Pack Baths

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The Physiomedical Dispensatory by William Cook, M.D., 1869

This kind of bath consists in wrapping the entire body in a sheet wrung out of water. The clothing of the patient is all to be removed, the wet sheet laid upon a firm mattress, the patient laid upon the sheet on his back, the sheet turned up over him and wrapped around his limbs so as to come in close contact with the surface, and one, two, or more blankets laid over him and closely tucked around him so as to keep in the accumulating heat. The real object of this bath is to secure and maintain a tepid warmth about the entire body; and hence it is desirable always to wring the sheet out of moderately warm water, so that the patient may get wrapped in it before it gets below the tepid heat. The Hydropathists are too largely in the habit of employing the sheet wrung from cold water, thus giving to the body a strong shock under circumstances where the patient is deprived of all muscular motion by which to aid reaction. In feeble persons, this shock may prove serious; while in all cases no benefit accrues till the sheet has become warmed and reaction has been secured; therefore common sense dictates to begin the operation at that temperature from which the patient will derive advantage from the first moment of application.

This pack steadily and largely relaxes the surface, absorbs excessive heat, enlarges the capillaries, and invites an outward flow of blood, relieves the internal organs from irritable accumulations, depurates the skin by an abundant perspiration, quiets nervous agitation, and promotes the absorption of internal effusions. Under its influence, the pulse softens and becomes fuller and slower; the patient rarely fails to become drowsy, and presently to fall into a deep sleep; and an abundant perspiration breaks out. Thus its action is similar to the tepid sponge bath, being much more profound, as it is also more continuous; and it is usable for the same general class of cases to which the tepid bath is applied. Properly employed, it is a searching and valuable measure; but may be, and often is, continued too long for the welfare of the patient. The case which is obtained from it, and the quiet sleep into which the patient passes, are liable to deceive the nurse and to tempt her to continue the bath till the patient awakes. This may not be for one, two, or even four hours. Sleep ensues as a consequence of general relaxation; and to allow a patient thus to repose in the wet sheet, is to secure excessive relaxation, exhaustive perspiration, and a most unwarrantable wasting of his strength. (See Therapeutics, §§ 55, 187.) A due regard for the welfare of the sick will never, under any circumstances whatever, allow such a bath to be prolonged in this manner; for while robust frames, and cases of rheumatic fever, may merely feel tired after being removed from it; those of slender build, and cases of pneumonia, meningitis, puerperal fever, and similar maladies tending to congestion, will be exhausted to an extent that is not advisable, even if it be not utterly reprehensible. Sometimes such persons will seem greatly improved after such a long pack, and the physician and friends will be much elated with the success of the application ; but the true condition of the patient is probably overlooked, and is not realized till he is found to be sinking from the sheer inability of over-relaxed arterial and nerve and fibrous tissues to rally a proper degree of tone.

Two rules should always be observed, in order to the successful use of this pack; first, to give the patient some diffusively stimulating tea before and during the bath, to sustain the inner organism; second, to discontinue the bath when a fair perspiration has appeared on the face, whether the duration of the bath itself has been long or short. The patient, being removed from the bath, is to be well dried and placed in a fresh bed. By the observance of these directions, the tepid pack will prove a very valuable measure; though one that should not be used too frequently, being an exertion to the patient as well as to the nurses. Sometimes the wet pack is made a little stimulating by employing a blanket instead of a sheet, the woolen fibers causing a slight mechanical excitation. Partial packs, called compresses, are much used for local difficulties, such as achings of the back, weight and pain through the loins, irritation of the respiratory passages, and similar cases. In such instances, it is most common to wring a narrow and soft towel out of cool water, wrap it about the part, cover this with two layers of a broader and dry towel, and

wear it during the night. Both general packs and local compresses may be made powerfully medicinal by the addition of either stimulants or relaxants to the water. Relaxants are rarely used for general packs, but may be of service in acute inflammatory troubles; but the use of such agents as xanthoxylum, polygonum, or capsicum in this manner, makes the most powerful measure that can be employed in cases of profound congestion, as cholera, the last stages of malignant dysentery, etc. The stimulant may be applied to the surface as a wash, and the tepid pack then used, as a method often preferable to adding the stimulant to the water of the pack.