Wrapping

WRAPPING (wet wrapping). Wrappings differ from most hydrotherapy procedures in their duration (up to two hours). As in every hydrotherapy method, the vascular reaction is of essential importance in wrapping. The general therapeutic effect of W. depends on the duration of the procedures. W. produce a fever-reducing, calming effect on the nervous system, or diaphoretic effect. The first effect of applying W.—after brief constriction of the skin vessels, there follows prolonged general reactive dilation and sensation of heat, which is maintained by the presence of the poorly heat-conducting woolen blanket. When studying temperature during W., between the first and second layers of the wet sheet, a maximum temperature was noted after 30-60 minutes, and the latter rarely exceeded 36°. The degree of warming during W. depends on the nutritional state, presence of fat deposits, and reactivity of the skin vessels. Thus, for example, in people with average nutrition, the temperature over the abdomen reached 31° after 5 minutes from the start of W., then gradual warming occurred, reaching its peak after 30 minutes. In obese individuals, after 5 minutes the temperature over the abdomen was 23.5°, and after 30 minutes it reached the maximum point—35°. Subjective sensations of heat usually begin after 5-10 minutes, and the whole body warms up quite evenly, although in obese individuals warming occurs more slowly, and in many very thin individuals, the legs warm up insufficiently and very slowly. The accelerated heart activity observed at the beginning of the procedure decreases by 10-12 beats per minute compared to the initial value, and only in a few individuals is acceleration of the pulse noted again by the end of the procedure, reaching or slightly exceeding the initial point. Blood pressure after single W. in healthy individuals and especially in hypertensives, after a small initial increase of 5-10 mm Hg, decreases by the end by 20-50 mm Hg. The decrease in pressure lasts in different people from 2 to 24 hours. Such a decrease is noted by authors as a result of a course of treatment in the first 3-4 weeks. In an acute experiment, the systolic pressure usually decreases more than the diastolic. Thus, with gradual warming and increase in temperature over 30 minutes, favorable conditions are created for the dilation of the deeply lying skin vessels in the sense of Hauffe, and this dilation, spreading over the entire surface of the body, draws blood to the periphery, freeing the heart and the pulmonary circulation from excess blood, which facilitates the work of the heart. Breathing after initial acceleration slows down and deepens. Relaxation of the musculature, decreased sensitivity of the nervous system, slowing of cardiac activity, and anemia of the brain (Schiller's experiments) cause a decrease in the excitability of the nervous system and the onset of drowsiness. Technique. On a bed or wide-long couch, a woolen blanket—2 m in length and 2.5 m in width—is placed. Over the blanket is spread a linen sheet (avoiding folds), moistened in cold water and wrung out. The undressed patient, after preliminary moistening of the face and head with cold water, lies down and is quickly wrapped in the wet sheet, the latter also being placed where two surfaces of the body come into contact, for example, the flexor surface of the arm and the axillary region, the inner surfaces of the thighs, etc. The sheet should fit the body tightly. Then the woolen blanket is carefully pulled taut, with its upper end at the neck being folded into pleats. The patient, tightly wrapped, is covered with another blanket so that the latter covers the torso twice and the lower extremities 3-4 times. Parts of the body that emit little heat, such as the legs, are first rubbed red with a dry towel; if redness does not occur, then a hot water bottle is placed over the wet sheet. Methodology. The water temperature for moistening the sheet is 20° and below. If the procedure is stopped as soon as the patient war up, i.e., after 20 minutes, then the effect of W. is stimulating. Long wrapping (from 30 minutes to an hour) has a calming effect and is used in neurasthenic states; longer W. (up to 2 hours), leading to sweating, is used in reduced metabolism. In febrile patients, a decrease in temperature is achieved by the sequential application of W. By the time of the first warming up, everything is prepared for a repeated procedure on a nearby bed. After 20 minutes, the unpacked patient is transferred to the second bed and, without drying him, a second wrapping is performed. After the last W., rubbing with the warmed sheet is done. Usually under the influence of repeated W. in febrile patients, the temperature slowly falls and then slowly rises. The final procedure (pouring, etc.) is not applied to febrile patients, but in other cases after W., in order to constrict the dilated skin vessels, tone the musculature, and stop sweating, a cool procedure is used (pouring with water at 32-30°; half-bath 3 min.—34-32° or shower from 33 to 30° for 1.5-1 minute). W. in febrile patients act calming on the temperature-regulating centers, which leads to decreased heat production, and in combination with increased heat loss, this all leads to a decrease in body temperature. Hydrotherapy acts on the thermoregulatory centers not directly, but indirectly, through its effect on the vasomotors. Thus, not only a decrease in temperature is achieved, but also relief of the activity of the cardiovascular system, increased diuresis, excretion of toxic substances, improvement of respiration, enhancement of skin functions, and—in case of loss of consciousness—its return in patients. By using the correct technique of W., it is possible to achieve dilation of peripheral vessels with all the resulting consequences, but in the absence of a thermal reaction, W. will not only not lower, but may even increase body temperature. At the beginning of the procedure, to prevent reverse blood flow to the head, cooling of the head (compresses) is used. The latter is especially necessary in cases where the nervous state is accompanied by rushes of blood to the head.

| Application. Wrapping is widely used in nervous diseases: a) for insomnia (one hour before bedtime with subsequent rubbing dry, while in combination with any hydrotherapeutic procedure, wrapping is prescribed at other times of the day), b) for neuralgias, motor neuroses (chorea, athetosis), erethic psychoses (maniacal forms). In all these cases, the procedure lasts 45-60 minutes followed by a cool half-bath from 33° to 28° for 3 minutes; c) for arthritis, wrapping is applied for 1 to 1.5 hours (until sweating occurs, thereby enhancing the absorption of joint exudates). The same technique is used in cases of intoxication with heavy metals to eliminate toxic products. Here sweating is increased if hot water at 38-40° is used to moisten the sheet, and a hot water bottle is applied to the feet; d) for hypertension, the duration of wrapping is 40-60 minutes, with the temperature of the wet sheet at 20-25°. The maximum blood pressure decreases by 10-15 mm Hg and the minimum by 5-15 mm Hg. Modification of the procedure. Three-quarter wrapping differs from full wrapping only in that the arms remain free; it is used a) in cases where full wrapping is undesirable due to patients' fear. Additionally, such wrapping is used b) with Leiter's cooler on the heart area in cardiac neuroses; the cooler is placed between the layers of the wet sheet and blanket; c) in combination with a compress on the abdominal area in motor neuroses of the stomach and intestines, through which water at 41-45° flows through a spiral tube. Torso wrapping (performed from the armpit to the symphysis) is used: a) in febrile patients as an antipyretic; b) with Leiter's cooler on the heart area in cardiac neuroses; it causes a slowing of cardiac activity, better pulse filling due to increased tone of the heart and blood vessel muscles, disappearance of unpleasant sensations in the heart area (tightness, pain). In the latter cases, only the heart area is covered with a wet sheet, while the rest of the body is wrapped in a dry sheet and over that with a blanket; c) torso wrapping with Wintermitz's compress on the stomach or abdominal area; a good symptomatic remedy for nervous diseases of the gastrointestinal tract; its action is antispasmodic due to accelerated emptying of the stomach, reduces sensitivity in pain; d) for uncontrollable vomiting in pregnancy (the procedure is performed half an hour before meals and is stopped at the height of digestion); e) for crises in tabetics, spastic constipations, and nervous diarrheas. Absolute contraindications: cases of weakened cardiac activity, decompensated diseases of the cardiovascular system and lungs, depressive forms of neurasthenia, skin diseases, etc. Dry wrapping is performed in the same way as wet wrapping, only the sheet is not moistened. The procedure is most often used as a final step after warm procedures, such as hot bath, steam bath, dry-air, mud bath, and other procedures in which heat is retained in the body to enhance diaphoretic action. The procedure is also used for preliminary warming in anemic, chilly, and other patients to ensure the occurrence of 'vascular reaction' when applying COLD procedures to these patients.

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