Mrs. Beeton's Book of Household Management/Chapter LXX

by Isabella Beeton

THE DOCTOR

The doses of medicine prescribed in these pages are those intended for adults, unless otherwise stated

CHAPTER LXX

How to keep Well, Infectious and Contagious Diseases, Non-Infectious Diseases and their Remedies, Common Complaints and their Remedies and What to do in Cases of Accident or Sudden Illness.

HOW TO KEEP WELL

Introductory.—Health of body and mind is a blessing of such inestimable value, and is so obviously one of the greatest sources of earthly happiness, that the efforts of all wise persons should be directed towards its attainment. As disease is simply a departure from perfect health, our earliest attention should be given to the chief agents which produce any disturbance of, or departure from, absolute health, so that we may be the more able to combat them successfully. The innumerable external influences which disturb the natural condition of our organs, or the balance of the functions which they perform, as, for example, excess or privation of the air we breathe, the water we drink, the food we eat; variations in the direction of the superabundance or deficiency of the light, heat, and electricity which modify the nutrition of our bodies: all these are among the prime factors in the disturbance of human health, and as such demand our serious consideration.

Heat and Cold as Causes of Disease.—These are two of the most prolific sources of disturbance of perfect health, and they enter very largely into health considerations, chills especially being responsible for a large proportion of our ailments. Unguarded exposure to intense heat, especially from the direct rays of the sun, is liable to produce sunstroke, which often proves rapidly fatal. Ingenious experiments have shown that the faintness, giddiness and insensibility which accompany this seizure are due to the immediate effect of heat upon the brain substance. Every one susceptible to such influence, therefore, should avoid exposure to the sun in very hot weather between the hours of 11 and 3 o'clock; or, if obliged to be out, should wear a large brimmed hat, to which a pugree may be added, so that all parts of the head and the back of the neck are protected from the sun's rays. Failing this a wet handkerchief, arranged to cover the scalp and the back of the neck, is a useful substitute.

When giddiness or weakness with heat about the head come on and an attack of a serious nature is threatened, the patient should be at once removed to a cool, shady place, and the head, neck and chest rubbed with small pieces of ice, to reduce the temperature.

Extreme cold is no less fatal in its effects than extreme heat. In a minor degree it gives rise to frost-bite and chilblains. When only a small part of the body has become frozen (recognizable by the spot turning a dull, yellowish-white colour) serious injury may often be prevented by thawing it very gradually, which may be done by bathing the affected part with ice-cold water or rubbing it with snow.

Cold also acts as a disease-producing agent by checking perspiration, and thus prevents the carrying off of injurious worn-out materials of the body by that great avenue of purification—the skin.

Another effect of a chill is to drive a great part of the blood out of the little blood-vessels which run everywhere just beneath the surface of the skin. This it does by its contracting and constricting influence, and the blood so driven away flows inwards to the warm parts of the body, filling them too full of blood, or, as it is called, congesting them.

When the surface of the body has been chilled in consequence of exposure to cold and wet, the feet should be soaked for 10 minutes in hot mustard and water, and the patient covered over with blankets in a warm room, and given one or two cups of hot milk, cocoa, tea or gruel, to induce free perspiration.

In soaking the feet, the mustard and water should only be moderately hot, to commence with, and the temperature of the foot-bath gradually raised by the addition of boiling water provided in a jug at the side of the bath. The general mistake is to have the water in the basin or bath so hot to commence with that the sufferer is quite unable to put even his toe in. Consequently he waits till the water is little more than lukewarm, and then immerses his feet, when the bath is of very little practical use. By starting as suggested with water only moderately warm, and then making additions of boiling water as the feet become accustomed to the bath, a much higher temperature can be borne, and the bath is thus rendered much more effectual.

Pure Air.—The importance of a sufficient supply of pure air can scarcely be over-estimated. In ill-ventilated places the proportion of carbonic acid in the air becomes greatly increased, which renders it deleterious and dangerous our very life being dependent upon the blood unceasingly gaining fresh oxygen, and getting rid of stale carbonic acid.

Among the more important causes of atmospheric vitiation are the carbonic acid and other substances given off from the lungs; gases arising from drains, sewers, cesspools, and decomposing animal matters which often contaminate the air, giving rise to pestilential disorders; the vapours given out from thickly crowded graveyards, which greatly increase the sick and death-rates of the neighbourhoods in which they are disseminated; noxious gases from manufactories, chemical works of various kinds, and the air of marshes or low-lying meadows, which favours the growth and circulation of micro-organisms, producing disease.

The dust in the air contains, among other things, bacteria, innumerable epithelial scales from the skin of men and animals, hairs, fragments of wool, cotton and flax fibres, pollen grains, splinters of wood, bark, shreds of leaves, particles of coal and many other substances. Some of these irritate the lungs mechanically, as, for example, anthracite or bituminous coal, which gives rise to miner's consumption; the fine particles of steel thrown off in grinding saws and other instruments; the dust in potteries, and the fragments of wool flax, etc., in cloth factories and cotton mills: all exert an injurious influence upon the lungs.

The great remedy for the impurity of the air within doors is ventilation; and the best method of accomplishing this has been for many years one of the great problems of science.

As the air of an inhabited room cannot, at the best, be as pure as the external atmosphere, the problem of ventilation is to reduce the impurities of respiration to the point where health will not manifestly suffer by drawing them into our lungs again.

In order to keep the ratio of carbonic acid and its associated animal impurities down to this limit, it has been found by experiments that it is necessary to supply 3,000 cubic feet of perfectly pure air each hour for every adult person who is vitiating the atmosphere of a room by his breath.

It must be remembered also that the gas-lights and other sources of illumination (the electric lights excepted) exercise a powerful influence in rendering the air of an apartment impure, by exhausting the oxygen, and giving off various products in combustion.

With natural ventilation, that is, ventilation from the cracks of doors and windows, and open fireplaces, it is almost impossible to replace the air of a room more than three times in an hour without the inmates being exposed to unpleasant currents of air. To observe the best hygienic conditions, therefore, it would be necessary that persons should not congregate in a room to a greater number than one to every 1,000 cubic feet.

An apartment 10 feet high, 10 feet wide, and 20 feet long, should thus contain 2 persons; and in a room 20 feet square and 10 feet high 4 persons, but no more, would be able to sit, eat, or sleep. But as it is impossible always to regulate the number of occupants thus, the simpler and entirely feasible plan of always having one window in each room opened at the top, should be invariably observed.

Of course all such laws of health are constantly outraged, but sooner or later such violations are sure to entail their own punishment.

Pure Water.—Water is the second great material necessary for existence. Without food or water life has been prolonged for 14 days. Without food, but with access to water, a man has lived for over 8 weeks.

If water is thus an absolute requisite for life, pure water is a no less imperative necessity for health, and as the possibilities of contamination are very numerous, owing to its great solvent powers, the sources of our drinking supply should be very carefully watched.

Water constitutes about three-fourths of the surface of the earth, and the greater part of the bodies of man and other animals; some vegetables contain as much as 95 per cent, of this fluid.

A healthy individual requires from 3 to 5 pints of water daily, nearly one-third of this quantity being contained in articles of diet, and the rest supplied to the system in the form of liquids.

Rain-water is the purest of all forms ordinarily met with, if collected in clean vessels as it falls. This only applies to country districts. In towns the rain carries down with it blacks, dust, and organic matter in suspension in the air. Rivers are probably the most usual sources of supply for our drinking-waters, and where due care is exercised to prevent contamination from sewers, factories, etc., this variety of water is one of the least objectionable. A still better source for our large towns is the water of mountain lakes, conveyed direct in covered channels.

A certain amount of saline constituents, especially of the sulphates and chlorides of the alkaline earths, must be present in order to render river and lake waters safe from the contamination of lead house-pipes, if these are used for distributing the fluid, as they are in most of our larger cities and towns.

The way in which these soluble salts act is by forming with the metal an insoluble coating over the inner surface of the pipe, which mechanically precludes the water from acting upon the metallic surface. It is on account of the purity of rain-water from these saline compounds that lead pipes or lead-lined cisterns should never be used for its conveyance or retention.

Rain-Water.—When rain-water falls upon the surface of the ground, a portion of the moisture runs off into brooks, creeks and rivers, but a much larger part soaks downwards through the earth, and after a few hours or days finds its way through the soil into the subterranean streams and reservoirs which feed our wells. In the course of its journey it may meet with materials from the animal kingdom, which will change it into a slow and insidious poison or a swift agent of destruction. One of the most fatal diseases of humanity, typhoid or enteric fever, is particularly apt to be transmitted by the medium of contaminated well-water; and the same may be said of Asiatic cholera, happily now very rare with us due chiefly to modern improvements in sanitation and hygiene.

Recent observations on the propagation and spread of typhoid or enteric fever have shown that in all the instances of excessive malignity, when great numbers were swept away in a few weeks, the cause of the fearful mortality lay in contaminated water-supplies. It is most important, therefore, that wells should never be sunk in the vicinity of cesspools or similar anti-hygienic contrivances.

In towns and villages where the water supply is doubtful, during epidemics of typhoid or cholera, all water used for drinking purposes should be boiled and filtered through some reliable make of filter. It must, however, be borne in mind that filtration only removes substances mechanically suspended in the water; to free the liquid thoroughly from all dissolved matter boiling or distillation is requisite. A well-constructed filter, especially one in which sand is the medium, will practically remove all the bacteria. Generally speaking, a filter should be cleansed once a month in summer, and every two months in winter.

When travelling in unhealthy countries, or during the prevalence of an epidemic, it is a wise plan to use for cooking or drinking purposes only boiled rain-water, if obtainable. The small portable filters such as those which were supplied to our soldiers in South Africa are invaluable travelling companions in a malarial district, in an emergency when reliable water cannot be had.

Make it a rule neither to sleep nor eat in a house where the drains are in bad order.

Baths and Bathing.—The employment of baths goes back to the highest antiquity, and was indulged in almost to excess by the Greeks and Romans. So important are baths in warm countries, that the Jewish and Oriental religions enjoin frequent ablutions as a necessary part of the ceremonials of their creeds; this no doubt has largely contributed to the health and well-being of their adherents.

In order to understand the value of bathing we must glance briefly at the anatomy and physiology of the skin. In the first place, we have on the entire outer surface of the body a layer of membrane, like thin leather, called the epidermis or cuticle; this stratum is not supplied with nerves, and is therefore insensitive. It is the portion which rises up when the hands are blistered by rowing, or when a fly blister is applied.

Just beneath the epidermis lies the true skin, or corium, a tough strong membrane, richly supplied with blood vessels and nerves. Hence it bleeds and feels pain at the slightest cut or puncture, since even the finest needle cannot be thrust into it without wounding some little artery or vein and some tiny filament of nerve. Under the true skin again lies the subcutaneous cellular tissue, which generally contains a quantity of fat.

The most important constituents of the skin to be noticed for our present inquiry, are first, the sweat glands; second, the oil glands; and third, the hair and nails are usually spoken of as appendages to the skin.

The sweat glands are twisted and coiled-up tubes, occupying the true skin and the layer of tissue beneath. They open upon pores, almost invisible to the naked eye. When we are at rest the flow of perspiration, though constant, is seldom so free that it does not evaporate almost as rapidly as it exudes, so that the skin is only kept pleasantly moist; but during exercise, especially in warm weather, the cutaneous surface becomes covered with drops of fluid.

When the pores of the skin are partly choked up, so that they cannot perform their work properly, some of this duty of purifying and regulating the volume of the blood is thrown upon certain internal organs, such as the kidneys or intestines; and should these happen to be weak, diseased, or already overtasked, serious disturbance may be quickly brought on throughout the whole system. Hence the importance of keeping the skin of the whole body clean by the free use of the bath.

Warm Baths.—For purposes of cleanliness, the baths par excellence are those of warm water, this term being applied to those in which water of a temperature from 70° to 80° Fahrenheit is employed.

Liquids of this degree of heat usually give a sensation of warmth when placed in contact with the human skin, and therefore avoid the disadvantages of the shock to our systems produced by a cold bath (that is, below 60°), and the excessive stimulation resulting from a hot bath, i.e., one of 85° and upwards. Soap or alkali in some form is necessary to remove the fatty matter poured out by the oil glands already described, and for most people there is nothing better than the old-fashioned white Castile. Many persons are apt to remain too long in a warm bath, and care should be taken to avoid this error which, if often indulged in, has a very debilitating effect on the system.

The frequency with which a warm bath should be repeated varies with different individuals. A safe rule, to which of course there are exceptions, is to bathe the body twice a week in winter and every other day in summer, gradually increasing the frequency to a tri-weekly washing in winter and a daily one in summer, if experience proves that better health is secured by such a habit.

It is very important to avoid being exposed to cool air after immersion in a warm bath, because the blood vessels of the skin being dilated from the stimulation of the warm water, the amount of prespiration poured out upon the skin, and consequently also the cooling effect of evaporation from the cutaneous surface are greater, and the danger of contracting a chill is much increased.

The condition is accurately expressed by the popular saying that a warm bath "opens the pores," although the exact mechanism by which this opening is accomplished is not so generally understood. The best time for a warm bath for those who are in robust health, but are liable to take cold, is in the evening, when they can go to bed at once, and so avoid all exposure for some hours afterwards. Invalids, however, and those of a delicate constitution, will often find that they endure the exertion of taking a bath best about 11 o'clock in the morning, after the digestion of the morning meal is accomplished, and before they are tired out with the fatigues of the day.

Hot Baths,— by which are meant those of a temperature of from 85° to 105° F., are chiefly used in the treatment of ailments and diseases as powerful stimulants. Every parent should remember that a hot bath, causing free perspiration, followed by wrapping up warm in bed with blankets, will often save children and adults from severe attacks of illness, if promptly resorted to after exposure to cold or wet.

Cold Baths are invaluable aids in promoting and preserving health, if properly used in suitable cases; but may become dangerous agents, causing even fatal results, if employed by the wrong individuals, at improper times, or with excessive frequency. If an experimental cold dip the first thing in the morning, followed by a brisk rubbing with a loofah and drying with a rough towel, produces a healthy glow and a feeling of exhilaration, the practice may be safely followed every day for at least eight months in the year. But if the skin turns blue, or headache, languor or sickness follow, the practice must be given up.

Sea-Bathing is one of the best means of strengthening the system, either to prevent the development of actual disease, or to restore the original vigour to a constitution recovering with difficulty from the effects of some debilitating malady.

Many delicate women and children are not strong enough to endure the shock of cold sea-baths from the beach; for them a bath of warm salt water, taken comfortably at home, is invaluable.

Baths should never be taken immediately after a meal, nor when the body is very much exhausted by fatigue, or excitement of any kind. Women should avoid bathing at such times when it would be under conditions liable to endanger their health. Children and elderly persons should use warm or tepid baths, never below 70° F.

Food.—Nothing is more important to physical well being, and consequently to the attainment of long life, than the two evidences of a healthy stomach, which the immortal dramatist has linked together in the oft-quoted saying of Macbeth:

"Let good digestion wait on appetite,
And health on both."

If we consider the amount of ill-temper, despondency, and general unhappiness which arises from want of proper digestion and the assimilation of our food, it seems obviously well worth while to put forth every effort, and undergo any sacrifice for the purpose of avoiding indigestion and the bodily ills which result.

It would be as reasonable to expect a locomotive to run without plenty of fuel as expect the human body to perform its daily labour without a sufficient supply of suitable food, properly masticated, swallowed, digested, assimilated and carried by the blood to nourish the various organs and tissues of the system, as they hourly wear out and are hourly replaced.

Every part of our organism is the subject of continual change. The flesh of the arm to-day is not precisely the same flesh as yesterday; some of its cells have been used up, dissolved, and carried away by the blood, and have been cast out of the system through the kidneys or bowels, whilst their places have been supplied by new molecules formed by digestive changes from the food taken into the stomach. If the stomach or the blood do not do their work properly, or if, doing the best they can, they are not supplied with suitable materials in the food furnished them, the effete molecules of the arm do not get fully replaced, and so the muscles become flabby and dwindle away; or, on the other hand, if, by unusually nutritious food and the stimulus of exercise, a greater number of new muscle cells are elaborated in the blood than are carried away by it in a worn-out condition, growth and development of the arm is the result. And so on with all the different parts of the body.

Another very important office of food, especially of the fatty (highly carbonised) articles of our diet, is to supply the bodily heat by being slowly burnt up within our systems, exactly as the coal (mineral carbon) burnt up in fireplaces warms our dwellings, except that the process of combustion is so managed in our bodies that it goes on slowly, and only a very little at a time, giving out no light and but a moderate amount of heat.

Materials of Food.—The materials which make up our food, besides water and saline ingredients, are: first, the nitrogenous (such as meat, eggs, cheese, the gluten of wheat flour, animal jellies, etc.); second, the fatty (as the fat of animals, butter, olive-oil, etc.); and third, the saccharine, comprising starch, sugar and molasses in all their varieties (bread, potatoes, rice, etc.).

The office of the first of these groups is to supply the waste of muscular substance or tissue caused by pulsation of the heart, breathing, eating, etc., and by physical exercise, such as manual labour, walking, or riding. Fatty articles of diet are chiefly employed to sustain the heat of the body by their gradual combustion, and the saccharine elements contribute to the same end.

Quantity of Food.—A healthy, full-grown man, doing a moderate amount of work, requires daily about 4½ ozs. of dry nitrogenous, 3 ozs. of fatty, and 15 ozs. of sugary and starchy food, besides 1 oz. of saline matter.

Under ordinary circumstances, the penalty for taking less than this amount of food is loss of flesh and strength, more or less rapid in proportion to the degree in which economy of nutriment, forced or otherwise, is actively carried on.

The penalty incurred by eating more than these quantities is derangement of the stomach, the liver and intestines, by thus over-loading them; and a consequent production of dyspepsia, biliousness, diarrhœa, or constipation, with their innumerable attendant evils, which, perhaps, more than any other class of influences, prevent the attainment of long life.

As a rule, women need about nine-tenths of the nourishment requisite for men; boys of 16 about the same as women, and children of 10 years half the amount necessary for adults. Individual peculiarities, whether temporary or permanent, should be studied and conformed to with the utmost care.

Quantities at Different Meals.—The quantity of food taken into the stomach at different meals is a matter of great importance. Speaking generally, the morning meal should comprise one-third of the meat and two-sevenths of the starchy nutriment; dinner should include the remaining two-thirds of the meat and three-sevenths of the starchy materials; and the evening repast consist of the last two-sevenths of the saccharine and starchy matters.

Few adults and hardly any children and old people, can be careless about their diet without suffering severely later on, even if no ill effects are immediately experienced.

Mental anxiety or labour, as well as bodily exertion, should be avoided during, and for half an hour after, a full repast. Lighter meals may be advantageously followed by gentle exercise, such as walking or moderate work. Complete mastication of the food is vitally important to health and long life.

Exercise.—Exercise, in the strict signification of the word, means the performance of its function by any and every organ of the body. As generally used, however, it signifies the action of the muscles under control of the will.

The most important effect of exercise is felt by the lungs and the heart. The circulation of the blood is hurried much above the ordinary rate, and, as a consequence of this greater influx of blood to be oxygenated in the air-cells, the quantity of air inspired, and the amount of carbonic acid exhaled, are both largely increased. During active exertion, therefore, the free play of the lungs should not be impeded by tight-fitting clothes.

Muscular exertion very speedily increases the force and frequency of the heart's pulsations; to a moderate extent, this is very beneficial to the organ, but care must be taken that it is not overdone, even by the strongest. Persons suffering with "weak heart" should indulge in athletics only under medical advice.

Severe muscular exertion increases the flow of blood in the small blood-vessels of the skin, and causes a profuse discharge of perspiration, which may be even doubled or trebled in amount. During active exercise there is little danger of chill; but immediately afterwards, and also during the intervals of rest, the skin should be so warmly protected as to prevent the least coolness of the surface. For this purpose flannel is by far the best covering.

Moderate exercise causes the muscles employed to increase in size, become harder, and respond more readily to the commands of the will; but if the exercise is too prolonged, or excessive, the opposite effect is produced, and they begin to soften and waste.

Deficiency of exercise is apt to lead to weakening of the heart's action, from a change of the muscular structure into fat (fatty degeneration).

It has been calculated that, for an individual weighing 150 lb., and in good health, the daily amount of exercise ought to be equal to that put forth in walking 8 miles on level ground. For females of average strength, a smaller amount of outdoor exercise, equivalent to 3 or 4 miles daily, would generally be appropriate. The modern girl, however, is almost as hardy and athletic as her brother, and can safely exceed this amount.

Exercise in Childhood.—The amount of exercise in childhood and youth should be carefully regulated. It is important not to restrict too much the movements of infants, and care must be taken that their clothing is not too tight to allow ample freedom of the limbs.

During childhood and youth, effort should be made to exercise every important muscle in the body, each in its turn, so as to secure for all the muscles a complete and symmetrical development, and consequently robust health.

Physical exercise, as well as mental exertion, should be regulated with especial care in young girls about the epoch of puberty, since the changes of the constitution at that critical period often render ordinary rules and habits useless or even injurious.

In advanced life the power, as well as the inclination for active exertion, alike fail, but moderate exercise should be encouraged as long as possible.

Sleep.—Sleep is intended to repair the expenditure of power in the system consequent upon mental or bodily fatigue, and its duration should therefore be proportional to the loss of vigour actually met with during the preceding period of daily activity.

In early infancy, the active processes of growth and development going on in the budding organism require a correspondingly greater amount of repair, which is largely contributed to by frequent slumbers, occupying a majority of the twenty-four hours.

The necessity for sleep, which is quite imperative in the young child, becomes gradually less and less pressing until, after the age of 2 or 3 years is reached, repose during the night only is required.

In the prime of manhood or womanhood, the proper period is more readily determined, and is much shorter than that suited to infancy. In advanced life the expenditure of physical and mental power is smaller, and less need of prolonged repose is felt by the system; although in extreme old age, or second childhood, the body often reverts to its infantile habits of frequent slumber.

Importance of the Habit of Sleep.—Habit, which so powerfully affects all the bodily functions, exercises a great influence upon the duration of sleep. Those who, from necessity or from choice, remain awake through the night, learn to feel, it is true, as soon as the habit is well established, no necessity for nocturnal sleep, yet the enfeebling of their forces and impoverishment of their blood are the usual consequences.

In regard to the influence of temperament, it may be observed that a plethoric habit of body, kept up by a full diet, especially of animal food, predisposes to sleep, provided the digestive powers are in vigorous condition. Persons of lymphatic temperament are usually great sleepers. Thin, wiry people, on the other hand, in whom the nervous temperament predominates, usually require comparatively little sleep; but their slumber, while it lasts, is very deep.

The amount of sleep is greatly influenced by habit, and, contrary to what might have been anticipated, we find that exceptionally brief sleepers have generally been men of the greatest mental calibre. Thus, Frederick the Great, John Hunter (the often-quoted surgeon), and the first Napoleon, are said to have required only 5 hours' sleep out of the 24. As a general rule, from 6 to 8 hours of repose are required in the 24 to keep the system in a state of healthful activity.

Usually, when people are abruptly aroused from profound slumber, the action of the heart becomes quickened or otherwise disturbed. The effects of a habitual deficiency of sleep are a sense of wretchedness and prostration, frequently accompanied by great restlessness.

Headache, fulness, heat, throbbing and various other unpleasant sensations about the head, give warning that the brain is being over-tasked, and, should this warning pass unheeded, sleep, which at first it was difficult to resist, becomes even more difficult to obtain; a state of general restlessness and feverish excitement is induced; and if, in spite of this, the mental task be continued, serious consequences are almost sure to be induced.

In average health, the best cure for sleeplessness is duly regulated exercise of body and mind. Among the simpler and hygienic means of promoting sleep is cold water, or cold water and vinegar, sponged over the forehead and temples when the restlessness appears to be due to congestion and heat about the head.

Mental activity and consequently sleeplessness, mean an excess of blood in the brain. A very efficacious method of procuring sleep after lying awake for some time is to take a small quantity of food, e.g., a glass of milk and a biscuit. This stimulates the digestive organs, draws the excess of blood from the brain into the abdomen, and speedy sleep is the result.

The bed-chamber should be well-ventilated. It is best to lie upon an inclined plane, or with the head moderately raised, but not so high as to produce any strain upon the muscles of the neck. Complete darkness should be secured as far as possible. Anxiety and excessive effort to procure sleep, are foes to slumber. A light supper taken about 2 hours before retiring is in many cases conducive to sleep. People with feeble circulation should guard against cold feet, a common, cause of sleeplessness, by the use of bed socks or hot water bottles.

INFECTION, CONTAGION, AND INFECTIOUS AND CONTAGIOUS DISEASES

Contagion, a name derived from the two Latin words, con and tango to touch together, is the term applied to the substance which communicates disease from an unhealthy person to a healthy one when there is actual contact. The word infection is applied to the vehicle by which a malady is transmitted from one person to another by the air, and with or without actual contact. The type of infectious disease is small-pox, and this is also, as is well-known, a highly contagious complaint. Scarlet-fever, measles, whooping-cough, mumps, etc., are likewise both contagious and infectious, and make up the class of disorders popularly known as diseases which are "catching."

The most probable doctrine of the true nature of contagion is that set forth in the germ theory of disease. This hypothesis, which has exercised a most important influence on modern medicine and surgery, accounts for the symptoms of contagious diseases by attributing them to the more or less mechanical irritation of groups of microscopic plants (bacteria), and in some cases minute animal micro-organisms, developing in the blood, the skin, and the vital organs of affected persons.

The period of incubation (by which is meant the time between exposure to small-pox, for example, and the outbreak of the complaint) is supposed to correspond with the time required for the sprouting of the seeds of these minute plants within the body. The gradual increase in the severity of the symptoms is attributed to the progressive growth of millions of tiny vegetable organisms, whose period of greatest luxuriance marks the height of the attack, and the death and destruction of which correspond to the decline of the disease.

Germ Theory.—The contagiousness of the communicable maladies is accounted for by the existence of the immense number of almost inconceivably small micro-organisms, which are constantly produced by and given off from the sick person, and carried through the air of a room or house either alone or attached to the innumerable epithelial scales which are all the time being rubbed off, as dandruff, etc., from our bodies.

The general absence of second attacks has been explained by the hypothesis that a substance is produced in the blood by the first attack, which is detrimental to the life of the micro-organism. This substance is called an antitoxin. Another explanation is that the micro-organism, on the first occasion, has exhausted all, or nearly all, of some peculiar unknown organic ingredient in our systems, which is absolutely requisite for its support.

Every individual afflicted with small-pox, scarlet fever, or any of the other diseases above mentioned, is, according to the germ theory, to be looked upon as a sort of hot-bed or forcing-house for the seeds, or spores (as they are called), of that malady.

From his or her body are continually given off in all directions, by the skin, the breath, the perspiration and the other secretions, millions of spores so minute that 20,000 placed end to end would not measure 1 inch in length, and a group of them the size of a grain of sand might contain 50,000,000. Each one of these infinitely minute organisms, if it were received into a human system under favourable circumstances, would rapidly reproduce itself, and after a few days or weeks, corresponding, as already mentioned, to the period of incubation, give rise to a new case of disease—again a new hot-bed for other unprotected persons.

But these spores (like the seeds of larger noxious weeds, which, when allowed to gain a foothold in our fields and gardens, propagate themselves with such immense rapidity) can only develop if they meet with air, moisture, and soil suited to their peculiar requirements. That is to say, if the contagion of small-pox is not carried by the air to un-vaccinated persons until it has lost its vitality, or if the microbes of this loathsome disease do not fall upon good ground, then, and then only, no harm is done to mankind.

It must be remembered that small-pox and other contagious maladies do not arise, as is often supposed, without previous exposure to the seeds of disease. It may be, and doubtless is, frequently impossible to say how certain cases of infectious disease have arisen; but most persons competent to judge are agreed that, in our own day at least, every new case of contagious disease is the immediate offspring of a preceding case.

This truth was clearly demonstrated in an epidemic of measles which appeared last century in the Faroe Islands, an isolated group in the North Sea. For sixty-five years the inhabitants of these islands had been free from measles, when, on April 1, 1846, a workman from Copenhagen, who had arrived three days before, fell ill with the complaint. His two most intimate friends were next attacked, and from that time the malady was traced by Dr. Pannum, the Danish Commissioner, from hamlet to hamlet, and from island to island, until 6,000, out of a total population of 7,782, had been affected by it. Age brought no immunity from the disease, though it was found to spare all who, in their childhood, had suffered at the time of the previous epidemic, more than sixty years before.

Caprieiousness of Contagion.—Contagion is often very capricious. Occasionally, in a family of children, one will be very ill with scarlet fever, and the rest, although exposed to the microbes of the disease, will escape without being infected: at other times, all the members of a household, except those protected by a previous attack, will take the malady in spite of the ordinary precautions to seclude the affected child from its brothers or sisters. This is, no doubt, due to some constitutional peculiarity.

The contagion of small-pox is probably the most virulent of any that we have ordinarily to deal with, and, but for the discovery of vaccination by Jenner, would, perhaps, have continued to prevail as a terrible scourge of our race. People of the present day, who complain of the temporary inconvenience and the dangers of vaccination, can only do so through ignorance of the horrible suffering, painful deformity, and appalling mortality which attended small-pox in pre-vaccination days. The method, then, to avoid the contagion of small-pox is to be vaccinated and re-vaccinated with fresh vaccine matter, direct from healthy calves, in order to avoid any possible danger from this virulent poison.

The contagion of small-pox is extremely active, spreading readily through a house, and often to neighbouring dwellings. It may be conveyed by the breath of a person affected with it before any eruption appears, and has been caught from a dead body, 12 days after decease. It may be transmitted for long distances in clothing, bedding, letters, etc., unless great care is taken to thoroughly ventilate and disinfect them. As it is often propagated by unscrupulous persons when travelling whilst sick with mild forms of small-pox, or varioloid, we would advise every one to examine carefully, at the first opportunity, a vaccine pock upon a child's arm, 5 or 7 days after a successful vaccination, and then studiously avoid proximity to any strangers having similar eruptions upon their skin. Stringent laws are properly enforced against persons who endanger the public health by running the risk of disseminating the poison of small-pox or other infectious disease.

Unfortunately, such safeguards as vaccination against other contagious diseases, such as scarlet fever, measles, etc., are not in general use, and precautions against entering the sphere of their influence become doubly important, especially during epidemics, or at times when our systems are enfeebled in any way by other maladies or unfavourable conditions.

Diseases among School Children.—These diseases are very apt to be propagated among school children by the return of scholars recovering from measles or diphtheria, for example, before the poison has entirely passed from their bodies, and without proper purification of their clothing—a pernicious practice which has been legislated against, but which can only be fully abolished by the action of enlightened public opinion in regard to the injustice and criminality of such acts.

At the end of the section dealing with diseases of children (p. 1924) is appended a Quarantine table showing the length of time which should elapse after the various infectious diseases before the patient should mix freely with the outside world.

Isolation and Disinfection.—When any member of a family is attacked with small-pox, scarlet fever, diphtheria, or other contagious disease, the malady may generally be prevented from extending by attention to the following rules: Place the patient in one of the upper rooms of the house, the furthest removed from the rest of the family, where the best ventilation and isolation are to be had. He should be under the sole charge of a nurse who is protected by a previous attack of the disease. The apartment should be at first cleared of all curtains, carpets, woollen goods, and unnecessary furniture. To secure the utmost cleanliness, provide a basin partly filled with chloride of lime or strong carbolic acid solution (a teaspoonful of acid to half a pint of water), in which the patient may expectorate when necessary. Change the clothing and bedding of the patient as often as needful, but never let the cast-off articles be carried dry through the house.

A large pail or bath containing carbolic acid solution (4 fluid ozs. of carbolic acid to each gallon of water) should always stand in the room, for the reception of bed or body linen immediately after it has been removed from contact with the patient. The nurse should wear in the chamber a loose gown and tight-fitting cap, to be thrown off at the door, and the hands should be washed, before going out, with the carbolic acid water. Pocket-handkerchiefs and napkins should not be used, but in their stead pieces of rag, which should be at once burned. A solution of carbolic acid, 1 teaspoonful to 4 ozs. of water, should frequently be sprayed over the patient and his bed, about the room and over the nurse's dress.

Glasses, cups, dishes, etc., must be scrupulously cleansed in fresh carbolic acid solution, or in boiling water, before they are carried away from the room. All discharges from the body are to be received at once into vessels containing some disinfectant, such as a solution of per-chloride of mercury, 1 part per 1,000 of water, or the carbolic solution, and immediately removed under cover. They should be thoroughly disinfected before poured down the drains. A sheet kept moistened with carbolic acid solution of double strength, or half a pint to the gallon, should be hung over the door outside, or beyond in the passage way, for the purpose of catching any germs of the disease which might otherwise escape. Boiling is the surest way of disinfecting contaminated clothing, or it may be baked in an oven heated to about 240° Fahr.

After the disease is over, the patient should be kept isolated for 10 days after all the scabs fall off in small-pox, or after desquamation ("peeling" of the skin) is complete in scarlet fever; for the last week of his seclusion, baths should be given daily, or every other day, containing carbolic acid, Sanitas, or other disinfectant, and every part of the body should be bathed, especially the scalp, as the disease poison is apt to linger about the roots of the hair among the dandruff. The peeling of the feet and palms of the hands may be hastened by the use of pumice stone.

To purify the apartment, wash the furniture, woodwork, floor and walls (scraping off the paper) with the carbolic acid solution and soap. Then shut up the room tightly, pasting up windows and chimney with brown paper, and burn in it 1 Ib. of sulphur for every thousand cubic feet of space it contains. (A room 15 feet long, 12 feet broad, and 9 feet high, for instance, would require 1½ lb.) The action of the sulphur dioxide produced is more certain if the air of the room is moist. Steam should therefore be introduced into the room half an hour before the sulphur is burnt, or the walls of the room should be thoroughly sprayed with water.

The sulphur is best burnt in an iron dish supported upon a basin of water. To start it burning moisten with a little methylated spirit. Allow the fumes to remain in the closed room for 24 hours. Lastly, open doors and windows so as to ventilate freely, for a week, at the end of which time disinfection may generally be considered complete.

A more modern method of disinfecting, which has the great advantage over sulphur of not injuring fabrics and pictures and not bleaching colours, is the use of Formic Aldehyde Gas. The same precautions are taken of pasting up windows, chimneys and doors, and the gas is introduced into the room through the keyhole. Formalin, as it is also called, is best made by passing the vapour of methylated spirit over platinised asbestos. Special apparatus can be procured for this purpose, the use of which can be quickly learnt. The principal disinfecting establishments now use formalin in preference to sulphur.

Small-pox, or Variola.—This is a febrile, eruptive and contagious disorder, which in the past raged with much violence in this country, but in recent periods has been vastly controlled by the discovery of vaccination. About its origin not much is known. The earliest records mention a disease which was probably small-pox, as far back as the sixth century; since this period it has appeared with more or less virulence at various periods. The most common varieties are: the discrete, in which the pustules are distinct; the confluent, in which the pustules run together; the malignant, which is often associated with purpura and an eruption resembling measles—a very dangerous form; and the modified, which comes on in those partially protected by vaccination, and is a kind that runs a very mild course. In cases of small-pox there are: (1) the stage of incubation, which lasts 12 days from the date of receiving the poison; (2) the stage of eruptive fever, lasting 48 hours; (3) the stage of maturation, wherein the rash is fully developed, lasting about 9 days; (4) the stage of secondary fever or decline, lasting a variable time, according to the severity of the disease. Discrete small-pox is, next to the modified, the simplest form of the disease, and is rarely attended with danger to human life. Confluent small-pox is much more serious, and often proves fatal. In the discrete or distinct form the primary fever is less intense than in the confluent form; in the latter there is often delirium, and more especially in intemperate persons. The malignant variety is terribly fatal; the blood seems profoundly poisoned from the first, and is more fluid than usual; bleeding from the mouth, nose and bowels is not uncommon; in women there are also genital bleeding and other disastrous results. In modified small-pox the patient is often able to keep about the whole time, and the rash may suddenly decline on the fourth or fifth day, and recovery follow.

Symptoms.—The disease begins with shivering or rigors, pain in the back, vomiting, thirst, headache, and a general feeling of indisposition; in children, convulsions may come on. In many cases the rash of small-pox in vaccinated cases is preceded by a more or less scarlet or roseolous rash, which is mottled over the body. If the finger be pressed on the forehead, a sensation is experienced as if pressing small shots, for the rash of small-pox generally commences there; at first a pimple forms, but afterwards a pustule, and then dries or scabs over, and leaves a pit or depression behind. When the rash comes out the temperature falls, but rises again about the eighth or ninth day; in mild cases, however, the secondary fever is hardly perceptible. The eruption usually appears first on the forehead, face and wrists, then on the rest of the body, coming out on the legs and feet 2 days later. The eruption takes about 8 days to arrive at its full development; during this time there is much swelling of the face and eyelids, so that the patient cannot see for a few days; in bad confluent cases the face seems covered with a mask, and a disagreeable odour proceeds from the body. Boils are apt to form in cases of confluent small-pox; the victims are also very subject to pleurisy, pneumonia and bronchitis; sometimes the tongue is much swollen and dry, and the patient may be unable to close the mouth or to speak; this is a very bad symptom. Inflammation of the ear, followed by an abscess, is not uncommon in this disorder. Erysipelas, gangrene, and pyæmia are occasionally met with. Inflammation of the eye and ulceration of the cornea may add to the general mischief. A medical man should always be called in when small-pox appears.

Treatment.—In the early stage, poultices and hot bottles will relieve the pain in the back and the chilly feeling. If the fever is high and delirium is present, sponging the body with tepid water is beneficial. When the eruption appears, warm baths are to be given night and morning. The pocks should be treated with some antiseptic application, such as carbolized oil or zinc ointment, or dusted with finely powdered boracic acid, as soon as the scabs come away. Painting with flexible collodion will both allay the irritation and in many cases prevent pitting. Dilute acetic acid, 1 part to 4 of water, often relieves the intense itching. Pitting is generally worse when the scabs are scratched away; children should therefore wear fingerless gloves.

Vaccination. Small-pox is of all diseases the one in which the fact that prevention is better than cure can be most emphatically proved, because we have a means of prevention ready to hand. Vaccination was first practised by Jenner, who noticed that milkmen, whose hands became inoculated with cow-pox in the pursuit of their calling, escaped the scourge of small-pox, so prevalent in those days. Since his day vaccination or inoculation with lymph taken from vesicles, the result of inoculation with calf-lymph, has been practised more and more generally till now it has been made compulsory in most of the countries of the civilized world. Arm to arm vaccination was formerly the custom in this country, but now the law orders that only lymph taken from calves that have been proved to be healthy is to be used. Vaccination undoubtedly protects against small-pox. An infant successfully vaccinated is considered safe against infection for a period of ten years, when he should be re-vaccinated. The operation should be repeated in another seven or eight years' time, and again at similar intervals should there be an epidemic or exposure to infection. A recently successfully vaccinated person never takes small-pox; and one who has been adequately vaccinated in the past, if he should catch the disease, will have it in a very mild form and make an almost certain recovery.

Scarlet Fever, or Scarlatina.—This is an acute febrile disease, producing a scarlet rash upon the skin, attended by a sore throat, and often swelling of various glands, and sometimes followed by dropsy. The disease is most prevalent during the last 3 months of the year, from October to December. The minimum number of cases occur during April. The cause of scarlet fever is principally due to contagion, but there is a considerable mass of evidence to show that cases have arisen from milk derived from cows suffering from an ulcerative disease of the udders (corresponding in the main to scarlet fever), supposed to be scarlet fever in a modified form.

Measles and whooping cough are more contagious; typhus fever and diphtheria are less so. The poison may be retained in clothes for a year or more, and then give rise to fever. Both sexes are equally liable to an attack; between 18 months and five years is the most common time to have the fever. Many people confuse the terms scarlet fever and scarlatina, and imagine the latter is a milder and less dangerous affection; this is a great mistake, for scarlatina is only the Latin name for scarlet fever, and not a different form; the term is too often adopted when there is some doubt as to the nature of the case, and then it is used to conceal ignorance. Scarlet fever may be very mild, or malignant, or latent. The period of incubation is generally less than a week, and may be only 24 hours.

Symptoms.—1. Mild Scarlet Fever.—The onset is sudden; there is sore throat with tenderness at the angles of the lower jaw, and stiffness at the back of the neck; vomiting is very common, and chiefly so in children; shivering and rigors come on, and occasionally convulsions in young children. The temperature rapidly rises and will go up to 104° or 105°; the pulse is very quick, the tongue is covered with a thin white fur; there is thirst and loss of appetite. This stage lasts from 12 to 30 hours, and then a rash comes out. Sometimes the earlier symptoms are so slight that the rash is the first thing noticed. This consists of small scarlet dots on a background of lighter red almost running together so as to give a flush all over the skin; the colour disappears on pressure, but rapidly reappears when the pressure is removed. It generally appears at first on the sides of the neck and upper part of the chest and in the bends of the joints; it then spreads downwards, and is found to come out last on the legs; it begins to fade on the fourth or fifth day, and is generally quite gone within a week. The sore throat is always present in some degree; there is redness and swelling of the tonsils and soft palate, so that it is often very painful to swallow, while the glands beneath the jaw also swell and are painful. The temperature is generally higher than in measles, and much higher than in diphtheria, but it rarely exceeds 105° F.; the temperature falls to normal during the second week of the illness, or seventh to tenth day of disease. In no fever is the pulse quicker than in this disorder, and it may be 140 or 160 in a minute. Moderate delirium and headache are often present in these cases. After the rash has gone the epidermis is dry and harsh, and about the ninth or tenth day it begins to peel, and is sometimes cast off in large flakes, and this desquemation or peeling may last a few days or occupy several weeks.

2. Malignant Scarlet Fever—is characterized by an increased severity of the above symptoms; there are great prostration, delirium and sleeplessness; the rash does not always come out well; the face may be livid, and stupor and coma come on and end in death; the throat is ulcerated, and there is much difficulty in swallowing.

3. Latent Scarlet Fever—is when the disease is so mild that until the sequelae appear one is not aware of having had scarlet fever. Sore throat may be the only symptom. There is no relation between the abundance of the rash and the danger to the patient. However mild the disease may be, the sequelae may come on with great severity; and the fever is just as likely to spread from a mild case as from a severe one.

4. Sequelae.—After the fever has passed, a train of symptoms may follow, which are very inconstant in their character and of much danger to the patient. The throat may continue to be affected, and the glands outside maybe inflamed and swell, so that the child's head seems encased in a collar; often these glands suppurate, and a large ulcerated surface is then seen. Deafness may supervene, and a discharge from the ear. Bronchitis and pneumonia are not so common as in measles. Sometimes convalescence is retarded by abscesses forming in various parts of the body; at other times there is a painful affection of the joints which much resembles rheumatic fever. Renal dropsy is also one of the most usual sequelae, but it frequently varies in different epidemics. Its onset is associated with a rise of temperature, headache, and often sickness and vomiting; the face and loose parts of the skin are very pale and puffy, which is best seen under the eyes and on the insteps; the urine is scanty, and dark from containing blood; loss of appetite is common, and convulsions sometimes occur, Renal dropsy often comes on 2 or 3 weeks after the first appearance of the rash.

Treatment.—Most cases recover in a fortnight, except the malignant ones, or where the sufferer is at the same time pregnant (this condition much increases the danger, and hence women should then be extremely careful not to go near a case of scarlet fever). Even the mild cases must be nursed, for there is no remedy which will cut short an attack. The patient must be put to bed and administered a milk diet. Hot flannels or cotton wool, or spongio-piline, should be wrapped round the throat, and steam may be inhaled by the mouth when the throat is sore. If dropsy supervenes it is a symptom that the kidneys are affected, and the patient must be put to bed again if he has been up previously, and the diet still consist chiefly of milk. A hot bath and purgatives must be given to remedy the kidney affection, which is a serious development.

Exposure to cold too soon after an attack of scarlet fever often causes dropsy, so that great care should be taken to keep the patient in the house for at least three weeks after the rash and until the peeling has quite finished. During the stage of peeling, baths containing an antiseptic, such as Sanitas, should be occasionally given, care being taken to see that the water is as warm as the patient can comfortably bear it, and that a warm bottle is placed in the bed, or other precaution used, to ensure freedom from chill. When there is great prostration ammonia may require to be given. The throat may be thoroughly syringed with chlorine water by means of a 4 oz. ball syringe. During convalescence tonics should be administered, for which purpose quinine and iron are probably the best. For the disinfecting measures to be used the reader is referred to the remarks in the earlier part of this section.

Enteric, or Typhoid Fever.—Typhoid or enteric fever is a continuous and infectious fever, caused chiefly by the contamination of drinking water with sewage containing the bacillus of this disease, lasting an uncertain period of from four to six weeks, and sometimes followed by a relapse. It is also known by the names of low, gastric, and drain fever. It seems to have been known from the earliest times. It is always endemic in the British Isles, but is perhaps most common in England.

Causes.—Among the predisposing causes are age, mode of prevalence, months and seasons, temperature and moisture, idiosyncrasy, residence in an infected locality, overcrowding, deficient ventilation, and bad drainage. (1) Typhoid fever appears to attack one sex as readily as the other; (2) the disease is chiefly met with in youth and adolescence; (3) typhoid fever is always endemic amongst us, and the cases treated in the London hospitals do not vary greatly from year to year; (4) it is most common in the autumn and winter; (5) it is most common after a dry and hot summer, and unusually scarce in summers that are cold and wet; (6) it does not appear that intemperance, fatigue or mental emotions predispose to this disease; (7) some people, owing to what is called a peculiar idiosyncrasy, are more liable to it than others; (8) all classes are alike subject to it when exposed to the exciting cause; (9) fresh comers in an affected locality take the fever more readily than the ordinary residents of the place; (10) there is no clear evidence that occupation has much influence. Numbers of cases go to prove that those nursing the sick from this disease very frequently catch it, but this is probably due to neglect of proper precautions in the sanitary management of patients.

It is not often transmitted to the nurses who take care to wash and disinfect their hands after all attentions to the patients, and carefully avoid breathing when stooping over vessels containing discharges. Whenever any drainage soaks from the surface into a well used for drinking purposes, or when sewer gases escape into a house by a leaky pipe, or when the traps are out of order, or when one drinks foul or stagnant water into which drainage has entered, then arise the conditions which excite the disease. Very many old houses are improperly drained, and whenever a storm occurs and the sewers are suddenly flushed, the gases escape upwards into the waste-pipes of the houses along the route, and overcome the resistance of the traps. It is therefore of the greatest importance that the drains of all old houses should be thoroughly tested by a competent surveyor, and, if possible, an approved modern scheme of pans, traps and ventilating shafts substituted. In any case it is essential that the house drain shall never enter the main sewer without first a communication with the open air, preferably by a shaft carried above the level of the house; that a small air-pipe be carried from beneath the pan or trap of an indoor water-closet to the house-top; that a cistern with a continuous supply of water should be applied close to and above each water-closet, and that the cistern for the drinking water should be quite distinct from the other cisterns. In modern houses the sanitary arrangements are usually much better, but to insure health all drains should be thoroughly flushed with a couple of pails of water every other day in winter and every day in summer, and the pans kept thoroughly clean. In small places the dry earth system should be adopted, and lime mixed with the excreta when removed, as otherwise the typhoid bacillus will not be destroyed and will remain active for years. Care must be taken that no leakage from an old cesspool can escape into the well.

Symptoms.—The onset of typhoid fever is always very gradual and insidious; it begins with an "out of sorts" feeling, aching pains in the limbs, headache, loss of appetite and chilliness. For many days the sufferer is able to go about and think there is not much the matter. Sometimes there is diarrhœa. Then the pulse is quicker, the skin hot, and the tongue red and dry. At the end of the first week or later he is feverish, has no appetite, is thirsty, and the bowels are generally relaxed. The urine is scanty and high-coloured; there is still more restlessness at night. Between the seventh and twelfth day an eruption, consisting of a few slightly-raised, rose-coloured spots, makes its appearance. They are generally situated on the abdomen and chest, but they may occur over the whole body. These disappear in 2 or 3 days, but fresh crops come in their place. Pain may be experienced, and gurgling felt on pressing over the right side of the abdomen. About the middle of the second week delirium comes on. The tongue is dry, red and glazed, and often cracked. As the disease advances the patient loses flesh and strength; he lies prostrate and perhaps unconscious of what is going on around, and, if it is to end fatally, he will become quite insensible, have a high temperature, and fumble at the bed-clothes. If the disease progress favourably the symptoms abate during the fourth week, the temperature gradually falls to normal, and the patient slowly recovers.

Complications.—Diarrhœa may be profuse and exhaust the patient. Bleeding from the nose may occur, but is not often a bad symptom; bleeding from the bowel is common and, if large in amount, is of serious import. Perforation of the bowel may occur from an error in diet; it is attended by collapse and is very dangerous. Inflammation of the peritoneum adds greatly to the danger. Bronchitis and pneumonia may supervene and increase the mischief.

Treatment—Place the patient in a well-ventilated room. Remove all curtains, carpets and bed-hangings. Prevent exertion on the part of the patient. The greatest cleanliness must be observed, and all excreta removed at once, perchloride of mercury, carbolic acid, Sanitas, or chloride of lime being mixed with them. The diarrhœa need not be checked unless excessive, and then a little starch injection may be made. The diet must be very light, and no solid food should be taken under six weeks or two months, because in consequence of the ulceration of the bowels the coats are very thin and liable to burst. Absolutely nothing should be given to the patient beyond what has been ordered by the medical attendant. Milk must form the main article of diet, and then an egg or two may be beaten up in it, or a custard may be given and beef-tea. If there is much intestinal distension hot flannels sprinkled with turpentine will be useful.

Typhus Fever.—This is a highly infectious fever which occurs in epidemic form, generally in periods of famine and destitution. For it was often confused with typhoid fever, and the difference between the two has only been recognized within the last fifty years.

Typhus fever is now happily rare, only small outbreaks occasionally occurring. This is chiefly due to the general improvement in sanitation, and the fact that badly built and over-crowded hovels are gradually giving place to clean tenements and model dwellings.

Causes.—Typhus is met with in both sexes and at all ages, though it is rare in young children. Famine, bad food, dirt and over-crowding are all important factors in its production. In all probability the essential factor is a micro-organism, but this as yet has not been demonstrated. Neisseria petechialis is however found associated with the disease.

Symptoms.—It is difficult to say how long the disease may be incubating in the system before it appears, but the period is certainly not constant, and seems to vary from five to twelve days. The onset is marked by a severe headache, loss of appetite and languor, and aching of the limbs. For three or four days the patient gets worse, is unable to get about, and feels chilly and prostrate; he is then worse at nights and restless; the skin is hot, the tongue coated; there is thirst and sometimes vomiting. The patient then lies prostrate on his back, with a dull and weary if not stupid look; the eyes are suffused and watery, and a dusky flush overspreads the face. As the disease progresses the eyes are half shut, and the mouth open; the tongue dry, brown or black, and marked with cracks. The temperature rises from the first, and reaches 103° or 104° F. by the middle of the first week; the highest temperature reached in the fever is seldom less than 105°, although it may be higher. The fever may slightly abate, in favourable cases, about the ninth or tenth day; no marked fall, however, takes place until the end of the second week, and generally on the fourteenth day, when defervescence, usually takes place suddenly. The other symptoms then quickly disappear and convalescence is rapid, the normal temperature being reached in 24 hours. A rash appears in nearly every case. Sometimes it looks like a general mottling just beneath the skin, or distinct spots may appear of small size and purplish colour. The rash appears on the fourth or fifth day, rarely later; it comes on the back of the wrists first, in the armpits, and over the epigastrium; then it more or less covers the trunk; it seldom comes on the face and neck.

Treatment.—The patient should be placed in a well ventilated room. The windows should be kept open, for the specific poison of typhus loses its potency when well diluted with air. The diet and treatment is the same as for any other infectious fever. When the temperature has fallen, fish and poultry may be added to the diet sheet.

Fever and delirium should be treated by cold sponging. Isolation should be continued for four weeks from the commencement of the attack.

Influenza—is the name applied to an acute febrile disease, which is always present in this country, but sometimes takes an epidemic form, and attacks a large number of people in a particular locality. There seems little doubt that it is extremely infectious. The micro-organisms Microccocus roseus and Streptococcus seiferti are associated with this disease.

Symptoms.—The disease begins suddenly with headache, pain at the back of the eyes, and in the back and limbs. The temperature is raised, and usually there is running at the nose, and frequently some bronchitis.

The abnormal temperature continues for 3 or 4 days, there is loss of appetite, with great thirst, and the sufferer is quite incapacitated from work. When the fever declines there is a feeling of great exhaustion or weakness, which may persist for a long time; in fact, the return to the former state of health is usually slow. Unfortunately one attack is by no means protective, and many people who have suffered from an attack of influenza, whenever the disease is prevalent again fall victims to it.

Treatment.—Absolute rest in bed, with light nutritious diet. A purge should be taken at the onset of the attack. During the fever a mixture containing salicylate of soda (10 grains every 4 hours) relieves the pains and reduces the fever. Later, Easton's syrup after meals is one of the best tonics for the feeling of exhaustion and weakness. A change of air is always beneficial.

Cholera.—Cholera, as known to us, is of two kinds—what is known as British cholera, a disease bad enough, but not particularly fatal—and that terribly fatal disorder, Asiatic, malignant, or epidemic cholera. This last disease seems to have been known in India for centuries, and to have its natural home or headquarters in the Delta of the Ganges. In this country the disease has almost always prevailed in its worst form in poor, crowded dwellings, among those whose food supply was bad, and whose hygienic conditions were otherwise unfavourable, but especially among those who had a tainted supply of water. Very frequently cholera and diarrhoea prevail together.

Causes.—The disease is usually due to drinking water contaminated with sewage containing the cholera vibrio, a twisted motile bacillus (comma-bacillus), the cause of the disease.

Symptoms.—In a case of ordinary intensity, Asiatic cholera is ushered in by an attack of diarrhœa. This may last a longer or shorter period, but speedily the matters passed by the bowel assume a flocculent or rice-water character. Vomiting, too, comes on, the fluid being thin and colourless. Then follow severe cramps, especially of the abdominal muscles and legs. The flow of urine ceases, the body becomes icy cold on the surface, the tongue is cold, and so even is the breath. The lips are blue and shrivelled, the face pinched, the voice is hardly audible. This is called the cold or algid state of the disease. The condition may go on getting worse till the heart stops, the patient being quite conscious to the end. Frequently it is impossible to tell whether the patient will live or die, when suddenly the sickness lessens, the body begins to get warm, the face flushes, and restlessness subsides. The patient may go through this reactionary stage to perfect recovery, or he may relapse into his former state of diarrhœa and vomiting, ultimately dying from heart failure and collapse. Thus, in an ordinary mild case of cholera, a man will pass through three stages, probably, in about 48 hours. Firstly, that of premonitory diarrhœa; secondly, that of collapse; and thirdly, that of reaction.

Treatment.—He who would avoid cholera during a cholera season ought to live by rule and method. First, see that the sanitary arrangements are in good order, and that every precaution is taken in cleansing and disinfecting the offices. Calvert's carbolic acid powder, Sanitas, or Jeyes' fluid, answer very well for this purpose. See that the house is clean, sweet and airy, and that no decaying matters remain upon the premises. Be sure that the water supply is pure; if there is any doubt about the matter, it is safer to drink only water that has been boiled and filtered. Have all cisterns emptied and thoroughly cleaned out, and see that the coverings fit accurately. Let no stale meat or vegetables, no sausages, game, or substances likely to create digestive disturbances be used; avoid unripe fruit, prolonged abstinence from food and excessive fatigue. Avoid strong aperient medicines of every kind.

Diarrhœa in Cholera time should not be neglected.—The astringents used should not be powerful; chalk mixture, sulphuric acid, or lemonade, with a little opium added, are best. Try to keep up the bodily heat in every way that does not disturb or fatigue. If the diarrhœa develops into cholera and the patient is consumed with thirst, there is no reason for refusing him drink if it is of a wholesome kind. Should reaction occur, he must be kept quiet. If his head troubles him, and his face is flushed, apply ice or cold water. If there is much sickness let him have a little ice-water to drink. If his lungs become gorged, warm poultices or turpentine stupes will be best. But the kidneys are the chief anxiety. If they do not act, warmth must be tried, perhaps as a warm bath, but this requires caution. If they are acting well and the patient requires a stimulant, let him have some sal-volatile. The food to be given is of especial importance; broths, soups and jellies may be given, but certainly not meat. Small quantities must be given at a time, and repeated as frequently as necessary.

Erysipelas.—Erysipelas of the face is an infectious disease of somewhat frequent occurrence. It is rarely seen in children, but it attacks adults of both sexes. It comes on without apparent cause in many cases, but a blow or exposure to a cold and cutting wind may be predisposing causes of the inflammation. The inflammation itself is produced by a micro-organism growing in the skin. While only mildly infectious in ordinary cases, erysipelas is very likely to infect persons suffering from unhealed wounds of any kind. Hence great care should be taken to avoid exposing such persons to the risk of infection,

Symptoms.—The disease usually begins at the ear or one side of the nose, and redness and swelling extend over that side of the face; more rarely it crosses over the median line and affects the whole of the upper part of the face. Pain and tingling precede the inflammation, and when the latter has reached its height, the eyelid is so swollen that it cannot be opened; the ear is large, red and flabby, while the skin adjacent is swollen, red and painful. Erysipelas is, in fact, an inflammation of the skin, and it is severe according to the depth to which this tissue is implicated. Sometimes only the upper layer is affected, and then the appearance is like that seen in erythema, diffused redness of the skin produced by capillary congestion. There is but slight swelling, and the constitutional symptoms are not severe. But if the whole thickness of the skin be attacked, and, in addition, the loose cellular tissue underneath, then the inflammation is of graver import, and may spread over a large area. A high temperature, quick pulse, thirst, often a sore throat, loss of appetite and a thickly-coated tongue, are among the earliest symptoms. The patient feels very restless and sleeps badly at night: in many cases delirium comes on towards evening: mostly observed in those previously addicted to intemperate habits. The bowels are often constipated, and the urine high coloured and containing a little albumin. Erysipelas of the face without other complications usually runs a course of 6 or 7 days, when the temperature rapidly runs down, the tongue begins to clean, and all the febrile symptoms disappear, leaving the patient weak and anaemic. If, however, the inflammation has affected the deeper layers of the skin, or if the patient has been previously in bad health, matter or pus may form beneath the scalp through the spreading of the disease upwards: when this occurs the pus soon burrows about under the scalp, and an opening must be made to allow the matter to discharge.

Treatment. The patient must be kept in bed and fed on light and nourishing diet. The light should be kept from his eyes and access of air to the inflamed skin prevented by dusting the surface with flour, or smearing the part gently with a mixture of equal parts of castor-oil and collodion, or castor-oil alone. This effectually keeps off the air and relives the tightly-stretched skin. Some opening medicine may be given at first, if constipation is present and the tongue is much coated. Steel drops are a useful medicine in this disease: they should be given in doses of from 15 to 20 drops, with the same quantity of glycerine, in a little water, every 3 or 4 hours. Larger doses are frequently administered, but it is better not to give these unless ordered by a medical man. During convalescence, tonics containing iron and quinine may be given, and for some time all exposure to cold winds, etc. should be avoided.

'Chicken-pox, Diphtheria, Measles, Mumps and Whooping Cough, being more frequently contracted in childhood, are dealt with in the section Diseases of Children. All of these complaints, however, may be developed by adults.

NON-INFECTIOUS DISEASES AND THEIR REMEDIES

Anaemia.—This is a condition in which there is an impoverished state of the blood, the red cells being deficient in quantity and quality, the blood becoming more watery than in health. It arises under conditions in which the individual is deprived of the materials necessary for the making of good blood, as, for example, when the food supplied is insufficient in amount or kind, or the greater part of the day is spent in close, badly-ventilated workshops. It also arises in the course of exhausting diseases, and through excessive study and insufficient physical exercise. One of the commonest causes of anaemia is indigestion, due to incomplete mastication of food caused by bad teeth, and by absorption of the discharges from rotten and decayed stumps.

Symptoms.—A pale appearance of the skin and mucous membranes; the lips and gums lose the rosy look of health, and become of a delicate pink colour; exertion is difficult, and going upstairs or climbing a height out of doors give rise to breathlessness. Palpitation of the heart, headache, pain in the back, and in the left side, are frequently complained of; failure of physical and mental energy. Obstinate constipation is nearly always a prominent symptom. Such importance did the late Sir Andrew Clark attach to the treatment of the constipation in this disease that he is reported to have said that had he an anaemic girl to treat, and he were offered the choice of two drugs, iron or aloes, to effect a cure he would choose aloes.

Treatment.—Remove the patient, if possible, from all influences that tend to injure the health. Have the teeth attended to, and if necessary artificial teeth supplied. Well-ventilated rooms and workshops with plenty of light are desirable. A moderate amount of exercise in the open air is helpful in giving tone to the system. Change of air from the town to the country, or more particularly, to the sea-side, is often beneficial, and cold sponging, especially with salt water, is also helpful. The diet should be plain and nourishing, and a moderate amount of animal food should be taken. Under ordinary circumstances there is no necessity for stimulants. In regard to medicines, the one thing needful is iron. This may be given in the form of steel drops or Blaud's pills; 10 to 20 drops of the former, and 1 or 2 of the latter 3 times a day. Aloes may be given with iron in the form of a pill; or as a mixture for the constipation, salines or a dose of cascara daily may be substituted.

Appendicitis.—At the commencement of the large intestine there is a small blind offshoot of gut about 4 inches long. From its resemblance in size and shape to a worm it is called the vermiform appendix.

In man it is a rudimentary structure, but in some of the lower animals it plays an important part in digestion. Inflammation of the vermiform appendix, or, more shortly, appendicitis, is not an uncommon disease, and of later years has received more attention than formerly; the dangerous illness of King Edward in 1902 especially brought this malady into prominent notice. Appendicitis is more commonly met with in children and young adults.

Causes.—Since the lumen of the appendix is small it may readily become blocked by a faecal concretion or by a foreign body, cherry stone, etc. These, by pressure on the walls of the appendix, and by stopping the exit of the mucus secreted in its interior, set up inflammation.

Over-eating, constipation and indigestion, and a sudden chill, are common factors in its causation.

Symptoms.—Pain in the abdomen, more especially in the lower part on the right side. This pain is often accompanied by nausea and sickness. The tongue is furred, the temperature is often raised, and there is no constipation.

Treatment.—The patient should be put to bed and hot flannels applied to the painful side. The diet should be entirely fluid. Medical assistance must be obtained at once, since some cases, happily the minority, progress very rapidly, and early surgical treatment is essential for the safety of the patient.

Asthma, from a word signifying "to gasp for breath," is a nervous disease, depending upon contraction of the circular muscular fibres surrounding the bronchial tubes. Occasionally it is connected with, and dependent upon, original malformation of the heart, or an unnatural conformation of the chest, in which case it usually makes its first appearance in childhood; otherwise it is most frequently met with about the middle period of life.

Symptoms.—Asthma, whether connected with malformation or not, is a hurried, oppressed and noisy state of the breathing, coming on in paroxysms, and leaving the patient comparatively well in the intervals; although in some cases there may be observed wheezing and a more confined dilation of the chest than is natural in inspiration. In a typical asthmatic attack, the patient wakes up in the small hours of the morning with a sensation of suffocation; the difficulty of breathing continues, and a terrible struggle begins. He sits up in bed, or gets up and goes to the window, where he stands struggling for breath. The wheezing is attended with successional coughing, and at length the expectoration of some viscid phlegm gives him great relief; he breathes for a while, and after a little more coughing and expectoration the paroxysm ends. A peculiar state of the atmosphere is an exciting cause; damp, foggy weather will induce it in some, a north-east wind in others; some asthmatics are liable to attacks while spending the night in a large town; others enjoy freedom from attacks while similarly circumstanced. A single indigestible meal, particularly a hearty supper, is another exciting cause.

Treatment.—Avoid everything likely to set up an attack, particularly, the articles of diet. During the attack, if there is reason that the stomach is at fault, an emetic of 20 grains of powdered ipecacuanha, or the same of sulphate of zinc, may be given to an adult. Temporary relief may be obtained by the patient taking a few whiffs from a pipe of tobacco or stramonium. Ozone papers are useful, as are also Joy's Cigares Anti-asthmatiques Inhaling the fumes from smouldering Himrod's powder gives relief. The general health of the patient should be carefully attended to. Change of air is often beneficial, and so are such tonics as cold sponging and the shower-bath, when there is no other reason to prevent their employment.

Bright's Disease.—This is a name applied to several inflammatory affections of the kidneys, generally associated with albumin in the urine and often with dropsy. It may be either acute or chronic.

Causes.—Acute Bright's disease may occur from cold, from a blow, from taking substances such as turpentine or cantharides, which irritate the kidneys, but more usually it follows some acute febrile disturbance, and more especially scarlet fever.

Symptoms.—Cold shivers, headache, pain in the back, often sickness. The temperature is raised, and the amount of urine excreted is diminished or almost suppressed, is occasionally bloody, and coagulable. Dropsy is often a secondary disorder.

Treatment.—Hot baths do good by causing sweating and giving free action to the excretory power of the skin. They may be taken at bedtime and repeated every night; the water should be about 95° to 98° Fahr., and the patient may remain in it for from 5 to 10 minutes, then be quickly dried and put to bed. Purgatives should be taken, such as compound jalap powder, 20 to 30 grains of which may be taken by an adult. Rest in bed in a warm room is most important, nor ought the patient to think of leaving his room until all the dropsy and acute symptoms have subsided. Light nourishing food may be given, such as bread and milk, veal tea, broth, rice pudding, arrowroot and gruel. During convalescence, great care must be taken to avoid cold, and flannel should be worn. Tonics containing iron and quinine are useful.

In Chronic Bright's Disease, even if an unskilled person were able to detect it, little if anything of practical use can be done except under medical direction.

Bronchitis.—This is an inflammatory disease of the lining membrane of the bronchial tubes. It may be acute or chronic.

Symptoms.—Acute bronchitis is very liable to attack persons in the winter, and during the prevalence of east or north-east winds. It begins like an ordinary cold, succeeded by a feeling of chilliness, and aching pains in the limbs. The patient is thirsty and feverish, with languor and headache, loss of appetite and restlessness; there is an uneasy feeling of soreness behind the breast bone. At first there is a dry, hacking cough, and very little phlegm is brought up; in two or three days the cough becomes looser, and the expectoration is more abundant. Wheezing sounds are heard in the air passages.

Treatment.—When the chilly feeling is experienced, the patient should go to bed and keep there till he is warm again; in this way an attack may be checked in a short time. The air should be warm, and for this purpose a fire should be lighted and the temperature kept at about 60° F. A bronchitis kettle of boiling water placed on the fire, and the steam allowed to pass into the room, will help to keep the air moist. Inhalations of steam are very soothing, and may be obtained through an inhaler, or by holding the face over a jug of boiling water and wrapping a towel round the head and jug so as to prevent the escape of the steam. The inhalations may be medicated by the addition of a few drops of Eucalyptus oil, Terebene, or compound Tincture of Benzoin, to the boiling water. A warm bath before going to bed is also useful, as it encourages free perspiration. A hot linseed-meal poultice may be placed on the chest, and renewed every few hours if necessary. A piece of gutta-percha tissue may be placed over the poultice to prevent the moisture from wetting the clothes. Rubbing the front of the chest with turpentine liniment often gives great relief. Turpentine stupes (cloths steeped in hot water, wrung nearly dry, and made irritant by moistening with a few drops of some volatile liquid) and sinapisms (mustard plasters), may be useful, should milder measures fail to give relief. A mixture such as the following may be given: ipecacuanha wine, 2 drachms; concentrated infusion of senega, 1 oz.; water to make 8 ozs.; a tablespoonful to be taken every 3 or 4 hours. Should the case be one in which stimulation seems necessary, as in old or debilitated subjects, carbonate of ammonia may be given with advantage in doses of 3 to 5 grains. A drachm to a drachm and a half added to the above mixture would answer very well. Five to ten drops of ipecacuanha wine mixed with thirty drops of syrup of squills, and a teaspoonful of glycerine every four hours, is also useful. In children, this disease is at all times to be regarded gravely. The above treatment should be adopted with the modifications necessary to the child's age, and the avoidance of turpentine stupes and sinapisms unless ordered by a medical practitioner. The diet should consist of milk, beef-tea, veal-broth, milk, arrowroot or cornflour.

Chronic Bronchitis is a very common disease, and is very prevalent during winter, causing considerable mortality. It is most usually met with in middle-aged or old people. Cough, shortness of breath and expectoration, are the three most constant symptoms of chronic bronchitis. This disease may occur as a consequence of old age merely, or it may come on as a sequel to an attack of acute bronchitis. Cab-porters, costermongers, bargemen, and others whose occupation exposes them to all kinds of bad weather, are extremely subject to this disease.

Treatment—Removal of the sufferer to a warmer climate for the winter and spring, if possible. If this is out of the question, the treatment must be directed to avoiding, as much as possible, any exposure to cold, or any of the exciting causes of the disease. For those who are engaged in outdoor occupations, and exposed to all the inclemency of the weather, but little can be done to alleviate any distressing symptoms that may arise. Thick boots should be worn, clothes changed when wet, and the patient be told to breathe through the nose, to be out as seldom as possible at night, and use a respirator.

Cancer.—The very name of this disease is fraught with so much significance, and the diagnosis is a matter of so much doubt to the lay mind, that the subject becomes out of the scope of this work. In the case of any tumour being discovered medical advice should be taken at once, as if it should be of a malignant type early treatment may effect a permanent cure.

Colic is a griping pain in the intestines, and often accompanied by a painful distension of the whole of the lower region of the bowels, with vomiting, costiveness and spasmodic contraction of the muscles of the abdomen.

Causes.—The complaint is produced by various causes, such as crude, indigestible fruits, long continued costiveness, cold, or it may be due, as in painter's colic, to poisoning by lead.

Treatment.—If caused by some indigestable article of food, a dose of castor-oil had better be taken, say a tablespoonful for an adult, to which from 10 to 15 drops of laudanum may be added. If the pain is very severe, a turpentine stupe may be applied over the abdomen.

Constipation is a symptom which may be due to disease of the bowels, or to an imperfect performance of their function. Any disease, such as ulceration or cancer, which obstructs the passage of the food, will cause constipation; and any condition which produces a paralysed or sluggish state of the muscular walls of the bowel will likewise cause constipation by removing or interfering with the propelling power. With rare exceptions people can never enjoy good health while they suffer from constipation; liver complaint, dyspepsia, headache, vertigo, and piles are some of the direct results of this condition.

Of all the causes which originate and establish habitual constipation, there is none so general as inattention to regularity. Men of sedentary pursuits are naturally more prone to the error of irregular habits than practical men; hence general and local disorder of the stomach is more prevalent among them. Women often fall into the same error in the neglect of regularity. Habitual constipation is not unusual in women after a confinement, in people of a nervous temperament, and in those who lead a sedentary life. The practice of taking relaxing medicine, pills, etc., habitually, also disposes to this. In all such cases an altered diet and regular habits will nearly always suffice.

Treatment.—A glass of cold water taken on rising in the morning will, in some, prove efficacious. A light breakfast to those who are sedentary will favour this action. Coarse brown or bran bread is very useful; figs, prunes and ripe fruits are also beneficial; exercise in the open air and a cold sponge in the morning are also helpful. The habit of taking an apple or an orange an hour before bedtime will often effect a permanent cure. An occasional aperient may be required, and then Friedrichshall water, in the dose of a wineglassful taken fasting, may be employed. In children a similar treatment may be adopted, with such modification as the age will require, while in infants an altered diet and a little magnesia occasionally, mixed with the milk, will suffice.

Clysters or Enemata are now in frequent use in constipation. It is not, however, advisable to use them daily. Where they are employed, care should be taken to see that the fluid is bland in its nature, such as barley-water, thin gruel, linseed tea, or milk and water. Warm water by itself has a tendency to injure the mucus membrane of the bowel. The injection of a teaspoonful of glycerine is a simple and efficacious means of relieving the bowels; also glycerine suppositories.

Consumption.—This disease is called technically phthisis, a Greek word, meaning a wasting away, wasting being a common symptom in the latter stages of the disease.

Cause.—Consumption is a form of lung disease which is characterised by destruction and ulceration of the lung itself. It is caused by the growth and multiplication in the lung substance of the tubercle bacillus, discovered by Professor Koch. These bacilli produce inflammatory changes in the lung; tissue of an inferior kind is then deposited round the bacilli, and gradually invades the lung tissue proper. At a later stage ulceration and degeneration take place in this tissue and in the inflamed lung adjacent, resulting in the destruction of the lung by the formation of cavities in its substance. The blood that is often coughed up is a sign that destruction of the lung is present.

Symptoms.—The earliest symptoms of consumption are probably connected with digestion. The appetite becomes capricious, there are pains in the chest, some cough, often dry and hacking, with a small quantity of frothy expectoration. There is debility, flushing of the face and shortness of breath on slight exertion; at other times the countenance is pale, except for a hectic patch of red in the middle of the cheek. There is some fever at night, and a tendency to night-sweats. Very likely there is some spitting of blood. As the disease advances emaciation becomes more marked, and the fingers become clubbed at their ends. The night-sweats, diarrhœa and expectoration reduce the bodily strength and substance; at the same time the capricious appetite and the imperfect digestion leave the bodily supply very deficient. Usually, if the disease be not arrested, the patient dies of exhaustion.

Treatment.—The selection of the conditions under which the consumptive is to live is the first and most important item of the treatment. At different health resorts in Europe there are to be found people who have suffered all their lives from bad chests, but who, by moving from one resort to another, according to the season of the year, are able to live with little pain or discomfort. In selecting a house for a consumptive, the first great thing is to avoid a damp building, and to choose a dry and porous soil. Consumptives should live plainly, but their food should be nourishing; they must avoid excitement, but cheerful society is of the greatest value; they must not fatigue themselves, but daily exercise is essential; they must not be exposed to too great heat, but cold is even more to be dreaded. They should always wear flannel, and the clothing must at all times be warm. There are a great many health resorts that might be mentioned, but only a few are given here. On the south coast of England, Bournemouth, Torquay and South Devon, Hastings, Ventnor and Penzance are all frequented by consumptives. Abroad, the chief places recommended are the Engadine, St. Moritz, Davos Platz, etc., all Alpine climates, situated 4,500 to 6,000 feet above sea level; and the south coast of France. Latterly much attention has been paid to the open-air treatment of consumption, and several sanatoria have been opened for the purpose throughout the United Kingdom and abroad. This treatment has proved very successful, especially in the earlier stages of the disease—the progress of the disease being arrested, and the patient cured.

A sea voyage to South Africa, Australia or New Zealand is also useful in the early stages of the disease. No better climates can be found for the complete cure of the disease than those of the South African veldt, or the interior of Australia. The coast towns should be avoided, as the conditions there are not much better than those obtaining in English cities. When well advanced, it is unwise to send patients from home. Fat is one of the articles of food to which consumptive patients have a great aversion, and it is to be regretted, for it is to them the most necessary. If they cannot be got to take fat in the ordinary way as food, they should take cod-liver oil, which, indeed, is rather food than medicine. It must be given cautiously and after a meal. When oil cannot be taken by the mouth it may be rubbed into the skin. Hypophosphites have proved useful in this disease. Fellows' syrup is an excellent preparation, and may be given to an adult in doses of a teaspoonful 3 times a day. Oil of eucalyptus is useful; it may be dropped on the sponge of one of Dr. Yeo's respirators and inhaled; 3 to 5 drops may be used at a time. Should bleeding come on, the patient should be kept at rest, and the liquid extract of ergot given in 15 drop doses in water every 2, 3, or 4 hours, according to severity. Ice, if it can be had, should be taken internally. 10 grains of gallic acid with 15 drops of aromatic sulphuric acid may be given every 3 hours instead of the ergot if more convenient. An ice bag may be applied to the side from which the blood is supposed to come. The night-sweats may be relieved by the administration of dilute sulphuric acid in 15 drop doses in water at bedtime, or by 10 drops of tincture of belladonna in water. If diarrhœa is troublesome, 10 to 15 drops of laudanum may be given with 15 drops of dilute sulphuric acid every 4 hours, in water. Patients afflicted with the disease should avoid indiscriminate expectoration, since the sputum contains millions of bacilli, and when the sputum is dry these may be carried about in the air, and become a source of infection to healthy individuals. Little flasks are now sold in which patients can expectorate when travelling. At home a spittoon, containing a 1 in 20 solution of carbolic, should be used.

Diarrhœa.—Diarrhœa, like constipation, is a symptom of disease rather than a disease itself.

Causes.—Exposure to cold not unfrequently gives rise to diarrhœa by driving the blood from the surface of the body to the internal organs, thus producing in the bowel an excess of blood (congestion) which is relieved by the escape of the watery parts into the bowel, and an increased production of fluid by the intestinal glands. Exposure to intense heat and over-exertion may also occasion diarrhœa. Among other causes may be mentioned malarial influences, sewer gas, decaying animal and vegetable substances, errors of diet, exhaustion, and the disarrangement of the regular habits of life.

Symptoms.—Pain is usually present, often of a colicky nature, and is relieved by an action of the stomach. It is occasionally unattended by pain.

Treatment.—It is of great importance to ascertain the cause, and if possible, remove it. Give the body rest and administer bland food such as milk, arrowroot or cornflour. If caused by some undigested food, give a dose of castor-oil with 10 or 15 drops of laudanum for an adult. Apply a mustard poultice or mustard leaf over the abdomen if there is much pain. In tropical climates, where severe attacks of diarrhœa from chills are common, a broad flannel belt should be worn round the abdomen day and night. This will prevent many chills, and its value is so well recognized that the so-called "Cholera Belt" is a regulation garment in the kit of every British soldier on Indian service.

Flatulence.—Flatulence is an undue collection of gas or air in the stomach or bowel, generally arising from the decomposition of unsuitable foods, or from the irritation of the walls of the stomach, etc., when in an enfeebled state. It is a common and very unpleasant symptom of indigestion or dyspepsia. In a great number of instances it is due to temporary errors of diet, and disappears on correction. The abuse of certain articles of food, and especially of tea, is responsible for much persistent flatulence.

Symptoms.—Often there is pain on the left side over the heart, and some palpitation. There may be a feeling of faintness, giddiness or choking. Eructation is a frequent symptom.

Treatment.—Flatulence is best treated by dieting, keeping mainly to solid food, with stale bread, or, better still, toast. Vegetables, pastry, tea and beer should be avoided. The offending article of food, if known, should of course be relinquished. Spirituous liquors should be avoided. Flatulence may often be only the symptom of dyspepsia, It may be relieved temporarily by a slight stimulant, such as aromatic spirits of ammonia, or by 15 drops of sal-volatile in water every hour or two. The following may be used with benefit: 3 drachms of bicarbonate of potash, or the same of bicarbonate of soda, 1 oz. of the concentrated infusion of calumba, and sufficient peppermint water added to make 8 ozs. A tablespoonful of this mixture to be taken 3 times a day in water. From 1 to 2 drachms of tincture of mix vomica, with 1 oz. of the concentrated infusion of calumba, and water as before added to make 8 ozs., is another useful combination. This mixture should be taken in tablespoonful doses as the other. From 2 to 5 drops of pure terebene, taken on a lump of sugar, and repeated 2 or 3 times a day, is also a most useful remedy. The best beverages for flatulent subjects are weak cocoa essences, and hot water with a little lemon juice.

Gastric Ulcer.—This is a disease most frequently met with in young servants, and is nearly always preceded by anaemia.

Symptoms.—Pain, vomiting of coffee-ground matter, the colour being due to the presence of blood.

Treatment—has to be long and careful, as if the ulceration continues it may end in perforation of the walls of the stomach. Peritonitis will result from perforation, and will probably prove fatal, unless an immediate and dangerous operation should prove successful.

When there is bleeding ice should be sucked; this is also most useful in checking vomiting. Opium in one or other of its forms (laudanum, morphia) will relieve the pain. Small doses of morphia with bismuth may be given thus: 5 or 10 minims of the solution of the muriate of morphia with 10 or 15 grains of sub-nitrate of bismuth 2 or 3 times a day. Milk is the best food. If the patient is very sick and pained, it may be necessary at first to withhold food from being given by the mouth, in which case it ought to be administered in the form of enemata, but only under definite medical direction. (The writer has found a teaspoonful of Carlsbad salts given in water 3 times a day useful in this disease.)

Gout is a complaint depending upon the presence in the system of an excess of uric acid. It may be acute (or regular) gout, showing itself in the joints and more especially in the large joint of the great toe; or irregular gout, having other and manifold manifestations. The disease is either hereditary, in which case it often misses a generation, or acquired. Excessive eating, undue indulgence in alcohol, and indolent habits will tend to produce it. Meat, especially beef, the more potent wines and malt liquors are the articles of diet most prone to originate gout.

Symptoms.—Inflammation and pain in the great toe or other joints, heartburn, various skin diseases, nervous and other manifestations, protean in their variety.

Treatment.—Moderation in quantity of food. Less meat should be eaten, and that chiefly white meat. Sugar, sweets and pastry should be avoided, also all root vegetables. All stimulants are best given up: if any be taken, the least harmful are Hock, Moselle and Chablis. Of spirits, brandy is to be taken in preference to others. Sedentary habits should be altered, regular healthy exercise being taken instead.

Medicines.—In acute gout, 10 to 20 drops of tincture or wine of colchicum may be given every 4 hours, combined with 10 to 15 grains of citrate of potash or lithia. Saline Aperients: Half a wineglassful of Hunyadi, Apenta or Friedrichshall, or a teaspoonful of Carlsbad Salts before breakfast are all useful. For the local pain: Fomentations with laudanum or poppyheads constantly applied are very soothing; and the affected parts should be kept wrapped up in flannel.

In Chronic Gout, sensible dieting, and a course of the waters at Bath, Baden-Baden or Aix-les-Bains will do much good.

Hæmorrhoids, or Piles.—These are swellings situated sometimes within and sometimes outside the lower bowel opening. They are liable to irritation and inflammation, in consequence of which they give rise to a good deal of suffering. External piles consist in a collection of rounded hard tumours and of prominent ridges of skin situated on the outer edge of the opening. When these become irritated and inflamed they occasion very acute pain, with throbbing and a sense of great heat, and a constant desire to relieve the bowels. This affection originates in the distension of the local veins, caused by the circulation being obstructed. Piles are generally met with in persons who follow sedentary employments, and those who, in consequence of highly-seasoned foods and indulgence in alcoholic drinks, suffer from congestion of the liver. The presence within the opening of large, rounded, and soft tumours, covered by red mucous membrane (internal piles) is attended with more serious symptoms. These are very apt to weaken by giving rise to frequent bleedings. Persons subject to piles should carefully avoid sitting on rocks or stones, or on wet grass or omnibus seats.

Treatment.—The diet should be carefully regulated, and all highly seasoned dishes, alcoholic liquors and pastry avoided. Walking exercise is highly beneficial. Bathe the affected region every morning with cold water, and carefully dry and push the obtrusions in. Hazeline is a useful application in bleeding piles. Gall and opium ointment or pure vaseline smeared over the parts often give relief. A quarter-grain morphia suppository (or plug) may answer when these remedies fail. The bowels should be kept open, either by the confection of sulphur, the confection of senna, or compound liquorice powder. Purgatives containing bitter aloes and other irritants of the lower bowel should be avoided.

Heart Disease is a complaint which, like cancer, is too serious and difficult to permit of self-treatment. If there is any suspicion of its existence, if there is shortness of breath, pain over the heart or running down the left arm, any labouring or irregularity in the heart's action, medical advice should be sought and carried out.

Jaundice, though often spoken of as a disease, is not a disease by itself but only a symptom common to many disorders of the liver.

Liver Complaints.—The liver, like the kidneys and other organs, is liable to various acute and chronic diseases. Amongst the acute changes may be classed catarrh, or inflammation of the bile ducts, acute atrophy of the liver, congestion and inflammation of the liver, and the presence of gall-stones in the hepatic duct.

Catarrh of the Liver.—Symptoms.—Jaundice, loss of appetite, coated tongue, slight sickness and a feeling of retching; the motions are pale, the urine dark, the skin and eyes become yellow, and there may be, in some cases, a troublesome itching of the skin. The pain is not in itself a very troublesome symptom, and it is generally felt, if at all, in the right shoulder-blade and along the lower edge of the liver, and is often worse on pressure.

Treatment.—The best treatment is first to open the bowels freely; a dose of calomel at night followed by a saline draught in the morning will generally suffice. The diet must be very light, and capable of being easily digested; all rich food should be avoided, while milk, broth, beef-tea, toast and biscuits, or a light pudding, may be taken. No stimulants should be given, as they tend to increase the congestion of the liver. Effervescing solutions may be given with benefit, since they allay thirst and sickness; those which contain soda salts are the best, and those also which have an aperient action; for this reason effervescing Carlsbad waters are often beneficial. In 3 or 4 days a mixture containing extract of dandelion, hydrochloric acid and gentian may be given 3 times a day. The bowels must be kept open daily. Active exercise should be taken every day, if the patient can bear it; and for some time after recovery care must be taken to avoid indigestible food.

A "sluggish" or congested Liver is generally associated with catarrh of the bile ducts, and arises often from want of exercise, and excess in eating and drinking; but congestion may develop to inflammation in tropical countries, and end in the formation of an abscess. This may be known by the pain over the region of the liver, the swelling of the abdominal wall on that spot, and the frequent shiverings; the patient loses flesh, strength and appetite, and his skin becomes of a sallow tint. People who have suffered from this complaint generally come back to this country invalided, and if they recover from the illness, they seldom regain their former state of health. Regular exercise, and a plain and sparing diet, are the best preventatives.

A gall-stone in the hepatic duct will cause great pain over the liver (chiefly in one spot), much sickness and intense distress, and a feeling of faintness. A hot bath and the administration of chloroform will ease the pain, or hot fomentations constantly renewed may be applied to the affected side, and 25 drops of laudanum (for an adult) in half a glass of water given, repeating the dose in two hours if the agony still continues. Jaundice will come on from the obstruction to the flow of the bile, but this will disappear when the stone has escaped from the duct into the intestine, or has become dislodged and returned to the gall bladder, thus leaving the bile duct open.

Amongst chronic changes of the liver may be enumerated cancer, cirrhosis, fatty and waxy degeneration, passive congestion, syphilitic deposits, and the presence of hydatid cysts.

Cancer of the Liver is a most fatal and serious disorder, carrying the patient off within a year, or a year and a half, from the first appearance of any symptoms. These are, at first, loss of appetite and pain over the abdomen; the latter begins to swell as the cancer increases in size, and becomes extremely tender; rapid emaciation goes on, but the temperature is generally no higher than usual, and there is no attendant fever. The loss of flesh, the hollow temples, the great prostration, the pain and swelling or enlargement of the liver, are the chief symptoms: these gradually become worse, and finally cause a lingering and painful death. Jaundice is not often present, nor does the patient suffer from shivering. Cancer of the liver may occur in both sexes, and be met with at any period of life ; more frequently, perhaps, between 30 and 50 years of age.

Treatment.—The treatment must be directed to the relief of the patient, as cure must hardly be looked for. The pain may be alleviated by the administration of opium or morphia, given internally as a draught, or injected under the skin in small quantities with a hypodermic syringe. The diet must be light and nourishing, and must be varied from day to day to please the fancy of the patient, whose appetite will be small and capricious.

Cirrhosis of the Liver comes on more generally in middle life; at first it may be mistaken for cancer, as there is loss of flesh and appetite and pain in the abdomen, but the symptoms come on more gradually. The liver does not increase in size, but rather shrinks; dropsy of the abdomen soon comes on, and the distended abdomen becomes marbled over with blue veins as the stream of blood through them is impeded.

Fatty degeneration of the Liver is common in many disorders. A liver may be very fatty, and yet give rise to no symptoms, as in cases of consumption. The symptoms in any case come on very gradually, so that the organ is generally much diseased before any notice is taken of the mischief. The disease is often very chronic, and will last for years unless there be much mischief in other organs; dropsy is a bad symptom, and, when general, will frequently point to disease in the kidneys.

Treatment.—The chief attention must be given to the diet, and all indigestible foods avoided. If dropsy be present purgatives must be given to remove the fluid, and the general health must be kept up by tonic medicines, such as iron and quinine.

Waxy degeneration of the Liver is a less frequent disease. It rarely, if ever, occurs alone, and is generally associated with similar disease in the kidneys, spleen and intestines. It occurs in persons who have long suffered from diseased joints and chronic abscesses and in scrofulous subjects. Practically the only special symptom is obvious enlargement of the liver; and its treatment is included in that of the chronic disease with which it is associated.

Passive congestion of the Liver often occurs in heart disease and some disorders of the lungs, arising from the fact that since the course of the circulation is disturbed at these points the veins become too full all over the body, and the hepatic vein sharing in this fulness the liver gets stuffed with blood, and so the stream flows through too sluggishly. From a similar cause the veins in the leg and kidney are over-filled, resulting in dropsy of the lower extremities, and a scanty flow of urine, which will contain a variable amount of albumin. Pain over the liver will be present, and, frequently, there is some yellowness of skin from the presence of jaundice. After a time dropsy of the abdominal cavity may come on, with fatal results.

Treatment.—Since passive congestion of the liver results from the disease of the heart or lungs, the treatment must be directed to allaying any tumultuous or irregular action of the heart, and to removing any dropsy by purgatives or small punctures in the leg.

Syphilis will produce various changes in the liver, and cause a hardening of that organ and thickening of the capsule. Sometimes rounded masses, somewhat resembling cancer, are met with in the organ.

Treatment.—The health, in such cases, must be improved by a visit to the seaside, if possible, or a sea voyage, by liberal diet and regularity of living. Preparations containing iron and quinine are valuable, and may be given in conjunction with iodide of potassium.

Hydatid cysts occur more commonly in the liver than in any other organ, although they are by no means very often met with. They may occur in the liver either as small, round and firm tumours, formed of a fibrous capsule, with putty-like contents these are hydatid cysts which have undergone spontaneous cure, and can do no more harm; or as cysts with a tough, fibrous capsule, enclosing a quantity of fluid, and a greater or less number of smaller cysts floating about in them. These cysts may attain a great size; they are seldom attended with pain, unless there is inflammation outside setting up adhesions. The general health is seldom affected, so that the nature of the disease is chiefly recognized by the presence of a tumour in the liver and the absence of any constitutional symptoms. Should the contents of the cyst suppurate, the condition becomes one of abscess of the liver, and constitutional symptoms such as pain and shivering fits occur.

Treatment.—The treatment will consist in having resort to surgical aid, whereby the contents may be evacuated and the cyst allowed to shrink. If allowed to grow, such cysts may cause death by bursting into the abdominal cavity, or into some neighbouring organ.

Lumbago.—This is a form of chronic rheumatism affecting the lower part of the back and loins. The individual moves stiffly and has pain in getting up from the sitting posture or in turning over in bed at night.

Treatment.—The application of a menthol plaster, or strapping the affected side, often gives relief. Should it be impossible to apply either of these remedies, a hot bath and wrapping the part up in flannel will be found useful. Rubbing with a compound camphor liniment containing a little laudanum often relieves. In gouty persons the diet should receive attention.

Meningitis (Simple).—By this is meant inflammation of the membranes covering the brain. It is always serious.

Causes.—It may be produced by the presence of the micro-organism Diplococcus pneumoniae. It often follows a neglected discharge from the ear.

Symptoms.—In young children there is disturbed sleep, a cast or rolling of the eyes, dilated pupils, convulsions and fever. With older persons, who can express their symptoms, there is severe headache, intolerance of light, want of sleep, mental disquietude, sometimes unnaturally acute hearing, constipation; sometimes sudden loss of speech and delirium.

Treatment.—Put the patient in a darkened room; apply cold to the head by means of cloths wrung out of cold water; send at once for the doctor; purgatives are generally required to combat the constipation; the greatest quiet must be maintained. Milk is the best food.

Meningitis (Tubercular). This disease is associated with a scrofulous constitution, and occurs in children of different ages up to 12 or 13 years. Bad air, insufficient or unnutritious food, exposure to cold, want of sufficient clothing, all increase the unhealthy tendencies which combine to produce the disease, which is nearly always fatal.

Symptoms.—Loss of appetite, loss of spirits (seen in aversion to play); constipation; gradual wasting of the body; drowsiness; squinting of the eyes; vomiting; enlarged and glassy look of pupils, rolling of the head.

Treatment.—Keep the child quiet in a dark room, and give milk as food. The one medicine which the writer has found of benefit in this is iodide of potassium, given in doses of 2 grains every 4 hours to children from 2 years up. It is needless to say that medical assistance should be procured as speedily as possible.

Peritonitis.—Inflammation of the membrane, called the peritoneum, which lines the abdominal cavity. It is usually caused by diseases or wounds of the abdomen or its contents.

Symptoms.—Severe pain is complained of, increased by pressure; the knees are generally drawn up and the patient lies on his back; the abdomen is puffed up; there is obstinate constipation, and sometimes continued vomiting.

Treatment.—It is most essential that a doctor should be called in at the onset of the disease, for often immediate surgical treatment is the only possible means of saving the patient's life. The administration of opium, unless specially advised by the doctor, is not to be undertaken, for it will effectually mask many of the important symptoms by which the cause of the disease can be discovered, and the remedies applicable to that cause administered.

Pleurisy.—This is an inflammation of the pleura or serious membrane which covers the lungs, and lines the greater part of the cavity of the chest. It is generally brought on by exposure to cold and wet, but may be the result of an accident in which the ribs are broken.

Symptoms.—Stabbing or shooting pain in the affected side, increased by breathing deeply or coughing. The pain is usually confined to one spot, and, if the ear be placed against the side, a fine, rubbing sound will be heard, which goes by the name of "friction," and resembles that produced by rubbing a lock of hair between the finger and thumb. The pulse is quick, the tongue is coated; there is thirst and loss of appetite, and the temperature is raised. In a day or two the breathing becomes more difficult, owing to fluid being infused into the pleural cavity and pressing upon the lungs; this fluid after a time usually becomes absorbed, when the breathing grows easier. Sometimes this fluid does not become absorbed, when a slight operation has to be performed for its removal.

Treatment.—Place the patient in bed without delay, in a room the atmosphere of which is kept moist by allowing steam from a bronchitis kettle to pass into it; the temperature should not be below 60° F.; 63° or 64° would be better. He should not be allowed to speak more than he is absolutely obliged. Linseed meal poultices should be applied to the chest. A mustard leaf poultice or a hot poppy fomentation, will often give relief at the onset. Strips of adhesive plaster placed obliquely in the direction of the ribs will often procure rest and relieve pain. Milk, beef-tea, broth and jelly should be given in the early stage; and later, when the fever has abated, light puddings, eggs, white fish, and other light, easily digested and nourishing diet. During recovery, cold and damp-must be carefully avoided.

Pneumonia.—This is an inflammation of the lung substance proper, and is caused by the presence of Bacillus pneumoniae. It is generally ushered in with a rigor (a sudden coldness attended with shivering), which is often very severe; in children convulsions may take the place of the rigor. The temperature rises, and may reach 104° or 105° F. There is pain and loss of appetite; the face is flushed, breathing is rapid, and there is a short hacking cough; the matter expectorated is tenacious and rusty-coloured.

Treatment.—Keep the temperature of the room at about 65° F., or rather higher, but not lower if it can possibly be avoided. Support the shoulders well with pillows; this will assist breathing. Give milk, beef-tea, white of egg, custards, Brand's jelly, strong chicken tea, etc. Cold water may be given to allay thirst. Medical aid should be sought at once.

Quinsy. This is a severe inflammation of the throat, chiefly involving the tonsils and frequently going on to suppuration. It is usually ushered in by chilly feelings, which are succeeded by fever. The speech becomes nasal in character, and there is pain and difficulty in swallowing.

Treatment.—In the early stage this disease may be cut short by the administration of an emetic of 20 grains of powdered ipecacuanha, or by small doses of tincture of aconite frequently repeated, say, a quarter or half a drop every 15 minutes or half-hour till the patient is in a good perspiration, when the medicine may be given less frequently. A mixture containing the following ingredients may be given with advantage: Steel drops, 3 drachms; sulphate of quinine, half a drachm; chlorate of potassium, 2 drachms; glycerine, half an oz.; water added to make 8 ozs. A tablespoonful in water every 4 hours. The food should consist of milk, eggs, beef-tea, cocoa, etc.; pieces of ice may be given to suck. A medicated spray will afford much relief and is preferable to gargling. Sprays can now be bought very cheaply.

Rheumatic Fever.—This disease begins with restlessness and fever; there is a white or creamy condition of tongue, and the bowels are deranged. Presently the joints begin to ache, the pain increases till there is great swelling and tenderness over one or more of the large joints of the body; the temperature rises, and, in some cases, becomes excessively high; the urine deposits a thick brickdust sediment on cooling. As there is a great risk of the heart becoming affected in this disease, it must always be regarded with apprehension, and medical advice procured at once.

Treatment.—Absolute rest in bed must be enjoined, and careful nursing and light, nutritious diet provided. Milk and potass water, alone or together should be given. Beef-tea and beaten-up eggs are important items in the diet. The following medicine may be usefully given: Salicylate of sodium, 3 drachms; iodide of potassium, half a drachm; water added to make up to 8 ozs. A tablespoonful of this mixture to be given every 3 hours. The joints should be wrapped in cotton wool, and the patient wear woollen in preference to linen articles of clothing next the skin, since profuse sweating is often a characteristic feature of the disease.

COMMON COMPLAINTS AND THEIR REMEDIES

Abscess.—A circumscribed inflammation ending in the formation of matter which has to be discharged either by breaking through the skin or being let out by an incision. May occur in any part of the body. Should be ripened by poulticing or fomenting. When the abscess "points" an incision should be made in the softest spot, and the matter evacuated.

Acidity.—Give equal parts of lime-water and milk; or 10 to 20 grains of magnesia may be given in a little milk 3 times a day. The following mixture is useful in this affection: bicarbonate of soda, 3 drachms; subnitrate of bismuth, 2 drachms; water, 8 ounces. Shake the bottle, and take 1 tablespoonful 3 times a day.

Ague.—Give 4 or 5 grains of sulphate of quinine every 4 hours during the interval of the fit.

Baldness may be due to impaired nutrition in the scalp, or to a scurfy condition of the skin. In the first case a stimulating lotion should be used. 3 drachms of tincture of cantharides, 6 drachms of tincture of quinine, 4 drachms of sal-volatile and water to 8 ozs. Apply to the roots of the hair. If the head is scurfy use as a shampoo a mixture of soft soap 3 parts and eau-de-Cologne 1 part. If the scurf persists, it is probably due to a complaint called seborrhœa, which will require skilled attention.

Bed Sores.—Clean the sores thoroughly with carbolic lotion 1 part in 40 of water, and then apply zinc oxide ointment. Avoid pressure on the affected part by means of a ring-shaped pad.

Blackheads or Acne.—Common at the age of puberty. Steam the face, and then squeeze out the contents of each pimple with a watch-key. Subsequently apply an ointment consisting of 1 drachm of flowers of sulphur to an ounce of cold cream. Do this in the evening, and wash off the ointment in the morning.

Boils.—Brush tincture or liniment of belladonna over them before they are broken, to cause them to abort; this may be done night and morning. If very painful, and not likely to be thus got rid of, use hot boracic fomentations.

Bunions.— Inflammation of the tissues over the great toe joint, with enlargement of the bone itself, partly real, and partly apparent, due to the pushing of the great toe towards the second toe, and consequent semi-dislocation. Cause.—Short or tight boots, high heels and pointed toes.

Treatment.—Rational boots with straight inside edge of sole from heel to toe, and fully large. Instruments and splints of many kinds, intended to keep the great toe in its proper position, have been devised. Inflammation to be treated with soothing fomentations and rest. Bad cases require operative treatment.

Carbuncle.—Apply belladonna, as recommended in the treatment of boils, or, better still, use hot fomentations till the core is discharged. Attend to the bowels, and give as good diet as the patient can digest.

Chapped Hands.—Rub them with lanoline or glycerine at bed-time, and put gloves on. If glycerine is used the hands should first be washed in warm water, partly dried on a warm soft towel, and the glycerine applied immediately. This saves much smarting.

Chilblains.—Paint them with tincture of iodine, or apply camphor ointment to them. See that the boots are water tight, and do not pinch the feet.

Chill may result in cold in the head, cold in the throat or windpipe, cold in the lungs (bronchitis) or cold in the stomach or bowels.

General Treatment of Chill.—A hot bath before getting into a warmed bed, followed by a hot drink of either gruel or wine and water. One or two grains of calomel or blue pill, followed by a seidlitz powder in the morning. If at all feverish the patient should stay in bed next day, when the effects of the chill will probably pass away.

Cold, of which catarrh is the most prominent symptom, is, perhaps, the most frequent malady in this country. Its causes are as numerous as its consequences, which vary from slight temporary inconvenience to speedy death. Colds are very frequently felt to date from some particular period, but frequently their onset is not noticed for a time.

Symptoms.—The preliminary symptoms are shivering and sneezing, with lassitude, pains in the back, loins and limbs, with tightness of the forehead, and an unnaturally dry state of the lips and nostrils. These are quickly followed by excessive acrid discharge from the nostrils, which later becomes mucous or even purulent. There is hoarseness and slight sore throat, watering of the eyes, feverishness, loss of appetite, furred tongue, thirst and quick pulse. Sometimes small vesicles, called herpes, appear on the lips or about the nose. These symptoms do not last long; they either pass away, or become aggravated if the inflammation passes onwards into the interior of the lungs.

Treatment.—Put the feet in hot water, and, if an adult, take 10 grains of Dover's powder, a cupful of gruel, and then go straight to bed. The following is also useful, and may be taken instead of the Dover's powder: Sweet spirits of nitre, 20 drops; Mindeterer's spirit (acetate of ammonia solution), a teaspoonful; camphor-water sufficient to make 1 oz.; to be taken as a draught at bed time. 10 to 15 drops of spirit of camphor taken on a lump of sugar, and repeated in 2 or 3 hours, is also a useful remedy in cases of cold. As the debility is real, the diet should be stimulating.

Corns caused by friction.

Treatment.—Cold water dressings at night till the corn is soft enough to be extracted by the root. Circular, felt corn plasters are useful to remove pressure. Touching repeatedly with strong acetic acid sometimes destroys corns. Boots should not be tight.

Deafness may be caused by an accumulation of wax in the ear passage. This can generally be seen, and can be removed by syringing with warm water. Before doing so, 2 or 3 drops of glycerine, or bicarbonate of soda, 15 grains to the ounce of water, will, if dropped into the ears for a couple of days, twice daily, much expedite matters. Other causes of deafness are trouble in the middle ear, or catarrh of the eustachian tube, both of which require skilled medical attention.

Dropsy may be due to heart disease, Bright's disease or disease of the liver.

Drunkenness.—See Intoxication in "What to do in Cases of Accident."

Dyspepsia.—Give 10 grains of the sub-nitrate of bismuth and the same of bicarbonate of soda 2 or 3 times a day. 1 teaspoonful of Benger's Liquor Pancreaticus may be taken with advantage an hour or two after each meal; it will materially assist digestion. The diet should be carefully regulated, and all indigestible articles of food avoided.

Earache.—Sponges wrung out of hot water should be applied over and behind the ear. Drop a few drops of warm oil or warm oil and laudanum into the ear. If the pain is persistent for more than two days, medical attention should be procured.

Ear Discharge.—The ear should be gently syringed with warm water, in which a little boracic acid has been dissolved, a teaspoonful to a teacupful of water. A little of the same powder should be afterwards puffed into the ear.

Enlarged Glands are nearly always due to some source of irritation in the neighbourhood of the glands. In the case of enlarged glands in the neck, trouble will be found in the scalp, ear, nose or throat.

Treatment.—First attend to the exciting cause. In some delicate children, glands enlarge very readily. In these cases cod-liver oil, steel wine, plenty of fresh air, good feeding and warm clothing are required, with a change of air if possible. The disappearance of the glands may be accelerated by painting them with tincture of iodine. If the glands become red, painful and inflamed, medical advice should be at once obtained.

Eyes.—Sore or inflamed eyes should be bathed with boracic acid lotion (a teaspoonful to a pint). This is soothing and antiseptic. A good extempore substitute is a very weak infusion of tea leaves.

NURSING, No. 1.

1 and 2. To roll a bandage. 3, 4, and 5. To bandage a finger. 6. To bandage a rickety child. 7. To bandage varicose veins.

NURSING. No. 2.

1. To bandage a broken arm. 2. A ready sling for injured arm. 3. To bandage broken wrist. 4. Splints and bandage for broken leg.

Epilepsy.—Give bromide of sodium in 20-grain doses in water 2 or 3 times a day. (See also under "What to Do in Case of Sudden Illness.")

Face Burning.—Exposure of the complexion to intense sun or to snow reflection, as in Alpine climbing, may produce severe burning and blistering. Preventive measures should be taken, the best of which is to thickly coat the face with cold cream or prepared lard. Severe burning may require treatment by powdering the face with boracic acid powder, or flour, and wearing a linen mask, to prevent exposure to the air. Glycerine and cucumber and glycerine are useful for mild cases.

Falling Hair.—See Baldness.

Foul Breath may be due to decayed teeth, to disease of the nose or throat, or to defective digestion. Much may be done by careful cleansing and disinfecting the mouth and nose. The following may be used as a mouthwash, or for syringing the nose: carbolic acid, 1 drachm; eau-de-Cologne or lavender water, 2 drachms; and water to 8 ozs. It is of primary importance to ascertain the cause of the offensive breath, and to treat that.

Frost-bite.—Parts most frequently affected: ears, nose, cheeks, fingers and toes. The frost-bitten part is greyish-white, and absolutely insensitive.

Treatment.—Rub with snow or ice-cold water till sensation returns. Artificial warmth applied to a frost-bite will cause mortification.

Gravel or sand in urine is due to an excess of uric acid in the system. A gouty tendency, too much rich food, and a sluggish liver will cause the excess.

Treatment—consists in adopting a plain, light and spare diet, avoiding sweets, creams, wines, malt liquors and much red meat, and in taking plenty of demulcent drinks, such as barley-water or milk and soda. A dose of Carlsbad salts in the morning, with a mild mercurial pill over night will relieve the congested liver.

Hay Fever, due to irritation of the lining membrane of the nose and throat by the air-borne pollen from the flowering grasses. Spraying the throat with a lotion containing carbolic acid, 8 drops; sulphate of quinine, 2 grains; tannic acid, 4 grains; sulphurous acid, 3 drachms; and water to the ounce will be found of use; but the only certain cure is to live by the sea, or in town during the hay season.

Headache.—Take 10 grains of salicylate of sodium every hour, for 2 or 3 hours, or 7 grains of phenacetin every half-hour for an hour and a half. A drachm of potassium bromide at night will often relieve headache and sleeplessness. More "natural" cures are to lie down in a dark room and fast, or to sip a glass of cold water slowly. An aperient is often all that is needed. (See Tired Eyes.)

Heartburn.—Bismuth and soda powders as in dyspepsia (q.v.) may be given, also bismuth tablets.

Housemaid's Knee.—A swelling over the lower part of the knee-cap, brought on by frequent chills, bruising or friction. The swelling may be painless, with water in it, or it maybe inflamed, and develop into an abscess. The latter is the easier to cure, as the opening of the abscess will cure the condition. The former may require a surgical operation to get rid of it. Painting with iodine is useful.

Ingrowing Toe-nail.—Generally the result of small boots. Cotton wool dusted with iodoform and pressed between the nail and the soft parts will relieve the pain, but the best method is to cut a groove down the centre of the nail with a small file or a penknife, which practically divides the nail and removes the pressure. Larger boots should be worn.

Itch is due to direct infection by a small parasite called Acarus. The irritation is most intense at night. Examination will show small elevated pimples, generally with the heads scratched off, all over the body, but especially in the angles between the fingers. The face is not attacked.

Treatment.—A warm bath at night followed by rubbing sulphur ointment all over the affected parts. The patient should sleep in the underclothing worn on the previous day. Another warm bath should be taken in the morning, and clean underclothing put on. The soiled underclothing should be disinfected. This treatment repeated for two or three nights will effect a cure.

Internal Hæmorrhage.—Give a little ice to be sucked. Keep the patient at complete rest. The liquid extract, of ergot, in doses of 10 to 15 drops every 2 hours in water, will be found useful. 10 grains of gallic acid with 10 drops of tincture of opium, and 15 drops of aromatic sulphuric acid, may be given every 3 hours in bleeding from the lungs. The ergot extract may be given for this, and for bleeding from the stomach as well.

Nettlerash, or Urticaria, consists of white wheals and red blotches, intensely irritating, coming and going, first in one and then in another part of the body. The cause is usually some article of food which has been ingested, and has disagreed. Shell-fish, pork, canned meats, and some fruits will bring on an attack.

Treatment.—An emetic, if the offending article of diet has recently been swallowed, followed by a dose of castor-oil. A light diet, and a few doses of fluid magnesia will complete the cure.

Neuralgia.—Give quinine and iron 2 grains of the former and 10 drops of the latter (as steel-drops) 3 times a day in water. Menthol may be applied externally, also ether spray. Decayed teeth or stumps should be removed, and ear discharge or defective sight attended to. If the attack comes on at the same hour every day, a dose of the quinine taken half an hour before the period may ward it off. Hot fomentations or camphorated oil containing some laudanum, will often relieve the pain during an attack.

Nightmare.—Give, 20 grains of bromide of potassium in water at bedtime. Nipples (Sore).—These should be hardened beforehand with weak arnica lotion, or a little glycerine and eau-de Cologne. When sore, apply green oil, prepared by boiling some elder leaves in olive-oil, and wear a nipple shield with a breast-tube teat. An excellent application is glycerine of borax. The nipples should be carefully washed and dried each time they are used, and the application put on afterwards.

Otorrhœa. See Ear-discharges.

Palpitation of the heart does not necessarily mean heart disease. It is more likely to be due to indigestion and flatulence. It may be relieved by taking a glass of hot water with half a teaspoonful of bicarbonate of soda, and 1 teaspoonful of sal-volatile in it. 5 or 6 drops of essence of peppermint on a lump of sugar are useful. External applications are hot fomentations and turpentine stupes. (See also Flatulence.)

Rheumatism of the Joints or Muscles.—Rub camphorated oil or a similar stimulating embrocation, such as hartshorn and sweet oil, well into the affected parts with the bare hand for 15 to 20 minutes morning and evening. Flannel should be worn next to the skin.

St. Vitus' Dance or Chorea.— A nervous disease, characterized by involuntary twitching movements in all parts of the body. It is closely connected with rheumatism, frequently following on rheumatic fever, and associated with heart disease. It is common amongst the poorer classes, especially amongst those who do not get sufficient food and rest.

Treatment.—In many cases rest and good food will effect a cure. Cod-liver oil will help, but other medicines should be taken under medical advice. An attack usually lasts about two months, but it may go on for two years or more.

Sciatica.—Rub the limb well with chillie paste or belladonna liniment. Pure chloroform applied in the same manner will often give relief when other liniments fail. Give iodide of potassium in 3 grain doses, combined with 30 drops of compound tincture of cinchona 3 or 4 times a day. Salicylate of soda in 10-grain doses every 4 hours is very useful in severe cases. Injection of half a grain of cocain into the nerve will sometimes cure sciatica at once, but this kind of treatment should only be used under medical advice.

Scurf or Dandruff.—See Baldness.

Snoring and Snuffles result from impediment to breathing, either through the nose (closed nose) or through the throat. If they are persistent, and not merely due to temporary catarrh, a doctor should be consulted, as very probably there is a spongy growth (adenoids) at the back of the throat, with or without enlargement of the tonsils. This may require removal to effect a cure. Any impediment to free respiration in children and young growing people is most detrimental to their growth and development.

Sore Throat.—The commonest form is that due to cold or catarrh. The throat and tonsils will be seen to be of a darker red than the surrounding parts.

Treatment.—A mild dose of laxative medicine, cold compresses, or hot fomentations to the throat externally, and internally painting the inflamed part with glycerine of borax or alum.

A second form is due to chill, or the intaking of impure gas or water. One or both tonsils will be seen to be inflamed and swollen, and either dotted or covered with white or yellow spots and patches. The glands under the jaw will be swollen and painful, and there will be a varying amount of fever present. In this case medical advice should be obtained, as the complaint may be either simple tonsilitis or diphtheria. (Q.v. "Diseases of Childhood.")

The Treatment of Tonsilitis.—Give an active aperient, foment the throat constantly, paint the throat with a solution containing 1 part of lactic acid to 7 of water, and give a mixture containing 2 drachms of tincture of iron, 4 drachms of glycerine to 6 ozs. of water: 1 tablespoonful to be given every 4 hours. A gargle of a teaspoonful of carbolic acid to half a pint of hot water is useful. Rest in bed is necessary while there is fever.

Spasms, in the ordinary sense of the word, mean gripes, and commonly depend on indigestion and constipation.

Treatment.—In many cases relief may be obtained by the administration of a purgative. If the pain is very severe, it may be relieved by adding 15 drops of laudanum to the purgative. Half an oz. of castor-oil with 10-15 drops of laudanum is a favourite prescription suitable for an adult. As soon as the pain is relieved the general condition of health must be attended to, and anything in the diet that has been known to give rise to pain should be scrupulously avoided, and only simple plain foods taken.

Specks before the Eyes are generally indicative of a sluggish liver, and may be readily removed by taking the old-fashioned blue pill at night, followed by a black draught or seidlitz powder in the morning.

Squint is an acquired disfigurement. At first it is only occasional, and should be treated before it becomes permanent. It is due to abnormality in the vision generally to strain, caused by long sightedness. The eyes should be tested and suitable spectacles worn; this will nearly always effect a cure. If the squint is permanent, an operation may be required to correct it.

Stiffness.—Treatment. Hot baths and massage.

Superfluous Hairs can only be permanently removed by the process of electrolysis. This must be applied by a skilled expert.

Tape Worm.—Treatment.—1 drachm of oil of male fern, to be given in milk early in the morning, on an empty stomach, to be followed, 2 hours later by a large dose of castor-oil. This may be repeated for 3 days.

Tic Douloureux.—See Neuralgia.

Tired Eyes.—Aching of the eyes shows overstrain of the ocular muscles, and is frequently accompanied by the most persistent and intractable form of headache. Some slight defect in the vision will be discovered, correction of which by suitable glasses will relieve the symptoms.

Toothache.—Poppyhead fomentations should be applied to the face, externally. A small pledget of cotton wool, soaked in oil of cloves, placed in the cavity of an aching tooth will give speedy relief.

Varicose Veins are prominent, thickened and tortuous veins in the leg and thigh. The inner part of the leg, just above the ankle is often blue and congested, and here ulceration of a very obstinate and painful kind may form, due to deficient circulation through the veins. A vein may get so distended that it may burst through the skin, in which case dangerous bleeding may result. (See "What to do in Case of Accidents.")

Treatment.—To prevent the veins getting worse, and to relieve the aching, elastic stockings or bandages should be worn. In bad cases the veins must be removed by operation.

Warts.—Apply concentrated acetic acid daily, when they will soon wither away. Collodion corn paint will also often cure them. A sulphur lozenge taken 3 times a day is also useful.

Whitlow is an inflammation at the top of the finger, usually involving the nail. (It may be due to a poisoned finger or to an unhealthy, poor state of the blood.) It is characterized by throbbing pain in the finger, often extending up the arm. The finger end is swollen, red, shiny, and very tender to the touch. If it progress, matter is formed, and no relief is obtained till the matter is evacuated either by a small incision or by waiting till the abscess bursts, a much more tedious proceeding.

Treatment.—Bathe the finger in a bath of hot antiseptic for half an hour 2 to 3 times daily. (Carbolic acid, 1 teaspoonful to the pint of water. Sanitas, 1 teaspoonful to the pint of water.) A hot antiseptic fomentation should be kept on the finger, and the hand supported in a sling. After the pus has been let out the same treatment is pursued till all matter ceases to come away, when the finger may be dressed dry and allowed to heal up.

WHAT TO DO IN CASE OF ACCIDENT OR SUDDEN ILLNESS

Apoplexy.—Treatment.—When a person is in an apoplectic fit prevent all unnecessary movement; raise the head and remove everything tight from the neck, then apply ice or cold water cloths to the head, and put the feet in hot mustard and water. The bowels should be freely opened by the administration of calomel.

Burns and Scalds.—Treatment.—When any part has been scalded, immediately immerse it in cold water or pour cold water over it; or dust bicarbonate of soda over it, and then apply a wet cloth. When blisters have formed, prick them with a needle or pair of scissors, and press the skin carefully down, after which apply the bicarbonate of soda as before, or carron oil (equal parts of olive-oil and lime-water); thymol or carbolic oil (1 part to 100 of olive-oil) answers well. The oil should be applied on clean linen rags or cotton wool, and the dressings should not be made more often than is required by cleanliness. The injured portion should be exposed as little as possible in the changes. In case of clothes catching fire, the patient should be immediately laid down and rolled in a thick coat, rug, blanket, tablecloth, etc., to extinguish the flames.

Bruises.—These are caused by blows, the skin remaining unbroken.

Treatment.—Apply either tincture of arnica, spirit and water, vinegar or sal-ammoniac and water. The following is a useful combination: chloride of ammonium (sal-ammoniac), 1 oz.; rectified spirit, lavender water, or eau-de-Cologne, 2 ozs.; vinegar, 3 ozs.; water to make 16 ozs. in all. Rags dipped in this solution should be laid over the bruise and kept constantly wet. Hot fomentations are frequently more effectual than cold applications in removing the associated discolouration.

Choking.—Treatment.—If the substance causing choking be at the upper part of the throat, thrust the finger and thumb into the mouth, and endeavour to seize it. If this cannot be done, take a penholder, a quill, or piece of whalebone anything, in fact, that will do, and endeavour to push it down the gullet. A smart blow on the back will sometimes dislodge a foreign body from the throat. If the obstruction be only slight, swallowing a small piece of dry bread will often effect the removal. If it seem serious, medical aid should be sought instantly. Children may be held upside down, and smartly slapped on the back.

Concussion of the Brain.—Treatment.—Move the patient as little as possible, and keep him absolutely quiet in a darkened room. He should be placed between hot blankets and hot bottles, or a hot brick wrapped in flannel applied to the feet and body. Alcohol should not be administered unless ordered by the doctor.

Croup.—Treatment.—Take the child out of bed and put it into a bath of 100° F., and keep it there for half an hour; or wrap it in a sheet wrung out of warm water, with dry blankets on top, and keep it in this for 1 hour. Give 1 teaspoonful of ipecacuanha wine every quarter of an hour in tepid water, and give drinks of tepid water between, until vomiting takes place. Keep the atmosphere moist by the steam from a bronchitis or other kettle, which should be kept boiling in the room. Medical aid should be sought at once.

Dislocations.—Treatment.—If medical assistance is at hand do not touch a dislocation; merely support the limb in the position of greatest comfort, until the arrival of the doctor. If skilled assistance cannot be had, get some one to steady the body or the part of the limb nearest the body, and use gentle, steady extension upon that furthest removed until the parts are again in apposition. Then apply cooling lotions (such as Goulard's lotion with a little spirits of wine in it) to the injured joint, and keep the limb in proper position by means of slings and bandages.

Drowning.—Treatment.—Loosen the clothing about the neck and chest, the braces or stays. Place the patient on the floor or ground if possible on a slope with the head lower than the heels, in order to allow the water to run out of the air-passages, with the face downward and one of the arms under the forehead. If there be only slight breathing, or no breathing, or if the breathing presently fail, then turn the patient instantly on the side, supporting the head, and excite the nostrils with snuff, hartshorn and smelling salts, or tickle the throat with a feather. Rub the chest and face till warm, and dash cold water or cold and hot water alternately on them. If there be no success, imitate the motions of natural breathing. To do this place the patient on his back, supporting the head and shoulders on a small firm cushion or folded article of dress; draw the tongue forward, and slip an elastic band over it and under the chin, or tie a piece of string or tape in the same way; then, kneeling behind the patient's head, grasp the fore-arms just below the elbows, and draw them gently and steadily upwards above the head, and keep them stretched upwards for 2 seconds; then turn them down and force them gently and firmly for 2 seconds against the sides of the chest. Repeat these measures about 15 times in a minute. When breathing is restored, rub the limbs upwards with firm grasping pressure and energy, to drive the blood along the veins to the heart, using handkerchiefs, flannels, etc. Apply hot flannels, hot bottles, bladders of hot water, or heated bricks to the pit of the stomach, the armpits, between the thighs and to the soles of the feet, or, if these are not available, cover the limbs when dried and rubbed warm, with coats, waistcoats, or any articles of clothing to hand. On the restoration of vitality a teaspoonful of warm water should be given, and then small quantities of warm coffee.

Epilepsy.—Treatment.—At the onset of a fit the patient should be caught in the arms of a bystander and laid gently down upon his back, with something placed under his head for a pillow, and everything tight should be removed from his neck. Insert a cork between the teeth to prevent the tongue being bitten, then wait patiently till the fit is over.

Fainting.—In this affection there is pallor of the face, coldness, perspiration; feeble, shallow and irregular breathing; noises in the ears; indistinctness of vision and giddiness.

Treatment.—A fainting fit can frequently be prevented if the patient is told to sit in a chair and his head is then gently pressed down on a level with his knees. Another method is to lay the patient upon the back, remove all constricting articles of clothing from about the neck, and apply strong smelling salts to the nostrils; sprinkle cold water over the face, and give a dose of half a teaspoonful of spirit of sal-volatile in a little water.

Foreign Bodies.—In the Nose.—These are generally peas, beads, sweets, cherry-stones, etc.

Treatment.—If old enough, get the child to forcibly blow down the obstructed nostril after taking a deep breath, while the finger is pressed tightly against the free nostril. Failing this, grasp the nostril behind the seat of obstruction, and introduce a small flat article, such as the handle of a salt spoon beyond it, and endeavour to scoop it out.

In the Ear. Treatment.—If an insect has found its way into the ear, pour in olive oil, when the intruder will generally float to the top. If a pea, bead, or cherry-stone, use the head of a hairpin as a snare and, with the utmost gentleness, endeavour to insinuate it beyond the object it is intended to remove.

In the Eye. Treatment.— If the offending substance is not imbedded in the globe of the eye it can generally be easily removed, either with or without everting the lid (turning the lid outwards), by using the corner of a soft pocket handkerchief, or a camel-hair pencil moistened with water or olive-oil, or by drawing the top lid down over the lower. Blowing the nose sharply will often effect removal. If the substance is imbedded in the globe of the eye, a camel's hair pencil dipped in water or oil may be passed over it, and an effort made to dislodge it. Should this fail, and medical assistance is not at hand, a blunt-pointed instrument may be carefully passed across the surface. The eye must not be rubbed, or permanent injury may be done. Should quick-lime get into the eye, wash it out as thoroughly as possible with water, then bathe with a lotion consisting of a teaspoonful of vinegar to a wineglassful of water, or drop a little castor-oil into the eye. In case of injury by acid, bathe with milk or 1 part of lime-water to 3 of water.

Fractures.—Treatment.—When a fracture has taken place the object is to bring the ends of the bone that has been broken as nearly as possible to the position they were in previous to the accident. In order to do this, the part nearest the body must be steadied by some one, while that furthest removed is gently stretched out, the sound limb being uncovered and observed as guide. Having got the limb into good position, splints must be applied to fix it in the position in which it has been placed, and the limb must then be kept still.

In dealing with fractures immediately after they have happened, great care must be taken in moving the patients in order to prevent a simple fracture being converted into a compound one: that is, to prevent the fractured bone protruding through the skin. For this reason it is always best, in giving first aid, to apply temporary splints outside the clothes till the sufferer can be placed in more favourable conditions for treatment.

Hæmorrhage, or Bleeding.—From a Wound.—The blood from an artery is distinguished from that of a vein by being brighter in colour and by flowing in a saltatory or jumping way.

Treatment.—If from a vein make a compress by folding up a piece of lint or a small handkerchief, and apply it to the wound with a bandage over it. This treatment also generally answers in bleeding from small arteries, although the pressure requires to be greater. If this is insufficient, and the sufferer is losing a great deal of blood, pending the arrival of medical aid, a rough and ready tourniquet should be applied also, by winding a handkerchief or silk scarf around the limb, on the side of the wound nearest the heart if an artery has been cut, or below it if a vein, and twisting tightly by means of a stick slipped beneath one of the turns. A hard pad over the artery or vein, under the handkerchief, will greatly assist the local pressure.

From Varicose Veins. Treatment.—Place the patient on his back, and apply a compress and bandage, or put half-a-crown or a penny in a handkerchief, place it over the wound, and tie it down tightly. (See Nursing Illustration, No. 1, Fig. 7.)

From the Nose. Treatment.—Apply cold water cloths or ice to the forehead; raise the arms above the head; seize the nose between the fingers, and squeeze the sides together. Make the patient sit upright in a chair; do not let him stand with his head over a basin, as this is a common cause of the bleeding continuing. In severe cases it may be to plug one or both nostrils, but medical assistance is then necessary. One or other of these methods may be tried, or they may all be tried in turn if the bleeding is difficult to check.

From Leech-bites. Treatment.—Lay a crystal of iron alum upon the wound. Dried alum and tannic acid may be used in a similar manner. Two strong needles run through the skin cross-wise, passing beneath the wound, and a piece of linen thread tied round them, will frequently answer when the simpler means fail.

After Tooth Extraction. Treatment.—Sponge the gums dry and see exactly whence the bleeding comes, then plug the tooth socket with wool moistened with perchloride of iron solution. A still better way is to paint the bleeding point with a solution of adrenalin, 1 in 1,000. Sometimes a saturated solution of antipyrin acts as an efficient styptic.

After Confinement. Treatment.—Keep the patient at absolute rest on her back, and remove the pillows so as to keep her head low; cover only very lightly with bedclothes. Place the hands on the lower part of the abdomen, and press deeply down with a kind of kneading motion. If the womb is felt contracting into a hard lump under the hands, grasp it and keep it tight till the arrival of the doctor. Give the patient a little tepid milk and water to drink.

From the Umbilical Cord.—When bleeding takes place from the umbilical cord, the child generally becomes restless, and the blood may saturate its clothing. Undress the child immediately, and tie a liagture of three or four thicknesses of worsted or linen thread behind the original ligature.

Internal Bleeding.—Instances of this form of bleeding are seen in hæmorrhage from the lungs and stomach. That from the lungs is ally bright scarlet in colour and frothy in appearance, owing to the admixture of air; that from the stomach is dark in colour and is not frothy.

Treatment.—Keep the apartment cool, and the patient quiet and in the recumbent posture. Ice may be sucked, or a little cold water taken when ice cannot be had. 5 to 10 grains of gallic acid with 5 to 10 drops of tincture of opium, and 10 or 15 drops of aromatic sulphuric acid, may be given in a little water every 3 or 4 hours.

Hysteria.—This may manifest itself by intense sobbing or immoderate laughter, or by alternations of both. There is frequently wild tossing of the arms, the hair is dishevelled, the face is generally pale, and complaint is made of a suffocating feeling in the throat.

Treatment.—The patient must be spoken to kindly, yet firmly, and be told to stop any eccentricities. Loosen the dress and remove anything tight from the neck. Give 1 teaspoonful of spirit of sal-volatile in water. If no heed is paid to what is said, dash cold water upon the face. Change of scene, cheerful society, physical exercise, and the cultivation of mental control are the best means of overcoming hysterical tendencies, especially the two latter means.

Intoxication.—Treatment.— When loss of consciousness has occurred from this cause, give an emetic of mustard and water (1 tablespoonful in tepid water), or 20 grains of sulphate of zinc or powdered ipecacuanha. The emetic should be followed by 2 or 3 draughts of warm water. Remove to a warm atmosphere, and give strong tea or coffee after the emetic has taken effect.

Poisons.—Treatment.—Many of these give rise to vomiting, and are thus got rid of. In such cases the vomiting should be encouraged by tickling the back of the throat with a finger or feather or by giving draughts of tepid water. If it is at hand, a stomach-syphon, which is much more convenient to use than the stomach-pump, should be employed to withdraw the poison. Care must be taken to pass the tube along the back of the throat, as otherwise harm may result. If the poison has not given rise to vomiting, a handful of salt in lukewarm water may be given and draughts of tepid water afterwards. Mustard and water is a good emetic when the poison taken is not irritant in character. 20 grains of powdered ipecacuanha in water, or the same quantity of sulphate of zinc in water, may be used in the same way.

General Directions.—When an alkali (see below) is the poison, give drinks of weak vinegar or lemonade. When an acid, chalk and water, whiting plaster from the walls, or white of egg; if a narcotic, give strong coffee, and do everything to keep the patient awake, walking him about, opening the windows wide, applying cold water to his face, and so on.

Particular Poisons.—Aconite, Monkshood, or Blue Rocket. Treatment.—Give 1 tablespoonful of mustard in water or 20 grains of sulphate of zinc in water: then a dose of castor-oil. Hot bottles should be applied to the feet, and a teaspoonful of spirit of sal-volatile in water, or a cup of strong coffee given. Alkalies, such as potash, soda, ammonia, taken as pearl ashes, soap-lees, common washing soda, and ammonia in vapour, solution and solid form.

Treatment.—Give drinks containing vinegar; or lemonade, lemon-juice or olive-oil may be given, and stimulants in case of collapse.

Arsenic. Treatment.—Empty the stomach with an emetic and the stomach-syphon, and then give freshly prepared ferric oxyhydrate, prepared by adding a solution of carbonate of soda to a solution of ferric chloride. The patient must afterwards be fed for a considerable time on a milk and farinaceous diet only.

Barytes. Treatment.—Give 2 teaspoonfuls of Epsom or Glauber's salts every 2 hours until the bowels act.

Belladonna. Treatment.—Give an emetic of 20 grains of sulphate of zinc in water, or 1 tablespoonful of mustard in warm water; then drinks of tepid water, or stewed tea, the tannin in which renders the poison innocuous. Afterwards give strong coffee.

Carbolic Acid. Treatment.—Use the stomach-syphon if at hand. Empty the stomach with it, and then wash out that organ with a dilute solution of Epsom salts. White of egg and milk may be given. External warmth, and brandy by the rectum, are useful to combat the depression.

Copper.—Use the stomach-syphon or give an emetic followed by draughts of hot water, barley and water, or arrowroot and water, to soothe the inflamed coats of the stomach.

Mercury, Corrosive Sublimate.—If the patient has not vomited give an emetic, followed by white of egg and demulcent drinks (lime-water, barley-water, etc.).

Foxglove. Treatment.—Give an emetic of mustard and water or 20 grains of sulphate of zinc in water, then give a dose of castor-oil and a cup of strong tea.

Fungi (Toadstools, etc.). Treatment.—Give an emetic of mustard and water, afterwards a dose of castor-oil.

Hemlock. Treatment.—The same as for Foxglove.

Henbane, Thorn Apple, and Tobacco.—Treatment. The same as for Belladonna.

Hydrochloric Acid. Treatment.—The same as for sulphuric acid poisoning.

Laburnum. Treatment.—Give an emetic of mustard and water or 20 grains of zinc sulphate in water, followed by draughts of warm water. If there is much collapse, strong coffee or other stimulants should be administered.

Laudunum, Opium, and Morphia. Treatment.—Give 20 grains of sulphate of zinc or 1 tablespoonful of mustard in water, then drinks of tepid water. Wash the stomach out with a weak solution of Condy's Fluid if a stomach-syphon is available. Afterwards give strong coffee, and keep the patient constantly in motion in the open air till drowsy feeling wears off. Lead. Treatment.—Give an emetic in the first place, then 2 teaspoonfuls of Epsom or Glauber's salts every 2 hours until the bowels act. When this has been accomplished continue the salts in smaller doses. Opium may be needed if the abdominal pain is severe.

Nitric Acid or Aquafortis.—Treatment. The same as for poisoning by sulphuric acid.

Oxalic Acid or Acid of Sugar.—Treatment. Give magnesia or chalk mixed with water. When the acid is neutralized by these means give 1 tablespoonful of castor-oil.

Phosphorus. Treatment.—Use the stomach-syphon to evacuate the contents of the stomach. If this is not available, give an emetic of 20 grains of zinc sulphate or 3 grains of copper sulphate dissolved in water. Purgatives should afterwards be given, but castor-oil must not be used since phosphorus is soluble in oil and the poison is then more easily absorbed.

Prussic Acid. Treatment.—Evacuate the stomach with the syphon or give emetics of mustard and water, or 20 grains of zinc sulphate in water. Then commence artificial respiration, as described under "Drowning."

Shell Fish. Treatment.—Give an emetic, then a purgative, afterwards 20 or 30 drops of spirit of sulphuric ether on a lump of sugar.

Sulphuric Acid or Oil of Vitriol. Treatment.—Give chalk, magnesia or soda, mixed with water. Failing these, white of egg or soap and water may be used to neutralize the acid. Treat the collapse with hot bottles and blankets, and an enema containing 1 oz. of brandy and an egg beaten up.

Shock.—After a severe—or sometimes even after a slight—accident, and after a fright, some people suffer from collapse or shock. They will be faint, depressed, and cold; the pulse will be weak and difficult to count and the breathing shallow, the face pale and pinched and the expression alarmed. Sometimes this condition of shock is so severe that it ends in death, even when the accident itself has been but slight. The degree of shock depends very much upon the temperament of the sufferers, being much greater in those of a weak and timid disposition.

Treatment.—Recumbent position, application of warmth to body and limbs, friction and massage of limbs, rubbing towards the heart. Give hot drinks, tea or coffee, and if the nature of the accident will permit, a little weak stimulant, also hot. Loosen all tight clothing, and finally if the patient is conscious, cheer him up as much as possible.

Sprains.—Treatment.—Foment the part well with warm water, then brush tincture of arnica over it with a camel-hair brush several times a day. In place of the fomentations, cold water bandage or lint well moistened with lead lotion or an evaporating lotion containing methylated spirit, often give relief. When the more acute symptoms have passed, wrap the part in cotton wool, and apply a good firm bandage (india-rubber if it can be had) to diminish the swelling and give a feeling of security when the patient is able to move about. Later on, if the part is still not quite right, use the cold douche, and friction it with a rough towel.

Suffocation.—Treatment.—If the person is found hanging, he should be at once cut down and artificial respiration employed, as in drowning. If the suffocation results from articles of food blocking up the throat, the treatment recommended in choking must be had recourse to. Should the suffocation be the result of breathing coal-gas or sewer-gas, or by being in a room in which charcoal has been burnt, get the patient into the fresh air as speedily as possible, dash cold water in the face, and then perform artificial respiration.

Sunstroke.—Treatment.—Dash cold water over the face and head, apply ice or ice cloths or cold water to the head, and give a teaspoonful of spirit of sal-volatile in water. Tea or coffee may be given afterwards. The patient should be placed in the shade as soon as possible.

Swallowing a Stone or Coin.—If symptoms of choking follow, act as directed in the paragraph "Choking." If a stone has been swallowed or a small coin, and if it has apparently passed into the stomach, a quantity of porridge or hasty pudding may be taken, to be followed 2 hours later by a dose of castor-oil. A doctor should be consulted, and if the article should have stuck in the gullet, he may be able to recover it by means of an instrument called the coin catcher.

WOUNDS, BITES AND STINGS

The simplest are those in which the tissues are clean cut through, and where the edges, when brought together, fit accurately the one to the other.

Treatment.—Remove all dust or dirt from the region of the wound by thorough washing with pure soap and water, and bring the edges carefully together by means of a bandage or strips of plaster. Keep at rest for a few days.

Contused or lacerated wounds should be treated by cleansing the parts with Sanitas and water, carbolic acid and water (1 teaspoonful of the acid to 8 or 10 ounces of water), or Condy's Fluid and water, then place a piece of lint or rag soaked in carbolic lotion (1 part in 20 of water) over the wound, and draw the edges as nearly as possible together. If it still contains gravel or dirt, boroglyceride fomentation (as described in "Recipes for Sick Nurses ") should be regularly applied when the bleeding has ceased.

Perforating wounds are dangerous because of their depth, and the greater possibility of their containing dirt.

Treatment.—The best treatment is to foment them from the first with hot boroglyceride fomentations, and to ensure that they heal from the bottom upwards.

Gun-shot wounds. Treatment.—If a stimulant is necessary, give a teaspoonful of spirit of sal-volatile in water. Remove pieces of clothing, wadding, or bits of paper that may be found in the wound, then bathe it with Sanitas and water, carbolic acid and water, or Condy's Fluid and water, and foment as in the case of perforating wounds. (See above.)

Poisoned wounds may result from a number of causes, such as stings of insects, snake-bites, the bites of rabid animals, etc.

Dog-bites.—When any one is bitten by an animal supposed to be mad, unless the actual fact of the animal's madness is already known, it should be kept and carefully watched; if it is found not to be suffering from rabies, no ultimate harm will result to the patient. The rabies will soon make itself apparent, for, if mad, the dog will be seen snapping at imaginary objects, with a copious flow of saliva from the mouth, and a convulsive closing of the jaws.

Treatment.—The wound should be thoroughly cleaned with carbolic lotion 1 in 20. It should then be cauterised with lunar caustic or a red-hot wire, and bandaged up. Stimulants, such as the spirits of sal-volatile in teaspoonful doses, may be given every 2 or 3 hours.

Snake-bites. Bites received from serpents abroad are often exceedingly formidable injuries, and may be followed by death within a few hours, so that prompt action is necessary.

Treatment.—The part should be at once sucked. A very tight bandage should then be applied just above the wound, either by means of a strong elastic band, a leather strap, or a handkerchief twisted tightly with a stick. The wound should then be freely cauterised by means of a red-hot wire or a red-hot cinder; or the part may be cut out with a knife; or caustic, such as nitrate of silver, may be applied; a red-hot wire is, however, the best. Stimulants, especially preparations of ammonia, must be freely given. A teaspoonful of ammonia should be put into a wineglassful of water, and the patient given 1 tablespoonful every quarter of an hour. If those present are afraid to suck the wound, a wineglass, into which a piece of burning paper has been put to exhaust the air, should be inverted over it. Treatment by anti-toxins has been successfully used.

Stings.—If the sting still remains in the wound, it must of course be removed; then some alkaline lotion should be applied to the part, such as a little ammonia water, liquor potassae and water, or bicarbonate of soda and water. The pressure of a hollow key will often force a sting sufficiently above the skin to allow of it being seized with tweezers.