If the patient does not react to the pack, that is, if he remains cold, or if, as is sometimes the case in malaria, the fever is accompanied by chills or if profuse perspiration is desired, bottles filled with hot water or bricks heated in the oven and wrapped in flannel should be placed along the sides and to the feet, under the outside covering.

This form of application is called the bed-sweat bath. It may be used with good results when an incipient cold is to be aborted.

After the pack has been removed, the body should be sponged with cold water, as already stated. Use a coarse cloth or Turkish towel for this purpose rather than a sponge, as the latter cannot be kept perfectly clean. Dry the body quickly but thoroughly, and finish by rubbing with the hands.

In the meantime the damp bed clothing should be replaced by dry sheets and blankets (a second cot or bed will be found a great convenience), and the patient put to bed without delay and well covered in order to prevent chilling and also to induce, if possible, a copious aftersweat. The patient is then sponged off a second time, put into a dry bed, and allowed to rest.

If the patient is too weak to leave his bed, the cold sponge may be given on a large rubber sheet or oilcloth covered with an old blanket, which should be placed on the bed before the pack is applied. After removing the pack, put a blanket over the patient to prevent chilling and wash quickly but thoroughly first the limbs, then chest and stomach, then the back, drying and covering each part as soon as finished. Remove the rubber sheet from the bed and wrap the patient in dry, warm blankets, or lift him into another bed.

How to Apply the Short-Body Pack

A wide strip of linen or muslin, wrung out of cold water, is wrapped around the patient from under the armpits to the thighs or knees in one, two or more layers, covered by one or more layers of dry flannel or muslin in such a manner that the wet linen does not protrude at any place.

Similar packs may be applied to the throat,* the arms, legs, shoulder joints or any other part of the body.

The number of layers of wet linen and dry covering is determined by the vitality of the patient, the height of his temperature and the particular object of the application, which may be:

  1. to lower high temperature
  2. to raise the temperature when subnormal
  3. to relieve inner congestion
  4. to promote elimination.

If the object is to lower high temperature, several layers of wet linen should be wrapped around the body and covered loosely by one or two layers of the dry wrappings in order to prevent the bed from getting wet. The packs must be renewed as soon as they become dry or uncomfortably hot.

If the object is to raise subnormal temperature, less wet linen and more dry covering must be used, and the packs left on a longer time, say from thirty minutes to two hours. If the patient does not react to the pack, hot bricks or bottles filled with hot water should be placed at the sides and to the feet, as explained in connection with the whole-body pack.

If inner congestion is to be relieved, or if the object is to promote elimination, less of the wet linen and more dry wrappings should be used.

When packs are applied, the bed may be protected by spreading an oilcloth over the mattress under the sheet. But in no case should oilcloth or rubber sheeting be used for the outer covering of packs. This would interfere with some of the main objects of the pack treatment, especially with heat radiation. The outer covering should be warm but at the same time porous, to allow the escape of heat and of poisonous gases from the body.