The Book of Household Management · Chapter 790Chapter XLIII. (3)
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2644. LIVER COMPLAINT AND SPASMS.—A very obliging correspondent recommends the following, from personal experience:—Take 4 oz. of dried dandelion root, 1 oz. of the best ginger, 1/4 oz. of Columba root; braise and boil all together in 3 pints of water till it is reduced to a quart: strain, and take a wine-glassful every four hours. Our correspondent says it is a "safe and simple medicine for both liver complaint and spasms."
2645. LUMBAGO.—A "new and successful mode" of treating lumbago, advocated by Dr. Day, is a form of counter-irritation, said to have been introduced into this country by the late Sir Anthony Carlisle, and which consists in the instantaneous application of a flat iron button, gently heated in a spirit-lamp, to the skin. Dr. Corrigan published, about three years ago, an account of some cases very successfully treated by nearly similar means. Dr. Corrigan's plan was, however, to touch the surface of the part affected, at intervals of half an inch, as lightly and rapidly as possible. Dr. Day has found greater advantages to result from drawing the flat surface of the heated button lightly over the affected part, so as to act on a greater extent of surface. The doctor speaks so enthusiastically of the benefit to be derived from this practice, that it is evidently highly deserving attention.
2646. PALPITATION OF THE HEART.—Where palpitation occurs as symptomatic of indigestion, the treatment must be directed to remedy that disorder; when it is consequent on a plethoric state, purgatives will be effectual. In this case the patient should abstain from every kind of diet likely to produce a plethoric condition of body. Animal food and fermented liquor must be particularly avoided. Too much indulgence in sleep will also prove injurious. When the attacks arise from nervous irritability, the excitement must be allayed by change of air and a tonic diet. Should the palpitation originate from organic derangement, it must be, of course, beyond domestic management. Luxurious living, indolence, and tight-lacing often produce this affection: such cases are to be conquered with a little resolution.
2647. Poisons shall be the next subject for remark; and we anticipate more detailed instructions for the treatment of persons poisoned, by giving a simple LIST OF THE PRINCIPAL POISONS, with their ANTIDOTES OR REMEDIES.
Oil of Vitriol ……………\ Aquafortis ………………. Magnesia, Chalk, Soap-and-Water. Spirit of Salt ……………/
Emetic Tartar…………….. Oily Drinks, Solution of Oak-bark.
Salt of Lemons, or………… Chalk, Whiting, Lime or Magnesia and Acid of Sugar…………….. Water. Sometimes an Emetic Draught.
Pump on back, Smelling-Salts to nose, Prussic Acid………………. Artificial Breathing, Chloride of Lime to nose.
Pearlash ………………….\ Soap-Lees…………………. \ Smelling-Salts…………….. \ Nitre…………………….. Lemon-Juice and Vinegar-and-Water Hartshorn…………………. / Sal-Volatile………………./
Arsenic……………………\ Fly-Powder, or…………….. Emetics, Lime-Water, Soap-and-Water, White Arsenic……………… Sugar and Water, Oily Drinks. Kings Yellow, or…………… / Yellow Arsenic……………../
Mercury……………………\ Corrosive Sublimate………… Whites of Eggs, Soap-and-Water. Calomel……………………/
Opium…………………….. Emetic Draught, Vinegar-and-Water, Laudanum………………….. dashing Cold Water on chest and face, walking up and down two or three hours.
Lead………………………\ White Lead………………… Epsom Salts, Castor Oil, Emetics. Sugar of Lead………………/ Goulard's Extract…………./
Copper Blue-stone ……………….. Whites of Eggs, Sugar-and-Water, Verdigris…………………. Castor Oil, Gruel.
Zinc …………………….. Lime-Water, Chalk-and-Water, Soap-and-Water.
Iron …………………….. Magnesia, Warm Water.
Henbane……………………\ Hemlock…………………… Emetics and Castor Oil; Nightshade………………… Brandy-and-Water, if necessary. Foxglove…………………../
Poisonous Food…………….. Emetics and Castor Oil.
2648. The symptoms of poisoning may be known for the most part from those of some diseases, which they are very like, from the fact of their coming on immediately after eating or drinking something; whereas those of disease come on, in most cases at least, by degrees, and with warnings. In most cases where poison is known, or suspected, to have been taken, the first thing to be done is to empty the stomach, well and immediately, by means of mustard mixed in warm water, or plain warm salt-and-water, or, better, this draught, which we call No. 1:—Twenty grains of sulphate of zinc in an ounce and a half of water. This draught to be repeated in a quarter of an hour if vomiting does not ensue. The back part of the throat should be well tickled with a feather, or two of the fingers thrust down it, to induce vomiting. The cases where vomiting must not be used are those where the skin has been taken off, and the parts touched irritated and inflamed by the poison taken, and where the action of vomiting would increase the evil. Full instructions are given in the article on each particular poison as to where emetics are or are not to be given. The best and safest way of emptying the stomach is by means of the stomach-pump, as in certain cases the action of vomiting is likely to increase the danger arising from the swollen and congested condition of the blood-vessels of the head, which often takes place. In the hands, however, of any one else than a surgeon, it would be not only useless, but harmful, as a great deal of dexterity, caution, and experience are required to use it properly. After having made these brief introductory remarks, we shall now proceed to particulars.
2649. Sulphuric Acid, or Oil of Vitriol (a clear, colourless liquid, of an oily appearance).—Symptoms in those who have swallowed it. When much is taken, these come on immediately. There is great burning pain, extending from the mouth to the stomach; vomiting of a liquid of a dark coffee-colour, often mixed with shreds of flesh and streaks of blood; the skin inside the mouth is taken off; and the exposed surface is at first white, and after a time becomes brownish. There are sometimes spots of a brown colour round the lips and on the neck, caused by drops of the acid falling on these parts. There is great difficulty of breathing, owing to the swelling at the back part of the mouth. After a time there is much depression of strength, with a quick, weak pulse, and cold, clammy skin. The face is pale, and has a very anxious look. When the acid swallowed has been greatly diluted in water, the same kind of symptoms occur, only in a milder degree.—Treatment. Give a mixture of magnesia in milk-and-water, or, if this cannot be obtained, of finely powdered chalk, or whiting, or even of the plaster torn down from the walls or ceiling, in milk-and-water. The mixture should be nearly as thick as cream, and plenty of it given. As well as this, simple gruel, milk, or thick flour-and-water, are very useful, and should be given in large quantities. Violent inflammation of the parts touched by the acid is most likely to take place in the coarse of a little time, and can only be properly attended to by a surgeon; but if one cannot be obtained, leeches, the fever-mixtures (the recipe for which appears repeatedly in previous paragraphs), thick drinks, such as barley-water, gruel, arrowroot, &c., must be had recourse to, according to the symptoms of each particular case and the means at hand. The inflamed condition of the back part of the mouth requires particular attention. When the breathing is very laboured and difficult in consequence, from fifteen to twenty leeches are to be immediately applied to the outside of the throat, and when they drop off, warm poppy fomentations constantly kept to the part. When the pain over the stomach is very great, the same local treatment is necessary; but if it is only slight, a good mustard poultice will be sufficient without the leeches. In all these cases, two tablespoonfuls of the fever-mixture should be given every four hours, and only gruel or arrowroot allowed to be eaten for some days.
2650. Nitric Acid, commonly known as Aqua Fortis, or Red Spirit of Nitre (a straw-coloured fluid, of the consistence of water, and which gives off dense white fumes on exposure to the air).—Symptoms produced in those who have swallowed it. Much the same as in the case of sulphuric acid. In this case, however, the surface touched by the acid becomes yellowish. The tongue is mostly much swollen.—Treatment. The same as for sulphuric acid.
2651. Muriatic Acid, Spirit of Salt (a thin yellow fluid, emitting dense white fumes on exposure to the air).—This is not often taken as a poison. The symptoms and treatment are much the same as those of nitric acid.
N.B.—In no case of poisoning by these three acids should emetics ever be given.
2652. Oxalic Acid, commonly called Salt of Lemons.—This poison may be taken by mistake for Epsom salts, which it is a good deal like. It may be distinguished from them by its very acid taste and its shape, which is that of needle-formed crystals, each of which, if put into a drop of ink, will turn it to a reddish brown, whereas Epsom salts will not change its colour at all. When a large dose of this poison has been taken, death takes place very quickly indeed.—Symptoms produced in those who have swallowed it. A hot, burning, acid taste is felt in the act of swallowing, and vomiting of a greenish-brown fluid is produced, sooner or later, according to the quantity and strength of the poison taken. There is great tenderness felt over the stomach, followed by clammy perspirations and convulsions; the legs are often drawn up, and there is generally stupor, from which the patient, however, can easily be roused, and always great prostration of strength. The pulse is small and weak, and the breathing faint.—Treatment. Chalk or magnesia, made into a cream with water, should be given in large quantities, and afterwards the emetic draught above prescribed, or some mustard-and-water, if the draught cannot be got. The back part of the throat to be tickled with a feather, to induce vomiting. Arrowroot, gruel, and the like drinks, are to be taken. When the prostration of strength is very great and the body cold, warmth is to be applied to it, and a little brandy-and-water, or sal-volatile and water, given.
2653. Prussic Acid (a thin, transparent, and colourless liquid, with a peculiar smell, which greatly resembles that of bitter almonds).—Symptoms produced in those who have swallowed it. These come on immediately after the poison has been taken, and may be produced by merely smelling it. The patient becomes perfectly insensible, and falls down in convulsions—his eyes are fixed and staring, the pupils being bigger than natural, the skin is cold and clammy, the pulse scarcely perceptible, and the breathing slow and gasping.—Treatment. Very little can be done in these cases, as death takes place so quickly after the poison has been swallowed, when it takes place at all. The best treatment—which should always be adopted in all cases, even though the patient appears quite dead-is to dash quantities of cold water on the back, from the top of the neck downwards. Placing the patient under a pump, and pumping on him, is the best way of doing this. Smelling-salts are also to be applied to the nose, and the chest well rubbed with a camphor liniment.
2654. ALKALIS: Potash, Soda, and Ammonia, or common Smelling-Salts, with their principal preparations—Pearlash, Soap Lees, Liquor Potassae, Nitre, Sal Prunella, Hartshorn, and Sal—Volatile.—Alkalis are seldom taken or given with the view of destroying life. They may, however, be swallowed by mistake.—Symptoms produced in those who have swallowed them. There is at first a burning, acrid taste in, and a sensation of tightness round, the throat, like that of strangling; the skin touched is destroyed; retching mostly followed by actual vomiting, then sets in; the vomited matters often containing blood of a dark brown colour, with little shreds of flesh here and there, and always changing vegetable blue colours green. There is now great tenderness over the whole of the belly. After a little while, great weakness, with cold, clammy sweats, a quick weak pulse, and purging of bloody matters, takes place. The brain, too, mostly becomes affected.—Treatment. Give two tablespoonfuls of vinegar or lemon-juice in a glassful of water every few minutes until the burning sensation is relieved. Any kind of oil or milk may also be given, and will form soap when mixed with the poison in the stomach. Barley-water, gruel, arrowroot, linseed-tea, &c., are also very useful, and should be taken constantly, and in large quantities. If inflammation should take place, it is to be treated by applying leeches and warm poppy fomentations to the part where the pain is most felt, and giving two tablespoonfuls of the fever mixture every four hours. The diet in all these cases should only consist of arrowroot or gruel for the first few days, and then of weak broth or beef-tea for some time after.
2655. When very strong fumes of smelling-salts have in any way been inhaled, there is great difficulty of breathing, and alarming pain in the mouth and nostrils. In this case let the patient inhale the steam of warm vinegar, and treat the feverish symptoms as before.
2656. Arsenic.—Mostly seen under the form of white arsenic, or fly-powder, and yellow arsenic, or king's yellow.—Symptoms produced in those who have swallowed it. These vary very much, according to the form and dose in which the poison has been taken. There is faintness, depression, and sickness, with an intense burning pain in the region of the stomach, which gets worse and worse, and is increased by pressure. There is also vomiting of dark brown matter, sometimes mixed with blood; and mostly great thirst, with a feeling of tightness round, and of burning in, the throat. Purging also takes place, the matters brought away being mixed with blood. The pulse is small and irregular, and the skin sometimes cold and clammy, and at others hot. The breathing is painful. Convulsions and spasms often occur.—Treatment. Give a couple of teaspoonfuls of mustard in a glass of water, to bring on or assist vomiting, and also use the other means elsewhere recommended for the purpose. A solution, half of lime-water and half of linseed-oil, well mixed, may be given, as well as plenty of arrowroot, gruel, or linseed-tea. Simple milk is also useful. A little castor-oil should be given, to cleanse the intestines of all the poison, and the after-symptoms treated on general principles.
2657. Corrosive Sublimate.—Mostly seen in the form of little heavy crystalline masses, which melt in water, and have a metallic taste. It is sometimes seen in powder. This is a most powerful poison.—Symptoms. These mostly come on immediately after the poison has been taken. There is a coppery taste experienced in the act of swallowing, with a burning heat, extending from the top of the throat down to the stomach; and also a feeling of great tightness round the throat. In a few minutes great pain is felt over the region of the stomach, and frequent vomiting of long, stringy white masses, mixed with blood, takes place. There is also mostly great purging. The countenance is generally pale and anxious; the pulse always small and frequent; the skin cold and clammy, and the breathing difficult. Convulsions and insensibility often occur, and are very bad symptoms indeed. The inside of the mouth is more or less swollen.—Treatment. Mix the whites of a dozen eggs in two pints of cold water, and give a glassful of the mixture every three or four minutes, until the stomach can contain no more. If vomiting does not now come on naturally, and supposing the mouth is not very sore or much swollen, an emetic draught, No. 1, may be given, and vomiting induced. (The No. 1 draught, we remind our readers, is thus made:—Twenty grains of sulphate of zinc in an ounce and a half of water; the draught to be repeated if vomiting does not take place in a quarter of an hour.) After the stomach has been well cleaned out, milk, flour-and-water, linseed-tea, or barley-water, should be taken in large quantities. If eggs cannot be obtained, milk, or flour-and-water, should be given as a substitute for them at once. When the depression of strength is very great indeed, a little warm brandy-and-water must be given. In the course of an hour or two the patient should take two tablespoonfuls of castor-oil, and if inflammation comes on, it is to be treated as directed in the article on acids and alkalis. The diet should also be the same. If the patient recovers, great soreness of the gums is almost certain to take place. The simplest, and at the same time one of the best modes of treatment, is to wash them well three or four times a day with brandy-and-water.
2658. Calomel.—A heavy white powder, without taste, and insoluble in water. It has been occasionally known to destroy life.—Symptoms. Much the same as in the case of corrosive sublimate.—Treatment. The same as for corrosive sublimate. If the gums are sore, wash them, as recommended in the case of corrosive sublimate, with brandy-and-water three or four times a day, and keep the patient on fluids, such as arrowroot, gruel, broth, or beef-tea, according to the other symptoms. Eating hard substances would make the gums more sore and tender.
2659. Copper.—The preparations of this metal which are most likely to be the ones producing poisonous symptoms, are blue-stone and verdigris. People are often taken ill after eating food that has been cooked in copper saucepans. When anything has been cooked in one of these vessels, it should never be allowed to cool in it.—Symptoms. Headache, pain in the stomach, and purging; vomiting of green or blue matters, convulsions, and spasms.—Treatment. Give whites of eggs, sugar-and-water, castor-oil, and drinks, such as arrowroot and gruel.
2660. Emetic Tartar.—Seen in the form of a white powder, or crystals, with a slightly metallic taste. It has not often been known to destroy life.—Symptoms. A strong metallic taste in the act of swallowing, followed by a burning pain in the region of the stomach, vomiting, and great purging. The pulse is small and rapid, the skin cold and clammy, the breathing difficult and painful, and the limbs often much cramped. There is also great prostration of strength.—Treatment. Promote the vomiting by giving plenty of warm water, or warm arrowroot and water. Strong tea, in large quantities, should be drunk; or, if it can be obtained, a decoction of oak bark. The after-treatment is the same as that for acids and alkalis; the principal object in all these cases being to keep down the inflammation of the parts touched by the poison by means of leeches, warm poppy fomentations, fever-mixtures, and very low diet.
2661. Lead, and its preparations, Sugar of Lead, Goulard's Extract, White Lead.—Lead is by no means an active poison, although it is popularly considered to be so. It mostly affects people by being taken into the system slowly, as in the case of painters and glaziers. A newly-painted house, too, often affects those living in it.—Symptoms produced when taken in a large dose. There is at first a burning, pricking sensation in the throat, to which thirst, giddiness, and vomiting follow. The belly is tight, swollen, and painful; the pain being relieved by pressure. The bowels are mostly bound. There is great depression of strength, and a cold skin.—Treatment. Give an emetic draught (No. 1, see above) at once, and shortly afterwards a solution of Epsom salts in large quantities. A little brandy-and-water must be taken if the depression of strength is very great indeed. Milk, whites of eggs, and arrowroot are also useful. After two or three hours, cleanse the stomach and intestines well out with two tablespoonfuls of castor-oil, and treat the symptoms which follow according to the rules laid down in other parts of these articles.—Symptoms when it is taken into the body slowly. Headache, pain about the navel, loss of appetite and flesh, offensive breath, a blueness of the edges of the gums; the belly is tight, hard, and knotty, and the pulse slow and languid. There is also sometimes a difficulty in swallowing.—Treatment. Give five grains of calomel and half a grain of opium directly, in the form of a pill, and half an ounce of Epsom salts in two hours, and repeat this treatment until the bowels are well opened. Put the patient into a warm bath, and throw up a clyster of warmish water when he is in it. Fomentations of warm oil of turpentine, if they can be obtained, should be put over the whole of the belly. The great object is to open the bowels as freely and as quickly as possible. When this has been done, a grain of pure opium may be given. Arrowroot or gruel should be taken in good large quantities. The after-treatment must depend altogether upon the symptoms of each particular case.
2662. Opium, and its preparations, Laudanum, &c.—Solid opium is mostly seen in the form of rich brown flattish cakes, with little pieces of leaves sticking on them here and there, and a bitter and slightly warm taste. The most common form in which it is taken as a poison, is that of laudanum.—Symptoms. These consist at first in giddiness and stupor, followed by insensibility, the patient, however, being roused to consciousness by a great noise, so as to be able to answer a question, but becoming insensible again almost immediately. The pulse is now quick and small, the breathing hurried, and the skin warm and covered with perspiration. After a little time, these symptoms change; the person becomes perfectly insensible, the breathing slow and snoring, as in apoplexy, the skin cold, and the pulse slow and full. The pupil of the eye is mostly smaller than natural. On applying his nose to the patient's mouth, a person may smell the poison very distinctly.—Treatment. Give an emetic draught (No. 1, see above) directly, with large quantities of warm mustard-and-water, warm salt-and-water, or simple warm water. Tickle the top of the throat with a feather, or put two fingers down it to bring on vomiting, which rarely takes place of itself. Dash cold water on the head, chest, and spine, and flap these parts well with the ends of wet towels. Give strong coffee or tea. Walk the patient up and down in the open air for two or three hours; the great thing being to keep him from sleeping. Electricity is of much service. When the patient is recovering, mustard poultices should be applied to the soles of the feet and the insides of the thighs and legs. The head should be kept cool and raised.
2663. The following preparations, which are constantly given to children by their nurses and mothers, for the purpose of making them sleep, often prove fatal:—Syrup of Poppies, and Godfrey's Cordial. The author would most earnestly urge all people caring for their children's lives, never to allow any of these preparations to be given, unless ordered by a surgeon.
2664. The treatment in the case of poisoning by Henbane, Hemlock, Nightshade, and Foxglove, is much the same as that for opium. Vomiting should be brought on in all of them.
2665. Poisonous Food.—It sometimes happens that things which are in daily use, and mostly perfectly harmless, give rise, under certain unknown circumstances, and in certain individuals, to the symptoms of poisoning. The most common articles of food of this description are Mussels, Salmon, and certain kinds of Cheese and Bacon. The general symptoms are thirst, weight about the stomach, difficulty of breathing, vomiting, purging, spasms, prostration of strength, and, in the case of mussels more particularly, an eruption on the body, like that of nettle-rash.—Treatment. Empty the stomach well with No. 1 draught and warm water, and give two tablespoonfuls of castor-oil immediately after. Let the patient take plenty of arrowroot, gruel, and the like drinks, and if there is much depression of strength, give a little warm brandy-and-water. Should symptoms of fever or inflammation follow, they must be treated as directed in the articles on other kinds of poisoning.
2666. Mushrooms, and similar kinds of vegetables, often produce poisonous effects. The symptoms are various, sometimes giddiness and stupor, and at others pain in and swelling of the belly, with vomiting and purging, being the leading ones. When the symptoms come on quickly after taking the poison, it is generally the head that is affected.—The treatment consists in bringing on vomiting in the usual manner, as quickly and as freely as possible. The other symptoms are to be treated on general principles; if they are those of depression, by brandy-and-water or sal-volatile; if those of inflammation, by leeches, fomentations, fever-mixtures, &c. &c.
2667. FOR CURE OF RINGWORM.—Take of subcarbonate of soda 1 drachm, which dissolve in 1/2 pint of vinegar. Wash the head every morning with soft soap, and apply the lotion night and morning. One teaspoonful of sulphur and treacle should also be given occasionally night and morning. The hair should be cut close, and round the spot it should be shaved off, and the part, night and morning, bathed with a lotion made by dissolving a drachm of white vitriol in 8 oz. of water. A small piece of either of the two subjoined ointments rubbed into the part when the lotion has dried in. No, 1.—Take of citron ointment 1 drachm; sulphur and tar ointment, of each 1/2 oz.: mix thoroughly, and apply twice a day. No. 2.—Take of simple cerate 1 oz.; creosote 1 drachm; calomel 30 grains: mix and use in the same manner as the first. Concurrent with these external remedies, the child should take an alterative powder every morning, or, if they act too much on the bowels, only every second day. The following will be found to answer all the intentions desired.
2668. Alterative Powders for Ringworm.—Take of
Sulphuret of antimony, precipitated . 24 grains. Grey powder . . . . . 12 grains. Calomel . . . . . . 6 grains. Jalap powder . . . . . 36 grains.
Mix carefully, and divide into 12 powders for a child from 1 to 2 years old; into 9 powders for a child from 2 to 4 years; and into 6 powders for a child from 4 to 6 years. Where the patient is older, the strength may be increased by enlarging the quantities of the drugs ordered, or by giving one and a half or two powders for one dose. The ointment is to be well washed off every morning with soap-and-water, and the part bathed with the lotion before re-applying the ointment. An imperative fact must be remembered by mother or nurse,—never to use the same comb employed for the child with ringworm, for the healthy children, or let the affected little one sleep with those free from the disease; and, for fear of any contact by hands or otherwise, to keep the child's head enveloped in a nightcap, till this eruption is completely cured.
2669. SCRATCHES.—Trifling as scratches often seem, they ought never to be neglected, but should be covered and protected, and kept clean and dry until they have completely healed. If there is the least appearance of inflammation, no time should be lost in applying a large bread-and-water poultice, or hot flannels repeatedly applied, or even leeches in good numbers may be put on at some distance from each other.
2670. FOR SHORTNESS OF BREATH, OR DIFFICULT BREATHING.—Vitriolated spirits of ether 1 oz., camphor 12 grains: make a solution, of which take a teaspoonful during the paroxysm. This is found to afford instantaneous relief in difficulty of breathing, depending on internal diseases and other causes, where the patient, from a very quick and laborious breathing, is obliged to be in an erect posture.
2671. SPRAINS.—A sprain is a stretching of the leaders or ligaments of a part through some violence, such as slipping, falling on the hands, pulling a limb, &c. &c. The most common are those of the ankle and wrist. These accidents are more serious than people generally suppose, and often more difficult to cure than a broken log or arm. The first thing to be done is to place the sprained part in the straight position, and to raise it a little as well. Some recommend the application of cold lotions at first. The editress, however, is quite convinced that warm applications are, in most cases, the best for for the first three or four days. These fomentations are to be applied in the following manner:—Dip a good-sized piece of flannel into a pail or basin full of hot water or hot poppy fomentation,—six poppy heads boiled in one quart of water for about a quarter of an hour; wring it almost dry, and apply it, as hot as the patient can bear, right round the sprained part. Then place another piece of flannel, quite dry, over it, in order that the steam and warmth may not escape. This process should be repeated as often as the patient feels that the flannel next to his skin is getting cold—the oftener the better. The bowels should be opened with a black draught, and the patient kept on low diet. If he has been a great drinker, he may be allowed to take a little beer; but it is better not to do so. A little of the cream of tartar drink, ordered in the case of burns, may be taken occasionally if there is much thirst. When the swelling and tenderness about the joint are very great, from eight to twelve leeches may be applied. When the knee is the joint affected, the greatest pain is felt at the inside, and therefore the greater quantity of the leeches should be applied to that part. When the shoulder is sprained, the arm should be kept close to the body by means of a linen roller, which is to be taken four or five times round the whole of the chest. It should also be brought two or three times underneath the elbow, in order to raise the shoulder. This is the best treatment for these accidents during the first three or four days. After that time, supposing that no unfavourable symptoms have taken place, a cold lotion, composed of a tablespoonful of sal-ammoniac to a quart of water, or vinegar-and-water, should be constantly applied. This lotion will strengthen the part, and also help in taking away any thickening that may have formed about the joint. In the course of two or three weeks, according to circumstances, the joint is to be rubbed twice a day with flannel dipped in opodeldoc, a flannel bandage rolled tightly round the joint, the pressure being greatest at the lowest part, and the patient allowed to walk about with the assistance of a crutch or stick. He should also occasionally, when sitting or lying down, quietly bend the joint backwards and forwards, to cause its natural motion to return, and to prevent stiffness from taking place. When the swelling is very great immediately after the accident has occurred, from the breaking of the blood-vessels, it is best to apply cold applications at first. If it can be procured, oil-silk may be put over the warm-fomentation flannel, instead of the dry piece of flannel. Old flannel is better than new.