Dry and Moist Heat.—In applying heat, either dry or moist, to the insane, care must always be used to protect the skin from being blistered. This happens very easily when it is applied directly to old, feeble, paralyzed, or paretic patients, and also to those who are too demented to complain if they are being burned. Burns are very serious accidents among this class of patients, and may, if they extend over a large surface, even though not deep, heal with difficulty, and even prove fatal.
Dry heat is applied by means of rubber bags filled with hot water, hot-sand bags, bricks, or soapstones, and by the lamp bath. Moist heat by hot baths, fomentations, turpentine stupes, and poultices.
Hot Baths and Wet Packing.—Hot baths are sometimes prescribed for patients. The water should be about 100 degrees F., and, if ordered, slowly increased to 110°. The patient is to be left in as long as directed, which may be but a few minutes, or half an hour, or even longer. Sometimes a blanket is ordered thrown over the tub, the head only being uncovered.
When the bath is being given, the pulse should be counted; if it become weak and rapid, if the face become flushed, and the patient complains of dizziness, or if the lips show venous congestion, the patient should be at once removed, and, unless there is immediate recovery from these evil effects, the physician should be informed.
In giving a wet pack, the patient is wrapped in a sheet, without any clothing, wet either in cold or warm water, as ordered, and then rolled in a blanket, put to bed, and left in it as long as directed.
These methods of treatment are frequently ordered by physicians for patients who are restless, violent, and sleepless, with a view of giving quiet and sleep. The attendant should observe and report the result.
Application of Cold.—The attendants are frequently ordered to apply ice to some part of the body, for the purpose of producing local cold. The ice should be broken into small pieces and put into a bladder, or rubber bag, partly filling it. It remains sufficiently cold until all the ice is melted.
Another way is to put a piece of ice in a sponge and bathe the part. When cold cloths or compresses are applied, the heat of the body soon warms them, when they become warm applications and act as a poultice; they should therefore be frequently changed. In applying moist dressings care must be used not to have any leaking nor wetting of the bed or clothing.
Hypodermic Injections.—Morphine, hyoscyamine, or hyoscine, in solution, are frequently injected under the skin. The direction to do this, and the quantity to be given, will, in every case, be ordered by the physician. A fold of the skin is held between the finger and thumb, while the needle held in the other hand is quickly pushed straight under the skin to the depth of about half an inch. Care should be used to inject no air, and not to inject the contents of the syringe, into a vein.
Forcible Feeding with the Stomach-Tube.—Attendants are frequently called upon to assist in the forcible feeding of patients, and in some cases may themselves be directed to do it. The dangers of feeding are that the pharynx may be filled with fluid, and the patient choke, or it may be drawn into the lungs, that the wedge with which the mouth is held open may be so loosely held that in the struggle of the patient the soft parts of the mouth may be injured, and occasionally it happens that the mere pressure of the tube causes choking.