mation. The leech-bite leaves a permanent stellate scar. The bleeding may be encouraged by hot fomentations or poultices, or checked, if too profuse, by a compress of lint, an application of ice, or, if it resists these, by touching with nitrate of silver. A patient should never be left for the night till all bleeding has ceased.

After they have been used, the leeches may as well be thrown away, as it is only after a long time and considerable care that they will ever be good for anything again. Leeches not used may be kept in a jar of water, with sand in the bottom, and having a perforated cover. The water must be changed every four or five days. A piece of charcoal in the water will help to keep it pure.

CHAPTER XI.

Poultices of various kinds-Fomentations-Modes of applying heat and cold locally-Lotions and similar applications.

POULTICES, also called cataplasms, are in common use as convenient means of applying warmth and moisture. Their effect is to soften the tissues and dilate the capillaries, relaxing the tension of inflamed parts, and so relieving pain. Applied early, they may check the progress of inflammation, and prevent the formation of pus; when suppuration has set in, they facilitate the passage of matter to the surface, and limit the spread of inflammation. They are useful not only when in immediate contact with inflamed tissues, but will also often relieve deep-seated pain. A poultice applied for the relief of the internal organs, or to hasten maturation, ought to be large enough to extend over a considerable surrounding surface, but, over a suppurating wound, should be but little larger than the opening. Apply as hot as can be comfortably borne, but do not burn the patient. There is danger of this with the thin and sensitive skin of a child, and in cases of paralysis, when the generally lowered condition gives rise to an inability to resist heat and cold, and the skin may be blistered by a poultice that would produce little effect on a healthy subject. Cover with some impervious material-oiled muslin or rubber tissue-to keep in the heat, and change frequently, the exact time depend

ing upon the thickness of the poultice. One of ordinary size will keep warm for three or four hours. If allowed to become cold and hard, it will do more harm than good. Poulticing should not be too long continued, or it may retard rather than help the healthy processes, by rendering the flesh sodden and irritable; it may even develop an eruption.

Poultices are made of various materials. The simplest form consists of several thicknesses of lint or soft cloth, wrung out in hot water. A convenient substitute is spongio-piline, which is made of two or three layers of sponge and wool, felted together, and coated on the outer surface with caoutchouc. This holds the heat a long time.

Linseed-meal is very generally used, and when of good quality is an excellent material. To make a linseed poultice, bring a saucepan of water to the boilingpoint, and, without removing it from the fire, stir into it the meal little by little, until it has the proper consistency-just thick enough to be cut with a knife. It must be smooth and perfectly free from lumps. That eccentric old genius of the last century, Dr. Abernethy, says that, if it is perfectly worked together, you might throw your poultice up to the ceiling, and it would come down without falling in pieces. The poultice should be spread evenly, about a quarter of an inch thick, upon a piece of muslin previously cut to the desired size, leaving an inch and a half of margin in each direction. Bartholow advises that the muslin be twice the length of the intended poultice, only half of it spread, and the remainder folded back as a cover, but it is rather better to have a separate cover of some thinner material, as mosquito-netting, old tulle, or illusion, if such can be obtained, and to fold over together like

a broad hem the edges of both. This makes a strong border. The cover is sometimes entirely omitted, and the poultice applied directly to the skin, but portions of it are likely to adhere, so that it becomes difficult to remove it neatly. A little oil on the poultice will help to keep it soft, and make it less likely to stick. A layer of cotton-wool on the outside will help to retain the heat; and when the weight of a poultice is painful, and it has in consequence to be made thin, it will be found a valuable addition. Sometimes a flannel bag is made to contain the poultice, one end being left long and free to fold over it. The best way to apply a large poultice for the relief of the internal organs is to make one or two turns of a flannel bandage about the part, and then to apply the poultice in such a bag, and confine it in place with the rest of the bandage. So arranged, it will keep hot a long time.

A small board, or a tray, on which to carry the poultice to the patient, will be found very convenient, and is in hospitals always used. Quite as important is it to have a basin in which to carry away the old one. If it is to be applied to a wound, the old poultice will have been removed, the wound washed, and protected by a guard "—a piece of muslin wet with some disinfecting solution-before the fresh one is made.

66

A poultice-jacket is sometimes prescribed, to envelop the entire chest. This is made in two pieces, front and back, with strings to tie over the shoulders and under the arms. The edges must be firmly sewed, to keep the poultice from escaping.

Bread poultices are lighter and more bland than linseed, but cool quickly and hold less moisture. Not having the tenacious quality of linseed, they are likely to crumble and become rough as they dry. Milk ought

never to be used in their preparation, as it has no advantage over water, and it very soon becomes sour and offensive. Pour boiling water over slices of bread without crust. Let them simmer a few moments until well soaked, then drain off the water, beat up the bread quickly with a fork, and spread.

As bread is more porous than linseed, it forms a better basis for the charcoal poultice. The formula given is Fresh wood charcoal-powder, 3 ss.; bread crumbs, ij; linseed meal, iss.; boiling water, 3 x. Mix half the charcoal into the poultice, and sprinkle the rest either over its surface or directly upon the wound. This poultice needs very frequent renewal. It is used for putrid sores; it absorbs the fetid odor and promotes a healthy condition, but it is always a dirty application, and other neater and equally effective antiseptics have largely taken its place. A linseed poultice may be made with some disinfectant solution instead of pure water, as weak carbolic acid, bichloride of mercury, or solution of chlorinated soda. The latter, as well as correcting the odor, affords moderate stimulation to the wound. It is made in the proportion of one part Labarraque's solution to four of water. Another gently stimulant application is the yeast poultice, mainly used to hasten the separation of gangrenous sloughs. Mix six ounces of yeast with the same quantity of water at blood heat. Stir in fourteen ounces of wheat flour, and let it stand near the fire till it rises. Apply while fermenting. Another recipe given for the yeast poultice is: Mix a quarter of a pound of flour, or linseed-meal, with two ounces of yeast, or beer grounds. The mixture is then heated, being constantly stirred until it is warm. The former is officinal.