Poultices and fomentations are applied for the relief of localized pain, when caused by inflammation. The heat, by dilating the superficial blood vessels, draws the blood from the congested area.

The linseed poultice is the one most generally used. To make it, stir the meal slowly and evenly into water while it is boiling. When it is thick enough not to run, boil it a minute more; remove from the fire and beat it briskly. When properly made it is perfectly smooth, and just stiff enough to drop away from the spoon. Spread it on a piece of muslin the required size and shape, leaving an inch margin all round to turn over. The side which is to go next to the patient is best covered with cheesecloth or gauze. This is cut slightly larger than the muslin, so as to turn back over it to keep the contents of the poultice in place.

Few poultices should be more than half an inch thick. They should always be applied as hot as the patient can possibly stand them. To keep the poultice warm while taking it to the bedside it can be placed between two hot plates or rolled in a piece of hot flannel. The flannel can be left over it when applied if there is no oil muslin or oil paper to be obtained; these latter are preferable, however, as they are very light and keep in the heat and moisture better.

The poultice is kept in place by a bandage. A muslin binder is the best means for keeping a chest poultice in place. Poultices should always be shaped to fit the affected part. They should be changed at least every two hours.

Starch poultices are used in certain skin diseases. The starch is mixed with a little cold water, then enough boiling water added to make a thick paste. It is boiled, spread and applied in the same manner as the flaxseed.

The cotton jacket or "dry poultice" is made by tacking a layer of non-absorbent cotton or wadding between two pieces of cheesecloth, shaped for the chest, and is excellent to keep on for a few days after other poultices have been discontinued.

Sinapisms relieve pain through the agency of the mustard which, by irritating the sensory nerves, causes the dilatation of the superficial blood vessels-under the point of application-and the consequent lessening of the congestion in the inflamed tissue. Sinapisms are made of flour, mustard, and tepid water, in varying proportions. Those for a man are generally made one part mustard to four of flour; for a woman one part mustard to six of flour; for a child one part mustard to ten of flour. The water used should always be tepid; cold water feels uncomfortable to the patient, while hot destroys the virtue of the mustard. The flour and mustard are first mixed well together, care being taken to crush all lumps of mustard; enough water is then slowly added to make a thick paste, which is spread on muslin and covered with gauze. The sinapism is generally left on from fifteen to twenty minutes, but it must be watched carefully, and removed as soon as the surface of the skin is well reddened, as otherwise it will blister. After the re-moval of the sinapism the skin must be washed, and if a little vaseline be rubbed on, this will allay the irritation.

The usual method of applying fomentations is to have two pieces of flannel in use, applying them alternately and changing every three minutes for twenty minutes. The easiest way is to have the water boiling over an alcohol or gas lamp near the bedside.

Put two layers of coarse, soft flannel (an old blanket is good) in the center of a towel; dip this into boiling water, wring it out by twisting the ends of the towel, give the flannel a quick shake, and apply the flannel; cover with oiled muslin or oiled paper.

As hot applications promote suppuration there are conditions when their use is contra-indicated and cold applications are ordered.

The most effectual way of applying continuous cold is by means of the ice cap. The pieces of ice put into the cap should be about the size of a walnut; it should never be more than half filled, and the air should be expelled before putting on the cover. Salt is sometimes mixed with the ice to intensify the cold. The cap should be tied in an old handkerchief or piece of gauze to prevent the rubber from coming next the skin, as the extreme cold is very irritating, and may even produce frost bites.

Fomentations

Cold Applications

When ice caps are being used all the ice must not be allowed to melt before the cap is refilled, as the reaction caused by the resulting change of temperature is very injurious, especially if there is any inflammation.

Ice Caps

For the application of cold to the head, old handkerchiefs or pieces of soft gauze can be used, folded so that they will come down well over the temples, but not touch the pillow. They must not be wide enough to wet the hair, or come far down over the eyes. Compresses should not be made too wet. The best scheme is to have a piece of ice in a basin, and two compresses, then while one is on the forehead the other can remain rolled round the ice.

Compresses for the eye should be small and very light. If both eyes need the compresses two separate ones should be used. If only one eye is affected be careful that the compress on it does not touch the other, lest it should become infected. If gauze is used for compresses always turn the ends in, that the ravellings may not annoy the patient.

Compresses

Ice Caps