40. Warm Baths should not exceed a temperature of 98° without medical orders.

41. Fluids for Inhalations should have a temperature of about 170° Faht.

42. The Lights in a Sick-Room should always be placed behind the patient, not in front. Gas should not be used at all. (See "Ventilation.") Candles are better than lamps.

43. Coals in the Sick-Room. "G.E." ("Lancet," Nov. 17, 1866), says: The discordant clatter caused by the rattling of the iron shovel in the metal scuttle whenever coals are put on is a most irritating disturbance in the room of a sick person; and as anything tending to the comfort and quiet of an invalid is always welcome, I suggest the following simple plan, which prevents all noise, and costs nothing: - Fill the scuttle or coal-box with the coals screwed up in paper, each screw or packet containing about half a pound; the screw part of the paper to be kept downward. The fire can thus be attended to without using the shovel, without soiling the hands, and without the slightest noise.

44. Freezing Mixture. Well-pounded ice 2 lbs., salt 1 lb., water 1 pint.

45. The Heart-Bed, Couch, or Chair. (From the Author's work "On Affections of the Heart, etc.") There are few chronic cases of severe heart-disease, whether terminating in recovery or death, that do not pass through a stage in which the patient is unable to lie down, or even to lean back beyond the perpendicular line, without distress or danger, and there are many in which, at some period of their course, the only possibility of sleep is to lean forward on pillows placed upon a table in front of the patient.

Dropsy of the lower extremities is produced long before it need be, by the continued maintenance of the sitting posture with the legs down, or by keeping them up when the patient is obliged to lean forward, and thus to compress the veins and lymphatics in the groins by keeping the trunk flexed at an acute angle with the thighs.

These difficulties of position go on for days and weeks, and - what with the pains in the back, due to the strain upon the lumbar muscles; the sore arms and elbows, due to leaning upon them; the disfigured forehead and face due to the inequalities and other inconveniences of the pillows upon which the head is rested; the dropsy of the legs due to the force of gravity, and to compression of the veins and lymphatics at the groins; the dropsy of the hands due to the constrained flexure of the elbows; the dropsy of the integuments of the abdomen, due to the constrictive bending forward at the waist; the interference with the action of the stomach and bowels, due to the postural compression of the digestive organs; the cramping of the diaphragm, and the hampering of the already obstructed heart, by the pressure of the abdominal organs upwards: and, in addition to all these, the difficulty of finding any support for the head and elbows in front, that will not continually slip away, when the weight of the body is thrown upon it, and thus disturb the only opportunities of sleep: - these circumstances accumulated around a patient already suffering from a most distressing disease, combine to constitute a state of martyrdom of the most agonising and wearing description.

In attending such cases, whether in hospital or private practice, I have so often endeavoured, in vain, to find any couch, bed, or chair that would at all meet the necessities of the case; and I have been so often distressed by the urgent appeals of patients and their friends for something which might give the poor sufferer a little more comfort, and a passing chance of sleep; that I have at length contrived a heart-led, which does to a very great extent meet all the necessities of the case; and I trust it may prove an unspeakable boon both to patients suffering from severe heart disease, and to those anxious friends and attendants weary of witnessing their unalleviated woes. It can be either hired or purchased of the makers, Messrs. Ward, of Tottenham Court Road.

46. Obstinate Constipation and Obstruction of the Bowels, As constipation or want of action of the bowels, is the usual first symptom of obstruction, purgatives, increased in violence if the bowels fail to act, have almost always been used to excess before a doctor is called in.

A fatal termination of the case is often caused by this mistake in the early stages of obstruction. It is, therefore, most important for the public to know how unwise it is to give strong purgatives in such cases, and to be informed of a safer and more efficient means of treatment. I have seen the most remarkable results from the following simple and absolutely safe proceeding, which I advise to be adopted whenever the bowels appear to be obstructed and resist mild purgatives.

Place the patient on his knees and elbows, so as to raise the buttocks above the level of the abdomen. Inject a pint and a half of olive oil warmed to the temperature of the blood (98°). Pass a tape through a soft sponge, about the size of a cocoa-nut. Soak the sponge in hot water till quite soft, and directly the injection tube is removed from the bowel, insert the sponge, pushing it as far as the finger can reach, and leaving the tape hanging out. Then let the patient lie down and keep the oil and sponge in as long as possible. When the desire for the bowels to act can no longer be resisted, pull out the sponge and let them act.

The above is only a slight modification (in order to suit it for domestic use) of the plan designed by my ingenious friend, Dr. Samuel Newington, of Ticehurst, the exact details of which, as published by him, are as follows, and require the assistance of a medical man.

"Apparatus for breaking down Scybala or Hardened Faecal Matter collected in the Colon, (Exhibited at the International Congress, 1881.) This consists of an India-rubber bottle of a pint or one-and-a-half-pints capacity, fitted with a long elastic-gum tube to pass through the sigmoid flexure into the colon, and a piece of sponge, the size (when dry) of a cocoa-nut.

Directions for use: - After the tube has been softened, by placing it in hot water, and well lubricated with oil, carefully pass it into the colon; fill the India-rubber bottle with olive oil and half an ounce of turpentine well mixed with the yolk of an egg; attach it to the end of the elastic tube, then very gradually inject the contents into the colon, and carefully withdraw the tube. The sponge is then passed in a wet state from five to six inches into the rectum, and provided with tapes which are left outside. The patient generally sleeps at once after the injection, especially if a glass of brandy is added to the fluid. The sponge is not to be removed for twelve or eighteen hours, when the whole contents of the colon are generally broken down and expelled. If a doubt exists that more scybala remain in the colon, the same operation may be repeated the following day. The operation is more simple and less dangerous than passing a tube from three to four feet long into the bowels, and it has for the last thirty years always been attended with success."