External Applications in Anthroposophic Nursing

Compress Fundamentals

The Term "Compress"

To understand external applications we require a more precise description of them. Different terms may be used to describe the same thing, depending on the context.
External applications are used to convey healing processes via the skin. Many of them are three-part compresses:

An inner cloth is used to carry various kinds of agents; it is followed by a second and third cloth (this is described in detail under "General Information For Administering Compresses" in the text below. The inner cloth is placed gently but quickly on the skin, the second (intermediate) cloth is sculpted over it to fit the shape of the body; the third (outer) cloth completes the compress.
Next the patient is covered, tucking in the shoulders but not restricting the neck area. The blanket should lie as close as possible to each side of the body. This kind of firm packing emphasising the body's boundaries gives the person security and support as they entrust themselves to a loosening and dissolving process in the body and a letting go of consciousness. The person experiences himself or herself as an entirety and can fall asleep.
Thus a particular organ or area of the body is wrapped up, but so is the entire human being, who feels enfolded in the application. When we want to emphasize the medication aspect of the application (along with its size relative to the area under treatment, or the whole body), we speak of a compress, poultice or wet pack. In the German language when we want to express the local application as a whole, or when we look at the patient who is receiving it, the term "wrap" ("Wickel") is the most appropriate and universally valid. It also covers the meaning that one person is doing the wrapping and the other gets wrapped.
Moist-hot and moist-warm compresses are the prototypes. Most of the external applications are called compresses. Depending on the organ or body part they are called liver, abdominal, chest or wrist compresses, or to indicate the agent they are called arnica, calendula or onion compresses. Sometimes the terms are combined: a yarrow liver compress.
Poultices form a special category, e.g., applications made with mustard powder, ginger powder, quark, onions, potatoes.

In Germany the term "Wickel" (wrap) is a recognized name that has found its way into legislation.

Important Aspects to Keep in Mind (see also "General Information For Administering Compresses")

1) The more comfortably and relaxed a patient can lie wrapped up with a compress, the greater will be his or her bodily and mental receptivity for the therapeutic impulses of an external application. We achieve this through well-conceived, careful preparation and implementation (warmth, position, rest, etc., see below).
During the application the patient should be able to surrender his or her body to it undisturbed, so that the organism can enter into dialog with the healing substance. This is why the caregiver takes care of the removal of the compress afterwards, not the patient, so that there is no interruption of this process before the start of the post-treatment rest.

2) Warmth is a prerequisite for circulatory and healing processes that we want to set in motion via the external application. That is why we need to be aware of any warmth deficiencies and balance them out in advance if necessary (the feet must be warm).
On the other hand, additional sources of warmth should not distract the organism from the actual effect of the application (no electric blanket, no hot water bottle on the feet during the compress application).
In Anthroposophic Medicine the range of variation of warmth for a specific length of time plays an important role in the application of compresses and poultices.
Moist warmth on and over the skin has a dissolving effect that seeps down to the diseased organ. It helps create "sensitive chaos" (2), freeing the way for formative forces to regulate the transformation of the body on all levels. Order can then be restored and even individualized. The patient's awareness is naturally diminished during these creative processes of transforming the body, and this must be permitted. We can understand the strict necessity for a sufficiently long application followed especially by a sufficiently long post-treatment rest. Without this the external application is more likely to harm the organism than to support it.

3) Use only pure natural materials, as they are able to facilitate the required balance of warmth of and moisture, in contrast to synthetic materials. The inner cloth always consists of smooth cotton, in order to achieve as much contact between the substance and the skin as possible. The intermediate cloth should be absorbent and suitable for moulding to the body. The outer cloth (wool, flannelette or terrycloth) should hold the intended warmth and soak up excess moisture. This dispenses with the need for bed protection made from rubber or plastic.

4) Duration of treatment: in general a compress should be left on for half an hour. Then all of the material is removed (including the hot water bottle), the treated area is covered, and the post-treatment rest follows for half an hour. It is imperative to adhere to this. "The period of application serves to engender creative chaos, to loosen up the ill condition. During the period of post-treatment rest the organism adopts the effect of the compress in a creative phase and develops a new order. A new interaction of the bodily processes can ensue." (1)
The secret of the effect of a compress is that something is done to a particular part of the body and the entire organism reacts. The healing substance applied to the skin flows into the deepest parts of the body and affects the entirety.

5) Concentrated mindfulness is required to prepare the patient and the application, so that the "ingredients" are really all there. Self-assured handling by the caregiver and speedy, foresightful actions awaken confidence and a sense of security in the patient.

Successful applications that improve the patient's condition enable the patient to sense that healing forces are at work and gain hope.

(1) Kusserow M. Weleda Korrespondenzblätter für Ärzte 1992;133.
(2) Schwenk, T. Sensitive chaos. The creation of flowing forms in water and air. 2nd, revised ed. London: Rudolf Steiner Press; 2014.