Packs may be given dry or wet, hot or cold. A cold pack for relieving insomnia is given in the following manner : Have ready one rubber sheet, two bath blankets, one long sheet, towels, hot water bag with covers and ice cap or compresses. The sheet is pleated lengthwise and folded, as in this form it is more easily placed under the patient. It is placed in a tub of water at 60° F. until thoroughly wet and then wrung out. Remove the bedclothes and cover the patient with a bath blanket; remove the gown; turn on side and slip under the rubber sheet covered with the bath blanket; then the wet sheet is slipped under, so that more than half the width is on the far side; the patient is then turned on the back and packed in the wet sheet, in this order: Fold the sheet back at the bottom to about the ankles; fold the narrow side over the body under the arms and tuck in smoothly between the legs; place the arms at the side and bring the far side of the sheet across and smoothly tuck about the shoulders and under the back, taking care to have no uncomfortable ridges to make pressure, and that

no two parts of the body are in contact; the feet are wrapped in a dry towel and the hot water bag applied; the ice bag or compresses are applied to the head, and a bath blanket placed over the patient. If compresses are used they should be changed frequently. Turn the lights low, do not permit conversation, and keep as quiet as possible. At the expiration of the time prescribed (twenty to thirty minutes) remove the pack, dry, rub with alcohol, put on fresh gown, replace covers, give hot drink and provide fresh air without draughts. All preparations for the treatment should be made outside the patient's room and every detail must be systematically and quietly carried out.

In cases of delirium and mania a cold pack is often prescribed, and because of the marked restlessness, further measures are necessary to keep the patient in the sheet. This is usually accomplished by the use of blankets and very large safety pins. The procedure is the same as for the cold pack, only two or three heavy blankets in addition are placed under the patient. Plenty of help should always be summoned in order that the treatment may be given without struggling. After being packed in the sheet, the blankets are, one at a time, securely wrapped about the patient, and the outside one is pinned. Care must be taken to place the pins where there is little or no pressure, and not on the shoulders, hips or back. The application of strap sheets across the knees and hips may be indicated if the restlessness continues, for this treatment is given for its sedative action, and it is necessary to help the patient to become quiet. The bed is then covered with a spread; an ice cap or compresses are applied to the head, and cold water is given freely to drink. The patient must be carefully observed. The pulse which at first is rapid, becomes slower and stronger when perspiration begins, the mental activity is diminished and the patient becomes quiet, drowsy and oftentimes goes to sleep. If the face becomes much flushed and the pulse is weak and irregular, the treatment must be terminated at once. The duration of this treatment may

be from twenty minutes to an hour or more, depending upon the condition of the patient. When removed from the pack the patient is given a shower or sponge bath, thoroughly dried, rubbed with alcohol and placed in bed.

A dry pack is often prescribed in cases of shock, collapse and subnormal temperature. It is given in the same manner as the cold pack, except that the sheet is not wet and the feet are wrapped in it. This treatment is given to secure an increase of heat by lessening heat elimination, and the effect may be hastened by the application of hot water bags, extra blankets and giving hot drinks.

A hot pack is given by means of a blanket which is wrung out of water at a temperature of 130° to 145° F. and applied when about 105° to 110° F. Care must be taken not to apply it when too hot, and also not too cool. This is wrapped about the patient and a dry blanket is used for a cover. The feet are wrapped in a dry towel and a hot water bag placed to them. Cold is applied to the head. This treatment may continue twenty to thirty minutes. The patient is then taken out, care being exercised to avoid chilling, rubbed with alcohol and made comfortable in bed. As heat applied for a long time tends to depress the heart, the pulse must be taken frequently. This treatment is given to increase elimination and to relieve convulsions and the spasms of chorea.

REFERENCES

"Principles and Practice of Hydrotherapy," Baruch. "Rational Therapeutics," Kellogg.

Arsphenamine, in treatment of syphi-Bladder distention, 74

Arteriosclerosis, psychoses with, 38, Bloomingdale Hospital, 27

Clothing on fire, management of, 83 Distention of bladder, 74, 75

Constitutional psychoses, nursing in, Emergencies, management of, 81