are in
colors.

    =Third Edition—Pub. September, 1913.=
    By LEROY LEWIS, M. D.      Cloth, $1.75 net.

WARNSHUIS’ SURGICAL NURSING

Here you are given the essential basic principles of operative nursing.
Dr. Warnshuis presents facts gleaned from his own personal experience.
You are told the definite, specific things you must do throughout
the entire surgical procedure. Dr. Warnshuis’ instruction is always
clear and definite, and, in addition, he takes you through a typical
operation and shows you exactly how each little thing should be done.

    =Published March, 1918.=
    By FREDERICK C. WARNSHUIS, M. D.       Cloth, $2.50 net.

AIKENS’ PRIMARY STUDIES

Miss Aikens brings together in this book well-rounded courses of
lessons in anatomy, physiology, hygiene, bacteriology, therapeutics,
materia medica, dietetics, and invalid cookery—subjects which, with
practical nursing technic, constitute the primary studies in a nursing
course. Throughout the book there are many practical suggestions and
helps. The chapter on dietetics is really a monograph. At the end of
the book there are questions for self-examination, arranged by subjects.

    =Third Edition—Published June, 1915.=
    By CHARLOTTE A. AIKENS.      Cloth, $1.75 net.

AIKENS’ CLINICAL STUDIES

This work by Miss Aikens is written along the same lines as her
successful book for primary students. It takes up all the studies
the nurse must pursue during her second and third years in the
training-school. It gathers together in one volume matter previously
scattered in several books and often very unsystematically taught by
lectures. Here you get all this information stated in such a way that
the nurse will be able to grasp the subject with ease.

    =Third Edition—August, 1916.=
    By CHARLOTTE A. AIKENS.      Cloth, $2.00 net.

AIKENS’ HOSPITAL MANAGEMENT

The keynote of this work is _highest efficiency_. It is a book on
_modern_ hospital construction and management. Every phase of hospital
management is taken up and most profusely illustrated. Some of the
more important chapters are: The superintendent, the medical service
of a hospital, the furnishing of a 100-bed hospital, hospital incomes
and management, bookkeeping, the hospital store, the kitchen, the
laundry, surgical supplies, drug room, the training-school, out-patient
department, and laboratory.

    =Published April, 1911.=
    Edited by CHARLOTTE A. AIKENS.      Cloth, $3.00 net.

AIKENS’ TRAINING-SCHOOL METHODS

Miss Aikens solves for you those many problems that constantly arise
in the management of a training-school. She tells _how_ to teach,
_what_ should be taught the nurse, and _how much_. The chapter on
hospital ethics and discipline includes such subjects as head nurse’s
relation to rules, first principles in teaching ethics, honesty,
obedience, personality, social relations, discreteness of speech,
carriage, quietness, expression of appreciation, criticism, maintaining
discipline, personal responsibility, etc.

By CHARLOTTE A. AIKENS.

AIKENS’ ETHICS FOR NURSES

This book emphasizes the importance of ethical training for nurses. It
is a most excellent text-book, particularly well adapted for classroom
work. The plan of the book calls for a combination of the recitation
and discussion method of class teaching. The book is inspirational in
that it will arouse desires to work up to higher standards of life and
conduct. The illustrations and practical problems used in the book are
drawn from life. There is no other work just like this one.

    =Published April, 1916.=
    By CHARLOTTE A. AIKENS.      Cloth, $2.00 net.

ASHER’S CHEMISTRY AND TOXICOLOGY

It was Dr. Asher’s constant aim to make this work unusually useful to
the student nurse and to the nurse in postgraduate practice. You get
chapters on the elements, nomenclature, molecular and atomic weights,
non-metallic elements, the metallic elements, carbon and its compounds,
the acids, physiologic chemistry (proteins, milk, urine), giving the
technic for the tests, the formulas, chemical equations, etc.

    =New (2d) Edition—Published October, 1918.=
    By PHILIP ASHER, PH. G., M. D.      Cloth, $1.50 net.

WILSON’S OBSTETRIC NURSING

Dr. Wilson’s little book presents in detail everything connected
with pregnancy and labor and their management. The entire subject is
covered—from the beginning of pregnancy, its course, signs, on to
the approach of labor, its actual accomplishment, the puerperium,
complications, care of the infant, and after-care of the mother—_always
emphasizing the nurse’s duties_.

    =Third Edition—Published April, 1916.=
    By W. REYNOLDS WILSON, M. D.   Flexible leather, $1.50 net.

MACFARLANE’S GYNECOLOGY

Dr. Macfarlane’s work is a companion to Dr. Wilson’s successful book.
Both are flexibly bound in red leather with gold stamping, and fit into
the pocket. Here you get chapters on anatomy, physiology, hygiene,
menstrual disorders, gynecologic examinations and positions, douches,
diseases and their treatment, gynecologic operations—preparation for
them, after-care, etc.—urinary organs, rectal diseases. The text is
illustrated. It is decidedly a book you will carry with you in your
pocket.

    =Second Edition—Published May, 1913.=
    By CATHARINE MACFARLANE, M. D.      Cloth, $1.50 net.

BECK’S REFERENCE HAND-BOOK

You get in this one volume such important information as the action,
use, and dosage of the important drugs, poisons, and their antidotes,
miscellaneous formulas, tests for albumin, infant feeding, nursing in
the acute fevers, disinfection, all information needed for surgical
cases, emergency helps, baths and packs, massage, electricity, recipes,
obstetrics, nursing in children’s diseases, miscellaneous remedies,
essential anatomy. This work has been called _the nurse’s encyclopedia_.

    =Third Edition—Published February, 1913.=
    By AMANDA K. BECK.      Flexible leather, $1.50 net.

DUNTON’S OCCUPATION THERAPY

Dr. Dunton emphasizes the basic principles of occupational therapy and
gives those forms likely to be of most service to the nurse in private
practice. You get chapters on puzzles, reading, physical exercises,
card games, string, paper, wood, plastic and metal work, weaving,
basketry, chair-caning, book-binding, gardening, nature study, drawing,
painting, pyrography, needlework, photography, and music.

    By WILLIAM RUSH DUNTON, JR., M. D. Cloth, $1.50 net.
    =Published October, 1915.=

FRIEDENWALD and RUHRAH’S DIETETICS

This work gives the essentials of dietetics, and considers briefly the
chemistry and physiology of digestion. It gives you many _excellent
recipes_ for beverages, cereals, breads, vegetables, soups, milk
preparations, eggs, meats, raw beef, panopepton, meat jellies, diabetic
foods. But the strong feature about this book is the practical
information it gives you on the _dietetic management_ of your cases.
Then you get the milk cure, the salt-free diet, the _dietetic
management of surgical cases_, diet after operations, etc.

        =Fourth Edition.=
        By JULIUS FRIEDENWALD, M. D.,
                 and JOHN RUHRAH, M. D.
    Cloth, $1.50 net.      =Published July, 1917.=

McCOMBS’ DISEASES of CHILDREN

Dr. McCombs emphasizes _just those points you most want to know_.
He gives you a short but adequate description of each disease,
considerable attention to prophylaxis, methods of nursing, emergency
measures, illustrated descriptions of how to take the temperature,
pulse, respiration, perform intubation, give hypodermics, etc. You get
also special chapters on infant feeding, modification of milk, and
therapeutic measures employed in childhood.

    =Third Edition—June, 1916.=
    By ROBERT S. MCCOMBS, M. D.      Cloth, $2.25 net.

DeLEE’S OBSTETRICS

This work is used more extensively by nurses than any other book on
obstetrics. It really considers two subjects—obstetrics for nurses and
the actual obstetric nursing. A chapter of special value is that on
_massage of the breasts_, covering 20 pages, and showing you by lines
and arrows just exactly what directions the strokings should take. In
addition, you get the anatomy and physiology of the female reproductive
organs. The work contains 235 illustrations, many of them in colors.

    =Fifth Edition—Pub. July, 1917.=
    By JOSEPH B. DELEE, M. D.      Cloth, $2.75 net.

DAVIS’ OBSTETRIC NURSING

In this work every phase of obstetric and gynecologic nursing is
considered. You get really two books in one, the first half being given
over entirely to _obstetric nursing_ in all its complications, and the
second to _gynecologic nursing_, and the special training it demands.
You are told how to manage a case from pregnancy right on to the care
of the baby. You are told just how to meet every emergency. There is
an entire section on _obstetric surgery_. The _Fifth Edition_ has been
thoroughly revised.

    =Published May, 1917.=
    By EDWARD P. DAVIS, M. D.      Buckram, $2.00 net.

BOYD’S STATE REGISTRATION

For this new edition the entire work has been re-written, more than
doubled in size, and reset. You get a comparative summary of the laws
of the various States governing the registration of nurses, presented
in such form as to furnish a means of ready reference for the trained
nurse in choosing her field of activity. You get the requirements
for registration, the fees and their disposition, exceptions and
restrictions, violations and their penalties. This book tells you what
you have to do in any State.

    =Published February, 1915.=
    By LOUIE CROFT BOYD, R. N.      Cloth, $1.25 net.

PAUL’S MATERIA MEDICA

In this work you get definitions—what an alkaloid is, an infusion,
a mixture, an ointment, a solution, a tincture, etc. Then a
classification of drugs according to their physiologic action, when
to administer drugs of the various classes, how to administer them,
and how much to give. Next, the individual drugs are taken up. For
convenience, all the newer medicinal agents are placed in one section.

    =3d Edition—August, 1917.=
    By GEORGE P. PAUL, M. D.      Cloth, $1.50 net.

PAUL’S FEVER NURSING

In the first part you get chapters on fever in general, hygiene, diet,
methods for _reducing the fever_, alleviation of symptoms, detection
of complications. In the second part each infection is taken up _in
detail_. In the third part you get antitoxins and vaccines, bacteria,
urine examination, warnings of the full dose of drugs, poisons,
enemata, etc.

    =Third Edition—Published October, 1915.=
    By GEORGE P. PAUL, M. D.      Cloth, $1.00 net

HARDING’S HIGHER ASPECT OF NURSING

Miss Harding’s book is a study of character building, founded on
personal experience. It will be a help not only to the student nurse,
but also to those in active practice in hospitals or private homes.
She tells you how to become a “real” nurse, emphasizes the necessity
for striving for higher ideals, telling you many things that will make
for this end. She impresses upon you the responsibilities of nursing
service, shows you how to anticipate difficulties and how to avoid or
overcome them.

    By GERTRUDE HARDING.      =Published March, 1919.=

W. B. SAUNDERS COMPANY

West Washington Square, Philadelphia

London: 9, Henrietta Street, Covent Garden