Fig. 3. Shake the hot flannel before applying it to the patient everything ready - hot basin, knife, spoon, linseed
Fig. 4. Before commencing to make a poultice have meal, and flannel square chest ailment may be treated by a hot fomentation or a poultice.
3. In lumbago and in strain of muscles fomentations are extremely useful.
4. In cases of strains and sprains of joints the application of hot fomentations will relieve the pain at once.
After applying the fomentation it should be covered with another layer of flannel, and then a layer of waterproof tissue, which must be larger than the fomentation, to prevent evaporation of moisture.
Fomentations can also be "medicated." For example, if poppy-heads are boiled in the water which is used to make the fomentation, the anodyne effect of the opium is obtained. Another method of making the fomentation anodyne, or soothing to pain, is to sprinkle a teaspoonful of laudanum over the wet flannel before applying it to the patient. Then in colic, when the bowels are distended, it is a good thing to sprinkle twenty drops of turpentine over the hot flannel.
Fomentations require to be frequently changed, as they cool rapidly; and the nurse ought to have two flannels in use at the same time. Whenever the patient complains of insufficient heat, a fresh one can be made, so that it is possible to change fomentations every half-hour, if necessary. If, however, they are well covered with water-proof, they ought to remain hot for an hour or so.
After finally removing the fomentations the skin should be dried carefully and covered with warm, dry flannel. The advantages of fomentations over poultices are that they are lighter, cleaner, and less irritating to the skin. Also, they can be made much more quickly, and require no materials except hot water and flannel.
The Making: and Application of Poultices
Poultices, however, retain their heat much longer than fomentations, and if they are hot, soft, and moist, they are invaluable in relieving pain and inflammation. They also help matter to discharge when pus is formed, but under any such circumstances they must be very small.
There is quite an art in making a poultice, and there is no doubt that the amateur poultice is a poor thing in ninety per cent of cases. It is either dry and hard, or moist and sloppy, whilst its most important quality, heat, is conspicuous by its absence. The very first thing and the last thing that a poultice must be is hot; thus the chief precaution in making it must be directed towards preserving the heat (Fig. 4). Before beginning to make the poultice have a basin, a spoon, a knife, the material which is to be used, either crushed linseed meal or bread-crumbs, all ready. Heat the spoon, knife, and basin with boiling water, and when they are hot empty this water away.
Put a little boiling water in the basin, take a handful of meal and gradually stir it into the water. Add water and meal alternately until the poultice is well mixed. Stir all the time, and mash the poultice against the side of the basin until it is like porridge, and can be easily spread with a knife. The poultice should be a quarter of an inch thick, and it is then spread on cotton-wool, or thin tow, or old flannel, and smeared with a little olive oil. The poultice must be almost large enough to cover the material, leaving perhaps an inch and a half all round to be doubled down on the poultice. It must be applied immediately to the patient.
The usual method is to apply the poultice direct to the skin, but it is better to put a layer of flannel between the poultice and the skin, or to place the poultice in a flannel bag, and apply that to the skin. Any risk of the poultice sticking to the patient and the unpleasant sensation of having the poultice on the bare flesh are thus avoided. It is most important to have the patient ready before the poultice is brought to the bedside, and the skin must be rubbed dry with a warm towel whenever a poultice is removed
"A poultice rash" indicates that the nurse has not taken proper care to keep the skin clean and dry. A poultice can remain on for two or three hours if it is covered with a piece of mackintosh or jacket of waterproof material. If, however, there is a wound underneath, the mackintosh must not be used, and the poultice requires to be more frequently changed. If any eczematous rash appears on the skin, the poultice should be given up for a time.
In taking off a poultice one should begin at the top corner and gently pull the poultice downwards, peeling it off the skin. It is necessary to be careful with this if the poultice has been applied against the skin without any intervening flannel.
The Preparation of Poultices
Now we must deal with the various kinds of poultices, and their method of preparation.
1. Linseed poultice. The preparation of this has already been considered.
2. Bread poultice. Coarsely crumbled bread is used for this, put in a warm basin, and boiling water poured on it. A hot plate is put over the top of the basin, which is placed on the range for four or five minutes till the breadcrumbs have soaked up the water. Any superfluous water must now be poured off, boiling water again poured over the crumbs to reheat them, which is in its turn poured off. Spread the poultice on a piece of muslin, and press it between two hot plates until it is free from water. Spread some warm olive oil on it, and apply. This poultice is useful in inflammation of the fingers or thumb, or in glandular swellings.
3. Mustard poultices are made by mixing first with a little cold water, and then adding hot water, and spreading on muslin, which must be doubled over the poultices, so that the mustard is not placed against the skin. After removing a mustard poultice the skin should be treated with a little boracic ointment, and covered with cotton-wool.
4. Mustard-and-linseed poultices. A mustard poultice, however, is much more often given mixed with linseed meal as a "mustard-and-linseed "poultice. Equal parts of mustard and linseed are worked into a paste with hot, not boiling, water. In the case of children, it is better to have three parts of linseed meal to one part of mustard, and no poultice containing mustard should be applied directly to the skin. A thin layer of muslin should be used to cover the poultice.
5. Charcoal poultice. The easiest way to make this is to sprinkle powdered wood charcoal on a bread or linseed poultice. Use a quarter of an ounce of charcoal to an ordinary poultice; the charcoal can easily be bought from a chemist.
These poultices are used for unhealthy sores to absorb the foul-smelling gases.
6. Yeast poultices are also used for cleansing wounds. They are made by mixing equal parts of yeast and flour with hot water into a paste, or equal parts of yeast and linseed meal with boiling water.
7. A boracic poultice is a useful antiseptic dressing. The application of a boracic poultice is a very excellent means of bringing a gathered finger to a head. Take two or three layers of boracic lint, and soak them in hot boracic lotion - that is, hot water to which boracic powder has been added in the strength of a teaspoonful to half a pint. Squeeze this free of superfluous water, and apply it to the finger. Cover it with guttapercha tissue, which must lie over the poultice an inch in all directions to prevent drying. Cover the waterproof tissue with a little cotton-wool, and wrap the whole finger and dressing in a gauze bandage. In early cases of inflamed finger the application of this poultice will prevent suppuration taking place. Later, it will bring the gathering to a head and diminish the pain.
8. A "jacket"; poultice is simply a large poultice that is applied to the whole surface of the chest - front and back. It is used in chest or lung diseases, such as bronchitis. It should be made in halves, one for the back and one for the front, and they can be united by strings at the corners, whilst other strings should be stitched on to be tied above the shoulders. Sometimes, however, large safety-pins are used for fastening the sides together.
Poultices may be used under the same circumstances as fomentations. Their prolonged application is apt to make the part soft, and render the skin liable to irritating rashes.
Spongio-piline is a most useful material to have in the house, and can be bought from chemist. It is porous on one side and waterproof on the other, so that when applied hot it does instead of a fomentation or a poultice. It is very clean and useful when materials for a poultice are not available. It should not be used to apply over a wound, as it is waterproof on one side.
Now, in applying any of these remedies the nurse never for a moment forget that through carelessness on her part she may give the patient a severe chill, or cause a troublesome eruption or eczema of the -kin, which will be extremely difficult to cure. To avoid this, she must lay the following rules to heart:
1. Do not uncover the patient any more, or for one moment longer, than is absolutely necessary.
2. Never allow a half-cold poultice to be in contact with the patient.
4. On removing the poultice, first dry the skin carefully, dust with boracic powder, and cover with cotton-wool.
5. In lung cases it may be necessary to make a flannel jacket for the patient to wear when the poultices are discontinued.
6. Be very careful to guard against any dampness of the patient's clothing and subsequent chafing, for which reasons a waterproof sheet is essential. When this cannot be obtained, a couple of thick sheets of brown paper may be used as a temporary measure over a double layer of clean dry flannel.