in accordance with recipe No. 3 of the preceding chapter, is excellent for administration in this manner. Solutions having a slightly acid reaction are absorbed with the greatest facility. These injections should not be given too frequently, or they may fail to be retained; absorption is slow, and the rectum not very tolerant of foreign matter. Once in five hours is often enough, and four ounces the maximum quantity. If so much can not be borne, try three, two, or even one at a time. Before giving a nutrient enema, it is important to ascertain whether or not the rectum contains fæces. If it is not found empty, it will be necessary to give first a purgative enema.

After using a syringe, clean it by letting plenty of warm water run through it, wipe it on the outside, and hang it up by the extreme end to drain. Never put it away in the box wet. A hard-rubber syringe shrinks in drying, and if left long unused will be apt to leak, but this can be remedied by soaking in hot water. A bed-pan should always be warmed before use by dipping in hot water. Dry it carefully, and, if any difficulty is found in adjusting it, oil the edges. Have a little disinfecting solution in it.

Suppositories are solid bodies for introduction into the rectum, answering, to some extent, the same purposes as enemata. They are of various sizes, conical or spherical in form, and, while firm enough to retain their shape under ordinary conditions, are sufficiently soft to melt under the heat of the body. They are usually made of cacao butter, in which some medicinal agent is incorporated. They have the advantage of facility of application, and being of little bulk are easily retained. Opium is often given in this form for the relief of local pain or diarrhoea. Suppositories of soap

or boiled molasses are given to children for laxative purposes, and are very effective. A suppository, having been first oiled, should be introduced very gradually and gently into the rectum, the patient lying on the left side as for an enema. It should pass well beyond the sphincter ani, and it is well to keep the finger applied for a moment, until the rectum becomes accustomed to its presence, to lessen the danger of its immediate expulsion.

In the case of female patients the nurse will frequently have to give the vaginal douche. This, when tepid, is simply for cleanliness; but the hot douche has a distinct therapeutic effect on congested or inflamed pelvic tissues. At first the congestion is increased; but a continued application of the hot water causes a secondary and more or less lasting contraction of the bloodvessels. Thus it is an excellent hæmostatic in all forms of capillary hæmorrhage. It also induces uterine contractions, and acts, to a certain extent, as a local anodyne.

The patient should lie on the back, with the hips elevated. A douche taken sitting or standing is of very limited utility. An interrupted current is more beneficial than a steady stream; but the Fountain syringe is much used. This should be suspended from a considerable height, to give good force to the flow. The long nozzle of the syringe should not be perforated at the immediate extremity, as there is danger of injecting the water into the cavity of the uterus and doing serious harm, especially after confinement, when the mouth of the uterus remains open. The tube should be carefully passed along the posterior vaginal wall until it has reached a point behind the cervix, then the water slowly injected at a temperature at first of 100°, but rapidly

increased to 110°, or over. Any medication ordered should be included in the last quart. Continue for fifteen or twenty minutes. A bed-pan with an overflowpipe is needed. Care must be taken that the mucous membrane is not blistered by the hot tube. For this reason ivory or hard-rubber nozzles are preferable to those of metal.

A hot rectal douche is sometimes used, with the idea that the heat can so be applied more directly to the affected tissues than through the vagina. The water must, in this case, be allowed to escape from the anus by the side of the tube.

CHAPTER X.

Local applications-Counter-irritants-rubefacients-vesicants-pustulants-issues and setons-Cupping, dry and wet-Leeches.

BESIDES general remedies are numerous local or topical applications, either irritant, soothing, or protective. Such as protect by arresting fermentation are called antiseptic. These will be spoken of later.

Counter-irritants relieve inflammation of the deeper parts by drawing the circulating fluid and the nervous energy to the surface. There are two distinct degrees of them-rubefacients, producing merely local warmth and redness, and vesicants, epispastics, or blistering agents. Still a third class produce a pustular eruption over the surface to which they are applied. Of this kind are Croton-oil, and tartrate of antimony.

Counter-irritants are applied usually over or near the seat of disorder, but sometimes at a remote part, to obtain what is called revulsive action. In this way mustard poultices on the feet, or a mustard foot-bath, may be employed for the relief of the head.

Mild counter-irritation results from hot fomentations and poultices, and from the various ammoniacal and camphorated liniments. One of the most commonly used rubefacients is mustard. To make a mustard plaster or sinapism, take one part of powdered mustard and from two to five times the quantity of flour, according to the strength desired. Mix into a paste with tepid

water, and spread it evenly between two pieces of muslin. Hot water or vinegar, often recommended, will weaken the active principle of the mustard, and though, when made with tepid water, the plaster on first application feels cold, it soon gets warm. It should not be left on long enough to vesicate, as the sore produced is painful and slow to heal. From twenty minutes to half an hour is usually long enough. With an insensible or delirious patient, the action must be carefully watched ; if neglected, deep ulceration may ensue. For a child, it is well to mix it with one third glycerine, instead of pure water, as the action will be less severe, and it can stay on longer. Confine in place with a bandage. The burning sensation which follows the use of a mustard plaster may be relieved, if extreme, by dusting the part with flour or fine starch, or dressing it with vaseline, and covering with cotton to exclude the air. Cayennepepper plaster is made by mixing a tablespoonful of cayenne into a thin paste of flour and water. Spread like a mustard paste. Or a quantity of red pepper may be stitched into a flat flannel bag, wrung out in warm water, and applied over the seat of pain. Rigollot's mustard leaves, the mustard paper, and capsicum plasters of the pharmacopoeia, are prepared for use by simply dipping in tepid water. They are neat, quickly ready for use, and very effective.

Similar local stimulation may be obtained from bits of cantharidal plaster, kept on for an hour or two, but removed before the point of vesication is reached. These are called "flying blisters." The same effect follows the rapid passage of a hot iron over a piece of brown paper, or thin flannel, laid upon the skin. This will often relieve lumbago or chronic rheumatism. Reddening only is desired. The chief use of the actual cautery is as a