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PART II.

HEALING BY SPECIAL SCHOOLS AND METHODS.

HYDROPATHY, WATER-CURE OR HYDROTHERAPY.

History.—The use of water in the treatment of disease was practiced by the most skilled of all the Greek physicians, Hippocrates, 400 years before the time of Christ. Zechariah spoke of Christ as the healing fountain, and, in the thirty-sixth Psalm, David speaks of the fountain of life, showing that water was considered a healing agent even at that time. It was very extensively used by the Romans at the time of their highest development. During the middle ages it fell into disuse, along with many other rational agents. From time to time, however, men of more penetration than their fellows tried to restore it to general use, but usually only succeeded in arousing interest for a short time. Dr. James Currie, well known as the editor of an edition of Burns' poems, who practiced in Liverpool from 1780 to 1805, was the most prominent advocate of hydrotherapy during the eighteenth century. He published a book entitled "Medical Reports on the Effects of Water, Cold and Warm, in the Treatment of Fevers."

Father of Modern Hydropathy.—But it was a German farmer, named Priessnitz, who must be called the founder of modern hydropathy. In the year 1840 nearly sixteen hundred persons visited Graefenberg to be treated by him. His patients came from all parts of the world, and when cured they became missionaries of the new treatment. Schools were started not only in Europe, but in this country also. There is every reason to believe that the water-treatment has now secured a permanent place among the remedies used in combating disease. Professor Wilhelm Winternitz, of Vienna, is to-day the leading advocate of this method of treatment.

Definitions.—Hydropathy is not a good term, since it is derived from two Greek words, which mean respectively, water and to suffer. It would, therefore, mean strictly water-suffering. The term water-cure is a good one, but may not be considered entirely scientific. Hygienic medicine is another term sometimes used for this method of treatment, but it is not sufficiently distinctive. A far better name, however, is Hydrotherapy, which means healing by water. This expresses with entire correctness the end sought by those who practice this form of medication. It is not confined to the use of cold water only, as some have supposed. That idea may have arisen from the fact that Priessnitz was a special advocate of cold water.

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Hydrotherapy.—Hydrotherapy includes the application of water, internally and externally, in any form and at any temperature. It may vary from solid or fluid to vapor; from ice to steam. Mineral waters are not used in hydrotherapy. They are not needed. There is, however, no objection to such waters being used if they are available.

Physiology.—The effects of water upon the body are produced by its heat or cold and the manner in which it is applied. In order to understand this action it is necessary to consider the structure of the skin or outer covering of our bodies. It is an exceedingly complex and sensitive part of us.

The Human Skin.—The skin is very elastic, and this is due to the presence of a network of elastic fibres in its deeper parts. Many very small muscles are also present in the skin. When they all contract at once the appearance known as "goose-flesh" is produced. Great numbers of tiny glands are present, and their openings on the surface are called pores. But more important than any of these are the fine blood-vessels and nerves which are so numerous that it is impossible to pass the finest needle point into the skin without causing pain and bleeding. Through these the application of water can affect the entire system most profoundly.

FUNCTIONS OF THE SKIN.

Nerve Endings.—The fine nerve endings in the skin guard the body like an army of sentinels. They warn us of too great heat or cold, or draughts or threatened injury. Wherever these nerves are the more numerous there the sense of heat and cold is the more acute.

Skin Excretions.—The chief materials given off by the skin are watery vapor and urea, both of which are contained in the sweat; also a gas known as carbon dioxide. Urea, however, is more freely removed from the body by the kidneys. The amounts of these several constituents can be increased or decreased in a wonderful degree by applications to the skin of water at varying temperatures.

Skin a Heat Regulator.—The human body is remarkable in its power to live under conditions so exceedingly variable. It can exist amid the burning heat of the tropics, or surrounded by the icy blasts of Greenland. The skin is one of the main agents in making this possible. So remarkable are its powers that in a hot climate it helps to cool the body, while in cold climates it prevents the waste of heat.

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PROPERTIES OF WATER.

Value of Water.—The value of water as an agent in treating bodily ills rests in: First, its power of absorbing and transmitting heat and cold; one pound of water will absorb eight times as much heat as a pound of iron and yet not be any hotter than the iron; second, its flexibility; water can be used in the solid, liquid or gaseous state; its volume increases seventeen hundred times in passing from ice to steam; third, its fluid form enables us to control it so easily and well that we can apply it at pleasure to any portion, or all of the body, as we desire, and for any length of time; fourth, the ease with which pressure can be applied to any part of the body through the force of the stream used. Any or all of these properties can be used at the same time in treating diseases by hydrotherapy.

Action of Water in Health.—The most important means employed in hydrotherapy is the application of water to the skin surfaces. It acts upon the nerve endings by heat, cold and impact. The nerves transmit the effects to the brain, where it may be switched off and sent to any part of the body. Thus the amount of blood at the body surface can be increased or decreased. The speed of the blood current can be altered and the blood itself improved. More blood can be sent to the brain, thus securing greater mental activity; or less blood being sent there sleep will follow. The pulse can be increased or decreased in force. The breathing may be increased in frequency and depth. The muscular system, too, is affected by the increased activity and the kidneys do more work. The body temperature can be directly affected. It is raised by hot and lowered by cold water. Three conditions, however, will be found to modify the last statement; these are the degree of temperature used, the length of time it is allowed to act and the manner in which it is applied.

THE PRACTICE OF HYDROTHERAPY.

Ablution.—This is the simplest and most widely-used method of applying water. It is effective in many diseases and is a good introduction to the other more active measures.

Definition.—Ablution is the application, of water by the hand, without or with a bath-glove or washcloth. Sponges are not rough enough. The hare hand or a rough cloth can be made to produce just as much friction as is desired.

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Method of Applying.—Have ready several vessels of water at the temperatures desired. In acute fevers with a temperature above 101 degrees Fahrenheit, first the patient should be stripped completely and covered with a blanket, remove the pillow, roll the patient upon his left side in the portion of the bed away from the one where you desire to work; lay upon the bed a rubber sheet or oil cloth, covered by a blanket. This should be so placed that its near edge will overhang the bed, while the remainder is tucked against the patient's back. He is then rolled over again toward the nurse, while the rubber sheet and blanket are smoothed out on the opposite side of the bed. The patient can now be rolled upon his back, and you are ready to begin the bath. If the patient is a child he can be lifted from the bed, wrapped in a blanket, while the rubber sheet is being adjusted. Beginning with water at 65 degrees, first wash the face, dip the hands into the water and rapidly but gently apply it to the part, using gentle friction; next go to the chest, forearms, back, abdomen and legs as far as the knees. Repeat the process in the same order, but with water at a lower temperature, and so on until water at a temperature of 50 degrees is used. The ablution is continued until slight chilliness is produced. When the effect is sufficiently marked the patient is dried and allowed to remain perfectly quiet, with only a sheet or light blanket over him. Do not attempt to replace the nightgown until reaction is fully established. If sleep follows let the patient remain undisturbed until he awakes.

In vigorous persons with high temperature the effect may be made more pronounced by not drying the parts, but by simply spreading a sheet over the patient and allowing him to dry gradually. Care must be taken not to produce chilling.

In Chronic Affections.—Ablution is useful as a beginning treatment. It may be used in the following way. A bed is prepared as described above; the patient is then stripped and laid upon the under blanket, with the arms raised above the head. The blanket is then folded over the body and between the limbs, hugging the surfaces closely at all points. The arms are now brought down close to the sides and the other side of the blanket laid over all and tucked in around the neck and under the feet. This should be done in a warm room and the patient given sips of cold water to drink at intervals of a few moments to promote sweating. More covers may be used if needed. After a half to one hour the patient's face is bathed in water at 50 degrees Fahrenheit. The blankets are now loosened and each part—arms, chest, back, abdomen and limbs—bathed in turn in water at 80 degrees. They are then dried and replaced under the blanket. A dry rubbing with hands or a towel follows and a short period of exercise is then ordered if the patient is able. If unable to exercise he should remain in bed and take a cup of warm liquid food. Morning is the best time for this procedure, but is useful whenever it can be had.

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General Ablution.—The next step in the training is a general ablution. The patient stands in twelve inches of water at 95 degrees, and is quickly washed from head to foot by pouring water upon him and rubbing at the same time. The heat of the water will vary with the patient and his length of training, from 80 degrees to 50 degrees. The great importance of care in these measures cannot be too deeply impressed upon all who undertake them. In chronic conditions the patient must be wooed back to health slowly, realizing all the while that a very small accident may destroy the results of weeks of patient care. It is not sufficient to advise a sick man that he should bathe in cold water every day. He must know just how, when and where, and also how long the bathing should proceed, and what changes are needed and when they should be made.

When May Ablution be Used?—General ablution may be used in febrile diseases to reduce fever and at the same time prevent its rise. In mild cases of infectious fevers like measles it may be all that is necessary throughout the attack; typhoid fever, in which the temperature does not go above 102-1/2 degrees; in severer cases more extended baths are indicated. In chronic cases of anemia and chlorosis, which are due to poverty of the blood; tuberculosis of the lungs, rheumatism, gout and loss of nervous tone. In the most severe cases of the last class it is a good introduction to more severe treatment.

The Half Bath.—How applied: Into an ordinary bath-tub enough water is run to cover a patient's hips and limbs. The temperature may vary from 85 to 70 degrees. The patient enters the bath, or, if too weak, is placed in it. A wet towel is wrapped about his head and the nurse proceeds to bathe his face and then dash the water over his body with a ladle. At the same time the patient's back is rubbed by the attendant, while the patient himself rubs his own chest and abdomen. Cold water is added gradually and the process continued until the patient shivers. He is then removed before chilling ensues and dried before returning to the bed. This is a more stimulating procedure than ablution.

When Used.—in chronic diseases, after the wet pack or procedures yet to be described, the half bath naturally follows to insure the closing of the pores and general reaction. It should continue from five to ten minutes. The patient should be rapidly dried, and in fever cases this may be done in bed.

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Affusion.—Definition: Affusion is a bath by pouring.

How Applied.—The patient may sit or stand in an empty tub or lie upon a rubber-covered cot while water is poured upon his head, shoulders and body in a stream from a bucket, pitcher or basin. The temperature of the water may be varied from 65 to 50 degrees, and may be poured from different heights. The stimulation will vary with the temperature and height. The reclining and sitting postures are used for acute cases and the standing for chronic.

Indications for its Use.—When patients are unconscious or delirious and seem absolutely exhausted, ablutions will often result in very surprising improvement. In advanced fever cases, when collapse is threatened, instead of injuring the heart action, they help it materially. In the collapse of children's diseases a warm half bath, with affusions over the head and chest, will often restore completely. In diseases of the lungs, when breathing is difficult; in scarlet fever, with very high temperature, they will bring relief when all other methods fail. They are a better stimulant to the circulation than the most powerful medicines. In brain fever or meningitis, sunstroke and the brain symptoms of pneumonia they are the most useful agents known.

The Sheet Bath.—Method of applying: Protect the bed by a rubber sheet, spread a blanket upon it, have ready several linen sheets, a basin, a tub of water as cold as desired, 50 to 80 degrees, and nearby on a chair place a cup and sponge. The patient should be undressed and ready, wrapped in a blanket or woolen gown. Wash the face with cold water and wrap a cold wet towel about the head. A sheet is now quickly wrung out of the water selected and spread evenly upon the bed. On this the patient is laid, and while he holds his arms up over his head one side of the sheet is brought over and tucked in on the opposite side and between the limbs. The arms are then brought down, and the opposite edge of the sheet is carried over and tucked in around the patient's neck and feet. In feeble patients the arms may be left out and bathed separately during the process. The first effect of this procedure will be a shock to the surface nerves by contact with the cold wet sheet. For a moment the breath will come in gasps and some shivering may follow. These quickly pass away as the nurse begins to rub the body by passing the open palms swiftly over all parts of the body and limbs. As soon as reaction follows, begin to pour water at 50 or 60 degrees temperature from the cup or squeeze it from the sponge over the body, rubbing at the same time with the other hand. Keep this up until the patient is cooled as much as desired or until he Is on the verge of a, chill. The combination of friction and cold water application through an enveloping sheet is an admirable way of securing the abatement of fever. To increase or prolong the effect allow the patient to remain in the cold sheet, covered by a blanket, from a half to one hour. If he sleeps do not disturb him until he awakes. When it is desirable to end the bath, remove the sheet, dry the patient quickly, place him in a dry bed and cover lightly.

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Drip Sheet Bath.—How applied: This is applied while the patient is standing. The room should be at 70 degrees or over. Place the patient, completely stripped, in a foot-bath of water at 100 degrees Fahrenheit and six inches deep. A sheet is now removed from a bucket of water at 70 degrees and rapidly wound about the patient in the following manner. The right arm is held above the head while the edge of the sheet is placed upon the right breast. The sheet is then carried backward under the arm, which is now lowered, and serves to keep the sheet in place. The edge is now carried over the left shoulder, across the breast, over the right shoulder, and tucked in snugly about the patient's neck. As soon as it is in place the nurse proceeds to stroke the body rapidly from head to foot over the sheet and slap it more or less vigorously. Water at 60 degrees is poured upon the head at intervals of a few moments and the rubbing continued between the dashes of water. The process is kept up from five to ten minutes, according to the condition of the patient and his requirements. At first it should be very short in order not to weary him; gradually it can be lengthened as the power to react increases. After the bath dry rapidly then rub with a warm towel or sheet. This bath is applied once a day and best during the forenoon.

Uses of the Drip Sheet Bath.—Many chronic ailments are benefited by it, such as chlorosis, anemia, neurasthenia, intestinal catarrh, melancholia, neuralgias, pulmonary and bronchial diseases. Its application can be varied in a great variety of ways.

The Cold Rub.—Definition: This is a modification of the drip sheet and is generally applied immediately after the patient arises in the morning and while he is still warm.

Application.—A coarse linen sheet is wrung out of water at 60 to 75 degrees and quickly wrapped about the patient in the manner described above. Friction is now applied rapidly over the sheet, accompanied by slapping, the object being to produce a definite reddening of the skin. This is only a short process, and when finished the sheet is dropped and the patient quickly dried. After dressing and drinking a cup of hot milk or cocoa the patient should take a walk in the open air.

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Uses.—In anemias of feeble patients, tuberculosis of the lungs, any case lacking in blood.

The Wet Pack.—How applied: The method is very similar to that described in the preparation for ablution. The body is, however, first enveloped in a wet sheet in the manner described, so that it will lie in contact with every part of the body. The sheet should be wrung out of water at 70 degrees, or even as low as 60 degrees. Over this a blanket is folded so snugly that all outside air is excluded. A wet towel is folded about the head like a turban. If the patient feels cold more blankets are placed over him. He should remain in the pack from a half hour to an hour. It should be followed by some form of cold application to restore tone to the skin. A half-bath, heat bath or cold ablution will serve this purpose.

Uses.—If it is desired to abstract heat the sheet should be 60 to 70 degrees. When it has become warm replace by one a few degrees colder on a fresh bed, and so on until the desired body temperature is reached. It is estimated that five baths, each of ten minutes, will equal a full bath of fifteen minutes' duration. With temperatures varying between 100 and 103 degrees this is an excellent procedure. When used to quiet restlessness and promote sleep the higher temperature of water is used, say 70 degrees, and the patient is allowed to remain in the pack until he awakes; he is then given a rapid cold ablution. The wet pack is useful in most of the acute fevers at the outset. The addition of salt or other medicines to the water is sometimes advised.

In Chronic Diseases.—In these cases the pack should not be quite as low in temperature. The cold stage lasts longer, reaction comes on more slowly, but when it does the soothing and refreshing effect is very evident. The whole body is in a sort of water poultice. It is valuable in functional nervous diseases, hysteria and some heart troubles. In tuberculosis of the lungs, with fever, it is found very effective. In diabetes, rheumatism, gout and digestive disorders, anemia and chlorosis it has proved very effective.

The Wet Compress.—This is probably the most extensively used of all hydriatic procedures. It is in fact a local wet pack.

Method of Use.—Several folds of old linen or cotton, gauze or cheese-cloth, sufficient to cover the part to be treated, are wrung out of water at the proper temperature and placed upon the part. A dry flannel or piece of oiled silk or rubber band sufficient to cover the compress follows, and over this a retaining bandage.

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The Head Compress.—Take a linen towel wrung out of water at 60 to 75 degrees and apply it like a turban to the head. This is used to prevent congestion of the brain and during all hot baths and wet packs.

The Throat Compress.—It should be made and applied as follows: A piece of flannel, 8x24 inches, is made ready; then a compress of soft linen, four inches wide and long enough to reach from one ear under the chin to the opposite ear, is soaked in the water at 60 degrees and laid upon the throat; the flannel bandage is next placed on it and drawn up snugly over the head, to be fastened by pins. A slit for each ear to be cut in the flannel if it is uncomfortable. Two bandages are made so that one can be dried while the other is in use. In children it is wise to first put a band around from the back of the head to the forehead, to which the upper bandage can, be pinned at the intersections.

The Chest Compress.—Make two jackets out of three folds of old linen. They should be large enough to reach from the neck to the waist and entirely around the chest. At the points, by measure, where the two armpits will come cut a deep slit so that the arms may sink in far enough to allow the ends to be pinned over the shoulders from front and back. Cut two pieces of close-woven flannel of the same shape as the jackets, but about an inch larger in every direction. Roll up one of the compresses and wring it out of water at 60 degrees. Spread it upon one of the flannel covers and roll them up together half way. Now, with the patient gently turned on to one side, spread the unrolled portion on the bed behind him, so that he can be rolled back upon it in just the right place, to fit. Now unroll the remainder and bring the ends together across the chest, fastening them with safety pins. Also pin the portions at the top over the shoulders. This compress should be changed every half hour when the temperature is 102 degrees or over, hourly when the temperature is below that and down to 99-1/2, when it should be stopped. Always have the fresh compress entirely ready before loosening the first. Thus, one movement of the patient will be sufficient to remove the old and apply the new compress. Use fresh water at 60 degrees each time and always rinse the compress between using to keep it clean. Continue the changing night and day unless the patient is asleep. By being so thorough and careful the patient's chest will never be without a compress except at the brief moment when one is being rolled from and the other being unrolled upon his body. If stupor and low muttering delirium is present use water which is colder than 60 degrees, also throw a few dashes of ice water on the chest before placing the fresh compress. When insomnia is marked use water slightly warmer than 60 degrees. These methods are used in croupous and broncho-pneumonia.

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The Hot Fomentation Compress.—Two or three folds of flannel, as large as desired, are wrung out of boiling water, making it as dry as possible. The part should be anointed with vaseline and the hot flannel applied as quickly as possible, so as not to lose any of its heat. Surround the patient with a dry blanket over the compress. It may be necessary to lead up through several temperatures before the very hot compresses can be used. These compresses should be renewed every ten or fifteen minutes until the patient sweats. After the pain is relieved the body may be carefully uncovered and quickly rubbed dry or washed with water at 75 degrees, accompanied by friction. In sciatica nothing exceeds this method of treatment. In lumbago and other muscular rheumatisms a hot fomentation each night will soon result in relief.

The Heart Compress.—Wring out a piece of linen from water at 40 degrees and lay it upon the heart. On this place a rubber coil and pass ice water through it. A flannel binder will keep all in place. This is especially useful in irregular heart action, due to nervous conditions, in rapid heart action in some very weak patients. It will also be effective even when digitalis has failed. It can be used in a course of severe fevers, such as typhoid.

The Cold Full Bath.—By this is meant the placing of the entire body in water 10 to 30 degrees below the normal body temperature for from, five to twenty minutes. It is this form of bath which has revolutionized the treatment of typhoid fever. Its application varies with the ends in view. In acute cases it should be applied as follows: A movable bath-tub is provided, if possible, and rather than use the ordinary house bathroom an improvised bath apparatus is advisable.

Method of Applying a Tub Bath.—When the tub is ready the patient is stripped and a breech-cloth applied, or he may be left enveloped in a sheet. A stimulant is then given, either hot coffee or half an ounce of whiskey. Two attendants then lift him carefully from the bed and place him directly in the bath. A towel soaked in cold water is bound about his head. The head is supported by a strip across the tub or a rubber cushion. If neither of these are available one hand of the attendant must support the head while the other is employed in the rubbing process. Both attendants vigorously rub the patient from head to foot. From time to time fresh cold water is poured upon the head and face. The rubbing is an absolute necessity in this form of bath. There is always some shock when a patient is placed in cold water, but under brisk rubbing the surface is warmed and stimulated, so that there is a continuation of little shocks and reactions. As rapidly as the surface is cooled the blood is pushed forward and fresh hot blood from the deeper parts takes its place and is in its turn cooled. The process continues thus until the temperature falls sufficiently or the bath is continued long enough, or the danger of severe chill makes it wise to end the bath. The bed in the meantime has been spread with a blanket and dry linen sheets; the patient is lifted from the bath and placed upon the bed. The sheet and blanket are then folded over from one side under the raised arm and tucked between the limbs, then the other half over the arms, so enveloping the whole body. Very frequently he will fall asleep. If shivering is prolonged it is an evidence that the bath has been too cold or too long, and a change should be made at the next application. If reaction does not come on promptly hot water bottles or bricks should be placed to the feet and between the limbs. Friction must always be used in the cold bath treatment. If it is neglected the bath will really be a cause of increasing the fever by closing the pores and contracting the surface blood-vessels.

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The Warm Full Bath.—The warm bath is one in water a little below the normal body temperature. Hot baths are those with the temperature above the normal body temperature. These baths should be arranged so that the temperature may be increased after the patient is in the water, either by kettles of hotter water or by gradually increasing the water from a hot faucet. They should last from five minutes to an hour, according to the object sought and the conditions being treated. Their general effect is soothing, although the very hot baths are stimulating; for example, those of the Japanese at 130 degrees Fahrenheit. Warm baths are useful in relieving pain and nervousness, reducing temperature, the latter especially in children and infants. Care should be taken to dry thoroughly after baths and protect from draughts.

The Hammock Bath.—The hammock bath is a means of applying the effects of water through long periods of time. An extra deep tub is used, the patient is swung upon a strong sheet which is fastened to the edges of the tub or to a frame work over it, so that the water surrounds him up to his neck. Constant renewal, by the inflow of water at a given temperature.

The Douche.—This is the application to parts or the whole of the body of a stream or streams of water at varying temperatures. Moreover, the stream should be under different degrees of pressure. When the stream is made to take a form which is broad and flat it is called a fan douche. This is made by partially closing the outlet or nozzle by the thumb or finger. The shower bath is another form. In this the pressure ought to equal the fall from a cistern fifty feet above the outlet. The needle or circular bath is one in which the water is forced against the body in fine jets from all sides at once. The ascending or bidet douche is one in which a jet is directed upward from below, usually while the patient is sitting, and is used in rectal treatment to overcome piles.

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The Hip-Bath.—The hip- or sitz-bath, as its name implies, is one applied to the lower part of the body only. The bath is first prepared, then the patient stripped, a wet towel bound about the head and a warm blanket about the feet. Sometimes it is wise to add a hot water bottle with the foot blanket. When the patient is in the bath the under side of the knees should not rest upon the tub; if they do a stool should be placed under the feet. Rapid friction should be used over the parts in the water by an attendant and also the patient himself. When the bath is over dry the patient and have him return to bed for a short rest, or, if an invalid, remain there. Hot baths are 104 to 110 degrees Fahrenheit, cold baths as low as 50 degrees. All grades between these are used. The duration of hip-baths may vary very greatly. Hot hip-baths are used to overcome pain in the abdomen and pelvis, to reduce inflammation of the pelvic organs, to cure cystitis, urethritis, uterine hemorrhage, diarrhoea and dysentery, and especially vesical straining.

Uses.—Cold hip-baths of short duration are stimulating and are used to overcome muscular paralysis or loss of tone, in prolapsus of the rectum, spermatorrhea, prostatorrhea, impotence, weakness of the uterine ligaments, prolapsus of the uterus, the leucorrhea of chlorosis, stoppage of the menses, passive bleeding, constipation and flatulency.

Steam.—Vapor of water, with or without medicines, has been used for softening the mucus in case of croup, laryngitis, false-croup and diphtheria. A tent or canopy is arranged over the patient and the steam conducted under this from one or more kettles kept heated by alcohol lamps or any other available method. When nothing else can be found heat some bricks or stones and drop them into buckets of water under the tent until sufficient steam has been generated. Steam is also used to check bleeding by some surgeons; also as a cleansing agent in some operations for cancer.

The Turkish Bath.—This, as its name implies, has come down to us from the Turks, and they obtained it from the Arabians. It consists first of a sojourn for a considerable time in a hot-air chamber, with a temperature from 105 to 125 degrees. The patient remains in this room until he is in a thorough perspiration; he is then laid upon a table and an attendant rubs him thoroughly with his hands and kneads the flesh from head to foot. The attendant scrubs him with soap and water, using a brush, and finally washes him off with warm. water. After another short stay in the hot room the patient stands for a few moments under the shower bath and is then wiped dry. He then passes to what is known as the "cooling off" room, where he lies quietly upon a cot; the temperature of this room is usually 80 degrees. A quiet sleep will often follow the bath, and after it the patient should be rubbed with alcohol and take a cup of coffee or chocolate before dressing and leaving the bath.

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Russian Bath.—This bath differs from the Turkish in that the first chamber is filled with steam instead of dry air, and the final process before drying is a cold plunge into a tank or swimming pool. The latter may be replaced by pouring cold water over the bather. The last two methods are used to reduce flesh, particularly in corpulent individuals. In well-nourished, rheumatic and gouty patients, in neuralgic affections, in persons of this same class, these baths will be especially beneficial.

HYDROTHERAPY IN SPECIAL DISEASES.

Typhoid Fever.—The following methods may be used in treating this disease:

1. Ablutions and compresses until the temperature has reached 103 degrees, or when the cold baths are impossible.

2. The cold bath; a bath at 65 degrees, lasting fifteen minutes, whenever the temperature rises to 102-1/2 degrees, in the rectum.

3. If this method is not advisable the Ziemssen half-hour baths may be used, where the water is reduced gradually from 90 to 70 degrees.

4. In very weak, nervous patients, coming under treatment in the second week or later, only five- or ten-minute baths at 88 to 95 degrees, followed by short cold affusion, or a wet pack, should be risked. The temperature and duration of the bath can be altered with the improvement of the patient.

5. The hammock bath, as described above, can be substituted in treating very timid patients.

Measles.—With a temperature at 103 degrees a bath of ten minutes in water at 95 degrees is very soothing. It should be repeated every four hours and the water temperature reduced five degrees each time until the desired effect is produced. The patient generally falls into a quiet sleep after such a bath. When the full bath cannot be given ablution may be used rapidly, but without friction. Cerebral symptoms should be overcome in this way. The half-bath can be very successfully used in measles. This may be repeated oftener than the full bath. Do not wait too long before beginning the water treatment. If the patient's nervous tone is kept high by the above methods there will be less likelihood of any lung complications beginning.

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Scarlatina.—In the early stages, before the diagnosis is sure, a warm full bath at 100 degrees, for a few minutes, will quiet the patient wonderfully. If the heart action is feeble, the bath should be followed by a few dashes of cold water over the shoulders and chest, or the latter method may be used without the full bath. In urgent cases an effusion may be used every hour until reaction is sufficient and the heart is relieved by bringing the blood to the surface. When the eruption is well out and the mind clear there is not much need for treatment; but when temperature is high or mind clouded and congestion evident ablutions with water at 90 degrees, gradually reduced to 75 degrees, are very effective. The time occupied in single ablution should be short, as it is the nervous system that we wish to effect more especially. The number of ablutions will depend upon the result obtained. It may be necessary to have them repeated every hour.

Pneumonia—1. In Children.—Begin bathing when the temperature reaches 103 degrees, or earlier if nervous symptoms are marked. The bath should begin at a temperature of 95 degrees and last for ten minutes. They should be repeated every four hours, and the temperature of the water decreased two degrees each time until 80 degrees is reached. Never omit friction. Between the baths, in bad cases, use the chest compress every one or two hours. If alarming symptoms appear, or heart failure is feared, place the child up to the waist in a bath at 100 degrees and dash several basins at 75 to 65 degrees over the shoulders. Follow this with rapid friction and drying. Repeat this process as often as every two hours if necessary. Crying and coughing are caused and they are a wonderful help in relieving the congestion. In less severe cases, wet packs, ice jackets or cold sponging may be sufficient.

2. In Adults.—The greater difficulty in applying baths to adult patients and the fact that practically as good results can be secured in another way, have led to the adoption of the latter plan, which is the chest compress. The full bath can be reserved for the more urgent cases. The warm half-bath and cold affusion to the chest is also exceedingly valuable in emergencies.

The Chest Compress.—This has been described in the foregoing pages. Do not neglect the careful observance of all the details. Usually a temperature of 60 degrees is best, but in cases with stupor or muttering delirium, a lower temperature will be needed. Dashes of ice water can be used when the compress is being changed. If there is sleeplessness or excitability allow the compress to remain for two hours, or even longer, without changing; this will increase its soothing effects.

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Acute Cholera Infantum.—The element of shock in this disease is so decided that the attacks resemble sunstroke. The internal temperature is often very high indeed. Reaction must be secured quickly or it will be too late. It is sometimes necessary to proceed with these measures before attending to any of those which logically precede, as indicated above. Prepare a bath at 90 degrees, wrap a cold cloth about the child's head and have it supported by an assistant. Lower the child's body into the bath, holding it by the hands and feet. Begin gentle friction over the different parts of the body, arms and legs to the elbows and knees. Have another assistant remove water from the bath and replace it with ice water until the temperature falls to 80 degrees. Continue the bath ten minutes, or if shivering occurs before that time remove the child. If the temperature has been very high follow the bath by a wet pack and a blanket over that. Put hot bottles to the feet and keep the head cool. If the symptoms are not so urgent a wet pack alone may secure the desired reaction.

Sunstroke.—Put the patient upon a rubber-covered cot, cover him with a sheet, dash upon him, at intervals, dipperfuls of cold water in the meantime keeping up constant friction over all parts of the body and limbs. Keep an ice-bag or cold cloth upon the head, and occasionally pour ice water upon the forehead from a height of six feet. The friction must not be neglected under any circumstances. When the rectal temperature has fallen to 104 or 103 degrees wrap the patient in dry blankets, with hot bottles to the feet and limbs. Usually the patient will fall asleep and break out in a gentle sweat. If reaction does not occur and the temperature again rises repeat the above treatment. Continue thus until the temperature remains down. As soon as the patient can swallow give small drinks of ice water at frequent intervals.

Anemia or lack of Blood.—Here we must distinctly understand that we are not to abstract heat from the body. On arising in the morning the bath should be taken as follows: In a room the temperature of which should not be lower than 68 degrees. Let the patient stand in water at 100 degrees and pour over him water at 80 degrees and at the same time have him rubbed thoroughly and let him rub himself. Reduce the temperature of the water 2 degrees each day. Dry rapidly after the bath, dress and let the patient take a short walk in the open air. In weak patients the dry pack may precede the ablution.

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Consumption.—To give a consumptive patient full benefit of the water treatment it should be begun and carried out systematically. If the body is already well cared for the treatment can begin at once, if not, a good warm water and soap bath must be given on the first day, and then the following day proceed thus: Strip the patient entirely naked, wrap him in a blanket, cover him with other blankets and give small drinks of water at short intervals, say every ten minutes. During this dry pack the windows may be wide open even in winter. After an hour has passed wash the face with quite cold water and dry. Have a basin ready with water at 75 degrees, remove one arm from the covers and wash it briskly with the wet hand or with the hand covered by a bath glove. Rub well and then dry and replace. Do the same with the other arm, then the different parts of the body successively. At the end rub the entire body with a rough towel. Repeat this treatment daily until, by reducing the temperature 2 degrees daily, the water is used at 60 degrees.

Neuralgia.—In this trouble great relief has resulted from the various water methods of treatment. Especially good results have followed when rapid contracts of temperature have been used like that obtained in the Scotch douche. In sciatica this treatment has been wonderfully successful.

Chronic Rheumatism and Gout.—These cases may be divided for treatment into two classes:

1. The Well-Nourished Subjects.—These should be given full baths for from eight to fifteen minutes, in water at 95 degrees, gradually raised to as high a temperature as can be borne; gentle massage to be given during the bath. Allow the patient to drink large quantities of water both during and between the baths. The bath should be followed by sweating between blankets. These baths should be given daily, or less often according to the patient's condition and progress. Between the baths cold wet compresses at 65 degrees can be bound upon the affected parts and allowed to remain until almost dry. Such compreesses may be used during the night. A sweat in the cabinet for five to fifteen minutes followed by the douche at 100 degrees, reduced to 90 degrees during the progress of the bath, will be found very useful after the above courses.

2. The Poorly Nourished.—Hot baths must be used very cautiously and infrequently in this class of treatment. Once or twice a week will be found sufficient. Ablutions gradually decreased in temperature are most effective. Scotch douches to the joints, followed by cold compresses, should also be used. As the patient becomes more used to lower temperatures the baths may be made more stimulating. More food will be taken, digestion improved and the patient gradually increase in weight and strength.

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Dyspepsia.—Catarrhal and nervous types of this disease are recognized. The treatment is similar to that for anemia. As a local stimulant the Scotch douche over the region of the stomach is very effective. The hygienic rules must be carefully remembered during the treatment of this condition. The daily cold plunge bath, or its equivalent, will be a great help.

THE INTERNAL USE OF WATER.

Effects.—Drinking cold water slows the pulse and makes it stronger and fuller. Hot water weakens and makes it rapid. Cold water is the best diuretic, warm water the best diaphoretic or sweating agent.

Acute Infectious Diseases.—The methods of using cold water externally in the treatment of acute diseases has been detailed in the previous pages, but the good effects of that treatment will often be lost unless enough cold water is given internally. At least a glassful of cold water should be drunk every two hours by a patient suffering with fever. The drinking of so much water insures a good flow of urine and increases the perspiration.

Gastric Catarrh.—A pint to a pint and a half of water, taken a half-hour to an hour before meals so hot that it cannot be drunk but only sipped, will cleanse the stomach and prove an excellent stimulant to the muscular walls of that organ. This method of treatment has been very widely employed but has often failed because the water was not drunk at a sufficiently high temperature. The administration of water to babies has already been mentioned.

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Last Modified: Monday, 13-May-2013 15:31:47 EDT