Part 15

The fomentation is a local application analogous to such general appliances as the hot pack, vapor bath, and hot-air bath. It consists in the application of a cloth wet in hot water. It may be considered as a hot compress. Fold a soft flannel cloth twice, so that it will be of three or four thicknesses. Lay it in a basin, pour boiling water upon it, and wring it dry by folding it in a dry towel. Or, if only one end of the cloth is wet, it may be wrung by folding the dry portion outside of the wet; in wringing, the whole will become equally wet. Apply it to the patient as hot as it can be borne. The second application can usually be made much hotter than the first. Frequently dipping the hands in cold water will enable the attendant to wring the cloth much hotter than he would otherwise be able to do. The most convenient way is to heat the cloths in a steamer; by this means they are made as hot as boiling water, and yet they are more easily handled, not being saturated with water. When no hot water is at hand, a fomentation may, in an emergency, be quickly prepared by wetting the flannel in cool water, wringing it as dry as desired, folding it between the leaves of a newspaper, and laying it upon the top of the stove, or holding it smoothly against the side. The paper prevents the cloth from becoming soiled, the water protects the paper from burning, and the steam generated quickly heats the cloth to boiling heat. For a long fomentation, the heat may be made continuous by applying over the wet cloth a hot brick or slab of soapstone.

The hot cloths should be re-applied once in five minutes. Two cloths should be employed, so that the second may be applied the moment the first is removed. To retain the heat, a dry flannel, rubber, or oilcloth should be placed over the fomentation. The application may be continued from ten minutes to half an hour, or longer in special cases. This appliance is very powerful, and should not be employed to excess. Alternate hot and cold fomentations are frequently more efficient than the continuous fomentation. Hot applications should always be followed by a cool or tepid compress for four or five minutes, at least.

The uses of the fomentation are very numerous. It is indicated whenever there is local pain without excessive heat, or evidences of acute inflammation. Local congestions, neuralgia, toothache, pleurisy, pleurodynia, and most local pains vanish beneath its potent influence as if by magic. For indigestion, colic, constipation, torpid liver, dysmenorrhea, and rheumatic pains, it is a remedy of great power, and is used with almost uniform success. In relieving sick headache by application to the head, neck, and stomach, its efficiency is unrivaled.

When applied to the head for some time without intermission, it will often occasion faintness; hence, a cooler application should be made after the use of the hot cloths for fifteen or twenty minutes.

If the applications must be continued for a long time, it is well in most cases to apply them at a temperature slightly lower than when they are to be used for only a few minutes.

This remedy may well replace the blisters, plasters, cataplasms, scarifications, rubefacients, and other irritating measures so long used for relieving pain, local congestions, and inflammations.

REFRIGERANT APPLICATIONS.

A freezing mixture which will reduce the temperature to 4° is made by mixing equal parts of salt and pounded ice. The ice and salt should be stirred together very quickly and applied at once to the part to be frozen. Two parts of dry snow and one of salt make an equally good mixture. Freezing is more conveniently performed by the rapid evaporation of ether or rhigoline.

Freezing is a useful process in numerous cases. By its use, excrescences—as warts, wens, and polypi—fibrous tumors, and even malignant tumors, as cancer, may be successfully removed. Small cancers may sometimes be cured by repeated and long-continued freezing. Their growth may certainly be impeded by this means. Felons, if treated early in their course, may be cured by two or three freezings.

For freezing a felon, place the finger in a mixture ice and salt, or surround it with cotton, saturate the cotton with ether or rhigoline, and blow it very strongly with a pair of bellows. This is a very good method when an apparatus for producing a fine spray is not at hand. The latter instrument facilitates the freezing very much if used with the bellows.

No harm results from repeated freezing if proper care is used in thawing the frozen parts. They should be kept immersed in cool water, or covered with cloths kept cool by frequent wetting with cold water, until the natural feeling is restored.

The application of ice is found extremely serviceable in many inflammatory diseases, and in some nervous affections. In inflammation of the brain, the ice cap is of inestimable value. Ice applied to the spine will check the convulsive spasms of chorea and hysteria when other remedies fail. In putrid sore throat, or malignant diphtheria, ice is a sovereign remedy. It should be applied to the neck externally, and held in small bits in the mouth. Small bits swallowed will sometimes relieve the pains of gastralgia.

Rubber bags are very convenient for applying ice or iced water; but their place can be very well supplied by dried bladders filled with pounded ice. The ice cap is a double head cap stuffed with pounded ice.

Some physicians recommend the application of ice to the spine in cases of congestive chill and paralysis, and in inflammation of the stomach, kidneys, uterus, and other internal organs. The real worth of such applications in these cases has yet to be determined by careful and repeated observations. We would not recommend an unskillful person to attempt to relieve a violent ague chill by rubbing ice on the patient’s back, and we have some fears that a very skillful operator would hardly succeed to his entire satisfaction and that of the patient.

The snow bath, applied by rubbing the part vigorously with snow, is a useful application for restoring the circulation to frosted parts. In cases of extreme chilling or absolute freezing, there is perhaps no better remedy. Powdered ice may be used when snow cannot be readily procured.

MISCELLANEOUS BATHS, ETC.

VAPOR BATH.

This bath can be readily and successfully administered with such conveniences as every family possess. Place the patient in a cane-seat chair, having first taken the precaution to spread over the seat a dry towel. Surround the patient and the chair first with a woolen blanket, and then with two or three thick comfortables, drawing the blankets close around his neck, and allowing them to trail upon the floor so as to exclude the air as perfectly as possible. Now place under the chair a large pan or pail containing two or three quarts of boiling water. Let the blankets fall quickly so as to retain the rising vapor. After a minute or two, raise the blankets a little at one side and carefully place in the vessel a very hot brick or stone, dropping the blankets again as soon as possible avoid the admission of cold air. Before the first brick or stone has cooled, add another, and so continue until the patient perspires freely. The amount of perspiration must be judged by the face and forehead, as much of the moisture on the skin beneath the blankets is condensed steam. Should the bath become at any time too hot, a little air may be admitted by raising the bottom of the blankets a little, being careful to avoid chilling the patient in so doing. The bath should seldom be continued more than half an hour, and fifteen to twenty minutes will usually accomplish all that is desired by the bath. If too long continued, it induces faintness. A too high temperature will be indicated by a strongly accelerated pulse, throbbing of the temples, flushed face, and headache. The head should be kept cool by a compress wet in cool water and often changed. The temperature of the bath should be from 100° to 115°. Unpleasant effects are sometimes produced at 120°.

After this bath, apply the tepid spray, rubbing wet-sheet, pail douche, or full bath. No time should be allowed to elapse after the blankets are removed before the concluding bath is applied, as the patient will chill. He should not be allowed to become chilly by exposure to cool air before the application of the spray, douche, or other bath, which should be followed by vigorous rubbing.

For “breaking up a cold,” relieving rheumatism, soreness of the muscles from overexertion, and relaxing stiffened joints, this is a valuable agent. It may also be used to advantage in chronic diseases in which there is torpidity of the skin; but great care must be exercised to avoid excessive use, as too frequent repetitions of the bath produce debility.

This is a milder application than the hot-air bath, unless employed at a high temperature, 120° or more, when it becomes more severe.

In institutions where the bath is in daily requisition, a permanent arrangement for giving the bath is usually employed. It sometimes consists of a box in which the patient sits upon a stool, his head being allowed to remain outside by a suitable opening. A wet towel is placed around the neck to prevent the steam from rising about the head. Others prefer a box or small room large enough to admit the whole person, the whole body being subjected to the warm vapor. An opening guarded by a curtain is made in one side to allow the bather to inhale cool air if he should wish to do so, and to give the attendant access to the patient without chilling him by the admission of a large quantity of cold air. As in the simpler form of vapor bath, the head should be kept constantly cool by a cool wet compress often re-applied. Patients troubled with “rush of blood to the head,” should be further protected by a large cool compress placed around the neck and the upper part of the chest.

Steam may be generated for these larger baths by boiling water in the box with a spirit-lamp or a gas-burner, or it may be conducted into the box by a rubber tube connected with a tight boiler.

RUSSIAN BATH.

This is essentially the same in effect as the vapor bath. It consists of a room filled with vapor, and so arranged that by transferring the patient from one point to another the heat may be gradually increased. It has no advantages not afforded by the simpler vapor bath. It is now much used in the larger cities. Probably as much harm as good results from the indiscriminate and reckless manner in which it is employed. Patients have been known to die in the bath of apoplexy induced by the excessive heat. It is followed by shampooing and cooling baths of various sorts.

HOT-AIR BATH.

In administering this bath, prepare the patient precisely as directed for the vapor bath. Instead of placing under the chair a vessel of hot water, place a large alcohol lamp or a small dish containing a few ounces of alcohol. When all is ready, light the lamp or alcohol, and carefully exclude the air. It is hardly necessary to suggest the propriety of putting the lamp in such a position as to insure safety from fire. If alcohol is used in an open dish, it is important to wipe the outside of the vessel quite free from any trace of the fluid, as otherwise it might be communicated to the floor or carpet. Also avoid spilling any portion in putting it in place, for the same reason. It is a very good precaution to place the dish containing the burning alcohol in a plate or shallow vessel containing a little water.

This bath should be conducted in the same manner as the vapor bath. A temperature of 140° to 160° is not at all disagreeable to the patient. At 170° or 180° the same effects are produced as in the vapor bath at 120°. The bath should be followed by cooling baths as directed for the vapor bath.