- Email: [email protected]
A sheet bandage for the treatment of eczematouschildren
A S H E E T BANDAGE FOR THE TREATMENT OF ECZEMATOUS CHILDREN H E ~ A ~ VOLL~ER, M.D. NEW YORK, N. Y. IIE elimination of itching and the prevention of scratching are imed The tormentc eczematous child frustrates again and again every therapeutic success by scratching, i.e., by mechanical irritation and destruction of epithelium in the diseased skin area. There are three ways to break this vicious cycle: (1) the local application of remedies which relieve the itching, (2) the calming of the nervous system by sedatives, and (3) mechanical measures that prevent scratching.
T portant considerations in the treatment of eczema.
Fig.
I.
Fig,
2.
l~ig. 3.
The available local remedies are unsatisfactory; they temporarily appease the itching, but do not eliminate it entirely. Sedatives alleviate the suffering to a great extent, but likewise cannot entirely prevent the itching. Therefore one cannot dispense with the common measures used for keeping the child from scratching, namely fastening the hands or extending the arms by cuffs or splints. These methods likewise are not very satisfactory. Fastening the hands occasionally causes venous congestion and strangulation. Extending the arms by From Schiek,
the M.I).
Pediatric
Set"vice
of
The
:hffount 522
Sinai
Hospital,
Chief
of
Staff,
]3ela
VOLLMER:
SHEET
BANDAGE FOR ECZE1KATOUS CHILD
523
splints requires bulky pads and bandages which cause the skin to overheat and perspire, and have an unfavorable influence on the eczema in case the skin of tile arms is also involved. Moreover, the u p p e r edges of the cuffs or splints offer the patient an opportunity to chafe the face. All these methods are regarded to be cruel fettering. One has to consider that man changes his sleeping posture almost every fifteen minutes. I f eczematous children are denied these physiologic changes of posture for days and weeks, central nervous disturbances may result. We have seen eczematous children restricted in their movements who were pathologically excited in spite of high doses of phenobarbital. After removing the bandages, these children frequently became cahner even when phenobarbital was discontinued. Herein a method is described to wrap an eezematous child in a sheet so that changes in posture and movements of the arms remain possible - - t h u s eliminatif~g the tormenting feeling of being f e t t e r e d ~ a n d yet scratching of body or face is entirely prevented. As demonstrated in the figures, the child is placed in the middle of a quadrangular sheet so that the neck lies upon the upper edge of the sheet. The sheet is then folded from both sides over the shoulders and arms, drawn under t.he armpit, then a r o u n d the back, and knotted above the chest (Figs. I and 2). Thus the arms in the sheet wrapping are allowed full play which can be regulated at will, but they cannot be lifted toward the chest or face. The lower edge of the sheet is finally drawn up between the legs and fastened with safety pins on both sides in the region of the shoulder, in order to avoid movement of the bandage (Fig. 3). This sheet bandage is practical for hospital use as well as for private practice. I t is hygienic because the sheet can be changed as frequently as necessary. I t avoids overheating because it dispenses with bandages and pads, and can be applied on the undressed child in the summer time. The children although unable to scratch themselves do not feeJ disagreeable nor confined. 25 CENTI~AL
PARK
WEST
T portant considerations in the treatment of eczema.
Fig.
I.
Fig,
2.
l~ig. 3.
The available local remedies are unsatisfactory; they temporarily appease the itching, but do not eliminate it entirely. Sedatives alleviate the suffering to a great extent, but likewise cannot entirely prevent the itching. Therefore one cannot dispense with the common measures used for keeping the child from scratching, namely fastening the hands or extending the arms by cuffs or splints. These methods likewise are not very satisfactory. Fastening the hands occasionally causes venous congestion and strangulation. Extending the arms by From Schiek,
the M.I).
Pediatric
Set"vice
of
The
:hffount 522
Sinai
Hospital,
Chief
of
Staff,
]3ela
VOLLMER:
SHEET
BANDAGE FOR ECZE1KATOUS CHILD
523
splints requires bulky pads and bandages which cause the skin to overheat and perspire, and have an unfavorable influence on the eczema in case the skin of tile arms is also involved. Moreover, the u p p e r edges of the cuffs or splints offer the patient an opportunity to chafe the face. All these methods are regarded to be cruel fettering. One has to consider that man changes his sleeping posture almost every fifteen minutes. I f eczematous children are denied these physiologic changes of posture for days and weeks, central nervous disturbances may result. We have seen eczematous children restricted in their movements who were pathologically excited in spite of high doses of phenobarbital. After removing the bandages, these children frequently became cahner even when phenobarbital was discontinued. Herein a method is described to wrap an eezematous child in a sheet so that changes in posture and movements of the arms remain possible - - t h u s eliminatif~g the tormenting feeling of being f e t t e r e d ~ a n d yet scratching of body or face is entirely prevented. As demonstrated in the figures, the child is placed in the middle of a quadrangular sheet so that the neck lies upon the upper edge of the sheet. The sheet is then folded from both sides over the shoulders and arms, drawn under t.he armpit, then a r o u n d the back, and knotted above the chest (Figs. I and 2). Thus the arms in the sheet wrapping are allowed full play which can be regulated at will, but they cannot be lifted toward the chest or face. The lower edge of the sheet is finally drawn up between the legs and fastened with safety pins on both sides in the region of the shoulder, in order to avoid movement of the bandage (Fig. 3). This sheet bandage is practical for hospital use as well as for private practice. I t is hygienic because the sheet can be changed as frequently as necessary. I t avoids overheating because it dispenses with bandages and pads, and can be applied on the undressed child in the summer time. The children although unable to scratch themselves do not feeJ disagreeable nor confined. 25 CENTI~AL
PARK
WEST