Part 11

This bath is administered in two ways; with the sheet very wet, or dripping, and with it wrung nearly dry. The first method is frequently called the dripping-sheet bath. In giving it, proceed as follows:—

When necessary to prevent injury to the floor or carpet, place upon the floor a large rug or oilcloth. In the center, place a large wash-tub, in the absence of a more convenient vessel. While the patient is making himself ready for the bath, procure two large cotton sheets. Gather one end of each into folds so that it can be easily and quickly spread out; lay one upon a chair close at hand, and place the other in the tub. At a distance of three or four feet from the tub, place a low stool. Now place in the tub—if a bath at about 93° is desired, and this will be the most usual temperature—half a pailful of fresh well or spring water, and one-third as much boiling water. If a thermometer is at hand it should, of course, be used to test the temperature. After the patient has wet his head, let him step into the tub, facing the assistant, with his arms straight and pressed closely to his sides. Now draw up the wet sheet by its gathered end to its full length; draw out one side quickly, place the corner over one shoulder of the patient, and while holding it in place with one hand, quickly draw the remainder of the sheet around him with the other, bringing it up well around the neck, and folding the second corner under the top so as to hold it in place. But a few seconds should be occupied in applying the sheet. Then commence rubbing the patient vigorously with both hands, one upon each side, rubbing to and fro three or four times in each place, passing over the whole body very rapidly, and then repeating the same, to prevent chilling of any part. Coarse, robust, and phlegmatic people may be rubbed with a good deal of severity; but persons with delicate skin and acute sensibilities require gentler manipulation.

After three or four minutes of energetic rubbing, pour over the chest and shoulders a pailful of water four or five degrees cooler than that of the bath, which should be in readiness for instant use. Then rub two or three minutes longer. Now quickly disengage the wet sheet, allowing it to drop into the tub. While the patient is stepping upon the stool, quickly grasp the dry sheet, and by the time he is in place, have him enveloped in it. Rub him dry, passing over the whole body several times in rapid succession, to prevent chilling. Care must be taken that every part is thoroughly dried. The head, armpits, groins, and feet are liable to escape attention. No moisture should be left between the toes. After wiping nearly or quite dry, apply the hand-rubbing, as elsewhere described, using care not to induce perspiration by too vigorous or long-continued rubbing. If the skin should become moist from perspiration after having been once dried, gradually lower the temperature of the room and continue light rubbing until the skin becomes dry and cool before allowing the patient to dress.

Very few baths afford a better opportunity for the display of skill and energy on the part of the attendant than this. Some practice is required to enable one to give it really well.

The other form of rubbing wet-sheet is given in about the same manner, the only difference being that the sheet is wrung before its application, and is re-applied one or more times, according as a milder or more severe form of treatment is required. The douche may be reserved until the sheet is removed the last time.

One precaution especially necessary to be observed in this bath, as well as in all others where a tepid application is succeeded by a cooler one, is frequently overlooked. The second cooler application should never be made until there is good reaction from the first.

This is an excellent bath to apply after packs or warm baths which have induced perspiration, as hot-air and vapor baths. It is especially applicable to cases in which there is defective circulation in the extremities, torpid skin and liver, and nervousness. It is of special benefit in cases of debility accompanied by night sweats.

WET-SHEET PACK.

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.

SHOWER PACK.

In many cases of fever in which the temperature rises so high as to produce delirium, the ordinary pack does not seem to be sufficiently powerful to fully control the excessive heat. In such cases, the shower pack is found of great service; it is thus used in Bellevue Hospital, New York:—

A rubber blanket is placed upon an ordinary mattress. Upon this, the patient is placed, enveloped in a wet sheet, as in the ordinary pack. Instead of being covered with blankets, however, he is left exposed to the air, so that the powerful cooling effects of evaporation may be obtained. As the sheet becomes warmed by the heat of the body, cool water is showered upon it from a sprinkler or watering-pot. The bath is continued thus until the temperature of the patient, as indicated by the thermometer, is sufficiently diminished.

This bath, combining as it does the cooling effects of cool water and of evaporation, is the most powerful refrigerant that can be employed; yet it is perfectly safe when judiciously used, being only applied in cases of extreme urgency on account of the high temperature.

Some practice opening the ordinary pack at intervals, and sprinkling cool water upon the patient, thus obtaining, in some degree, the prolonged cooling effect. The pack must be studied well to enable one to apply it with skill, and certainty of success.

DRY SHEET PACK.

Though this can hardly be called a bath at its commencement, it really becomes a wet-sheet pack before its termination. Its application differs from that of the wet-sheet pack in that the patient is wrapped in woolen blankets instead of the wet sheet. The object of this treatment is to produce perspiration, which may be encouraged by drinking either cold or hot drinks in considerable quantity, and by the application of dry artificial heat to the feet and sides. It is a very severe form of treatment, and is now seldom practiced. Many years ago, patients at hydropathic establishments were often kept for several hours in the dry pack, smothered beneath loads of comfortables, blankets, and feather-beds. If cautiously employed, it is occasionally useful in “breaking the chills,” in fever and ague. It should be administered about half an hour before the time for the beginning of the chill, if required for this purpose.

The several varieties of local packs are described under the head of Local Baths.

FULL BATH.

For this bath a tub is required the length of the body, about eighteen inches deep, two feet wide at the top, and, preferably, six inches narrower at the bottom. It is better to have the end intended for the head a little elevated. Place in the tub sufficient water so that the patient will be entirely covered, with the exception of the head, when he lies upon his back. During the bath, the body should be vigorously rubbed by the bather or an attendant, or both, particular pains being taken to knead and manipulate the abdomen, in a gentle, but thorough manner. The temperature of the bath, when taken for cleanliness, or for its soothing effects, should be not more than 95°, and it should be cooled down to about 85° before the conclusion of the bath, by the addition of cool water.

Every family ought to possess conveniences for this bath. Indeed, it is now found in every well-regulated modern house in our large cities. It is not so expensive but that any one can possess it. Portable baths of rubber can be obtained which are worth many times their cost. A cheap bath can be constructed of duck well oiled or covered with paint and suspended from a frame; but it will be quite unsatisfactory, not being perfectly water-tight, as such a bath should be for family use. A stationary bath may be made of wood, of the dimensions given, and lined with lead or zinc. There should be an opening in the lower end for withdrawing the water.

The full bath is one of the most refreshing of all baths, being also one of the most pleasant. Employed at a low temperature, it is a powerful means of reducing excessive heat in fevers. The hot full bath very promptly relieves the pains of acute rheumatism, and is almost a specific for colds, if taken just before retiring. Very hot and very cold temperatures are quite hazardous with this bath, since it involves so large a portion of the body. Such extremes are rarely useful in any case, and should not be used except under the eye of a physician.

HALF BATH.

The half bath is much the same as the full bath. A smaller tub is required, as the bather sits upright with his limbs extended. The water should be at least a foot deep. During the bath, the body should be well rubbed, and water should be poured over the upper portion of the body. Its general effects are nearly the same as those of the full bath, and it may be used for the same general purposes. A little more vigorous rubbing is required to prevent chilling, as so large a portion of the body is exposed. It affords a better opportunity for stirring up the bowels and abdominal viscera by shaking, percussing, and kneading the abdomen.