THE SICKROOM. (continued 3)

Coughing is greatly under the control of the will, and children ought to be taught to try to restrain the inclination to cough; very often, by this very effort, the desire to cough will vanish. If it cannot be avoided, they should be taught how to cough. It is not in the least necessary to give way to coughing on every occasion, even though there be really something to expectorate, until the mucus or other irritating matter be within easy reach, and then one good, effective, deliberate cough will do as much, or probably more, for the relief of the individual, than perhaps a dozen repeated, noisy, resultless fits of coughing. The noise which accompanies the act can be greatly modified at the will of the individual. There are some people who make not the slightest effort to lessen this annoyance. In many cases the mouth may be closed, and in all the hand may be held before the mouth during the act, whereby considerable modification of the noise may be attained.

Avoid making use of any nostrum vaunted as a cure for all sorts of coughs and colds: all contain opium in some form, and may prove prejudicial to the complaint which initiates the cough. At the same time, a distressing cough calls for amelioration. There never can be harm in causing the patient to inhale steam from a sponge or basin of boiling water; or infusion of hops may be inhaled. Lozenges of various kinds are often useful, e.g. fruit, gum, glycerine, liquorice, marsh-mallow, tamarind, ipecacuanha, &c. Linseed-tea is a bland, soothing demulcent, useful in sore throat, and in allaying tickling cough.

The common mullein, Verbascum thapsus, has long been used in Ireland as a domestic remedy for consumptive cough, and Dr. Quinlan finds that when boiled in milk the patient takes the decoction readily, and experiences a physiological want when it is omitted. Its power of checking phthisical looseness of the bowels and the relief afforded to coughing are very marked, so that patients take hardly any other cough mixture. In early stages it appears to have a distinct power of increasing weight, but in advanced cases Dr. Quinlan remarks that he is not aware of anything that will do this except koumiss. (Brit. Med. Jour.)

Dr. Square recommends a solution of 1 part ethyl bromide in 200 of water as a remedy for whooping-cough. This is of similar strength to the chloroform water of the British Pharmacopœia, and its dose is the same, namely, ½-2 oz.

A German journal mentions a case of whooping-cough treated with turpentine by Ringk, of Berlin, with astonishing results. The patient was a little girl 3½ years of age, and a fatal issue seemed imminent. The doctor prescribed ol. terebinth., 10 grams; syr. altheæ, 80 grams; a teaspoonful every 3 hours. The next day the child was sitting up in bed, with a great slice of bread and butter in her hand, which she was eating and evidently enjoying. The cough had totally disappeared, and no evil results followed.

Following are a few simple recipes for expectorants, useful for winter coughs. The first is particularly suitable for young children:—(a) 1 fl. dr. syrup of squills, ½ fl. dr. gum acacia, powdered, 8 gr. ammonium chloride, enough peppermint water to make 2 fl. oz. Dose for a child, 1 teaspoonful every 2 hours. (b) For older children and adults, 2 parts syrup of ipecac., 4 syrup of squills, 1 paregoric. Dose, ½-1 teaspoonful, repeated as often as necessary. (c) 1 oz. syrup of ipecac., 1 oz. syrup of tolu, ½ oz. paregoric, 1 oz. syrup wild cherry. (d) For hoarseness, Dr. Eichelberger gives the following, which he says is very good:—2 dr. tinct. chloride of iron, 4 dr. glycerine, 4 dr. water. Dose, ½ teaspoonful.

Sore throat is a constant accompaniment of some very serious disorders, such as scarlet fever, measles, smallpox, diphtheria, &c., but is most frequently the result of exposure to cold and damp, when the body is heated. It may be confined to the parts situated at the back of the mouth, i.e. the tonsils, palate, and pharynx, or it may extend a little further into the windpipe. The affection is an inflammation of the mucous membrane of the parts enumerated. Many cases speedily recover without any active treatment, provided the invalid will have patience for a few days, confine himself to the house, better to one apartment, and still better to bed, for a couple of days; avoid all conversation; apply a warm poultice to the throat, or a moist compress round the throat night and day. This last is made by wringing a piece of lint, or a pockethandkerchief, out of water sufficiently so that it does not drip, and it is of small moment whether the water be cold or warm; it is now applied to the throat, and covered with a piece of macintosh, and then a woollen comforter is put over all. Ice may be sucked continuously, if agreeable to the patient. If it be not, then a gargle of warm milk and water should be employed every hour. A smart aperient dose of Epsom salts or castor oil should be taken in the morning before breakfast, 1 tablespoonful salts in a tumblerful of hot water. If, under this treatment, the throat do not improve in 2 days, it has ceased to be a minor ailment, and the physician must be sent for.

A very painful form of sore throat is that called quinsy. It is inflammation of the tonsils, two glands situated at the back of the mouth. This inflammation is principally observed in changeable climates; and seems to attack, by preference, young adults. Children rarely suffer from quinsy. Persons who have once been the subjects of this ailment are very liable to a recurrence of the disorder. The most common exciting cause is exposure to wet and cold, with a chilly east wind.

Those who are liable to this form of sore throat, and know from the premonitory symptoms what is impending, ought at once to adopt preventive measures. These consist in using strong astringent gargles; in the administration of single drop doses of tincture of aconite, every hour, for half a day, and a brisk saline purgative in the morning, such as a dose of Rochelle salts. For gargle, one of the best is the old-fashioned homely mixture, consisting of 3 tablespoonfuls red wine (port or claret), 1 of vinegar, ½ teaspoonful powdered alum, and a little sugar, in a tumbler of cold water. This to be used every hour. If, however, the affection has gone too far for this abortive treatment, then the patient must be confined to bed; hot poultices must be kept constantly applied to the throat; steam from hot water should be inhaled often; a gargle of hot milk and water should be used hourly; and ice, if grateful, may be constantly sucked. A sal prunelle ball may be allowed slowly to dissolve in the mouth. The diet should be in semi-solid form, e.g. arrowroot made with milk, soup thickened with rice-flour, or better still, beef-jelly, if the patient can be persuaded to swallow at all. If the abscess do not speedily rupture, and more particularly if both tonsils be simultaneously affected, then it may be necessary to call in the aid of the surgeon to lance it. The necessity for this will be evident by continued and increasing distress of the sufferer, great difficulty in breathing, and extreme restlessness and feverishness. In a first attack, too great delay ought not to be allowed to take place before getting professional assistance.

Every one has a cure for sore throat, but simple remedies appear to be most effectual. Salt and water is used by many as a gargle, but a little alum and honey dissolved in sage tea is better. An application of cloths wrung out of hot water and applied to the neck, changing as often as they begin to cool, has the most potency for removing inflammation. It should be kept up for a number of hours; during the evening is the usually most convenient time for applying this remedy.

For loss of voice in singers and speakers, Dr. Corson recommends the patient to put a small piece of borax (2-3 gr.) into the mouth and let it dissolve slowly. An abundant secretion of saliva follows. Speakers and singers about to make an unusual effort should the night before take a glass of sugared water containing 2 dr. potassium nitrate (saltpetre) in order to induce free perspiration. In similar circumstances this gargle may also be used:—6 oz. barley water, 1-2 dr. alum, ½ oz. honey. Mix, and use as a gargle. Or an infusion of jaborandi, made by putting 2 scr. of the leaves in a small cup of boiling water, drunk in the morning before getting up. The free sweating is said very quickly to restore the strength of the voice.

Constipation.—Short of mechanically obstructive disease, there are many states in which constipation is the most marked feature. On the nature of these, apart from the mere symptom, the possibility of permanent relief by treatment must of course largely depend. We may procure comfort with a pill, but often we cannot retain it with many. Habit cannot be reformed or expelled by purges. Accordingly, when we proceed against the fault of habit, now under notice, we must take account of the constitution and circumstances in which it is formed. By so doing we do much to ensure the desired relief, though it may be that even then we fail somewhat of complete success. A bowel long deficient in activity, dilated irregularly, with torpid though thickened walls, does not soon, if ever, renew its original tone and contractility. The difficulty is a pathological one, and arises from structural as well as functional perversion. The natural efforts to obtain relief are hindered and enfeebled by the effects of some cause which may still be operative. If we would undo the past or prevent further mischief, we must seek and treat that cause. Aperients of different kinds, however potent at the time, are but temporary palliatives of discomfort so long as no pains are taken to trace the trouble to its origin. Whether it be a sedentary habit of life, an excess of food overloading and overworking the viscus, purgation draining and depleting it, gout, diabetes, struma, chlorosis, altering either the structure of the intestinal wall or the consistence of its contents, it must be sought for as a chief guide to the means of cure. It is not likely that constipation will ever form the chosen hobby of a specialist. A far too general view of medicine and its adjuvant sciences is necessary for successful treatment to encourage such appropriation. We are not, however, outside the sphere of nostrums. There is in our time, if anything too much reliance on physic-taking for constipation. More might be done by appropriate dieting and by inculcating active habits of life than is customary. It may be noted, with regard to diet in particular, that a free use of simple fluids, as water, or mild mineral waters, is of distinct advantage in assisting both digestion and evacuation. There are also many aperient vegetable foods which, with the same end in view, we should like to see in daily use at the table. Almost any kind of wholesome fruit and green vegetable might thus be made serviceable. When, again, we come to medicines, we must remember that the disorder which we have to combat is a complex one. We cannot in this case, more than in any other morbid state, put a finger on one tissue as alone or invariably at fault. Thus in the costiveness of anæmia we have atony of the intestinal muscle combined with defective secretion, and both but part of a general tissue starvation; in the gouty disorder of elderly people the same conditions appear, though due to a very different dyscrasia; and so on. We may say, therefore, speaking generally, that no single drug can be relied on to meet the intestinal difficulty. An agent which aids secretion either of bowel or liver will not alone suffice. The long-inactive muscular coat likewise requires assistance. A free purge may have its value now and then, but when the object to be attained is the correction of a habit, a milder remedy used regularly is much more effective. To meet these various necessities, perhaps no combination is superior to the time-honoured union of belladonna with the compound rhubarb pill and nux vomica, or the most recent mixture of the fluid extract of cascara with the last-named drug. An agreeable change of remedy is afforded by many aperient mineral waters. The effect of these latter, however, is unfortunately apt to pass off after a time, probably from their causing a too copious intestinal secretion. The action of saline or other enemata is not quite similar. More strictly local, and exerted rather on the fæces than the bowel, it gives relief without so much exhausting the latter by secretion or peristalsis; while the very rest which the colon thus easily obtains is itself a help to the recovery of normal nutrition and muscular tone. The chief points which we would therefore bear in mind, whatever the remedies used in combating the habit of costiveness, are the need for recognition of its primary cause, and the fact that its proximate condition is an atonic bowel. (Lancet.)

Dr. Mortimer Granville gives 3 prescriptions for habitual constipation. It is indispensable to regard persistent inactivity of the bowels, when not demonstrably due to other causes, as the result of, either defect of peristaltic action; deficient glandular secretion; or interruption of the habit of periodic evacuation.

When there is a lax and torpid condition of the muscular coat of the alimentary canal, we get food retained in the stomach or intestines until it ferments, or sometimes “decomposes,” with the result of distension, pain mechanically induced, and either eructations or incarcerated flatus. In a considerable number of cases this last-mentioned trouble is so great, and at the same time so masked, as to give rise to the impression that grave disease exists; whereas every anomalous symptom has quickly disappeared as soon as the muscular tone has been restored, and the contents of the bowels have commenced to pass naturally on their course. The essential fault is partial, in some instances almost complete, loss of the reflex contractility of the muscular coat, so that the presence of ingesta at any part of the canal does not excite the intestine to contract and propel it onwards. It is worse than useless to employ ordinary aperients in such a condition as this; they only irritate without strengthening the nerves, on the healthy activity of which everything depends. When, therefore, there is the form of “constipation” which requires treatment, use a prescription something like the following; and it is, in the majority of instances, successful:—

Sodæ valerianatis gr. xxxvi.; tincturæ nucis vomicæ ♏ lx.; tincturæ capsici ♏ xlviii.; syrupi aurantii ℥iss.; aquâ ad ℥vj. Misce, fiat mistura, cujus sumatur cochleare magnum ex aquâ ter die, semihorâ ante cibum.

The second form of constipation, in which there is a deficiency of glandular secretions generally throughout the intestine, manifested by a peculiarly dry and earthy character of the dejecta when the bowels do act, may be treated by a mixture such as this:—

Aluminis ʒiij.; tincturæ quassiæ ℥j.; infusi quassiæ ℥vij. Misce, fiat mistura, cujus sumantur cochlearia duo magna ter quotidie, post cibum.

The third form, which depends chiefly on interruption of the natural habit of periodic discharge, often results from repeated failure to move the bowels, in consequence of one or other of the two preceding forms of this trouble. This may generally be relieved by directing a perfectly regular attempt to go to stool, and by the use of the following draught, taken the first thing after rising from bed—not on awakening—in the morning, as nearly as possible at the same hour. It will be observed that it is not an aperient in the ordinary sense of the term. It is, as a rule, neither necessary nor desirable to continue it for longer than a fortnight. In most instances, it will be found to re-establish the normal habit in a week or less.

Ammoniæ carbonatis ʒj., tincturæ valerianæ ℥j.; aquæ camphoræ ℥v. Misce, fiat mistura; capiat partem sextam in modo dicto. (Brit. Med. Journ.)

The value of castor oil as a family aperient is undoubted. Referring to its use, Dr. Soper enlarges on the great advantages of a combination of castor oil and glycerine in equal proportions to act as a purgative. Glycerine has great therapeutic value, especially in its solvent properties, and this combination renders it especially valuable. In regard to castor oil, a great mistake is often made in the largeness of dose administered; in this mixture, only ½ teaspoonful is required combined with an equal bulk of glycerine. In all cases of chronic constipation, piles, &c., it has proved most useful. Also ½ teaspoonful doses in the early stages of bronchitis seem to promote exudation from the tubes, and is certainly expectorant. The great difficulty is the obstinacy with which the mixture becomes a mixture, as it can only be made by placing the bottle in hot water and violently agitating. By adding the oil to the glycerine gradually, and mixing the two in a mortar, the taste of the oil completely disappears. The following is recommended as a pleasant form for children:—1 dr. castor oil, 1 dr. glycerine, 20 drops tincture orange peel; 5 drops tincture senega; cinnamon water to make up ½ oz. mixture.

Consumption.—It is highly probable that adult mortality from phthisis might be considerably reduced, if members of phthisical families, and persons of phthisical habit and tendency, could be induced to pursue an intelligent course of life. In wisely-chosen food, suitable exercise, well-adapted clothing, and pure air, are four distinct and potent details of every-day life, well within control, which may be turned to efficient account in the prevention of phthisis. Precautions, if they are to be effectual, must not be put off until signs of lung mischief become manifest. Then the evil can only be mitigated, not avoided. If consumption be apprehended, the daily diet should be rich both in nitrogenous flesh-forming and fatty constituents. The especial nutritive value of milk in such a case is universally recognised. Next to well-arranged daily food, exercise in the open air is of the greatest importance. On this point the late Dr. Parkes laid down the rule that “the best climates for phthisis are perhaps not necessarily the equable ones, but those which permit the greatest number of hours to be passed out of the house.” By well-adapted clothing, many of the chills, catarrhs, and pulmonary congestions which often lead up to consumption, might be prevented. The rules in this respect are well established. The feet should always be dry and warm; the covered parts of the body, excepting the head, should be clothed in suitable woollen fabrics; the underclothing should be kept of the same thickness all the year round, and variations of apparel to suit the changes of season be made only in the outer garments; and no constrictions or compressions should be allowed to hamper the respiratory play of the chest and abdomen, or to impede the circulation of blood through the lungs and heart. With regard to the respiration of pure air, it may be said generally that it is within doors that the breathing of vitiated air is most likely to become dangerous, and is such a powerful excitant of consumption. (Brit. Med. Journ.)

No person, particularly if young, should be allowed to sleep in the same bed, or even in the same room, with a consumptive. No person should be allowed to remain for too long a time in too close or too constant attendance on a consumptive. Ventilation as perfect as possible should be secured. The expectoration of phthisical patients should be carefully disinfected. Those phthisical patients who are in the habit of mixing freely with other persons should wear one of those antiseptic respirators which are now to be obtained for a few pence.

Corns.—(a) Salicylic plaster has recently been put upon the market as a cure for corns, bunions, and thickened skins generally. The price is reasonable enough, but some may prefer to make it for themselves. Dissolve 2 dr. each of salicylic acid and common yellow resin in 6 dr. sulphuric ether, and paint the solution over belladonna or opium plaster spread on swan’s-down. The mixture dries almost instantaneously, and the plaster is then ready for cutting up into suitable sizes for corns. Considering that the whole does not cost more than 3-4s. per yd., and that several thousand plasters may be made out of that quantity, it is cheap.

(b) Some corns are so painful that neither paint nor plaster can be endured, something of the nature of a shield alone giving relief. For such cases as these, the following wrinkle may be appreciated: Take a corn-shield, enlarge the diameter of the hole to a small extent by means of a knife or scissors, and apply in the usual way. Then place in the hollow thus formed over the corn, a small quantity of any of the following solutions: Salicylic acid and extract cannabis indica dissolved in ether; or ½ dr. extract cannabis indica dissolved in 2 dr. liquor potassæ; or a saturated solution of iodine, or iodide of potash, in strong alcohol. The shield does the double service of taking the pressure of the boot off the corn, and at the same time preventing the liquid being rubbed off by the sock; while all these solutions penetrate the skin with more rapidity than the usual collodion preparation, and are consequently much more effective in their operation. The saturated solution of iodine often succeeds in removing corns and indurated epidermis when other remedies have failed, and the well-known solvent action of liquor potassæ is a sufficient credential to induce for it at least a trial.

(c) Many corns may be removed by a persevering application of the ordinary shield, which, relieving the pressure of the boot, enables nature to throw off the old skin. Acetic acid, too, is an excellent remedy for corroding the indurated epidermis; but it is necessary to protect the surrounding parts by means of a paper shield.

(d) Mix 16 fl. oz. collodion with 2 oz. (avoir.) salicylic acid, and, when this is dissolved, add 1 oz. (avoir.) zinc chloride. Keep it tightly stoppered and away from lights or fire.

(e) Three dr. euphorbium, 6 dr. powdered cantharides, 4 dr. Venice turpentine, 4 oz. alcohol. Macerate the euphorbium and cantharides with the alcohol for 48 hours, strain, and add the Venice turpentine; spread on French tissue-paper with a soft brush—size of each sheet about 18 by 24 in. This article is in much repute for the cure of corns and bunions, and the relief of gout.

(f) Dissolve 1 part salicylic acid in 40 of collodion: apply several times a week. The corn dissolves with little trouble.

(g) For hard corns apply at night a mixture of 1 part carbolic acid, and 10 of distilled water, glycerine, and soap liniment. Envelop with guttapercha tissue, and the corn may generally be removed the next morning.

(h) Gezou’s remedy for corns and warts is prepared as follows:—30 gr. salicylic acid, 10 gr. ext. cannabis indica, ½ oz. collodion.

(i) Fasten a piece of lemon on the corn, and renew night and morning. Simple but very effective.

Diarrhœa and Dysentery.—Beyond everything stands a strict regulation of the diet. When the intestinal canal is in a diseased state almost any substance introduced into the stomach acts mischievously, and it is not infrequently necessary to suspend all food until the intestine is in a condition to bear it. Every solid article is then mischievous, but even fluids, by reason of their temperature, may act as prejudicially. In most cases taking a few spoonfuls of warm soup, or drinking a mouthful of cold water will immediately be followed by severe colics, and soon afterwards by evacuations. Only allow lukewarm soups or other drinks, and only by a spoonful at a time. Of course these stringent rules apply to very obstinate diarrhœa, and especially dysentery, for there are many cases of temporary diarrhœa in which the patients continue to eat fruits and the like, and still soon get well. Such cases must, however, not be taken into account, and it is always most prudent at the commencement of diarrhœa to cut off the supply of food as far as possible, and at all events to prohibit all articles likely to augment the affection.

Opium is the most valuable medicine in diarrhœa, for it keeps the sphincter in a state of permanent contraction, a contraction which is often propagated to the large intestine, and the small intestine is unable to propel its contents far enough to induce the irritation which causes their expulsion. When, by reason of this contraction, these contents are retained, their amount may become considerably diminished by the absorption of the fluid. Frequently, however, there is no spot of the canal which is not so diseased as to prevent such absorption taking place, and then the diarrhœa will continue in spite of the opium and of the contraction of the sphincter. It appears, moreover, that opium, besides its action on the muscular portion of the canal, exerts, by contact, a soothing effect upon the mucous membrane. In consequence of the diminution of the irritation of this membrane, its secretion is probably lessened, as are possibly those of the liver and pancreas. However this may be, opium acts very favourably in profuse secretion from the intestinal mucous membrane. From ½-3 gr. may be given in the 24 hours, the best preparation being the ext. opii aquosum.

If opium or morphia do not suffice, it must be aided by astringent remedies, by far the best of which, and the most easily supported, is zinc sulphate. One would have supposed that tannin in its separate state would have proved more useful than zinc, but this is not the case, and it is much less easily borne. It acts much better and more energetically when employed as a household remedy (e.g. as a decoction of sloe or wild pear tree) than in its separated form, and is then of great service in practice among the poor. Alum is of no use whatever in diarrhœa. Lead approaches zinc in efficacy, but still it is less certain than it. The dose should not be greater than ¼ gr., and this may be repeated every 2-3 hours, and at most every hour. If these means do not suffice, we must have recourse to enemata of salep or starch (with which may be combined 1 gr. opium or ½ gr. zinc) not throwing up more than 2 oz. at a time. If the clyster does not cause pain in the rectum, and the disease continues obstinate, the dose of zinc may be increased to 2 gr. Tannin may be added to the enema, but the zinc is far more serviceable. In the most obstinate cases we must have recourse to cauterisation; but this is only the case when there is a diseased condition of the lower part of the rectum. Very obstinate cases of blenorrhœa confined to the anus maybe completely cured by the application of silver nitrate, in substance as high as it can be passed. The injection of a strong solution does not usually attain the same end. (Prof. Skoda.)

A case of chronic diarrhœa, which had lasted for nearly 40 years, was cured by the administration of a saturated solution of salt in cider vinegar, 1 dr. being taken 3 or 4 times a day; it always produces good results.

For cholera, a ready remedy is Dr. Rubini’s tincture of camphor, taken on sugar, not in water. Or 1 teaspoonful cayenne pepper in ½ wine glass brandy.

To stop violent diarrhœa, take 2 drops each brandy and laudanum in 1 teaspoonful water every 3 minutes; go up to 60 doses if necessary.

Dr. Christopher Elliott speaks strongly in favour of the use of camomile tea in infantile diarrhœa. The dose for infants under 1 year is ½-1 dr., and double that quantity for older children, given 2 or 3 times a day, or oftener. The rationale of the action is the power the drug possesses of subduing reflex excitability. This power belongs especially to the volatile oil contained in the flowers.

Dislocations.—These are distinguished from broken bones by stiffness at the joint, intense pain and swelling. They demand surgical skill and must not be touched by any one but a doctor.

Ear complaints.—Do not wear anything over the ears which presses upon them. Growths may occur in the ear from the custom of wearing ear-rings, and especially when of base metal, although gold ones sometimes give rise to the same. Such may require removal by the surgeon’s knife. Inflammation may be set up in the lobe after piercing it for wearing ear-rings, should a portion of gristle happen to be transfixed by the needle, and all the more likely should that be a dirty or rusty one. The best thing to do is to bathe it frequently with hot water. The silly habit of pulling children’s ears is very liable to cause disease and injury. Never “pick” the ears with any sharp implement. For removing excess of wax, syringe gently with warm water, softening it first, if necessary, by dropping a little glycerine and water or soda dissolved in water, into the ear for a night or two. Any foreign body (including insects) accidentally getting into the outer ear can generally be removed by dropping a little warm water or salad oil into the ear, and then inclining the head. The popular dread of their getting into the brain is utterly unfounded: the drum head of the ear is an effectual stop. Dr. Jacobi remarks that closing the mouths of infants and children and simply blowing into the nose is often a very valuable method of relieving earache, the cause of the trouble probably being a catarrhal affection of the Eustachian tube. Perhaps even better is the method of inflating the ear by blowing into it gently, while the mouth and nose are held closed, and syringing the ear with warm water. Much harm has been done by putting oil, chloroform, laudanum, the heart of roasted onion, and similarly improper things into the ears of children.

Eye complaints.—In every case skilled advice should at once be sought. The following remarks relate only to what should be done in urgent cases ere professional assistance can be obtained. In inflammation, simple bathing with water (either cold or tepid as the sensations may direct) is the safest remedy, and no other application should be had recourse to, till sanctioned by the doctor. The practice of applying poultices, common bread and water, bread and milk, tea-leaves, porridge, &c., to an inflamed or injured eye is totally wrong, often endangering the sight. Keeping wet cloths applied to the eye, and bandaging up an inflamed eye, may also be productive of much mischief, and should never be employed without orders.

A particle of foreign matter entering the eye will often produce such a flood of tears that it is soon washed out, especially if the eye be kept closed and not rubbed for a few minutes; but sometimes the irritating substance finds its way under the upper eyelid, and remains fixed there by the pressure of the lid. In some cases plunging the face into cold water and opening the eyes under the water will suffice to remove it, but generally the eyelid requires to be turned inside out, and the offending body picked off with a feather; or the upper eyelid drawn forwards off the eye by means of the eyelashes, and the lower eyelid pushed up under it: when the eyelids are released, the eyelashes of the lower lid will brush over the inner surface of the upper lid, and almost certainly remove any substance that may lodge there. To evert the lid, lay a bodkin or pencil along it, and turn it up by taking hold of the eyelashes about the middle, the patient meanwhile looking down. Should such simple means fail, the eye may be tied up with a pad of cotton wool over it, so as to prevent the eyelid moving till professional advice be secured.

Serious damage is frequently occasioned by lime or other caustic substance getting into the eye. Wash the eye as quickly as possible thoroughly with cold water or vinegar very much diluted with water (say 1 teaspoonful vinegar in 2 oz. warm water), a stream being allowed to course across the opened eye, while any particle of caustic substance that remains should be carefully removed. A drop of castor oil or olive oil applied every half-hour to the inside of the eye will greatly allay irritation. Never bandage or poultice. In all cases of injury the less done at home the better. A light pad of cotton wool applied over the closed lids and kept in position by a handkerchief or a pledget of cotton wool soaked in cold water reapplied cold at least every 5 minutes, may be employed till the doctor comes.

Dr. Louis Fitzpatrick says he has never seen a single instance in which a stye continued to develop after the following treatment had been resorted to: The lids should be held apart by the thumb and index finger of the left hand, or a lid retractor, if such be at hand, while tincture of iodine is painted over the inflamed papilla with a fine camel’s-hair pencil. The lids should not be allowed to come in contact until the part touched is dry. A few such applications in the 24 hours are sufficient. (Lancet.)

Hair complaints.—Ladies should undo their hair at night, unplait the hair, and wear it loosely in a net. In this way the nourishment of the hair is duly provided for. Night-caps should always be light. When forced to remain in bed for long periods, through illness, have the hair oiled and combed with a coarse comb daily; if circumstances permit, the head may be washed twice a week with soap and water, warm, lukewarm, or cold, as taste or health directs. In long-continued illness, it is often advisable to cut the hair, so as to reduce its length by about a third, not merely from considerations connected with the cleanliness of the hair, but also that stronger aftergrowth may be encouraged. Few realise the injurious effects of curling-irons and hair-dyes.

Ordinary baldness may be constitutional or local. The former is a matter for the medical man. For persistent daily loss of hair, the following remedy is recommended by Pincus:—15 gr. soda bicarbonate dissolved in 1 oz. water; a little to be well rubbed into the scalp daily, and persisted in. Sir Erasmus Wilson says that a lotion composed of 1 oz. each spirits of hartshorn, chloroform, and sweet almond oil, added to 5 oz. spirits of rosemary, and well rubbed into the roots of the hair after brushing, is effective; it may be used half-strength, diluted with eau-de-cologne. Other lotions are:—(a) 2 dr. tincture of Spanish flies, ½ oz. tincture of nux vomica, 1 dr. tincture of capsicum, 1½ oz. castor oil, 2 oz. eau-de-cologne; apply night and morning with a sponge to the roots of the hair after brushing. (b) 2 oz. spirit minderus, ½ dr. ammonia carbonate, ½ oz. glycerine, ½ oz. castor oil, 5 oz. bay rum; apply as in (a). These will be found serviceable in the treatment of commencing general baldness, where the whole scalp is parting with its hair. Singeing the hair is not of the slightest use for hair stimulation, and the frequent use of the “curling-tongs” cannot but be detrimental to the health of the head-covering. When the hair demands a tonic application, the following—which any chemist will compound—may be tried:—1 oz. tincture of red cinchona bark, 2 dr. tincture of nux vomica, ½ dr. tincture of cantharides, add eau-de-cologne and coconut oil to make up 4 oz.; apply to the roots of the hair with a soft sponge night and morning. Where means are being taken to restore the health in cases of sudden or premature greyness of hair, Dr. Leonard recommends the following application:—2 oz. coconut oil, 3 dr. tincture of nux vomica, 1 oz. bay rum, 20 drops oil of bergamot. Washing with egg yolk is highly commended in such cases.

The common trouble known as dandriff (dandruff) frequently occurs in strumous (scrofulous) individuals who are anæmic (poor-blooded) and have a sluggish circulation, marked by cold hands and feet. Adolescence is its peculiar time of appearance, and chlorotic (greenish skinned) young girls are apt to be annoyed by it. It is an attendant upon chronic debilitating diseases, as rheumatism, syphilis, phthisis, and the like, and comes on after profound disturbances of the constitution, such as fevers and parturition. Dyspepsia and constipation are very common exciting causes or aggravants of the disease. Improper care of the scalp, the use of the fine-toothed comb, and of pomades, hair “tonics,” and hair-dyes will give rises to disorder.

A good deal in the way of prevention, according to Dr. Jackson, can be accomplished by proper care of the scalp and general health. The brush should have its bristles well set into the back, placed in little clumps at regular distances and rather far apart, and those in each clump should be of unequal length and arranged so that the longest ones are in the centre of the group. It is well to have two brushes, one stiff enough to warm the scalp when used with vigour, and one quite soft. The comb should be made with large teeth set wide apart; held up to the light the teeth should show no roughness or inequality of surface. The fine-toothed comb should be banished from the toilet table, as it is an active agent in producing inflammatory conditions of the scalp. In the morning the hair should be thoroughly opened up in all directions with the comb, and it and the scalp brushed vigorously with the stiff brush. Then the soft brush should be used in parting the hair, in polishing it, and in subsequent brushings during the day.

Do not wash the head too much. The so-commonly practised daily sousing of the head in water is hurtful to the hair and scalp, especially if they are not carefully and properly dried afterwards, and a little oil or a vaseline rubbed into the scalp. It is not the daily sousing which is objectionable, but the insufficient aftercare. Water renders the hair dry, and the daily sousing only washes the head superficially. A good shampoo every week or ten days for those persons exposed to a good deal of dust, and every 2-3 weeks for other people, is sufficient for cleanliness. For the shampoo, soap and water, borax and water, or the yolk of an egg beaten up in lime water, are all simple and good, but it must not be forgotten to wash out these materials with plenty of clean water, and to thoroughly dry the hair and scalp.

Patent hair “tonics,” pomades, washes, and dyes are to be avoided. None of these dressings is needed by the healthy scalp, and proper care will preserve the hair in better condition than they will. The nearer the body can be kept to the standard of perfect health by means of bathing, exercise, and good diet, the less likely is dandruff to develop. When, therefore, the disease has appeared, first inquiries should be concerning the general health, and first efforts addressed to remedying anything found to be wrong.

If the case presents itself with a decided accumulation of scales, or if crusts are present, saturate with sweet almond oil, before going to bed, and place over the head a flannel cloth soaked in the oil, and outside of all an oiled silk cap. Next morning shampoo thoroughly with soap and water, using by preference the tincture of green soap, and wash out the soap with plenty of water. The scalp is then to be dried by vigorous rubbing with a coarse towel, and the hair by pulling it through a soft towel. If the crusts by this method are not completely removed, the oil should be kept on during the day, the head again soaked at night, and washed with the soap and water in the morning. If the scalp should appear very hyperæmic after the crusts are removed, anoint the head with red vaseline or some simple ointment, as rose ointment, until lessened. When the crusts are removed and the hyperæemia overcome, have an ointment composed of 1 dr. sulphur loti to 1 oz. vaseline, applied every morning to the scalp. If the scales form rapidly, apply every night, and the sulphur ointment every morning, and wash the head every second or third day. As soon as scaling is lessened stop the use of the oil, but continue the ointment, at first using it every second morning, then gradually reducing its application to once a week. Throughout this plan of treatment the head should be shampooed about once a week with a tincture of green soap, borax and water, or the yolks of 3 eggs beaten up in 1 pint lime water, to which ½ oz. alcohol is added. Another excellent ointment for these cases is composed as follows:—

℞Hydrarg. ammon.gr. xx.

Hydrarg. chlor. mitis. gr. xi.

Petrolati1 oz.

This applied once or twice a day has yielded admirable results in a number of cases of simple dandruff. Its consistence, being that of a salad dressing, renders it an elegant pomade for private practice. Its use should be combined with the occasional shampoo as directed above.

The persistent and systematic use of either of the two plans of treatment, together with a proper oversight over the general health, should cure every case of dandruff. But be prepared for occasional relapses.

Headaches.—Headaches vary much in degree and in kind. Their causes may be grouped under 3 types—(1) when the blood-supply of brain and body is at fault; (2) when some distant organ (such as stomach or liver), with which the brain is in sympathy, is out of order; and (3) when there is some affection of the nervous system, and especially of the brain: or “circulation,” “digestive,” and “nervous” headaches. Circulation headaches arise from the condition known technically as anæmia (bloodlessness) of the brain, in which the mental powers are weakened, and much brain-work will result in headache. Chief among its causes are a feeble heart and excessive drain on the system, especially among women, the evil frequently lying in the excessive use of purgative medicines. Hyperæmia (excessive blood supply) may also give rise to headache in those who use the brain to such an extent as to cause excessive waste, to repair which an increased flow of blood to the head takes place, and may be so great as to overwhelm the nerve-centres. This is often aggravated by an irregular mode of life and too much stimulants. Interference with the blood return to the heart may be due to causes within the chest, such as chronic bronchitis or heart obstruction, to swellings in the glands of the neck pressing on veins which convey the blood back to the heart, and improper dress, such as tight stays, or tight collars and cravats.

In the bilious or dyspeptic headache, also known as the “sick headache,” the brain sympathises with the stomach or liver in its affliction, and thus is due to those errors of diet which lead to indigestion or dyspepsia, e.g., unwholesome food, late suppers, hasty and inefficient mastication, and continuous drinking and wine-bibbing.

The nervous system itself seems to be chiefly at fault in organic, nervous, and neuralgic headaches. The organic headache often precedes insanity. The nervous headache, more commonly known from the nausea and vomiting which occur during an attack, as “sick headache,” is due to various exciting causes, such as brooding over unpleasant thoughts, bodily fatigue, dietetic errors, too little exercise, overstraining of vision, loud noises of a disagreeable character, unpleasant smells, and even disturbances of the weather; it is often inherited. The attack may sometimes be warded off by the application of atropine; the tendency to attack has been got rid of by the use of a proper pair of spectacles. The neuralgic headache is a form of tic douloureux, has its seat in one or other of the nerves of the head, and may be excited by decayed teeth, exposure to cold, and similar causes. It rarely occurs, even in those conditions, unless the nervous system is lowered in tone. Many people have decayed teeth without suffering the slightest ache so long as they keep their health at par. Too much work, bodily or mental, or exposure to conditions which act injuriously on the health, result in a neuralgic headache.

Any irregularity in the mode of life, such as errors in diet and drink, must be particularly shunned by those who are liable to any form of headache. Where alcohol is found to do good, it should be taken only in small quantities and with the meals. All worry and excitement must be avoided. Sleep in sufficiency, as well as moderate exercise, is essential. When headaches continue to burden the frame and to make life miserable, change of air or scene, prolonged absence from business, pleasant society, music, and other enjoyments may help to get rid of them. Sometimes all that is wanted may be cod-liver oil, or some other nutrient and tonic medicine. During the paroxysms of sick headache, complete rest on sofa or bed in a darkened room is found by many to be the only thing which gives relief; while others believe they are assisted to endure by drinking cups of strong tea or coffee. Those who suffer from this tendency, and disorders of vision, should consult an oculist regarding the condition of their eyes. (Dr. Maxwell Rose.)

Indigestion.—Indigestion may be due to the food or condition of the stomach. The food may be defective in quality. There may be excess or deficiency of the normal ingredients, saccharine, starchy, albuminous, or fatty, or some of the natural indigestible materials which form a part of all food. The food may be introduced in an indigestible form on account of defects in the cooking of it, or imperfect mastication, or from its having undergone putrefaction or fermentation, which arrests the functions of the stomach. Imperfect mastication of food is a very common cause of indigestion. Eating too much is probably the most common of all causes of indigestion. The secretion of the gastric juice in the stomach seems to be proportioned to the amount of material required for the nourishment of the system. Food taken in excess of this amount acts as a foreign substance undergoing fermentation and putrefaction, and occasioning much disturbance in the system. Much may be done for the cure of indigestion by eating very abstemiously of suitable food, thoroughly masticated, taking exercise in the open air, breathing pure air, and observing the laws of health generally. The amount of food should be reduced until the quantity is reached which the stomach can digest without evincing any symptoms of indigestion.

Hot water of a temperature varying from 110° F. to 150° F., has been found highly serviceable in relieving painful conditions induced by improper feeding. This beverage, diluting the ordinary fluids and secretions of the digestive system, effects the work of the liver and kidneys, and produces the happiest results. Dr. Cutter, of New York, has summarised the methods of using hot water. He tells us that the water must be really hot, and not merely lukewarm. If lukewarm, it will only excite vomiting; whereas, when really hot, it appears to soothe the irritable lining membrane of the stomach and bowels. The quantity of hot water to be taken at a draught, according to Dr. Salisbury, varies from ½ pint to 1 pint or more at a drinking. The test of benefit being derived from the use of hot water is said to be that derived from the kidney-secretion, which should be pure, free from odour and deposit. Regarding the times at which hot water should be taken, 1-2 hours before each meal, and ½ hour before retiring to rest, are stated as the periods most suitable for its administration; while the water must be sipped, and not taken so fast as to cause distension of the stomach. Dr. Cutter says that ¼-½ hour may be consumed in the draught of hot water. This form of hydropathic treatment, according to the authorities just named, should be practised in cases of digestive troubles for a period of 6 months or thereabouts. Regarding the amount of liquid to be taken with a meal, not more than 8 oz. has been prescribed as the regulation quantity; a larger amount tends to dilute the gastric juice to too great an extent. Various additions may be made to hot water by way of rendering it palatable, although persons accustomed to drink it in time learn to like it.

Dr. Milner Fothergill made some experiments with our ordinary native fruits, to test the value of correcting the acid by means of alkali to render the fruit more suitable for dyspeptics. The result was that the amount of bicarbonate potash required for each lb. of fruit was found to be about as much as would lie upon a shilling. With all fairly ripe fruit this is just sufficient to neutralise the acidity, and bring out the natural sweetness; indeed, the resultant product was quite sweet enough for most adult palates. Such stewed fruit can be eaten alone, or with milk puddings, cream, or Swiss milk; gooseberries, currants, apples and plums are excellent when so prepared. With dark fruits, as the black plum, the colour is impaired by the alkali, and the fruit is less attractive to the eye than is that of the ordinary stewed fruit, which is of a deep clear crimson. A little cochineal will give the desired colour. Where there is no natural sweetness, to neutralise the acid completely by an alkali leaves nothing, simply a cold mass, to which the palate is indifferent. Such is the case with rhubarb. Here it is well to use half or all the amount of alkali with some sugar. The same is the case with early gooseberries before they have any natural sweetness; no sugar formed in them. Here the full quantity of alkali should be used, and the remaining acidity be met by sugar. When ¾ lb. of sugar is required to sweeten 1 lb. of fruit, only ¼ lb. of sugar is necessary after the alkali has been added. The sour-sweet taste is thus secured, which is toothsome. In these two instances the stewed fruit is only rendered less objectionable to the stomach plagued with acidity, not made quite inoffensive.

Infectious Diseases.—All infectious (catching) diseases have several features in common. They begin with a period of dormancy (“latency” or “incubation,”) during which the poison is actively developing. The duration of this period in smallpox is 12 days; in typhus fever, 8-14 days; in typhoid fever, 14-21 days; in scarlet fever, 3-6 days; measles about 4 days, at the termination of which the sickness is said to begin, though its distinctive characters may not appear for some days longer. These diseases (fevers) all commence with a marked, and sometimes sudden, elevation of bodily temperature, which, with variations, continues during the course of the illness. Characteristic eruptions appear in scarlatina on the 2nd, smallpox on the 3rd, measles on the 4th day, and so on; with them begins the infection, and increases with the activity of the disease. The following table, modified from that given by Domville in his ‘Manual for Hospital Nurses,’ is exceedingly useful:—

Name.Period of Dormancy.Day of Rash.Characters of Rash.Duration of Illness.Observations.

Chicken-pox.21 days—Small rose pimples, becoming vesicles.6-7 days.

Erysipelas3-7 days2nd or 3rd.Diffuse redness and swelling.—Most common in face and head, and after surgical operations or injuries.

Measles10-14 days.4th day of fever.Small red dots like fleabites.6-10 days.Accompanied with running at eyes and nose.

Relapsing Fever.Sudden—Purpuric spots—Caused by want of food. After 7-14 days from the first attack, and during convalescence, it is liable to recur 2 or 3 times.

Scarlet Fever.4-6 days2nd day of fever.Bright scarlet diffused.8-9 daysVery infectious. Often accompanied by sore-throat, followed by desquamation (peeling off of the skin).

Smallpox12 days3rd daySmall red pimples, becoming vesicles, then pustules.14-21 days.Discrete or confluent. Great pain in back and intense headache. Secondary fever sets in about 11th day of disease.

Typhoid Fever.10-14 days or suddenly7th to 14th.Rose-coloured spots, few in number.22-30 days.Seldom infectious. Usually caused by bad drainage. Accompanied by diarrhœa and sometimes bloody stools.

Typhus Fever.1-12 days.4th to 7th.Mulberry colour general over abdomen.14-21 days.Very infectious. Usually caused by over-crowding and destitution.

In scarlet fever, infection is due to the particles which peel off from the skin, the patient should be anointed once a day with carbolic oil, made with 1 part carbolic acid to 50 of olive oil. The efflorescence (peeling off) occurs first on the skin of neck and arms, sometimes as early as the fourth day. The anointing should include the head, the oil being freely applied to the roots of the hair, and continued for 6 weeks, a warm bath being given weekly during that time. After 6 weeks, the patient may mix with the other members of the family; but children should not return to school for 2 weeks longer.

In measles, the same rules are to be observed, with the addition that the discharges from mouth and nostrils should be received on rags and destroyed by burning.

In typhoid fever, the poison is chiefly contained in discharges from the bowels. These may infect the air of the sickroom, the bed, body-linen, w.c., and drains, and, by soaking into wells, they poison the drinking-water—a common and dangerous way by which this fever spreads. The discharges should be disinfected immediately on their escape from the body as will be directed.

Typhus fever is very infectious, and is apt to attack those who are much exposed to it for the first time; therefore engage a nurse who has been previously attacked. The poison is thrown off by the skin and lungs and readily affects clothing, furniture, and everything in contact with the air of the room.

Efficient protection from smallpox is proper vaccination, known by a large mark or scar. Re-vaccination after the fourteenth year is advisable. Smallpox affects at a greater distance than any other, the poison escaping chiefly by the skin and mucous membrane.

Diphtheria poisons by the breath and expectoration; and to avoid contact with these is absolutely necessary. The expectoration should be received into a vessel containing Condy’s fluid, or on rags that may be at once burnt. Gargle the throat frequently with a solution of the same, of the strength of 1 small teaspoonful to 1 qt. water.

Whooping-cough is a disease which is most fatal to children under 2 years of age. The poison comes chiefly from the mucous secretions of the lungs and air passages, and is readily imparted to the clothes of those who nurse the patient; the secretions are infectious from the beginning.

Asiatic cholera rarely visits this country. As in typhoid fever, it spreads by means of the bowel discharges, and the same precautions are needed.

In any infectious disease, where the home has no accommodation for fully carrying out the precautions, the patient should be removed at once to a fever hospital. No time should be lost in obtaining medical advice.

One other source of danger may be mentioned here, and that is the poisonous vapours arising from broken gas mains, which will cause illness and even death from the carbonic oxide present. As a precaution against ground air contaminated with illuminating gas entering houses, open all cellar windows, as well as those on the ground floor of threatened houses, so as to prevent directly sucking in the ground air or render it harmless by dilution. The smell of gas should serve as a warning.

The following advice is addressed to those who have to visit or attend upon infectious cases. Always have the window open before entering the patient’s room or ward. Never stand between the patient and the fire, but always between him and the open window. If possible change your coat before entering the room. Do not go in for any unnecessary physical examination. Stay as short a time as possible in the room. Never, while in the room, swallow any saliva. After leaving the sickroom, wash the hands with water containing an antiseptic. Rinse out the mouth with diluted “toilet sanitas” or Condy’s fluid; also gargle the throat with it, and bathe the eyes, mouth, and nostrils. Expectorate and blow the nose immediately on leaving the sickroom. Keep up the general health by good food, exercise, and temperance. Filter all the air you breathe while in the sickroom or ward through an antiseptic medium, such as a McKenzie inhaler over the nose and mouth; carefully soak the sponge in a strong solution of carbolic acid before entering the sickroom; all the air breathed must necessarily come through this sponge, and the expired air is emitted, by a valve action, at another place.

Nurses should keep themselves and their patients as clean as possible, remembering that the more the infection accumulates, the more dangerous does it become. Special care should be taken, in changing sheets and clothing, not to shake or disturb them more than is absolutely necessary to remove them; as these acts disseminate the particles of skin which are removed with them, and which convey the germs of disease, they should be removed carefully, folded together, and immediately disinfected.

Whatever the nature of a malady, so soon as it is pronounced to be infectious the same precautions should in all cases be taken. Let it at once be decided who is to nurse the patient, and make all arrangements by which nurse and patient may be isolated from the rest of the household. If possible, 2 rooms communicating should be given up to them, and over the outer doors of these rooms sheets should be hung, which must be kept constantly saturated with disinfectants, either Condy’s fluid or carbolic acid in water. No servant in communication with the rest of the household must enter the sickroom; if she does so, she should be isolated like the nurse, and any message that may require to be given must be spoken through the sheet. The best plan is to have a regular nurse from one of the many excellent institutions which provide them; they make the patient more comfortable, take entire charge of the arrangement of the sickroom, and know exactly what is required to be done in an emergency, and for disinfection. At the very commencement all curtains should be taken down, and at once sent out of the house to be disinfected by properly qualified persons; the same course should be pursued with the carpets (woollen articles hold infection beyond any others), and then the floors can be kept sprinkled with disinfectants, besides having a broom steeped in them passed over every morning. Linen used in the sickroom should always be put into water with either carbolic or Condy, before leaving the room; but, even with this precaution, it is far better to send it to be disinfected than to allow it to go to a laundry. The windows should be open, top and bottom, but more especially at the top, during the entire day, and if possible at night also; a thorough draught through the room is most desirable, if the patient can be kept out of the direct line of it. As much as possible, all cups, basins, jugs, and glasses should be kept upstairs; but those that must occasionally be sent down should be carefully washed in Condy and water, and at once placed outside the door, and again passed through disinfectant on their arrival downstairs. The clothes that may have been worn for the day or two before the disease absolutely declared itself should be sent for disinfection, but those which have only been in casual contact may be disinfected at home. A small room should be chosen for the purpose, and the dresses, petticoats, shawls, or other articles hung up, so as to be fully exposed. The doors, windows, and all other apertures must be kept closed, and the disinfection may be effected either by chlorine, which is formed by pouring hydrochloric acid on chlorate of potash, or else by burning sulphur. In either case the quantity must be sufficient to render the atmosphere of the room unbearable to a human being, or otherwise the disease germs will not be destroyed. The bedding and blankets must be sent for proper disinfection at the close of the illness. Nothing should be kept in the room except for use. Clothes in a wardrobe under such circumstances have been known to spread infection 10 years after. Handkerchiefs should be replaced by rags, burnt when used. Letters from the patient should be backed, or written on postcards dipped in carbolic; they are capable of spreading disease otherwise. A thing in which people are often lamentably careless is in allowing books that have been used by the patient to be afterwards used by others. It cannot be too often impressed on the minds of those who have to do with illness, that every book, paper or magazine used by an infectious patient must be burnt without leaving the sickroom. Infection is very often spread by allowing books from a circulating library to be returned to it after use by a person suffering from an infectious disorder.

Infection ceases in the individual as soon as the skin has thoroughly peeled—a process which takes a longer or shorter time in different individuals. The danger after this lies in the clothes, furniture, and rooms, and if these are at once thoroughly disinfected all danger is absolutely at an end. It is impossible to reprobate too strongly the conduct of those who wish and endeavour to shirk the expense and trouble of proper disinfection. It would be well if in such cases doctors would always avail themselves of their power to report the existence of a case of infectious disease to the sanitary officer of the district, when official pressure would at once be brought to bear, and all that is necessary be effected under compulsion.

The cured patient on the day of leaving home should go into a fresh room to dress, and put on things either new or disinfected, not returning to the sickroom. Brushes and sponges, as coming most in contact with hair and skin, are best destroyed. While a patient is in the infectious stage it is best that no letters should be written; but if, as is sometimes the case, some communication in writing must be made, danger is obviated by holding the paper and envelope in the fumes of chlorine.

A few words would not be amiss respecting those in the house who do not enter the sickroom. However great the precautions taken, the air of a house in which there is a case of infectious disease can never be absolutely safe, and it is far better to err on the side of caution than the reverse. Visitors should not be allowed to enter the house, and it is far better and more honest for the servants to state clearly at the door what disease is in the house. Special attention should be paid to the health of each member of the household. Any slight disorder is liable to predispose to infection.

There is a great variety of good disinfectants, and as many different ways of using them. A good plan, both effective and economical, is as follows:—Freely use moistened chloride of lime all through the house, and even in the sickroom, if the fumes are not found to be irritating; secondly, place in various parts of the room 5 or 6 soup-plates, or other flat vessels, containing Condy’s fluid; or hang about in the room as many perforated boxes filled with solid iodine; thirdly, keep the windows opened freely but the doors as seldom as possible; guard it both inside and outside with a large sheet, hung up to at least the height of the door, and at about 1 ft. distant from it, and kept constantly well moistened with a solution of carbolic acid (strength, about 1 of the acid to 40 of water); and, most important of all, receive as soon as possible all discharges, excreta, soiled linen, and all such matters, in vessels containing a strong solution of Condy’s fluid, chloralum, or carbolic acid. Many infectious diseases have (in addition to their common property of infecting the air through the effete products of respiration from the lungs and skin) some special channel of transmission. In cholera, typhoid (enteric) fever, and, in a less degree, typhus and relapsing fevers, it is principally by the excreta from the bowels and kidneys. These should be received at the very moment of their issue from the body into vessels fully charged with disinfectants. In diphtheria, it is by the throat. In erysipelas, hospital gangrene, and puerperal fever, by discharges peculiar to each. In smallpox, by pustular exudation from the skin. In scarlet fever, measles, &c., by desquamation (peeling off of the skin), rendered harmless by slightly moistening the surface of the body once or twice a day with ordinary olive oil or camphorated oil, or a weak solution of glycerine and carbolic acid. Never mix disinfectants; for instance, Condy’s fluid and carbolic acid act in precisely opposite ways, and might decompose each other.

The nurse must not neglect proper precautions for her own safety. She should use disinfectants freely about her own person, be sure that she has a sufficient quantity of undisturbed rest and regular meals, and avoid coming into unnecessary close contact with the patient. She should at once give up the occupation if she feel her general health at all injured. She must also be careful not to undertake a non-infectious case after being in attendance upon an infectious one for a considerable time; and until she has put herself through a complete process of disinfection, and done the same with all clothes worn at the time which she has not discarded altogether. Nothing must induce her to go near a confinement for several (at least 3) months.

Disinfection.—The most useful agents for the destruction of spore-containing infectious materials are:—

(1) Fire: Complete destruction by burning.

(2) Steam under pressure: 230°F. for 10 minutes.

(3) Boiling in water for 1 hour. This temperature does not destroy the spores of Bacillus subtilis in the time mentioned, but is effective for the destruction of the spores of the anthrax bacillus, and of all known pathogenic organisms.

(4) Chloride of lime: a solution of 4 in 100 containing at least 25 per cent. of available chlorine.

(5) Mercuric chloride: a solution of 1 in 500 containing at least 3 per cent. of available chlorine.

For the destruction of infectious material which owes its infecting power to the presence of micro-organisms not containing spores:—

(1) Fire: Complete destruction by burning.

(2) Boiling water ½ an hour.

(3) Dry heat: 230°F. for 2 hours.

(4) Chloride of lime: 1 to 4 in 100 solution, containing at least 25 per cent. available chlorine.

(5) Solution of chlorinated soda: 5 to 20 in 100 solution, containing at least 3 per cent. available chlorine.

(6) Mercuric chloride: a solution of 1 in 1000 to 1 in 4000.

(7) Sulphur dioxide: exposure for 12 hours to an atmosphere containing at least 4 volumes per cent. of this gas, preferably in presence of moisture. This will require the combustion of 3-4 lb. sulphur for every 1000 cub. ft. of air space.

(8) Carbolic acid: 2 to 5 in 100 solution.

(9) Sulphate of copper: 2 to 5 in 100 solution.

(10) Chloride of zinc: 4 to 10 in 100 solution.

Following are recommendations with reference to the practical application of these agents:—

For Excreta.

(a) In the sickroom:

For spore containing material:

(1) Chloride of lime in solution, 4 in 100.

(2) Mercuric chloride in solution, 1 in 500; addition of an equal quantity of potassium permanganate as a deodorant, and to give colour to the solution, is to be recommended.

In the absence of spores:

(3) Carbolic acid in solution, 5 in 100.

(4) Sulphate of copper in solution, 5 in 100.

(5) Chloride of zinc in solution, 10 in 100.

(b) In privy vaults:

Mercuric chloride in solution, 1 in 500. A concentrated solution containing 4 oz. mercuric chloride and 1 lb. cupric sulphate to 1 gal. water is recommended as a standard solution; 8 oz. this solution to 1 gal. water will give a diluted solution for the disinfection of excreta, containing about 1 in 500 of mercuric chloride and 1 in 125 of cupric sulphate.

(c) For the disinfection and deodorisation of the surface of masses of organic material in privy vaults, &c.:

Chloride of lime in powder, diluted with plaster of Paris, or with clean, well-dried sand, in the proportion of 1 part to 9.

For Clothing, Bedding, &c.

(a) Soiled underclothing, bed linen, &c.:

(1) Destruction by fire, if of little value.

(2) Boiling at least ½ hour.

(3) Immersion in a solution of mercuric chloride of the strength of 1 in 2000 for 4 hours. The blue solution containing sulphate of copper, diluted by adding 2 oz. concentrated solution to 1 gal. water, may be used for this purpose.

(4) Immersion in a 2 per cent. solution of carbolic acid for 4 hours.

(b) Outer garments of wool or silk, and similar articles, which would be injured by immersion in boiling water or in a disinfecting solution:

(1) Exposure to dry heat at a temperature of 230° F. for 2 hours.

(2) Fumigation with sulphurous acid gas for at least 12 hours, the clothing being freely exposed, and the gas present in the disinfection chamber in the proportion of 4 volumes per cent.

(c) Mattresses and blankets soiled by the discharges of the sick:

(1) Destruction by fire.

(2) Exposure to superheated steam—25 lb. pressure—for 1 hour. Mattresses to have the cover removed or freely opened.

(3) Immersion in boiling water for 1 hour.

(4) Immersion in blue solution (mercuric chloride and sulphate of copper) 2 fl. oz. to 1 gal. of water.

Fire.—Materials used in wiping away discharges may be burned in the open fireplace of the sickroom. In general, this method is to be recommended for all substances which have been exposed to infection, which cannot be treated with boiling water, and, could it be carried out in all cases, would make disinfection a very simple matter. If there is no fire in the room, such substances may be wrapped in a sheet soaked with solution, carbolic acid, and in this condition conveyed to a fire elsewhere.

Boiling Water.—Boiling in water for ½ hour will destroy the vitality of all known disease germs. This is therefore the best means for all articles which can be thus treated, such as body-clothing of the patient, bed-clothes, towels, &c. All utensils used in the room in feeding the patient should likewise be treated with boiling water before being removed from the room. Food itself, not consumed by the patient, should not be used by others, as it is liable to become infected in the sickroom. If there are no facilities for treating articles with boiling water in the sickroom, they may with safety be removed to another part of the house for this treatment if they are carefully enveloped in a towel or sheet, as the case may require, which has been thoroughly soaked with carbolic acid solution. Thus enveloped, they should be put in the water, and boiled for the required time.

Chloride of Lime.—To be effective as a disinfectant this must be of the best quality, and in purchasing it, only that should be accepted which is enclosed in glass bottles, as, when packed in paper or wooden boxes, it is liable to have so deteriorated as to be worthless for disinfecting purposes. Dissolved in water, in the proportion of 4 oz. to 1 gal., it forms a standard solution recommended to be used in the disinfection of discharges in contagious diseases, especially in typhoid fever and cholera; 1 pint should be well mixed with each discharge; after 10 minutes, disinfection is completed, and the contents of the vessel may be then safely thrown into the water closet. The expectorated matter of those sick with consumption should be discharged into a cup half filled with this or carbolic acid solution.

Solution of Chlorinated Soda.—To be effective, this solution must contain at least 3 per cent. of available chlorine, and care should be exercised to obtain such a quality. This is sometimes spoken of as Labarraque’s solution; but, as this latter is too weak to act as a disinfectant, the name is liable to mislead. A standard solution is made by adding 5 parts water to 1 of the solution of chlorinated soda. The cost of this solution is about 5d. a gallon. When thus diluted it may be used for all the purposes for which chloride of lime was recommended, and is of a somewhat more agreeable odour, though more expensive. It should be used to cleanse portions of the body soiled with discharges of those sick with infectious diseases, or the hands of attendants similarly soiled.

Bichloride of Mercury (corrosive sublimate) is recommended to be used only in the disinfection of privy vaults which contain so much material, believed to be infected with the germs of typhoid fever or cholera, that the disinfection by chloride of lime would be impracticable. In using this, it should be dissolved in the proportion of 1 oz. bichloride of mercury to 1 gal. water; this quantity will disinfect 4 gal. infected excremental matter.

For Clothing after Recovery or Death.

The clothing of the patient should be treated in the manner already described as necessary during the sickness. Whatever can be boiled in water should be thus disinfected; articles which cannot be boiled should, if circumstances will permit, be burned; all other articles should be left in the room to be subjected to the fumigation hereafter to be described, and until thus treated, the room and its contents should be closed with lock and key, to prevent any one from entering. If it is desired to burn any articles, and facilities for it do not exist in the house, the authorities should be notified, and an officer will call and remove the articles for destruction.

Permanganate of potash (commonly known as Condy’s fluid), Burnett’s fluid, and chloride of lime, can all be mixed with water, and used for clothing if care is taken. Carbolic soap is excellent for scrubbing. Sulphate of zinc and common salt, dissolved together in water in the proportion of 4 oz. sulphate and 2 oz. salt to 1 gal. will do for clothing, bed-linen, &c.

Armfield & Son, 15 Lower Belgrave Street, London, W., and Victoria Bridge Road, S.W., disinfect and clean articles after fever, &c., by means of special apparatus.

For Furniture and Articles of Wood, Leather, and Porcelain.

Washing several times repeated with:

(1) Solution of mercuric chloride 1 in 1000. The blue solution, 4 oz. to 1 gal. water may be used.

(2) Solution of chloride of lime, 1 per cent.

(3) Solution of carbolic acid, 2 per cent.

For articles of metal use No. 3.

For the Person.

The hands and general surface of the body of attendants of the sick, and of convalescents at the time of their discharge from hospital:—

(1) Solution of chlorinated soda diluted with 9 parts of water (1 in 10).

(2) Carbolic acid, 2 per cent. solution.

(3) Mercuric chloride, 1 in 1000; recommended only for the hands, or for washing away infectious material from a limited area, not as a bath for the entire surface of the body.

For Body of the Patient after Recovery.

When the patient has recovered, he should be first sponged over with the solution of chlorinated soda, diluted in the proportion of 1 part to 20 of water; and, indeed, during the course of the illness occasional sponging of the body with this very dilute solution under the direction of the attending physician, will be of value in preventing the escape from the surface of the body of infectious material. When, after recovery, the body has been thus sponged, not omitting the head and hair, a thorough washing of the body with soap and warm water should follow, and the patient dressed in clothes which have not been exposed to infection. This should take place in another room than the one occupied during the illness.

For the Dead.

Envelope the body in a sheet thoroughly saturated with

(1) Chloride of lime in solution, 4 per cent.

(2) Mercuric chloride in solution, 1 in 500.

(3) Carbolic acid in solution, 5 per cent.

The body should be thoroughly sponged with either (1) or (3), and then wrapped completely in a sheet saturated with one of these solutions, and enclosed in a coffin, which is to be closed, and the interment must take place within 24 hours, and be strictly private. If the interment is to take place at a distance requiring transportation by any other means than a hearse, the coffin must be of metal, or metal-lined, and hermetically sealed.

When danger is to be apprehended from this source, the body should be, when coffined, surrounded with sawdust, in which these solutions have been placed. Carbolic sanitas powders also present effective means whereby disinfection of the dead body may be performed when coffined; and nitrous acid fumes form the best disinfectant for mortuaries or apartments in which the dead have lain for some time.

Room and Contents.

The room, having been vacated by the patient, should first be fumigated by burning sulphur. This fumigation should be done under the supervision of the physician or some other intelligent person. Nothing should be removed from the room until this is completed, unless it has been disinfected in the manner already described. Everything to be fumigated should be so opened and exposed that the sulphur fumes can come in contact with all portions thereof. All cracks of doors and windows, fire-places, or other channels by which the gas may escape should be tightly closed, using cotton wadding when necessary. For a room 10 ft. in all its dimensions—that is, one containing 1000 cub. ft. of air space—2 lb. broken sulphur and 1 lb. flowers of sulphur should be provided, and an increased amount for larger rooms, in the same proportion. This quantity is important, as less will not so efficiently accomplish the desired disinfection. The sulphur should be put in an iron pot, and this placed on bricks in a large washtub half filled with water, or in a large coal-scuttle containing wet ashes. This precaution is necessary to prevent setting fire to the floor, which would occur if the pot were placed directly on the floor or carpet. The vessel containing the sulphur should not be one with soldered joints, as the intense heat would melt the solder. A pot capable of holding 1 gal. is about the right capacity for 3 lb. sulphur. The pot should be placed in the centre of the room; if the room is a large one, containing several thousand cub. ft. of air space, several pots should be provided, distributed at different points. Everything being in readiness, sufficient alcohol to moisten the sulphur should be poured on it, a lighted match applied, and when it is seen that the sulphur is well ignited, the room should be left and the door shut, and all cracks outside, including the key-hole, closed by paper, cotton, or other material. At the end of 10 hours the fumigation is completed. Great care should be exercised in emptying the room of the sulphur fumes, as these cannot be safely breathed, and are excessively irritating to the eyes and throat. If possible, a window should be opened from the outside, and through this the fumes permitted to escape; if this is impracticable, all the windows and doors of adjoining rooms should be opened, and then the door of the fumigated room, and through these outlets the fumes allowed to find an exit. Thorough airing will remove the slight odour which remains.

The fumigation being completed, all woodwork, as of floors, windows, and door, and the walls and other surfaces, should be washed over with solution of chlorinated soda, particular attention being paid to cracks, crevices, and out of the way places, in which dirt ordinarily finds a lodgment and from which it is with difficulty removed. A subsequent washing with hot water and soap will complete the cleansing process, and the room may be considered again habitable.

(a) While occupied, wash all surfaces with:—

(1) Mercuric chloride in solution, 1 in 1000. The blue solution containing sulphate of copper may be used.

(2) Chloride of lime in solution, 1 per cent.

(3) Carbolic acid in solution, 2 per cent.

(b) When vacated:—

Fumigate with sulphur dioxide as described in the next paragraph.

A pleasant disinfectant for rooms is 20 parts camphor, 50 each hypochlorite of lime, alcohol, and water, 1 each eucalyptus and clove oils. The ingredients must be mixed slowly in a spacious vessel kept cool. A few drops on a plate will suffice to disinfect a chamber pleasantly.

Carbolic acid, when combined with water and boiled, evaporates with the steam in a constant ratio, and the steam contains the same relative quantity of the acid as the water from which it evaporates. Pour 20-40 drops of a mixture of equal parts turpentine and carbolic acid into a kettle of water, which keep simmering over a slow fire, so that the air of the sick room will be constantly impregnated with the odour. An excellent vaporiser for disinfecting purposes is made by Savory and Moore.

To purify the air in a sickroom, place in the bed a small basket or other porous article, containing wood charcoal, for the purpose of absorbing the foul air which, if diffused throughout the surrounding atmosphere, would be constantly returned to the lungs.

In a sickroom in which infants are sleeping, put a box or basket containing a piece of quicklime and some wood charcoal, for the purpose of fixing the carbonic acid exhaled from the lungs, and of absorbing all the foul air generated in the system, and given off by exhalation from the skin or otherwise.

Cellars, yards, stables, gutters, privies, cesspools, water-closets, drains, sewers, &c., should be frequently and liberally treated with copperas (sulphate of iron) solution. The copperas solution is easily prepared by hanging a basket containing about 60 lb. copperas in a barrel of water, or say 1½ lb. per gal. It stains linen.

Another good solution is made thus. Dissolve ½ dr. nitrate of lead in 1 pint boiling water; dissolve 2 dr. common salt in a pail of cold water. Pour the two solutions together, and allow the sediment to subside. Areas, dustbins, heaps of refuse, w.c.’s, or close rooms are all alike benefited by this mixture, which has the advantage of being without smell. Cloths dipped in the solution and hung up in a room will sweeten a fetid atmosphere immediately. It is cheap, nitrate of lead being procurable at about 6d. a lb.

Rheumatism.—This common ailment is essentially due to damp or being chilled. One of the easiest and most satisfactory means of treatment is to apply a flannel bandage, pretty tightly, round the chest, in order to restrain the movements of the chest wall. Soothing liniments may also be laid on the side, such as belladonna and chloroform liniments, mixed in equal proportions, or the liniment of turpentine, or cajeput oil mixed with olive oil. Some of the popular domestic remedies for lumbago (rheumatism in the back), are not to be despised, such as ironing with a hot smoothing iron (with the interposition of a double layer of flannel between the skin and the iron), the efficacy of which is heightened by wrapping the flannel round the hot iron, and moistening the flannel with vinegar. The iron, thus guarded, is left in contact with the skin for ¼ minute, at various points. Another good remedy is the application of turpentine, effected by taking a doubled piece of flannel, say 12-14 in. long by 8-10 in. wide, and dipping it into boiling water. It is then wrung firmly, and turpentine is sprinkled liberally over it. This is applied to the loins, and kept on for 20-30 minutes. When removed, cotton-wool is applied to the skin. At the outset a strong effective purge ought to be taken.

A good hot bath (104° F.) is very beneficial, and it may be advantageous to make it alkaline, by adding about 6 oz. carbonate of soda (washing soda) to the bath before entering it; this will be specially efficacious in stiffness of the joints or muscles. Of the many drugs which have the effect of inducing free perspiration, solution of acetate of ammonia may most safely be used in tablespoonful (adults) doses freely diluted with water. The bowels may be opened by a mild aperient, preferably saline, taken largely diluted in hot water, and early in the morning. The action of the kidneys ought to be kept up by diuretics, the simplest being water, say a tumblerful drunk slowly in the morning, while dressing, or it may be rendered more energetic by the addition of 1 teaspoonful cream of tartar.

Diet ought to be restricted to light forms of solid food, e.g., fish, soups, chicken, puddings, vegetables, fruit, milk. Beer and wines should be avoided; ærated waters may be taken freely; smoking is prejudicial. Finally, persons who suffer from rheumatism ought always to wear flannel next the skin, and encourage perspiration. Most alkalies are useful in relieving rheumatism. Potash, or soda bicarbonate may be freely used in doses of ½ teaspoonful, in ½ tumbler of ærated water, twice daily, for 3-4 weeks at a time.

Sea-sickness.—Many people, as soon as sea-sickness commences, have recourse to oranges, lemons, &c. Oranges are very much to be avoided, on account of their bilious tendency, and even the juice of a lemon should only be allowed in cases of extreme nausea. Champagne, too, is a very common remedy, and, without doubt, in many cases does good; but this appears to be chiefly due to its exhilarating effects, as, if it be discontinued, the result is bad, and a great amount of prostration follows. Creosote is an old, but still good, remedy, and, in cases accompanied by great prostration, is very useful; but if given in the early stages of sea-sickness, it is often followed by very bad results, and even increases the nausea. Bicarbonate of soda is useful in slight cases, as it relieves nausea, and checks the frequent eructations which often follow attacks of sea-sickness; but in severe cases it is absolutely useless, and, in fact, it very often prolongs the retching. A very good remedy in the earlier stages of sea-sickness is a teaspoonful of Worcester sauce; it relieves the symptoms, and renders the patient easier. Its action is probably of a stimulant nature. Hydrocyanic acid is of very little service, and most acid mixtures are to be avoided, except that perhaps for drinking purposes, when it is best to acidulate the water with a small quantity of hydrochloric acid. Of all drugs the most effectual is sodium bromide. When sodium bromide is given in doses of 10 gr., 3 times a day, the attacks entirely subside, the appetite improves, and the patient is able to walk about with comfort. In sea-sickness it is very desirable that the patient should take sufficient food, so that at all times the stomach may be comfortably full, for by this means over-straining during fits of retching is prevented, and the amount of nausea is diminished. The practice of taking small pieces of dry biscuit is not of much use, as although the biscuit is retained by the stomach, yet the amount taken is never sufficient to comfortably fill the stomach. Soups, milk-puddings, and sweets are to be avoided, as they increase the desire to be sick, and are followed by sickening eructations. Fat bacon is easily borne, and does much good, if only the patient can conquer his aversion to it. When taken in moderate quantity it acts as a charm, and is followed by very good results. Of all food, curry is the most useful in sea-sickness, and is retained by the stomach when all other food has been rejected. Next to curry come small sandwiches of cold beef, as they look nice on the plate, and are usually retained by the stomach. Brandy should be used very sparingly, as, in many cases, it induces sea-sickness; and its chief use is confined to those cases where the prostration is very great, and even then champagne is more effectual. (Dr. Kendall, Brit. Med. Jour.)

Skin complaints.—Many of these are of a character to demand the early attention of the doctor, but there are others which can readily be combated by home treatment.

Pimple (Acne).—These are a frequent trouble in young people and may be very disfiguring. They arise from inefficient action in the fat (sebaceous) glands of the skin. Generally they can be dislodged by squeezing with the thumb nails. To promote healthy action of the glands and prevent formation of the pimples, Dr. Liveing recommends the following plan.

(a) Steam the face every night by holding it over a basin of hot water for a few minutes. (b) Rub the skin for 5-10 minutes with soap (preferably terebene) and flannel, or with a soft nailbrush; then sponge off the soap with warm water. (c) When the face has been dried, a lotion should be thoroughly applied, composed as follows: ½ oz. precipitated sulphur, 2 dr. glycerine, 1 oz. spirits of wine, with 3 oz. each rose-water and lime-water. This is allowed to dry on the skin and to remain on all night. In the morning the face is cleansed with warm oatmeal and water or weak gruel. If, for any reason, an ointment seems preferable to a lotion, a combination of precipitated sulphur and vaseline is very useful. The treatment must be modified or suspended for 2 or 3 nights if the skin becomes sensitive and somewhat tender. If this plan be unsuccessful, try application of potash soap in the form of a lotion. The lotion is composed of 1 oz. each soft soap and rectified spirits of wine, and 7 oz. rose (or distilled) water. This should be rubbed in vigorously with a piece of flannel for a short time, taking care not to make the skin sore. According to Dr. Liveing, the worst cases of acne will yield to the soft soap treatment if practised with necessary caution.

Something is often required to be done during the daytime to pacify the heat and throbbing, which are part of the usual history of acne. An excellent lotion is made by combining oxide of zinc, calamine, prepared chalk, lead lotion, and lime-water, to which may be added a small quantity of glycerine. Let the bottle containing this be gently waved about so as to diffuse the materials, which are only held in suspension; then pour a little into a saucer, and with a sponge (reserved for the purpose) sprinkle the face from time to time. Wipe off, when necessary, with a bit of fine muslin the powder which remains on the skin after the evaporation of the fluid, and the face may be washed occasionally with a little starch gruel. The cases are not a few in which it is better not to use any kind of soap as part of the evening ceremonial. After the face has been steamed, put on a medicated jelly composed of zinc oxide, gelatine, and glycerine. It must be liquefied by putting the vessel that holds it into hot water, and then applied with a brush. Some sensitive skins are intolerant of sulphur in any guise. When this is so, try combinations of lead, chalk and zinc, blended as a quasi-ointment with the finest vaseline. Dr. McCall Anderson’s formula of bismuth oleate with vaseline and white wax has been aptly described as “one of the most healing of salves.” Sometimes nothing agrees better than the old-fashioned but capital substance called Kirkland’s “neutral cerate,” which is composed essentially of lead plaster and olive oil.

Nettlerash.—A form of nettlerash seen in little children, showing itself as slightly raised red blotches, worst in the night, is referred to “teething,” and that is thought sufficient reason for neglecting it. The best treatment is strict attention to cleanliness and diet. The child should get a tepid bath night and morning. Take care that no part of the dress irritates the skin, flannel not being allowed to touch it; and let the patient enjoy fresh air and sunshine. If itching continues, instead of a simple tepid or warm bath at night, an alkaline bath should be given in this bath: in 8-10 gal. water as warm as the hand; dissolve 1-2 oz. soda bicarbonate. Bathe the child for a few minutes, do not be too exact in drying, and put to bed immediately. Nettlerash in adults requires medical treatment.

Eczema.—Of this skin disease there are many forms, all arising more or less from a disordered state of the blood, and demanding medical advice. As a general rule, the patient should avoid soap in washing, using oatmeal instead. Starchy food, such as potatoes, are deemed unsuitable, while plenty of green vegetables and fruit should be taken. Clean linen is essential, and the patient’s towel should not be used by any one but himself.

Itching.—This troublesome affection may be cured by the use of the following:—(a) 500 grm. milk of almonds; ¼ grm. each corrosive sublimate and ammonium chloride. (b) 60 grm. glycerine of starch; 5 grm. bismuth subnitrate; 5 grm. zinc oxide. (c) 1 litre infusion of mallow; 50 grm. cherry-laurel water (filtered); 10 grm. borax. (d) Vaseline often gives relief.

Ringworm.—Whenever the disease is observed, efficient measures should be taken to cure it, instead of wasting time with feeble popular remedies, such as ink, permitting the affection to spread and become established. The hair should be cut for ½ in. round each patch of ringworm. Get a small camel-hair brush, and a solution of the following composition: 30 gr. iodine; 2 drm. colourless oil of tar. Apply the solution carefully with the brush to the diseased part only. Repeat the application in a week. Strong carbolic ointment may be applied around the patch. It is a most obstinate disease, and requires the exercise of great patience. Children suffering from ringworm should not be much confined in the house, and it is a good rule to give them cod-liver oil, or steel wine, or both.

Sweating (excessive).—(a) In the Michigan Medical News, Dr. Currie recommends in sweats, from whatever cause, 1 pint alcohol, 1 drm. sulphate quinine. Wet a small sponge with it, and bathe the body and limbs, a small surface at a time, care being taken not to expose the body to a draught of air in doing it.