When properly administered, this is one of the most powerful of all
water appliances. Some skill is needed to apply it with a uniform degree
of success. Two or three comfortables or thick blankets, one woolen
blanket, and a large linen or cotton sheet are the articles necessary.
It is important to be certain that the sheet is sufficiently large to
extend twice around the patient’s body. More blankets are required in
cool weather and by weak patients. Spread upon a bed or straight lounge
the comfortables, one by one, making them even at the top. Over them,
spread the woolen blanket, allowing its upper edge to fall an inch or
two below that of the last comfortable. Wet the sheet in water of the
proper temperature, having gathered the ends so that it can be quickly
spread out. Wring so that it will not drip much, place its upper end
even with the woolen blanket, and spread it out on each side of the
middle sufficiently to allow the patient to lie down upon his back,
which he should quickly do, letting his ears come just above the upper
border of the sheet, and extending his limbs near together. The patient
should then raise his arms, while the attendant draws over one side of
the wet sheet, taking care to bring it in contact with as much of the
body as possible, bringing it closely up beneath the arms, and pressing
it down between the limbs so as to make it come in contact with both
sides of them. Tuck the edge tightly under the patient on the opposite
side, using care not to include the other edge of the sheet. Now let the
patient clasp his hands across his chest, and then bring up the other
side of the sheet. Grasp it by its upper corner with one hand, drawing
it down over the shoulder and lengthwise of the body; then place the
other hand upon the covered shoulder, holding the sheet firmly in place
while the corner is carried upward upon the opposite side and tucked
under the shoulder, thus drawing the upper edge of the sheet well up
under the chin. Tuck the edge of the sheet under the body, carefully
enveloping the feet. Then bring over each side of the blanket and
comfortables in the manner last described, being very careful to exclude
all air at the neck, and allowing the blankets to extend below the feet
so that they can be folded under.
It is not desirable that the patient should be bound as tightly as a
mummy. All that is necessary is the exclusion of air, and as the neck
and feet are the points at which it is most likely to enter, these parts
should receive particular attention, as directed. If too tightly bound,
the patient will be more likely to be nervous than if allowed some
freedom. The application of the wet sheet should be made in a few
seconds, as it cools very rapidly when spread out. The first blanket
should be brought over the patient as soon as possible. If the feet are
not warm, a hot foot bath should be taken before the pack. If they
become cool in the pack, hot jugs, bricks, or stones should be applied
to them. If the patient does not become comfortably warm in a few
minutes—ten or fifteen at most—more blankets should be added, and, if
necessary, dry heat should be applied to the sides. If he still remains
chilly, he should be promptly removed and placed in a warm bath, or
vigorously rubbed with a dry sheet and then placed in a dry pack. The
head should be kept cool by frequent wetting while the patient is in the
bath. If a compress is applied, it should be often renewed.
The temperature of the pack must depend upon the condition of the
patient, being determined by principles elsewhere explained. A woolen
sheet is better for the administration of a hot pack than one of cotton
or linen. The cold pack is very rarely required. The usual temperature
for this bath should be about 92°. It is proper to wet the sheet in
water of about 100°, as it will be cooled several degrees while being
applied.
The duration of the pack should be carefully regulated by the condition
of the patient, the effects desired, and the immediate effects produced.
If the patient becomes very nervous, or sweats excessively, or becomes
faint, or has other seriously unpleasant or dangerous symptoms, he
should be removed from the pack at once if he has not been more than ten
minutes in it. Ordinarily, the pack may continue thirty to forty-five
minutes. If the patient sleeps naturally, he may remain in the pack a
full hour if strong, or even longer in many cases. In fevers, short
packs, frequently repeated, are more beneficial than long ones fewer in
number.
The pack should be followed by the spray, the sponge bath, the douche,
or the rubbing wet-sheet. It is a powerful remedy, and should not be
used to excess in chronic diseases; it has been much abused in this way.
Its depurating effects are really wonderful. The increased action of the
skin, together with determination of blood to that part, is so great
that poisons long hidden in the system are brought out and eliminated.
The odor of a sheet recently used in packing a gross person is often
intolerable. If the patient be a tobacco user, the sheet will be reeking
with the odor of nicotine. Many times, the sheet will be actually
discolored with the impurities withdrawn from the body.
The applications of the pack in treating disease are very numerous. In
almost all acute diseases accompanied by general febrile disturbance,
and in nearly all chronic diseases, it is a most helpful remedy if
rightly managed. It is an admirable remedy for nervousness, skin
diseases, and irritations of the mucous membrane. The warm pack is a
remedy worth more in the treatment of children’s diseases than all the
drugs in the materia medica, as many physicians have proved. It is a
most successful application in convulsions.