must be given as to the ventilation and warmth of the sick-room, the amount of light, the position of the bed (not to be placed in a corner), the degree of quiet to be maintained, the avoidance of excitement and whispering, the exclusion of visitors, the cleanliness of the sufferer, and the nature and quantity and times for administration of food. No cooking whatever should be permitted in the sick-room. In cases of long illness, when the patient can be moved without risk, it is often desirable to have two beds in the room, one to be occupied during the day, the other at night. Every precaution must be taken to prevent the spread of infectious disorders. Soiled linen, dirty water, etc., must be immediately removed. In all instances the evacuations ought to be passed in a bed-pan or night-stool containing some disinfectant material (carbolic acid, permanganate of potash, sulphate of iron, etc.).

11. While it is allowed that formulæ may often be employed with great advantage, yet they should not be prescribed with servile exactness; for it should never be forgotten that all medicines of any power have to be adapted to the requirements of the special case under treatment. It has been quaintly but truly observed, that a bundle of ready-made receipts in the hands of the routine practitioner is but a well-equipped quiver on the back of an unskilful archer.

12. In watching the restoration of a sick man to health, it is a mistake to attribute the improvement too confidently to the action of the medicine prescribed, for it may not have been taken, or it may not have been absorbed, or its properties may have been destroyed by adulteration, or it may have even proved injurious-recovery occurring in spite of it.

WHAT THE PRACTITIONER MUST LEARN OF THE PATIENT.

It is often a matter of convenience, in taking notes of a case, to base them on some general system of inquiry. The young practitioner, especially, should adopt some method of this kind at an early period of his career. In his history of a case from its inception to its close, whether the result be favorable or unfavorable, such an outline sketch, well filled up, will prove valuable for present uses and future reference. As has been truthfully remarked by Dr. Henry W. Acland, by whom the following table was prepared,' a skilful practitioner can learn the truth of any case in any order or in no order; but it may be added that such a table will prove useful even to the most systematic:

HISTORY.

When were you last quite well? at work? How did you first feel ill? Supposed cause, mode of onset, any medical treatment?

What do you now chiefly complain of? What illnesses have you had before this? (If the examination suggest it, obtain further information concerning resi dence, occupation, past life, change of habits, history of the family, hereditary prediposition, etc.)

PRESENT STATE.

I. GENERAL ASPECT.-Manner, posture (in bed, out of bed), color, shape, temperature, weight (alteration in), eruption, oedema.

Notice generally head, neck, chest, abdomen, limbs.

Handbook for Hospital Sisters, by Florence S. Lees, London, 1874.

II. ORGANS OF DIGESTION.-Hunger, thirst, taste. Lips, color, texture. Teeth, loose, etc. Gums, color, size, texture, position. Tongue, protrusion, volume, form, color, surface, dryness, coating. Stomach, nausea, vomiting, eructations, pyrosis, pain during, before, after (how soon after?) eating.

III. ORGANS OF ABSORPTION.-Lymphatics, red, tender, hard. Glands, tender, swollen (for what length

of time).

[The patient must be in bed or undressed for a complete inquiry into Nos. IV., V. and VI.]

IV. EXAMINATION OF ABDOMEN.-By palpation, percussions, measurement. Dimension of liver, spleen. Existence of pain, increased or diminished by pressure; general or circumscribed; under the hand or at another point. Existence of tumors, fluids, flatus, feces; of hernia; of tumors in groin; of hemorrhoids; of feces in rectum.

V. ORGANS OF CIRCULATION.-Heart, position, dimensions, force, rhythm, sound (character, situation, and distance). Arteries, pulse at wrist; rate, volume, hardness, laboring, regularity, intermission, dicrotism, etc.; tumors. Veins, enlargement, tenderness, murmurs.

VI. ORGANS OF RESPIRATION.- Respiration generally; frequency, regularity, difficulty, odor of breath. Nares, discharges, odor, action. Epiglottis; Larynx, tenderness, alteration of voice. Cough, its charac ter and supposed cause. Expectoration, color, odor, tenacity; chemical, microscopical properties. Examination of Thorax.-Form flattened, rounded, asymmetrical; supra and infra-clavicular spaces, etc. Movements; vocal fremitus; intercostal spaces.

Resonance on percussion; changed by posture. Sounds on inspiration, expiration, speaking, cough. ing, succussion.

VII. ORGANS OF SECRETION AND EXCRETION.- Skin, eruption; sweat, quantity, chemical quality; locality. Kidneys-Pain in micturition; its seat and direction; pain in the loins. Urine, fre quency (night or day), quantity, appearance. Microscopic deposits, organic, inorganic. Chemical examination-acidity, specific gravity, albumen, sugar, bile, excess of urea, etc.

Bladder, tumors, irritability, etc., calculus.

Bowels, frequency of action, character of evacuations.

VIII. ORGANS OF GENERATION.-(Male), penis, scrotum, testes, cord.

(Female), catamenia-color, quantity, frequency, duration.

Leucorrhoea, or other discharges.

Pain-its seat, duration, causes, periodicity.

Uterine, pelvic, ovarian enlargements, tenderness, ulcerations.

External sores-eczema, pruritis.

IX. NERVOUS SYSTEM. - Brain, general intelligence, memory, speech, slowness of manner, headache (where), giddiness, sleep, dreams, fits (one kind or more).

Spinal Cord and Nerves.-Pain, alterations in kind or degree of sensibility, in sight (pupils), hearing, smell, taste, touch, numbness; tremors, rigidity, rigors, paralysis.

X. ORGANS OF MOTION.-Pain, stiffness, swellings, nodes, ulcers, abscesses.

DOSES OF MEDICINES.

In addition to the actual quantity of any remedy to be prescribed in individual cases, modifying circumstances must be taken into consideration, such as age, physical condition, etc. It is difficult to limit the effective doses of a medicine within the fixed quantities assigned to it in the various posological tables, such quantities being mentioned as a general guide to the practitioner, beyond which he may sometimes step, according to his own discretion. As will be seen, however, in one of the accompanying tables (see p. 91), an effort has recently been made to define the maximum doses of the more potent agents. The practice of using caution marks for excessive doses knowingly prescribed, has not yet come into vogue in this country, but it has been suggested by the American Pharmaceutical Association, and other authorities, that such methods of protection and safety should be generally adopted.

Wherever desirable, the French metric system is mentioned in conjunction with that in general use, so that the practitioner may become familiarized with its peculiar construction.

Doses for Children.

The simple rule, generally applicable, is as follows:Under twelve years of age diminish the dose of the medicine in the proportion of the age to the age increased by twelve.

At one year of age the dose will be

1

=

1 + 12