2600. Heat.—There are three forms in which heat is universally applied to the body,—that of the tepid, warm, and vapour bath; but as the first is too inert to be worth notice, and the last dangerous and inapplicable, except in public institutions, we shall confine our remarks to the really efficacious and always attainable one—the
2601. Warm and Hot Bath.—These baths are used whenever there is congestion, or accumulation of blood in the internal organs, causing pain, difficulty of breathing, or stupor, and are employed, by their stimulating property, to cause a rush of blood to the surface, and, by unloading the great organs, produce a temporary inflammation in the skin, and so equalize the circulation. The effect of the hot bath is to increase the fulness of the pulse, accelerate respiration, and excite perspiration. In all inflammations of the stomach and bowels, the hot bath is of the utmost consequence; the temperature of the warm bath varies from 92° to 100°, and may be obtained by those who have no thermometer to test the exact heat, by mixing one measure of boiling with two of cold water.
2602. Fomentations are generally used to effect, in a part, the benefit produced on the whole body by the bath; to which a sedative action is occasionally given by the use of roots, herbs, or other ingredients; the object being to relieve the internal organ, as the throat, or muscles round a joint, by exciting a greater flow of blood to the skin over the affected part. As the real agent of relief is heat, the fomentation should always be as hot as it can comfortably be borne, and, to insure effect, should be repeated every half-hour. Warm fluids are applied in order to render the swelling which accompanies inflammation less painful, by the greater readiness with which the skin yields, than when it is harsh and dry. They are of various kinds; but the most simple, and oftentimes the most useful, that can be employed, is "Warm Water." Another kind of fomentation is composed of dried poppyheads, 4 oz. Break them to pieces, empty out the seeds, put them into 4 pints of water, boil for a quarter of an hour, then strain through a cloth or sieve, and keep the water for use. Or, chamomile flowers, hemlock, and many other plants, may be boiled, and the part fomented with the hot liquor, by means of flannels wetted with the decoction.
2603. Cold, when applied in excess to the body, drives the blood from the surface to the centre, reduces the pulse, makes the breathing hard and difficult, produces coma, and, if long continued, death. But when medicinally used, it excites a reaction on the surface equivalent to a stimulating effect; as in some cases of fever, when the body has been sponged with cold water, it excites, by reaction, increased circulation on the skin. Cold is sometimes used to keep up a repellent action, as, when local inflammation takes place, a remedy is applied, which, by its benumbing and astringent effect, causes the blood, or the excess of it in the part, to recede, and, by contracting the vessels, prevents the return of any undue quantity, till the affected part recovers its tone. Such remedies are called Lotions, and should, when used, be applied with the same persistency as the fomentation; for, as the latter should be renewed as often as the heat passes off, so the former should be applied as often as the heat from the skin deprives the application of its cold.
2604. Poultices are only another form of fomentation, though chiefly used for abscesses. The ingredient best suited for a poultice is that which retains heat the longest; of these ingredients, the best are linseed—meal, bran, and bread. Bran sewed into a bag, as it can be reheated, will be found the cleanest and most useful; especially for sore throats.
How to Bleed.
2605. In cases of great emergency, such as the strong kind of apoplexy, and when a surgeon cannot possibly be obtained for some considerable time, the life of the patient depends almost entirely upon the fact of his being bled or not. We therefore give instructions how the operation of bleeding is to be performed, but caution the reader only to attempt it in cases of the greatest emergency. Place a handkerchief or piece of tape rather but not too tightly round the arm, about three or four inches above the elbow. This will cause the veins below to swell and become very evident. If this is not sufficient, the hand should be constantly and quickly opened and shut for the same purpose. There will now be seen, passing up the middle of the fore-arm, a vein which, just below the bend of the elbow, sends a branch inwards and outwards, each branch shortly joining another large vein. It is from the outer branch—that the person is to be bled. The right arm is the one mostly operated on. The operator should take the lancet in his right hand, between the thumb and first finger, place the thumb of his left hand on the vein below the part where he is going to bleed from, and then gently thrust the tip of the lancet into the vein, and, taking care not to push it too deeply, cut in a gently curved direction, thus and bring it out, point upwards, at about half an inch from the part of the vein into which he had thrust it. The vein must be cut lengthways, and not across. When sufficient blood has been taken away, remove the bandage from above the elbow, and place the thumb of the left hand firmly over the cut, until all the bleeding ceases. A small pad of lint is then to be put over the cut, with a larger pad over it, and the two kept in their places by means of a handkerchief or linen roller bound pretty tightly over them and round the arm.
2606. When a person is bled, he should always be in the standing, or at any rate in the sitting, position; for if, as is often the case, he should happen to faint, he can, in, most eases at least, easily be brought to again by the operator placing him flat on his back, and stopping the bleeding. This is of the greatest importance. It has been recommended, for what supposed advantages we don't know, to bleed people when they are lying down. Should a person, under these circumstances, faint, what could be done to bring him to again? The great treatment of lowering the body of the patient to the flat position cannot be followed here. It is in that position already, and cannot be placed lower than it at present is—except, as is most likely to be the case, under the ground.
2607. BLEEDING FROM THE NOSE.—Many children, especially those of a sanguineous temperament, are subject to sudden discharges of blood from some part of the body; and as all such fluxes are in general the result of an effort of nature to relieve the system from some overload or pressure, such discharges, unless in excess, and when likely to produce debility, should not be rashly or too abruptly checked. In general, these discharges are confined to the summer or spring months of the year, and follow pains in the head, a sense of drowsiness, languor, or oppression; and, as such symptoms are relieved by the loss of blood, the hemorrhage should, to a certain extent, be encouraged. When, however, the bleeding is excessive, or returns too frequently, it becomes necessary to apply means to subdue or mitigate the amount. For this purpose the sudden and unexpected application of cold is itself sufficient, in most cases, to arrest the most active hemorrhage. A wet towel laid suddenly on the back, between the shoulders, and placing the child in a recumbent posture, is often sufficient to effect the object; where, however, the effusion resists such simple means, napkins wrung out of cold water must be laid across the forehead and nose, the hands dipped in cold water, and a bottle of hot water applied to the feet. If, in spite of these means, the bleeding continues, a little fine wool or a few folds of lint, tied together by a piece of thread, must be pushed up the nostril from which the blood flows, to act as a plug and pressure on the bleeding vessel. When the discharge has entirely ceased, the plug is to be pulled out by means of the thread. To prevent a repetition of the hemorrhage, the body should be sponged every morning with cold water, and the child put under a course of steel wine, have open-air exercise, and, if possible, salt-water bathing. For children, a key suddenly dropped down the back between the skin and clothes, will often immediately arrest a copious bleeding.
2608. SPITTING OF BLOOD, or hemorrhage from the lungs, is generally known from blood from the stomach by its being of a brighter colour, and in less quantities than that, which is always grumous and mixed with the half-digested food. In either case, rest should be immediately enjoined, total abstinence from stimulants, and a low, poor diet, accompanied with the horizontal position, and bottles of boiling water to the feet. At the same time the patient should suck through a quill, every hour, half a wine-glass of water in which 10 or 15 drops of the elixir of vitriol has been mixed, and, till further advice has been procured, keep a towel wrung out of cold water on the chest or stomach, according to the seat of the hemorrhage.