Compresses are also used to influence the distribution of the blood in a definite manner. A leg pack, a compress around the abdomen or the body, or finally, a full pack. tends to act as a sedative or a hypnotic by drawing the blood away from the head. The full and body packs are particularly important, since they have the power on the one hand of reducing temperature. and on the oilier of sweating, and even an increase in temperature. The cooling action depends upon the temperature of the water used, the degree of staturation of the compress, and the frequency with which it is changed; and, indirectly, upon the extent of the body surface, the condition of superficial circulation, and the height and persistence of the fever. In small children a body pack is usually sufficient, the water being lukewarm. 2-1° to 20° C. (75° to GS° F.). In the ease of larger children, it is used at room temperature in winter, and in summer as it runs from the faucet. 20° to 12° C. (6S° to 53° F.). The compress is changed about every twenty minutes, but usually every half hour or even every hour. Ilaving obtained a satisfactory result, the compress may be left on, or it may he taken off, the body being thoroughly dried and then warmly wrapped.
If warmth or sweating is desired. the full pack is to be preferred, at least for larger children. If sweating is desired, tepid or even warmer water is used, the child is very warmly covered, hot water bags or bot tles are placed at the feet and sides. and hot fluids (milk, elder flower, and lime tree flower tea, lemonade) are given to drink. A cloth is placed under the chin and the perspiration is wiped a may from the face as soon as it forms. In conditions of weakness. particularly in babies, it is neces sary to raise the temperature of the body. To bring this about, two com presses are prepared at the same time;, one is dipped in water so hot that is can just be wrung out, and the child is quickly wrapped up in it. In ten minutes it is removed and the other is used in the same man ner, and after perhaps six changes the temperature will have risen suf ficiently to place the child, temporarily, in its warm bed. To prevent the raising of the temperature beyond the desired point, constant use of the thermometer is necessary.
To obtain proper results from the use of the various compresses, it is necessary that the skin shall become congested. Failure to react is especially likely to occur in the use of cold compresses. from the inci dence of a sudden rise in temperature (as with a chill), or when the com press used is too cold. In such cases, it is well to rub the skin with the compress before it is applied, or to give a rubbing with alcohol, French brandy, camphor, or even oil of mustard, or perhaps a with hot water. When the pack induces free perspiration, the water treatment may be concluded with a cool sponge bath, which causes the vessels of the skin to contract again. This is done by using a cloth dipped into
water at the temperature of the room, washing and then drying in turn, arms, legs, chest, and back, keeping all of the body covered except the part being washed. If, on the contrary, the sweating is to continue after the pack has been removed, the body is but lightly dried and the child is allowed to remain in bed warmly covered. In many individuals sweating is produced only after repetition of the procedures properly performed.
The same effect upon the temperature of the body can be produced by baths as well as by compresses, or by a combination of the two. A bath is not quite so easily managed for a child as is a compress; hut it is much more easy than in the ease of an adult, and it is therefore of extended therapeutic application. The only contraindications are inflammation of the skin, particularly of a moist type, great bodily weakness, and fear of the water. But even when these are present, suitable additions (e.g., bran), appropriate temperatures, or especially gentle treatment (e.g., slow' immersion by means of a sheet), may make it possible to use the procedure. In a small bath tub which rests upon a stool and holds about 10 litres (three to five bucketfuls), the infant is held suspended upon the left hand and forearm, while with the right hand it is washed and gently rubbed.
When, in children suffering from high fever, no redness of the skin occurs under this treatment, it becomes necessary to produce much stronger friction with the hand. or a rough cloth, or even a friction glove. Since in the newborn the normal bath temperature, 35° C. (05° F.), when used for several hours is capable of reducing the temperature of the child, it is important not to make the bath too cool (in delicate infants 33° to 32° C. (91°-90° F.) should he the and even for larger children, a lower temperature than 30° C. (86° F.) should not be used for reducing fever. The rapid appearance of redness of the skin is necessary to indicate the benefit and success of the procedure, and is often obtained much more readily by using a bath of higher tem perature for a longer time (ten or even fifteen minutes), than by using a colder bath for a shorter time, say three to five initiates. It is often found best to begin the bath at the usual bath temperature, 35° C. (95° F.) and gradually to lower the temperature by allowing cooler water to flow in at the foot of the tub. To give a hot bath, it is started at 35° C. (95° F.) and is raised to a temperature of 3S° C. (100° or even to 40° C. (104° F.), by the addition of hot water; or it may be started at a higher temperature. The bath lasts from five to fifteen minutes, and the child, after being dried, is laid in the warm bed.