Mouth and Pharynx. - Weak solutions are applied to the mouth in the form of washes with which the mouth is rinsed out. Stronger ones may be painted with a camel's-hair brush inside the cheek, lips, gums, tongue or pharynx. Solutions may be applied to the pharynx by painting with a brush; solid substances, as caustics, by rubbing. In using caustic, care must be taken that it is firmly attached to the caustic-holder, and, in the case of nitrate of silver, that only a short point is used, as otherwise the caustic may fall off, or the stick of nitrate of silver may break and be swallowed. This is especially necessary in touching the throat in children. In cases of post-nasal or pharyngeal catarrh, solutions such as glycerin of tannin, etc, may be applied to the back of the soft palate and the posterior part of the nares by means of a camel's-hair brush fixed on a wire which may be bent to any desired angle.

Masticatories. - We sometimes give the patients solid pieces of a drug to chew. These are called masticatories. We use them for their action upon the mouth itself, e.g. pellitory, where we wish to increase the secretion of saliva; or where we not only wish to produce the effect upon the mouth, but the effect of the drug mixed with the saliva upon the stomach and intestines, as in the case of rhubarb.

Gargles. - In gargling, a full breath is taken, the mouth is filled with the liquid which is to be applied to the pharynx, and the head being then thrown back the fluid runs against the pharynx and is partly thrown up against the soft palate by the air which gradually escapes from the lungs. In cases where it is advisable for the fluid to reach the posterior nares, the patient should lie down flat, take a mouthful of the liquid, draw out the tongue as far as possible with a handkerchief, and gargle while in that position. By throwing the head suddenly forward the liquid may be brought through the nose. This is useful both as a method of applying the liquid more thoroughly to the pharynx and as a training preparatory to rhinoscopic examination.1

Stomach. - Drugs are applied to the stomach in the form of solutions or draughts, pills, powders, or boluses, etc, which are swallowed.

Powders may be very conveniently given in wafers. A thin wafer is moistened with water, and the powder being introduced,

1 Rumbold, Chicago Med. Journ., August 1877, p. 113.

is folded up in it and swallowed. Another most convenient vehicle is oatmeal porridge, a little of which is put upon a spoon, and, a depression being made in it with the finger, the powder is put into it and covered over with porridge. The porridge should fill the front half of the spoon, and the back part should be filled with milk, which helps the child to swallow more easily. Powders are sometimes given to children in jelly, but this is too soft, and so also is the paste made of bread and milk, although this may be used when porridge cannot be readily obtained. Pills may be simply swallowed with water, or taken in jelly, but some people are unable to take them without choking, and children especially have much difficulty in swallowing them. This difficulty is readily got over by dividing the pill into four or more parts, and taking each part in a little oatmeal porridge. Custard puddings, or puddings made of corn-flour or arrowroot, may be used instead of porridge, but are hardly so good.

Stomach-pump. - In cases where the patient is unable to swallow from paralysis of the pharynx, constriction of the oesophagus, or narcotic poisoning, the stomach-pump may be used. This consists of a large, double-acting syringe with a flexible tube attached. In using it care must be takenl (1) to have the tube well softened in hot water; (2) to keep its end directed towards the pharynx, and not bent too much forward, lest it enter the larynx; (3) not to use violence in introducing the tube, lest it should be driven into the mediastinum, or even through the walls of the stomach itself, into the peritoneal cavity; (4) not to use violence in working the syringe, lest the mucous membrane of the stomach should be drawn into the lower orifice of the tube and injured.

In place of the stomach-pump the gastric syphon may sometimes be advantageously employed, especially for feeding. It consists of a piece of thick-walled, soft, and flexible india-rubber tubing. It is so soft and flexible that it can hardly by any possibility injure the oesophagus or stomach, and yet it is sufficiently firm to pass down without much difficulty. After it is in, an ordinary funnel is attached to the projecting end, and water, beef-tea, or whatever substance one wishes to introduce into the stomach, is simply poured in, the funnel being kept at, or above, the level of the patient's mouth. When it is desired to empty the stomach water is poured in, in the manner just described, the tube being pinched, and then the outer end of the funnel is held down as low as possible - the syphon action is thus reversed, and the fluid which has just been poured into the stomach again flows out of it.

1 In cases of poisoning it may be absolutely necessary to use the stomach-pump, but in ordinary cases a tube should never be passed down the oesophagus until the absence of aortic aneurism has been ascertained by a careful examination of the patient's chest.

Intestine. - Drugs are applied to the intestine by means of enemata or suppositories. Enemata are liquid injections into the rectum for the purpose of emptying the lower parts of the bowels when we do not wish to excite the whole bowel, or when we wish to cause as little movement as possible to the patient. They are also used for the purpose of administering nutriment when the patient is unable to swallow or to retain food given by the mouth. In using enemata for the purpose of inducing action of the bowels the quantity should be considerable - sixteen fluid ounces, or even more. When they are intended to be retained, the quantity is usually small - not more than two to four fluid ounces at most. In using the enema syringe care should be taken that it is first emptied of air and that it is not pushed forcibly into the bowel. The nozzle should not be directed too much backward, as, if this be done, and especially if force be employed, ulceration of the posterior wall of the rectum may be induced. Where enemata are given for the purpose of nutrition, a much larger quantity than four ounces may be retained by using the proper method. A flexible, soft rubber tube should be passed for eight or ten inches up the intestine and the nutrient enema may then be slowly and gently introduced either by using a syringe or by simply pouring it into the tube by a funnel. By this method the fluid is introduced into the sigmoid flexure or descending colon, and if the patient can be propped somewhat so as to lie on his left side, none of it may descend into the rectum. In this case there will be little or no tendency to evacuate it and the whole may be readily absorbed.

The retention of a nutritive enema may be aided by folding a soft napkin so as to form a pad, and pressing it firmly against the anus for a few minutes after the enema has been given, and until the desire to evacuate the bowel has passed away.

Suppositories are drugs made up into a conical shape by means of cacao-butter. When introduced into the rectum the cacao-butter melts, the drugs become spread over the surface of the mucous membrane of the rectum and gradually absorbed. They are employed when we wish to get the local action of a drug upon the rectum, or the parts surrounding it, or when we wish to get the general action of a drug after its absorption without producing any local effect upon the stomach.