tion to it is carried so far, that people are in the habit of shifting twice a day indeed, if articles of dress are once soiled, and next the skin, there is danger of absorption of their noxious matter, and their renewal, therefore, cannot be too speedy.

In cases of typhus or putrid fever, general ablution of the body with cold water or vinegar is certainly very beneficial, and most grateful to the feelings of the patient, and also a change of linen; but by washing the rooms of invalids, and often by changing the bedclothes, considerable injury is frequently done, particularly in cases of eruptive fevers, inflammatory affections of the head, throat, lungs or bowels, and rheumatism. The object of ablution is to remove offensive matter that may be absorbed from the surface of the body, or contaminate the air. The perspiration of the body is an inoffensive secretion; and the dirt of a floor may be as effectually removed by a hard brush without the aid of water as with it. In a hot climate, the use of water may, however, prove useful, by cooling the atmosphere of the chamber.

USEFUL APPARATUS EMPLOYED IN MEDICINE.

LAVEMENT MACHINE.-Of all the instruments that have been recommended for administering the important remedy termed a clyster or lavement, that lately invented by Mr. Read appears to be the best, particularly in cases of obstruction in the bowels, and for an invalid to employ without assistance. This ingenious contrivance possesses sufficient power for propelling the fluid into the intestinal canal. The following diagram represents the apparatus as applicable to self-injection. The lefthand figure shows the syringe screwed to the reservoir, which holds a pint, into which the liquid is put. In lieu of a reservoir, the liquid may be put into a basin or other vessel, as shown by the right-hand figure.

जू

The patient being seated upon a chair, night commode, or any other convenient place, introduces the pipe into the bowel, and, by repeated strokes of the piston, pumps the injection into the intestines. In alluding to the remarks upon the efficacy of clysters contained in my treatise on Constipation, Mr. James Scott, a surgeon, of London, has published the following Observations:

"To give, however, this desirable plan its proper efficacy, an instrument was wanted, not only adapted to domestic use, but which could meet all the exigencies of those severe cases of obstruction that often baffle medical skill, and terminate fatally. For the first purpose, it was necessary that the machine should be so constructed that an invalid should be able to use it without assistance: and for the second, that it should be capable of transmitting any quantity of fluid desired, with a power equal to the resistance it might experience.

:

"This has lately been effected by the invention of a small syringe or pump, by an ingenious person, named Read, which is more suitable to this operation than any other instrument hitherto used. The cylinder of this syringe is not more than three quarters of an inch in diameter, and three inches and a half in length, and receives about an ounce of fluid, which is admitted at the extremity, and discharged through a small branch at the side attached to a long flexible tube that conveys it to the bowels. Notwithstanding the small size of this instrument, a large quantity of fluid may be injected in a very short space of time; in fact, it can be made to pass with a velocity not requisite in any case to which it may be applied, viz. at the rate of three quarts per minute. The French and other clyster syringes (containing a pint or more) are much too large to be either convenient or efficacious in the first place, if there be any obstruction in the intestinal canal, or the bowels oppose the passage of the injection by any degree of reaction (which they usually do) the force necessary to propel so large a column of fluid requires the arm of a Sampson or a Hercules; and, secondly, the clumsy size of these instruments renders their use so awkward, that the patient is often much hurt by the attempts to effect the operation. Besides this, if a large quantity of fluid be necessary (as in cases of introsusception, obstinate constipation, &c. where several pints or even quarts are often thrown up) the operation is unavoidably suspended as often as the instrument requires to be recharged, and this, perhaps, several times successively. There are also serious objections to the canister apparatus, the fluid contents of which are forced into the bowels by the agency of condensed air. One of the evils of this instrument is, that part of the confined atmosphere rushes through the liquid injection, and passes

into the bowels along with it, occasioning, of course, mischievous and hazardous consequences; and again, the injection is forced out by the expansive action of the compressed air within the canister, and, consequently, the propulsive power lessens as the operation proceeds, which is directly the reverse of what ought to happen, for with an accumulating resistance and volume anteriorily, the vis a tergo ought to be, of course, proportionally increased.

"Not one of these objections applies to Read's syringe, the action of which is so easy, that it may be worked with a finger and thumb, whilst its power is so great, that all resistance yields to it without any increased effort."

When the syringe is used without a reservoir, the basin containing the liquid may be placed upon a chair opposite to the patient.

The above injecting apparatus is also sold combined with a bidet, which certainly adds much to the convenience of the operation. The basin for holding the liquid enema is formed at the front of the vessel, with a pipe descending into it, upon which the syringe is screwed. The syringe being fixed, requires but one hand of the patient to use it, and allows therefore of the other hand being employed, if necessary, to support and retain the pipe in the bowel.

This apparatus is also very useful for female injection, whether it be of medicated lotions or simply ablutions of water. CLYSTERS and LAVEMENS, page 99.

See

WARM AIR, FUMIGATING, AND VAPOUR BATHS. The importance of these auxiliaries to internal

medicine, &c., I have briefly noticed under the head of "Auxiliary Remedies," p. 169 to 173. Under the directions of Mr. Green, of Great Marlborough Street, the warm air bath, the sulphureous fumigating, and the simple and medicated vapour baths have proved very beneficial in a great variety of cutaneous diseases and rheumatic affections. The 143d number of the Monthly Gazette of Health contains the particulars of a case of leprous affection of the skin, of many years' standing, which was effectually cured by sulphureous fumigation, under the care of Mr. Green, after the usual remedies, as mercury, arsenic, &c. had failed to produce any salutary effect. The following representation of Mr. Green's "fumigating bath" will exhibit the mode of employing it:

The division on the left shows a patient about to take a bath, and that on the right represents a patient exposing the whole of the surface of the body, excepting the face, to the influence of any gas impregnated more or less with the matter of heat, sulphur, mercury, &c., which arise from beneath and surround the body. The arterial system and various functions of the body during this time are greatly excited; and particularly if there be any abrasion of the skin, as from the previous application of a blister, whatever medicine is made to arise in the gaseous form is readily absorbed, and the system becomes influenced, as though the medicine had been taken in the usual way by the mouth. This is unquestionably a great advantage, especially with those persons whose stomach and bowels are too weak to bear the action of the usual medicines. The patient being exposed to a temperature greater than that of the body for about twenty

minutes, will soon be convinced that the temporary impulse given to the animal functions, with due repetition and not continued too long, will go far to ameliorate, and, in many cases of simple ailment, to cure disease, and at all times to prove a powerful auxiliary to medicines. The sulphur and other gaseous baths are given in the dry state; but the simple vapour can be used, on account of being free from the objections which are made to the customary and careless way in which they are administered; for in the box baths the whole process is more convenient to the patient; the feet are kept the hottest, and the patient breathing the atmospheric air, there is no fear of an excessive determination of blood to the head; but in pulmonary cases, inhaling the vapour is frequently desirable when at the natural temperature of the body. The prevailing opinion that great care is necessary to prevent taking cold after the use of this bath is a vulgar error, because the body being surcharged with the matter of heat, it is impossible to take cold after it, unless by an imprudent exposure to wet, or a current of cold air.

The view given is representative of the improved mode of using this bath, as daily practised by Mr. Green, at his establishment in Great Marlborough Street, whose late publication, with cases illustrative of the benefit of various simple and medicated baths may be obtained of any respectable publisher.