Chapter II: Part 2

The _dose_ of _opium_ is from ½ to 1 grain
(0.03-0.65 gm.); of the _Extract of Opium_
(Extractum Opii), ⅛ to ½ grain (0.008-0.03 gm.);
of the _Tincture of Opium_ or _Laudanum_
(Tinctura Opii), 10 to 20 minims (0.6-1.2 c.c.); of the
_Camphorated Tincture of Opium_ or _Paregoric_
(Tinctura Opii Camphorata), ½ to 4 drams (2-15 c.c.);
of _Dover’s Powder_ (Pulvis Ipecacuanhæ et opii),
5 to 10 grains (0.3-0.6 gm.); of _morphin_ and its
salts (sulphate, hydrochlorate, etc.), ⅛ to ½ grain
(0.008-0.03 gm.), and of _codein_, ½ to 1 grain
(0.03-0.06 gm.).

_Heroin_ is chiefly used to allay cough. The _dose_
is from ¹/₁₂ to ⅛ of a grain (0.005-0.008 gm.).

_Apomorphin_ is employed as an emetic and as an
expectorant in bronchitis. The _dose_ as an emetic
is from ⅒ to ⅙ of a grain (0.006-0.01 gm.), always
hypodermically; the _dose_ as an expectorant is
from ¹/₂₀ to ¹/₁₀of a grain (0.003-0.006 gm.), always by
the mouth.

=Paraldehyd.=—This is an oily liquid, having a
peculiar unpleasant odor and taste. It is used chiefly
as a hypnotic. While comparatively safe and reliable,
its disagreeable taste and persistent odor on the breath
detract from its usefulness. The _dose_ is from ½
to 1 dram (2-4 c.c.), in some pleasant vehicle.

=Phenacetin.=—This anilin derivative has properties
very similar to those of acetanilid, and is used for the
same purposes. _Dose_, 5 to 10 grains (0.3-0.6 gm.).

=Physostigma.=—This is the seed of a climbing plant
growing in Africa. Its activities depend upon an
alkaloid known as _eserin_ or _physostigmin_.
It depresses the spinal cord, stimulates the peristaltic
movements of the bowel, and, when applied to the eye,
contracts the pupil. It is employed to check certain
convulsions (tetanus and strychnin-poisoning), to overcome
atonic constipation, and, locally, to contract the pupils.

The _dose_ of the _Tincture of Physostigma_
(Tinctura Physostigmatis) is from 5 to 20 minims
(0.3-1.2 c.c.); of the _Extract of Physostigmatis_
(Extractum Physostigmatis), ¹/₁₂ to ⅙ of a grain
(0.005-0.01 gm.); of _eserin_ or _physostigmin_
and its salts, ¹/₁₅₀ to ¹/₅₀ of a grain (0.0004-0.0013 gm.).

=Pilocarpus=, or =Jaborandi=.—This is the leaves
of a South American plant. Its virtues depend entirely
upon an alkaloid known as _pilocarpin_. The
chief action of the drug is on the secretions—sweat,
saliva, and urine—which it markedly increases. Large
doses depress the circulation. Locally, in the eye, it
contracts the pupil like eserin. It is mainly employed
internally as a diaphoretic in Bright’s disease and
dropsical conditions. The _dose_ of the _Fluid
Extract_ (Extractum Pilocarpi Fluidum) is from 20 to
60 minims (1.5-4 c.c.); of _pilocarpin_ and its
salts, ⅛ to ½ grain (0.008-0.03 gm.). The latter are
usually administered hypodermically.

=Quinin.=—See _Cinchona_.

=Salicylates.=—These salts are employed in medicine
chiefly as antirheumatic remedies. Their manner of
action, however, is unknown. They are also used,
both internally and externally, to some extent as
antiseptics. Large doses cause ringing in the ears,
headache, deafness, nausea, and a greenish discoloration
of the urine.

The _dose_ of _salicylic acid_ or its salts
(ammonium, sodium, strontium) is from 5 to 20 grains
(0.3-1.3 gm.); of _Oil of Gaultheria_ (Methyl
Salicylate), 5 to 20 minims (0.3-1.2 c.c.). These
preparations should be given after meals, well diluted.

The following remedies have properties like the salicylates,
but are less powerful and less irritant to the stomach:
_Salol_, _dose_, 5 to 20 grains (0.3-1.3 gm.);
_salophen_, 5 to 30 grains (0.3-2 gm.); _aspirin_,
5 to 20 grains (0.3-1.3 gm.).

=Senna.=—This is a purgative cholagogue and is
used in the constipation of children and pregnant
women. _Dose_, in substance, 5 to 20 grains; in
fluidextract or tincture, 1 to 4 fluidrams.

=Silver.=—The most important salt of this metal is
the _nitrate_. Locally, in concentrated form, the
latter is a caustic; in dilute form it is a sedative,
astringent, and antiseptic. Internally, in small doses,
silver nitrate is useful as an astringent and antiseptic
in inflammatory and ulcerative conditions of the stomach
and bowel.

The prolonged use of the drug, even in small doses,
is followed by a permanent grayish discoloration of the
skin (argyria) from the precipitation of the metal in
the tissues.

Toxic doses of silver nitrate cause burning pain in
the abdomen, vomiting of white, curdy matter, and bloody
purging.

The _dose_ of silver nitrate is from ⅙ to ½ of a
grain (0.01-0.3 gm.), usually in pill form.

Several combinations of metallic silver with albumin are
much used as antiseptics and astringents in inflammatory
diseases of mucous membranes. They have advantage
over silver nitrate in being less irritating and in
not being decomposed by the juices of the tissues.
The most important of these organic compounds are
_protargol_ and _argyrol_. They are usually
applied in solutions of from 1 to 10 per cent. A soluble
form of metallic silver is also employed in the form of
15 per cent. ointment, known as _Credé’s ointment_.
It is recommended as an antiseptic in various infectious
diseases.

=Spartein.=—This is an alkaloid from the broom plant.
It is used to some extent as a heart tonic and diuretic
in _doses_ of from ¼ to ½ grain (0.015-0.03 gm.).

=Strophanthus.=—This is the seed of a climbing
plant growing in Africa. Its action very closely
resembles that of digitalis, for which it is sometimes
substituted. The _dose_ of the _tincture_
(Tinctura Strophanthi) is from 3 to 10 minims
(0.2-0.6 c.c.).

=Sulphonal.=—This artificial compound is used
almost entirely as a hypnotic. In single doses it is
comparatively safe and reliable, but slow in its action.
Languor, headache, and drowsiness not infrequently
follow its use. The repeated administration of sulphonal
over several days or weeks is distinctly dangerous,
being often followed by chronic poisoning. The latter is
marked by a red coloration of the urine, colicky pains,
profound depression, weakness, and collapse.

The _dose_ of sulphonal is from 10 to 30 grains
(0.6-2 gm.). It is best given in hot tea or hot milk,
one or two hours before bedtime.

=Tannic Acid, Tannin.=—This is employed externally
as an astringent and styptic, and internally as an
astringent in atonic diarrheas. It is used in the form
of a gargle or in troches in relaxed conditions of the
throat, in solution to prevent bed-sores, and in the form
of ointment or suppositories for the relief of internal
piles. _Dose_, 1 to 10 grains.

=Trional.=—This remedy resembles sulphonal in action,
and is used for the same purpose. It may also be given
in the same _dose_ and manner as sulphonal.

=Urotropin.=—This compound, prepared by the action
of ammonia on formaldehyd, is employed as a powerful
urinary antiseptic in _doses_ of from 3 to 5
grains (0.2-0.3 gm.). Large doses may cause pain in the
bladder, frequent urination, and bloody urine.

=Veratrum Viride.=—This is the root of a North
American herb. Its action resembles that of aconite in
that it depresses the heart and slows the pulse. It
is, however, more nauseating than aconite, and when
locally applied does not cause numbness, tingling,
and anesthesia. Large doses cause vomiting, muscular
weakness, dizziness, sweating, failure of pulse, and
collapse. It is used as a sedative in acute inflammatory
diseases to subdue overaction of the heart.

The _dose_ of the _tincture of veratrum viride_
(tinctura veratri viridis) is from 1 to 5 minims
(0.06-0.3 c.c.).

DOSAGE.

The following general rules will aid the student in remembering the safe dose of many important preparations:

1. Tinctures of very active drugs, such as opium, digitalis, belladonna, physostigma, nux vomica, gelsemium, arnica, and capsicum may be given in _doses_ of from 5 to 20 minims (0.3-1.2 c.c.), except the _tinctures of aconite_, _veratrum viride_, _iodin_, and _cantharides_, the _dose_ of which is from 1 to 5 minims (0.06-0.3 c.c.).

2. Tincture of less active drugs, such as gentian, calumba, krameria, quassia, valerian, cinchona, kino, may be given in _doses_ of from ½ to 1 dram (2-4 c.c.).

3. Solid extracts of active drugs may be given in _doses_ of from ⅙ to ¼ of a grain (0.01-0.016 gm.).

4. Solid extracts of less active drugs may be given in _doses_ of from ½ to 5 grains (0.03-0.3 gm.) or more.

5. Dilute acids (hydrochloric, nitric, nitrohydrochloric, sulphuric) may be given in _doses_ of from 5 to 20 minims (0.3-1.3 c.c.), except _dilute hydrocyanic acid_, the _dose_ of which is from 1 to 5 minims (0.06-0.3 c.c.).

6. All medicated syrups, except the _syrup of iodid of iron_ and the _compound syrup of squill_, may be given in _doses_ of 1 to 2 drams (4-8 c.c.) or more.

7. All infusions may be given in _doses_ of ½ to 1 ounce (15-30 c.c.) or more, except the _infusion of digitalis_, the _dose_ of which is from 1 to 4 drams (4-15 c.c.).

8. All official mixtures may be given in _doses_ of from 1 to 4 drams (4-15 c.c.).

9. All spirits may be given in _doses_ up to 1 dram (4 c.c.), except the _spirit of nitroglycerin_ (glonoin), the _dose_ of which is from 1 to 5 minims (0.06-0.3 c.c.), the _spirit of phosphorus_, the _dose_ of which is from 5 to 15 minims (0.3-1 c.c.), and the _spirit of bitter almond_, the _dose_ of which is from 5 to 10 minims (0.3-0.6 c.c.).

10. All _waters_ (aquæ) may be given in _doses_ up to 1 ounce (30 c.c.), except _aqua ammoniæ_, _aqua chlori_, and _aqua laurocerasi_ (cherry-laurel), the _dose_ of which is about ½ dram (2 c.c.).

11. Volatile or essential oils may be given in _doses_ up to 5 minims (0.3 c.c.) or more, except the _oil of bitter almond_, the _dose_ of which is from ¼ to ½ minim (0.015-0.03 c.c.).

TO ASCERTAIN DOSES OF MEDICINE FOR CHILDREN.

The following rule of Young is sufficiently accurate for most drugs: Add 12 to the age and divide by the age to get the denominator of the fraction, the numerator of which is 1. Thus, for a child of two years,

2 + 12
——— = 7, and the dose is ⅐ of that for an adult.
2

For children up to twelve months of age, Young’s rule may be worked out as follows: Add 144 to the age in months, which sum becomes the denominator of the fraction, the numerator of which is the child’s age. Thus, for a baby of eight months,

8 8
——— = ——, or ¹/₁₉ of an adult’s dose;
8 + 144 152

for a baby of six months,

6 6
——— = ——, or ¹/₂₅ of an adult’s dose.
6 + 144 150

The following table, based on Young’s rule, is sufficiently accurate in ordinary cases, and its use will avoid the necessity of mathematic calculations on the part of the physician:

Child aged one month ¹/₁₄₅ of an adult’s dose.
“ “ two months ¹/₇₃ “ “ “
“ “ three months ¹/₄₉ “ “ “
“ “ four months ¹/₃₇ “ “ “
“ “ five months ¹/₃₀ “ “ “
“ “ six months ¹/₂₅ “ “ “
“ “ seven months ¹/₂₂ “ “ “
“ “ eight months ¹/₁₉ “ “ “
“ “ nine months ¹/₁₇ “ “ “
“ “ ten months ¹/₁₅ “ “ “
“ “ eleven months ¹/₁₄ “ “ “
“ “ twelve months ¹/₁₃ “ “ “
“ “ two years ¹/₇ “ “ “
“ “ three years ¹/₅ “ “ “
“ “ four years ¹/₄ “ “ “
“ “ five years ⁵/₁₇ “ “ “
“ “ six years ¹/₃ “ “ “
“ “ seven years ⁷/₁₉ “ “ “
“ “ eight years ²/₃ “ “ “
“ “ nine years ³/₇ “ “ “
“ “ ten years ⁵/₁₁ “ “ “
“ “ eleven years ¹/₂ “ “ “
“ “ twelve years ¹/₂ “ “ “

Of powerful narcotics, such as opium, scarcely more than one-half of this proportion should be used. In the case of mild cathartics, however, two or even three times this proportion may be given.

THE DOSE OF DRUGS ADMINISTERED SUBCUTANEOUSLY AND BY THE RECTUM.

The dose of a drug given _hypodermically_ is usually about one-half the quantity given by the mouth, while _twice_ as large a dose is generally given by the _rectum_ as would be given by the mouth.

PROPER TIME TO TAKE MEDICINES.

Alkalis should be given before food. Iodin and iodids should be given on an empty stomach, when they rapidly diffuse into the blood. If given during digestion the acids and starch alter and weaken the digestion. Acids, as a rule, should be given between the digestive acts, because the mucous membrane of the stomach is in a favorable condition for the diffusion of the acids into the blood. Acids may be given before food when prescribed to check the excessive formation of the acids of the gastric juice. By giving it before meals you check the osmosis stomachward of the acid-forming materials. Irritating and dangerous drugs should be given directly after food, such as the salts of arsenic, copper, zinc, and iron, except where local conditions require their administration in small doses before food. Oxid and nitrate of silver should be given after process of digestion is ended; if given during food, chemic reactions destroy or impair their special attributes and defeat the object for which they were prescribed. Metallic salts, especially corrosive sublimate, also tannin and pure alcohol, impair the digestive power of the active principle of the gastric juice, so should appear in the stomach during its period of inactivity. Malt extracts, cod-liver oil, phosphates, etc., should be given with or directly after food, so that they may enter the blood with the products of digestion.

POISONS AND ANTIDOTES.

=General Treatment.=—Eliminate if possible by emetics, as zinc sulphate, 10 to 20 grains; copper sulphate, 5 grains; or hypodermic injection of apomorphin, ⅒ grain. Use stomach-pump or -tube where vomiting cannot be produced, observing great care if irritant poison has caused injury to tissues. In cardiac failure give stimulants. In narcosis keep patient awake. In threatened paralysis of respiratory movements use alternate hot and cold spray to chest, slapping, and artificial respiration. Ammonia, atropin, caffein, and strychnin are useful respiratory stimulants.

=Acetanilid.=—Emetic; rest in recumbent position;
stimulants—ammonia and strychnin; artificial
respiration; oxygen inhalations; external heat.

=Acid, Carbolic.=—Alcohol or Epsom salt as an
antidote. Three or four ounces of diluted alcohol,
followed by lavage with a solution of Epsom salt;
external heat; demulcents; stimulants hypodermically.

=Acid, Hydrocyanic.=—Fresh air; artificial
respiration; oxygen inhalations; ammonia by inhalation
and by intravenous injection.

=Acid, Oxalic.=—Chalk or lime as an antidote;
demulcents, like oil or egg-albumin.

=Acids, Mineral.=—Chalk, magnesia, soap, or
white-wash from wall to neutralize poison; demulcent
drinks—bland oils or egg-white; stimulants
hypodermically.

=Aconite.=—Recumbent position; empty stomach with
pump with patient flat on back; external heat;
stimulants—alcohol, ammonia, strychnin—hypodermically.

=Ammonia.=—Vinegar with lemon-juice to neutralize the
poison; white of egg or oil to allay irritation.

=Anilin Dyes.=—Give plenty of warm water to induce
emesis; place patient in recumbent position; loosen
clothing and permit free circulation of fresh air.

=Antimony (Tartar Emetic).=—Tannic acid as an
antidote; use stomach-pump; external heat; stimulants.

=Antipyrin.=—Same as Acetanilid.

=Arsenic.=—Stomach-pump or an emetic; freshly
precipitated ferric hydrate (tablespoonful every ten
minutes) made by adding magnesia to any iron solution;
demulcents—oil or egg-albumin.

=Atropin.=—Same as Belladonna.

=Belladonna.=—Emetic or stomach-pump; tannic acid as
an antidote; cold to head; enema of warm black coffee.

=Camphor.=—Empty the stomach; apply a hot-water bag to
the abdomen, and stimulate the patient if necessary.

=Cantharides.=—Emetic or stomach-pump; egg-white;
mucilaginous drinks in abundance; _avoid all oily
substances_.

=Chloroform.=—Withdrawal of drug; lowering of head;
pulling tongue forward; artificial respiration;
stimulants—strychnin, digitalis, ammonia.

=Cocain.=—Empty the stomach by means of the
stomach-pump or an emetic. Stimulate patient and
administer artificial respiration.

=Colchicum.=—Stomach-pump or emetic; external heat;
white of egg; stimulants; opium for pain.

=Copper Sulphate.=—Yellow prussiate of potassium,
soap, or magnesia; milk and albumin freely; opium for
pain.

=Corrosive Sublimate.=—White of egg freely; milk;
emetic or stomach-pump; opium for pain.

=Creosote.=—Same as Carbolic acid.

=Croton Oil.=—Emetic; mucilaginous drinks; opium.

=Cyanide of Potassium.=—Same as Hydrocyanic acid.

=Digitalis.=—Recumbent position; stomach-pump with
patient recumbent; external heat; tannic acid.

=Elaterium.=—Emetic; external heat; demulcents; opium.

=Ergot.=—Empty stomach; copious drafts of warm water,
coffee, or tea; quick purgative (croton oil); place
patient in recumbent position; give hot sponge-bath and
apply friction to the body.

=Gas, Illuminating.=—Fresh air; artificial
respiration; oxygen inhalations; injections of ammonia
and strychnin.

=Iodin.=—Starch-paste as an antidote; emetic; external
heat; demulcents; opium.

=Lead Salts.=—Epsom salt as antidote; emetic; milk or
egg-white.

=Lobelia.=—External heat; tannic acid; stomach-pump;
stimulants.

=Matches.=—Same as Phosphorus.

=Morphin.=—Same as Opium.

=Mushroom, poisonous (Toad-stools).=—Emetics; atropin
(¹/₁₀₀ gr.) hypodermically; castor oil; stimulants.

=Nux Vomica.=—Same as Strychnin.

=Opium.=—Stomach-pump or emetic; repeated lavage;
black coffee enema; potassium permanganate (5 gr.) in
tumblerful of water, or tannic acid as an antidote; keep
patient awake with cold affusions or electric brush;
artificial respiration; respiratory stimulants—atropin,
ammonia, strychnin, cocain, caffein.

=Phenacetin.=—Same as Acetanilid.

=Phosphorus.=—Copper sulphate as an emetic; dilute
peroxid of hydrogen or potassium permanganate as an
antidote; Epsom salt as a purge; _avoid all oils and
fatty substances_.

=Potassa or Soda (Lye).=—Vinegar or lemon-juice as an
antidote; oils or egg-white; opium.

=Ptomain Poisoning.=—Empty the stomach by means of the
stomach-pump or by an emetic. Apply a hot-water bag to
the abdomen. Give opium or morphin to allay the pain and
check diarrhea. Give a large dose of castor oil.

=Rat Poison.=—This usually contains arsenic or
phosphorus (q. v.).

=Silver Nitrate.=—Solution of common salt as antidote;
emetic; demulcent drinks. Silver nitrate stains on the
skin may be whitened and their removal much expedited
by the application of a solution made according to the
following formula:

Mercury bichlorid, gr. v;
Ammonium chlorid, gr. v;
Aqua, ʒij.

=Stramonium.=—Same as Belladonna.

=Strychnin.=—Absolute quiet; if convulsions have
begun, do not use stomach-pump unless the patient first
be etherized; tannic acid as antidote; inhalations of
chloroform or amyl nitrite for convulsions; potassium
bromid (ʒj) and chloral (gr. xxx) by mouth or rectum.

=Tobacco.=—Emetic; external heat; stimulants.

ANTIDOTES.

1. =Albumen, Egg-white.=—Dissolve 4 egg-whites in 1
quart of warm water.

2. =Milk, Fatty Oils, Mucilaginous
Substances.=—Substitutes for albumen.

3. =Castile Soap.=—Dissolve in plenty of water;
substitute for albumen.

4. =Tannic Acid, Coffee, Tea.=—To precipitate various
alkaloids.

5. =Vinegar, Diluted Mineral Acids.=—To neutralize
alkalies and alkaline salts.

6. =Emetics.=—(1) Zinc sulphate, grs. v-xv, repeated
twice if necessary at fifteen-minute intervals, or until
emesis is produced. (2) Mustard, ʒj-iv, stirred to a
cream with warm water. (3) Ipecac, gr. xv; repeat if
necessary in fifteen minutes. (4) Tartar emetic, gr. ½,
in sweetened water for children.

_Note._—In all poison cases loosen clothing
instantly and permit free circulation of fresh air;
protect body with warm blankets; do not use pump or give
emetics if acid has been taken in concentrated form;
secure necessary drugs so that medication may be given
at once upon direction of physician in charge.

MISCELLANEOUS FORMULÆ.

SEMMOLA’S MIXTURE.

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.

Contains 3 to 4 per cent. of fat } Sp. gravity
“ 6 to 7 “ “ of sugar } 1030.
“ 1 to 2 “ “ of proteids}

Inorganic materials ¹/₁₀ to ²/₁₀ of 1 per cent.

Average percentage, 12 per cent. of solids to 88 per cent. of water.

REGULATING THE COMPOSITION OF MOTHER’S MILK.

The percentage of proteids { Increased frequency of nursing;
is increased by { Increased liberality of nursing
{ and insufficient exercise.

The percentage of fat is { Deficiency of proteid food;
increased by { Excess of fatty foods and fasting.

The percentage of water } Increased fluid diets.
is increased by }

The percentage of water } Saline cathartics and diminished
is diminished by } fluid diets.

Percentage of sugar and ash vary little.—DR. COTTON.

FORMULÆ FOR ARTIFICIAL FEEDING FOR BABIES.

Age.

1. Sugar of milk ℥j }
Sterile water ℥xij }
Lime-water ℥ss } From 3d to 14th day.
Cream ℥ss }
Milk ℥ss }

2. Sugar of milk ℥j }
Sterile water ℥xij }
Lime-water ℥j } From 2d week to 6th week.
Cream ℥j }
Milk ℥j }

3. Sugar of milk ℥j }
Sterile water ℥x }
Lime-water ℥j } From 6th week to 11th week.
Cream ℥j }
Milk ℥j }

4. Sugar of milk ℥j }
Sterile water ℥viij }
Lime-water ℥ss } From 11th week to 5 months.
Cream ℥j }
Milk ℥j }

5. Sugar of milk ℥j }
Sterile water ℥vij }
Lime-water ℥ss } From 5 months to 9 months.
Cream ℥j }
Milk ℥ijss }

6. Granulated sugar ℥ss }
Sterile water ℥v } From 9 months to 12 months.
Cream ℥j }
Milk[A] ℥jv }

[A] It is sometimes desirable to substitute whey for milk and water.

AMOUNT OF FEEDINGS FOR INFANTS.

Twenty-four-hour Number of feedings,
Age. amount. amount and intervals.

{ 10 feedings of 1 ounce at 2
{ hour intervals.
1 week 10 to 12 ounces { 8 feedings of 1½ ounces at
{ 2½ hour intervals.

{ 8 feedings of 2½ ounces at
{ 2½ hour intervals.
4 weeks 20 ounces { 7 feedings of 3 ounces at
{ 3 hour intervals.

{ 7 feedings of 4½ ounces at
4 months 32 ounces { 3 hour intervals.

{ 6 feedings of 6 to 6½ ounces
6 months 36 to 40 ounces { at 3 hour intervals.

{ 6 feedings of 8 ounces at
{ 3 hour intervals.
9 months 48 ounces { 5 feedings of 9½ ounces at
{ 3 to 4 hour intervals.

First twenty-four hours—Infant should receive only water, and after that water to be given only between feedings, 1 to 2 ounces every four hours.

Water may be sweetened with saccharin.

Normal infant may feed every three or four hours and only one feeding during night.

After eight months old, no feeding after 10 P. M.

Three months’ child may take 5 ounces at one feeding.

Six months’ child may take 7 ounces at one feeding.

Nine months’ child may take 9 ounces at one feeding.

The child should consume the contents of a bottle in twenty minutes.

Orange juice is not a necessary food unless milk is pasteurized or sterilized (boiled) and in case of constipation. Give 1 or 2 teaspoonfuls one hour before feeding. After nine months reduce amount of milk and increase amount of carbohydrates, such as starch gruels, flour ball, barley flour, oatmeal, and vegetable soup. Zwieback or dry toast may be placed in infant’s hand to teach it how to feed itself. Milk allowed in second year, 1 quart in twenty-four hours. Fruit juices may now be given and should form a part of the food after fifteen months of age. Vegetables, such as beets, spinach and carrots chopped fine and squeezed through colander, may be a part of the regular diet in four meals a day. A child two years old may have small quantities of fresh fish, tender chicken, or beefsteak. No green fruits should be given under four years of age. Eggs should be soft-boiled for two minutes or coddled four minutes, and then only one a day if it agrees with the child.

RULES FOR STERILIZING BOTTLES.

Boil bottles and nipples in 2 per cent. soda solution for five minutes, then in clear water for five minutes. Keep empty bottles and nipples not in use in sterile water or weak boric solution. Plug with raw cotton.

TO PASTEURIZE MILK.

1. Place bottles in vessel of warm water. Heat to 147° F. Keep at that temperature thirty minutes. Take vessel off stove and cover with a heavy blanket. Then pour off hot water and fill vessel with cold water to cool the milk quickly.

2. Put milk in double boiler and raise to a temperature of 150° to 155° F. Let stand at this temperature for twenty to thirty minutes.

Pasteurizing milk does not kill the ferments in the milk, but it kills almost all bacteria except the spore-bearing bacteria, of which the gas bacillus is the most important.

TO STERILIZE MILK.

Boil milk for five minutes and then prepare as for pasteurizing, keeping it at temperature of 147° F. for thirty minutes and cooling it by the same process as given for pasteurization.

Boiling milk kills all bacteria. It is said that heating of milk to this degree impairs its nutritive value.

_Note._—Spores develop quickly in lukewarm milk, therefore the necessity of cooling it quickly and placing it in refrigerator.

MODIFIED MILK.

Add water or other substances to cow’s milk to change it to agree with the digestion of the infant. Malted foods when mixed with water are deficient, and by adding milk or cream it becomes modified milk.

All mixtures should be cold when adding milk, and water sterilized when used as a diluent.

_Note._—The natural food for the infant is human milk. The breast-fed babies are healthier, more vigorous, and more resistant to disease. (See _Rickets and Scurvy_.)

SUGARS.

Lactose or milk-sugar is best for normal babies. It may split up in the intestines into acids and when it ferments is likely to be a laxative. Sucrose (cane-sugar) has no advantage over lactose, except that it is cheaper. Do not give sucrose if other sugars are on hand.

Maltose (malt-sugar) is expensive and is never given pure.

Dissolve all sugars in warm sterilized water. Malt extract is more laxative than other milk-sugar preparations. Malt extract should be brought to boiling-point only.

PROPRIETARY FOODS.

Condensed and evaporated milks.

Malted foods, containing starch.

Starchy foods and various dry powders.

Kindolac, a dried milk.

Imperial Granum. Used in the same way as barley flour is prepared.

Eskay’s Food, which is valueless unless mixed with cows’ milk.

Mellin’s Food and Horlick’s Malted Milk.

The difference between Mellin’s and Horlick’s food is that Horlick’s Milk has as its basis a dried milk preparation containing maltose and dextrins. Use proprietary powders in the same way as oatmeal or flour barley.

_Note._—Proprietary foods are only given to tide over a delayed feeding of mother’s milk.

CARBOHYDRATE FORMULÆ.

Horlick’s food, 11 teaspoonfuls
Dextrimaltose, 10 “
Mellin’s Food, 11 “
Milk-sugar, 9 “
Barley flour, 15 “
Flour ball, 12 “

Dissolve carbohydrates in sterilized water before adding milk. All mixtures should be cold when adding milk.

FLOUR BALL.

Four cups of wheat flour; place in muslin bag; place in warm water and boil six hours. After taking out of bag, remove outer part; then break up in chunks, place in radiator or slow oven to dry out. Pulverize by grinding. May use it instead of sugar.

BARLEY GRUEL.

One tablespoonful barley flour; 1 quart of water. Boil twenty to thirty minutes, then strain.

RICE GRUEL AND OATMEAL GRUEL.

Prepare the same as barley gruel.

_Note._—The flours thus made are very good carbohydrate foods. Gruels from this kind of flour settle on standing. To prevent this, add barley, oat, or wheat gruel flour before cooking. In using starch, boil solution one hour.

SKIMMED MILK

is prepared by removing the gravity cream or by a centrifuge.

HOMOGENIZED MILK

is prepared by mixing olive oil and skimmed milk under great valvular pressure.

WHEY.

1.—Boil 1 quart of milk; add 2 teaspoonfuls of rennet. Keep
at temperature of 103° F. for thirty minutes. Strain
through sterile cloth. To secure a fine soft curd add ½
teaspoonful of chymogen; allow to drain one hour. Sodium
citrate softens casein curd.

WHEY FOR SPECIAL INFANT FEEDING.

Add sodium bicarbonate, gr. x, to ½ pint of whey to render it alkaline, and sugar of milk, ʒj, to raise sugar to 6 per cent.

WHEY: ESSENCE OF PEPSIN FORMULÆ.

2.—1 pint skimmed milk;
2 teaspoonfuls essence of pepsin or rennet.

Let milk in double boiler heat to a temperature of 105° F.; add pepsin; stir for a moment and let stand at same temperature for thirty-five minutes. Cut into cubes and raise temperature to 155° or 160° F. to stop action of the rennet or pepsin. Then strain through several thicknesses of gauze and put on ice. Do not use pressure while straining.

RENNET TABLET FORMULA.

Milk, 1 pint;
Rennet or junket tablet No. 1, gr. j.

Measure milk in double boiler and raise to temperature of 98° or 100° F. Dissolve tablet in cold water, ℥ss to one tablet. Stir rennet through milk and let stand at same temperature for thirty or forty minutes. Cut into cubes and raise to temperature of 155° or 160° F. to stop the action of the rennet. Strain through gauze and put on ice. Do not use pressure in straining.

MILK ALBUMEN.

Milk, 1 quart;
Chymogen, 1 dram;
Buttermilk, 1 pint.

I. Boil milk for five minutes.
II. Cool to temperature of 100° to 105° F.
III. Add chymogen (dissolved in ℥j of cold water) and let
stand for one hour at temperature of 100° to 105° F.
IV. Let drain through cheese-cloth for one and a half hours,
and then throw out the whey.
V. Press the curd through the colander twice, adding the
buttermilk as the curd is pressed through.
VI. Make up the quart by adding sterile water.

When the food is to be given to the baby, heat only enough to take off the chill, as more vigorous heating will cause the curd to clump at the bottom of the bottle in large curds.

If there is any clumping, shake the bottle well before giving to the baby.

Never put the baby directly from a milk diet to a milk-albumen diet, but give one intervening feeding of barley water before giving milk-albumen diet.

CHYMOGEN USED INSTEAD OF RENNET.

Boil milk two minutes. Cool to temperature 100° F. Add 60 grains of chymogen to the quart. Let stand until clabber forms. Then drain curds.

ALBUMEN-WATER.

White of one egg;
Water, ℥viij;
Pinch of salt.

Add white of egg to cold boiled water and pinch of salt. Shake thoroughly or break with fork and strain through one thickness of gauze to remove froth.

LACTOSE SOLUTION.

To each ounce of milk-sugar add 1½ ounces of water (boiled). Heat until all the sugar is dissolved. Filter, put in a sterile bottle, plug with sterile absorbent cotton, and put on ice.

Use ℥iss for every ounce of sugar ordered. Subtract this amount from the total amount of water ordered.

PARTIALLY PEPTONIZED MILK.

Milk, Oj;
Water, ℥ij;
Peptonizing powder, 1 tube.

Put milk and water into a bottle and add the peptonizing powder. Shake well and place bottle in warm water from 105° to 115° F., and leave about ten minutes at that temperature. Shake from time to time.

COMPLETELY PEPTONIZED MILK.

The process is exactly the same as the partially peptonized milk, except that it is continued for two hours, which is required for the conversion of all the proteins into peptones. For older children the bitter taste may be covered by lemon-juice and cane-sugar, one even teaspoonful of cane-sugar and two teaspoonfuls of lemon-juice being added to ℥iv of milk.

BUTTERMILK.

To 1 quart of fat-free milk add 8 ounces of sterile water. Crush tablet of lactic acid bacilli into the mixture; allow to stand for twenty-four hours at room temperature, then place on ice.

DIRECTIONS FOR MAKING BUTTERMILK FROM LACTONE TABLETS.

Fresh skimmed milk, 1 quart;
Hot water, 1½ to 2 cupsful;
Salt, ½ teaspoonful;
Lactone tablet, 1.

Add hot water to milk; then salt; then the lactone tablet, well crushed. Stir well, cover with clean towel, and leave at ordinary room temperature. When the milk becomes thick and fermented set in ice-box for use. Before using heat the buttermilk until perfectly smooth.

BARLEY JELLY.

Three tablespoonfuls of barley to 1 pint of water. Cook two hours.

OAT-JELLY.

Oat flour, 2½ tablespoonfuls to 1 pint of water. Cook four hours and strain.

Oatmeal, prepare same as oat flour.

For a feeding, dilute with baby’s milk; season with a little salt. Do not use sugar, then the child will not acquire the taste for sweetened cereals.

_Note._—To cook cereals use a fireless cooker.

BEEF JUICE.

I. Cut meat into one-inch cubes; broil slightly and press out juice with meat-press or lemon-squeezer. One pound of meat will make 2 or 3 ounces of juice.

Serve warm or cold with a little salt.

Do not heat enough to coagulate albumen in juice.

II. Cold method:

Finely chopped beef, 1 lb.;
Water, ℥viij.

Put in covered jar; allow to stand on ice from six to twelve hours; then squeeze out by twisting in coarse muslin.

Season with salt and serve as above.

This contains a smaller amount of extractives.

It may be served with sherry wine or celery salt.

If added to milk in the proportion of 2 or 3 tablespoonfuls to the feeding, the taste will not be noticed. The milk should not be heated over 100° F., as the albumen will coagulate.