Prepare a bed (long enough for the patient to lie at full length upon his back), with a large thick sheet folded on the lower part of it. Spread over this sheet a blanket wrung out of hot water, so as to be both moist (but not wet) and warm (see Fomentation). See that the blanket is not so hot as to burn the patient and add to his pain. It must be tested with the back of the hand, and be just as warm as this can well bear. On this let the patient lie down, and wrap him up tightly in it from the feet up to above the haunches. Have two or three towels folded so as to be about six inches broad, and the length of that part of the patient's spine above the hot blanket. Wring these out of cold water. Place one over the spine, so as to lie close along it; on this, place a dry towel to keep the damp from the bed, and let the patient lie down on his back, so as to bring the cold towel in close contact with the spine. When this towel becomes warm, another cold one must be put in its place. After about half an hour's pack and eight changes of the cold towel, the pain in the chest should be subdued for the time. If the cold towel does not heat in five minutes, the patient's vitality is low, and a hot cloth should be placed along the spine, and renewed several times, and then another cold one; but as a rule this will not be required. When taken out of the pack, let the skin be washed with soap (see) and warm water; then a slight sponge of nearly cold water, and a gentle rubbing with olive or almond oil. Rub the back first, and gently "shampoo" all the muscles; that is, knead and move the muscles under the skin so as to make them rub over one another.
If the pain in the chest be of an inflammatory nature, the cold towels must be applied over the place where it is felt, instead of on the spine (see Inflammation.)
Ankle Swelling.—When long continued in connection with disease or accident, this sometimes leads to a partial withering of the limb up to its very root. In such a case it is best to deal first with the roots of those nerves which supply the limb, which are, in the case of the legs, in the lower part of the back. It is important to apply light pressure to these roots by gently squeezing the muscles of the lower back. This raises a feeling of gentle heat, which slowly passes down the limbs even to the toes. Then the gentle pressure and squeezing must be carried all down the limb, avoiding any degree of pain, until all its muscles have had their share. While progressing down the limb with his rubbing, let the rubber be careful that the individual strokes of his hands be upwards, towards the hip. The blood will thus be propelled towards the heart, while the stimulus of rubbing is conveyed along the nerve trunks towards the foot. The squeezing should be done with a grasping movement of the hands, the limb being held encircled in both hands, thumbs upwards. Warm olive oil is used in this squeezing, and also, if the skin be hard and dry, soap lather (see Lather).
Even slight displacements of bones will disappear under such treatment, if patiently continued day after day, as the patient can bear it without fatigue. In such gentle remedies, perseverance plays a large part. (See Abscess; Diet; Exercise).
Ankle, Twisted or Crushed.—Place the foot as soon as possible in warm water, as hot as can comfortably be borne; keep it there until free from pain, or for an hour, or even more if necessary. If the flesh be torn, dress with cloths wrung out of vinegar or weak acetic acid before placing in the water.
When the bath has done its work, and the limb comes out of the water alarmingly swollen, good and skilful bandaging will do excellent work. If you have at hand an old shirt, or some such thing, tear it into strips about three inches wide, till you have as much material as will swathe the whole limb from behind the toes up to the top of the thigh. This need not be all in one piece, but only so that you may apply it in such a way as to bring a very gentle pressure on the whole surface of the injured limb. It is important that the bandaging should be comfortable. The way in which bandaging is sometimes done is cruel in the extreme. Cases that are a disgrace to humanity are constantly coming under our notice, in which limbs are lost for life by the treatment they receive in this respect. Skilful surgeons do it in the most gentle manner; they even swathe the limbs in soft loose cotton before they apply the bandages, so that a perfectly equal and comforting pressure may be secured. Lay the limb to rest, well and softly supported in a horizontal position. When the swelling falls, gently tighten the bandage from time to time as required. Each time the bandages are removed for this purpose, sponge the limb with warm vinegar or weak acetic acid (see). When the swelling subsides, the ankle may be put again in the hot bath for half-an-hour, and then, if any bones be broken, is the time for setting them right. The ankle will probably turn black. If so, do not apply leeches, but allow the black blood to be absorbed by natural process.
A twisted or bruised wrist or hand is to be treated in the same way. The swelling may also be removed by gentle rubbing upwards along the limb, so as to help the blood in its course.
Armpit Swelling.—Often this comes as the result of a chill, or of enfeeblement of the system from various causes. In the early stage, such a swelling should not be treated so as to develop a sore. Treatment with iodine is to be avoided.
The first thing, in this early stage, is to increase vital action in the part, and also in the whole system (see Abscess). Moist heat is to be applied. Make a bran poultice (see), which should come right round from over the spine, over the swelling, and over the whole shoulder. Let this be kept hot for an hour at least. If it can be thus applied twice a day without too much fatigue, do so. If the swelling softens and becomes less under this treatment, a few cold cloths may be applied to brace the part and aid its vitality. Do not, on any account, make the patient shiver. If the swelling increases and becomes discoloured, keep to the hot treatment until it bursts and discharges. For treatment then, see Abscess; Wounds.
During all this treatment the whole back should be gently rubbed daily with warm olive oil for half an hour, if as much can be borne.