THE WET PACK. 535 



to 80 or even 40, according to circumstances. Here the patient 

 remains for 10 to 20 minutes, his temperature being taken 

 during immersion, or if any shivering occurs, he is at once 

 removed. He is then wiped dry, placed in bed, and covered 

 with blankets. A stimulant may be required. The cold bath 

 may be repeated several times a day, if indicated. 



In very urgent or desperate cases the cold bath may be 

 increased in activity by lowering the temperature to freezing 

 point by ice, and by prolonged immersion, even to three hours. 

 This treatment requires great care and judgment. 



The douche, affusion, and shower bath. The stimulant 

 action of water may be greatly increased by directing it 

 against the body in a single or divided stream. The size, 

 height, direction, and temperature of the stream, the part and 

 extent of surface to which it is applied, have great influence 

 upon the effect of the douche. The uses of the shower bath 

 are chiefly in hysteria and mania ; of the local douche in loss 

 of sensibility of parts, chronic enlargements of joints or bones, 

 and sprains. Affusion is of value in convulsions, sunstroke, 

 mania, hysteria, and as a means of resuscitation. 



The Wet Pack. Prepare a bed by spreading two blankets 

 on the mattress and over the pillow of an ordinary single bed- 

 stead. Thoroughly wet a linen sheet with cold water, and spread 

 it smooth over the blankets. Strip the patient, place him flat on 

 his back on the wet sheet with his head on the pillow, and 

 envelop him in the sheet and blankets, by bringing these one 

 side at a time across his body, and tucking them under the 

 opposite side and under the heels. Finally cover him with 

 several more blankets, and again tuck these closely round him. 

 The ordinary duration of packing is a quarter of an hour to 

 an hour. The pack is then removed, and the skin rubbed 

 with a dry towel. The pack may be repeated several times a 

 day if necessary. 



The first sense of chilliness produced by the wet sheet is 

 quickly replaced by a delightful glow. The physiological 

 action of the wet pack is chiefly on the refrigerating function 

 of the skin : heat is abstracted so that the temperature quickly 

 falls ; the frequency and force of the pulse decline ; the central 

 nervous system is soothed both through the nerves and through 

 the circulation, and by the refrigeration ; sensibility, pain, irri- 

 tability, and delirium, are dispelled; and sleep often follows 

 immediately. 



The use of the wet pack is almost confined to the specific 

 fevers, such as scarlatina and typhoid, when the pyrexia is ex- 

 cessive, delirium high, and the rash ill-developed. 



