sacking, below which a rubber cloth is hung, one end lower than the other. The patient, wrapped in a sheet, lies on the sacking, and has buckets of cold water poured over him at stated intervals. The water runs through into the rubber trough, which conducts it into a pail at the foot of the cot.

Another mode is by the wet pack or envelope bath. To prepare for this, first put three or four blankets on the bed, over these a sheet wrung out in hot or cold water, as ordered. Lay the patient on this, and fold the sheet over him, tucking it in well on both sides from the neck to the ankles, the feet not included. The blankets are then to be folded over him, one by one, in the same way, and the patient left in them from thirty minutes to three hours. Give plenty to drink and keep the feet warm. This treatment is usually very comfortable to the patient, and he will often fall asleep while in the pack. It will render the skin moist, subdue restlessness and delirium, and reduce fever. Upon removal, dry off the patient quickly and wrap in a warm dry blanket for some hours. If the object is simply to reduce temperature, the sheet wrung out in cold water may be employed, without the superimposed blankets, and changed every ten or fifteen minutes. The same effect may be more easily produced by applying towels wrung out in ice-water, dry enough not to drip, one after another, from the neck downward. When the feet are reached, begin again at the head, and renew each in succession, continuing as long as necessary.

Cold or tepid sponging often gives much relief to a feverish condition. Sponge always downward, and wrap the patient, still wet, in a warm blanket, leaving him undisturbed for an hour or two. Alcohol in the water makes it more cooling by its rapid evaporation.

Alcohol alone may be used for sponging, after which do not wipe the patient dry.

If it is desired to produce a shock upon the nervous system, as sometimes when there is disease of the brain or nerves, affusion is employed. This is simply throwing cold water upon the body. The shower bath is one form of it, and the douche another. The latter is most used as a local tonic. The stream should be directed from a height not exceeding ten feet, and, if the affected part is very weak or sensitive, should first be brought to bear upon the surrounding portions, and only by degrees be brought immediately upon it. A douche of hot and cold water alternately is often advised.

A general warm bath is used to induce perspiration, soothe pain, or relax spasm. The effect of warm or hot water is at first agreeable. Transpiration is increased through both lungs and skin, and the circulation accelerated. A very hot bath excites and stimulates the nervous system, while tepid or warm water rather calms and soothes it. If the water is too hot, or the bath too long continued, languor, giddiness, or faintness may supervene. The temperature should be tested with a thermometer, and the same degree of heat kept up throughout. Care must be taken that no part of the body comes directly under the hot-water tap. Keep the head out, and cool. An invalid should never be left alone in the water, and must be taken out of it at once if any sign of faintness appears. A hot bath will not be given during the menstrual period, or in the last stages of pregnancy. Some surgical cases have been successfully treated by long-continued immersion of the injured part in hot water. For this purpose, especially constructed tubs are provided. Immersion in water as hot as can be borne is said to be useful for sprains in their earliest stage.

A foot-bath is usually given to relieve the head, and should be as hot as possible. If the patient is able to sit in a chair, see that he is warmly wrapped up, and cover both patient and tub with a blanket. Let the water come nearly to the knees. Adding mustard will increase the effect. The bath can be given in bed, if necessary, though less conveniently. Have it well protected, turn up the clothes from the foot of the bed, direct the patient to lie on the back, and bend the knees, when the feet can be set in a deep bowl of water. Have it well balanced, cover with a blanket, and let the feet soak from a quarter to half an hour. Then dry them well, and either wrap in flannel or put on woolen stockings.

For a sitz, or hip-bath, the patient is immersed from the knees to the waist, and covered with blankets. The temperature of the water must be well kept up, and the bath prolonged about twenty minutes. The object being to excite the menstrual flow, the bath should be given, as nearly as can be calculated, at the time when that would naturally appear.

For a hot air-bath, an Allen's lamp and a bodycradle are required. The sheets and the patient's clothing are taken off, blankets enough put over the cradle to render it nearly air-tight, and snugly tucked in. The heated air should enter on a level above the patient, whose body should be sponged with tepid water until there is free perspiration. The lamp may be kept burning for twenty minutes or half an hour, and the patient then sponged off with cool water. A vapor-bath may be given with a similar apparatus, or by conducting steam under the cradle from the spout of a boiling teakettle. Still another way is by wrapping hot bricks in wet flannel, and setting them on earthen dishes under the cradle.

Both the hot air and vapor-baths may in less severe cases be given in a cane-bottomed chair, constituting a modified Turkish bath. Let the patient, entirely without clothing, sit on a wicker chair, with the feet on a stool. Cover with several blankets, and under the chair burn a spirit-lamp with a large wick. Let the patient drink freely, and, after he has perspired sufficiently, put him in a general bath of 75° or 80°, or pour over him a pail of cold water. Dry thoroughly, and keep him warm afterward.

Both liquid and vapor-baths may be medicated. A mercurial vapor-bath is given like the above, but with a special apparatus for the evaporation of calomel. This, after being deposited upon the skin, is not to be rubbed off. An acid vapor may be produced by evaporating vinegar.

A formula for an acid liquid bath is, nitric acid, f3jss., hydrochloric acid, j-iij, and warm water Cxxx. This should be given in a wooden tub.

For an alkaline bath, add half a pound of carbonate of soda to fifteen gallons of hot water.

A sulphur-bath is prepared by adding to each gallon of water twenty grains of sulphuret of potassium. This also must be given in a wooden or porcelain-lined vessel, as the sulphides discolor most metals. This is ordered sometimes for rheumatic affections, and sometimes for disease of the skin, in the latter case not usually until the subsidence of the acute stage, as it tends rather to aggravate the rash. With all skin diseases, rain water should be used, or hard water softened by the addition of soda, bran, starch, or gelatine. The skin should not be rubbed, but dabbed dry with soft towels. For a bran-bath, boil a pound of bran for a quarter of an hour, strain off the fluid, and add it to the bath.

Unless the bran is all strained out, this bath must not be given in a stationary tub. Sometimes it is used without boiling.

For a starch-bath, take half a pound of starch, and mix it with two quarts of water before adding it to the bath.

A salt-bath is usually given cold for tonic effect. Either sea-water may be used, or a solution of rock-salt, in the proportion of one pound to four gallons of water.

After any emollient or soothing bath, the patient should be kept quiet; after a stimulating bath, energetic friction and exercise are in order.

MASSAGE.

Massage is, in the hands of a skilled operator, a valuable mode of treatment, though it has been somewhat in disrepute, from having been allowed to fall largely into the hands of charlatans, so-called " magnetic mediums," and others of that ilk, whose pretensions have degraded everything associated with them. But it is deserving of rescue, and, as reputable physicians are taking it up and using it appropriately, it is gaining ground in scientific estimation. Massage will, to a considerable extent, take the place of active exercise, keeping the muscles strong and supple. It develops heat at the points of contact, so elevating the general temperature and dilating the vascular system. It furthers absorption, accelerating the motion of the blood currents, removing effete matters, and so promoting nutrition. It has usually a powerfully sedative effect upon the nerves, though in some instances it will be found to excite rather than to soothe. Insomnia and neuralgia can be often relieved by it, and spinal irritation to some extent controlled. In the treatment