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Technicalities Of The Pack And Bath

Source: Hydriatic Treatment Of Scarlet Fever In Its Different Forms

Let me give you its technicalities, and the rationale of its action:

A linen sheet, (linen is a better conductor than cotton,) large enough
to wrap the whole person of the patient in it (not too large, however;
if there is no sheet of proper size, it should be doubled at the upper
end) is dipped in water of a temperature answering to the degree of heat
and fever, say between fifty and seventy degrees Fahrenheit, and more
or less tightly wrung out. The higher the temperature of the body, and
the quicker and fuller the pulse, the lower the temperature of the
water, and the wetter the sheet. This wet sheet is spread upon a blanket
previously placed on the mattress of the bed on which the packing is to
take place. The patient, wholly undressed, is laid upon it, stretched
out in all his length, and his arms close to his thighs, and quickly
wrapped up in the sheet, head and all, with the exception of the face;
the blanket is thrown over the sheet, first on the packer's side, folded
down about the head and shoulders, so as to make it stick tight to all
parts of the body, especially the neck and feet, tucked under the
shoulders, side of the trunk, leg and foot; then the opposite side of
the blanket is folded and tucked under in the same manner, till the
blanket and sheet cover the whole body _smoothly_ and _tightly_. Then
comes a feather-bed, or a comforter doubled up, and packed on and around
the patient, so that no heat can escape, or air enter in any part of the
pack, if the head be very hot, it may be left out of the pack, or the
sheet may be doubled around it, or a cold wet compress, not too much
wrung out, be placed on the forehead, and as far back on the top of the
head as practicable, which compress must be changed from time to time,
to keep it cool. Thus the patient remains.

The first impression of the cold wet sheet is disagreeable; but no
sooner does the blanket cover the sheet, than the chill passes away, and
usually before the packing is completed, the patient begins to feel more
comfortable, and very soon the symptoms of the fever diminish. The pulse
becomes softer, slower, the breathing easier, the head cooler, the
general irritation is allayed, and frequently the patient shows some
inclination to sleep. When the fever and heat are very high, the sheet
must be changed on growing hot, as then it would cause the symptoms to
increase again, instead of continuing to relieve them. The best way to
effect this changing of the sheet is to prepare another blanket and
sheet on another bed, to unpack the patient and carry him to the new
pack, where the process described above is repeated. Sometimes it is
necessary to change again; but seldom more than three sheets are
required to produce a perspiration, and relieve the patient for several
hours, or--according to the case--permanently. The changing of the sheet
may become necessary in fifteen, twenty, twenty-five, thirty or forty
minutes, according to the degree of fever and heat. In every new sheet
the patient can stay longer; in the last sheet he becomes more quiet
than before, usually falls asleep, and awakes in a profuse perspiration,
which carries off the alarming symptoms.

A few minutes before the perspiration breaks out, the patient
becomes slightly irritated, which irritation is removed by the
appearance of the sweat. I mention this circumstance, to prevent his
being taken out just before the perspiration is started. When he becomes
restless _during perspiration_, he is taken from his pack and placed in
a bathing-tub partly filled with cool or tepid water, (usually of about
70 deg.,) which has been prepared in the meanwhile; there he is washed down
from head to foot, water from the bath being constantly thrown over him
until he becomes cool. Then he is wrapped in a dry sheet, gently rubbed
dry, and either taken back to his bed, or dressed and allowed to walk
about the room. When the fever and heat rise again, the same process is

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