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SURGEON GENERAL'S OFFICE

    LIBRARY.
 Section



 Ko. 113,
W.D.S.6.0.
no. Jill A3
3-613 
 
 
 
 
The  Sick-Room

    A Practical Manual on Nursing

           WITH A CHAI'TF.R ON

THE DIETARY OF  THE SICK.
     NATIONAL PRINTING CO.,
Nos. 16, 18, 20 and 22 Chambers Street, New Yor^:-
          1879. 
wy
Entered according to Act of Congress, in the year 1879,  by
           The National Printing Co.,
In the Office of the Librarian of Congress, at Washington.
   DUPLIGATc
^G0AH^ 
PREFACE.
    PHYSICIANS  have always felt the need of a  tho-
     rough knowledge  of the principles and practice of
nursing, by the people.   So  much depends  upon  such
knowledge and its  practical application, that the doctor
always hails as a favorable sign, the presence  of a  good
nurse in the sick-room.   Being acknowledged  by all as
one of the principal  factors in  carrying a case  to a suc-
cessful  termination, it seems  strange that nearly all the
knowledge in this pain-easing and  life-saving  branch of
medicine should have found its  only record in a sort of
unwritten law, handed down from generation to o-enera-
             7                   o            o
tion ;  which, while in  part  excellent,  is in  the  main
vague, uncertain, and based upon any but scientific  prin-
ciples.   Natural nurses,  like natural  doctors,  are  just
those who would be specially valuable  and efficacious,
if  their natural tendencies were developed and guided
by stud\-,  and their  knowledge based on facts.   Without
this, while they may be better than the average of the
uneducated, they are still  far from being what  so impor-
tant  a matter demands.
   The necessity for educated nurses  has made itself 
 1V                      PREFACE.
 manifest  within  the  last few years by the establishment
 and success of training-schools for their special educa-
 tion, in  most  of our large cities.   From these schools
 come forth dexterous,  gentle and competent attendants;
 an honor to their profession, a blessing to their patients,
 and a valuable  aid  to  the physician.
    There are  many families,  however,  so  situated that
 they are  unable  to employ these nurses, and  many cir-
 cumstances where, in the unavoidable absence of an edu-
 cated  attendant,  a life  may  depend upon  the practical
 application of  a  knowledge of nursing.   For such fami-
 lies, and a better diffusion of this very important know-
 ledge  amongst the people generally, this little manual
 has  been written.   It does not aim to  treat the whole
 subject, or any of its branches, exhaustively,  but to  crive
 plain, concise, practical  information  on  the  many points
 where knowledge is lacking,  or  the  views  held  are
 incorrect.
    In addition  to the results of actual personal experience
 in the sick-room,  information  has  been gleaned  from
various trustworthy sources, whenever such  information
has presented itself in a specially terse and valuable form,
or has come from the  pen of a man peculiarly fitted  to
speak as an authority. 
TABLE   OF  CONTENTS.
        CHAPTER  1.—The Patient  and his Surroundings.

Location of sick persons room in relation to noise from street.—No such objection in
    country.—Importance of quiet.—How secured.—Size of room.—Number cubic
    feet of air for well person.—Number necessary for a sick person.— How to calcu-
    late  number of cubic feet in room.—Low ceilings.—Lamp, fire and gas, con-
    sumers of oxygen. — Motion of air in room.—Why necessary.—No drafts.—Poison-
    ous quality and augmentation of lung and skin secretion in  disease.—Remarks on
    fresh air in sickness, by Sir J. Ranald Martin.—Velocity of  air in a sick room not
    to exceed  two and a half feet per  minute.—Prof. Willard Parker's remarks on the
    poisonous qualities of expired air.—Popular errors in regard to taking cold.—Re-
    marks  of Sir J.  Ranald Martin on temperature of the sick room.—Advantages of
    an open or grate fire.—Why a wood fire is sometimes best.—Moisture and ab-
    sorption of organic matter by dishes of water.—Light and sunshine, importance
    of.—Air usually purer in third  and fourth story rooms.—Objections  to light on
    account of affections of the eyes—how to obviate.—The " blue glass " craze, why
    it did good.—Therapeutic value of light, Martin on.—The sunbath,  how to take ;
    to whom  suited.—Ventilation, not draught; sun, not broiling.—Arrangement  of
    sick  room.—How to avoid dust in  sweeping.—Removal.of curtains, etc., in con-
    tagious disease.—Pictures and small ornaments—change in, pleasing to patient.—
    Plants  and flowers in sick room, when allowable and when to remove.—Perfect
    cleanliness of room and attendants.—Flies, how to get rid of.—Appearance of the
    room as a whole.—The bed.—Mattress.—Springs, when allowable and when not.—
    Woven wire mattresses.—How to protect bed from wetting and discharges.—The
    " draw-sheet," how to make;  objections to.—Frequent change of bed linen neces-
    sary.—Fxample of  fever produced by dirty bedding.—" Parlor bedsteads."—
    Airing  and warming of bed linen.—Amount  of bed  clothes.—Over-loading and
    over-heating injurious, save in  special cases.—Fever patients unable to "take
    cold."—Sponging of fever patients.—How  to bring out a rash when slow to come
    or absent.—Light in  the  room  at  night.—Cleansing and scenting of room.—
    Whispering objectionable.—Accurate spoons for giving medicine.—How doses of
    medicine are calculated in prescriptions, example of.—Variations in drops.—"Drop-
    j)L.|-<."—Drinking ducks, advantages of.—Bed pans,  porcelain, delf and rubber.—
    Rubber and glass urinals, cleansing of.—The nurse,  cleanliness and  good  temper
    of. — list slippers.—Avoidance of questioning.—Natural nurses.—Physicians' or-
    ders to  be  taken down in writing and to be  exactly followed.—Keeping  record  of 
vi
TABLE OF CONTENTS.
prominent symptoms.—Sample of urine to be saved.—Reaction to be taken; how
to do this.—Nitric acid and test-tube.—The use of the thermometer.—The  pulse
in child-hood.—The discharge from the bowels to be saved.—Peculiarities  to be
noticed.—Disposal and treatment of in contagious disease.—Earth closets, advan-
tage of.—Definition of contagion and infection.—Change and relief of nurses.—
Tired nurses are tiring to  patient.—Reading to patients, especially children.—
Influence of mind  over matter. —Momentary rising to prevent hypostatic conges-
tion.—Woolen stockings on  feet  and legs in getting up to use chamber, etc.—
Thirst an annoying symptom of fevers.—Drinks best calculated to allay.—Sucking
ice.—An excess of water apt to disorder digestion.—Graves' fever drink.—Visitors,
when to allow their presence.—A kind never to be admitted.—Methods for isolat-
ing persons with contagious  disease.—Method of disinfection advocated by  the
National Board of Health.
            CHAPTER II.—The  Duties of the Sickroom.

Baths, general remarks on—importance of  a  knowledge  of—causes of variations in
    effects of—classification of.   The General  Hot Bath—its five actions—degree of
    temperature—weakening  in  disease—its primary action—how to excite delayed
    perspiration—length of time to obtain relaxant effect—relaxation  better obtained
    by other means, where there is great  weakness—an excellent means in strong
    patients; robust children with convulsions—time of immersion to  obtain stimu-
    lant, revulsant, relaxant and eilminative effect—uses  after exposure—pneumonia
    or pleurisy—kinds of congestion—how dissapated—"breaking up a cold"—why a
    good sweating should  follow the bath—why the  hot foot-bath is to be preferred—
    eliminative  action of service in Bright's disease and rheumatism.   The Hot Foot
    Bath—its common use in domestic practice—how  it  acts—how to be taken—to
    be put  to bed and be well covered—importance of sponging off,  the following
    morning—change of bed  linen—use in  suppression or absence  of menses—sitz-
    bath usually better—uses in cholera  infantum, infantile diarrhoea, dysentaryand
    congestion, and  inflammation of the brain—why  mustard and  salt are added.
    The Cold Foot Bath—when to use—for  foetid and  perspiring feet.    The Hip or
    Sitz Bath, hot and cold—scale of temperatures—how  to take—length of time to
    remain  in—relaxant and sedative action, when  desired—sweating afterwards,
    when best and when not—cold hip bath  of service  when—alternate cold and hot
    sitz-baths in delayed menstruation, &c.—when the hot hip-bath is to be followed
    by poultices.  The Sponge Bath, hot and cold—actions—advantages of—uses in
    fever—as a  soporific—in  the night crowing of infants—how to give—ingredients
    that may be used—their aciton—the  " sweating  point"—how to  dry the skin in
    eruptive fevers.   The  General Cold Bath—too severe a  measure for the sickroom,
    unless under direction of  physician—its  use in England and Germany—action—
    how to give to nervous children—medicated baths useless, except in skin disease.
    Sea Salt Bath—action—to be followed  by exercise.    The Douche ;  The Shower
    Bath—points of  difference—how to  give douche—care necessary—of service in
    opium poisoning and chronic alcoholism—Emetics for opium poisoning—doses of
    mustard and ipecac—special  bottles and boxes  for holding poisons.    The Cold
    Pack—The Hot Pack—essentially the same—how  to give—action—local packs— 
                      TABLE OF CONTENTS.                         vh

Ringer on superiority of packing over sweating by means of flannel clothing, &c.
Vapor Bath—uses—utensils for—improvised apparatus—how to give when sitting
—how to give mercurial or sulphur bath—care necessary to prevent inhalation of
fumes—temperature scale for vapor baths.    The Hot Air Bath—utensils for—
how to use.   Dr. jVevin's Acid Steam Bath—how to  give—after treatment.
The Electric Bath—how  to administer—action of—the electro-magnetic bath—
proportion o. ingredients of sea salt, bran, camphor, alkaline,  glycerine, balsamic,
sulphur and gelatine baths.   Poultices—general remarks on—ingredients ; lin-
seed meal, slippery elm (ground), browned corn meal, bread  and milk, soap  and
sugar.    Felons—how to treat—how  to make poultices—how to retain heat—
when to renew—as producers of boils—anodynes on surface of—the charcoal poul-
tice—how  to make—charcoal as an addition to other poultices—how to make a
yeasi poultice—how to add carbolic acid to poultices—the uses of gauze and oil-silk
in making—tobacco poultices—when and where dangerous—hop and chamomile
poultices—when to use—glycerine in poultices—the onion poultice.    Plasters—
classification of—irritant plasters—mustard  plaster—with  flour—with vinegar—
with white of egg—popular fiction regarding—mustard papers—Spanish-fly plas-
ter—evil  effects on children—as a producer of sloughing, congestion and inflam-
mation of the kidneys  and suppression of urine.—anodyne plasters—belladonna
ami stramoniuir  plasters—protective plasters—of "little use—kinds of—mechanical
plasters—"Swansdown ,; and surgical.    Blisters—how to produce—after treat-
ment of.    Cups—kinds—description of—how to apply—mode  of action—how to
improvise  a cup—domestic scarifier   Leeches—where used—how to  apply—
how to promote bleeding from bites  of—how to stop bleeding  from  bites  of.
Croup Kettle—how to  improvise one—how to  use.   Joints—how to do up.
Fomentations—hot and  cold—how to use—receipts for.  Oil-silk Jacket—
how tc make.    Massage—meaning of—how to apply—use  of.   Injections—
rectal—kinds—to be preferred to purgatives in great weakness—double action of
—how t'i give—ingredients of—quantity of—kind of syringe best suited for—how
to remove  hardened  faeces  from  the rectum—daily use  of  warm injections
injurious—medicated injections—hammamelis and krameria in haemorrhoids—
belladonna—opium—giving medicines by the rectum—proportion to be  used—to
kill worms in rectum—Ringer on—starch and laudanum in dysentery.—Nutritive
Injections.—Of use, when—what to inject—how to prepare it—artificial digestion
of it—defibrinated blood—beef essence. — Ear Injections—care in use of—proper
syringe  for. — Nasal Injections—kinds  of—syringe  for—dangers of—use in
catarrh—atomizers better than syringe sometimes.    Suppositories—what they
are—how  to  introduce—introduction  by patient—local action of.   SURGICAL
Dressings—things to have ready. — Child-birth—things needed at. — Haemor-
rhage—arterial, how to stop—venous, how to stop—cut throat, how to act.
                 CHAPTER III.—Diet  for the  Sick.

The importance of the diet of the sick.—Why more attention has not been paid to it.
    —What the physician should know and do.—What the cook and nurse are ex-
    pected to do.—Reference to books on diet.—Methods of cooking: broiling, bak-
    ing, boiling, stewing, roasting, frying, infusing.—Importance of meat in the diet 
Vlll
TABLE OF CONTENTS.
of the sick.—Fried foods of all kinds objectionable.—Dr.  Beard's ideas of frying.
 —Infusing—definition—how to accomplish—meats best suited for—to what  cases
suited.—When solid food is  necessary.—Robust patients  not  to  be  overfed.—
Broiling—its advantages—how to accomplish best—kind of  fire best suited for.—
Baking and Roasting—analogous  to broiling—to what meats best suited—baked
potatoes- — Boiling—Smith, remarks on—comparative value  of boiled and roasted
meats.—Stewing—advantages of—meat and vegetable  stews.—Falty  foods—the
role they play—objections to.—Experiments of Dr. Beaumont on Alexis St.  Mar-
tin.—Tables thus compiled,  showing the mean time of digestion of different arti-
cles of diet.—Manner of serving  food—cleanliness—neatness—overcrowding.—
The bed-table—how to improvise.—Some practical hints on kind and quantity of
diet, by Sir. J. Ranald Martin.—Modifications from  nature  of  disease, age, sex,
previous habits and employments, and  season.—Miss Nightingale  on cooking.—
Vegetables necessary in invalid diet.—Fats,  objection to—butter the best kind of
fat.—Ice-cream  and  beef.—Milk—importance of—idiosyncrasies regarding—how
to obviate.—Sour milk.—Butter-milk.—Eggs—a good food—sometimes causing
"biliousness"—egg-nog—how to boil—how to poach—amount of carbon and
nitrogen in.—Arrowroot, rice, Sec.—of  use how—amount  of starch in.—Bread—
importance of—yeast and baking  powders.—Cake.—Aerated bread.—Flours.—
Fruits.—Grapes, peaches, water-melons, Sec.—Meats—tables giving composirion
of.—How to determine the nutritive value of a food.—Their  heat producing value
—to what forms of disease fats are suited.—Beef extracts—valueless, as a rule—
how to make liquid beef—Darby, of England, on.—" Desiccated beef."—Fish—
worthless  as  a brain food—how to  cook.—Recipes.—Soups,  beef-teas, gruels,
stews, &c.—Puddings,  &c.—Meat,  fowl  and  fish.—Creams.—Vegetables  and
fruits.—Jellies, &c.—Drinks. 
CHAPTER   T.
        THE  PATIENT  AND  HIS SURROUNDINGS.

     FOR the first few days  of an acute illness or  a  severe  accident, it
       matters little to the sufferer what kind of a room he or she is in,
 or how the furniture or hangings are arranged, but it is a matter of con-
 siderable moment, affecting  the patient's ultimate chances of recovery
 and his personal comfort, as to where that room is situated, especially if
 it be in a  city.  In the country, a front room is usually as free from
 noise as one in the rear of a house, and the situation of the apartment is
 therefore of less importance.   In our large cities, however, the noise of
 the  street-cars, the rumbling of butchers' carts  and ice-wagons,  the
 jangling bells of the rag-merchant, and the penetrating cry of the vendor
 of fruits or crockery,  make a front room seem almost pandemonium to
 one whose suffering is intense, and whose nerves—to use an incorrect but
 expressive term—are highly strung, and ready to vibrate at a sound that
 would be unnoticed by a person in good health.   In such cases, a room
 must be had as remote from the noise and confusion of the street as is
 possible.  The room, further, should  be large and airy.   A person in
 good health should never sleep in an apartment with a capacity of  less
 than 1500  cubic  feet, and  a sick person in one  with less than 2000
 cubic feet.   Such a capacity is reached  by a  room fifteen feet long by
 ten feet wide  and ten high (1500),  and one  twenty feet wide by ten
 long and ten high (2000).  To  obtain the  contents of a  room in cubic
 feet, multiply the  length in  feet by the breadth, and the  result by the
 height.  Rooms with  low ceilings are always to be avoided where pos-
 sible.  They are  not  pleasant,  light  usually has  no free  entrance, the
 movement of air is restricted, and the heated air that should rise  above
 the level of the person's head when standing, is brought close to his face
when he  is lying down.  It  must  be  remembered that   the person
acting  as nurse, the fire—if there  is one, as there always should be in 
10
THE SICK ROOM.
dam])  or cold weather—and  the  gas  or lamp, are  all consumers of
oxygen,  and  consequently lessen the amount for the patient.   The air
should be constantly moving,  in a regular, uniform manner, but not in
unequal or direct currents or drafts.   This motion is necessary to carry
off the organic material thrown out  by the lungs  of the sick person, it
being in disease  greatly augmented and especially  poisonous.  Sir J.
Ranald Martin, in an article on Hospitals, in  Holmes'  System of Sur-
gery,* says, speaking of the value of fresh air:
   " In Scripture, the atmosphere is termed ' the breath of life,' as indi-
cating the vital properties of fresh air.  So life-giving is pure air, indeed,
that we must have it in  excess of our actual wants, if we would insure
that the air which we are inhaling may not be corrupted  by the con-
sumed air which we have exhaled; for, be it  remembered,  that no kind
of impure air is more injurious  to health than the impurity of air expelled
from the lungs.  Ample cubic  air-space is important and  necessary, but
it, alone,  will  nowhere  prove sufficient for  health,  without  provision
for the constant removal of exhalations from the lungs and skin of the
sick.
   " For thousands of years  the natives of India  have regarded purity
of skin  as obtainable  only  through the rinse of the river-stream, or
through the imitation  of it  in the bath-room, by a constant stream of
clear water poured  from a vessel, the same  water not applying to the
skin twice.  If we would enjoy a  perfect respiration, with  consequent
purity of the blood, we must secure the same kind of rinsing or cleansing
by a constantly succeeding  supply of pure  air for  the supply of the
lungs.
   " The motion of air in any  room should never exceed the velocity of
two feet and a half per minute, and it should  not at  any time be much
below that rate."
   Few realize how thoroughly a single pair of lungs can vitiate the air
of a fair-sized room  in the course of a  few hours.  In speaking on this
subject before a class of students, at  the College of Physicians and Sur-
geons of New  York City, Prof. Willard Parker called attention to the
matter very aptly, in the following  words :  "If, gentlemen, instead of
air, you suppose this room to be filled with pure, clear  water, and that in-
stead of air  you were exhaling twenty times  a minute  a. pint of milk,
you can see how soon  the water, at first clear and sparkling, would be-
come hazy and finally opaque, the milk diffusing itself rapidly through the
water.  You will thus be able to  appreciate, also, how at each fresh inspira-
* Holmes' System of Surgery. London: 1864.  Vol. 4, p. 994. 
            THE PATIENT AND  HIS SURROUNDINGS.          u

tion you would be taking in a fluid that grew momentarily more impure.
Were we able  to see the air as we are, the water, we would at once ap-
preciate how thoroughly  we  are contaminating it, and that unless there
be some vent  for the air thus vitiated, and some opening large enough
to admit  a free  supply  of  this very  valuable material, we will be
momentarily poisoning ourselves as  surely  as if we were taking sewage
matter into our stomachs."
   Decided objection is made by many persons to free  ventilation of the
sick  room  on   the score that there is  great  danger of  '• taking cold."
In regard to this  the following very sensible remarks  of Sir  J. Ranald
Martin should be borne in mind:
   " The danger of  thorough ventilation is much exaggerated ;  for, ex-
cepting a few  well known instances, the risks are hardly  worth estimat-
ing as compared to the benefits of that life-spring to the sick—fresh air.
Patients in bed are not generally inclined to catch cold.  Catching cold
while in bed follows  the  same rule  as while we are up.   If the atmos-
phere be foul,  with the lungs and skin oppressed, and unable to relieve
the skin by depuration, then a draught may bring a chill;  but this is the
fault  of the foul air, not of  the fresh.  As regards temperature, trifling
variations are  in general  rather beneficial  than  otherwise ;  and a cooler
atmosphere at night acts rather as a tonic. " *
    In summer, one or both windows and  the  door  should be open, the
bed being so placed  as to be out of any draught.  A thermometer should
hang near  the  bed, and  in winter, the temperature of the  room should
not be allowed to rise above 70D F.  Slight variations from 670 to 700
F. are immaterial, and are looked upon as favorable rather than other-
wise by Martin, as already shown.  An open fire burning in the room acts
as a good  ventilator and is bright and cheerful, the latter being a  great
desideratum.   A wood fire, -when it can be had, is to be preferred to one
of coal, a.s less gas is  given off.   In winter,  however, a more uniform
temperature may be maintained by the  coal fire.  It is always well to
have dishes of water standing about the room, as moisture  is  thus given
off and much  of the organic matter is taken up by the fluid,  which acts
as an air purifier.
    In winter,  it is well to make a frame  to  fit the space left by lowering
the upper sash of the window, and tack a layer of flannel on  each side
of it.  This admits and gives exit to the air, and  at the same time pre-
vents draft.  This frame may be made in the same way as for mosquito-
netting.
* Holmes' System of Surgery.  Vol. 4, p. 1000. 
12
THE SICK ROOM.
    Next in point of importance to fresh air is light and sunshine.   If pos-
sible, the room should be so situated as to allow the sunshine to enter it
for it least a few hours each day.   Better risk the noise of the street, get-
ting as far away from it as possible by going high up, where, by the bye, the
air s usually purer and fresher than on the first and second floors, than to
put a patient into a quiet room where light, air, or sunshine, are excluded.
There is much organic material in the dust from  the  street—the finely
powdered horse manure, &c.—that is  constantly blowing into the first
and second  story  windows.   There  are certain diseases  where  the
eyes are intolerant  of light,  and where, if admitted freely, it would do
decided harm.  In such cases it is,  of course, to be excluded  for the
greater  part of the day, but even then  it may be admitted for a short
time by protecting  the eyes of the sick person from  its  glare.   It is a
good plan to place the head of the bed towards the windows so that the
light there entering may not strike directly in the sick person's face.   A
room can  thus be kept quite light, even when the eyes  would be intoler-
ant of its  direct rays.
    In most  diseases light will  do no injury, and when  properly borne is
always of decided benefit.   This  is especially the  case during convales-
cence.  The " blue glass " craze was based upon the beneficial action of
light; the  blue glass  simply offering  an  inducement,  for persons who
would not otherwise  do it, to sit in  the  sunlight for several hours at a
time.  In this way,  it  undoubtedly did much good, but beyond protect-
ing the  eyes from glare, the  glass  might as  well have been  colorless as
blue.
    " Of all the elements which play a high part in the material universe,
the light which emanates from the sun is  certainly  the most remarkable,
whether we view it in its sanitary or scientific relations.  It is, to speak
metaphorically, the  very  life-blood of Nature, without which everything
material would fade and perish."*
    Sunlight is of especial benefit to persons convalescing from long and
wasting sickness.   They should  take  a  daily sun-bath of  an  hour or
more, as their strength permits.   They may be placed with their backs to
the sun  if the  glare hurts  the eyes, or wear  a pair of blue or green
glasses for the same purpose.  The patient  should be wholly or partly
nude, allowing the  sun  to  act  directly on  the cutaneous surface.  In
all these cases a light-colored and light-weighted straw hat, well perfo-
rated at the sides, and slightly dampened, should  be w.orn.   It protects
the head  from the direct  rays of the sun, which  is  important, as in
"Martin, op. cit., p. 998. 
            THE PATIENT AND HIS SURROUNDINGS.          13

weakly  persons prolonged  exposure might produce  congestion of the
brain or  other  serious trouble.   We have understood  that  there is a
large room on  the top floor of the New York Hospital, in this city,  tor
this especial purpose.
   It must not be supposed from what has been said here that the author
advocates the constant blowing of cold air over a sick  person, or broiling
him  for several hours each  day in the sun.   The fresh air must be had
only in proper quantity, not in excess.  Convalescents or chronic cases
only should have the sun bath; all  patients, however, need sun in the
room for a short time each  day,  except in special cases, which will  be
pointed out by the physician.  It is to be borne in mind that air, light,
and  sunshine are Nature's great scavengers and disinfectants.
   A few words may not be amiss in regard to the arrangement of the
furniture of the sick room.   As  a rule, the paper should be light and
pleasant  to  look at; the carpet should be bright and  cheerful; and the
furniture strong, well made and  free from squeak and  groan.  As the
carpet is apt to soil very soon, it is a good plan to put some light, cheap
material upon  it, especially near  the bed,  so that it can  be daily raised
and  shaken, thus obviating  the dust that  will  arise from a sweeping or
" dusting up," however  light  it may be.   When it can  be  done with-
out disturbing  the patient, or when there is an opportunity for arranging
the room before it is occupied, the carpet should be taken up.   It only
serves to deaden  the sound  of  footsteps—which can be much better
done by  requiring the nurse to wear  list slippers—it  is  being constant-
ly stained, catches all the dirt, and will serve as a medium of contagion
in such diseases for weeks after the person has left  the room.   Further-
more, the bare floor can be  thoroughly cleaned, without  dust or noise.
All  " dusting " should  be done  with a damp rag.  Too little furniture
is better than  too much in a sick room, especially if the room be small.
In contagious  diseases all  curtains, hangings, books, and trinkets that
can  possibly be dispensed with, should be removed, and  where curtains
are  needed, cheap paper ones that  may be  burned  should be put in
their place.
   There are  various little  things,  the  doing and leaving  undone  of
which add  greatly   to  the  comfort  and  contentment  of  the suffer-
er.    This  is especially  the case with children.   When well, they  go
from toy to  toy,  and play  to play, constantly  seeking  something
new  and fresh.  How  monotonous  must it be, then, for  these little
butterflies to be shut  up, day  after day, in a room that is  always  the
same  in furniture,  hangings  and  arrangement.    Sameness  and  the
modified  light are supposed by  some to soothe irritation  and induce 
H
THE SICK ROOM.
sleep.  It is a  great mistake.   They may force  sleep, but it will be
fragmentary; and instead of soothing irritation,  they often increase it.
These remarks  are, of course, subject to some modification in special
diseases.   There should be pleasant pictures and various  little nick-
nacks on the  wall  to attract the patient's attention and keep his mind
employed.  As  he gets well, he will tire of these and they may be partly
or wholly removed  and others put in their place  while the patient is
asleep.  His  surprise  and  pleasure on  awakening will well repay  the
trouble, and hasten his  cure.  A few  growing flowers will be pleasant to
the sight and smell.  Cut  flowers should never be allowed in a sick-
room.  All plants  and flowers should be removed at nighty for then  the
plants are throwing out carbonic acid gas and absorbing oxygen, while
in the day time  they exhale oxygen and rid the air  of the poisonous car-
bonic acid.  Patients  rarely care for  flowers before the period of con-
valescence.
   Everything  about  the  room, and those  who  enter it, should be
scrupulously clean and neat.   The  table upon which the medicines
are kept  should have a clean white  cover, and be  placed  out of the
patient's sight.  Glasses and spoons  should be rinsed after each time of
using, and wiped dry.  Water is a good purifier  of the air, and, of course,
if the medicine is dissolved in water and that is uncovered, such medicine
must absorb a vast amount  of  filth from the air of the  sick room ; it is
safer when kept in corked bottles.
   A piece of poisonous fly-paper should  be placed in a saucer of water
near each window.  If, in spite of this, these  pests are troublesome, a
large-meshed mosquito bar  may be put up over the patient.   When it
can be avoided, however, this  should not be done, for the netting ob-
structs the person's sight, prevents a free circulation of air about his bed,
and  is in the way when a medicine  is to be  given.  The whole room
should have a  bright,  cheerful and tasty  appearance.  The eyes soon
become weary from resting on the same dull surroundings day after day
and week after week.  Daily changes, however  slight, are alwavs agreea-
ble.
   The bed should be strong and well  made, so  as not to squeak or
groan every time the sick person turns or is moved.   In acute disease
and  long continued illness, the mattress should rest on good springs
having an even tension.   The woven wire mattresses of the Hartford
Company are excellent both in health and disease.   In accident cases,
such as broken  limbs, the bed should be strong and without springs,  the
mattress being laid directly on the slats or cording, the former being best.
A spring bed, by allowing too free motion, might in some of these cases 
            THE PATIENT AND HIS SURROUNDINGS.           15

interfere with the working of the apparatus which the medical man ap-
plies.  The mattress in all cases, where it can be afforded, should be of
hair, and well and evenly made.
    In cases where there is a discharge from wounds, where the patient
wets or soils the bed, or the applications made to the part are apt to soak
into the mattress, it is well to put a fair-sized piece of rubber cloth beneath
the sheet.  Each time the sheet is changed, this can be dried and rear-
ranged.  The  "draw-sheet" is, in some cases, a positive necessity;  in
others, a great nuisance.  Where the sheet is being constantly wetted  or
soiled, a sheet may be doubled upon itself in its narrow diameter, several
times, leaving  enough free  to place beneath  the patient.  The rest lies
folded up at the back of the bed.   As the parts beneath the person be-
come soiled, he is gently raised, and a fresh part of the sheet drawn under
him, by drawing forward the soiled part.   This arrangement is called the
" draw sheet" and is of value in that a dry surface can be kept constantly
beneath the person, without raising  him to put on a clean sheet.  It  is
disadvantageous, however, in that it keeps the damp, soiled linen within
a few feet of the sick person, who  necessarily inhales the offensive odor.
    It is best to sew one sheet to another, and as one is soiled, draw it out,
thus pulling the other  beneath him, and then,  ripping out the stitches,
remove the soiled  sheet altogether.   Another form of " draw-sheet,"
much used in hospitals, is made by folding a narrow sheet down its length
once, then folding it across  several times, leaving a part sufficiently wide
to go beneath  his buttocks.   This is put under the patient over the re-
gular sheet and is drawn forward in the manner spoken of before.  This
is of course open to the same objections as the other, and  either, if used
at all, should only be used when a patient is so very low that any move-
ment necessary to  change sheets  is hazardous  or weakening.  In  any
case, the plain sheets stitched  together  are best.  In all cases of pro-
longed  illness,  it is  well to have a  sheet  doubled once in its length and
laid across the bed with the  ends tucked in at each side  of the mattress.
This will not wrinkle in the same manner as the single sheet,  and can
be readily kept free from crumbs.  When soiled, it  can be removed and
another put in its place by  sewing the end of a clean one, so folded, to
the end of the soiled one and pulling it through.
    As a general rule, bed-linen should  be changed every other day.   It
is as important to have clean linen next  to the skin as to have  fresh air
for the lungs, as is shown by the following:
    Sir J.  Ranald  Martin*   quotes Dr. Rollo as saying that " cleanli-
* Martin, op. cit., vol. 4, p. 998. 
1(3
THE SIC A' ROOM.
 ness of the patient and of everything about him, is indispensable."  " To
 illustrate his  subject,  Dr. Rollo says  that in 1789, several men of  the
 artillery at Woolwich, were seized with a severe form of continued and
 relapsing  fever.   These men were found to have occupied beds differ-
 ent from  the rest of the barracks, having hammock bedding.   The
 hammocks were rolled up tightly every morning the moment  the men
 rose, and  they were unloosed when they went into them at night;  and
 this time we had so much and  so constant rain that this  bedding  had
 not been aired or opened for a single day for at  least two months.  The
 hammocks were,  with their  bedding,  examined, and the  moment they
 were opened, a very peculiar nauseating  smell  was perceptible.  Steps
 were immediately taken and no further mischief took place.  Here, an
 infectious  fever evidently arose from  the confinement of  the effluvia of
 a man's own person in a time of about two months."
   Many families are  daily imitating the  performances of these soldiers
 by shutting up  their bedding in "parlor-beds,"  so called.   In the case
 of sick persons such  shutting up of effluvia does not take place to the
 same extent, but as the matter passing  from the lungs and skin is materi-
 ally increased both in amount and  poisonous quality, a daily change is
 imperative.  All clean linen should  be aired  for at least two hours each
 day before being put on the bed, and whether in winter or summer should
 be warmed before a strong fire for half an hour.   There must not be the
 least trace of dampness about it.  A recent writer in Scribner's Monthly
 (September, 1879) gives some very  good directions as to how bed and
 body linen are to  be changed in the  most rapid and easy manner:
   " The bed linen should be changed at least once in three days;  the
 blankets once a week, those that have been removed being hung in the
 open air for a few  hours, then thoroughly aired  in a warm room, and
 put away to replace those in  use, which should be similarly treated.
   " In changing body linen, have the fresh garment aired and close at
 hand;  let the arms be drawn out of  the soiled one, slip the clean one on
 quickly over the head, and  by  the  same  movement draw it down and
 remove the other  at the feet.
   " Nothing is more easy to an experienced nurse, or more difficult to
an inexperienced one than to change the bed linen with a person in bed.
 Everything that will be required must be at hand, properly aired before
beginning.   Move the patient as far as possible  to one side of  the bed,
and remove all but one pillow.   Untuck the lower sheet and cross sheet
and push  them towards  the middle  of the bed.  Have  a sheet ready
folded  or  rolled the long way,  and  lay it on the mattress, unfoldhv  it
enough to tuck  it  in at the side.  Have the cross sheet prepared as de- 
THE PATIENT AND HIS  SURROUNDINGS.
17
scribed before, and roll it also, laying it over the under one and tucking
it in, keeping the unused portion of both still rolled.   Move the patient
over  to the side thus prepared for him, the soiled sheets can then be
drawn away, the clean ones completely unrolled and tucked in on the
other side.  The coverings need not be removed while this is being done;
they can be pulled out from the foot of the bedstead and kept wrapped
around the patient.  To change the upper sheet, take off the spread and
lay the clean sheet over the blankets, securing the upper edge to the bed
with a couple of pins;  standing at the foot, draw out the blankets and
soiled sheet, replace the former and put on the spread.  Lastlv, change
the pillow-cases."
    Sick persons are  to  be overloaded with bed-clothes only when free
perspiration is desired.  In all  other cases  the covering should be just
sufficient  to  keep the  person comfortably warm.  It should be remem-
bered that it is almost impossible for a person with a high fever to take
cold, and that, therefore, unless a free sweating  is aimed at, a heavy pile
of blankets and " comforters" are positively hurtful.   They irritate the
patient and render him restless by reason of their weight and  the increased
heat.  Many persons  in attendance on  the sick wonder why the  fever
keeps so  high, when all the time they are producing more heat and pre-
venting that of the body from  leaving it  by using too many and too
heavy bed-clothes.
    To persons  suffering with a high temperature, sponging  off several
times daily in lukewarm or cool water is very agreeable, and often mate-
rially lessens the fever and induces a pleasant, healthy sleep,  sometimes
followed by free perspiration.  This sponging  will never  do any  harm
and is so agreeable that patients request it again and again.  No bad
symptoms follow  its  use  even  in  the  eruptive  fevers, (scarlatina,
measles, Sec.) after the rash is well out.  During the first few days, a table-
spoonful each of mustard and salt, with a little spirits, say two ounces, to
a wash-bowl half full of warm water, will bring the rash out fully and
allay the  intense itching which is often  so annoying.  Sponging with
water and dilute acetic acid is  often very grateful, allaying the trouble-
some itching of the eruptive fevers, keeping out the rash, and hastening
desquamation.   It should be used of the  strength of one part of dilute
acetic acid to ten parts of water.   A table-spoonful of spirits of camphor
to the wash-bowl of  water is  also of use to  allay itching.   Where  there
is no  itching and the rash is well out, and in other than eruptive fevers,
the water  may be lukewarm or cool, and the mustard and salt omitted.
A fine soft sponge or cloth should be used, one part at a time  being
rapidly sponged and as rapidly dried.  The patient should be wrapped 
i8
THE SICK ROOM.
in a blanket while this is being done.  After each sponging the patient's
hair should  be dampened, dried, and then so arranged as to be kept off
the face and out of  the eyes.   In females  it is  well to  do it  up in
two braids.   The patients  back  should be  examined daily  to see if
any of the prominent points are reddened.   When found to be so they
should receive immediate attention, for it is thus that bed-sores com-
mence.   The part should be bathed several times daily with the follow-
ing mixture, then thoroughly dried and powdered  with pulverized oxide
of zinc:
                Alum..................2 drachms.
                Tannic Acid............i drachm.
                Alcohol................8 ounces.

   These prominent  points, which are very  prominent and numerous
when a patient is emaciating  fast, should be protected by making little
rings of cotton, and so  placing them  that  the reddened or excoriated
part shall fall into the hollow, and be thus relieved of all pressure.  These
rings  may be  made to  keep  their shape better by stitching the cotton
through and through into string or cord.
   Vaseline is a reliable and elegant preparation, that is of great service
in healing excoriations and a decided allayer of irritation  and itching.
It is free from the objections so justly urged against oils and fatty salves—
their getting rancid.
   At night a light  should  always be kept  burning in the room, espe-
cially in the case of children or nervous women, for waking in the dark
often gives them  a  fright.  They  seem to sleep  quite as well,  some,
indeed, better with than without a light.
   Any unpleasant  odor about the room should be treated with plenty
of fresh air  and the burning of a piece or two of cascarilla bark, which
is  much better than the pastiles sold in the shops.  After each burning
the window  should be opened and the air allowed to circulate freely, the
patient being, of course, well covered.
   Whispering in a sick-room  is  always  objectionable.   This tone of
voice is penetrating and more annoying to the sufferer than that of ordi-
nary conversation.  The words in the whispering tone are just indistinct
enough to excite the patient's curiosity aud cause a straining and tension
in the endeavor to catch their meaning.  It is to be borne in mind that
conversation in  any tone should be limited to the absolute necessity of
the case.  These remarks will, of course, be understood to appl)- only
to severe cases of acute  illness and before convalescence.
   Physicians in  ordering medicine generally specify the  dose of fluids 
THE  PATIENT AND HIS SURROUNDINGS.
'9
by  the tea-spoonful,  that being supposed  to represent  one  drachm
Upon this basis, the dose of each of the ingredients of the mixture  are
calculated,*  and if the spoon holds more or less than the amount speci-
fied, the dose is more or less altered.   It is well, therefore, to obtain one
of the porcelain or glass spoons for sale in the drug stores, they being
correct and consequently reliable.   It is not always necessary that a tea-
spoon should hold just  one  drachm
of fluid, for  a  few drops more  or              Fig. i.
less will  make  but little difference,
but it is sometimes imperative that it
should; and if we are accurate always,
we are sure of suffering  from no mis-
takes.   Where medicine is to be given
by  drops, the little glass " droppers"
of  the  drug stores are inexpensive
and invaluable.   It must be remem-
bered that drops vary much in size,
this variation being due to different         porcelain  duck.
causes, as the size of the neck of the
bottle,  the density of the fluid, etc.   For  administering drinks and fluid
foods, the porcelain " duck " is very useful.   The  patient does not have
to be raised, and its narrow neck prevents a too rapid flow  of fluid into
the mouth (Fig. i).
    Another  great convenience  in the sick room and one that  obviates
sitting up in  or  getting out of bed, is the bed-pan.  The porcelain or delf
    "Take the following as an example :
        Tincture of Nux Vomica......                  ..  160 drops.
        Tincture of Opium...............................    i drachm.
        Syrup of Wild Cherry Bark.........................    I ounce.
        Water, add to make..... ..........................    4 ounces.
        Mix.
           Take a tea-spoon-full every day.

    This is a four ounce mixture.  There are eight drachms to  the ounce, therefore
thirty-two drachms in all (4 times 8) or thirty-two tea-spoonsful.  The amount of each
ingredient in a tea-spoonful, then, would be one T3L2- of the amount placed opposite
the drug, as:
        Nux Vomica, ■£% of 160 drops........=5 drops.
        Ooium, -:J.r of one drachm (60  drops) — '}% of a drachm or ij drops.
        Wild  Cherry, -j-.r of 1 oz. (480 drops,) = 15 drops.
    Adding these togethei we have 21J drops which would leave us the rest of the
tea-spoonful, or 38^ drops, consisting of water. 
Fig.
20                       THE SICK ROOM.

article, however,  is at best  clumsy, hard  and unmanageable.  A very
elegant affair is made by the Goodyear Rubber Company.  It is known
                         as the "Inflatable Bed-Pan."  It is  made
                         of rubber, is put under the patient readily, is
                         easily cleansed, and less objectionable than
                         those in  use as  it has  no cold  surface or
                         hard, sharp edges.   It is to be  inflated before
                         each time of using.   It has all the advan-
                         tages of the solid pan and none of its  draw-
                         backs (Fig. 2).
                           In inflammation of  the bladder,  and other
                         disease where there is  a spurting or dribbling
                         of urine that is almost continuous, the rub-
                         ber unnais made  by the same firm will  be
                         found very convenient  (Figs.  3,  4 and  5).
For occasional urination the  small glass or porcelain urinal will be found
very serviceable.  Those of glass are better than those of porcelain, as
BED PAN.
&g- 3-
Fig. 4.
RUBBER URINALS.
their cleanliness can be readily determined.   They should be washed
with hot water and suds after each urination.
    In lung, bronchial and throat affections, where there is considerable
expectoration, the " spit-cup " is a great convenience, preventing strain-
ing and concealing the sputa from  view.   This latter is important to
persons who are subjected to nausea.
    The person who acts as nurse should be of a kind, gentle disposition, 
THE PATIENT AND HIS SURROUNDINGS.
>
of unvarying temper, patient and strong.  He or she, it is usually the lat-
ter, should have a quick ear, a shaqj eye, and be very neat and clean in
person and dress, for nothing worries a patient, himself cleanly, so much as
a nurse with dirty hands or face, unkempt hair, or care-
less dress.   A  clean, white apron  and white cap add
much  to  her  neat  and  pleasant  appearance.   She
should wear slippers,  preferably of list, and should
never do anything hurriedly or  by jerks.   When not
busied about the  patient, she should have  some little
piece of work in her hands.  It looks better and  keeps
her in better  spirits than sitting  idly, gazing at the
patient or out of the window.   She  should not annoy
the sufferer by constant questions as to what he will   .
have ;  this practice renders the patient fretful and rest-   j
less.  The true nurse can readily see and anticipate  a   ■
wish without catechising.                              :
   Temperature.—" Taking the temperature " of a sick   \
person by means of the thermometer is a comparative-   ;
ly recent advance in medicine.  By its use the  exact
amount of bodily heat is readily ascertained, and im-
portant evidence  is thus furnished  to  the physician.
In  a very sensible and well written little  book  upon
the subject, especially designed  for the people, Dr. E.
Seguin, of this city, commends the use of the ther-
mometer in every family.  The mother is thus enabled
to determine in  a few moments whether her child is
suffering  with   any fever,  and whether  the doctor
should be sent  for.   She will often recognize the approach of a  serious
illness some days before  there  is a distinct  outbreak  of the disease,
and by the  advice of her physician  possibly  ward  it off.  The use
of the thermometer is, therefore, very important.  It is of service, also,
and more commonly employed, to record variations in temperature when
Fk. 6.
A SELF-REGISTERING FEVER THERMOMETER.
a person is sick, and every nurse or attendant should become proficient
in its use  and keep a record of her observations for the  inspection of
the physician at each visit.  A thermometer such as is used for this pur-
pose is here shown (Fig. 6). 
22
THE  SICK ROOM.
   The temperature of a healthy person is about 98^° Farenheit.* Any-
thing above 990  indicates fever and  should be  attended to at once.
Temperature below 980 indicates collapse.   A recent English writer t
says, " No indication is more simple or more valuable than  that supplied
by the thermometer;  by its aid alone we are often led to suspect the
advent of typhoid or scarlet fever, or to detect some latent pneumonia
or tubercle  producing  irritation, or worms or some other malady which
we had overlooked.     *    *     *     Temperature is a better guide
than the pulse in the diseases of young children, and should be used to
correct its indications."
   The method of taking the temperature is as follows:   Holding the
thermometer, which should be self-registering, in the right hand, hit that
hand against the palm of the left until the little registering line of mer-
cury is at or below 900.   Then place the bulb under the tongue, in the
armpit, or in the vagina or rectum.  In infants and children, the  rectum
will give the most  reliable results, for children are apt to break or drop
the instrument  when in the mouth, or fail to keep  the arm folded firmly
across the chest, when in the  axilla..  The armpit  should be wiped  dry
before introducing  the thermometer.  The thermometer  should be left
in place  three minutes.   It is to be borne in mind by nervous and anx-
ious  mothers, that the temperature of their little ones, when  ill, sometimes
rises out of  all proportion to the gravity of the disease.   It may be well
to remark here that the pulse % in infancy and childhood is  very different
from that of adult life.   "The pulse varies from no to 150 consistently
with health; it may be  irregular  consistently with health.  It is rather
quicker in the female  than the  male after seven years; it is  somewhat
slower during sleep.  A very slow  pulse is an indication of cerebral
(brain) disease.

                    Table of the Pulse (Mtiller). §
     At birth........130 to 140  3d year........  90 to 100
     1st year.........115 to 130  7th   "  .........  85 to  90
     2d   "    ........100 to 115  14th "  .........  80 to  85

   * So wonderful a  piece of mechanism  is man, that at  all seasons of the year,
and in all countries, the very  hot and the very cold, the temperature of  the body  in
health is always at about 980.
   t Edward Ellis.  Diseases of Children. New York : 1879.  P.  3.
   X The  pulse (from pello, pidsum, to drive, to beat, or strike) is not a  peculiar
something that is found at the wrist only, as some suppose, but is nothing but the
beating or pulsation of any artery ;  that at the wrist being  usually chosen because it
is superficial and easy of access.
   § Ellis, op. cit., p. 4. 
THE PATIENT AND HIS SURROUNDINGS.
23
    As soon as taken, the temperature should be recorded, for these little
matters  slip the  mind.  The temperature is usually taken by  the  phy-
sician, twice a day, morning and night.   When  necessary,  however,
it may be taken  by the nurse, at noon also, and  during the night if
the patient is  awake.   Aside from their immediate  value to  the  phy-
sician, these records may prove of the utmost importance  in the study
and advancement of medical science.
    The physician's orders, when many, should be taken down in writing
and should always be followed exactly, whether the  nurse understands
their reason why,  or not.  This is imperative.   The nurse should  keep
a record of all the  prominent symptoms occurring between  the physi-
cian's visits.  A sample of the urine should be saved in a clean two or
four ounce bottle  for his inspection, and the nurse should determine  its
reaction just after it is passed.   This is of more importance in some dis-
eases than in others;  as for instance, rheumatism and inflammation of
the bladder.  Ten cents worth of litmus paper, red and blue, should  be
had from the drug store, cut into  strips y^ in. wide by i^ inches  long
and placed in separate, well-stoppered, wide-mouthed bottles.  These
bottles are to  be  kept securely corked.  A piece of the blue  paper is
to be immersed half way in the urine for a moment, and if the urine be
acid  the paper will be turned  red.   If  the blue  color remains un-
changed a piece of the red paper may be immersed in the same manner,
when, if the fluid be alkaline, the red  will be changed to  blue.   If  no
change is produced in either paper, the urine is  neutral.   These  test-
papers should be saved for the physician's inspection.  A four inch  glass
test-tube  should  be on hand in  case the doctor wishes to  boil any of
the fluid; also a small phial of nitric acid.
    The  discharge from the bowels, in  case  there  is  anything unusual
about it, should be set aside, well covered, in a neighboring room, subject
to the doctor's inspection.   If not saved,  the  prominent points should
be noted—viz., quantity, consistence, number  of passages, color, odor,
whether  containing blood or  mucus,  and  whether these  latter  coat
or streak the stool, or are intimately mixed with it.   In contagious*  or

    * '-In this connection the terms infection and contagion may be defined.  These
terms have been and  still are used without much precision as regards the relative sig-
nification  of each. They are often used as synonyms.  The definitions of different
writers do not agree.  It is not easy to settle upon definitions which are in every re-
spect satisfactory.  The term contagion, in its etymology, implies communication of a
disease by contact. If,  however, the  sense of the term be extended by considering
that the contact may be immediate or mediate, it may embrace all modes of communica-
bility, including emanations, the medium of contact,  in the latter, being  the atmos- 
24                        THE  SICK ROOM.
infectious diseases, the stool should be passed into a chamber containing
some disinfecting fluid.   It should be remembered that the active poison
of typhoid fever rests mainly  in  the alvine discharges.  These should,
consequently, be thoroughly disinfected before being thrown out.  In-
deed it is best to pursue this plan in all cases.  The small earth closets,
such as those made by the Bloomfield Co., are especially convenient for
the sick-room.  Dry  disinfectants can  be used in the hopper, and the
pan emptied after each stool.  They have the further advantage of ob-
viating the strained and uncomfortable  position necessary  in  using the
chamber.  This applies, of course, only to those patients who are strong
enough to rise from bed, and to convalescents  who are  too  weak to
reach the water closet in  city houses, or fear exposure to cold in country
privies.  The author's views on the subject of privies in country towns
may be found in  the Public Health, for July 12th, 1879. t
    In case  of acute  disease where the nursing is likely to  be prolonged
for  many weeks, the nurse who  has charge  during the day, should be
relieved  in  the evening,  in order that she may be enabled to take the
air, and sleep.  It is  poor policy to overwork a nurse, or  allow her to
overwork herself, however willing she may be, for in a few days  she be-
comes tired and jaded and is able to do her work  but poorly.   Let one
in the family do all the day nursing and another all the night  nursing
for a week, and then change about.   Both, in that way, get their required
amount of sleep and bring fresh bodies, bright faces and clear heads to
their task.   A tired nurse, aside  from doing  her  work  imperfectly, is a
positive source of irritation to a patient.
    When the stage of convalescence has been reached, or if the disease
be not acute, the patient's mind may be pleasantly occupied,  and his
thoughts taken away  from his surroundings  and  suffering, by the occa-
sional reading of a pleasant story or magazine article.   Children are es-
pecially fond of fairy tales, and so many really excellent ones are  to be

phere.  If it be desirable to give a precise definition to each term., contagion may be
restricted to the communication of a disease by means of a virus contained in a palpa-
ble morbid product, viz., serum, lymph, pus,  or solid matter.   On the other hand,
infection may be used to denote communication by means  of an inappreciable emana-
tion or miasm.  With this use of the  terms, some diseases are propagated by con-
tagion alone—for example, syphilis; some by both contagion and infection—for ex-
ample, small pox; and others by infection alone—for example, pertussis or  whooping
cough.  It is, however, customary and convenient to treat of the diseases  which are
diffused exclusively by infection (scarlatina, typhus fever, etc.) as contagious diseases.
Moreover, the term infection is often applied to miasms which do not contain a virus."__
Flint  Practice of Medicine.  Phila.:  1873. P. 97.
    f Privies and Water Contamination in Country Towns. 
THE PATIENT AND HIS SURROUNDINGS.
25
obtained that it is well to gratify this taste.  A mind pleasantly occu-
pied and entertained will carry the body a  long stride  towards health.
The influence of mind over matter will bear  even closer study than it
has had.
    Patients who lie for a length of time upon the back always have more
or less congestion of the posterior portion of the lungs.   It is well, there-
fore, to  insist on their sitting up several times a day, for a few minutes,
and taking  a number of full, deep inspirations.   A rope hanging from
a staple in  the wall, with a  cross piece at  the  lower  end, facilitates
this  rising and also  turning in  bed.   This congestion  is termed hypo-
static, and means the settling of blood in a part from gravitation alone.
    In case  the person is allowed to get up on the chamber, or sit in a
chair by the window, it  is well to draw on a good pair of warm, woolen
stockings that shall reach to the knees.   Colds  are usually caught dur-
ing convalescence by exposure of the feet and legs.  These parts of the
body are farthest  from the centre  of  circulation—the heart—and when
heart power is decidedly lessened,  they are  especially susceptible to
variations of temperature.
    Thirst is a very prominent and annoying symptom of fever, and one
that requires a little consideration.  Plain water, when taken beyond a
certain amount, is very apt to disorder the stomach and bowels, especially
in fevers where much fluid and but little solid food is taken.  Enough
water to quench the  thirst would certainly be enough in most cases to
disorder digestion, or rather, further disorder it, and so important is the
little that  remains of this  function that we cannot afford to  abuse it.
Small pieces of ice held in the mouth, and allowed to dissolve, sometimes
answer  the  purpose, but not in  the majority of cases.  Up  to a certain
point, the action of  water taken internally, in fevers, is excellent; aside
from allaying irritation  by quenching thirst, it flushes the kidneys, car-
rying off much  of the effete material produced by the high tempera-
ture.  It  has been  found that  the addition  of certain substances to
water greatly increases its powers to quench thirst. This  is especially the
case with acids.   One drachm of hydrochloric acid added to a quart of.
water will give it  sufficient acidity to accomplish  the desired  purpose,
while at the same time, it adds  to its pleasantness, and sometimes relieves
nausea.   The use  of acids  in  fevers is highly commended by some
authors, and this is,  I  think, the best  way  in which  to   administer
them.   The same amount of sulphurous acid may be added to a quart
of water when the bowels are loose or there is  a tendency that way.   In
these cases  acidulated  barley water is pleasant and nourishing.  The
same may be said of toast water.   In constipation, oatmeal water may be 
26
THE SICK ROOM.
used in the same manner.   A few  tamarinds added  to a glass of water
will often assuage thirst and open the bowels gently.
    Ringer,* speaking  on this  subject, says:  " Although, perhaps, not
strictly relevant to our present subject, a few remarks may be made here
conveniently on  the  drinks best suited to  fever  patients.   To them,
thirst is most important and distressing, often causing much restlessness
and irritability, these in  their turn often increasing the fever.  The urgent
thirst must therefore be allayed, but if left to themselves to satiate their
craving, patients  will always drink to excess, which is very liable to  dis-
arrange  the  stomach,  impair  digestion, produce  flatulence  and  even
diarrhoea.  Theory and experience both show that drinks, made slightly
bitter and somewhat acid, slake thirst most effectually. A weak infusion
of cascarilla or orange peel, acidulated slightly with  hydrochloric acid,
was, with Graves, of Dublin, a favorite thirst-allaying drink for fever pa-
tients.   Raspberry vinegar is a useful drink.   Sucking ice is very grate-
ful.  Sweet fruits, although at  first agreeable  and refreshing, must be
taken with care and  moderation, for they often give rise to a  disagreea-
ble taste, and are apt to produce flatulence and diarrhoea."
    I have not found the  Graves' mixture  so agreeable to patients as I
was led to believe I should from its  hearty  commendations by many
medical men.   Flint t makes a  very good suggestion, as follows :  " The
patient may be allowed to take into  the mouth small pieces of ice, al-
most ad libitum, and for young children, a convenient plan is to confine
pieces of ice in a gauze bag, which  may be held in  the mouth."
    During acute  disease  and convalescence, care should be taken to
keep the  room free from visitors,  especially strangers.  The effort re-
quired to converse is very wearying to the patient, and the sympathetic
looks of friends and strangers are often annoying.
    " Visitors  ' with faces twenty-six  inches long,' as one has quaintly ex-
pressed it, should forever  be excluded.  Such, ever  predicting  evil,  re-
lating cases known to  them, which of course proved fatal,  with sad-
dened visage, morose  and peevish, constitute  continued  pestilence, a
moral sirocco, a pestilential miasm, and should  be as carefully forbidden
entrance as the small pox patient.  Such domestic lepers may have their
uses, but certainly are not needed in the sick  room; and yet they will
thrust themselves  upon  the sick if allowed to  do  so, since  in  the sick
room they can find room for their morbid appetites ;  they  seek it as the
vulture scents the carrion.   On the contrary, the genial, hopeful, amia-

        * Ringer.  Handbook of Therapeutics.  New York: 1875.  P.  2.
        t Flint.  Practice of Medicine.  Phila.: 1873.   P. 990. 
            THE  PATIENT AND HIS SURROUNDINGS.          27

ble, the true friend who will sit by the bedside with a sunny face, asking
no questions, making no  conversation that demands  answers, holding
the hand of a friend and soothing the  sick one, may be admitted at al-
most any time.  Such can cheer, animate, encourage, and really sustain,
and may be of great service to the sick."*
    In  the  case of contagious or infectious  disease,  the  greatest care
should be taken to establish and maintain isolation.   The patient should
be put in a large,  airy room, as far  distant from the sleeping-rooms of
the other members of the family as is possible.  Those  in attendance on
the person so  affected, should,  when obtainable, have a room near to or
next that of the patient, and there eat and  sleep.   Daily exercise in the
open air should be taken by the nurse or nurses.  All dejections should
be passed into disinfecting fluid, and the clothes and bedding be washed
in the same, separate from those of the rest  of the family. Dishes of dis-
infecting fluid should be  set  about  the  room and  in the hall-ways.
I give here the report of  the commission  of experts  appointed by the
National Board of Health to prepare a circular embodying judicious in-
structions for  disinfection : " Disinfection is  the destruction of the poisons
of infectious or contagious diseases.   The disinfectants to be used are :—
First, roll sulphur, for fumigation; second, sulphate  of iron (copperas),
dissolved in water in the  proportion of 1^  pounds to the gallon, for
soil, sewers, ccc.;  third, sulphate of  zinc  and common salt,  dissolved
together in water, in the proportion  of four ounces of  salt to the gallon
for clothing and bed linen.  In using disinfectants in  the sick room the
most available agents  are fresh air and cleanliness. The towels, clothing
and bed linen should,  on removal from the patient  and before they  are
taken from the room, be placed in a pail of the  zinc solution, boiling hot
if possible.  All discharges should either be received in vessels contain-
ing copperas solution, or should be immediately covered with copperas
solution.   Fumigation with sulphur is the only  practicable  method of
disinfecting the house.  For. this  purpose  the  rooms  must  be vacated.
Heavy clothing, blankets,  bedding and other articles  which cannot be
treated with zinc solutions should be opened  and exposed during fumi-
gation.  Close the room as tightly as possible, place the sulphur in iron
pans  supported on bricks contained in tubs  containing a  little water.
Set it on fire and allow the room to  remain closed for twenty-four hours.
For a room about ten feet square at least two pounds of sulphur should
be used.  Cellars, yards, stables, gutters, privies, cesspools, water-closets,
drains  and sewers should  be treated with copperas solution.   It is best
to burn articles which have come in contact with  sick persons."
* Good Words, July, 1856. 
CHAPTER  II.
             THE DUTIES OF THE SICK ROOM.

     THERE are many things to be done in a sick-room, the proper and
     easy performance of which adds much to the patient's comfort, and
hastens his convalescence.  A bungling or ignorant nurse does positive
injury continually.  The present chapter is devoted entirely to a descrip-
tion of the various  agents employed, and the method of preparing and
applying them, with a few, necessarily limited, remarks on  the rationale
of their action.

                             BATHS.

   General Remarks.—When fully understood, the uses to which water,
in the form of baths, may be put in the treatment of disease,  are as
valuable as they are various.  I say when fully understood for the reason
that the majority of people do not have correct ideas upon this subject.
Knowledge  is important, and ignorance dangerous, from  the fact that
while a very valuable means of curing disease  and alleviating suffering,
baths are quite as powerful agents for evil, when used at improper times or
in unsuitable cases.  The  effects  of a bath, especially  in  disease, vary
greatly with the temperature of the bath, the  amount of fluid  used, the
time at which it is  given, the time occupied  in its administration, and
whether  the whole or only a part of the body is immersed.   AVhen a
clear idea of the principles  involved is had, various modifications may
be made to suit special cases and  conditions.   The following  classifica-
tion  presents, as fully as is' possible to present in  any classification, the
main actions of the various forms of baths.  It is to be borne in mind, of
course, that a bath will vary in its effect  according to  duration.  For
example—a momentary shower  bath is stimulant, a  prolonged one
sedative. 
THE  DUTIES OF THE SICK ROOM.
29
                                          (/ Relaxant.
                                            Revulsant.*
          General Hot Bath............{ Eliminative.
                                            Sedative.
                                          (_ Stimulant.
                                          C Eliminative.
          Vapor Bath..................) Relaxant.
                                          ( Revulsant.
                                          ( Stimulant.
          General Cold Bath ...........) Anti-febrile.
                                          ( Sedative.
          Shower Bath and Douche......j Stimulant.
                                          ( Sedative.
                                          C Anti-febrile.
          Tepid and Cold Sponge Bath... 1 Soothing.
                                          ( Cleansing.
                                          ( Local Tonic-.
          Hot and Cold Hip or Sitz Bath.. ) Local Relaxant.
                                          ( Revulsant.
                                          C Revulsant.
          Hot Foot  Bath  ..............) Eliminative.
                                          ( Stimulant.
                                          C Soothing.
          The Pack...................j Eliminative.
                                          r Anti-febrile.
          The Electric Bath............  Stimulant.

    The General Hot  Bath.—By this  is understood  the immersion
of the body in water having a temperature of from 900 to  1150 F.   At
900 the bath is moderately warm;  from ioo° to 1150 very hot.   As
we have seen, the general hot bath has five actions—revulsive,  elimina-
tive, relaxant, sedative and stimulant;  it is, furthermore, the most perfect
type of the first three; less so of the last.   For this reason we shall say a
few words regarding its mode of action.  Except in cases of momentary
immersion, the hot bath is weakening to the sick.  Its first action is to raise
the temperature, slightly increase the force and  frequency  of the pulse,
and relax the skin and dilate  its vessels.   The  sensation of fullness of
the head and the flushing of the face give way as soon as free  perspira-
tion commences; if this does  not  appear promptly, it may be  excited
by drinking a cup of warm tea, or a glass of water.  If a relaxant effect
is desired, the patient  may be allowed to remain in the bath for twenty

    *  By a revulsant bath is here meant one that acts to draw blood away from the seat of
threatened or existing disease.
    We shall for convenience, discuss each bath separately, not following the order
above given. 
3°
THE SICK ROOM.
minutes or half an  hour,  even longer if required.   If the person be
very weak, it is better to make use of other means for producing relaxa-
tion than to risk the debilitating effects of the prolonged hot bath. When
the patient is robust, as a strong, apparently healthy child suffering with
convulsions, this bath is a very useful  agent;  the good it does far out-
balancing the evil, and there being little or no risk attending its use.  In
acute illness, the general hot bath is rarely used, the patient being too
weak to be moved, and the desired result being  better accomplished by
other means—as the pack, the sponge bath, vapor bath, etc.  Allowances
being made for differences in temperature, to obtain  the different effects
of the hot bath, the following time should be calculated on: stimulant,
five or six minutes;  revulsive, six to ten; eliminative,  the same; relax-
ant and sedative, from  ten to thirty.   It must be understood that revul-
sion and elimination usually go together, at least the revulsion produced
by the hot bath.   After a person's exposure to cold or wet,  when  there
are distinct chills  or chilly sensations, with a tendency to congestion of
some of the  internal organs, more commonly the lungs, the  general hot
bath or the hot foot-bath, by restoring the equilibrium of the circulation,
thus freeing the congested parts of their excess of blood, often prevents
an impending  attack of pneumonia, bronchitis or  pleurisy.  The first
stage of, or rather the first departure from healthy condition  in almost
every disease being congestion, if we can dissipate congestion we can
usually ward off the disease.  In medicine  there are recognized two
principal forms of congestion—active and passive.  In  active congestion
(acute hyperemia) the excess of blood in a part is due to an unusually
rapid carrying of it there by the arteries; in passive congestion the excess
is due to a failure  of the veins to remove the blood, there being usually
no marked excess  of blood carried to the part.   It is this active  conges-
tion that usually forms the first stage of all acute diseases, and in which
revulsant  baths are  especially  efficacious.   It is thus  that these  baths
often " break up a cold " and prevent  it from " settling on the lungs."
The good resulting from the free perspiration in such cases is not due to
the  elimination of any poisonous material by the skin, but to the fact
that free action of the skin cannot take place without the  presence of
an unusual amount of blood  in it.   Thus, while the  first effect of the
bath (revulsive) is to  draw  the  excess of  blood from the threatened
organ, its second effect, free perspiration, when  promoted by warmth in
bed and warm drinks, is to keep the excess of blood,  that would other-
wise  congest the  threatened organ, actively employed in the skin.   It
should, therefore, be borne in mind that, to obtain the best effect  in these
cases, a good sweating should follow the bath.   For these purposes the 
THE DUTIES  OF THE SICK ROOM.
31
hot foot-bath  is usually better than the general hot bath.   There are
some diseases where the beneficial effects of the sweating are due solely
or chiefly to the elimination of certain morbid materials from the blood.
This is the case in rheumatism and acute and chronic disease of the
kidneys;  in these  affections, however, the vapor bath is to be preferred.

    The  Hot Foot-Bath.—This very valuable agent is  well  known
and extensively used in domestic practice.  In  almost  all  cases it is to
be preferred to the general hot bath.  Its  action is to draw  blood to the
feet and legs, equalize the circulation and  cause a free perspiration.  It
is to be taken as follows:
    A foot tub or scrubbing-pail is to be two-thirds filled with water as
warm as the person  can bear it.  To  this may be added a handful of
salt and two tablespoonfuls of mustard.  Foot-baths  taken in a wash-
bowl are, at  best, poor things, as well as  untidy, there being danger of
upsetting the  bowl.  The legs should be immersed nearly to the knees,
and be allowed to remain for a period varying from fifteen to thirty
minutes, the person  being meanwhile  well wrapped in a heavy blanket
or quilt.  He should always be in his  night clothes, so that when the
bath is over, he may be put to bed without delay.  He is then to be warmly
covered and left to perspire freely. The following morning he is to be
rapidly sponged off with warm water and  bay-rum or whiskey.   This is
quite as necessary as the bath  itself, for  his body is covered with the
results of his heavy sweat. The bed linen should be completely changed,
having been previously well warmed and  aired.
    In cases where there  is not a proper amount of blood  in the pelvis
of the female  to perform the normal monthly function, or in sudden re-
pression, usually due to exposure to cold, the hot foot-bath sometimes
proves  effective.    For  this  purpose, however,  the  hot  hip-bath is
to be  preferred.   In  cases   of  cholera  infantum,  dysentery,  or the
diarrhoea  of children, these baths often produce  the happiest  results,
checking  the  alvine  discharge, restoring warmth to the surface, and re-
lieving the troublesome  head symptoms, so often present. In congestion
and inflammation of the brain, the foot-bath may be employed to great
advantage, cold being at the same time applied to the head.  The  mus-
tard and  salt  which  are usually added to the  foot-bath act as  gentle
stimulants to  the  cutaneous surface of the legs,  are  possibly slightly
irritant, thus increasing the amount of blood in the parts, and at. the
same time accelerating its movement.
   The cold foot-bath should never be used in the sick-room.  In cases of
feet id and perspiring feet, it is often of great service.   A cold foot-bath 
»2                       THE SICK ROOM.

at night, followed by brisk rubbing with a coarse towel until the feet are
in a glow, does away with that troublesome affection, cold feet.
   The  Hip or Sitz Bath may be used either hot or cold.   Above
9o°, it acts as a relaxant and soother; below 6o°, as a direct tonic to the
contents  of  the  pelvis.   It  may  be  taken  in a  small  wash-tub.
Tubs  are, however,  made for that purpose.   In the warm bath, the
water should be as hot as can be borne, the patient should be put into it
carefully, with the legs and body well covered, and be allowed to remain
there  about  fifteen, but seldom over thirty or thirty-five minutes.  The
exceptions to this are cases such as retention of urine and the passage of
kidney  stones, when it acts as  an allayer  of pain  and spasm, and
may  be continued for a much  longer period.   As a general thing
hot water alone is to be used.   If the direct action  on the contents
of the pelvis only is desired, the patient should be dressed at once and
be allowed to sit or walk around.  If put to bed, the sweating is accom-
panied by an increase of blood in the skin, which takes from the pelvis
the blood that the bath has just drawn to it.
    The cold hip-bath is a decided local tonic.   It is to be followed  by
some exercise, or if the patient be too weak, by a brisk  rubbing.   It is
of service in relaxation of the rectum, paralysis of the bladder and like
affections.  Also in young girls whose menstruation is delayed or irregu-
lar ;  here the  cold  should be followed  by the hot sitz-bath.   These
combined baths should be  given about  once a week, and be followed
by brisk rubbing and exercise.
    If it is desired to continue the action  of the hot  hip-bath after the
person  leaves it, a good sized  hop and chamomile poultice (see p. 41)
may be  laid over the lower part of the  abdomen, and kept there for
several hoars.

    The Sponge Bath may be taken hot  or cold, and is a modification
of the general hot or  cold bath. In action it is cleansing  and stimulating,
cooling and occasionally eliminative.   It is suited to cases of acute dis-
ease, where the sick person  is too weak to be raised and put into a tub.
These  spongings are especially  grateful  to fever  patients,   acting
directly to lower the temperature of the  body, soothe  restlessness, and
induce a pleasant, refreshing sleep.   Aside from its cleansing action on
the skin, and its soothing and anti-febrile  power, just spoken of, it has  a
decided tonic action.  There must, however,  be  strength enough to
allow of reaction, and for  this  reason very weak patients  should be
sponged with warm water only.   The cold sponging has almost a specie
fie curative effect on the night crowing of infants. 
THE DUTIES OF THE SICK ROOM.              53
   To a basin of hot, lukewarm or cold water, as the case may require,
there should be added one tablespoonful of mustard, two of salt, and six
of whiskey or bay-rum.   These incite the skin to action, and  the liquor
by evaporating  cools the surface gently, thus  reducing the temperature.
Camphor,  dilute  acetic  acid  and other substances  may  be added for
various purposes (see p. 17.)   If it is not  desired to  produce sweating,
only  the water and whiskey need be used.  If free perspiration be de-
sired, the  three ingredients above mentioned should be used, and the
person  well covered with bedclothes  after the body has been briskly
rubbed.   Fever always  carries the temperature of the body above what
is known  as " the  sweating  point."  and the whiskey and water, by re-
ducing  the fever, tend  to restore this  valuable function.  Hot  tea or
a glass  of water will sometimes start the perspiration.
    As a rule, but one part should be sponged  at a time, a soft rag or
sponge being  used, and the  part rapidly dried.   In the  eruptive fevers
(scarlatina, measles, etc.) the  part should be dried by mopping, the skin
being too tender to allow of rubbing.

    The General Cold Bath.—This  is  the type of all the  stimulant
baths, and like them all, must not be prolonged, and reaction must be
secured or harm will result.   The general cold bath is too severe a  mea-
sure  to be used  in  acute  illness or  convalescence  from  it, unless
under the direct supervision of the  attending  physician.  These baths
have been used extensively in Germany and England, for the purpose of
reducing  high temperature, and with very good results.   They have not
been much tried in America, and should not be undertaken by any one
but a competent physician.   Stimulant when brief and followed by free
reaction, they are markedly sedative when prolonged, even to healthy
persons.   In acute illness, where decided and continued  reduction of
temperature is  not aimed at, some of the other baths in this class are to
be preferred;  as the sponge bath and cold pack.
    This bath  should always be followed by brisk  rubbing.  Mustard
may be put in either the hot  or cold bath, if needed.  The head should
be wet with cold  water before  going  into either.   In  giving nervous
children a cold bath, put their feet in  a tub of hot  water, wet the head,
and  then  sponge  the  body with cool water.  After this they may be
put  directly in the  tub  for two  or three minutes, if  necessary, and  when
removed, be well rubbed and warmly covered or dressed.
    Medicated  baths, hot or cold, looking to the absorption  of any of
the drug used,  are valueless.   That no such absorption  takes place has
been settled beyond question.    Medicated baths are sometimes of ser-
vice in skin diseases. 
34
THE SICK ROOM.
    No instructions as to  how hot  and cold baths are to be taken are
 necessary, as every one is familiar with their modus operandi.

    Seasalt  Baths.—During  convalescence  from  many  weakening
 diseases, these baths are of very decided benefit, giving strength to the
 patient, and tone to the skin and muscles.  The appetite and digestion
 are also improved by it.  Whether in health or disease, the proper time
 for taking a bath is about three hours after breakfast, dinner being so
 arranged as not to take place under two hours after the bath.  In weakly
 persons a little rum and sugar may be taken just after the bath.
    Seasalt is  an admirable  preparation.  It may be used in the propor-
 tion of two tablespoonfuls to the gallon.  Two  elements  of the  natural
 sea-bath are,  of course, lacking—the sea air  and the  motion of the
 waves.   Nevertheless the substitute is a most excellent restorative mea-
 sure.  When able the patient should take a very little exercise after it.
 The skin should be rubbed until there is a good hearty glow upon it.

    The Douche.—The Shower Bath.
    These are really the same in principle, the difference being only  one
 of degree. The  douche is a most powerful agent, and should be used
 only in cases of poisoning by opium and chronic  alcoholism.   The per-
 son so suffering  should be stripped and the water poured on his head
 and body from  a height of five or ten  feet  until  he  revives.  The
 pulse and respiration must be watched with great care meanwhile, as this
 is a powerful  agent and one likely to do harm in ignorant or careless
 hands.   Dashing water in the  face is a modification  of the  douche, is
 harmless, and  specially efficacious in fainting spells,  hysterical attacks,
 and the " night-crowing" of infants.   The colder the water,  the better
 the effect.
    It must be remembered,  in using the douche in alcoholism and poi-
 soning by narcotics, that it is only an adjunct to other treatment.  Where
 opium or other poison has been  taken  accidentally or intentionally an
 emetic  should be given, and the doctor sent for at once.   Mustard is
 the best emetic in these cases, and has the advantage of being in every
 household.  A heaping dessert-spoonful should be stirred into a pint of
 warm  water, of which the  patient is to drink as much as possible.  If
vomiting does not result, another  dose may be  given in ten minutes.
 Ipecac  is slower in action  and  depressant.   To adults, the syrup or
wine  of ipecac may be given in two  table-spoonful doses; the fluid
extract in forty drop doses.
   The douche  should, furthermore, be only used, if used at  all by lay- 
THE DUTIES  OF THE SICK ROOM.
35
men, in extreme cases, and until the arrival of a physician, who will know
at once what is best.
   The shower-bath, though not so powerful, is still a very strong agent,
and except in cases where the douche is useful, should never be used in
illness; other baths, as the cold sponge-bath, are equally efficacious and
more readily rallied from by convalescents, than this.
   We, every now  and then, hear of cases where persons are poisoned
by mistake, the wrong  medicine  being given.  Every bottle containing
medicine in any way poisonous, should be put in a bottle or box, in some
way peculiar, so that when a person puts their  hand on it, day or night,
they know by the  touch  alone, the character of its contents.   Such bot-
tles can be had by  druggists, but they are not generally used by them.
    Nervous and gastric headache, and pain  in the head in fever cases,
are often  greatly relieved, sometimes cured, by pouring cold water on
the head  for some minutes.  The head should hang over a bowl  or
basin,  so that the bed shall not be wetted.

    The  Cold Pack.—The Hot Pack.
    These are very valuable means for reducing fever and producing free
sweating.    They, further, have a soothing effect on an irritated nervous
system.   The  latter  is  less  apt to  produce shock, though  this  is
always slight.   It  should, therefore, be preferred  for very  weak pa-
tients.   The plan  of  giving is as follows:  The windows and doors of
the room must be closed, the bedclothes removed, and the patient laid
on  two heavy blankets, evenly  spread out.   A sheet is then rapidly
wrung out of hot  or  cold water and laid upon the blanket ;  a sheet
though wrung  out of warm water is usually  cool  or  cold before the
patient reaches it.   This is of no consequence,  as he very soon becomes
warm from the blankets in which he is wrapped.   Indeed, the coolness
of the sheet is of advantage, being slightly stimulant and never hurtful.
The sheet should be brought up from one  side and snugly tucked in on
the opposite, from  the neck to below the  feet.   The  other  side of the
sheet is to be treated in the same way, as also the blankets, one after
the other.   When  completely enveloped,  the feet are to be raised and
the blanket  and sheet turned under them.   In  this, he may be left from
thirty minutes to two  hours.   We have seen  patients  thus enveloped
sink into a natural,  refreshing sleep, the first in several days.  The sheet
should be wrung  out  as dry as possible before being applied.  When
the degree of perspiration desired has been reached, the blankets and
sheet are removed  and the patient is rapidly  sponged off with lukewarm
water,  dried, and well  covered in bed.  If the patient is able to react 
36                       THE SICK ROOM.

well  from it, a good  tonic effect is had by sponging him off with  cold
water, and then rubbing him well.   The pack is used to eliminate mor-
bid material from the system, as well as to quiet nervousness and re-
duce temperature. Wrapping a fever patient in a wet sheet, and leaving
him thus with no other covering, with the object of reducing  tempera-
ture, is never to be used save by the physician, who knows when it can
be borne.
   Parts of the  body may be  packed in the same manner.  This will
often allay the severe pain of gout and rheumatism.   Compresses are
really only local  or minor  packs.   Hot compresses to the  abdomen are
often of  service in cholera infantum, colic and dysentery.   Cold com-
presses to the neck are of service in croup, inflammation of the  throat,
whether  simple or occurring in the course of the eruptive fevers, as  scar-
latina.
   Speaking of producing perspiration by means of the pack, Dr.  Rin-
ger* says: " There can be no question of the  superiority  of this treat-
ment over that of swathing the patient in flannel  clothes,  and covering
him  with blankets to make him sweat.  To avoid the supposed  danger
of catching cold, these woollen clothes are worn day after day, till  satu-
rated with putrefying perspiration, the stench sickens and deappetizes
the patient, and a crop of irritating miliary vesicles is engendered, which
breaks the patient's sleep."
   And  again : " This treatment is useful in specific fevers and acute in-
flammatory diseases.   It  has long been employed in  scarlet  fever, and
should be used  from the beginning and  throughout its  course.    In
moderate attacks it is sufficient to pack the patient for from thirty to fifty
minutes; but if the fever is very high—if the rash comes out slowly, im-
perfectly, and is of a dull color—if the patient is restless and wanders, the
packing  must be continued an hour or longer, and be repeated three or
four times a day. This treatment develops the rash, greatly reduces the
fever, quiets  the pulse, renders the  skin moist  and comfortable, and
abates the restlessness and  wandering.
    " On suppression or recession of the  rash, when serious symptoms
arise, the packing is  especially indicated." t

    Vapor Bath.—This bath is often of the greatest service.   It is used
chiefly to produce free perspiration, when it is desired to rid the blood
of some morbid  material.  This  is especially the case  in  acute  and
* Op. cit. p. 34.
t Op. cit., p. 33. 
               THE  DUTIES OF  THE SICK ROOM.              37

chronic Bright's disease and rheumatism.  Vapor-bath utensils are to be
had  at any  instrument maker's.    In case there  is no  time to send
for these,  arrange a  standard on  the  gas bracket, so as to hold  a
large-sized coffee-pot, or  make some arrangement whereby water can
be rapidly heated near the bed.   Fill the pot half full  of water,  hot, if
at hand, and fixing a rubber tube over the end of the spout, conduct it
under the  bedclothes,  which should  be somewhat raised by half  barrel-
hoops.  In this way the steam generated in the kettle will pass directly
to the patient's skin.   Care must be had that he  is not burned by it.

                              Fig. 7.
CROUP KETTLE.
This same apparatus may be used in croup.  In this case a tent of sheets
should close him  in completely.   He is thus breathing steam, without
being burnt.   (Fig. 7.)  When the patient is able to get up, he may be
stripped, placed in a chair, closely enveloped in blankets, and the vapor
be produced by a tin  kettle or pan, heated by a spirit-lamp  beneath the
chair.  This is a very effective manner in which to give this bath.   The
same proceedings may be taken where a mercurial or sulphur bath  is to
be given, great care being  taken  to  have the blanket  tight about the
neck, to  prevent the fumes from  being inhaled.  The substance to be 
38                      THE SICK ROOM.

vaporized is to be placed on a metal plate, over a spirit-lamp, beneath
the chair.

                TEMPERATURE OF VAPOR, Fahr. *
                               breathed.       not breathed.
       Tepid Vapor Bath....... 90   ioo°         960   1060
       Warm   "     "  .......100   no         106    120
       Hot     "     "  .......no   130         120    160

   A hot-air bath,  usually less effective  than the  vapor bath, may be
given by driving hot  air beneath the bedclothes, or producing it by a
lamp under a chair in the manner described  (Fig. 8).

                              Fk. 8.
                       hot-air bath apparatus.

   Dr. Nevin's plan of giving a rheumatic patient a pleasant acid steam
bath, is given as follows, by Dr. Ringer: f
   " A couple of common red bricks are  to be  placed in an oven hot
enough for bread, and in half an hour, or little more, they are sufficient-
ly heated for the purpose.   The patient's body-linen having been previ-
ously  removed, these two bricks  are to be folded up in a piece of com-
mon thick flannel, thoroughly soaked in vinegar, and laid  on two
* Cooley's Cyclopedia of Practical Receipts.
t Op. cit., p. 31.
London, 1864.  Article, Baths. 
THE DUTIES  OF THE SICK ROOM.
39
plates.   The one is to be placed about a foot distant from the shoulder,
and the other  about equally distant from the opposite leg, and the bed-
clothes are then to cover the bricks and  the patient closely round the
neck.  A most refreshing acid steam bath is thus obtained, and the sup-
ply of steam may be kept up, if necessary, by removing one brick and
replacing it by another hot one, kept in reserve.  When the patient has
been  in the bath for fifteen or twenty minutes, the bedclothes and plates
should be removed, and the palietit instantly mopped all over, very rapid-
ly, with  a  towel wrung  out of cold water, and then should be quickly
rubbed  dry.   Dry, warm linen must be put on at -once, and dry bed-
clothes must replace those which were on the bed.   *     *     *     *
The  steam bath and subsequent cold douche should be continued after
the patient is able  to walk about, as they contribute to the  healthy ac-
tion of the skin, and promote free mobility of the joints."

   The Electric Bath, which acts as a general as well as cutaneous
stimulant, may be  given as follows: *
   " Place an ordinary bath  upon a sheet of mackintosh, which, being a
non-conductor of electricity, has the effect of insulating the bath, as it is
termed.  Then fill the bath  with warm water to a convenient height, and
to the water add a handful of salt or a wine-glassful of vinegar, in order
to increase its conducting  power.   Next get a galvanic battery, one
having 30 or 40 Leclanche Elements is sufficient, and place it on a chair
or on the floor beside the bath.   To each of the poles of this battery,
positive and negative, affix a suitable length (3 or 4 yards) of insulated
telegraph wire, having its extremities freed from the gutta-percha  or
other insulating material.   Place a length of stout broom-handle across
the bath, resting on its two  edges, and round the middle of this twine
the bright metal end of the  wire in connection with the positive pole of
the battery, covering  it with a piece of flannel, or wrapping it  round
with a sponge. The  bather then  gets into the bath, and gets hold of
the centre of the broom-handle, previously moistened, so that his hands
are out  of the bath.   The end of the negative wire is then placed in
the bath itself, and as this is done the bather will feel  the shock of the
electric  current.  The current in this case travels from the positive pole
of the battery  through the wire to the broom-handle, down the patient's
arms, through his body, to the water of the bath, and so to the negative
pole.  This form of bath is a very powerful stimulant to the skin, but
beyond  its action on  the skin we know nothing.   It is said that by its
aid it is  possible to  extract metallic bodies, such  as mercury  or lead,

         * Baths and Bathing.   " Health Primer."  D. Appleton & Co. 
4°
THE SICK ROOM.
which may be lurking in the body and causing harm.  Of such a power
there is no evidence whatever.   We have heard it said that at some gal-
vanic baths visitors have been shown  discolorations on the  side of the
bath  as evidence of the deposits  of mercury, etc., but this is merely a
quackish imposition, and it is well that persons should be on their guard
against it.
    " The electro-magnetic bath  is given in the same way as the galvanic
bath, an electro-magnetic body being  substituted  for the galvanic bat-
tery."
           proportions of some ingredients of  baths:
    Seasalt or common salt, 2 oz. to the quart.
    Bran Bath.  1 lb. to the gallon—boil.
    Camphor Bath. 1 oz. to the gallon; boiling water; used also in vapor
bath.
    Alkaline Bath.  Carbonate of potash, \ oz. to the gallon.
    Balsamic Bath.  Bordeaux turpentine, 1 oz. and liquid tar \ oz.  to
1 gallon.
    Glycerine Bath.  Glycerine, 1 oz., gum arabic, 2 oz., water, 1 gallon.
    Sulphur Bath.   2 oz to 1 gallon.
    Gelatine Bath.  Isinglass, \ oz. to gallon.
    While by no means having canvassed the whole subject of the exter-
nal use of water in disease, we  have said as much as space will permit,
have given some practical directions, and have, we hope, aroused enough
interest in the mind of the reader, to lead him to a careful study of the
subject.

    Poultices:—Almost every person  we meet, with any pretensions  at
all to a knowledge of domestic  medicine, has some favorite poultice  or
modification of a  poultice, which she  believes is better than any other.
Any poultice, properly made, answers  every indication.  The virtues  of
a simple poultice rest only in its retention of heat and moisture.  Of  all
the  various  substances  used, linseed-meal is  probably the  best,  its
consistence, when moistened, and its  oily nature especially fitting  it  to
remain moist and hot  for a long time.  Ground slippery elm is good.
Corn-meal, slightly browned in  a spider, is more cleanly than  linseed-
meal, and about as efficacious.    Bread and milk make a pleasant,  light
poultice.  Soap and sugar belong rather to the list of plasters; the active
principle  is the alkali  in  the  coarse,  brown soap,  which  softens the
- tissues, and the compound further aids this action by retaining the heat.
It is said to  " draw " very decidedly, and has been used on felons and
boils.   A word here about felons;  they should be laid open freely  with 
THE DUTIES  OF  THE SICK ROOM.
41
the knife, as soon as  recognized, otherwise the  affected  finger-end is
likely to be  lost.  The linseed-meal  and the elm poultices are to  be
made by pouring boiling water on the substance, and letting it simmer
for a few minutes.   It is then  to  be  spread on  a cloth, one  part
of which is folded  over it, and applied to  the  seat  of pain or disease.
The heat may be retained for an  unusually long period by covering the
outside of the poultice cloth with oil-silk.  Poultices should  be renew-
ed  as often as  they lose their  warmth.  The kettle  containing the
meal should not be allowed to remain on the fire all the time.  Just be-
fore making the new poultice the kettle should be put on the stove, a
little fresh water added, and the whole well stirred while heating.
    It is to be  borne  in mind that while poultices hasten the formation
of pus in abscesses, and the separation of the core in boils, they tend  by
their very heat and moisture to bring out a fresh crop of the latter.   In
case of severe pain, a little laudanum for adults, and paregoric for children,
may be sprinkled  on  the  surface of the poultice.  Charcoal  poultices
have been tried and found very useful applications  to  foul ulcers and
wounds.   They absorb the ichorous or foetid discharge,  and cleanse the
surface  of the wound.   Powdered  charcoal  should be put between
two layers  of moderately fine   gauze,  and this  be applied  directly
to the wound.  Charcoal  may  be  sprinkled  on  the surface of other
poultices, or be mixed with them,  in cases where there  is much sup-
puration.  A half teaspoonful of carbolic acid may be added to the pint
of any poultice material for the same purpose.   Yeast poultice, made of
the liquid yeast, has  been used in like manner.   If necessary, it may be
thickened with browned flour or corn-meal.  When it is desired to bring
the face of any poultice directly upon the affected surface, as in wounds
or ulcers, the  meal or other substance  may be spread on gauze.  The
back of it is to be protected with  cloth and oil-silk.
    Tobacco poultices are dangerous, especially when applied to the  in-
ner  surfaces  of thighs and legs, armpit  and  groin.   They  are  very
dangerous in children.
    Hop poultices, and poultices of hops and chamomile,  combine ano-
dvne with the properties of the common poultice.  They are of use in
neuralgia, sleeplessness, tooth and earache, and in painful affections of
the abdomen  in children or adults.   Retention of urine in children is
often speedily relieved by them.   They may be applied  to the abdo-
men in the colic of children, cholera  morbus, and cholera infantum.
    By adding a tablespoonful of glycerine to  each poultice, it is kept
moist, of uniform consistence, and does not adhere to the parts.
    A useful poultice is made by frying onions, chopped very  fine, in 
42
THE SICK ROOM.
pork fat.  This poultice retains, heat and moisture for a long time, and
acts also as an irritant.  The objections to it are the odor of the onions
and the soiling of the garments with the fat.
   Charcoal Poultice (Ph. L.).—Soak  bread, 2 oz., in  boiling water, y'2
pint;  to this  add, by degrees, of linseed-meal,  10 drachms, and  after-
wards of powdered (recently burned) charcoal, 2 drs.; lastly, sprinkle on
the surface of the poultice powd. charcoal, 1 dr.
   Poultice of Yeast (Ph. L.).—Beer yeast and water, at  ioo°  F., of
each 5 fl. oz.;  stir in flour 1 lb., and place it near the fire until it rises.
   Tobacco Poultice.—A pint of boiling water is to be poured upon ten
cents worth of fine cut (chewing) tobacco, and linseed-meal stirred in
until a proper consistence is reached.

   Plasters are of various kinds,  each kind having its special work to
accomplish.  They may be conveniently classified  as :
   1. Irritant.   2.  Anodyne.  3. Protective.  4. Mechanical.
   Chief among  the irritant or counter-irritant class stands the mustard
plaster.  It may be made to vary in strength by diluting with flour.  The
delicate skin of children can seldom bear more than one part of mustard
to four of flour; and the weaker plasters, though not producing so  rapid
an effect, act better by acting  during a longer period.  The " strength"
of a mustard plaster, that is to say, its power to redden and blister the
skin, is much increased by making with vinegar, or part vinegar, instead
of with pure water.   That mustard plasters made with  white of egg will
not blister, however long they  remain on, is a popular fiction.  The
mustard  papers sold  in the drug stores are very  convenient, requiring
only to be dipped in water before being used.  They can be cut of any
size and  shape, and be made to fit a part accurately and evenly.  The
common plaster  is made by  spreading mustard,  previously moistened
with water, upon  a thin cloth, and then turning the  cloth upon itself.  It
is to be placed with its face upon the  part to be  acted  on.   It should
be left in position for a period varying from  twenty minutes to an  hour,
according to the amount of irritation desired.
   Next in point  of common use, but standing first in point of strength,
is the cantharides, or Spanish-fly, plaster.  It is  so strong that it always
blisters, and should never be used unless under advice of a physician.
In children this plaster sometimes produces sloughing, from the intensity
of its local action, and  congestion, and even inflammation of the kid-
neys, with suppression of urine, may result from the absorption of some
of the material by the blood. This plaster is procured at the drug stores,
already spread. 
THE DUTIES OF  THE SICK ROOM.
43
   2. Anodyne.—Belladonna and stramonium plasters are the only ones
that  I shall speak of under this head.  The former comes already spread,
and  has simply to be applied to the surface, when it  sticks  fast with
the heat of the body.   It is of service in neuralgia and rheumatism ; es-
pecially  lumbago.  They are both of service  in glandular and other
inflammations and enlargements.
   3. Protective.—These plasters, the name  of which is legion, are  of
service only in that they protect  certain  portions of the  body, as the
chest and small of the back, from cold, and act as gentle counter-irritants
during a long period.   They are known  as porous,  electric, poor man's,
etc.,  etc , ad infinitum.  One is about as good  as another, and none of
much service.
   4. Mechanical.—The most important are the two forms of surgeon's
plaster—the  plain and the " swansdown."   The first  is  that used in
surgical dressings, to  bring the edges of wounds together and maintain
them in apposition.   Every family should  have  a quarter or half
yard of it.   It requires to be heated before being  applied.   The swans-
down is  very heavy and  strong, and is used only in  such surgical cases
as require the attention of the doctor, who knows when and where to ap-
ply it.

   Blisters.—Blisters are  usually produced by painting the required
space with a little vesicating collodion, applying a Spanish-fly plaster,
or with ammonia.   The latter, when small blisters are needed, is the
speediest, and is  easy of application; all that is necessary being usually
at hand.  Saturate enough cotton to  fill a small pill-box,  or watch-
crystal, with the officinal stronger water'of ammonia.  Place this  cotton
in the box  or glass,  and invert on the skin, holding it in position for
about  three  minutes.   It sometimes takes a little  longer than three
minutes to raise a blister in this way, but the time required by different
skins is usually easily determined.
    When filled to distension with fluid, the  blister may be pricked with
a needle, the serum be allowed to run  out, and the raw  surface dressed
with a little oxide of  zinc ointment spread on sheet lint.

    Cups.—Cups  are of two kinds;  wet and dry.  By wet cupping
we  mean the scarifying of a surface, from  which  blood  is afterwards
drawn by exhausting.the  air  in a metal or glass cup.  By dry cupping
we mean the drawing of  skin into  a  glass or metal cup by exhausting
the  air therefrom.  This proceeding draws an excess of blood into the
skin thus treated, usually rupturing some  of the  capillary blood-vessels,
and  allowing some blood to escape into the  tissues.   Wet-cupping is 
44
THE SICK ROOM.
never used  for  the  abstraction of blood from  a part  simply  for  a
remedial action  on that part.   It  is intended  to  produce  a certain
degree  of  counter-irritation and to withdraw  blood from  the deeper
tissues, as the liver, kidneys or lungs.
   The exhaustion of air is accomplished in various ways : [a) by means
of a little air-pump; (b) by means of a hollow rubber ball, out of which
the air  is squeezed before applying it; (c) by rarefaction of the air.   In
case the regular cups are wanting, a cup may be applied in the following
manner:  Take a small wine-glass, dip a little  piece of tissue-paper in
ether or alcohol, light it, thrust  it into the glass, and apply the glass to
the part to be treated.   As the air is rarefied  by the rapidly burning
paper, the flesh will  be  seen to rise into the glass.   One  or more may
be put on as the case may require, and  be left there for half an hour.
If it is desired to wet-cup, and  no instruments are at hand, scarification
may be produced by setting four needles into a piece of wood, eye-
end  imbedded, and scraping the skin for  a little time  until the blood
begins  to show ;  over this the cup is  to be applied.  The small vaccin-
ating scarifier shown at  Fig. 9, is very cheap and convenient.  In sud-
den dropsy of the lungs, cupping is invaluable. Six or eight cups should
be put  on.

                              Fig. 9.
vaccinating scarifier.
    Leeches are to be had at almost all drug stores.   They are used
chiefly about the head and neck, for the local abstraction of blood.  To
apply one, put it in a wine-glass, invert the glass on the skin, and keep in
position until the leech has taken firm hold.   Momentary immersion
in cold water will often make them bite quickly.   When full they will
drop off of their own  accord.   If further abstraction of blood is desired,
bathe the part with warm water, which will promote the bleeding.  The
bleeding from leech-bites is  sometimes  hard to control.  Ice should be
used first, and  if this fails,  cleanse  the parts, and tearing a common
glazed card into small pieces, press a piece firmly for a minute over the
bite, leaving  it there. This is usually prompt and efficient.  When through
with the leeches put them in a tumbler or bottle of water, covered with
gauze. 
THE DUTIES  OF THE SICK ROOM.
45
   Croup Kettle.—In case there is not,a regular croup kettle in the
house, steam may be generated in a coffee-pot and conducted to the
sufferer through a rubber tube, as described at page 37.
   For croup, diphtheria and diseases of like nature, the steam atomizer
is a very convenient  apparatus.  The steam may be used pure, or  be
medicated, by adding the  drug to the water in the cup.   These instru-
ments are always advantageous, as steam can be produced in a very k\v
minutes, night or day.  See Fig. 10.

                             Fig. 10.
steam atomizer.
    Joints may be  done up  in  cotton  batting with a covering  of oil-
silk.  It often gives relief to pain, especially after fomenting with decoc-
tion of poppy-heads,  hops or plain hot water, also after painting with
iodine.  This especially applies  to rheumatic joints; this is better than
wrapping  in flannel.

    Fomentations are of service in allaying pain and spasm.   They are
chiefly used in joint disease.  The  poppy fomentation is that most com-
monly employed.   It  is made by pouring two quarts of boiling water on
four ounces of poppy-heads.  A half ounce of belladonna leaves may be
added with advantage.  The  joint or affected part may be sponged off
with this,  or be  wrapped  in cloths, preferably flannel, soaked in it.
These are to be renewed every few minutes.   They  may be rendered
more  efficacious by surrounding them with a double layer of oil-silk. 
46                      THE SICK ROOM.
Flannels wrung out of hot water and applied to the abdomen, being
changed every few minutes, are very soothing in the pain of colic, also
when applied to  the throat in scarlet fever.  The water used must be
hot, and the cloth covered with a dry one or oil-silk.
    When it  is desired to keep a  part hot,  two cloths should  be
used; one should be ready in the fluid, and the other on the part.   As
the flannel on the joint is about to be removed, the flannel in the  hot
fluid should be taken out, the water quickly wrung out  in  a towel,
and the cloth applied as the other is removed.  In this way the part is
not allowed to get cool, as will be the case if some such plan as this is
not followed.  White flannel retains heat longer than colored flannel.
The whole should be covered with a dry cloth, or a piece of oil-silk.
    In applying cold cloths to a part, the same plan, with the exception
of wringing out the cloths in a towel, may be followed.  The bowl con-
taining  the fluid should be stood in a deep dish or pail of  cracked ice.
Ice melting in the fluid weakens it.  As evaporation of the fluid in-
creases  the cooling power of the  application, the wet cloth should be
left uncovered; it being of some light material instead of flannel.  The
compressor on the  tube of the fountain syringe  may be so arranged as
to allow water to fall, drop by drop, upon a part.   In  such case there
should be something below the part to protect the bed from wetting.

    Poppy Fomentation.—Poppy-heads, 2 oz.; water, 4 pints.  Boil to
three pints, add 1 oz. of  elder flowers, boil to a quart and strain.

    Poppy and Lead Fomentation.—Poppy-heads, 2 oz.; water, 4 pints.
Boil to 1 quart; strain and add 2 drachms of sugar of lead.

    Belladonna Fomentation.—Belladonna leaves, 3 oz.;  water, 3
pints.  Boil to 1 quart and strain.

    Belladonna Fomentation.—Extract of belladonna, 1 drachm ;
boiling water, 1 quart.

    Chamomile and Hop Fomentation.—Chamomile  and hops, each
y2 pound; water,  2  quarts.    Boil to a quart and a pint, and strain.
    In some cases the vegetable substances employed in the making  are
used as  well as the  liquid.

   The oil-silk jacket is of great use in pneumonia and other  diseases.
It should be made  extra large,  with the seams on the outside, and be
applied directly to the skin. 
THE DUTIES  OF THE SICK ROOM.
47
   Massage is the name given to the systematic rubbing of parts or the
whole of the body.  In lameness, joint disease, sluggish circulation, etc.,
the proceeding is often of great benefit.  It should be very gentle at
first, being increased in force and duration day by day.   It is spoken
of by Hippocrates as  a curative measure.  The rubbing, save in the
case of joints, which may be rubbed in all directions, should be from the
extremities towards the trunk and heart.   The blood is thus carried out
of the limbs more rapidly, the arteries and veins are improved in tone,
and the  nutrition and mobility of the skin and tissues are increased.  Stiff
joints are, thus,  often restored to full power.   Kneading, slapping,
pounding  with little cork-faced mallets and paddles, come under the same
head.

   Swabbing the Throat.—It is often necessary in diphtheria and
other diseases affecting the throat or tonsils, to make applications there-
to.   In  cases when the physician is too  far distant to come often and
make the  application  himself, as in the  country, and for other reasons,
this duty falls to the lot of the nurse or one of the family, and a knowl-
edge of the proceeding is therefore  necessary.   It is done with either a
brush or  probang.  The former, when  used, should not be the  small
camels'  hair  brush of the  drug stores, but a flat, broad one.   If such
cannot be obtained readily, a suitable one may be improvised by lashing
three or four of the small brushes together, on a thin flat piece of board.
Probangs, which are pieces of whalebone having a bit of sponge fastened
on the end, are for sale at most drug stores.  They may be readily  made
at home, by securely fastening a piece of sponge or soft linen on the end
of a stick or whalebone.  To use  this properly the  person's mouth
should be widely opened, the tongue  held  down with a spoon  handle,
and  the brush or probang, dipped in the fluid to be used, be passed into
the back  of the  throat, and the  diseased  surface rapidly mopped or
brushed.  Rapidly, for the patient is apt to " gag," and will then vomit
if the instrument be not at once removed.  No drinks should be allowed
for some time after the application has been made.

   Injections.—Rectal injections, or enemata, are of three kinds; pur-
gative, medicated and nutritive.
   Purgative injections  are for  the  purpose  of  ridding the large  intes-
tines of faecal matter.   In acute illness, where the person is  very weak,
and in chronic constipation, this method of moving the bowels is  much
to be preferred to  the taking of laxatives or purgatives by the mouth.
Enemata  do not alone empty the rectum of faeces by reason of softening 
48
THE SICK ROOM.
and dissolving the hardened mass, but  when  properly given cause the
intestines to contract high up, thus freeing the bowels for a considerable
distance beyond the point which the injection reached.   Injections as
usually given are inefficient,  not enough  water being used, and the
action on the rectum only being all that is had.   An injection may be
properly given in the following manner.  Take a basin or bowl holding
one or two quarts, fill two-thirds full of warm water, make a good suds
in the bowl, using a piece of Castile  soap;  to this add two tablespoon-
fuls of castor-oil and  two teaspoonfuls of turpentine.  By beating  and
stirring mix the ingredients well together.  In case any materials that do
not mix  readily with water are used,  soap is added to  facilitate  and
maintain  the mixture.   When simple  soap and water are  used,  and
this  should be seldom,  the soap  acts as a lubricant.   The injection
now being ready,  the  patient  is placed on  his left side (the rectum
passes to the left to join  the large gut), and the nozzle of the syringe, the
bulb  being filled with  fluid to the exclusion of all air,  is introduced
somewhat backward and  to the left.  The best instrument for this pur-
pose is the rubber-bulb syringe, with various sized nozzles.   One end of
the syringe rests in  the  basin, the other in the  rectum.   The bulb
of the syringe is to be slowly  compressed and  relaxed  until  the
patient complains that  he desires  to  use the  chamber and  cannot
retain  any more.  The  syringing  is  then  to  be stopped for  a  few
moments, and as the distressing feeling passes off, is to be resumed.
This is to be continued until two or three pints of fluid have been in-
jected, when the nozzle of the syringe is  to  be withdrawn, and the
patient must endeavor  to hold  the injection ten or fifteen minutes.
When placed upon the  chamber then, he usually has a copious  move-
ment, that greatly relieves him.
    Unless the ingredients of the  injection  are  thoroughly mixed  and
the oily matter and  turpentine are held in suspension by the soap, they
will rise to the top, and entering  the syringe last will only reach  the
rectum, their effect on  the  intestines high  up being lost.   The  nozzle
of the syringe should always be warmed before it is introduced.   Care
should be had in introducing it that the  walls  of the  rectum are  not
scraped or perforated.  Great gentleness, with an observance of  the di-
rections already given, will  obviate the possibility of the  occurrence of
accident.   Use plenty of water.
   In case the rectum is blocked up with hardened faeces, as is often the
case in old people, these should  be softened as much as  possible  with
soap-and-water injections, then scooped  out with the finger or handle of a
spoon, and  the whole gut afterwards freed  by a copious turpentine and 
THE DUTIES  OF  THE SICK ROOM.
49
castor-oil injection.   The daily use of warm injections over a long period
is injurious, relaxing and lowering the tone of the intestines, and  predis-
posing to piles and constipation.
   Injections  of ice-water are often of great service  in hemorrhoids
and chronic constipation.
   Medicated.—Injections  containing castor-oil and  turpentine are, of
course, medicated, but this medication has but one end in view, a move-
ment of the bowels.   In  using the term medicated  injection here, we
mean those enemata  containing medicines that are intended for local
healing  or  tonic  action,  constitutional effect,  or  for the destruction of
worms.
   Thus hammamelis and krameria injections are used for hemorrhoids,
belladonna and opium for inflamed  piles, and pain and  inflammation of
the bladder, also  to relieve the pain of cancer of the stomach or intes-
tines.   When  medicine cannot be  taken  by the mouth, it is often  con-
sidered desirable  to inject it into the rectum.   As a rule  it requires twice
or three times  the amount of drug used by the mouth to affect the system
in the same degree.  No extended directions are given here, as these
measures should be taken  only under the  advice of a physician, who will
know just how to graduate their strength.  As a rule, but a small amount
of fluid—from half an ounce to two ounces—should be used at a time. In
attempting to destro)  worms, a much   larger  amount  must be  em-
ployed.    The small hard-rubber syringes  are  best  suited for giving
medicated  injections where but little fluid is to be used.
   In the painful bearing-down and frequent bloody or mucous passages
of dysentery, especially in children,  starch injections are of great benefit,
giving sometimes almost immediate relief.  In some cases, however, they
have to be repeated every hour.   Enough of boiling water is poured on
a handful of starch to  make it of  the consistence of thin jelly.   To this
may be added, for adults, thirty, and for children, five drops of lauda-
num,  and  a drachm  of the subnitrate  of bismuth.  These are to be
thoroughly mixed, injected and retained  as long as is possible.  If the
injection has  to  be repeated within a short time, reduce the amount of
laudanum in adults, and omit it in children.
   Ringer,*  speaking of the destruction  of seat-worms by  injection,
says:—
   " Injections are  commonly used to destroy thread-worms, which in-
fest the rectum and the intestines in its immediate neighborhood, but
occur in no other part of the canal.  As  the object of the injection is to
* Op. cit., p. 599. 
5°
THE SICK ROOM.
destroy these entozoa, a  sufficient quantity of fluid should be employed
so as to reach a little higher than the rectum.  For an adult half a pint
is sufficient, and for a child, of course less must be used.  To the water
injected, various substances can  be added, as common salt, tincture of
sesquichloride  of iron, lime-water, quassia, and  various  other  similarly
acting  agents, with the object of either directly poisoning the worms, or
of destroying them  by coagulating the albuminous structures of their
bodies.  Injections are always  successful in removing  worms, and so
affording temporary relief;  but in the treatment of worms it must always
be recollected that the morbid state of the mucus coats of the intestines,
favoring the production of  worms, must be remedied  if a permanent re-
lief is to be obtained.  Solutions too  concentrated  must not  be  injected,
otherwise inflammation may  occur,  perhaps severe enough to cause
sloughing in the rectum and margins of the anus.  A teaspoonful of salt
or a drachm of the tincture of steel to half a pint of water is sufficiently
strong  to effect the destruction of these delicately formed animals."
   Nutritive Enemata are of the greatest  service in cases where from
vomiting, cancer of the oesophagus, and diseases of the stomach  or intes-
tines and their adjacent glands, food cannot reach  the stomach  or is not
retained, and digestion does not take place.
  In these  cases,  the rectum has been  used for months  to  receive
foods,  previously artificially digested,  they being  absorbed, and going
to build up the tissues and sustain life.   Moreover, the diseased or-
gans are in  this way given rest, which  is a  gr^eat  factor  in the cure
of disease.   Starchy foods are of little use in rectal feeding.   Meats are
all important.  Half an  ounce  of liquid  beef may  be  injected every
two hours in case of extreme weakness; oftener,  if necessary.  The rec-
tum should be well cleansed by injection before the food is thrown into it.
A table-spoonful of whiskey or other liquor may be injected every two
hours, if necessary. Beef-tea, to which pepsine or lacto-pepsine has been
added, may be injected, four to eight ounces at a time.   Meat,  cut  and
pounded until very fine, should be scalded with boiling water, and  after
being partially digested, be also injected through a wide-nozzled syringe.
To every half pound of meat there should be added fifteen grains of
pepsine and ten  drops of hydrochloric acid.  It is to  be  well shaken
or stirred every half hour, being kept  for eight  hours  at  a tempera-
ture of ioo° F. before being used.
   Defibrinated blood has been used in  rectal alimentation with very
happy  results.  Fresh blood is to be procured at a slaughter-house, and
after all the fibrine is separated by stirring  and beating with  a bundle of
sticks or twigs, to .which  it adheres in  long  gelatinous fibres, the blood 
               THE  DUTIES OF THE SICK ROOM.              51

is to be treated by the  addition  of a pinch  of  salt, pepsine and  hy-
drochloric acid, and be  injected.   It may be used, however,  without
any additions.
   To four ounces, which is the usual injection for the adult, ten grains
of pepsine, as much salt  as can be held on the end of a table-knife, and
ten drops of hydrochloric acid may be added, the whole beaten up for
half an hour, and then injected.  Some prefer to inject it at once, with-
out any preliminary beating or shaking.
   The subject of rectal alimentation is an extensive one, and we have
only given a few practical hints here, referring  those who  wish fuller in-
formation, to books especially devoted to the subject.

    Ear Injections should never  be undertaken save under the advice
of a competent physician.  They  should  be  made with a syringe de-
signed especially for that purpose.   But  little force  should be used in
making them.  The ears should  never be picked; perforation  of  the
drum, serious  inflammation,  and  loss  of  hearing may result.   Sharp-
nozzled syringes are likewise dangerous.  When, from the production of

                              Fig. 11.
ear syringe.
Fig. 12.
ear spatula.
an unusual amount of cerumen, or wax, in the ear, it is necessary to use
some instrument for its removal—the hard-rubber spatula is the safest—
although syringing the ear is to be preferred to the use of any hard in:
strument in any other hands than those of a physician.   See Figs. 11
and  12.

   Nasal  Injections are of great  service in chronic catarrh.   They
may  be plain or  medicated.   The best syringe to use in these cases is 
52
THE SICK ROOM.
the fountain syringe, made by the Goodyear Rubber Co.  (Fig. 13.)  It is
to be hung on a nail on the wall;  the bag filled with warm water, plain
or with salt, the nozzle, placed well in one nostril, the stop-cock turned
and the fluid allowed to pass in at  one nostril and  out  at  the other.
Great care must be taken not to swallow or make the attempt to swal-
low during the operation, as this act opens the mouth of the tube leading
into the ear, and water may enter and excite acute and very serious in-
flammation.   For making moderately strong applications to the mucous
membrane of the nose, as in diphtheria, etc., a small  syringe should be
used, and only one or two  teaspoonfuls injected.   Medication of the
mucous membrane of the nose  is best  attained by the use of a steam
atomizer,  with  tubes  for  both the  nostrils and  the posterior open-
ings of the  nose into the  throat, a very common seat of chronic in-
                         fountain syringe.

flammation.   The  membrane should, when possible, be  thoroughly
cleansed  with  a warm water  injection  before  applying  any  medical
agents, otherwise, the membrane is  rarely reached, the dried mucus and
pus shielding it.

   Suppositories are small conical bodies, made of cocoa-butter, with
which are incorporated certain medicines—as opium, belladonna, ergot, etc.
They are to be used in the rectum or vagina.  They should be taken be-
tween the first and second fingers of the right or left hand of the nurse,
with the thumb against the large end,  the small  end or apex is  made to
press against  the anus, and, as the butter softens a little on the outside,
the suppository slips in, aided by gentle pressure.   If the patient inserts
them himself, the large end should rest on the tips of the fingers, the in-
 
THE DUTIES  OF  THE SICK ROOM.
53
traduction being accomplished in the same manner.   They are of great
service in painful affections of the bowels, bladder,  uterus,  etc., their
action being chiefly confined to the pelvic organs.

   Surgical Dressings.—In surgical cases certain things should always
be in  readiness for the  physician.    Hot  and  cold water, a wash-
hand basin, one  or two  small  sponges, two  towels, and  a pair of
scissors.   He will usually bring  adhesive plaster with him.   Some cot-
ton batting and old soft linen should also  be on hand.   The nurse or
attendant should be gentle, watchful, ready to interpret a sign or look,
be quick of finger and steady of hand.

   Childbirth.—At birth there should be  in readiness  a wash-basin,
a pail of hot and a pail of cold water, a binder, clean sheets  and bedding,
a blanket to  receive the child, a pair of scissors, a spool of strong silk
and a spool of thread, a bottle of vaseline, a  roll of cotton batting,  one
dozen clean towels, a bottle of hot water or a brick  for the feet, a bed-
pan, a  chamber, a bottle  each  of ammonia  and  brandy, and  the
child's  clothes.  The mattress should be protected by a piece of rubber
sheeting.

   For vaginal examinations, or  the performance  of surgical oper-
ations,  a common kitchen  table is to  be ready in the room.   It is always
better than a bed.  It  should be covered with  an old blanket, as it is
liable to be stained  or soiled.

   Hemorrhage.—The blood in arterial hemorrhage is usually red, and
is thrown out in jets.  Compress the limb by rope, handkerchief, or any-
thing at hand, between the heart and the cut.   The blood in venous hem-
orrhage is  usually of a  dark  red or blue  color, and flows slowly  and
regularly. Compress the limb between the cut and the extremity; or taking
a piece of lint dipped in ice-water, or  a knotted handkerchief,  force it
into  and upon the  wound, and  maintain even pressure until a doctor
comes.   In cut throat this procedure is to be put into execution without
a moment's loss of time. 
CHAPTER  III.
                  DIET  FOR  THE SICK.

    SECOND to nothing, in the treatment of the majority  of diseases,
     stands the administration of good food, properly prepared, in proper
quantity, and at the right time.   Save in a few instances, the dietary of
the sick has been a middle  ground between  the physician and  the
patient's family, neither occupying it fully or satisfactorily.  It is out of
the question to expect the physician to be familiar with  receipts for  the
various sick-room dishes, or to give his personal attention to their pre-
paration.  He should know and state what he wishes the patient to have,
and very properly expect the nurse or family to prepare  that something
in a palatable and easily digested form.  This knowledge is seldom pos-
sessed by the average lady, nurse, or cook, and  it is for the  purpose of
placing a number of tried receipts before them, and making some perti-
nent remarks on methods of cooking, relative nutritive value and relative
digestibility of foods, that this chapter is written.
    It is not my  intention to go extensively into the subject of foods
proper.   I  simply wish to offer some suggestions and make passing  re-
marks on the subject of diet for the sick, referring those who  desire to
study the subject at length to  Smith on Foods, Pavy on Food  and Die-
tetics, and works of like nature.  I am indebted to Smith for most of the
tables here used, they being chiefly made up  from facts contained in his
very valuable book.
    First, then, as to methods of cooking.  These are :
    i.  Broiling.   2. Baking.  3.  Boiling.   4.   Stewing.   5.  Roasting.
6. Frying.  7. Infusing.
    Meats are the principal articles of food to be relied on in acute illness
and convalescence therefrom, as in them nutriment is presented in its most
concentrated, agreeable, and easily digested  form.  Of the seven varie-
ties of  cooking; broiling, roasting and infusing head the list in point of
desirability, while frying ends it.   Fried food of any kind should never 
DIET FOR  THE SICK.
55
be admitted to the sick-room.   The process renders the food very hard
of digestion, as it gives it to us cased in a dark outside of browned  ma-
terial and fat.   It is necessary for the stomach and intestinal juices to
liquefy  the  fat and dissolve the casing  before  the food  itself can be
reached;  thus protracting the period of digestion.  Fried foods are ob-
jectionable  in health, much more so then in disease.   Dr.  Geo. M.
Beard says,  in his excellent  little book*:  " Frying.—This is a method
of cooking  meat which has  no other recommendation than conven-
ience.   It is a rude method, adapted for coarse natures, and disappears
before civilization.''
   Infusing.—By infusing we mean that process best calculated to ab-
stract, by means of water, the nutritive portions from meat.   This is best
attained by procuring fresh, tender meat, free from fat, chopping it fine,
placing  it in cold water, where it is to remain for several hours, and then
gradually raising its temperature to just below  the boiling point, where it
is to be kept for several hours longer.   A uniform  heat is often best
maintained by placing the meat and water in a fruit jar, the top of which
is  then  closed, and  the jar  set  in  a  kettle of hot  water on  the
stove.   The meat water should never be allowed to boil.   When done
it is to be strained,  all fat carefully skimmed off, and  be well seasoned.
Beef tea, as  usually made,  is  a tasteless,  worthless  fluid, holding
but a very  small proportion of the nutriment of the  meat in solution.
Meat infusions are usually made of beef, which is the meat best suited for
this purpose. They are of service in acute illness or where patients cannot
swallow solid food.  As soon  as the acute stage of the disease is over, how-
ever, and sometimes  before this, small  quantities of meat and other
solid food are to be added to the diet for the following reasons: {a) Fluid
foods seldom contain an amount of nutriment proportionate to their bulk.
(Beef tea, as usually  made,  seldom contain more  than a quarter of an
ounce of solid matter  to the  pint, and a large proportion of that is salts.)
(b)  They do not present sufficient bulk, or rather sufficient  consistence
for  the  stomach to work upon.   (c) They pass  too readily from the
stomach into the small intestine, being thus but imperfectly mixed with
and  acted upon by their natural solvent, the  gastric  juice,   (d) Soups
and meat infusions are not more rapidly or thoroughly digested than prop-
erly cooked  solid food, t and (e.) they are apt to disorder the stomach and
bowels.  In many cases, judiciously given and properly made, they are of
great service. I do not wish  to be classed with those who are raising a hue
and  cry against  all  liquid  nourishment.   Their  arguments,  many of

    * Eating and Drinking.  New York :  1877.   P. 140.
    t Combe.  Physiology of Digestion.  New York : 1836.  P. 133. 
56
THE SICK ROOM.
which are  good, are by no means conclusive.  They say that Nature
seldom, if ever,  gives food to man, animal or plant in a concentrated
form, but leaves them to accomplish the separation of the elements them-
selves.  True, but a poorly nourished plant is always benefited by placing
about its roots, judiciously, a proper amount of manure, which is its food
in concentrated  form.   It must  be remembered,  furthermore, that
Nature's preparations are supposably made for  healthy plants, animals
and men, and not for the sickly.   Perfect digestion cannot  be  expected
from  the stomach of a sick person, however well suited to  that end the
food may be.
   In acute illness, where the patient is robust at the outset of the dis-
ease,  and has not suffered much in strength, crowding the stomach with
concentrated animal food is both foolish and hazardous. In cases where
the digestion is very weak, and there is not immediate danger of extreme
prostration, light diet, well  chosen, varied,  and gradually  increasing in
strength, is to be used.
   Other meats  than beef are rarely infused, as they contain too  much
fat for that purpose.  Mutton is sometimes used, a soup  being  made.
This is agreeable to many, especially when thickened with rice or barley,
and is quite nutritious when properly made.  Soups of chicken  are often
very palatable, though less nutritious than  those of beef and mutton.
The  same  may be said  of  rabbit and wild fowl.   The latter  are often
displeasing from  their strong flavor.  Soups made from oysters and clams
are often very well received and easily digested.  This is especially true
of oysters, the  patient  being allowed  to  eat  a few with  the  soup.
Milk,  which  is used  in cooking them,  adds  to  their nutritive  value.
Most vegetable soups stand very low in the nutritive scale.

   Broiling.—Broiling  is unquestionably the best manner in  which to
cook meat.  By  it the meat is thoroughly cooked and the juices remain
incorporated  with  the fleshy fibre.  To  perform  it properly, the fire
should be very hot, so that the outside of the meat is at once hardened,
thus  imprisoning the juices  within the piece so treated.   The gridiron
should be turned every few moments so as  to  cook all parts evenly.
Broiling meat in  the flame of a coal fire gives it an unpleasant odor and
taste,  due to the  gases of the coal; and broiling over a smoky wood-fire
is also to  be deprecated.   Hickory wood  coals impart a peculiar and
very  pleasant  odor and taste to  meats  broiled over  them.  Broiled
meats should be  served while hot.

   Baking or Roasting is an excellent and pleasant  manner of cook-
ing meat and fowl.  It  is really  a  slow broiling.   It is especially suited 
DIET FOR THE SICK.
57
to large pieces.   As a rule, the meat is not so well done as in broiling.
Baked potatoes, hot ashes being best suited for  this purpose, are often
longed for by patients, and are quite allowable.

    Boiling, so far as  the nutritive value  of meat so treated is  con-
cerned, is  not  a desirable  form  of cooking.   Much of its nutritious
material is  taken up by  the  water, and, unless  this also  is consumed,
its  nutritive value is greatly lessened.   Smith,* speaking of the relative
value  of  boiled and roasted  meats  as foods, says:—"If the meat
be  boiled,  the introduction  of fluid into the substance  of the meat,
whether between the structures or within the fibres, aids the  extrac-
tive process, but at  the same time retains and preserves that which is
extracted.   If it be roasted while surrounded on  all sides by the air, the
heat is not applied so uniformly and gently, and therefore the outside
becomes over-cooked before the inside is sufficiently cooked, and this
occurs to  a  far greater extent than with  boiling.   Hence, not only is the
fluid part of the juices extracted and lost, but the loss is  greater than
when the meat is boiled. It  is, however, to be understood, that  the
matters extracted are only such  as  may be dispersed by heat; and
whilst,  therefore  the  evaporated  water may carry  off  some  of  the
flavors of the meat, it does not remove the salts which are present in the
juices.  Hence, meat which is properly  roasted has lost  weight more
than that  which is boiled; but if no account  be taken of the matters ex-
tracted, it contains a  larger proportion of nutritive elements than  the
larger  mass of  boiled  meat, and in a given weight is more nutritious.
When, however, the  extracted matter  is collected and  used, there is a
greater proportion of nutriment in the boiled meat with the broth, than
in the roast meat with the liquified fat, and it is clearly desirable  that
both the  broth  and the boiled meat should be  eaten together."   It is
very evident then, that broiled or roasted meats are best suited  to  the
sick, as they  contain a larger proportional  amount of nutriment, and
have their fatty matter liquefied and removed by  heat.  It would be out
of the question for a sick person to eat both the meat and the. water in
which it was boiled, unless the piece so treated was  very small.   More-
over, the water or broth would be more or less fatty.

    Stewing.—Meat stews are very desirable foods  for the sick.  They
occupy a place between broths and boiled  meats.   The meat is made
tender,  enough  broth is present, rich in extractives, to furnish  liquid
food, and  if the meat has  been properly selected,  will be quite free from
* Foods.  New York :  1873.  P. 20. 
58                          THE  SICK ROOM.
fat.   All kinds  of meat and fowl  may be thus treated.   For convales-
cents or invalids the stew with vegetables proves very serviceable.
    Fats have been nearly  universally considered as heat producers, and
in acute illness with  high  fever, and  in immediate convalescence there-
from, we want as little of them as possible.  Furthermore, they are apt to
digest slowly and disorder the stomach and bowels.
    We  give here a table *  showing the relative digestibility of  certain
articles of diet, as determined  by the  experiments  of Dr. Beaumont, on
Alexis  St. Martin, a portion of whose stomach was  accidentally shot
away.   They are, of course, inaccurate, in  that what takes the stomach
three hours to  digest  one day, may be digested  the next day  in  two
hours.   Then, too, the stomach and  gastric juice of  the person is much
weaker  in disease, than  in health.   Still the tables  are of considerable
value in giving the relative digestibility- of these substances.
Table  Showing the Mean  Time  of Digestion  of Different Articles of Diet.
Articles of Diet.
Rice..................Boiled
Sago..................  do
Tapioca...............  do
Barley................  do
Milk..................  do
 do ..................Raw
Gelatine..............Boiled
Pigs' feet, soused.......  do
Tripe,  soused..........  do
Brains.................  do
Venison steak..........Broiled
Spinal  marrow.........Boiled
Turkey, domestic.......Roasted
  do       do   ......Boiled
  do    wild......___Roasted
Goose.................  do
Pig, sucking...........  do
Liver,  beef's, fresh.....Broiled
Lamb,  fresh...........  do
Chicken, full-grown.....Fricassee
Eggs, fresh............Hard boiled 3 30
 do   do*............Soft   do  3
 do   do  ............Fried      3 30
 do   do............Roasted    2 15
 do   do  ............Raw       2
 do whipped..........  do       1 30
Custard...............Baked     2 45
Codfish, cured, dry.....Boiled     2
Trout,  salmon, fresh___  do       1 30
     do       do  ___Fried      1 30
Bass, striped, fresh.....Broiled    3
Flounder      do .....Fried     3 30
   of     quired for
Preparation. Digestion.
           H. M.
            I
            1  45
            2
            2
            2
            2  15
            2  30
            I
            I
            '  45
            1  35
            2  40
            2  30
            2  25
            2  18
            2  30
            2  30
            2
            2  30
            2  45
                       Mode
    Articles of Diet.          of
                    Preparation.

Catfish, fresh..........Fried
Salmon, salted.........Boiled
Oysters, fresh..........Raw
  do    do  ..........Roasted
Oysters, fresh..........Stewed
Beef, fresh, lean, rare__Roasted
 do   do  dry.........   do
 do  steak.............Broiled
 do  with salt only.....Boiled
 do  with mustard, &c.   do
 do  fresh, lean........Fried
 do  old, hard, salted.. .Boiled
Pork steak.............Broiled
 do  fat and lean.......Roasted
 do  recently salted.....Boiled
 do       do     .....Fried
 do       do     .....Broiled
Pork, recently salted___Raw
 do       do     .....Stewed
Mutton, fresh..........Roasted
  do    do  ..........Broiled
  do    do  .........  Boiled
Veal, fresh.............Broiled
 do   do .............Fried
Fowls, domestic........Boiled
 do      do   ........Roasted
Ducks,   do   ........   do
 do      do   ........   do
Suet, beef, fresh........Boiled
 do  mutton...........   do
Butter................Melted
Cheese,  old, strong.....Raw
 Time re-
quired for
Digestion.
  H. M.
3
4
2
3
3
3
3
3
2
3
3
4
3
5
4
4
3
3
3
3
3
3
4
4
4
4
4
4 3°
5 03
4 3°
3 30
3 3°
3°

55
15
3°

3°

45
3°

»5
«5
15
3°
15
15
i5
30
* Combe's Physiology of Digestion, p. 127. 
DIET FOR  THE  SICK.                      59
                      Mode
    Articles of Diet.         of
                    Preparation.
Soup, beef,vegetables and
   mead..............Boiled
 do  marrow-hones.....  do
 do  beans............  do
 do  barley............  do
 do  mutton...........   do
Green corn and beans...  do
Chicken soup..........Boiled
Oyster soup...........  do
Hash, meat and vegtbls.Warmed
Sausage, fresh___.....Broiled
Heart, animal..........Fried
Tendon...............Boiled
Cartilage .____........  do
Aponeurosis...........  do
Beans, pod............  do
Bread, wheaten, fresh. ..Baked
'5
45
3 3°
2 30
3 20
4 3°
5 30
4 15
3
2 30
3 3°
                      Mode
   Articles of Diet.         of
                    Preparation.

Bread, corn............Baked
Cake   do ........... do
 do   sponge......... do
Dumpling, apple.......Boiled
Apples, sour and hard.. Raw
  do    do    mellow do
  do   sweet     do   do
Parsnips..............Boiled
Carrot, orange......... do
Beet.................. do
Turnips, flat........... do
Potatoes, Irish......... do
   do    do  .........Roasted
   do    do  .........Baked
Cabbage, head.........Raw
   do-   with vinegar., do
   do       do
 Time re-
quired for
Digestion.
15
2	30
3	15
3 45	
3	3°
j	3°
2	3°
2	3°
2	3°
2	
4	3"
    Manner  of Serving  Food.—Nothing is so distasteful to a patient
as food served in a careless, slovenly fashion.   Gravy spilled, or coffee
slopped over, will often take all appetite from a patient who might other-
wise have made a good meal.   The tray should be perfectly clean, and be
covered with a  spotless napkin.   The dishes should also be clean and
neatly  arranged, and not too much food be  crowded on one plate.


                                Fig. 14.
BED-TABLE.
Better make two trips  between the kitchen and the sick-room, than to
sicken the patient with  an over abundance.   The food should never be
allowed to become  cold before being served, the patient should be clean
of hand and face, and be in an easy position before partaking of it; a lit-
tle glass  with  a few bright flowers  in it, makes a pleasing appearance
on the tray.  The napkin should be a fresh one at  each meal.  The
75 
6o
THE SICK ROOM.
 attendant should be neat and handy, and not force the food upon the
 patient too rapidly.  If he has to be fed by spoon, give time enough to
 swallow one spoonful before another is given.
    A convenient " bed-table"  may be made  by nailing two  pieces
 of wood  on the  end  of  a  smooth,  even  board,  one foot  wide.
 The  side-pieces  may be  five or  six  inches in length, and  should
• be so cut out on their outer surface  as  to fit the side-boards of the bed
 accurately; thus securing firmness (Fig. 14).
    This is to be placed on the bed over  the patient, and while bringing
 everything into convenient reach, prevents the spilling and slopping that
 is  so common  when a tray is used.  They may be made more or less
 fancy, to suit the taste of the patient or the maker; at all events they
 should look clean, neat and tasty.  Children like them very much, using
 them to hold their toys or pictures.

    Some  Practical Hints.—Sir J  Ranald  Martin *  speaks of some
 factors that modify the diet of the sick,  as follows:
    (a) Nature of the Disease.—There is perhaps no diseased state found in
 hospitals for the cure of disease in which so much food should be given
 as  in health.  In acute disease, the activity of all the functions must be
 lessened, and therefore less food of all  kinds  given, especially of the
 nitrogenous  kind, since on that quality mainly depends the activity of
 function, t  In  chronic disease there is  usually a reduced state of the
 powers of transformation, and hence starchy food should not be given in
 excess; while a full admixture of nitrogenous food  is called for.   More-
 over, the heart's action is often enfeebled  in such states;  and then nutri-
 tive articles of diet, with ale or wine, are called for.
    (b) Age.—Under the age of twenty-two some excess of food must be
 allowed to maintain growth.   In  old age the quantity should be less
 than  in middle life; and  then the quality should be such as to contain
 more nitrogenous food, or that which  promotes the transformation of
 starch and fat.  Arrowroot taken alone is then wasted, and probably the
 same may be said of fat.
    (c) Sex.—The difference in the amount of nutriment required by the
 two sexes is less than is found in  the  dietaries of gaols.  The chief
 ground for the difference is, the difference  in weight and size of the
 body.

    * Op. cit., p. 1012.
    t Medical men of the present day do not fully agree with this author on this point.
 In the conditions spoken of there is great waste of nitrogenous tissue, and there must
 be a proportionate amount of nitrogen supplied to meet this waste. 
DIET  FOR  THE SICK.
61
   (</) Previous Habits and Employments.—These considerations must
constitute a reason  for variation  in  diet; but  from evident causes, the
requirements can only be met by having two or more classes of dietaries;
one of which shall  suffice for those whose occupations have been more
laborious,  and another for  such as have been of sendentary  habit,
more nutriment  being, as  a matter  of course, required for the former
class.
   (c) Season.—The quantity of food  supplied in  the  winter months
should be one-sixth greater than in June, July, August and September,
and  it should be rich both in  nitrogen and  carbon.   In  the summer
months the quantity of starch and fat should be much lessened, and  in
a greater degree than the nitrogenous, since then the powerful indirect
transforming action of cold is absent.
    Miss Nightingale, quoted by  Martin,* makes the following excellent
points in regard to cooking :
    " Cooking.—Many a patient  can eat if you can only tempt his appe-
tite.  The fault lies in your not having got him the thing that he fancies.
    " But another patient does not  care between grapes and turnips—
everything is equally distasteful to him.  He would try to eat anything
which would do  him good; but  everything ' makes him worse.'  The
fault here  generally lies in the cooking.
    " It is  not his ' appetite which requires tempting'—it is his digestion
which requires sparing.  A good sick cook will save the digestion half
its work.
    " There may be four causes, any one of which will produce the same
 result—viz., the patient slowly starving to death from want of nutrition :
     i. Defect of cooking.
     2. Defect in  choice of diet.
     3. Defect in  choice of hours  for taking diet.
     4. Defect of appetite in the patient.
 Yet all these are  generally comprehended in one sweeping assertion, that
 the patient has ' no appetite.'
     " Surely many lives might  be saved by drawing a closer distinction,
 for the remedies are as diverse  as the  causes.  The remedy for the first
 is to cook better;  for the second, to choose other articles of diet; for the
 third, to watch for the hours when the patient is in want of food; for the
 fourth, to show him what he likes, and sometimes unexpectedly.   But no
 one of  these remedies will  do  for  any other of the defects  not corres-
 ponding with it."
     The diet of invalids or convalescents  should not consist solely of
*Op. cit., p. 1011. 
62
THE SICK ROOM.
meats.  As soon as a patient can  bear  it some vegetable food should
be added.   This is why the stew, containing  both meat and vegetables,
is so serviceable in building up the  system.   Fats, being  heat producers
and not easy of digestion, should never  be allowed until convalescence
is well advanced.   Butter is  the lightest and most  desirable  form of
fat.  In chronic disease and some lung affections fat is given as a food-
medicine, as in  convalescence from wasting  disease,  chlorosis, scrofula,
and consumption.  Butter and cream will often be found easier of assim-
ilation and pleasanter to take  than  cod-liver oil.  Ice-cream is a pleas-
ant relish, and somewhat nutritious.  Meat, uncooked and chopped very
fine, may be thoroughly mixed with the ingredients before freezing, and
makes a very pleasant and nutritious dish.  Children often  take it with
avidity.  When there is some idiosyncrasy, where eggs  are not well borne
by the system, these should be omitted.

  Milk, is at all times a most excellent  food.  In intestinal disorders,
and when there  is  weak digestion and nausea, it  should  be mixed with
one-third lime-water.  It is the bill-of-fare set before us  by  Nature in early
life, and is a very excellent one to  follow and imitate, as it contains all
the ingredients  necessary to sustain  life.   Its value as a food cannot be
over-estimated.  There  are some, however, with whom  milk does not
" agree ", and persistence in its  use in such cases is foolish and hazardous.
The addition of lime-water will often remove all such  objections.  Milk-
toast is an excellent dish  for the convalescent, being palatable  and nu-
tritious.    Sour milk is unpleasant to take, and often produces diarrhoea.
Buttermilk is milk freed of its fat, and is a very good food. It was largely
used in the army during the late war, in camp-diarrhcea, and with  good
results.

   Eggs.—When well borne  by the stomach, these are  excellent  food.
Some persons are  unpleasantly affected  by them, that  condition known
as "biliousness" being produced.   Persons who cannot  eat  the egg
alone  may take it, and digest it easily, when beaten up with wine.   It is
used in making " egg-nog."  When  the whole egg cannot be borne, the
yolk alone  may be given.  When boiled,  it is probably most  easily
digested when the " white" is just beginning to get flaky and a little hard.
An  egg should never  be  dropped into boiling water,  as is the common
custom.   It is thus unevenly cooked.  It should be put into cold water,
the temperature of  which  is  gradually raised  to the  boiling  point.
Poached eggs are  finely flavored and easy of digestion.  They should
be poached in an earthenware  dish, and be served hot.   " An egg weigh- 
DIET FOR  THE SICK.
°3
ing i ^  ounces consists of 120  grains of carbon, and 173^  grains ol
nitrogen." *  Fried eggs are always  objectionable.   Omelets  are  less
easily digested than soft-boiled, poached, or raw eggs.  Scrambled eggs
make a pleasant dish for the advanced convalescent  or chronic invalid.

   Arrowroot, Rice, and foods of that kind, are of little nutritive value,
though forming the staple article of diet, in fact almost the only food, of
the inhabitants of  many Eastern countries.   They are, however, excel-
lent  additions to  the diet list, giving bulk  to soups and infusions, and
modifying the evils of a purely nitrogenous diet.   They are very rich in
starch, as will be seen by the following table: t
                                                 starch.
     Arrowroot...............................  82.0 per cent.
     Rice...................................  79.1    "
     Rye meal...............................  69.5    "
     Barley flour..............................  69.4    "
     Wheaten flour............................  66.3    "
     Indian corn meal..........................  64.7    "
     Oatmeal................................  58.4    "
     Peas....................................  55-4    "
     Wheaten bread...........................  47.4    "
     Potatoes................................  18.8    "
     Parsnips................................   9-6    "
     Carrots.................................   8.4    "
     Turnips.................................   5.1    "

   Bread.—Bread is so commonly used as an article of diet, that it has;
attained  to the  dignity of being called " the staff of life."   That most
universally used is made from wheaten flour.   Bread made  with baking
powder is superior to that made by yeast.  In the latter, the " rising " is due
to fermentation, and is carried on at the expense of the nutritive material of
the bread.   This process continues some hours after the bread is baked;.
hence  the indigestibility of hot bread.  Baking powders depend for their
action on the liberation  of gases, without the aid  of fermentation, and
when  properly made are  excellent.   Cake is simply a modification of
bread, being, as a rule, richer and more nutritious.  It is too rich for most
sick persons.  Aerated bread is an excellent article.
   The flour and meal prepared by the New Cereals Company of this
city are very excellent and well worthy of trial.   They contain the entire
nutritive  material  of the grain, it being presented in a pleasant and easily-
                  * Smith, op. cit., p. 99.
                  t Smith.  Foods.  New York: 1873.  p- *S2- 
64
THE  SICK ROOM.
digested form.  This is not the case in the flour that we commonly buy,
there being a deficiency of gluten and the salts.

    Fruits, while  containing but a small amount of nutritive material,
are very agreeable to the palate, and  are partaken of with relish  by the
sick.   They should always  be perfectly  ripe when eaten.   Peaches are
especially  easy of digestion.   The same may said of cherries.    The
furry coat of the peach should always be removed.   Grapes are easy of
digestion, and very pleasant to the palate.   They should be kept cool.
The skin and seeds should never be eaten, in health  or disease.  Water
melon is almost innutritious, and is  apt to disorder  the  stomach and
bowels.  The same is true of other melons, but in a less degree.

    Meats.—Beef is, in most cases, the meat best suited for the sick.   Its
delicacy of flavor, large amount of nutriment, and little fat, making it es-
pecially valuable.  I have already described the best methods of cooking it.
During convalescence, other meats may  be used for the sake of variety.
The relative nutritive qualities of meats and of fish may be judged  by the
following table:*
         FOOD.      Water.    Nitrogen.
      tBeef..........72.50       23-5o

      tMilk (cows)..  87.02        4.48
      Veal..........  63.00       16.50
      Poultry........  74.00       21.00
      Ox liver.......  74.00       18.90
      Tripe.........  68.00       13.20
      Sole...........  86.10        1.90
      Whiting.......  92.90        2.40
      White fish.....  78.00       18.10
      Salmon........  77.00       16.10
      Eel..........   62.00        2.00
      Mackerel......  68.20        3.70
      Pike..........  77.50        3.30

Composition of 1 pound of: Carbon, grains.
      Roast beef,............   3,600
      Boiled beef............   3.240
      Raw beef..............   2,401
      Boiled mutton..........   3,175

                                Ox.
      * Muscular fibre free from fat,  25.0
      Fat... ...................   2.5
      Water.....................  72.5

             In the Food.*
                                 Pig.
      Of 100 nitrogenous..........  13.5
      Of 100 carbonaceous.........  18.5
      Of 100 mineral..............   7.3

    * Smith  Foods, pp. 49, 59, etc.

    t Anderson.   Phosphates  in Nutrition.
Sugar.
Fat.
2.50
7.90
Salts.
 1.50

  .60
 4.70
 1.20
 3.00
 2.40
.00
.40
15.8
 3-8
 4.1
16.4
 0.2
 o-3
 2.9
 5-5
23.8
 6.7
 6.0
Nitrogen, grains.*
      262,
      215.
       175, average of carcass.
       192, with usual proportion of fat.
Fowl.
24.9
  1.4
73-7
 Pig.
24.3
 6.0
69.7
Sheep.	Calf.
23-4	22.7
3-o	2.9
73-7	744
Per cent, stored up.
       Sheep.
        4.2
        9-4
        3-1
Oxen.
 4.1
 7.2
 1.9
London:  1878.  P. xiii, Appendix. 
DIET FOR THE SICK.
65
    In judging of the nutritive value of foods, it is to be understood that
the nitrogenous elements represent flesh-forming, and the carbonaceous,
as starch, sugar and so forth, heat-producing materials.    It is for this
reason that foods rich in nitrogen are better suited to build up the system
after, or supply it during long illness, than those rich in carbon. Physiology
teaches us, however, that some fatty material is of service in aiding this
flesh formation, and the study of disease has taught us their value in cer-
tain lung and blood disorders.
    Beef extracts are, as a rule, of absolutely no value in the sick room.
In the process of preparation the greater part of the nutriment is left
behind, and most of the salts are preserved.  While acting as occasional
flavorers of soups and  additions to regular diet, they are utterly  un-
worthy of reliance as the chief article of food.  When the patient needs
such concentrated  food, as  this is represented to be, it  may be better
made at  home, by the following process: Take four ounces of  beef,
free from fat, and mince very fine.   Upon this, in a bottle or cup,  pour
eight ounces of water in  which is dissolved ten grains of pepsine, and
fifteen drops of hydrochloric acid.   Stir this  well, and  set by the fire,
where it is to remain for six hours, being kept at a temperature of about
ioo° F.  At the end of this time, strain through a coarse strainer, sea-
son, and serve.    If a  little too acid add  more  water and a little (10
grains) of bicarbonate  of soda.   Such a preparation is  made by Mr.
Stephen Darby, of England.   He says that the addition  of a little  fresh
pancreas during the latter part of the process, will  remove the bitter
taste always present.   I  have never found this bitter taste (and I  have
made  and  prescribed  this  fluid  beef  many  times),  unless  too  much
pepsine was added.   A preparation  of meat  known  as  " Flour  of
Beef, " or  " Dessicated Beef," made  by Mr.  Hawley,  of Brooklyn, I
have found to contain  all the nutritive elements of beef, to  keep well,
and have a pleasant flavor and taste.   Beef tea or soup are to be made
by pouring boiling water upon the powder.
    Fish are usually less nutritious  than meats,  but  are a pleasant and
easily-digested food.  They serve as a pleasant change from  meat, dur-
ing convalescence. As a special  brain or fierve food, they are worthless.
" When boiled,' all large fish, with the skin whole, must be placed on the
fire in  cold water; if crimped or cut into slices  or  pieces, in boiling
water;  if whole, it must not be covered with more than two or three
inches of water, or the skin  will crack, and not only spoil the appearance
of the fish, but will diminish the gelatine and gluten it contains, and  in-
stead of eating firm and full of flavor, it will be soft and woolly, especi-
ally if over-boiled' (Soyer). As soon  as a scum  arises from boiling, it 
66
THE SICK ROOM.
should be  removed by the skimmer.   The  addition of a little salt or
vinegar to  the  water improves the flavor of most fish, and renders the
flesh firmer.  *   *   *   'If the fish be whole, as soon as it begins to
boil, remove the cover on one side, and let it simmer gently until done.'
(Soyer).  *   *   *   Fish  for broiling should be well washed in strong
vinegar, wiped  dry  with  a towel,  and floured before putting on  the
gridiron." *
                         RECIPES.

    These recipes  have  been taken  from various sources  and are all
worthy of confidence.  The following marks will designate the authors
from whose works these recipes are taken:

        \ Ellis.  Diseases of Children—Dietary.
        § Economical Cook Book.
        fl Ringer.   Handbook of Therapeutics—Dietary.
        || Miss Dods.  In a lecture quoted in Phil. Med. Times.
        t Miscellaneous.

    The directions should be followed to the letter:

              SOUPS, BEEF TEAS, GRUELS, STEWS, &c.

    Oyster Soup.—To one hundred oysters take one quart of milk, half
a pint of water, four spoonfuls of flour, half a cup of butter, and  one
tea-spoonful of salt, with a very little  cayenne pepper.  Boil and  skim
the liquor off the oysters.  Steam the flour and butter over the tea-ket-
tle until soft  enough to beat to a froth; then stir it in the liquor while
boiling; after which add  the other ingredients, and throw in the oysters,
allowing them merely to  scald, t
    Macaroni Soup.—One ounce and a half of macaroni; a piece of but-
ter, the size of a nut; salt to taste; one quart of stock. Throw the maca-
roni and butter into boiling water, with a pinch of salt, and simmer half
an  hour.  When tender, drain and  cut into thin rings or lengths, and
drop it into the boiling soup.  Stew gently fifteen minutes, and serve.fl
    Beef Soup.—One pound of beef; two quarts of water; one  cup rice
or barley; salt to season.  Put in a soup pot,* let it boil slow and steady
for two hours; in another vessel have a good soup bone, leek, parsley,
one onion, a potato, half a carrot, turnip; let it boil as long as the meat;
when ready to set the table, strain the soup off the bones and vegetables
into the other; stir up when ready to put  on the table;  take two eggs,

    * Cooley's Cyclopedia of Practical Recipes. London : 1864.  Article, Fish. 
RECIPES.
67
beat well in the  soup tureen, and add the soup  gradually so the  eggs
will not curdle.  Always boil bones and vegetables separate, and strain
them, and you will always have good as well as cheap soup, f
   Barley  Soup.—One  pound of shin of beef,  four  ounces of pearl
barley, one  potato, salt and pepper to taste, one  quart and a half of
water.   Put all  the ingredients into a pan, and simmer gently for four
hours.   Strain, return the barley, and heat up as much as required.  A
small onion may be added, if not objected to.fj
   Bread Soup.—One pound of bread, two ounces of butter, one quart
of stock.  Boil the bread with the butter in stock.   Beat the whole with
a  spoon or fork, and keep it  boiling till the  bread and stock are thor-
oughly mixed.  Strain, season with salt, and serve.fl
    Good Nutritious Beef Tea.—Mince one pound of good beef (from
which all skin, fat, &c, have been carefully removed), and pour upon it
in an earthen  jar one pint of cold water.  Stir, and  let stand for  one
hour.  Then place the jar in a moderate oven  for one hour, or stand
the jar in a saucepan  of water and allow  the water to boil gently for an
hour.  To be  exact, the heat to which the beef tea is raised should not
exceed  1800 F.   Strain through a coarse  sieve and allow it to get cold.
When  wanted, remove  every particle of fat from the top; warm up as
much as may  be required, adding a little salt.   Beef tea should, except
in the hottest  weather, be made a day before it is wanted. \
    Tapioca  Soup.—Two ounces and a half of tapioca, one quart of stock.
Put  the tapioca  into cold stock, and  bring it gradually to the  boiling
point, simmer  gently till tender, and serve. f[
    Essence  of Beef.—One pound of gravy beef free from skin and fat,
chop as fine as  mince-meat, one pound in a  mortar  with three table-
spoonfuls of soda water, and soak for two hours.   Then put in a covered
earthen jar with a little salt, cement the edges of the cover with pudding
paste, and tie  a piece of  cloth over the top.   Place the jar in a pot half
full of boiling water, and keep  the pot on the fire for four hours, sim-
mering.  Strain off the liquid essence through a coarse sieve: it will be
about  five or six ounces in quantity.   One tea-spoonful  of  cream may
occasionally be added with advantage to  four ounces of the essence, or
it may be thickened with flour,  arrowroot, or sago, f
    Beef and  Chicken Broth.—One  pound  of good, lean  beef and a
chicken boned should be pounded together in a mortar, a little salt add-
ed, and the whole placed in a saucepan with  nearly three pints  of cold
water.  Stir over the fire until  it boils,  then  boil half an  hour, strain
through a coarse sieve, and serve. %
    Chicken, Veal, and Mutton  Broths.—The  fleshy part of  the knuckle
of veal, a chicken, bones and  all, chopped up; or two pounds of the
scrag end of  neck  of mutton, added to two  pints of  water  with a little
pepper and salt, and boiled two hours and strained, all make excellent
broth.  Pearl barley, rice, or vermicelli, boiled separately till quite  soft,
may be added when either of the broths is heated for use.  All fat must
be always carefully removed by skimming when cold. $ 
68
THE SICK ROOM.
   Stewed Oysters.—Half a pint of oysters, half an ounce of butter, flour,
one-third  of a  pint  of cream, cayenne and salt to taste.   Scald the
oysters in  their own liquor, take them out, beard them, and strain the
liquor.  Put the  butter into a stewpan, dredge in sufficient flour  to dry
it up, add the oyster liquor, and stir it over a sharp fire with a wooden
spoon.   When it boils, add the cream, oysters, and seasoning, and sim-
mer  for one  or two minutes, but not longer, or the oysters will harden.
Serve on a hot  dish,  with croutons  or toasted sippets  of bread.  A
quarter  of a pint of oysters, the other ingredients being in proportion,
make a dish large enough for one person, fl
   Rice Gruel (for Diarrhoea).—Ground rice, two ounces;  cinnamon, a
quarter of an ounce; water, four pints.  Boil for  forty minutes, and  add
a table-spoonful of ofange marmalade. %
   Egg Soup.—The yolks of  two eggs, a pint of water, half an ounce or
so of butter and sugar to taste, beat up together over a slow fire, adding
the water gradually.    When it begins to boil pour backwards and for-
wards between  the jug  and saucepan till quite smooth and frothy.  |
   Water  Gruel.—Oat or corn meal, two table-spoonfuls; water,  one
quart. Boil for ten or fifteen minutes, and  strain, adding salt, and  sugar,
if desired. §
   A Gruel.—Beat up an egg to a froth,  add a wine-glassful of sherry,
flavor with a lump of  sugar,  a strip of lemon-peel, and a little  grated
nutmeg.   Have ready some  gruel, very  smooth  and hot, stir in the
wine and egg, and serve  with sippets of crisp toast.   Arrowroot may be
made in the same way. fl
   Restorative  Beef Essence, i.—Take one  pound  of fresh  beef, free
from fat, chop it up fine, and pour over it eight ounces of soft water, add
five or six drops of hydrochloric acid, and fifty or sixty grains of com-
mon salt, stir it well, and leave it for three hours in a cool place.  Then
pass  the fluid through a hair sieve, pressing the meat slightly, and adding
gradually towards the end of  the straining about two more ounces of
water.  The liquid thus obtained is of a red color, possessing the taste
of soup.   It should be  taken  cold,  a tea-cupful at a time.   If  preferred
warm, it must not be  put  on  the  fire, but  heated in  a covered  vessel
placed in hot water.  Should it be undesirable  for the patient to take
the acid, this soup may be made by merely soaking the minced beef in
distilled water.fl
   Another Beef Essence, 2.—Take one pound of gravy beef,  free from
fat and skin, chop it  up very  fine, add a little salt, and put it into an
earthen jar with a lid,  fasten up the edges with a thick paste, such as is
used for roasting venison in, and place the jar in the oven for three or
four  hours.  Strain through a coarse sieve, and give the patient  two or
three tea-spoonfuls at a time, fi
   Quick Made Beef Tea.—Take any desired quantity of steak from the
top part of the round, as this  has less fat and more juice than  any other
part  of the ox;  remove every  morsel  of fat and divide the meat into
small pieces, cutting across the grain;  put the meat in a dry saucepan 
RECIPES.
69
and allow it to sweat for five minutes over a slow fire, stirring occasion-
ally to prevent sticking.   After sweating for five  minutes  you will find
the meat white in color and surrounded by a very rich, nourishing gravy,
which in case of great exhaustion may be given in this form.  But ordi-
narily you next pour over the meat its weight of cold water, allowing a
pint of water to a pound of beef.   Stir until the water boils ; it must not
boil again, but simmer gently for five or ten minutes until all the juice is
drawn out; then strain carefully into a bowl, and if there is a particle of
fat on the top remove it with a piece of brown, unsized paper., By  this
method you may  take off every star of fat without wasting any of the
beef tea, as is' done when using a ladle or spoon.  In this way you may
have strong beef tea in twenty minutes.
    You  have noticed that I have  said nothing about salt.   It is be-
cause in sickroom-cookery we never allow a grain to be used.   In some
cases of sickness, as for instance typhoid fever, salt is thought to act as
an irritant and, therefore, on our sickroom cookery days, salt is left out of
our list of ingredients.  Of course, the nurse, if the condition of the pati-
ent allow it, may add a pinch when about to give the beef tea.* ||
    Beef Tea with Oatmeal.—Mix two table-spoonfuls of oatmeal, very
smooth, with two spoonfuls  of cold water,  then add a  pint  of strong,
boiling beef tea.   Boil together for five or six minutes, stirring it well
all the time.   Strain it through a sieve,  and serve, fl
    Long Made Beef Tea.—Get two  or  three  pounds of shin of beef;
remove all the skin and marrow from the bone;  cut the meat into small
pieces, and have  the bone broken up.   Take also  a knuckle of veal—
that is, just the knuckle-bone—have it broken up and put into a strong
earthen jar; place the jar in a large saucepan of" boiling water, and tie
the cover down with a piece  of stout brown  paper, using neither salt nor
pepper.  Let it boil  slowly  all day.  AVhen done, the jar will be filled
with meat gravy ;  strain this, and when cold it will be a strong jelly.  In
summer, this may be served cold;  and  in winter,  pour hot water over a
portion, and you have beef tea.  This will keep a week in summer,  in a
cold place, and much longer in winter. ||
    Rice  Gruel.—Ground rice, one heaping table-spoonful; ground  cin-
namon, one table-spoonful;  water, one  quart.   Boil  gently for twenty
minute;;, adding the cinnamon near the conclusion.  Strain and sweeten.
Wine may be added in some cases. §
    Sago Gruel.—Sago, two table-spoonsful; water, one pint. Boil gently
until it thickens, stirring frequently.  Wine, sugar and nutmeg may be
added, according to circumstances. §
    Mutton Broth.—One pound of the scrag end of neck of mutton, two
pints of water, pepper and salt, half a pound of potatoes, or some pearl

   * I  must enter my hearty protest against this wholesale  condemnation of salt in
sickness.  Unsalted food has always seemed to me less easily digested, and is certainly
less palatable  than that which is salted.  Concentrated beef soups are often  salty
enough from the salts of the beef used to make them ; when so, additional salt is not
needed.  Salt soothes rather than irritates mucous  membranes.  Mucus, the natural
soother and lubricator of these membranes, is rich in salt. 
7o
THE SICK ROOM.
barley.  Put the mutton  into a stewpan, pour the water over it, pepper
and salt.  When it boils, skim carefully;  cover the pan, and let it sim-
mer gently for an hour.   Strain it, let it get cold, and then remove all
the fat.  When required for use, add some  pearl barley or potatoes in
the following manner: Boil the potatoes, mash them very smoothly so
that no lumps remain ; put the potatoes into a pan, and gradually add
the mutton broth, stirring it till it is well mixed and smooth ;  let it sim-
mer for five minutes.^]
   Soup."—Take three or four pared potatoes, a thick  slice  of bread,
half a tea-cupful of pearl barley or  rice, a little  salt and pepper, two
quarts of beef tea or mutton broth.   Heat the beef tea  or broth in  a
pan, and when  quite boiling add the rest of the ingredients, except the
pepper and salt, which should be added when nearly done ;  cover the
pan, and let it boil slowly for an hour.   Serve with toasted bread.fl

   Sippets.—On an extremely hot plate put two or three slices of bread,
and pour over them some of the juices of boiled beef, mutton or veal, if
there  be no butter in the dish.  Sprinkle over them a little salt. §
   Rabbit Soup.—Soak a rabbit in warm water, and when qufte  clean,
cut it  in pieces, and put it into a stewpan with a tea-cupful of veal stock
or broth;  simmer  slowly till  done through, then  add a quart  of  water
and boil for an hour.  Then take out the rabbit, pick the meat from the
bones, covering it up to keep it  white; put the  bones back into the
liquor, and simmer for two  hours, skim, strain, and let it cool.  Pound
up the meat in a mortar, with the yolks of two hard-boiled  eggs, and
the crumb of a French roll, previously soaked in milk; rub it through a
tammy,  and gradually add the strained  liquor, and  simmer  for fifteen
minutes.   If liked thick,  mix  some arrowroot with half  a pint of new
milk,  bring it to the boil, mix with the soup, and  serve.  If preferred
thin, have  ready some  pearl  barley and  vermicelli boiled in milk, and
add to the  soup, instead of  the arrowroot.  Serve with little squares of
toast.fl
   Arrowroot Gruel.—Arrowroot, one table-spoonful;  sweet milk, half a
pint;  boiling water, half a pint. To  be sweetened with loaf sugar. §

   Chicken Water.—Take half a chicken, divested of all fat, and  break
the bones ; add to this  two quarts of water, and boil for half an hour.
Season with salt. §
   Calf's Foot Broth.—One calf s foot, three pints of water, one small
lump  of sugar, the yolk of one egg.   Stew the foot in  water, very gently,
till the liquor is reduced to half; remove  the scum, set it in a  basin till
quite  cold, then take off  every particle of fat.  Warm up about half a
pint, adding the butter and sugar, take it off the fire for a  minute or two,
then add the beaten yolk of the egg; keep stirring it  over the fire till
the mixture thickens, but do not let it  boil, or it will be spoiled.^

   Milk Porridge.—Wheat flour, corn meal or oat meal, two table-spoons-
ful ; milk,  one  pint; water, one pint; mix the flour or meal with cold
water, to form  a thin paste;  put the milk and water over the  fire and, 
RECIPES.
7'
when they come to the boiling point, add the  paste, carefully stirring.
Boil at least half an hour. §

    Veal Soup.—A knuckle of veal, two cow-heels, twelve  pepper-corns,
a glass of sherry, and two quarts of water.  Stew all  the  ingredients in
an earthen jar six hours.   Do not open it till cold.   When wanted for
use, skim off the fat, and strain it.  Heat as much as  you require for
use.  Serve very hot.'J
    Good Slock for Soup.—One  pound  of shin of beef, one pound of
knuckle of veal, four white peper-corns, a lump of sugar, one quart of
water.  Simmer gently for six hours, skim well, and strain.fi
    Nourishing Soup.—Stew two  ounces  of the  best  well-washed pearl
sago in a pint of water till it is quite  tender and very thick, then mix it
with half a pint of good boiling cream and the yolks of two fresh eggs.
Blend the whole carefully with  one  quart of  essence of  beef.  The
beef  essence must be heated separately, and mixed while both  are
hot.  A little of this may be warmed up at a time.fi
    French Milk Porridge.—Stir some oatmeal and water together; let
the mixture  stand  to clear, and pour off the water.  Then put more
water to  the meal, stir it well and let it stand till the  next day.  Strain
through  a fine  sieve and boil the water, adding milk while so doing.
The proportion of water must be  small.   With toast  this is a good pre-
paration for weak persons. §
    Vegetable  Soup.—Take  one turnip, one  potato, and one onion, let
them be sliced and boiled in one quart of water for an hour.   Add as
much salt as  is agreeable, and pour the whole upon a  piece of dry toast.
This  forms an  agreeable substitute for animal food,  and may be given
when the latter is inadmissible. §
    Sago Soup.—An ounce and a half of sago, one pint of stock.  Wash
the sago in boiling water.   Put one pint of stock on  the fire, and bring
it to the  boil; add the sago  by degrees, and simmer  till  it is  entirely
dissolved.  When cold, it will form  a jelly.fi
   Rice Soup.—Three ounces of Patna rice, the yolks  of two eggs, half
a pint of cream or new milk, one  quart of stock.  Boil  the  rice in  the
stock, and rub half of it through a tammy, put the Stock  in a stewpan,
add the rest of the rice whole, and simmer gently for five minutes. Have
ready the cream or milk, boiled.  Beat the yolk of the eggs, and mix
them gradually with the cream.   Take the soup off the fire, and add the
cream and eggs, stirring them well together as you mix them.   Heat it
up gradually, but do not let it boil, or the eggs will curdle, and the soup
be spoiled.fi
    Oyster Soup.—Make a little  broth of lean veal or mutton, simmer
with a little celery.  Strain it; put it again on the fire, and when it boils
throw in  the oysters with their liquor, and a trifle of pepper and  salt.
Serve as soon as it comes  to a boil on little squares of toast.  §
    Thickened Milk.—With a little  milk mix smooth  a tablespoonful of
flour and a little salt.  Pour upon it a quart of boiling  milk, and when it 
72
THE SICK ROOM.
 is thoroughly mixed put all  back into  the saucepan, and boil up once,
 being careful not to burn, and stirring all the time, to keep it perfectly
 smooth and free from lumps.   Serve with slices of dry toast.  It is
 excellent  in diarrhoe, and becomes a specific by scorching  the flour
 before mixing with the milk.  §
    Semolina Soup.—Drop an ounce of semolina into one pint of boiling
 stock, and stir constantly to prevent burning.  Simmer gently for half
 an hour.  Season with salt to taste.  Thirst in fevers  can be  assuaged
 by the use of whey, or water acidulated with  currant  jelly or raspberry
 vinegar, or a light infusion of cascarilla, acidulated with a small quantity
 of muriatic acid.fi
    Stewed Eels.—One eel, half a pint of strong stock, two table-spoon-
 fuls of cream, half a glass of port wine, thickening of flour, a little cay-
 enne.  Wash and skin the eel, cut it in pieces about two inches long;
 pepper and salt them, lay them in a stewpan, pour over the stock, and
 add the wine.  Stew gently for twenty-five minutes or half  an hour, lift
 the pieces carefully on to a very hot dish,  and place it  by the fire, strain
 the gravy, stir into the cream sufficient flour to thicken it, mix with the
 gravy, boil for  two  minutes, and add  a little cayenne.  Pour over the
 eels and serve.   Sometimes the  addition of a little lemon-juice is grati-
 fying to the palate.fi
    Chicken and Rice.—Cut up the meat of boiled chicken.  Have ready
 some rice well creed and seasoned with salt, put round a small flat dish
 or vegetable dish, warm up the chicken in a little good gravy,  and serve
 in the middle of the dish with the rice round it.fi


                          PUDDINGS, &c.
   Light Pudding.—Boil very smoothly in new milk one table-spoonful
 ground rice, let it get quite cold, then add two eggs, very well beaten up,
 a lump of white sugar, and, if liked, a dessert-spoonful of brandy.   Line
 a  small tart  dish (sufficient for  one person) with paste, put in the pud-
 ding, and bake quickly.   Serve the moment,  it is ready, for  it falls di-
 rectly.fi
   Custard  Pudding.—Four  eggs beaten  with four table-spoonfuls of
 sugar, a little salt, a tea-spoonful lemon, and a little ground  cinnamon;
 add  one quart  of milk; set it to bake in a moderately quick oven, and
 watch very carefully that it does not whey, t
   Milk for Puddings or Stewed Fruit.—Boil a strip of lemon  and  two
cloves in a pint of milk; mix half a tea-spoonful of arrowroot in a little
cold milk, and add it to the boiling milk; stir it till about the consistency
of cream.  Have ready the yolks of three eggs, beaten up well in  a little
milk.  Take  the  hot  milk off the fire, and as it cools add the eggs  and
a  table-spoonful of orange-flower water, stirring it constantly till quite
cool.  Keep it in a very cool place till  required for use.fi
   Baked Custard Bidding.—Warm half a pint of milk, or a little more;
 whisk two eggs, yokes and whites;  pour  the milk to them, stirring all 
RECIPES.
73
the while.   Have ready a small tart dish, lined at the edges with paste
ready baked.  Pour the custard into the dish, grate a little nutmeg over
the top, and bake it in a very slow oven for half an hour.fi
    Cream for Stewed Fruit.—An ounce and a  half of isinglass boiled
over a slow fire in a pint and a half of water, to half a pint.   Strain and
sweeten, put in a glass of  sherry, and stir in half a pint of good  cream;
stir till cold.fi
   Boiled  Custard Pudding.—Prepare  tha custard as in  the foregoing
recipe.  Butter a small basin that will exactely  hold it, put in the  cus-
tard, and tie a floured cloth over it; plunge it into boiling water, turn it
about for a few minutes, boil it  slowly for half an hour, turn it out  and
serve.fi
   Invalid Cup Pudding.—One table-spoonful of flour,  one egg;  mix
with cold milk, and a pinch of  salt  to  a batter.   Boil or steam fifteen
minutes in  a buttered cup.  Eat with sauce, fruit or plain sugar. §
   Baked Bread Pudding.—Half a pint  of new  milk, a quarter of a
pound of bread crumbs, two eggs, one ounce of butter, sugar to taste.
Boil the milk, and pour it over  the bread crumbs, and let them soak for
half an hour.   Beat the eggs, mix them with the bread crumbs, add the
sugar and butter, and stir  well till thoroughly mixed.  Butter a breakfast
cup  or small pudding mould, fill it a little more than half full with the
mixture, and bake in a moderate oven for about twenty minutes.fi
   Sago Sauce for Boiled or Baked Pudding.—One dessert-spoonful of
sago, not quite half a pint of water, one table-spoonful of sherry, one
tea-spoonful of lemon-juice, and a little lemon-rind; sugar to taste.fi
    Tapioca Cup Pudding.—This is very light, and  delicate for invalids.
An even table-spoonful of tapioca, soaked for two hours in nearly a cup
of new milk.   Stir into this the  yolk of a fresh egg, a little  sugar,  a grain
of salt, and bake in a  cup  for fifteen minutes.  A little jelly may be eaten
with it, if allowed, or a few fresh strawberries. §
   Semolina  Pudding.—One ounce of Semolina, half a  pint of milk,
one ounce  of butter, two  eggs,  sugar to taste.   Heat the milk, and mix
with it the  semolina, sugar, and butter; stir this  over the fire for a few
minutes; then take it  off, and mix with it the eggs, which should be  well
beaten.  Butter a small tart dish, line it with puff paste, put in the pud-
ding, and bake in a slow oven.fi
   Rice Pudding.—Two  ounces of whole  rice, three-quarters of a pint
of milk, one ounce of butter, two eggs,  sugar to taste, flavoring of
lemon-peel.  Let the rice swell in the milk over a slow fire, put in a few
small strips of lemon-peel, stir in the butter, and  then let the  mixture
cool.   Well beat the eggs, and mix with  the rice.   Butter a breakfast
cup or small  mould, fill it three parts full, and bake.   Turn it out on a
white d'oyley, and serve with sauce.fi
    Tapioca Pudding.—One ounce  of  tapioca,  one pint of milk,  one
ounce of butter, two eggs, sugar to taste.   Wash the tapioca, and let it
stew  gently in the  milk  for a  quarter of an hour, stirring it now  and 
74
THE SICK ROOM.
then.   Let it cool.  Mix with it the butter, sugar, and eggs, which must
be well beaten; put it into a small tart dish, and give it an hour's baking
in a moderate oven.fi
    Vermicelli Pudding.—Two  ounces of vermicelli, three-quarters  of a
pint of milk, quarter of a pint of cream, one ounce and a half of but-
rer, two eggs, one ounce and a half of sugar.   Boil the  vermicelli in
the milk till it is tender, then stir in the remaining ingredients (omitting
the cream if that is not obtainable).  Butter a small  tart dish, line with
puff paste, put in the pudding and bake.fi
    Corn  Bread.—Four eggs, two cups sour milk, two cups sweet milk,
three  table-spoonfuls  sugar, one tea-spoonful soda, lard  size of hen's
egg, which must be melted  before mixing, one tea-spoonful  salt, corn-
meal to make batter thin enough to pour.   Bake in hot, quick oven, t
    Panada.—Break up three arrowroot crackers into small pieces; pour
upon  them boiling water and cover close for a minute, then  add a  tea-
spoonful of white sugar and a little milk.  It is an excellent breakfast or
supper for an  invalid or a child.   Instead of the milk, the  juice of a
lemon may be squeezed in and another teaspoonful of sugar added.  §


                     MEAT, FOWL  AND FISH.

    Broiled  Tenderloin.—This,  is highly  enjoyed  when the  patient  is
becoming convalescent.  Cut out the round piece from  the  inside of a
sirloin stake, broil it quick over a bright fire, turn it, with its gravy, upon
a piece of freshly made toast, sprinkle with salt and pepper, but no but-
ter ; place between two hot plates, and serve directly. A tender mutton
chop, or half the breast of a chicken  may be served the same way, only
the chicken will require longer and somewhat slower cooking. §
    Minced Foivl and Egg.—Cold roast fowl, a  hard boiled egg, salt,
pepper, or cayenne, to taste; three table-spoonfuls of new milk or cream,
half an ounce of butter, one table-spoonful of flour, a tea-spoonful of
lemon-juice.   Mince  the fowl,  and  remove all  skin and bones;  put
the bones, skin, and trimmings  into a  stewpan, with one small onion,
if  agreeable to the patient, and nearly half a pint of water;  let  this
stew  for an hour, then strain the  liquor, chop the  egg small,  mix
with the fowl, add salt and pepper, put  in  the gravy and other ingredn
ents, let the whole just boil,  and serve with sippets of toasted bread.fi
    Restorative.—Take two calf's feet, one quart of water, and one quart
.of new milk; place all in a close-covered jar, and bake three hours  and
a half.  When cold, remove the fat.  Any desired flavor may be  given
by adding  lemon peel,  cinnamon, or mace, while baking.   Add  sugar
afterwards. §
    Fowl and Rice.—A quarter of a pound of rice, one pint of stock or
broth, one  ounce  and  a half of butter, minced  fowl, egg,  and  bread
crumbs.  Put the rice  into the cold stock or broth, let it boil very gently
for half an hour, then  add the butter and simmer it till quite dry and  soft.
When cold, make into  balls, hollow  out the inside  and fill  them with 
RECIPES.
75
mince;  cover  with  rice,  dip the balls into egg,  sprinkle with bread
crumbs, and fry a nice brown;  a little cream stirred into the rice before
it cools improves it very much.fi

   Panada.—Take the crumb of a penny roll, and soak it in milk for half
an hour, then squeeze the milk from it;  have ready an equal quantity of
chicken or veal, scraped very fine with a knife; pound the  bread crumbs
and  meat  together in a  mortar.  It may be cooked either mixed with
veal or chicken broth, or  poached like  an egg, by taking it up in  two
tea-spoons, in pieces the shape  of an egg, after seasoning  it.   Serve  on
mashed potato.fi

   Plain  Chicken Fricassee.—Cut up the chickens, and wash well in salt
water; put them in a pot with enough  cold water to cover them;  add
(for two chickens) half a pound of salt pork, cut up in thin strips; cover,
and let heat very slowly, and then stew  until the fowls are tender. Cook
slowly—if they cook fast they toughen and shrink.  When almost done,
add, if desired, a chopped onion or two, some parsley and pepper; cover
closely again, and, when heated to boiling, stir in slowly a tea-cupful of
milk containing two  beaten eggs and two tea-spoonfuls of flour; boil up
again, and add one table-spoonful good butter.   Arrange the chicken
nicely in a deep dish, pour the gravy over, and serve hot.  t

   Baked Soup.—One  pound of lean  beef, one  ounce of rice, pepper
and salt to taste,  one pint and a half  of water.   Cut  up the  meat into
slices, add the rice and seasoning, place all in a jar with the water, cover
it closely, and bake for four hours.   Pearl barley  may be substituted for
rice, if preferred.fi
    To Prepare  an  Egg for  an Invalid.—Beat an egg until very light,
add seasoning to the taste, then steam until thoroughly warmed through,
but not hardened; this will take  about  two minutes.  An egg prepared
in this way will not distress very sensitive stomachs, t

   Raw Meat.—Lean meat (beef, fowl, or mutton)  minced  finely, or
grated, one part, and pure white  sugar, two parts, thoroughly mixed in
a mortar.   One tea-spoonful every two, three, of four hours. %

   Broiled Beefsteak or Chop.—Take a piece of the best steak, and beat
it first with a rolling-pin—never use  a sharp substance, as the back of a
knife, for that will cut the fibre, while the object  of the round-pin is to
thoroughly soften the fibre without breaking it, thus retaining all the
juice.  Put the meat on a broiler and keep it over a clear fire from from
seven to ten minutes; if  over gas, once turning is sufficient, but if over
coal turn  several times.   Have  ready a plate as hot as possible; place
the steak  on it, with a pinch of salt, a little pepper, and a morsel of but-
ter.   In five minutes the salt and butter will have drawn out a rich gravy,
which will be delicious as well as sustaining.  A chop should be cooked
in exactly the same  manner, except that seven minutes on the broiler
will  suffice.  This  is, of course, only suited  for convalescence  and
chronic illness, never for acute sickness. || 
76
THE SICK ROOM.
                             CREAMS.

    Rice Cream, i.—To a pint of new milk add a quarter of a pound of
ground rice, a lump of butter the size of a walnut, a little lemon-peel, and
a table-spoonful of powdered sugar. Boil them together for five minutes,
then add half an ounce of isinglass which has been dissolved, and let the
mixture cool.  When cool, add half a pint of good cream whisked to a
froth, mix altogether, and set it for a time in a very cool place, Or on ice;
when used, turn it out  of the basin into a dish, and pour fruit juice round
it, or some stewed apple or pear may be served with it.fi

    Milk Toast.—This  is a favorite dish with nearly all sick people when
they are getting well.   Cut stale baker's bread in thin slices, toast a nice
brown, and lay then in a deep dish.  Meanwhile boil some milk, salt to
taste, and pour it over the toast, cover, and serve quick.  For an invalid
no butter should be put in the milk. §

    Rice  Cream, 2.—A quarter of a pound of whole rice, well creed in
milk, and put in  a  sieve to  drain and cool; mix with the rice a gill of
good cream whisked to a froth, and add a wine-glassful of sherry, a little
powdered sugar, and a tea-spoonful of lemon-juice.fi

    Milk and Suet.—Chop one ounce of calves' suet very fine, tie lightly
in a muslin bag, and boil slowly in a quart of new milk;  sweeten  with
pounded loaf sugar.   This is an imitation of goat's milk. |

    Rice Milk.—Three table-spoonfuls  of rice, one  quart of milk, wash
the rice and put into  a saucepan  with  the milk, simmer till the rice is
tender, stirring now and  then, and sweeten.  Tapioca, semolina, vermi-
celli, and macaroni, may be  similarly prepared. \

    Fruit  Cream.—Apples,  gooseberries,  rhubarb,  or  any fruit.   To
every pint of pulp add one pint of milk or cream, sugar to taste.   Pre-
pare the  fruit as for stewing, put it in a  jar, with two  table-spoonfuls of
water, and a little good moist sugar.  Set this jar in a saucepan of boil-
ing water, and let it boil till the fruit  is  soft  enough to mash.   When
done enough, beat it to a pulp, work this  pulp  through a colander, and
to every pint stir in the above proportion of milk or cream.   Of course
the cream is  preferable, if obtainable.   Sweeten and serve  in  a glass
dish.fi
    Milk and Eggs.—Beat up a fresh egg, with a grain of salt, pour upon
it a pint of boiling milk, stirring all the  time.  Serve hot, with  or with-
out toast.  §

    Italian Cream.—One pint of cream, one-half pint  of milk, one cup
of sugar, one  cup of wine, to be whipped  one-half hour;  one-half box
gelatine, dissolved in one-half pint of water; mix with other ingredients.
Use milk in place of cream, if it cannot be obtained, t

    To keep Milk from turning sour.—Fifteen  grains of bicarbonate of
soda to a  quart of milk hinders  its turning sour.fi 
RECIPES.
77
                    VEGETABLES AND FRUITS.
   Rice and Apple.—Boil about three table-spoonfuls of rice in a pint
and a half of new milk, and simmer, stirring it from time to time, till the
rice is quite tender. Have ready some apples, peeled, cored, and stewed
to a pulp, and sweetened with a  very little loaf sugar.  Put the rice
round  a plate, and the apple  in the middle, and a little cream served
with it separately, if liked.fi
   Invalid Apple Pie.—Slice up one or more nice, tart apples in a saucer,
sweeten with white sugar, and cover with  a moderately thick slice of
bread buttered slightly on the under side.  When the bread is browned,
the apples, if of a tender kind and  thinly sliced, will be done. §
   Rice Milk.—Three table-spoonfuls of rice, one quart of milk.  Wash
the rice, put it into a  saucepan with the milk, and simmer gently till the
rice  is tender, stirring it  now  and then to prevent the milk burning.
Sweeten a little, and  serve with a cut  lemon, black-currant jam, or ap-
ples stewed.fi
    Rice Cakes.—Take one cup of cold, boiled  rice, one pint  of flour,
one  tea-spoonful of salt, two  eggs beaten lightly, and milk enough to
make this a thick batter;  beat all together well and bake on a griddle, t
    Apple and Rice.—Take three small apples, peel and halve them, take
out the cores, put them into a stewpan with about half an ounce of but-
ter, and strew over  them a little white sifted sugar.   Stew them  very
gently till tender, taking care  not to break them.   Boil the rice with the
milk and a little sugar till quite soft;  and when done, dish it with the
apples on the top of  it, and a little cream served with it separately.fi
    Rice Muffins.—Take  one cup of cold, boiled rice, one pint of flour,
two eggs, one quart of milk, one table-spoonful of butter, and one table-
spoonful of salt; beat very hard and bake quickly, t


                             JELLIES, &c.

    Restorative Jelly.—Take  of pure  isinglass, one ounce;  gum arabic
(powdered), one quarter  ounce; sugar, two ounces; port wine, half a
pint (imperial); cloves, half a dozen ;  half a tea-spoonful of pure lemon-
juice or  extract of  lemon.     Directions.—First put in a pitcher one
ounce  of isinglass; add to it one quarter of an ounce of  gum arabic
(powdered); next, two ounces of sugar, with half a  tea-spoonful of
lemon-juice and half a dozen of cloves.  Pour over this mixture half a
pint of best port wine, which should be  properly measured,  as bottles
are not made  to contain an imperial pint.  Then  cover  the pitcher
closely with brown  paper, in  order to retain the strength of the  port
 wine, and set  it aside for an hour to let the ingredients soak.  Some
 persons allow the mixture to stand over night, but  it is apt to lose its
 freshness and  become musty.  When the hour  is up, put  the pitcher
 into a  large saucepanful  of boiling water, and stir until the  isinglass is
 completely dissolved; then allow the water to  boil violently for a  few 
**'■
y8                       THE SICK ROOM.

moments, and strain the jelly into  a flat dish.   When cold, the  jelly
should be cut into dice, so that it can be served to a patient and eaten
by  him  without any  exertion.   Russian isinglass should  be  invari-
ably preferred, although it may be  made with the sheet.  By taking a
square of this jelly, pouring hot water over it, and allowing it to stand,
it will, when cold, make a delicious drink for invalids. ||

   Milk Blancmange.—Quater of a  pound of loaf sugar, one quart  of
milk, one ounce  and a half of isinglass.   Put all the ingredients into a
lined saucepan, and boil  gently until  the  isinglass is dissolved.  Keep
stirring it over the  fire for  about ten minutes.  Strain it through a fine
sieve into a jug, and when nearly cold pour it into an oiled mold.   Turn
it out carefully when required for use.fi

    Tapioca Jelly.—Tapioca, two table-spoonsful;  water, one pint.  Boil
gently for  an  hour, or until  it assumes a jelly-like appearance.   Add
sugar, wine, and nutmeg, with lemon-juice to suit the taste of the patient
and the nature of the case. §
    Jelly of Irish Moss.—Irish Moss, half an ounce; fresh milk, a  pint
and a half.  Boil down to a pint.  Remove any sediment by straining,
and  add the proper quantity of sugar and lemon-juice, or  peach-water,
to give it an agreeable flavor.  §

   Isinglass Jelly.—Isinglass, one roll.   Boil in one pint of water  until
it is dissolved.   Strain, and add one pint of sweet milk.  Put it again
over the fire, and  let it just  boil up.   Sweeten it with loaf sugar, and
grate nutmeg upon  it.  When properly made, it resembles custard.  §

   Rice  Blancmange.—A quarter of a pound of ground rice, two ounces
of loaf  sugar,  one  ounce  of butter, one quart of milk,  flavoring  of
lemon-peel.   Mix the rice to a smooth batter with a little milk, and put
the  remainder into  a saucepan with  the  butter, sugar  and lemon-peel.
Bring the milk to a boiling point, stir in the rice.   Let it boil for ten
minutes, or till it comes away from the saucepan.   Grease a mold  with
salad oil, pour in  the rice, let it get perfectly cold, and turn out.fi

    Wine Jelly.—To one and a-half  boxes  Cox's gelatine, one pint cold
water, juice of three lemons, grated rind of two;  let stand an hour,  then
add two pounds loaf sugar, three pints boiling water, boil five minutes;
just before  straining in  flannel bag stir in one of pint sherry wine, six
table-spoons best brandy, t

   Bread Jelly.—Steep stale  bread in boiling water and pass  through a
fine sieve while hot.  It may be flavored and taken alone, or mixed and
boiled with milk. %
    Chicken Jelly.—Half a  raw chicken pounded  with a mallet, bones
and  meat together.  Cold  water to cover it  well.   Heat slowly in a
covered vessel and  let it simmer until the meat is in white rags, and the
liquid reduced one  half; strain, and  press through a coarse cloth, add a
little salt, return to  the fire and simmer five  minutes longer, skim when
cool.  Wine or seasoning may be added with the salt,  if desirable. % 
RECIPES.
79
   Arrcnuroot Blancmange.—Two table-spoonfuls of arrowroot, three-
quarters of a pint of milk, lemon and sugar to taste.  Mix the arrowroot
with a little  milk to  a smooth batter;  put the  rest of the  milk on the
fire,  and let it boil,  sweeten and  flavor it, stirring  all the time, till it
thickens  sufficiently  to come from  the saucepan.   Put it  into a mold
till quite  cold.fi
    Calf's Fool Jelly.—Take two calf's feet, and add to them one gallon
of water; boil down  to one quart; strain, and when cold,  skim off the
fat; add  to this the white of six or eight eggs well beaten, a  pint of wine,
half a pound of loaf sugar, and the juice of four lemons, and let them be
well mixed.  Boil the whole for a few minutes, stirring constantly, and
then strain through  a flannel.  The wine may be  omitted  or added,
according to choice.  §

   Iceland Moss Jelly.—One handful of Iceland moss, well  washed; one
quart of boiling water; the juice of two lemons ; one glass  of wine; one
quarter of a tea-spoonful of cinnamon.  The moss should be soaked an
hour in a little cold water, then stirred  into the  boiling water, and left to
simmer  till  dissolved.  Sweeten, flavor, and strain into molds.  This
jelly is very nourishing and is specially useful in chronic colds. |

   Isinglass Jelly.—Isinglass,  one  ounce; pure  gum  arabic, half an
ounce; white  sugar-candy, one ounce; port wine, half a pint; a little
nutmeg  grated.   These should be put in a jar to stand twelve hours,
covered  well to  prevent  evaporation, then  placed in  a saucepan with
sufficient water to simmer till the contents are melted; the whole should
be stirred, then allowed to stand to cool.  A tea-spoonful is reviving in
cases of extreme exhaustion. $

   Bread Jelly.—Take the crumb  of a loaf, break it up,  pour boiling
water over it and leave it to soak for three hours.   Then strain off the
water, and add  fresh; place the mixture on the fire, and let it boil till it
is perfectly smooth;  take  it out, and, after pressing out the water, flavor
with anything  agreeable;  put  it into a mold, and turn it out when re-
quired for use.fi

   Blanc Mange—Excellent and Easy.—One quart of milk, one ounce
gelatine, sugar to sweeten to taste;  put it on the fire, and keep stirring
until it is all melted,  then  pour it into a bowl and  stir it  until it is cold;
season with vanilla;  pour it into a mold, and put it into a cool place to
stiffen, f
   Arrowroot Wine Jelly.—One cup of boiling water, two tea-spoonfuls
of arrowroot, two tea-spoonfuls of white sugar, one dessert-spoonful of
brandy or three  of wine; wet the arrowroot in a little cold water and rub
smooth, then stir into the hot water,  which should be  on the fire and
boiling at the time, with the sugar already melted in it.   Stir until clear,
boiling all the time, and  add  the wine or brandy.  Wet a cup in cold
water and pour the jelly in to form.  A tea-spoonful  of lemon-juice may
replace  the  wine  or brandy.   The jelly can then be  eaten with sugar
and cream. % 
8o
THE SICK ROOM.
   Muttoti Jelly.—Six shanks of mutton, three pints  of water, pepper
and  salt to taste, half a pound of lean beef, a crust of bread toasted
brown.   Soak the shanks in water several hours, and scrub them well.
Put the shanks, the beef and other ingredients into a saucepan with the
water, and let them  simmer very gently for five hours.  Strain  it, and
when cold take off the fat.  Warm up as much as is wanted at a time.'


                             DRINKS.

   A Very Pleasant Drink.—Put a tea-cupful of cranberries into a cup
of water, and  mash  them.    In the meantime, boil two quarts of water
with one large spoonful of corn or oat meal or a bit of lemon-peel; then
add the cranberries.  As much fine sugar as shall leave a smart flavor of
the fruit, and  a wine-glassful  of sherry.  Boil the whole gently fifteen
minutes, and strain. §
   Another.—Boil an ounce and a half of tamarinds, three ounces of
cranberries, and two  ounces of stoned raisins, in three pints of water, till
the water is reduced  to two pints.  Strain and add a bit of lemon-peel,
which must be removed in an hour, as it gives a bitter  taste,  if left  too
long. §
   Sage Tea.—Dried leaves of sage, half an ounce; boiling water, one
quart.   Infuse for half an hour, and strain.  Add sugar and lemon juice
as required by the patient.   Balm and other teas are made in the same
manner.   The  above form  agreeable and useful drinks in fevers, and
their diaphoretic powers may be increased by adding a little sweet spirits
of nitre. §

   Barley Water.—To a table-spoonful  of pearl  barley, washed in cold
water, add two or three lumps of sugar,  the rind of one lemon, and  the
juice of half a lemon.  On these pour a quart of boiling  water, and let
stand for seven or eight  hours.   Strain it.  The barley should never be
used a second time.   Half an  ounce  of isinglass may be boiled in the
water.fi

    Vinegar Whey.—Milk, one pint;  vinegar, one table-spoonful.   Boil
for a few minutes, and separate the curd. §
   Orange Whey.—Milk, one pint; the  juice of an  orange with  a por-
tion  of the  peel.  Boil the  milk;  then  put the orange to it,  and let  it
stand till coagulation takes place.  Strain. §
   Lemonade  i.—Well rub two or three lumps of sugar  on the rind of
a lemon, squeeze out the juice, and add to  it half a pint or a pint of
cold or iced water, or better still, one or two bottles of soda-water.fi
    Whey with Tamarinds.—Milk, boiling, one  pint;  tamarinds,  two
ounces.  Boil them together till coagulation takes place. §
    Wine Whey.—Milk, two-thirds of a pint;  water, one-third of a pint;
Madeira, or other wine, one gill; sugar, one dessert-spoonful.   Place
the milk and  water together in a deep pan,  and when it begins to boil
pour in  the wine and the sugar, stirring assiduously whilst it boils, for 
RECIPES.                           81
twelve or fifteen minutes.   Lastly, strain through  a  sieve.   It  may be
drank either cold or tepid, a wine-glassful at a time. §
    Effervescing  Lemonade.—Squeeze  two large lemons, and add a pint
of spring water to the juice, and three or four lumps of white  sugar.
When  required  for use, pour  half of it into a tumbler, and add  half a
small tea-spoonful of carbonate of soda;  stir, and drink while efferves-
cing.fi
    Lemonade  z.—The juice of four  lemons,  the  rinds of  two,  half a
pint of sherry, four eggs,  six ounces of loaf sugar, one pint and  a half
of boiling water.  Pare the lemon-rind thinly, put it into a jug with the
sugar, aud pour the boiling water on it.   Let it cool, and then strain it,
and add the wine, lemon-juice, and  eggs, previously  well  beaten and
strained.   Mix all well together, aud it is ready for use.']

    Lemonade  3.—Pare the rind of three lemons as thin as possible, add
one quart of boiling water and a  quarter of an  ounce of isinglass.  Let
them stand till next day covered, then squeeze the juice of eight lemons
upon half a pound of lump sugar; when the sugar is dissolved, pour the
lemon  and water upon it,  mix all well together, strain it, and it is ready
for use.fi
    Tamarind  Whey.—Two table-spoonfuls of tamarinds stirred  into a
pint of boiling milk, and strained.  A quarter of an  ounce of cream of
tartar may be  similarly treated, and a little sugar-candy added.  This  is
laxative. |
    Milk, Rum, and Isinglass.—Dissolve in a little hot water  over the
fire a pinch of the best isinglass; let it cool, and mix a dessert-spoonful
of rum with it in a tumbler, and fill up the glass with new milk.fi

    Sherry  or  Brandy and Milk.—To one table-spoonful of brandy, or
one wine-glassful of sherry, in a bowl or cup, add  powdered sugar and
a very little nutmeg to taste.  Warm a  breakfast-cupful  of new milk,
and pour it into a spouted jug; pour the contents  from a height over
the wine, sugar, etc.   The milk must not boil.*\\
    Mulled Wine.—Boil some  spice, cloves, nutmeg, cinnamon, or mace,
in a little water, just to flavor the wine; then add a wine-glassful of sherry
or any other wine, and some sugar, bring it to a boiling point, and serve
with sippets of toast.  If claret is used, it will require a good deal of
sugar.   The vessel for boiling the wine should be scrupulously clean.fi

    Egg and Sherry.—Beat up with a fork an egg  till it froths, add a
lump of sugar and  two table-spoonfuls of water; mix well, pour in a 4
wine-glassful of sherry, and serve before it gets  flat.  Half  the quantity
of brandy may be usedi nstead of sherry.fi

    Milk, Egg, and Brandy.—Scald some  new milk, but do not let it boil.
It ought to be put into a saucepan of boiling water, in  a jug, and scald-
ed very gradually.  When the surface looks filmy,  it  is  sufficiently done,
and should be put  away in a cold place, in the  same vessel.   When
quite cold, beat up  a fresh egg, with a fork, in a  tumbler, with a lump 
82
THE SICK ROOM.
of sugar;  beat  quite to a  froth, add a dessert-spoonful of brandy, and
fill up the tumbler with scalded milk.fi
   Egg and  Wine.—One  egg, one table-spoonful  of sugar and half  a
glass of cold water, one glass of sherry, and a very little grated nutmeg.
Beat the egg  to a froth with a table-spoonful of cold water.  Make  the
wine and  water hot, but not boiling; pour it on the egg, stirring all the
time.  Add sufficient sugar to sweeten, and a very little  nutmeg.  Put
all into a lined saucepan, set it on a gentle fire, and stir it one way till it
thickens, but do not  let it boil.  Serve in a glass with  crisp biscuits or
sippets of toast.fi
   Orgeat.—Two ounces of sweet  almonds blanched, aud a few drops
of bitter almond flavor.  Pound with a little orange-flower water into a
paste, and rub up with a pint of milk and a pint of water, until an emul-
sion is formed.   Strain and sweeten. %
   Jelly Water.—A dessert-spoonful of wild cherry or blackberry jelly ;
one goblet of ice-water.  Beat up well.   Excellent in fever as a drink, j

   Arrowroot Drink.—Mix two  tea-spoonfuls of arrowroot in about
three  table-spoonfuls of cold water, then  pour in  about  half a pint of
boiling  water;  when well  mixed, add  by degrees, half a pint  of cold
water, stirring all the time, so as to make it perfectly smooth.  It should
be about the consistence of cream; if too thick, a little  more water may
be added.  Then pour in two wine-glassfuls of sherry or one of brandy,
add sugar to  taste, and give it to the patient in a tumbler.   A lump of
ice may de added, if allowed.fi
   Barley  Water.—Pearl  barley,  two   ounces;  boiling water,  two
quarts;  boil to  one-half and strain.  A  little lemon-juice and sugar may
be added, if desirable.  To be taken freely in inflammatory diseases. §
   Rice water.—Rice, two ounces; water,  two  quarts;  boil an hour and
a half, and add sugar and nutmeg.  Rice when boiled for a consider-
able time becomes a kind of jelly, and,  mixed with milk, is an excellent
diet  for children.  It has  in some measure  a constipating property,
which may be increased by boiling the milk. §

   Lemon Water.—Put two slices of lemon, thinly  pared, into a bowl,  a
little bit of the peel and a little sugar.   Pour in a pint of boiling water,
and cover it close two hours. §
   Nutritious Coffee.—Dissolve a little  isinglass in water, then put half
an ounce of freshly ground coffee into a saucepan with one pint  of new
milk, which should be nearly boiling before the coffee is added, boil both
together for three minutes; clear it by pouring some of it into a  cup
and dashing it back again, add the isinglass, and leave it to settle on the
hob  for a few minutes.  Beat up  an egg in a breakfast-cup, and pour
the coffee into it; or, if preferred, drink it without  the egg.fi

   Barley Coffee.—Roast one pint of common barley in the same way
in which coffee is roasted.   Add two large spoonfuls of this to  a quart
of boiling water; boil five minutes. Add  a little sugar. § 
RECIPES.
83
    Crust  Coffee.—Toast slowly one  or two slices of brown or white
bread, pour boiling water over it, and drink hot or cold, according to
preference. §
    Milk and Isinglass.—Dissolve a little isinglass in  water, mix it well
with half a pint  of  milk, then boil the milk, and serve with or without
eggs, as preferred.fi
    Milk and Cinnamon Drink.—Boil in one pint of new milk sufficient
cinnamon to flavor  it pleasantly, and sweeten with white sugar.   This
may be taken cold with a teaspoonful  of brandy, and  is very good in
cases of  diarrhoea.    Children may  take  it, milk-warm, without the
brandy.fi
    Demulcent Drink.—Take a pinch of isinglass, and  boil  it in half a
pint of new milk, with half a dozen bruised sweet  almonds and three
lumps of sugar.fi
    Arrowroot and Black-Currant Drink.—Take two large spoonfuls of
black-currant  preserve, boil it in a quart of water, cover  it, and stew
gently for half an hour, then strain it, and set the liquor again on the fire;
then mix a tea-spoonful of arrowroot in cold water, and pour the boiling
liquor upon it, stirring meanwhile; then let it get quite cold.fi

    White  Wine Whey.—To half a pint of boiling milk  add one or two
wine-glassfuls of sherry; strain through a fine sieve, sweeten with sifted
sugar, and serve.fi
    Barley Water.—Wash two ounces of pearl  barley with cold water,
then boil  for five minutes in some  fresh water and throw both waters
away.  Then pour on a pint and a half of boiling water and boil down
one-half.   Flavor with thinly cut lemon-rind and add  sugar to taste.  A
little isinglass may be added if desired. %

    Caudle.—Beat up an egg to a froth, add a wine-glassful of sherry,
and half a pint of gruel, flavor with lemon-peel and nutmeg, and sweeten
to taste.fi
    Another Caudle.—Mix well  together  one pint of cold gruel with a
wine-glassful of good cream, add a wine-glassful of sherry and a table-
spoonful of noyau, and sweeten with sugar-candy.fi

    Egg and Brandy.—Beat up  three eggs to a froth  in four ounces of
cold spring water, and pour in  four ounces of brandy, stirring all the
time.  A portion of this may be given at a time.fi

    Milk and Gelatine or Isinglass.—Half an ounce of gelatine to be
dissolved in half a pint of hot barley water; an  ounce  of powdered
loaf sugar added, and a pint of new cow's milk poured in, makes an imi-
tation of asses' milk.   Dissolve a little isinglass  in water, mix  well with
half a pint of new milk, boil,  and add sugar or not  as desired. $

    Rice Water.—One  ounce of well-washed  Carolina  rice.   Macerate
for three hours at a gentle heat in a quart of water,  and then boil slowly
for an hour and strain.   It may be sweetened  and flavored with a little 
84
THE SICK' ROOM.
lemon-peel.   Useful  in  diarrhoea, Sec,  when  the  flavoring is best dis-
pensed with, and a little Cognac added. $
   Beef Tea  and Cream Enema.—Mix four  or five ounces of  strong
beef tea, one ounce  of cream, and  half an  ounce of brandy  or one
ounce of port wine.fi
   Apple Water.—Roast two tart apples until they are soft; put them
in a pitcher, pour upon them a pint of cold water, and let it stand in a
cool place an hour.   It is used in fevers and eruptive diseases, and does
not require sweetening. §
   A Refreshing Drink in Fevers.—Put a little sage, two sprigs of balm,
and a little sorrel into a stone jar, having  first washed and dried them.
Peel thin a small lemon, slice it, and put a small  piece of the peel
in; then pour in three  pints of boiling water.   Sweeten, and cover it
close. §—[This must never be used in kidney disease of any kind. k.J 
INDEX.
                  A.
Acid steam-bath,  Dr.  Nevin's, 38.
Air, motion of, in room, 2.
Ammonia for blistering, 43.
Anodyne plasters, 43.
Arrangement of room, 13.
Arrowroot, 63.
Arterial Haemorrhage, 53.

                  It.
Baking,  54-56-
Baths, 28-41.
  Classification of, 29.
    General  Hot Bath, 29, 31.
    Hot Foot Bath, 29, 31.
    Cold Foot Bath,  29, 31,  32.
    Hip or Sitz Bath, 29, 32.
    Sponge Bath, 17,29,32.
    General Cold Bath, 29, 33.
    Sea Salt Bath, 29, 34.
    Medicated Baths, 33.
    Douche, 29,  34.
    Shower Bath, 29,35.
    Cold and Hot Pack, 29,  35, 36.
    Vapor Bath,  29,  36, 39.
    Hot Air Bath, 38.
    Electric Bath, 39.
Beaumont, Dr., experiments  of, 58.
Beds, 14.
Bedding, 16, 17.
Bed pans, 20.
Bed sores, 17.
Bed table, 59, 60.
Belladonna plasters, 43.
Belladonna fomentations, 46.
Beef,  53,64.
Beef extracts,  65.
Beef tea, 55.
Beef, powdered, 65.
Bleeding, how to stop,  52.
Blisters, 43.
Blood, injections of, 49.
Bottles, specially for poisons,  35
Boiling, 54, 57.
Bread, 63.
Bread and milk poultice, 40.
Broiling, 54, 56.

                  C.
Carpets,  13.
Castor oil injections, 47.
Chamomile fomentation, 46.
Changes of bedding, 16.
Charcoal poultices, 41.
Childbirth, articles needed at, 52.
Chicken soup, 56.
Colds, how broken by baths,  30.
Cold feet, treatment of,  32.
Cold bath,  33.
Cold sponging, 17, 32.
Cold pack,  29, 35.
Congestion of kidneys,  42.
Congestion, hypostatic,  25.
Contagion, 23.
Convalescents, diet of,  62.
Cooking, methods of,  54.
Corn meal poultice, 40.
Croup, 37, 45- 
86
INDEX.
Croup-kettle, 45.
Cubic contents of sick-room, 1.
Cups, wet and dry, 43.
Curtains,  13.


                  D.
Defibrinated blood, injections of,  49.
Diet for the sick, 54.
Diet for convalescents, 62.
Diphtheria, 45.
Disinfection, rules for, 27.
Douche, the, 34.
Draw-sheet, 15.
Drinking ducks, 18.
Drinks in fever, 25.
Droppers,  18.
Dry cups,  43.
Dusting,  13,

                  E.
Ears, care of, 50, 51.
Earth closets,  24.
Eggs,  62.
Electric-bath, 39.
Enemas, 47.
Eruptive fevers, pack  in, 36.

                  F.
Fats, 58.
False croup, cold sponging in, 32.
Felons, 40.
Fever, 21.
Fever drinks,  25.
Fever thermometer, 21.
Fish, 65,  66.
Flannel for joints, 45, 46.
Fluid foods, objections to, 55.
Flowers in sick-room, 14.
Flaxseed-meal poultice, 40.
Fomentations, 46.
Fountain syringe,  51.
Foot-bath, 31,  32.
Fruit,  64.
Frying, 54.

                  G.
Glycerine in poultices, 41.
Graves' fever drink, 26.
                  II.
Haemorrhage, how to stop,  53.
Hip-bath, 32.
Hop fomentation, 46.
Hot pack, 35, 36.
Hot air bath,  38.
Hot foot-bath, 31.
How to serve food,  59.
Hypostatic congestion, 25.

                  I.
Inflammation of kidneys, 42.
Infusing,  54,55.
Infection, 23.
Ingredients of baths, 40.
Injections, 47, 53.
Irritant plasters, 42.

                  J.
Joints, how to swathe, 45, 46.

                  K.
Kidneys, congestion of,  42.
Kidneys, inflammation of, 42.
Kidney disease, baths in, 37.


Leeches, 44.
Light, 12.
Linseed-meal poultice, 40.
Linen, bed and body, how to change, 16.
List slippers,  13.
Litmus paper, 23.
Liquid beef injections, 49.
Low ceilings, 1.

                  M.
Martin, Sir J. Ranald, on food, 60, 61.
    "      "    "    " ventilation, 10,11.
Massage, 47.
Mattresses, 14.
Meats, 64.
Meat injections, 49.
Mechanical plasters, 43.
Medicated baths, 33.
     "    poultices, 41.
     "    enemas,  48. 
INDEX.
S7
Methods of cooking, 54.
Milk, 62.
Motion of air in room, IO.
Mustard plasters,  42.
Mutton, 56, 64.

                   N.
Nasal injections, 51.
Nevin's acid steam-bath, 38.
Nightingale, Miss, on cooking,  61.
Night crowing of  infants,  32.
Nitric acid for tests, 23.
Noises  from street,  I.
Nutritive injections, 50.
Nurses, rules for,  24.

                   O.
Odors in room, 17.
Oil-silk jacket,  46.
Onion poultice, 41.
Oysters, 56.

                   P.
Pack, hot and cold, 35, 36.
Parlor beds,  16.
Parker, Prof. Willard, on fresh air, 10.
Perfuming room,  17.
Physician's orders,  23.
Pictures in room, 14.
Plants in room, 14.
Plasters, 42,  43.
Pleurisy, 30.
Pneumonia, 30.
Poultices,  40, 42.
Poppy fomentation, 46.
Powdered beef, 65.
Proportions of bath ingredients, 40.
Protective plasters,  43.
Pulse,  22.
Purgative  enemas, 47.

                   <*.
Quantity of bed-clothes, 17.

                   K.
Reading to patients, 24.
Reaction of urine, 23.
Recipes, 66.
I  Relative digestibility of foods, 58, 59.
  Roasting,  54.
  Rules for disinfecting, 27.

                    S.
  Scarlet fever, pack in, 36.
  Scarifier for wet-cupping, 44.
  Seasalt baths, 34.
  Seat-worms, treatment of, 49.
  Shower-bath, 35.
  Sheet, draw, 13.
  Sick-room, situation  of, 1.
  Sick, the diet of, 54.
  Sitz-bath, hot and cold, 32.
  Slippers, list, 13.
  Slippery elm poultice, 40.
  Sloughing from cantharides, 4Z
  Soap injections, 47.
  Soap-and-sugar poultice, 40.
  Special bottles for poisons,  35.
  Spanish-fly plasters, 42.
  Spit cups, 20.
  Sponge-bath, 17, 32, 36.
  Spoons for giving medicine, 19
  Steam atomizer, 45.
  Stewing, 54, 57.
  Stramonium plaster,  43.
  Street, noises from, 1.
  St. Martin, experiments on, 58.
  Sunshine, Martin on, 12.
  Sun-bath,  12.
  Surgical dressings, 52.
  Suppression of urine,  from  Spanish-fly
      plaster, 42.
  Suppression of urine, hot baths  in, 32,
  Surgeon's plaster, 43.
  Swansdown plaster, 43.
  Sweating feet, treatment of, 32.
  Sweating, how to hasten in bath, 29

                    T.
  Tables  of relative  digestibility  of foods,
      58, 59-
  Temperature of room, 11.
        "       "  sick person, 21.
  Test tubes, 23.
  Thermometer, fever, 21.
  Thirst,  25.
  Thread-worms, injections for, 49. 
88

Throat, swabbing of, 47.
Tobacco poultice, 41.
Turpentine injections, 47.

                   I .
Urine, reaction of, 23.
Urine, suppression of,  32, 42.
Urinals, rubber, 20.

                   V.
Vapor-baths, 36-39.
Vaseline,  17.
Venous hemorrhage, 53.
Ventilation, 1, 2.
Visitors,  26.

                  W.
Water, as an air purifier, 14.
Wet cups, 43.
Whispering,  17.
Wild fowl, 56.

                  V.
Yeast poultice, 42. 
      THIS CUT SHOWS BUT ONE OF THE MANY POSITIONS OF

The Marks Improved Adjustable Folding Chair,
             SUPERIOR TO ALL OTHERS, AND COMBINING IN ONE A

  PARLOR, LIBRARY,        ^kiSl     LOUNGE,

     SMOKING, or         ^^^^S       BED, or

  INVALID'S  CHAIR.   ^^^^      CHILD'S  CRIB.


Easily Adjusted to any Position Desired for  Ease  or  Comfort.
  Universally acknowledged to be the Most Desirable and Complete Article of Fur-
niture ever produced.
  Fully Wiirranted as represented, and satisfaction guaranteed.
  (■all and examine, or send stamp for Illustrated Catalogue to
            MARKS A.  F. CHAIR  CO., Limited,
                         8=50  BROADWAY, NF.W  YORK.
   SOLE PROPRIETORS AND  MANUFACTURERS.
OUR  SELF-PROPELLING WHEEL CHAIR  IS SUPE-
                 RIOR  TO  ALL  OTHERS.
   We also manufacture the MOST COMPLETE OPERATING CHAIR for use of
                      Physicians and Surgeons.
WARMING  AND  VENTILATION.


            Fire  on  the  Hearth,
     BEST NURSERY STOVE IN THE WORLD, COMBINING, IN ONE APPARATUS, AN
OPEN FIRE, CLOSE STOVE, and WARM AIR FURNACE.
             MEDALS AWARDED:
   U. S. Centennial, 1876, Paris Exposition, 1878, and many
State and County societies.
   " For all rooms requiring independeut  warmers, " THE
FIRE ON THE HKARTH" is the greatest improvement
of modern times."—Dr. A. N. Hell, Editor of The S<o>ila-
rian. Sept. 1875.
   " We have tried this stove and found it satisfactory,
both as a heater and a ventilator."—Editor's Table, Popu-
lar Science Monthly, Nov., 1879.
   " It is easy to heat  iin apartment, but  to warm it uni-
formly by an inexpensive contrivance that secures at the
same time an abundant supply of fresh air, is a desideratum
that has not, that I am aware of, been previously attained."
—By PROF. E. L. YOUMANS.
Especial attention paid to the warming aud ventilation
         of School ami Lecture Booms.
Send for descriptive matter to the
      Open Stove Ventilating Co.,
                 78 Beekman St., New York.  111111111
 
HORLICK'S     FOOD!
             For Infants, Dyspeptics,  and InyaMs,
    A  (Perfect  Substitute  for Mother's  Milk.
BARON IiIEBIGf the greatest authority on Infant Diet, states that the
    majority of children who die under one year of age, do so from
          (he effects  of improper food, or from  improper
                 administration of the food.

   A concentrated extract, prepared according to
the  formula  of BARON  LIEBIG, and  recom-
mended  by the  highest medical  authorities  as
the  best  food  for

    INFANTS,  DYSPEPTICS  AND  INVALIDS.

               CONTAINS  NO  STARCH.
    It is well known by physicians that infants cannot digest starch until
they have their teeth, as until that  period they do not possess the special
ferment "Ptyaline" which is necessary for the digestion  of starchy foods.
Mother's milk contains no starch, but milk sugar, which is transformed by
the acids of the stomach into grape sugar.  Whenever infants cannot be fed
by breast milk, it is easy to help nature by giving


       HORLIOK'S   FOOD

which is prepared from malt and wheaten flour, the malt (which contains
vegetable diastase) so acting upon the flour as to transform it into dextrine
and grape sugar. It also differs from other foods in being alkaline instead
of acid.
    Mothers nursing will find great benefit by taking this Food them-
selves, as it greatly increases the quantity and quality of the  milk, or it may
be given to the child alternately with the breast milk, when the latter is
deficient.
    Horlick's Food is in the form  of a dry extract, perfectly soluble, and
entirely free from bran aud husks, and will be found on trial to be not only
the best food for infants and invalids,  but also the cheapest, as through their
increased sales the proprietors have reduced their price 25 per cent, to bring it
within  the reach of all.
Price,  75 Cents per Bottle.         Trial Size, 40 Cents.
For samples, pamphlets and particular information apply to

       OSCAR  KRESS,  Druggist,
                Wholesale and Retail Agent,
 1670 Broadway,  Cor. 52d  St.,        NEW YORK.
     EF* The large bottles contain 18 ounces, which is nearly
double the quantity usually furnished by other foods for $1.00. 
IMPURE   WATER   IS   DANGEROUS.
   The  best medical authority pronounces impure water a fruitful cause of many
diseases. Typhoid fever and all low types of levers. Kidney diseases, stone in the
bladder. Rheumatism and all Malarial diseases.   Miliaria entering the system through
voter is cren irorse than malarial atmosphere.

GRANT'S   REVOLVING  &   SELF-CLEANSING  FILTER,
Purifies  Water  Thoroughly.
         Patented April 1st, 1879.
  The handle of the Filter
should  not  be  changed
when the faucet is open.

  To filter the water, place
the handle horizontal.

  To cleanse the filter,
reverse the handle.

  To obtain  full  flow of
water  without  filtering,
place the handle upright.

  The  charcoal  in  this
filter can be replenished
at any  time by removing
the wire spring and sieve.

  A box of Charcoal and
new7 Sieves for this Filter
cost 10 cents.
 Any Filter  not  Easily

   Cleansed  is worse

      than none.

  Grant's Filter is easily
and instantly cleansed.

  Grant's  Filter  breaks
the force of water, there-
by giviug thorough filtra-
tion.

  Grant's Filter gives you
a  full  supply  of  water
without removing it from
your faucet.

  Grant's Filter is a public
benefaction.
                              OITSIDE vi K\V.

GRANT'S  FILTER  IS THE   BEST  IN  THE  WORLD,
               Endorsed  by the Medical Profession,
   And the  only Filter that can be thoroughly cleansed.

All Filters Warranted.           Use no Other.       Cleanliness is Health.
  This Round Ball is revolved by the haudle on the outside of the shell and cleanses
the Filter instantly.
                                The construction
                               of this Ball is such
                               that the force of the
                               water is broken and
                               made  to percolate
                               through  the  entire
                               body of filtering ma-
                               terial in four differ-
                               ent streams,thereby
                               securing perfect fil-
                               tration.

                                Bone Charcoal is
                               acknowledged to be
                               the  best  Filtering
                               material known, re-
                               moving foul  gases,
                               articles held iu solu-
                               tion or suspension,
                               such as decomposed
                               animal and vegeta-
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                               water.
     FOR l-ll.l i-.l;l.i> \\ VIKH.                           FOK TTNFII.TEKKD WATER.
            So Household can afford to  be without this Filter.
        We manufacture Filters all sizes for manufacturing purposes, such as
Soda Water Fountains,     Mineral Water Fountains,    Paper Manufactories,
    Beer Breweries,           Ale Breweries,             Cotton Mills,
        Cotton Bleacheries,        Steam Boilers,            Steamboats, etc., etc.
                        Price, $2.00 and  $S.OO.

                      CLINTON  E. PACE,  Manager,
                                      1L   IGast 14th.  St.,  New  York-
 
The Peerless  Earth Closet.
Closet Closed.                  Closet Open.
DRY SIFTED  EARTH, COAL ASHES, PEAT  DUST, CHARCOAL

    DUST, OR ANYTHING THAT  HAS DEODORIZING PRO-

       PERTIES  CAN  BE  USED  IN THIS  CLOSET.

   The above cut represents an article long needed in every family, especially
for ladies, children and the sick room.
   It consists of a Wood Case with a Galvanized  Iron Pail in bottom
part. The Cover or Top being used as an Earth Reservoir, holding enough
earth for 20 times usage of closet.
   The simple opening of Top exposes the Seat for use, and at same time fills
Earth Chamber from Earth Beservoir; by closing- down top, after using
the closet, the earth is distributed from Earth Chamber into Pail.  Every
time the top is lifted, Earth Chamber is filled,  and same distributed
when closed.
   No machinery to get out of order.  It is Simple, Practical, Durable and
completely answers the purpose.
   This little closet is invaluable is cases of sickness.  If the Excrement is un
usually offensive or Disease Contageous, any dry disinfectant can be mixed
with the earth or whatever is used in the Reservoir, thus disinfecting the Pail
and Closet, and preventing contagion.


n ,     C Pine,  Stained and Varnished  $7  00

rflCeS! < Ash, Black Walnut, trimmed- -- 8  50

       t Black Walnut________.....   10  00

                       ADDRESS,


        HENRY H. B.  BLOOMFIELD,

                34 Dey Street, New York.

 Also, WAKEFIELD AND PERFECTION EARTH  CLOSETS. 
'If we wnuld hare Health ire must use son/(."-ElUS5li:s Wll.soN, F. R. S., F. R. C.

         A   Perfect   Skin   Soap.
  " Whoever wishes to preserve the skin in
good order, and particularly if troubled
with a tender, chapped, irritable state of
tbis ortran, must attend seduously to the
use of two tilings: a proper soap and a
proper kind of bath.  A good soap cannot
be eery cheap.   Pungent scent is in no way
necessarily connected with good soap."—
J. L. Milton. Senior Surgeon to St. John's
Hospital for Skin Diseases, London.
  "A majority of  brands, yielding the
highest perfume  and commanding  the
highest prices, are not only inefficacious
but absolutely pernicious when applied to
the  skin—even  in health."—L. D. Bnlldey,
M. D., Physician  to  Skin  Dep'ts Demilt
Dispensary and New York, Hospital.
  " In many skin diseases the attending
physician finds his  prescribed remedies of
comparatively  little avail, without under-
standing why; the fact  being that the
patient  is daily applying  a poison to the
skin in the shajie of soaps made with im-
ptire fats".—Journal of Applied Chemistry.
  "The future health of the infant depends
to a great  extent  upon the manner and
method of its first  washing. During our
practice we have met with a large number
of cases of the severest kind affecting both
the skin and eyes, and lasting for years,
owing to the use of irritating or poisonous
soaps."—Dr. Neu-ton.
  " I have made a careful examination of
the samples of Packer's Tar Soap submit-
ted to me for  analysis, and find that it is
composed of pure vegetable oil, glycerine,
and refined piDe tar, combined by a pro-
cess which others have tried but failed.
I consider it the best soap for all purposes
mentioned in your circular, which  I have
ever used or examined."—TT. A. Wetherbee,
M. D., Prof, of Chemistry and Toxicology,
224 E. Uth St.,  New York.
  " I advise all my patients to use Packer's
Tar Soap  exclusively; three years' per-
sonal experience has convinced me that
it is by far the best soap in the  market.—
Edward Sutton Smith. M. D.,  20  Irving
Place, Neir York.
  "I am much pleased with the  results
obtained from Packer's Tar Soap.  I have
used it very extensively in my practice
in almost  all  varieties of skin disease—
but  have  especially found  it  useful in
Chronic Eczema and  Psoriasis, also in
Puriago."—Francis W.  Campbell,  M. D.,
Prof, of Physiology, Bishop's University,
Attending  Physician  Women's  Hospital,
etc., Montreal.
  "It is the best article I have ever used
in cases of skin diseases, whether suppu-
rative or not.   For infants' use it is inval-
uable."—Edward Barnes, M. D., Pleasant
Plains, New York.
   " The thanks of the profession are due to the Packer Manufacturing Company for
giving us in their tar soap an elegant article for the toilet, in which the well known
soothing and healing properties of Pine Tar are so skillfully combined with vegetable
oils.  In all cases of skin disease, where tar is indicated this soap will be found invalu-
able; and as an article for the toilet, vastly superior to  the highly perfumed soaps so
much in use.—The Homeopathic Times.
   Packer's Tar Soap is sold by Druggists.  Price, 25 cents per cake.  Descrip-
tive Pamphlet sent on applicatian, postpaid.
      Address                 THE  PACKER  MFG.  CO.,
P.  O.  Box  a985.                                NEW YORK.


    THE  NATIONAL PRINTING  CO.,

              16-22  CHAMBERS ST., NEW YORK,



JQak,  }ol   mi  feiifige   frinting,
ADDRESS CARDS.                  NOTICES.
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