Starch makes a very bland poultice, and retains the heat well. It is used for cancers and to allay the irritation of skin diseases. Make as for laundry use; mix first with cold water, and then add boiling water until it thickens.

Powdered slippery elm, Indian, and oatmeal are also used for poultices. A very light and soothing one may be made of one part slippery elm to two parts linseedmeal. Scraped carrots, boiled or raw, are thought to have an especially cleansing effect; onions and horseradish are sometimes used for their stimulating properties. A hop poultice is a thin bag loosely filled with hops, and wrung out in hot water. Bran is treated in the same way. A bran jacket may be made like that of linseed, above described, and has the advantage that the same one can be rewet and used again and again. It needs to be stitched through and through, as well as round the edges, to keep the bran in place. Bandage close to the body with a wide roller.

Laudanum is often added to a simple poultice, or sprinkled over its surface, for the relief of pain. Another sedative poultice sometimes ordered consists of one part powdered hemlock-leaf to three parts linseedmeal. In either case the constitutional effects of the drug are to be looked out for.

Camphor, incorporated in a bland poultice, is sometimes applied to the perinæum for the relief of strangury.

A spice poultice is made by mixing ginger, cinnamon, clove, and cayenne pepper, a teaspoonful of each, with half an ounce of flour, and brandy enough to make a paste. The same effect, that of mild counter-irritation, may be produced by sewing the spices into a bag, to be dipped into whiskey or brandy when required for

use.

A mustard poultice is made by the addition to a simple linseed poultice of a prescribed proportion of mustard, usually from one eighth to one fourth.

Fomentations are poultices in modified form, applications of hot water, pure or medicated, by means of pieces of flannel, cloth, or sponge. They have the advantages of being clean, light, and quickly prepared; but they require constant attention, needing to be changed every ten or fifteen minutes. Two pieces of flannel should be at hand, each doubled to the desired size. These are called stupes. They are to be saturated with boiling water, and wrung out as dry as possible. For this purpose a stupe-wringer is needed-a piece of stout toweling with a stick run through the hem at each end. Put the stupe in the middle of this, saturate with boiling water, and twist the sticks in opposite directions until no more water can be squeezed out. A towel may be used as a wringer, but there is danger of scalding one's fingers. A stupe cool enough to be wrung out by hand is too cool to be of much use. It should be dry enough not to wet the bed or the clothing. Have another all ready to apply before removing the first. There should be two layers, no more. Shake these slightly apart to let the air in between them, and they will keep hot longer. Cover with oiled muslin, an inch larger in each direction than the stupe, and over that lay a piece of dry flannel, or a layer of cotton-wool. The stupe should never be allowed to get cold. After the fomentations are discontinued, carefully dry the part to which they have been applied, and keep it covered for a time with a warm, dry flannel. Fomentations are not applied to discharging wounds, as the stupes would at once be soiled. Their chief use is to relieve spasm of the internal organs. They may be

made more irritant or sedative by the addition of appropriate medicaments. Twenty or thirty drops of turpentine or laudanum may be sprinkled over each stupe, or it may be steeped, instead of pure water, in some remedial decoction, as of poppy-heads, hops, or chamomile-flowers. A stupe recommended for a child consists of Jamaica ginger, paregoric, and hot water, in equal parts. In using turpentine there is some danger of blistering the skin, and any sore spot must be first covered with some impervious dressing.

When it is better to avoid relaxation of the tissues, "dry fomentations" are employed. Toasted flannel is often used, but it does not retain heat well. Thin bags of heated sand, ashes, or salt, bran or hops, hot bricks, tins, and water-bottles, and all applications of dry heat come under this head. Hot-water bottles should always be rolled in flannel.

Cold applications are used chiefly to subdue inflammation. They are good only in its earliest and latest stages, never when matter is forming, or during sloughing. To be of any use they must be kept cold, and confined to a limited space. If the treatment is begun and suspended, the reaction will render the inflammation more severe than if it had never been undertaken.

The simplest method of applying cold is by pieces of muslin wet in ice-water, and changed for fresh ones before they get warm. This calls for constant attention. A steady cold stream may be kept up over an inflamed part by carrying across it long strips of lint or lamp-wicking having one end in a pitcher of water, standing somewhat higher than the bed, and the other leading to a basin below it. The bed must be well protected; in all applications of water care must be taken that neither it nor the patient's clothing gets wet.

Sometimes coils of rubber tubing are employed, through which a continuous flow of cold water passes.

Ice is best applied in a rubber bag. These come in different shapes to fit the various parts of the body. The bag should be not more than half filled, with bits less than an inch square, and the supply be renewed before the last piece is melted. The ice will keep longer if mixed with one third sawdust. Put a fold of muslin between the ice-bag and the skin, and confine it with a bandage so that it may not slip about. An ice-bladder for application to the head can be folded in a napkin and pinned in position upon the pillow, so that its weight will not press upon the head. In the absence of a regular ice-cap, a cap-shaped sponge may be used, which will absorb the water as it melts. This must, of course, be wrung out before it is saturated. Ice can be finely broken by wrapping it in a stout cloth and pounding it.

All evaporating lotions must be left uncovered. A single thickness of lint is used, and frequently wet. this kind are alcohol, vinegar, muriate of ammonia, etc. Other lotions are put on several folds of lint, laid on the affected part, and covered closely with oiled muslin, or rubber tissue. The lint can be rewet without taking it off, by pouring some of the lotion over it.

A lotion applied to the eye is known as a collyrium. Collyria should be introduced at the outer angle of the eye, either by a glass dropper, or a camel's-hair brush used for nothing else. Draw down the lower lid, and tell the patient to look up at the instant the drops are slid in. Moist cloths must never be bound tightly upon the eyes, or they will assume the nature of a poultice, always harmful to those delicate organs.

Liniments differ from lotions in their mode of application, being rubbed in until the part is dry. Lini

ments usually contain poisonous ingredients, and must be used with care, the hands afterward being well washed before touching any sensitive spot.

Ointments are either spread on lint, the exact size required, or rubbed in like liniments. The rubbing in of an ointment is termed inunction.

The interior of the throat may be treated by gargles or by insufflation, as well as by inhalation, already described. Gargles are fluids thrown in contact with the tonsils, and forcibly agitated by the air from the larynx. About a tablespoonful at a time should be used, four or five times successively. After an acid gargle the mouth should be well rinsed with some alkaline solution, as bicarbonate of soda or lime water, to prevent injury to the teeth.

For insufflation, a rubber air-bag especially designed for the purpose may be used, or a large quill, a piece of glass tubing, or even a hollow roll of stiff paper, filled with the prescribed powder. This is placed as far as possible back in the throat, and its contents either blown in by the operator, or forcibly inspired by the patient.

The nasal douche, once so common, is now seldom prescribed, as there is danger attending its use. If it is followed by pain in the ears, it should not be repeated. The use of the post-nasal syringe and the spray has almost entirely superseded that of the douche.