awetpack.txt
                    THE WET-SHEET-PACK LETTER
                    =========================

This letter was received by me some years ago.  I have uploaded
it in case others find it as interesting as I do.

                    *  *  *  *  *  *  *  *  *
Dear Rob:

Thank you for sending Nurse Harvey's description of her wet-pack.

     <<<...... My favorite restraint is the wet-pack.  As many as
     30 wet cotton sheets are individually wrapped about the
     limbs and body - as tightly as possible, so that only the
     breathing tube from the inflatable gag remains exposed.  The
     sheets are then compacted and bound paralyzingly tight using
     several long roller towels.

     Once these have been wrapped and pulled very tightly round
     the patient, mummy fashion from head to toe, it is quite
     impossible to move - not even to blink or twitch a toe
     (unless a foot has been left exposed so that it can be
     tickled, or to have itching powder applied to it).

     Often panic has already set in, but the worst has yet to
     come.

     Since the patient is now rigid he can be picked up in an
     invalid hoist and lowered into a long water tank containing
     water, crushed ice - just as cold as I can make it.  You
     probably cannot imagine the shock or agony as this ice-cold
     water seeps through the bindings and numbs the skin.

     It is of no consolation that I hoist him out and strap him
     very tightly to a hospital type bed when he has been suffi-
     ciently soaked.  The muscle contractions due to struggling
     can reduce the cold but this soon results in unbearable
     heat, especially if the patient is further wrapped in heavy
     rubber sheets.  The patient can be reimmersed and the cycle
     repeated whenever my assistant or I feel like it.

     By the morning, after a sleepless night and only cramp and
     the fear of reimmersion to break the monotony, the patient's
     power to resist is often broken. .............>>>

The roller towels that you asked about are rarely seen in the
U.S., but are common in England.  Essentially each towel is
several hundred feet long by about one foot wide.  When utilized
for its intended purpose each towel is rolled up and sits in a
wall-mounted dispenser.  The user pulls a fresh section from the
cabinet to dry his or her hands.  The used portion rolls back up
into the cabinet.  The towel is a strong cotton weave without any
nap - like heavy sheeting.

Fearsome as her pack sounds, one of the institutions that I
worked in often used much more stringent packs on its troublesome
patients.  Instructions and observations follow:


PREPARE PATIENT

       -  shave all hair including legs, crotch and armpits.  Do
          not shave the head unless specifically ordered to do
          so.

       -  cleanse with enema.

       -  wash body using strong detergent (degreasing body
          minimizes insulation).

       -  depending upon orders, insert urethral catheter or put
          on rubber pants, sealed at legs and waist with water-
          proof tape.

       -  insert intravenous saline and nutrient drips as re-
          quired.

       -  insert ear plugs.

       -  either:   provide patient with mouth breathing tube
         
              or    insert gag, seal mouth with waterproof tape
                    and insert nostril tubes.

     Strap the patient to the corners of the frame (a strong
     rectangular metal frame approximately 10'6" x 2'6") using
     waterproof cuffs at ankles and wrists.  Pull the straps,
     attaching the cuffs to the frame, as tight as possible.


THE TANK

     Fill a hydro tank (approximately llft x 3ft x 3ft) with luke
     warm water (about 70 degrees fahrenheit).

     Hoist the frame and patient into the water filled tank. 
     Each end of the frame has one pivot at its center which fits
     into a corresponding socket inside the tank.  This arrange-
     ment allows the frame and patient to be rotated about the
     long axis like a barbecue spit.  Disconnect the hoist.  The
     frame is now free to rotate beneath the surface of the
     water.  Ensure that the patient is breathing properly
     through the tubes(s) provided and that the tubes remain
     kink-free and open during the packing procedure.


PACKING - STAGE 1

     Take each folded sheet from the soak-tub and refold it
     appropriately for its purpose.  Pass each sheet through the
     soak-tub rollers to expel any trapped air.  Quickly re-
     immerse the sheet in the tub until needed.

     The purpose of preparing the sheets in this way, and apply-
     ing the pack with the patient underwater, is to ensure that
     all air is excluded from the pack.  Air acts as an insulator
     and tends to diminish the effectiveness of the pack.  In
     addition, applying the pack in the tank is easier because
     the patient is relatively buoyant.

     Carefully wrap the sheets around each limb as tightly and
     smoothly as possible.  Use cloth tapes to tightly tie each
     sheet in place prior to bandaging.  After each sheet has
     been tied in place, use 6" cotton bandages to bind it even
     more tightly.  Remove the tapes during the bandaging to
     avoid localized pressure.  

     Bandaging the thickest part of the limb first tends to force
     the flesh to the thinner parts and make the limb a more
     uniform thickness and therefore easier to pack.  Ensure that
     each turn of the bandage overlaps considerably with the
     last.  It is important that the pressure be applied as
     evenly as possible to reduce the probability of pressure-
     sores.

     Such extensive use of bandages may seem extravagant but it
     is important to anchor each sheet individually to ensure
     that no amount of prolonged wriggling can loosen the pack. 
     The bandages are relatively cheap and can often be reused. 
     It may seem like a lot of extra work but the patient isn't
     going to be unpacked frequently.  This method actually takes
     less time overall than more frequent packing using less
     rigorous methods.

     To aid in the wrapping operation, rotate the frame and pa-
     tient like a spit.  This is a great improvement over manhan-
     dling the enormous combined weight of patient and wet-pack
     on a table.  Include the hands and feet in the wrapping
     process, removing and replacing the cuffs one at a time.  To
     help speed the process several hydro attendants should work
     at the same time on different body areas.  The supervising
     nurse must ensure that all the bindings are tight enough and
     that the pressure is uniform.

     When binding the head, use pads over the eyes to minimize
     any cavities in the packing.
     
     After a couple of sheets have been wrapped around the torso
     use a short corset to compress the waist and control respi-
     ration if this is a level 4 pack or higher.

     In the case of a male patient fold the penis back toward the
     buttocks and hold it in position with pack sheets applied in
     the style of a diaper.  Hold the sheets in place with a
     tightly strapped canvas waist belt and attached crotch strap
     designed to prevent erection.

     Once the limbs, trunk, crotch, neck and head are satisfacto-
     rily wrapped then stage 2 begins.


PACKING - STAGE 2

     Hoist the support-frame from the bottom of the tank so that
     the patient is supported by it.  Remove the ankle cuffs and
     place sheets between the legs to fill any gaps.  Securely
     wrap additional sheets around the legs and the trunk and
     fasten them in place again with bandages.  At this stage
     stronger bandages should be used, made out of cotton sheet-
     ing.  It is no longer necessary to bandage after every
     sheet.

     Splint the legs and body.  The splint is a canvas corset-
     like device, with metal rust-free stays, that laces up the
     back and extends from ankles to beneath armpits with adjust-
     able shoulder straps.  Fittings are provided for the level 4
     head-harness and shoulder brace to be attached.  Lace up the
     splint as tightly as possible, using heavy-duty buttonhook-
     like devices and temporary straps.  Once properly applied
     the patient is held in absolute rigidity.  If the feet are
     not going to be held en-pointe (level 5 and above) then the
     splint should be anchored by a strap across the soles of the
     feet.

     Release the wrist cuffs and remove the original frame alto-
     gether, leaving the water-logged patient supported by the
     "support-frame" - but still underwater.

     Put each arm into a splint.  Each splint has a mitt for the
     hand.  Tightly lace each arm splint from wrist to armpit. 
     Strap the arms securely to the side of the body using the
     special canvas straps built into the side of the body-
     splint, passing the straps through the loops in the arm
     splints.  A level 5 pack or above may specify different arm
     positions.

     Use extra-large sheets to wrap the entire body, from the
     crown of the head to the tips of the toes, as a single unit. 
     As with any other wrapping operation, pass each sheet at
     least 3 complete times around the patient (or limb) to
     ensure that it cannot be unwrapped by the patient.  After
     the last sheets are added then again bandage the patient
     from head to toe.

     Overall a lot of sheets are used.  They should be 100%
     cotton in order to absorb and retain the maximum amount of
     water and provide the minimum insulation.  They are usually
     made from an extra-heavy white sheeting in various sizes but
     are generally larger than regular bed sheets.  Although the
     number of sheets may vary from patient to patient, the
     following pack sheets might typically be used (not in the
     order of application):

            -  left leg             4
            -  right leg            4
            -  left foot            1
            -  right foot           1
            -  left arm & hand      3
            -  right arm & hand     3
            -  neck                 2
            -  head                 3
            -  crotch               2
            -  trunk                6
            -  between legs         4
            -  legs together        4
            -  entire torso        11
                                   --
                    Total          48


SECURITY BAG

     In a level 3 pack or above, canvas cinch straps should be
     used and the patient put in a heavy canvas security-bag. 
     (Remember that the patient is still immersed in the tank and
     that the staff should ensure that there is no air in the
     security-bag before using it.)

     Tightly lace and strap the security-bag and then perform a
     final heavy bandaging to prevent any possibility of air
     entering the security-bag when the patient is raised out of
     the tank.  The patient is then securely refastened to the
     support-frame with a number of canvas straps.  In a level 5
     and above, force the feet into an exaggerated en-pointe
     position using a ballet strap.


HOIST PATIENT

     When the patient and frame are hoisted out of the tank,
     excess body-heated water drains off.  As the water drains
     out of the pack no air can pass back through the pack-sheets
     to fill the voids previously filled by the water.  Thus the
     patient not only feels the oppressive weight of the wet
     sheets, but will also feel the pack draw tighter as the
     sheets "shrink" to fill any gaps previously filled with
     water.  It is rather similar to being vacuum packed.

     The canvas straps used to secure the patient to the frame
     should be retightened as any excess water drains from the
     pack.


IMMERSION IN COLD TANK

     Move the hoisted frame and patient to the cold tank where
     the water is kept refrigerated.  Gradually lower the patient
     into the tank.  In order to ensure that all the warm water
     is removed from the pack, hoist the patient out and allow
     the pack to drain before reimmersion.  Perform this process
     several times in quick succession.

     As the freezing water gradually passes through the pack you
     may hear the patient desperately trying to inhale more air
     through the breathing tubes as the cold water causes the
     oxygen requirement to shoot up.  The patient will try to
     inhale all the air that it can as its metabolism increases
     to combat the cold.  In a level 5 pack, or higher, a nurse
     may request that the air supply be reduced at such times.

     After the initial immersion cycles the patient is left to
     soak in the tank and the auto-immersion cycle is started. 
     This is essentially a timer that causes the patient to be
     hoisted out of the tank and reimmersed automatically.  The
     timer has a random setting that is most often used to avoid
     the patient being able to anticipate the next hoisting or
     reimmersion.  The period between immersions may be long
     enough for the patient to become uncomfortably hot but maybe
     not.

     In this way the patient is left without any contact with the
     outside world for as much as a week at a time.  The hell
     endured by such a patient is hard to imagine.  Itching,
     cramps and fear of reimmersion are the only companions.

     The timer switch may also activate the white-noise speakers
     in the hydro room, which effectively mask any outside noise
     that the patient might otherwise hear.  Since the white-
     noise is very loud, staff should wear hearing protectors
     while in the room.  The patient is protected by the ear
     plugs and layers of pack.


OBSERVATIONS

     A wet-sheet-pack is clearly a fearsome method of discipline. 
     The patient is transformed into an absolutely helpless and
     rigid mummy, without even the slightest hope of escape. 
     Even the fingers, toes, jaw and eyelids are immobilized. 
     Even shivering is reduced to a minimal level.  The patient
     is usually reduced to a state of blind panic, but is not be
     able to communicate that panic to anyone or get any form of
     comfort.

     The patient is alone!

     The patient is being crushed and needs to move to relieve
     the screaming cramps in the limbs and body.  The patient
     cannot possibly lie still any longer - but will!

     The patient has no idea when he or she will be released or
     how much time has passed.  The patient knows beyond doubt
     that it has entered a living hell - if this can be called
     living.

     If the patient is not catheterized then the question of
     eliminations will eventually arise:

          "Can I hold back until I am released"

          "How long will I have to wait - just a few minutes
          more?"

          Eventually the patient will succumb to the urge and be
          forced to urinate.  Later the issue becomes defecation
          and again the patient is eventually forced to succumb. 
          In addition to the shame of fouling themselves and
          lying in their own waste they are concerned about what
          "treatment" may be meted out to them if they foul
          themselves and the tank so horribly.

     "When is this going to end?"

     "I must have been here for hours!"

     "Is it night or is it day?"

     "Have I been in here for 6 hours or 24 hours or 2 days or a
     week?"

     "Nobody told me how long this treatment would last - they
     implied it would only be a couple of hours, but I know its
     been longer than that!"

     "Are they ever going to release me?"

     "The cramps keep getting worse and my muscles feel as if
     they are being torn apart." 

     "Are my arms turning blue?" 

     "If only I could die."
     "Oh god, please let me out." 

     But the patient is not released - the treatment continues. 
     "Life" remains a living hell of alternating heat, cold, re-
     immersion, fear of drowning, claustrophobia, suffocation,
     cramps and unimaginable boredom.  Nothing to do but lie
     there, nothing to hear, smell, control or feel except the
     cold.

     There is no way to know when the next immersion will come,
     or if it will come, and no way to judge the passing of time.

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