The bath tub should be a portable one which can be brought to the bedside, anc should be raised as nearly as possible to the level of the patient's bed, but so placed he nurses have room to lift the patient out aid in.
The bath is two-thirds filled with water at he proper temperature.
A stimulant, in the form of a wine-glassful A hot water with two tea-spoonfuls of whisky should be given the patient, and his face bathed with quite cold water. He is then undressed and lifted into the bath. He will gasp and shiver at immersion, hut if the nurses just go steadily on, encouraging the patient by a few words, and making as little fuss as possible, the patient is less likely to resist and give trouble than if they coaxed and talked and explained.
The chief thing to watch is the face ; blue ness appearing is a reason for immediate re moval from the bath ; but that is not likely to occur, provided the directions be properly fol lowed. The patient's bead should be supported by an air-cushion, which one nurse looks after. Immediately the patient is immersed the nurses proceed gently to rub every part of the body in succession. This continuous friction is to be maintained all the time the patient is in the water. Two or three times during the bath a basin of water at 50° should be gently poured over the head.
The bath should last 15 minutes.
Meantime someone other than the two administering the bath should prepare the patient's bed.
The bed is first made in the ordinary way. Then a towel is laid to cover the pillow, and double blanket, previously warmed, is placed on the bed on the side on which the patient is to be laid. On the top of the blanket is placed an old linen sheet, also warmed. Hot bags are placed where the patient's feet will be. The patient is now lifted out and placed on the sheet so that it reaches up to the top of the neck behind, the sheet is brought over his body, first one side and then the other, being made to clip in between arm and body on each side, and the blanket is then wrapped round. By friction with the hands under the blanket the patient is either immediately, or in five minutes, dried by the nurses by means of the sheet; his bed clothing is then replaced, the bed restored to its usual coverings, care being taken that the, patient's feet are kept warm by hot bags. Usually there will be little or no shivering, but the patient will be soothed and will fall asleep. This treatment may seem
heroic, but those who have employed it assert its entire freedom from risk if given as de scribed, the friction of the patient's whole body being maintained during his immersion.
Anyone wishing to use this bath, and yet afraid, might. begin with water at the tempera ture of 85° Fahr. for ten minutes, and the next time use water at a temperature of 80°. Hav ing thus ascertained how the patient bore it, and having got used to the administration, they might give the next at a temperature of 70', and only after several trials might the full cold bath at 65° be given for the full fifteen minutes.
The Graduated Cold Bath is another cautious method. The bath is, to begin with, made only one-third full of water at a tempera ture of 90°. The patient is placed in it, and while one attendant maintains friction, another gradually adds water at round the sides, till the temperature of the bath is reduced to 75°. In this case the bath should be prolonged to nearly half an hour.
The Cold Pack is another method for reducing temperature. On a bed prepared in the ordinary way a rubber sheet is spread. On this is laid a woollen blanket, long enough to extend from the back of the patient's head to half a yard or so beyond his feet, and so placed that one-third hangs over the left side of the bed. A large coarse linen sheet is now wrung out of water of a temperature from 60° to 70°, accord ing to the case, and laid on the blanket, and on this the patient is placed naked. The patient raises his arms above his head, and the right aide of the sheet is carried over his body, close up under the aim-pits, to the left side, where it is tucked in under the side, the lower portion being so arranged as to dip between the legs. The arms are now placed close to the sides against the sheet, and the left side of the sheet is carried over the body, arms included, close under the chin, and tucked in under the whole length of the right side. The left side of the blanket is now carried over the body and tucked in under the right side, and then the right aide is carried over in a similar manner and tucked in under the left side of the body, and close round the neck under the chin. At the feet the blanket is folded over. A wet towel is now fitted to the patient's head, like a turban, and then several woollen blankets are placed over him.