Part 5

Sodium iodid, gr. xv; Sodium phosphate, gr. xxx; Sodium chlorid, gr. cx; Aqua, ℥xxxvj.

A diuretic and laxative mixture.

NORMAL SALT SOLUTION.

Stock salt solution is kept for the purpose of making normal salt solution quickly and accurately. Use sodium chlorid (common salt) dried sufficiently to granulate.

Stock Salt Solution by Weight.

Sodium chlorid, ℥jss (47 gm.); Water, f℥viij (237 c.c.).

Boil in a closed vessel fifteen minutes. When cold make up with sterile water to f℥j-viij. Strain through sterile cotton into a sterile bottle, and keep tightly corked.

Normal salt solution should contain 90 grains of salt in 1 quart (1 L.) of water.

Normal Salt Solution.

Stock salt solution, f℥j (30 c.c.); Sterile water, Oij (1 L.).

Salt Solution.

Distilled water, Oiv; Purified salt, ℥xij.

CARBOLIC ACID SOLUTION (5 PER CENT.).

Cold sterile water, gal. j; Carbolic acid (95 per cent.), ℥iv.

1: 20 SOLUTION GLYCERIN FORMALDEHYD.

Sterile glycerin, ℥viss (23 c.c.); Solution formaldehyd, Oj (500 c.c.).

SOLUTION (1: 1000) OF BICHLORID OF MERCURY (CORROSIVE SUBLIMATE).

Mercury bichlorid or corrosive sublimate, gr. xv (1 gm.); Common salt, gr. xv (1 gm.); Sterile water, Oij (1 L.).

The salt in this formula is added to prevent decomposition of the mercurial salt by the albuminous juices of the tissues.

ALKALINE SOLUTION OF CYANID OF MERCURY.

Some surgeons recommend cyanid of mercury in solutions of 1: 1000 or 1: 2000 in place of the bichlorid of mercury. It is a powerful antiseptic that does not coagulate albumin, irritate the tissues, or attack metals.

Mercury cyanid, gr. viiss (0.5 gm.); Sodium borate, gr. xv (1 gm.). These tablets are made to correspond to bichlorid tablets.

Compressed tablets, each containing 7½ grains (0.48 gm.) of corrosive sublimate with tartaric acid, are also in common use. One of these added to 1 pint of water makes a solution of 1: 1000.

SATURATED BORIC OR BORACIC-ACID SOLUTION.

Boric acid crystals, ℥jss (47 gm.); Hot sterile water, Oij (1 L.).

This solution may also be made by putting an excess of the crystals into the water, then sterilizing by boiling twenty minutes and straining through sterile cotton.

SOLUTION OF POTASSIUM PERMANGANATE.

This substance is used in a solution of royal blue or purple color, which should be freshly made. Place a few crystals in a piece of sterile gauze, and suspend in sterile water of the required quantity and temperature until the right color is obtained.

IODIN SOLUTION.

This solution is made by adding to sterile water of the required temperature sufficient tincture of iodin to make the color of sherry wine. Add the iodin a few drops at a time, stirring until the sherry color is produced.

SOLUTIONS OF FORMALDEHYD.

All the preparations on the market (formalin, formol, formolose, etc.) contain 40 per cent. of formaldehyd gas.

As the gas is the true germicidal principle, it is much the better plan, in stating the strength of dilute solutions of these preparations, to give the proportion of the gas present, and this is done in the formulæ below.

1 : 100 or 1 per cent. of True Formaldehyd Gas.

Solution of formaldehyd, fʒvj (23 c.c.); Cold sterile water, Oij (1000 c.c.). This solution is approximately equivalent to

1 : 500 or ⅕ per cent. Solution of Formaldehyd.

Solution of formaldehyd, ♏︎xxxviij (2.3 c.c.); Cold sterile water, Oj (500 c.c.)

THIERSCH’S ANTISEPTIC SOLUTION.

Saturated boric acid solution, Oj (500 c.c.); Sterile water, Oj (500 c.c.); Salicylic acid, gr. lxxv (5 gm.).

Mix the salicylic acid with sufficient alcohol to dissolve it. Pour mixture into solution, and shake thoroughly.

HARRINGTON’S SOLUTION.

Bichlorid of mercury, gr. xxxij; Hydrochloric acid, 2400 c.c.; Distilled water, 12,000 c.c.; Alcohol (95 per cent.), 25,600 c.c.

PICRIC ACID SOLUTION FOR BURNS.

Picric acid crystals, gr. xx (1.3 gm.); Alcohol (95 per cent.), fʒij (8 c.c.); Cold sterile water, f℥viij (250 c.c.).

CHLORID OF LIME SOLUTION.

Chlorid of lime, ℥v (160 gm.); Water, Oviij (4 L.).

SOLUTION FOR SORE NIPPLES.

1. Glycerin, f℥ss (15 c.c.); Boric solution, f℥ss (15 c.c.); Alcohol (95 per cent.), f℥ss (15 c.c.); Tannic acid, gr. xx (1.3 gm.).

2. Compound tincture of benzoin, f℥j (30 c.c.). Apply with a cotton swab or camel’s hair brush.

NIPPLE OINTMENT.

Sulphur sub., gr. x; Acid tannic, ʒj; Borax pulv., ℈j; Syrup simp., ℥j; Glycerini, ℥ss. Wash off before nursing.

ARISTOL OINTMENT FOR CRACKED NIPPLES.

Aristol, gr. xxv (1.6 gm.); Vaselin, ℥j (30 gm.).

SOOTHING LOTIONS FOR THE HANDS.

1. Spirits camphor, } Glycerin, } āā f℥j (30 c.c.); Tr. benzoin, } Alcohol (95 per cent.), f℥v (150 c.c.).

2. Alcohol (95 per cent.) } Glycerin, } āā f℥j (30 c.c.); Tr. benzoin, } Distilled extract of hamamelis (witch-hazel), f℥ij (60 c.c.).

3. Alcohol, f℥ij (60 c.c.); Glycerin, f℥ij (60 c.c.); Lemon juice, f℥ss (15 c.c.); Tr. myrrh, f℥ss (15 c.c.).

4. Water, Oj (500 c.c.); Boric acid crystals, ʒiij (12 gr.); Gum tragacanth, ʒij (8 gr.).

Allow mixture to stand 8 hours, then dissolve by boiling; strain through cotton.

While stirring briskly add:

Alcohol (95 per cent.), Oss (250 c.c.); Glycerin, Oss (250 c.c.); Attar of roses, ʒij (ad lib.). Color with chlorophyl if desired.

5. Glycerin, } Whisky, } āā Peroxid, }

AN INUNCTION FOR THE HANDS WHEN THE SKIN IS DRY AND HARSH.

Lanolin, ℥iij (90 c.c.); Olive oil, ℥j (30 c.c.).

LASSAR’S PASTE FOR ECZEMATOUS SORES AND ULCERS.

Salicylic acid, gr. x (0.65 gm.); Pulverized starch, ʒij (8 gm.); Zinc oxid, ʒij (8 gm.); Vaselin, ℥ss (16 gm.).

UNNA’S PASTE.

Zinc oxid powd., ½ pound; Sheet gelatin, ½ pound; Glycerin, ℥xiv; Water, ℥xx; Salicylic acid powd., gr. xvj.

Dissolve gelatin in water and glycerin. Heat in a double boiler and stir in zinc oxid.

CARRON OIL FOR BURNS.

Lime-water, } Raw linseed oil, } Of each, equal parts.

BORATED VASELIN.

Boric acid, gr. xx (1.3 gm.); Sterile vaselin, ℥j (30 gm.).

Mix thoroughly; do not heat.

CARBOLATED VASELIN.

Carbolic acid (95 per cent.), ♏︎v (0.3 c.c.); Sterile vaselin, ℥j (30 gm.).

BORATED GLYCERIN.

Boric acid, ʒiss (6 gm.); Sterile glycerin, f℥ij (60 c.c.).

FORTIFIED OIL.

Croton oil, ♍︎j; Castor oil, ♍︎j-xiv.

SANITAS JELLY.

Vaselin, ℥j (30 gm.); Sanitas, gtt. iv.

SALOL VASELIN FOR BURNS.

Salol, gr. xx (1.3 gm.); Sterile vaselin, ℥j (30 gm.).

SWEATING OF THE FEET AND AXILLA.

Solution of formaldehyd, fʒss (2 c.c.); Water, f℥vij (210 c.c.).

One application is usually sufficient. Further applications should be made with great caution.

ENEMAS FOR FLATULENCE.

1. White of 1 egg (beaten), Oil of turpentine (add drop by drop), fʒj (4 c.c.); Olive oil, f℥j (30 c.c.); Warm water, Oj (500 c.c.).

2. White of 1 egg (beaten), Glycerin, f℥ij (60 c.c.); Oil of turpentine (add drop by drop), fʒij (8 c.c.); Warm water, Oj (500 c.c.).

3. Warm water, qt. j; Yeast, ½ cake. Mix thoroughly.

4. Hot water, qt. j; Pulv. alum, ℥j (by measure).

5. Molasses, ℥viij; Milk, ℥viij.

Follow by 1 pint of warm water within five minutes to secure better result and to relieve fermentation that follows the injection.

6. Milk of asafetida, ℥j; Warm water, Oj.

GLYCERIN ENEMA.

Glycerin, ℥j-iv (30-120 c.c.); Warm soapy water, ℥j-iv (30-120 c.c.).

OX-GALL ENEMA.

Ox-gall, ℥ss (15 gm.); Warm water, Oij (1 L.).

COMPOUND OX-GALL ENEMA.

Ox-gall, ʒj (4 gm.); Castor oil, f℥iv (118 c.c.); White of 2 eggs, Warm water, Oj (500 c.c.).

SALINE ENEMA.

Magnesium sulphate (Epsom salt), ℥j (30 gm.); Hot water, sufficient to dissolve.

1-2-3 ENEMA.

Magnesium sulphate, ℥j (30 gm.); Glycerin, f℥ij (60 c.c.); Hot water, f℥iij (90 c.c.).

COMBINATION ENEMA.

Turpentine, ʒj; Olive oil, ℥j; White of one egg; Tr. asafetida, ʒj; or Milk of asafetida, ℥j.

Beat egg well and with olive oil make an emulsion of the turpentine.

STARCH-WATER ENEMA.

Starch, ℥j (30 gm.).

Mix with sufficient cold water to make a thick paste; pour on boiling water until it becomes of the consistence of mucilage. From 10 to 30 minims (0.6-2 c.c.) of laudanum are often added to this enema.

STIMULATING ENEMAS.

1. Black coffee, ℥viij; Whisky, ℥j.

2. Hot N. S. S., ℥viij; Whisky, ℥j.

3. Black coffee, ℥viij; or Hot N. S. S., ℥xij; Without whisky.

NOURISHING ENEMAS.

1. Malted milk, ℥ss (15 gm.); Somatose, ʒj (4 gm.); Water, f℥iv (118 c.c.); Sodium chlorid, gr. xx (1.3 gm.); White of 1 egg, Add peptonized milk or brandy, p. r. n.

2. Peptonized milk, f℥x (300 c.c.); White of 2 eggs, Alcohol (95 per cent.), fʒij (8 c.c.); Pinch of salt.

THE METHOD OF ADMINISTERING NUTRITIVE OR STIMULATING ENEMAS.

Prepare the fluid and heat to between 100°-110° F. Pour the mixture into an enema pail or douche bag. To the tubing attach a large rubber catheter or small rectal tube by means of a glass nozzle. Place the patient on the left side with the knees flexed. Permit the fluid to flow through the tube to expel the air and then make pressure close to the point until ready to introduce it. Lubricate the catheter with vaselin or oil and insert gently eight or nine inches. Do not slip the catheter forward or backward unless absolutely necessary to encourage the fluid to flow, for it only increases the peristalsis and induces the patient to expel the contents which should be retained. Press the tube sufficiently to allow the solution to run very slowly, and occasionally make intermittent stoppage until it has all been given. Upon withdrawing the tube make digital pressure with a soft cloth against the anus for a minute or two. The use of an enema pail in place of a funnel insures more favorable results. Moreover, it is an easier and cleaner method and gives the advantage of having only the tube to take care of.

AMOUNTS TO BE GIVEN IN CLEANSING ENEMAS.

Adults, Oj-iv; Children, ℥viij-xvj; Infants, ℥ij.

TEMPERATURE OF ENEMA FLUIDS.

Nutritive enema, 100° F. Stimulating enema, 116° F. Cleansing enema, 100° F.

MUSTARD PLASTER.

Mustard, 1 tablespoonful; Flour, 3 tablespoonfuls; Glycerin, 1 tablespoonful; Baking soda (dissolved in hot water), 1 teaspoonful.

Beat well and spread between two layers of muslin or soft linen. Apply from 15 to 30 minutes.

MUSTARD POULTICE.

Mustard, 2 parts; Ground flaxseed, 4 “ Hot water, a sufficient quantity.

FLAXSEED POULTICE.

Ground flaxseed, ½ cupful; Olive oil, 2 teaspoonfuls.

Add enough boiling water to make a thick paste. Cook for a few minutes, and beat thoroughly.

ONION POULTICE.

Slice a large onion and fry in lard or olive oil. Place between layers of soft cloth. It should not be warmed over.

TURPENTINE STUPES.

1. Add 3 teaspoonfuls of oil of turpentine to 1 pint of boiling water. Immerse the flannel and stir. Remove the flannel, wring it out in a twisted towel until it no longer drips. Anoint the skin with olive oil, and then apply fomentation until it causes some discomfort or redness. If allowed to remain too long, it will blister the skin.

2. Oil of turpentine, 1 part; Olive oil, 7 parts.

Apply with applicator or soft cloth every 4 or 6 hours, and fomentations p. r. n.

SPICE POULTICE.

Powdered cloves; powdered ginger; powdered cinnamon, of each from 1 to 2 teaspoonfuls; flour, a tablespoonful; whisky, enough to make a paste sufficiently soft to spread on flannel.

CANTHARIDES BLISTER.

Cantharides is used for this purpose, either as a plaster or in liquid form; that is, in the form of vesicating collodion. Its most frequent use is as a plaster, rarely over one and a half inches square. Scrub the parts well with soap and water, and dry and rub with a soft cloth until the skin is red, then apply the plaster and bandage lightly, so there may be plenty of room for the formation of the blister. Vesication is produced generally within four to eight hours; if it is not, the plaster should be removed and the operation completed by applying a poultice. Great care should be exercised when blistering patients suffering from kidney affections. Cantharides is an acute irritant, and not infrequently causes strangury or acute nephritis. When the cantharidal collodion is used the space to be covered is outlined with oil to prevent spreading; the collodion is applied with a camel’s hair brush or other applicator, and covered with a layer of soft lint and oil silk.

_Dressing the Blister._—Puncture the lower part of the bleb; absorb the fluid with a piece of soft cotton; anoint with pure vaselin, and apply a soft dressing. Bandage lightly.

Sometimes it is desirable to have the fluid reabsorbed into the system, in which case precautions must be taken to prevent the blister from rupturing.

APPLICATIONS FOR PEDICULOSIS (LICE).

1. Pulverized larkspur seed, ℥j (30 gm.);

2. Pulverized sabadilla seed, ℥j (30 gm.); Boiling water, Oj (500 c.c.).

One application of these infusions is usually sufficient.

3. Kerosene oil is a cheap and excellent application; it also removes dandruff: Rub lightly upon the scalp for one or two nights and follow in the morning by a shampoo of soap and water. To destroy the nits apply hot vinegar every other day.

4. Wash hair and scalp thoroughly with a good soap, then saturate hair with hot vinegar and tie up securely. Repeat for a few days.

HAIR TONICS.

1. Resorcin, gr. xlviij (3 gm.); Glycerin, fʒij (8 c.c.); Alcohol (50 per cent.), f℥ij (60 c.c.).

Rub into the scalp each night.

2. Tincture of cantharides, fʒij (8 c.c.); Tincture of nux vomica, f℥ss (15 c.c.); Tincture of capsicum, fʒj (4 c.c.); Bay rum, f℥ij (60 c.c.). Rub into the scalp at night.

3. Tincture of cantharides, fʒij (8 c.c.); Quinin bisulphate, gr. xx (1.3 gm.); Bay rum, f℥iv (120 c.c.); Rain-water or distilled water, f℥iv (120 c.c.). Rub into the scalp each night.

FOR MATTED HAIR.

Use white vaselin freely each day. Untangle the ends and work gradually toward the scalp.

THERMOMETRY.

In the _Fahrenheit_ scale there are 180 degrees between the melting-point of ice and the boiling-point of water. In the _Centigrade_ scale there are 100 degrees between the freezing and boiling point of water.

RULES FOR CONVERTING ONE SCALE INTO THE OTHER.

To convert Fahrenheit degrees into those of Centigrade: Subtract 32, multiply by 5, and divide by 9. For example:

104° F. - 32° = 72; 72 × ⁵/₉ = 40° C.

To reduce Centigrade degrees into those of Fahrenheit: Multiply by 9, divide by 5, and add 32. For instance:

40° C. × ⁹/₅ = 72 + 32 = 104° F.

TABLE OF THERMOMETRIC EQUIVALENTS.

36° Centigrade 96.8° Fahrenheit. 37° “ 98.6° “ 38° “ 100.2° “ 39° “ 102.2° “ 40° “ 104.0° “ 41° “ 105.8° “ 42° “ 107.6° “

TO CONVERT THERMOMETER READINGS.

A correspondent of the “Lancet” (London) offers a new alternative method of converting degrees Centigrade into degrees Fahrenheit, which may be found easier to perform mentally than the usual method, because the factors can be more easily retained in the memory. This method consists of multiplying the centigrade figures by 2, deducting one-tenth of the product, and adding 32.

Example (_a_), 30° C.= 86° F. Method: 30 × 2 = 60. 60 - 6 = 54. 54 + 32 = 86.

Example (_b_), 37° C. = 98.6° F. Method: 37 × 2 = 74. 74 - 7.4 = 66.6. 66.6 + 32 = 98.6.

Example (_c_), 40° C. = 104° F. Method: 40 × 2 = 80. 80 - 8 = 72. 72 + 32 = 104.

RULES OF TAKING TEMPERATURE.

Per mouth.—Retain thermometer from 1 to 3 minutes. “ rectum “ “ “ 3 “ 5 “ “ axilla “ “ “ 10 “ 15 “ Temperature per rectum is ½° F. higher than per mouth. “ “ axilla is ¹/₁₀° to ³/₁₀° F. lower than per mouth.

TEMPERATURE OF WATER.

Cold signifies a temperature below 65° F. Cool “ “ between 65° F. and 80° F. Tepid “ “ “ 80° “ 90° “ Warm or neutral “ “ 90° “ 100° “ Hot 100° “ above. Very hot or very cold indicates extremes of temperature.

PULSE RATE.

Six to twelve months 105-115. Two to six years 90-105. Seven to ten years 80- 90. Eleven to fourteen years 75- 85. Adults 60- 78.

RESPIRATIONS.

Two months to two years 35 per minute. Two months to six years 23 “ “ Six months to twelve years 20 “ “ Twelve months to fifteen years 18 “ “ Fifteen months to twenty-one years 16-18 “ “

URINE ANALYSIS.

Normal urine is a clear, watery fluid, with an acid reaction and a specific gravity of from 1018 to 1020. It is composed of inorganic salts, organic constituents, together with some coloring and a small amount of mucus.

The most important of these inorganic salts are chlorid of sodium, phosphate of potassium, and the sulphates of calcium and magnesium. The inorganic constituents are chiefly urea, uric acid, and poisonous inorganic substances found in the body. The normal amount of urine voided by an adult weighing 160 pounds is from 40 to 70 ounces in twenty-four hours. The amount may be increased by drinking large quantities of fluid, especially water, and diminished by perspiration, emotion, and copious bowel movements.

_Normal urine_ is aromatic. In health it may be faintly alkaline at certain times of the day. Urine passed in the morning has an acid reaction, a high specific gravity, and a dark color. After a hearty meal it may be turbid—perhaps alkaline, and of low specific gravity. Large quantities are pale, and vary with concentration. When just passed it is clear; then it collects a cloudy material made up of mucous corpuscles, which can be easily shaken up. Concentrated urine, when it cools, deposits a pinkish (brick-dust) precipitate. Gentle heat clears it up. When highly concentrated the crystals are red. When they collect and adhere together they become stones; if all precipitate on heating it is normal urine.

_Alkaline urine_ throws down phosphates that are held in solution and clears up on addition of any acid; if urine is cold and acid in reaction, sediment, if present, may be urates, but is not phosphates; if urine is alkaline, they are normal phosphates.

TO TEST REACTION.

Litmus-paper is used. Acid changes the blue to red. Alkaline changes red to blue. When urine does not affect litmus-paper it is said to be neutral.

_Pus in urine_ is turbid or milky in appearance; after standing a while it settles down.

_Albumin in urine_ is held in solution, and therefore cannot be seen.

A SIMPLE AND RAPID TEST FOR ALBUMIN.

Fill an ordinary test-tube half full of urine, and add a half dram or more of potassium ferrocyanid solution (1 to 20). After thoroughly mingling the urine and the reagent, add a few drops of acetic acid (50 per cent.); then pause for a half minute and note the change. If albumin be present it will come plainly into view within half a minute to a minute, in the form of white, milk-like opacity, diffused throughout the whole contents of the tube. The above method precipitates all modifications of albumin. On the other hand, it gives no reaction with phosphates, peptones, mucin, the alkaloids, urates, or the pure acids. The reaction that sometimes occurs on long standing between the acid and potassium ferrocyanid should not be mistaken for albumin. The albuminous reaction appears within half a minute or so, while the other occurs only after ten minutes to half an hour, and is mingled with more or less blue coloration.

TO OBTAIN A 24-HOUR SPECIMEN OF URINE.

Begin early in the morning. _Throw away the first urination._ Save _all_ further urinations for the next twenty-four hours. For instance: Patient urinates at 6 A.M. _This first urination is thrown away_, or saved for an A.M. specimen if required and patient’s bladder is empty. Save all succeeding urinations for the next twenty-four hours, at the end of which time (6 A.M.) request the patient to urinate, and _save the last_ urination also, to complete the specimen. This gives us twenty-four hours’ secretion.

The addition of solution of formaldehyd (fʒij) to a twenty-four hour specimen of urine will preserve it, and prevent fermentation before the analysis is made.

INFANT FEEDING.

1. If the bowel movements are curdy, we may take it as an indication of an excess of proteids.

2. Sour vomiting often indicates too much fat.

3. Stools that are very watery but without curds may result from too much sugar or too much fat.

4. Vomiting of hard, curdy masses may indicate too much proteids.

5. Should the child seem to do well on its food in every way except that it does not gain in weight, it may be that the sugar is too low.

6. Vomiting may mean that the child has eaten too much.

7. Breast milk is the best infant food.

8. No artificial food can or should be trusted which does not contain the essentials of breast-milk—viz., fat, proteids, and sugar.

9. The elements named are to be found only in milk, cows’ milk being the only one available for general use.

10. Cows’ milk must be modified, because it does not contain the same proportions of the elements named.

CONSTITUENTS OF GOOD MOTHER’S MILK.

Reaction Alkaline.