shrink. There may be fat, but at the same, time much atrophy of the other bodily components. Atrophy occurring earlier in life, without obvious cause, ought to be regarded suspiciously. When an individual, without departing from ordinary habits, begins to lose flesh, the cause ought to be looked for, and if the change continue, the person should be submitted to a thorough medical examination, and the existence or not of incipient disease, if possible, ascertained. In young children, atrophy occurs as a consequence of faulty digestion, most frequently from improper feeding; it also is the result of a diseased condition of the glands of the belly, through which the nutrient portion of the food passes on its way to the general circulation. For this condition, cod-liver oil is the remedy, given in tea-spoonful doses twice-a-day, to an infant of six or eight months old, and the same quantity well rubbed into the skin of the abdomen night and morning. Some medicines, such as iodine, have the power of causing local or even general atrophy.

Local atrophy is liable to occur from various causes. Whatever diminishes the supply of blood to a part, will cause it to waste. Pressure on the main artery of a limb, obliteration of the smaller vessels of a part by previous inflammation, disuse of a member from paralysis or any other cause, are all followed by diminution in size of the part affected.

Refer to-Age-Infancy. AUSCULTATION.-The application of the sense of hearing to the detection of disease. The art is most extensively useful to the medical man in the case of the chest; but in diseases of the abdomen it is a great assistant, and indeed is applicable to most circumstances, such as affections of the blood-vessels, fractures, &c., in which, movement makes sound audible. When the medical man elicits various sounds by tapping on the body with his fingers or by any other means, it is called percussion, and the present meaning of auscultation, is the practical knowledge of those sounds which are produced by the movements within the living body. Probably, no addition to the science and practice of medicine has more extended the power of detecting the existence and nature of diseased action than the practice of auscultation. The stethoscope, now so well known from its universal use by medical men, is but a conductor of sound, used for obvious reasons of delicacy, convenience, and in some cases to prevent unpleasant contact with the uncleanly, but the sounds are equally well heard by the unassisted ear.

Some medical men affect to despise the aid of auscultation, and of the stethoscope, it can only be such as want either the capacity or industry to learn its proper use. The stethoscopic examination of females may always be conducted with perfect delicacy and sufficient nicety through a covering of linen, and never, as sometimes is done, though rarely, should this means of investigation be denied to the attendant practitioner.

AXILLA.-The arm-pit, is an important region of the body, on account of the large blood-vessels and nerves which occupy its space. A wound of the large artery in this situation, unless efficient means are speedily adopted to control the bleeding, must be quickly fatal. When from the copious flow of florid blood from a wound in or near the arm- pit, such an accident is supposed to have occurred, a bystander should with all speed exert pressure by means of his thumb upon the artery as it passed over the first rib, just behind the middle of the collar bone, until the effusion of blood ceases. This pressure of course must be kept up, but as to do so with the thumb simply, would be too fatiguing, some solid bodythe handle of a moderate-sized key is generally recommended-must be wrapped in a few folds of handkerchief and used for the purpose. While this is done, if medical assistance be many hours distant, as an additional safeguard, firm graduated pads should be tightly fixed into the hollow of the axilla, and firmly retained by a handkerchief or small shawl crossed over the opposite shoulder, but this must be a supplementary aid, until the artery is properly secured by the surgeon. The pressure behind the collar-bone, cannot be relaxed for one moment without risk to life.

Refer to-Artery.

AXUNGE, HOG'S-LARD, is used as principal component of various ointments, but is often injurious, in consequence of being slightly rancid, in which case, instead of soothing, it has an extremely irritating effect, upon abraded or blistered surfaces especially. Even when applied fresh, if allowed to remain too long unchanged, it will become a source of irritation.

AZOTE, NITROGEN.-One of the gaseous components of the atmospheric air, of which it forms 77 per cent. by weight. It is one of the most abundant and widely distributed of the elementary bodies. With oxygen, it forms various compounds, of which nitric acid is the best known. Combined with hydrogen it forms ammonia. Nitrogen is regarded as the characteristic element of animal substances; it is also present in vegetables, but in smaller proportion.

uterus.

Refer to-Spine-Kidneys-Lumbago, &c. BACON.-The flesh, or rather fat and flesh of the hog, salted and dried, and sometimes smoked, forms the staple article of diet of the English labourer; the dietetic breakfast of the invalid. In the former case it is undoubtedly a relishing, convenient, and in some degree nutritious, addition to the general fare; at the same time, it is a question, whether it does not in many districts form too large a proportion of the ordinary nutriment consumed, and whether an advantageous exchange might not be made, in part at least, for a more farinaceous diet. Owing to the great proportion of fat in bacon, there is comparatively little of those elements of food, which go to build up the constituent tissues of the animal body, and which are contained so abundantly in the grains and pulses. Where the choice lies between bacon and bread, or bread and milk, or oatmeal and milk as consumed in Scotland and in the northern English counties, there is no question that much more real nourishment will be obtained from the vegetable grain and milk, which contain whatever is requisite for every portion of the frame, than from that of which simple fat forms so large a share, and which cannot do more than afford respiratory food, or at the best, add fat to the body. To full grown men this may be of comparatively little importance, but to growing children and youths, it must of necessity be a consideration, whether, in consuming the amount of nutriment circumstances permit, they consume that which really will afford them strength and substance, or not. Of course these remarks apply principally to the pure bacon fat consumed in such large quantities by the labourers and servants in the midland and southern counties of England. Bacon used as a dietetic, as it is usually done, with breakfast, is often of much service in cases of biliary disorder. It is the fat alone, toasted in slices before the fire, which must be eaten, the lean is hurtful, and must be discarded by the bilious dyspeptic. When used in this way, a slight aperient action is certainly exerted, and it is to this, gently but regularly carrying off its daily proportion of, bile, that the undoubted beneficial effect is most probably to be attributed.

BALSAM.-The term is derived from two Hebrew words, signifying the "prince

of oils." It was formerly applied to many more substances than it is at present. The balsams of Peru and Tolu, and of Copaiba, are most generally known medicinally. The two former are used popularly as external applications. Tolu balsam is used to impart a pleasant flavour to lozenges, cough mixtures, &c., &c.; at the same time, it undoubtedly exerts a beneficial expectorant action. Quarter of an ounce of gum acacia powder, an ounce of Tolu syrup, one drachm and half to two drachms of ipecacuanha wine, and water sufficient to make up six fluid ounces, forms a pleasant and good cough mixture for children, to be given in from tea-spoonful to table-spoonful doses, according to age. When fever is absent, and the cough getting loose, a drachm of tincture of squill may be added with advantage to the above.

BALSAM OF COPAIBA acts decidedly upon the mucous surfaces of the body, and is employed in bronchitis, and in irritation of the urinary passages. It is extremely nauseous, and liable to disagree with the stomach. These properties are endeavoured to be overcome by enclosing the medicine in gelatine capsules, and by preparing it in various ways, as by covering the taste with aromatics, such as cinnamon or peppermint water. When active inflammatory or febrile action is present, copaiba must not be used.

BANDAGES are strips of calico, linen, flannel, or of any other convenient material, employed to envelope in rolls, any portion of the body requiring artificial support, or upon which it is requisite to produce pressure, or to retain dressing. The art of applying a bandage well, that is, both neatly and efficiently, requires some practice and attention, but it is often a most useful accomplishment; for a bandage if required at all, must be properly applied, otherwise it is worse than useless; if therefore, none but the surgeon can undertake the task, it necessitates a much more frequent attendance on his part than might otherwise be requisite. In general, the first few applications of a bandage, will be made by the medical attendant himself, and ought to be in the presence of the individual to whom the duty may be afterwards deputed. By careful attention on the one hand, and kind explanation on the other, much may be learned and taught, but not all, as the inexperienced bandager will discover on the first attempt; by all means, therefore, let the first beginnings be made on some one in health, before the call is made to the invalid. Attention to the following directions, will facilitate the application of the previous practical lesson, or in some measure supply

its place, if from circumstances it has been wanting. Whatever the material, the width of the bandage or roller must be proportioned in some degree to the size of the part to which it is to be applied, if too narrow it is apt to be stringy, and to cut, if too broad, it does not adapt itself readily to the inequalities, and the pressure is unequal. For an ordinary sized adult male leg, a bandage of two and a-half inches broad is a good proportion; for the arm of the same person, one of two inches ought to be sufficiently well adapted. The material for bandages must neither be too strong nor too weak, ordinary shirting calico" is a very convenient texture. The length, of course, must vary according to what is required, but rollers are usually put up in six or eight-yard lengths; they are better torn in one continuous strip, free from joinings, and without selvidge edge. The strip, when prepared for use, must be rolled up as firmly as possible, either into a single or double head, Fig. A., the former is

66

A.

much the most generally employed. If the bandage is a new one, of calico or linen, the loose threads of the roll at each end must be roved off, otherwise they are troublesome when the roller is applied. Bandages may be applied in simple circles, fig. B., in spiral, &c. or in reverses, fig. C. They are also applied in various other forms to suit the different portions of the body. In applying a bandage, the rolled-up strip being held in the right hand, the end which is commenced with is secured by the first turn. If it be the simple circular bandage, round the trunk of the body, or round a limb of nearly equal girth throughout, either naturally, or from swelling, the roller is carried round and round, each succeeding turn, slightly overlapping the one before it; if the spiral bandage be required, the rolls are carried up very obliquely, but if, as most likely, it is the reversed bandage, then, wherever the inequality of the parts prevents its being laid on flatly and evenly, the band must be turned upon itself, fig. C., so as to become reversed, the surface of the cloth which was next the skin, being turned outwards, and vice versa. It is difficult to describe the manœuvre, and it is a little difficult at first to execute it neatly and well, but when prac

B

tised it becomes perfectly simple. This is by far the most useful form of bandage, and a person who can put it on well, will have but little difficuly in accomplishing the other varieties.

For the purpose of retaining dressings upon the head, nothing answers better than a close-fitting calico cap; a handkerchief will often serve every purpose, or the split cloth-fig. D-may be used; applied-fig.

D

E-the upper tails being brought beneath the under ones, and fastened under the chin, the under tails being carried to the back of

E

the head. When it is desirable to retain the head in one position, it may be done by bands attached to a cap, and fastened as required to a band going round the chest. When for this purpose, or to fix a broken rib, such a band is required, it ought to be from eight to ten inches wide, made of tolerably strong double calico, and sewed firmly round the body.

To retain a pad or poultice in the arm-pit, a good-sized handkerchief answers better than any bandage, the middle being placed at the arm-pit, the ends are crossed at the side of the neck opposite, carried under the corresponding arm-pit, crossed and brought and tied on the shoulder. Slinging the arm, a very simple business, is often very badly done-in almost every case the forearm should be supported throughout its entire length, and it is generally well to include the hand, especially in children. The simple sling handkerchief may be put on as at fig. F, but a much more confining

F

Upon the trunk of the body, dressings, blisters, &c., may be retained by means of a broad band of any convenient material, fastened round and prevented from slipping down by braces over the shoulders-fig. M.

M

For bandaging the abdomen, a broad band, of whatever material is suitable, is generally made, the ends split for convenience of fastening either before or behind, and a triangular piece cut out of either edge at the centre, and the edges joined, in order to fit the shape of the region. In order to retain poultices, &c., at or near the groin, a piece of cloth is to be shaped to fit the region-fig. H, a band long enough

sling is made by enveloping the elbow in the long side of a triangular handkerchief, fastened up into a little pouch at the centre, and the point, including the hand, being fastened up to one of the ends going round the neck-Fig. G.

1

H

G

To re

to go round the body, cross and fasten in front is to be sewed to one end-1, and to the opposite point another small band-2, is attached, which, passing between the legs, is brought up to the band behind. tain dressings, &c., between the legs or nates, the double T bandage-fig. I, is used. For the groin and parts adjacent, the spica or figure of 8 bandage is also used. A roller eight yards long is taken, the end secured by one or two turns round the pelvis, and then the bandage is brought down across the front of the thigh, carried evenly between

I

of bandage at full length pulled round the limb every time. A many-tailed bandage, fig. L-is used to bandage the leg where it

L

the legs, and again brought up and carried round the pelvis, this being repeated at each turn till the roller is exhausted, fig. K.

K

For the extremities, the simple roller applied in reversed turns is generally used. Bandaging from above downward may be required, but generally it is upwards. There are various methods of commencing the application of the roller at the foot. The heel is covered by laying the end on the inner ankle, bringing the roller under the heel, then round the ankle so as to secure the end, from thence going down to the toes, and carrying the bandage up from that point round the foot and leg, reversing where required. The arm is to be bandaged -with the requisite modifications-by the reverse, like the leg. As a general rule, leg bandages, habitually worn, ought to be put on before the individual gets out of bed in the morning. A bandage which gives pain after its application, without obvious cause, ought to be taken off, and re-applied. If there is reason to suspect inflammatory swelling beneath, it will be well to try the use of cold water before disturbing matters There is some little management required in taking off a roller as well as putting it on as each successive turn is unrolled, it should be gathered in a bunch in the hand, and not, as is often done, three or four yards

is an object to avoid the slightest movement. It is formed of a number of short strips of bandage, long enough each to go once and a-half round the limb. They are placed obliquely, and overlapping one another; they may, or may not, be joined by a central strip, 1. Upon these arranged strips the limb is laid, and each strip in succession is brought round the limb, every succeeding securing the previous one. The advantage of the many-tailed bandage is, that it can be changed, either partly or entirely, if soiled, without the slightest disturbance. It is only necessary to attach a fresh strip to that which is to be removed, and pull the one away, and the other into its place. When, from movement, a bandage is liable to become displaced, the inconvenience is in great measure prevented, by brushing a weak solution of starch or gum over the turns as soon as applied. This is different from the starch bandage which is so useful in many cases-fractures, &c. For this bandage, the roller is thoroughly saturated, as it is put on, with strong starch or flour paste, and, if requisite, brown paper pasted on the top of the first bandage, and another dry one put over all. In thinly settled countries, where it might be requisite to move a person soon after a fracture, the foregoing application would prove simple, safe, and efficacious. It must not, however, be put on till inflammation has subsided. In many cases, in which bandages used formerly to be applied, they have been superseded by elastic materials, of which stockings and belts of all kinds are fabricated: elastic rollers are also manufactured. The flannel bandage unites at the same time, support and protection to the surface-it is useful in rheumatic cases, and also when applied over the abdomen in diseases of that cavity.