APPLICATIONS OF WATER.

The indications which are to be met in the treatment of disease are chiefly those enumerated below; and how admirably they are met by applications of water may be easily demonstrated by following the directions given.

1. Equalization of Circulation.—Disease cannot exist without some disturbance of the circulation. In perfect health each part receives its due share of blood. One of the first indications in disease, then, is to balance the circulation. If an organ contains too much blood, the application of cold water to the part will occasion contraction of the minute vessels of the part, and thus the amount of blood is lessened, as explained more at length in considering the physiological effects of water.

Or, the part may be relieved by the application of warm water in some form to adjacent or remote parts of the body, by which means the surplus blood will be drawn to other parts, thus relieving the suffering organ. Again, if an organ contains too little blood, the opposite course must be pursued. Warm or hot applications are made to the part, while cold applications may be made to other parts if necessary. Very often the 80two remedies may be advantageously combined, since one part cannot contain too much blood without some other part or parts being deprived of the due proportion, and vice versa; so that while a cold application is needed at one part, the opposite is required at another.

2. Regulation of Temperature.—As the condition of the bodily temperature is closely associated with that of the circulation, the two are usually controlled by the same remedies applied in the same manner. A part which contains too much blood has usually, also, too high a degree of heat. The cold application relieves both. If the entire surface of the body is involved, the application must be as extensive as necessary to affect the whole. In general fevers, the admirable adaptation of water to this end is well exhibited. When the temperature of the body rises above 100°, or even above 98°, a cooling bath should be resorted to. It may consist of a simple sponging with water, scarcely below the bodily temperature, an affusion with tepid water, a full bath of a tepid, temperate, or cold temperature, or some other form of cooling application according to the degree of cooling effect desired. Any temperature below 98° will be cooling. In general, it is better to employ a bath only a few degrees below the bodily temperature, as its application will not be followed by an increase of heat, called reaction, which follows a brief application of 81a cool bath. To obtain the proper cooling effects of a cool or cold bath, it must be continued for some time, from ten minutes to half an hour, at least. The same remark applies also to the application of cool baths for the purpose of equalizing the circulation.

3. Removal of Pain.—Pain is usually dependent upon disturbance of the circulation, being caused by the pressure of overfilled vessels upon the nerves in a confined space. Pain may be relieved by either hot or cold applications. The first object should be to remove the surplus blood, by local cold applications, and remote hot ones. If this plan is not successful, relief will be obtained by a hot local application, which operates by relaxing the surrounding tissues, so that the nerve fibers are relieved from pressure, as well as by quickening the local circulation, and so relieving congestion. The latter method is usually most quickly successful; but it is not so radically curative as the former. Pain dependent on passive congestion will be best relieved by the method next described.

4. To Excite Activity.—Many organs often become torpid or inactive, as the skin and liver, especially. Sometimes the blood-vessels of an organ become relaxed and inactive, passive congestion resulting. No remedy will so readily induce a return of activity to the affected parts 82as alternate hot and cold applications, continued for some minutes, fifteen to thirty or more. This is one of the best applications for the relief of old pains.

5. Removal of Obstructions.—A very large class of diseases are attributable to obstruction in various organs, caused by the reception of foreign matters into the system, and the accumulation of the natural waste of the tissues. The warm bath, to remove, external obstructions, and the internal use of water as a solvent for internal sources of obstruction, are the remedies which will achieve success in nearly all cases. Offending substances in the stomach are readily removed by the water emetic; and hardened accumulations in the large intestine are removed with equal facility by means of the enema.

6. Dilution of the Blood.—In fevers, cholera, and other diseases, the blood often becomes abnormally thickened, dark, and viscid, circulating with difficulty, and not imparting due nourishment to the tissues. Nothing but water can remedy this difficulty. It may be got into the blood by absorption from the skin, if the mucous membrane of the stomach will not absorb it.

7. Influence on the Nervous System.—Finally, it is often important to affect certain organs through their nervous centers. Water, properly applied, will accomplish this also. A fomentation 83applied to the abdomen will often remove headache, and is an excellent remedy for general nervousness, seeming to affect the whole system, just as does galvanic electricity when applied to the same locality, doubtless through the large nervous ganglia located in that region.

Some physicians claim to have obtained peculiar results by the application of heat or cold to the spine. It is said, for example, that cold applied to any portion of the spine will produce an increased circulation in the portion of the body supplied with organic nerves from the part. Hot applications to the spine are said to produce a contrary effect upon corresponding organs. Perhaps there should be still further observations upon this subject before any attempt is made to establish a definite law. It is well known that applications of ice to the spine is an excellent remedy for chorea, and several other nervous diseases.

For general nervous irritability, or nervousness, the warm full bath may be applied with uniform success. Neither hot nor cold applications are generally useful in such cases.

Temperature of Baths.—The thermometer is the only accurate measure of temperature; hence the importance of its use in the administration of baths. Yet the thermometer may be abused. A given temperature may seem warm to one individual and tepid or cool to another. The same difference of sensation will occur in the same individual 84on different occasions. What seems cool to-day will be thought warm to-morrow. The susceptibility of the body to sensations of heat and cold largely depends upon its condition and the temperature of surrounding objects. In consequence of this physiological fact, it is improper to attempt, as some have done, to fix certain exact temperatures at which baths must be given to all persons under all conditions.

For convenience and perspicuity, the temperatures of baths have been divided into six grades, as given in the following table by Forbes; all who attempt to use the bath according to the directions should carefully learn and preserve the distinctions here made:—

1. Cold Bath, 33° to 60° F.

2. Cool, 60° „ 75°

3. Temperate, 75° „ 85°

4. Tepid, 85° „ 92°

5. Warm, 92° „ 98°

6. Hot, 98° „ 112°

The vapor bath ranges from 98° to 120°; the hot-air or Turkish bath from 100° to 160°, or even higher, though not usefully so.

A bath of any temperature above the natural heat of the body, 98°, is a hot bath. At 32°, water becomes ice; a bath is very rarely given at this temperature, and then the application should be made to only a small surface. Water at 32°, and even ice and snow, may be usefully employed 85as topical remedies in local diseases. It will rarely be necessary to employ a full bath at a lower temperature than 65°, which will usually seem very cold to the patient. A temperature from 85° to 95° is the most generally useful for baths which involve a considerable portion of the body, though of course higher temperatures are employed in local applications.

How to Determine the Temperature of a Bath without a Thermometer.—It is often necessary to administer a bath when a thermometer cannot be obtained. In such cases it is customary to test the temperature by placing the hand in the water. This is an unreliable method, however; for the hand becomes, by usage, so obtuse to heat that water which would seem only warm to it would be painfully hot to the body of the patient. To avoid this source of error, it is only necessary to plunge the arm to the elbow into the water, by which means its real temperature will be determined. Water which causes redness of the skin is hot; when it feels simply comfortable, with no special sensation of either heat or cold, it is warm. Slightly cooler than this, it is tepid. When it causes the appearance of goose-flesh, it may be for practical purposes called cool, a still lower degree being cold.

Another Method.—The method about to be described is somewhat more accurate than the preceding, and may be found convenient for facilitating 86the preparation of a bath of proper quantity as well as temperature, a matter which though simple enough is often quite annoying to inexperienced persons. It is a fact of common knowledge that water boils at 212° F. Boiling water, then, is always of this temperature. Well and spring water, and the water of cisterns in winter, does not vary greatly from 53°. The temperature of well and spring water changes very slightly with the seasons. By combining in proper quantities water of these known temperatures, any required temperature may be produced. Not having seen this method suggested before, we have prepared the following table, which may perhaps be used to advantage in the absence of a thermometer; we advise all to obtain and use a thermometer, however, when it is possible to do so:—

Tem. 53°. Tem. 212°.

2 qts. added to 1 qt. equals 3 qts. at 106°

2½ „ „ 1 „ „ 3½ „ 98°

3 „ „ 1 „ „ 4 „ 93°

4 „ „ 1 „ „ 5 „ 85°

5 „ „ 1 „ „ 6 „ 80°

6 „ „ 1 „ „ 7 „ 76°

8 „ „ 1 „ „ 9 „ 71°

When larger quantities are needed, it is only necessary to multiply each of the combining quantities by the same number. For instance, if a gallon and a half of water is needed for a foot bath at 106°, pour into a pail or bath-tub four quarts of fresh well water and then add two quarts of 87boiling water. If four gallons of water are wanted for a sitz bath at 93° (a very common temperature), pour into the bath-tub three gallons of fresh well or spring water, and add one gallon of boiling water. Thus any required quantity can be obtained at the temperatures given. The cold water should be placed in the vessel first, and there should be no delay in adding the hot water, as it would rapidly lose its heat, and thus make a larger quantity necessary. Determinate measurement is not essential. The cold and hot water may be added alternately in proper proportions, being measured by the same vessel until the requisite quantity is prepared.

RULES FOR BATHING.

The following general rules should be carefully studied and thoroughly understood by any one who expects to employ the bath. Much injury to health and most of the discredit cast upon the use of water as a remedy have arisen from a disregard of some of them:—

1. A full bath should never be taken within two or three hours after a meal.

2. Such local baths as fomentations, compresses, foot baths, and even sitz baths, may be taken an hour or two after a meal; indeed, compresses and fomentations may be applied almost immediately after a light meal, without injury.

3. Employ the thermometer to determine the 88temperature of every bath when possible to do so; if not, employ the other methods described.

4. The temperature of the room during a bath should be 70° to 85°. Invalids require a warmer room than persons in health. Thorough ventilation is an important matter; but draughts must be carefully prevented, by screens of netting placed before openings into the room when necessary.

5. Never apply either very cold or excessively hot treatment to aged or feeble patients. Cold is especially dangerous.

6. Hot baths are rarely useful in health. The warm bath answers all the requirements of cleanliness.

7. Never take a cold bath when exhausted or chilly. A German emperor lost his life by taking a cool bath after a fatiguing march. Alexander came near losing his life in the same manner. Many have been rendered cripples for life by so doing. No harm will result from a cool bath if the body is simply warm, even though it may be in a state of perspiration. Contrary to the common opinion, a considerable degree of heat is the best possible preparation for a cold bath. The Finlanders rush out of their hot ovens—sweat-houses—and roll in the snow, without injury.

8. Cold baths should not be administered during the period of menstruation in females. At 89such times, little bathing of any kind is advisable with the exception of a warm or tepid sponge bath, or such treatment as may be advised by a physician.

9. Bath attendants should carefully avoid giving “shocks” to nervous people or to those inclined to apoplexy or affected with heart disease. Shocks are unpleasant and unnecessary for any one.

10. Never apply to the head such treatment as will cause shock, as the sudden cold douche, shower, or spray bath.

11. A light hand bath every morning will be none too frequent to preserve scrupulous bodily cleanliness. More than a week should never be allowed to elapse without a bath with warm water and soap.

12. The best time for treatment—especially cool treatment—is about three hours after breakfast.

13. Always employ for bathing purposes the purest water attainable. Soft water is greatly preferable to hard on many accounts.

14. Those not strong and vigorous should avoid drinking freely of cold water just previous to a bath.

15. The head should always be wet before any bath; and the feet should be warmed—if not already warm—by a hot foot bath, if necessary.

16. In applying a bath to sick persons, it 90should always be made of a temperature agreeable to the feelings.

17. One very important element in the success of a bath is the dexterity of the attendant. The patient should be inspired with confidence both in the bath and in the skill of the attendant. The mind has much to do with the effect of a bath.

18. In general baths, the patient, unless feeble, will derive benefit by assisting himself as much as possible.

19. Patients should receive due attention during a bath, so that they may not feel that they are forgotten. Nervous patients often become very apprehensive on this account. It is also important, in most cases, that a reasonable degree of quietude should be maintained.

20. When any unusual or unexpected symptoms appear during a bath, the patient should be removed at once.

21. In case symptoms of faintness appear, as is sometimes the case in feeble patients, during a hot bath, apply cold water to the head and face, give cool water to drink, lower the temperature of the bath by adding cool water, and place the patient as nearly as possible in a horizontal position.

22. The temperature of a warm or hot bath should always be decreased just before its termination as a precaution against taking cold.

23. In health, a cool or cold bath should be 91very brief, lasting not more than one or two minutes. A tepid bath should last not more than ten or fifteen minutes. A warm bath may be continued thirty or forty minutes, or even longer, but nothing could be more absurd than the custom prevailing in some places of prolonging the bath to great length. At Pfeffers and Leuck, in Switzerland, many persons spend the whole day in the water, taking their meals on floating tables, and occupying their time in reading, playing chess, and other games. Some remain in the water as many as sixteen hours out of the twenty-four. Of course, certain baths may be advantageously prolonged in cases of disease; but no intelligent physician will now recommend the antiquated practice which we sometimes see represented by a patient seated in a tub, with an open book in hand.

24. It is of extreme importance that the patient should be carefully dried after any bath. A large sheet is much better for this purpose than a towel. An old linen or cotton sheet is preferable to a new one, being softer. Full directions are given under the heading, “Dry Rubbing-Sheet.”

25. A patient should never be left chilly after a bath. Rub until warm.

26. It is equally important that the body should not be left in a state of perspiration, for it will soon become chilly.

9227. Patients who are able to do so should exercise a little both before and immediately after a bath to insure thorough reaction.

28. An hour’s rest soon after a bath will add to its beneficial effects. It is best to go to bed and cover warm.

29. If a bath is followed by headache and fever, there has been something wrong, either in the kind of bath administered, or in the manner of giving it.

30. Very cold and very hot baths are seldom required. The barbarous practices of half a century ago are now obsolete, or should be, if they are not quite discontinued as yet. No good resulted from them which cannot be attained by milder means, and much harm was occasioned which is avoided by the use of less extreme temperatures.

31. Patients should not be allowed to become dependent on any special form of bath, as an after-dinner fomentation to aid digestion, the abdominal bandage, or any other appliance. Destroy such a habit if it has been formed.

32. Order, cleanliness, dispatch, and a delicate sense of propriety are items which every bath attendant should keep constantly in mind, and which will often contribute in no small degree to success in the use of this agent.

33. Never employ a bath without a definite and legitimate purpose in view. It is somewhat 93customary, in many institutions where water is employed, to apply it in a routine way. Many baths are prescribed for the sake of producing variety, or pleasing the patient. A faithful and scientific physician will carefully adapt his remedies to the condition of his patient, and will observe the results. It seems to be a prevalent error that it makes little difference how water is applied, provided the patient is only wet. Warm, hot, tepid, temperate, cool, and cold baths are used indiscriminately.

So, also, the different modes of administering baths of the same temperature are disregarded in many cases. In general, each particular form of bath is especially adapted to the treatment of special conditions, and it is the best test of the proficiency of a physician, in the use of water, to observe whether he recognizes the distinctions between the various kinds of baths, and is able to adapt them to the appropriate conditions.

34. Giving too much treatment is likely to be the error into which the inexperienced will fall, rather than the opposite extreme. Nature cannot be forced to do more than she is capable of doing; and as nature must do the healing, if a cure is accomplished, remedies should be of a helping rather than a crowding or forcing nature. The vitality of patients may be expended uselessly by treatment, for baths excite vital resistance, as well as drugs, a fact which many overlook. 94The dangers of over-treatment are not so great as some imagine, however, who take the opposite extreme, and advocate rest as the great cure-all. We have seen patients who seemed to be quite monomaniacs on the subject of “rest cure,” who needed a good thorough stirring up with useful exercise more than any other kind of treatment.

GENERAL BATHS.

Baths applied to the whole surface of the body are, as we have already seen, among the most powerful means of affecting the human system either in health or disease. Baths of a temperature less than that of the body, 98°, unless of very brief application, uniformly decrease the bodily temperature. That the diminution of temperature is not merely local, being confined to the skin and superficial structures, is shown by the fact that the thermometer indicates a decline of temperature in the interior of the body as well. The bath diminishes the production of heat throughout the whole system, besides abstracting large quantities by its contact with the body, as previously explained. The diminution of temperature continues for hours after the bath, especially in cases in which it was excessively high at the time of administration. Hot baths have, in general, an opposite effect.

95

SWIMMING.

Swimming is a general bath combined with vigorous exercise, as nearly all baths should be. It is one of the most healthful kinds of exercise, if not continued too long, as it frequently is. The temperature of the water is commonly between 70° and 80° F., which make it a temperate bath. Its effects are not far different from other forms of bath of the same temperature. We have not space to devote to a description of the art, since there are valuable treatises on the subject.

PLUNGE BATH.

The hot baths of the ancient Greeks and Romans were usually followed by a plunge up to the neck in a large basin of water four or five feet deep, and large enough to allow the exercise of swimming. Many hydropathic establishments employ the same bath after packs and sweating baths. A bath of this kind is not always attainable without great expense; and it possesses no particular advantage over other methods of cooling the surface after a warm bath. It is a very severe form of bath when employed at a low temperature. In the days of Priessnitz, it was used at a temperature of 45° or 50°. More harm than good would result from a continuous employment of such treatment. The cool plunge should be of but a very few minutes’ duration, and the patient should rub himself vigorously during 96the bath. In this, as in all other cool baths, the first contact with the water produces chilliness or shock. After two or three minutes, or less, this will be followed by a partial reaction, even while the patient is in the water, accompanied by a feeling of comfortable warmth. This will shortly be again succeeded by a second chill, which is not so likely to be followed by prompt reaction; hence, the patient should always take care to leave the bath before the occurrence of the second chill, if he would avoid unpleasant after-effects.

SPONGE BATH.

The sponge or hand bath is perhaps the simplest and most useful mode of applying water to the surface of the body; for it requires the use of no appliances which every one does not possess, and it can be employed by any one without elaborate preparation, and under almost any circumstances. A great quantity of water is not required; a few quarts are a plenty, and a pint will answer admirably in an emergency. A soft sponge, or a linen or cotton cloth, and one or two soft towels, or a sheet, are the other requisites. The hand may be used in the absence of a cloth or a sponge for applying the water.

The temperature of the bath should not be above 95°, and 90° is generally better. Most people can habitually employ a temperature of 9775° or 80° without injury. The use of a much lower temperature is not commonly advisable, and is often productive of great injury.

Begin the bath, as usual, by wetting the head, saturating the hair well. Wash the face, then the neck, chest, shoulders, arms, trunk, and back. Rub vigorously until the skin is red, to prevent chilling; for even when the temperature of the room is nearly equal to that of the body, the rapid evaporation of water from the surface will lower the external temperature very rapidly unless a vigorous circulation is maintained.

After thoroughly bathing the upper portion of the body, turn the attention to the lower portion, continuing the rubbing of the upper parts at brief intervals to prevent chilliness. As soon as the bathing is concluded, envelop the body in a sheet and rub dry, or dry the skin with a towel. When the surface is nearly or quite dried, rub the whole vigorously with the bare hand.

The bath should not be prolonged more than ten or fifteen minutes. Five minutes is sufficient to secure all the benefits of the bath, and even three minutes will suffice for a very good bath.

Persons who chill easily will find it better to bathe only a portion of the body before drying it. Some will even find it necessary to retain a portion of the clothing upon the lower part of the body while bathing and drying the upper part.

98Weakly patients may receive this bath with very little disturbance, even in bed. Only a small portion of the body should be uncovered at a time, being bathed, dried, rubbed, and then covered while another part is treated in a similar manner.

The sponge bath may be administered anywhere without danger of soiling the finest carpet, by using care to make the sponge or cloth nearly dry before applying it to the body. A rug may be spread upon the floor as an extra precaution. When used for cleanliness—as it should be daily—a little fine soap should be added two or three times a week, to remove the oleaginous secretion from the skin.

This bath is applicable whenever there is an abnormal degree of bodily heat, and in such cases may be applied every half-hour without injury. It is useful in cases of nervousness and sleeplessness, and, in fact, whenever water is required in any form, it may be used with advantage.

RUBBING WET-SHEET.

This bath is administered in two ways; with the sheet very wet, or dripping, and with it wrung nearly dry. The first method is frequently called the dripping-sheet bath. In giving it, proceed as follows:—

When necessary to prevent injury to the floor or carpet, place upon the floor a large rug or oilcloth. 99In the center, place a large wash-tub, in the absence of a more convenient vessel. While the patient is making himself ready for the bath, procure two large cotton sheets. Gather one end of each into folds so that it can be easily and quickly spread out; lay one upon a chair close at hand, and place the other in the tub. At a distance of three or four feet from the tub, place a low stool. Now place in the tub—if a bath at about 93° is desired, and this will be the most usual temperature—half a pailful of fresh well or spring water, and one-third as much boiling water. If a thermometer is at hand it should, of course, be used to test the temperature. After the patient has wet his head, let him step into the tub, facing the assistant, with his arms straight and pressed closely to his sides. Now draw up the wet sheet by its gathered end to its full length; draw out one side quickly, place the corner over one shoulder of the patient, and while holding it in place with one hand, quickly draw the remainder of the sheet around him with the other, bringing it up well around the neck, and folding the second corner under the top so as to hold it in place. But a few seconds should be occupied in applying the sheet. Then commence rubbing the patient vigorously with both hands, one upon each side, rubbing to and fro three or four times in each place, passing over the whole body very rapidly, and then repeating the same, 100to prevent chilling of any part. Coarse, robust, and phlegmatic people may be rubbed with a good deal of severity; but persons with delicate skin and acute sensibilities require gentler manipulation.

After three or four minutes of energetic rubbing, pour over the chest and shoulders a pailful of water four or five degrees cooler than that of the bath, which should be in readiness for instant use. Then rub two or three minutes longer. Now quickly disengage the wet sheet, allowing it to drop into the tub. While the patient is stepping upon the stool, quickly grasp the dry sheet, and by the time he is in place, have him enveloped in it. Rub him dry, passing over the whole body several times in rapid succession, to prevent chilling. Care must be taken that every part is thoroughly dried. The head, armpits, groins, and feet are liable to escape attention. No moisture should be left between the toes. After wiping nearly or quite dry, apply the hand-rubbing, as elsewhere described, using care not to induce perspiration by too vigorous or long-continued rubbing. If the skin should become moist from perspiration after having been once dried, gradually lower the temperature of the room and continue light rubbing until the skin becomes dry and cool before allowing the patient to dress.

Very few baths afford a better opportunity for the display of skill and energy on the part of 101the attendant than this. Some practice is required to enable one to give it really well.

The other form of rubbing wet-sheet is given in about the same manner, the only difference being that the sheet is wrung before its application, and is re-applied one or more times, according as a milder or more severe form of treatment is required. The douche may be reserved until the sheet is removed the last time.

One precaution especially necessary to be observed in this bath, as well as in all others where a tepid application is succeeded by a cooler one, is frequently overlooked. The second cooler application should never be made until there is good reaction from the first.

This is an excellent bath to apply after packs or warm baths which have induced perspiration, as hot-air and vapor baths. It is especially applicable to cases in which there is defective circulation in the extremities, torpid skin and liver, and nervousness. It is of special benefit in cases of debility accompanied by night sweats.

WET-SHEET PACK.

When properly administered, this is one of the most powerful of all water appliances. Some skill is needed to apply it with a uniform degree of success. Two or three comfortables or thick blankets, one woolen blanket, and a large linen or cotton sheet are the articles necessary. It is 102important to be certain that the sheet is sufficiently large to extend twice around the patient’s body. More blankets are required in cool weather and by weak patients. Spread upon a bed or straight lounge the comfortables, one by one, making them even at the top. Over them, spread the woolen blanket, allowing its upper edge to fall an inch or two below that of the last comfortable. Wet the sheet in water of the proper temperature, having gathered the ends so that it can be quickly spread out. Wring so that it will not drip much, place its upper end even with the woolen blanket, and spread it out on each side of the middle sufficiently to allow the patient to lie down upon his back, which he should quickly do, letting his ears come just above the upper border of the sheet, and extending his limbs near together. The patient should then raise his arms, while the attendant draws over one side of the wet sheet, taking care to bring it in contact with as much of the body as possible, bringing it closely up beneath the arms, and pressing it down between the limbs so as to make it come in contact with both sides of them. Tuck the edge tightly under the patient on the opposite side, using care not to include the other edge of the sheet. Now let the patient clasp his hands across his chest, and then bring up the other side of the sheet. Grasp it by its upper corner with one hand, drawing it down over the shoulder and 103lengthwise of the body; then place the other hand upon the covered shoulder, holding the sheet firmly in place while the corner is carried upward upon the opposite side and tucked under the shoulder, thus drawing the upper edge of the sheet well up under the chin. Tuck the edge of the sheet under the body, carefully enveloping the feet. Then bring over each side of the blanket and comfortables in the manner last described, being very careful to exclude all air at the neck, and allowing the blankets to extend below the feet so that they can be folded under.

It is not desirable that the patient should be bound as tightly as a mummy. All that is necessary is the exclusion of air, and as the neck and feet are the points at which it is most likely to enter, these parts should receive particular attention, as directed. If too tightly bound, the patient will be more likely to be nervous than if allowed some freedom. The application of the wet sheet should be made in a few seconds, as it cools very rapidly when spread out. The first blanket should be brought over the patient as soon as possible. If the feet are not warm, a hot foot bath should be taken before the pack. If they become cool in the pack, hot jugs, bricks, or stones should be applied to them. If the patient does not become comfortably warm in a few minutes—ten or fifteen at most—more blankets should be added, and, if necessary, dry heat should 104be applied to the sides. If he still remains chilly, he should be promptly removed and placed in a warm bath, or vigorously rubbed with a dry sheet and then placed in a dry pack. The head should be kept cool by frequent wetting while the patient is in the bath. If a compress is applied, it should be often renewed.

The temperature of the pack must depend upon the condition of the patient, being determined by principles elsewhere explained. A woolen sheet is better for the administration of a hot pack than one of cotton or linen. The cold pack is very rarely required. The usual temperature for this bath should be about 92°. It is proper to wet the sheet in water of about 100°, as it will be cooled several degrees while being applied.

The duration of the pack should be carefully regulated by the condition of the patient, the effects desired, and the immediate effects produced. If the patient becomes very nervous, or sweats excessively, or becomes faint, or has other seriously unpleasant or dangerous symptoms, he should be removed from the pack at once if he has not been more than ten minutes in it. Ordinarily, the pack may continue thirty to forty-five minutes. If the patient sleeps naturally, he may remain in the pack a full hour if strong, or even longer in many cases. In fevers, short packs, frequently repeated, are more beneficial than long ones fewer in number.

105The pack should be followed by the spray, the sponge bath, the douche, or the rubbing wet-sheet. It is a powerful remedy, and should not be used to excess in chronic diseases; it has been much abused in this way. Its depurating effects are really wonderful. The increased action of the skin, together with determination of blood to that part, is so great that poisons long hidden in the system are brought out and eliminated. The odor of a sheet recently used in packing a gross person is often intolerable. If the patient be a tobacco user, the sheet will be reeking with the odor of nicotine. Many times, the sheet will be actually discolored with the impurities withdrawn from the body.

The applications of the pack in treating disease are very numerous. In almost all acute diseases accompanied by general febrile disturbance, and in nearly all chronic diseases, it is a most helpful remedy if rightly managed. It is an admirable remedy for nervousness, skin diseases, and irritations of the mucous membrane. The warm pack is a remedy worth more in the treatment of children’s diseases than all the drugs in the materia medica, as many physicians have proved. It is a most successful application in convulsions.

SHOWER PACK.

In many cases of fever in which the temperature rises so high as to produce delirium, the ordinary 106pack does not seem to be sufficiently powerful to fully control the excessive heat. In such cases, the shower pack is found of great service; it is thus used in Bellevue Hospital, New York:—

A rubber blanket is placed upon an ordinary mattress. Upon this, the patient is placed, enveloped in a wet sheet, as in the ordinary pack. Instead of being covered with blankets, however, he is left exposed to the air, so that the powerful cooling effects of evaporation may be obtained. As the sheet becomes warmed by the heat of the body, cool water is showered upon it from a sprinkler or watering-pot. The bath is continued thus until the temperature of the patient, as indicated by the thermometer, is sufficiently diminished.

This bath, combining as it does the cooling effects of cool water and of evaporation, is the most powerful refrigerant that can be employed; yet it is perfectly safe when judiciously used, being only applied in cases of extreme urgency on account of the high temperature.

Some practice opening the ordinary pack at intervals, and sprinkling cool water upon the patient, thus obtaining, in some degree, the prolonged cooling effect. The pack must be studied well to enable one to apply it with skill, and certainty of success.

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DRY SHEET PACK.

Though this can hardly be called a bath at its commencement, it really becomes a wet-sheet pack before its termination. Its application differs from that of the wet-sheet pack in that the patient is wrapped in woolen blankets instead of the wet sheet. The object of this treatment is to produce perspiration, which may be encouraged by drinking either cold or hot drinks in considerable quantity, and by the application of dry artificial heat to the feet and sides. It is a very severe form of treatment, and is now seldom practiced. Many years ago, patients at hydropathic establishments were often kept for several hours in the dry pack, smothered beneath loads of comfortables, blankets, and feather-beds. If cautiously employed, it is occasionally useful in “breaking the chills,” in fever and ague. It should be administered about half an hour before the time for the beginning of the chill, if required for this purpose.

The several varieties of local packs are described under the head of Local Baths.

FULL BATH.

For this bath a tub is required the length of the body, about eighteen inches deep, two feet wide at the top, and, preferably, six inches narrower at the bottom. It is better to have the end intended for the head a little elevated. 108Place in the tub sufficient water so that the patient will be entirely covered, with the exception of the head, when he lies upon his back. During the bath, the body should be vigorously rubbed by the bather or an attendant, or both, particular pains being taken to knead and manipulate the abdomen, in a gentle, but thorough manner. The temperature of the bath, when taken for cleanliness, or for its soothing effects, should be not more than 95°, and it should be cooled down to about 85° before the conclusion of the bath, by the addition of cool water.

Every family ought to possess conveniences for this bath. Indeed, it is now found in every well-regulated modern house in our large cities. It is not so expensive but that any one can possess it. Portable baths of rubber can be obtained which are worth many times their cost. A cheap bath can be constructed of duck well oiled or covered with paint and suspended from a frame; but it will be quite unsatisfactory, not being perfectly water-tight, as such a bath should be for family use. A stationary bath may be made of wood, of the dimensions given, and lined with lead or zinc. There should be an opening in the lower end for withdrawing the water.

The full bath is one of the most refreshing of all baths, being also one of the most pleasant. Employed at a low temperature, it is a powerful means of reducing excessive heat in fevers. The 109hot full bath very promptly relieves the pains of acute rheumatism, and is almost a specific for colds, if taken just before retiring. Very hot and very cold temperatures are quite hazardous with this bath, since it involves so large a portion of the body. Such extremes are rarely useful in any case, and should not be used except under the eye of a physician.

HALF BATH.

The half bath is much the same as the full bath. A smaller tub is required, as the bather sits upright with his limbs extended. The water should be at least a foot deep. During the bath, the body should be well rubbed, and water should be poured over the upper portion of the body. Its general effects are nearly the same as those of the full bath, and it may be used for the same general purposes. A little more vigorous rubbing is required to prevent chilling, as so large a portion of the body is exposed. It affords a better opportunity for stirring up the bowels and abdominal viscera by shaking, percussing, and kneading the abdomen.

SHALLOW BATH.

Of this bath there are two varieties; sitting shallow and standing shallow.

Sitting shallow differs from the half bath in employing less water, and being much more vigorous. 110Its effects and uses are about the same. The bather should rub his limbs and the front portion of his body while the attendant pours water over his chest and shoulders, and rubs vigorously his back and sides. A person can take the bath very well alone by using a rather long coarse towel which can be drawn back and forth across the back by grasping one end with each hand. It is a very valuable means of applying water, and is in constant requisition in the hydropathic establishments. From 85° to 90° is the proper temperature for this bath. It may be used at a lower temperature in fever cases. At Bellevue Hospital it is applied at about 70° in such cases, and is administered whenever the temperature exceeds 103°. To avoid the shock of a cool bath, it may be commenced at a temperature little below blood-heat and then gradually cooled by the addition of cool water until the desired temperature is reached. The reduction of the temperature obtained by this means fully equals that obtained by the sudden application of cold, and the shock and subsequent reaction are prevented. This applies equally to all cool baths as well as the cool shallow bath.

The duration of the bath may be from one to thirty minutes. Ten or fifteen minutes will be the usual extent.

The Standing Shallow is in some cases preferred by some to the preceding. The patient stands 111erect in a varying depth of water—from six inches to one or two feet being employed—while his body is vigorously rubbed by one or two assistants, water being poured upon the chest and shoulders at brief intervals. It is a very enlivening bath.

The shallow bath should be completed by a pail douche at a temperature three or four degrees lower than that of the bath.

AFFUSION.

This consists simply in pouring water over the body of the patient, who may be sitting or standing in a bath-tub. It is a very efficient bath for reducing unnatural heat. This mode of treatment was used by Hippocrates, Galen, and other ancient physicians. In the last century, Currie, Jackson, and many others used it with great success in scarlatina. It is a sovereign remedy for delirium tremens, sun-stroke, hysteria, and sometimes of acute mania, when applied of the proper temperature.

PAIL DOUCHE.

This bath scarcely differs from the preceding. It consists in the dashing of one or more pailfuls of water upon the body of the bather by an assistant. By means of a proper arrangement, the bather can administer the bath himself. For this purpose, a pail or other vessel filled with water 112may be suspended or supported above the head of the bather in such a way that it can be quickly upset by drawing upon a string attached to the side. The stream should fall upon the shoulders, chest, back, or hips, but not upon the head or over the region of the stomach. This bath may be applied after any warm bath, and should be a little cooler than the bath which precedes it. Whether taken alone or after another bath, it should always be followed by vigorous rubbing.

CATARACT DOUCHE.

This is a modification of the douche bath in which a broad sheet of water is allowed to fall upon the body of the bather. The force of the bath depends upon the height from which the water falls, and should be regulated according to the strength of the patient. Almost any one will bear a fall of three or four feet. When the height of the bath cannot be easily modified, it should be of such an altitude as to be well borne by the feeblest patients; the more vigorous can increase its effects by subjecting themselves to it for a longer time.

The observations made relating to the application of the pail douche, apply equally well to this bath.

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HOSE DOUCHE.

In this bath, water under pressure is thrown upon the patient from a hose, through a small nozzle. The bather turns his body while the attendant directs the stream upon different parts. It is a less pleasant bath than the spray or other forms of douche. Its general effects are the same as those of the baths mentioned.

SHOWER BATH.

This bath is simply an imitation of rain. Water is allowed to fall upon the body after being divided into a number of small streams by passing through a vessel with a perforated bottom. Its effects depend upon the size of the streams and the height from which they fall, together with the temperature of the bath and its duration. Although formerly much employed in water cure establishments, this bath is now little used, because its place is supplied by other more convenient ones which produce the same results, as the spray and douche. The best manner of administering it is to commence the application with tepid water, and gradually cool it. The temperature may range from 70° to 92°. The water should not usually be allowed to fall upon the head, but should be received first upon the hands and arms, then upon the feet and limbs, and afterward upon the back and shoulders, the body being well rubbed during the application.

114The cold shower bath, formerly so common almost everywhere, has been productive of much injury by its indiscriminate use, and has brought much reproach upon the use of water as a curative agent. None but the most vigorous can enjoy the bath at a lower temperature than 70°, and no advantage is gained by its employment at a lower temperature than that, while considerable harm may be done in many cases.

SPRAY BATH.

This bath consists in a number of fine streams of water thrown upon the bather, with considerable force. It may be produced by connecting a hose with spray attachment to a force-pump or reservoir from which to obtain water under a sufficient pressure. The best form of attachment consists of a hollow double-convex brass or copper piece, one side of which is perforated with fine holes, the other side carrying a rim for attachment to the hose. It is preferable to have an arrangement by which the temperature may be readily and gradually changed from warm or tepid to cool without interrupting the bath. In the absence of a proper spray attachment, the apparatus elsewhere described for the hose douche may be made to answer a very good purpose, the stream being broken by placing the thumb or finger over the nozzle in such a way as to partially obstruct the flow.

115This is an excellent bath to follow the pack, vapor bath, hot-air bath, sitz bath, or any other general bath which induces perspiration. It is very agreeable to most persons, and can be applied to feeble patients who would be unable to take any more severe form of treatment. The alternate hot and cold spray is very successful as a means of reducing local inflammations. The warm bath is very grateful and soothing to swollen and rheumatic joints; in gout, also, and illy defined, wandering pains, it is an admirable remedy. It is very successful, also, in the treatment of tumors, abscesses, and chronic ulcers, when thoroughly applied.

LOCAL BATHS.

The use of water as a local application is not less important, and is much more varied, than its general application. There is no other topical remedy which will produce such a variety of effects and such prompt results. In removing local congestions, subduing local inflammations, allaying circumscribed pain, and restoring activity to inactive parts, the appropriate applications of water give results which afford both physician and patient a degree of satisfaction which no other single remedy can rival, even electricity, an agent of acknowledged power, not being excepted.

116

SITZ BATH.

The sitz bath, also known as the hip bath, is one of the most useful baths employed in hydropathic treatment. Its utility was fully recognized by the earlier practitioners, who sometimes kept their patients so long in the bath that they became almost literally water-soaked, and were so numb from the long-continued application of cold water as to possess almost no external sensibility. It is said that in some cases the skin could be rubbed off in the attempts to obtain reaction, without the patient’s knowledge.

For this bath a common tub may be used, by placing a support under one edge to elevate it two or three inches; but it is better to use a tub made for the purpose, which should have the back raised eight or ten inches higher than the front, to support the back, the sides sloping gradually so as to support the arms of the bather. The bottom should be elevated two or three inches. The depth in front should be about the same as that of a common wash-tub.

Enough water is required to cover the hips and extend a little way up the abdomen; four to six gallons will suffice. Any temperature may be employed, being suited to the condition of the patient. The duration of the bath will also vary according to circumstances. A short cool bath is tonic in its effects, like all short cool applications; a more prolonged one is a powerful sedative. 117The hot sitz is very exciting in its effects if long continued. The warm bath is relaxing. The hips and trunk should be well rubbed during the bath by the patient or an attendant. The bather should be covered with a sheet or blanket during the bath. If it is desirable to produce sweating, several blankets may be used.

The sitz bath should seldom be taken either very hot or extremely cold. A very good plan for administering it, and one which will be applicable to most cases, is this: Begin the bath at 92° or 93°. If a thermometer is not at hand, pour into the bath-tub three gallons of fresh well or spring water, and then add one gallon of boiling water. This will give the desired temperature. After the patient has been in the bath ten minutes, cool it down to 85°, which may be done by adding a gallon of well water. Continue the bath five minutes longer, then administer a pail douche or spray, at about 85°, and wipe dry, as directed after a rubbing wet-sheet.

The sitz bath is useful for chronic congestions of the abdominal and pelvic viscera, diarrhea, piles, dysentery, constipation, uterine diseases, and genital and urinary disorders. In treating female diseases it is an indispensable remedy. It is very valuable in various nervous affections, especially those which immediately involve the brain.

There is no better remedy for a cold than a 118very warm sitz bath taken while fasting, and just before retiring. It should be continued until gentle perspiration is induced.

The sitz may be converted into a general bath by rubbing the whole body with the wet hand while in the bath, and may thus be made to answer the purposes of the half and shallow baths.

LEG BATH.

For this bath a vessel deep enough to receive the limbs to the middle of the thighs is required. The bath may be taken at any desired temperature; but it is usually employed somewhat cooler than baths which involve the trunk of the body. It is a powerfully derivative bath, and is found very useful to prevent wakefulness in nervous persons, and to relieve cerebral congestion in epileptic patients. It is especially applicable to chronic ulcers of the leg, swollen knees and ankles, and limbs which have suffered by exposure to severe cold. It gives much relief in gout; there is no danger of causing a metastasis of the disease by the application of this bath.

FOOT BATH.

Any vessel sufficiently large to receive the feet, and enough water to cover them to the ankles, is suitable for this bath. The feet should be rubbed during the bath. If the temperature is cool, only an inch or two of water should be employed.

119The walking foot bath is an excellent remedy for cold feet. It consists in walking in shallow water five or ten minutes.

The alternate hot and cold foot bath is another valuable remedy for cold feet, and is a certain remedy for chilblains. It is given thus: Place the feet in hot water—100° to 110°—three or four minutes. Then withdraw them and plunge them quickly into a bath of cold water—60° or less. After two or three minutes, restore them to the hot bath. Thus alternate three or four times, and conclude by dipping the feet quickly into cold water and wiping dry. This bath produces most powerful reaction.

The foot bath is applicable in the treatment of headache, neuralgia, toothache, catarrh, congestion of abdominal and pelvic organs, colds, and cold feet. It is very useful as a preparatory for other baths, and as an accompaniment of other local applications.

HALF PACK.

This bath is given in the same manner as the wet-sheet pack, except that the wet sheet extends only from the armpits to the hips. The blankets are wrapped about the patient in the manner described for the full pack. All the precautions given in connection with the description of that bath are applicable to this.

This bath is frequently employed in cases of 120patients who are too feeble to bear the full pack, or as a preparatory treatment for that bath. It is much milder than the full pack, and is usually more agreeable to the patient, as it does not confine him so closely. It is a very useful remedy in all inflammations of the abdominal organs, gastralgia, pleurisy, acute bronchitis, croup, and pneumonia. When a hot application is required, it is well to use a woolen sheet instead of a cotton one. It requires the same after-treatment as the full pack.

CHEST PACK.

This application is made in the same manner as the half pack, allowing the wet sheet to extend only from the armpits to the navel. It is especially applicable to diseases of the chest. The general directions for the full and the half pack apply to it. It is a very mild application.

LEG PACK.

The pack may be applied to the legs with great advantage in cases of habitual coldness of the feet and limbs or knees. The same principles mentioned in relation to other packs apply to this. The application should be made either cool or cold, and should extend from the hips downward. It should continue from half an hour to an hour and a half.

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CHEST WRAPPER.

This consists of a jacket made something like a vest, reaching from the neck to a little below the navel. It should be made of double thicknesses of soft toweling. To protect the garments or bedding from moisture, it should be covered with another jacket made like it but a little larger. In applying it, the wrapper should be wet in tepid water, and should then be applied as snugly as consistent with the comfort of the wearer. It should be re-applied every two or three hours, as it becomes dry.

If properly managed, the chest wrapper is a valuable remedy; but it has been greatly abused. It should not be worn more than a week without intermission. The practice of some in continuing it until it produces an eruption of the skin, and even longer—to promote a discharge—under the idea that a vicarious elimination is thus performed, is highly reprehensible, and has no sound physiological principle to support it. Such treatment is damaging to the skin, and does the patient no good in any way. The better plan is to allow the wrapper to be worn during the night, but omitted during the daytime. If worn during the day, it should be changed often, and should be removed so soon as the patient becomes chilly. Whenever removed, the surface of the skin should be washed or sponged with cool or tepid water. Feeble patients with defective circulation should 122wear the wrapper only while walking or riding on horseback.

This appliance may be profitably employed in a large number of chronic diseases. In chronic bronchitis, pleurisy, pleurodynia, asthma, and the early stages of consumption, it gives relief.

WET GIRDLE.

This was a favorite remedy with the early German hydropathists, and it is a very useful appliance when properly employed, though it has been much abused by excessive use, as in the case of the chest wrapper. To apply it well, a coarse towel about three yards long is the most convenient for use. Wet one-half of this, in tepid water, wring it until it will not drip, and apply it to the abdomen, placing one end at the side, and bringing it across the front first, so that two thicknesses of the wet portion will cover the abdomen. After winding the whole tightly around the body, fasten the end securely. The remarks made in reference to the wearing of the chest wrapper apply with equal force to the wet girdle. For feeble patients it is better to wet only that portion of the towel which covers the abdomen.

This a very efficient remedy for constipation, chronic diarrhea, and most other intestinal disorders. It is equally valuable in dyspepsia, torpid liver, enlarged spleen, and uterine derangements.

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ASCENDING DOUCHE.

This modification of the douche is simply an ascending instead of a descending stream. It can be readily managed by constructing a reservoir in such position as to give the water ten or twelve feet fall, when the requisite force cannot be more easily secured. The water is conducted through a hose, and is allowed to issue through a nozzle near the floor. The patient sits or lies just over the nozzle, and a few inches above it.

This is a valuable remedy in treating piles, prolapsus of the bowels or uterus, and constipation.

DROP BATH.

In applying this bath, a vessel with a small opening in the bottom is elevated to a considerable height, water placed in it being allowed to drop upon the part to be treated. The aperture in the vessel should be only sufficiently large to give egress to a single drop at a time. The bath may also be given by placing in an elevated vessel one end of a skein of cotton yarn, the other being allowed to fall over the edge of the vessel and hang below it. By capillary attraction the water will be drawn up into the yarn and will drop off at the lower end very slowly.

This is a very convenient way of applying water where its cooling effects are required for a considerable length of time, as in wounds, bruises, sprains, and similar cases. It will “keep down 124inflammation” in a wonderful manner. It is not commonly necessary that the water should be very cold, as evaporation will keep the part sufficiently cool in most cases.

ARM BATH.

This is simply holding the arm in water of proper temperature. It is extremely useful in such painful affections as felons, sprains, and nearly all injuries of the hand and arm. Ulcers and acute and chronic skin diseases of the hands and arm are usually benefited by this bath. If cold water is painful, its application should be preceded by that of hot water, or alternated with it. Cold hands should be frequently rubbed in cool water, and alternately immersed for a few minutes each in hot and cold water. In case of painful felons, the arm must be immersed to the elbow to relieve the pain, although the disease is only in the finger.

HEAD BATH.

The patient should lie upon his back, resting his head in a shallow basin of cool water. The attendant should bathe the forehead, face, and temples during the bath. The bath may be continued until the heat is removed or lessened.

The pouring head bath is often preferable to the preceding. The patient should lie upon a bed or sofa, face downward, allowing his head 125to extend outward over a tub or other wide vessel, while the water is poured upon the head from a little height, by an assistant. The water may be either hot or cold, according to existing conditions. Very cold water is not usually advisable, as its application soon becomes painful, and produces powerful reaction. It should be tepid or temperate. Some cases require very hot water for a few minutes, followed by a slight affusion of tepid water.

In hysteria, epilepsy, apoplexy, sun-stroke, acute mania, delirium tremens, and cerebral congestion from any cause, the head bath is a promptly efficacious remedy.

EYE BATH.

Water may be applied to the eye in various ways. A convenient method when only a brief application is necessary, is to lave the eye with water dipped by the hand. A gentle spray may be applied, or the eyes may be opened and closed in water, thus bringing them freely in contact with the element. Small glass cups made for the purpose may be filled with water and placed over the eye, the water being frequently changed; or wet cloths may be laid upon them.

In applying water to the eye, it is important to be able to first distinguish the exact nature of the difficulty, as much damage may otherwise be done by a wrong application. As a general rule, 126inflammations of the conjunctiva and external structures of the eye require cool or cold applications, while inflammations of the cornea, iris, and other internal structures, require hot applications. This rule is often violated in hydropathic establishments through ignorance of the structure and diseases of the eye.

Cool applications are best made by laying upon the eyes thin folds of linen cloth wet in cold water. Not more than two or three thicknesses should be used, as a thick compress soon becomes warm, while a thin one is kept cool for a longer time by evaporation. The compress should be changed every five minutes, at least, when there is much inflammation. The fomentation is as good as any method of applying hot water to the eyes. The application, when hot, should be as hot as the patient can well bear. If it affords relief, continue half an hour or more; if it increases the pain, desist at once. The same may be said of cold applications also.

Alternate hot and cold applications will give most relief in some cases. After a hot application, a slightly cooler one should always be applied for a few minutes.

A little milk, quince-seed mucilage, or other bland substance, added to the water, makes it more agreeable to the eye in bathing it.

The eye bath is applicable in all inflammations and injuries of the eye, and is infinitely superior to all other eye washes.

127Daily bathing the eyes in tepid water is a good practice for those who use them much in reading, writing, or other work requiring close attention. Many eyes are ruined by neglect and maltreatment.

EAR BATH.

Water applications are made to the ear by means of fomentations, compresses, the douche, or the spray. Compresses and fomentations are useful in inflammations of the structures of the ear, including abscesses which often form in the walls of the external canal. Alternate hot and cold applications are useful in causing the absorption of inflammatory deposits, and thus restoring the hearing. The douche, administered with the fountain syringe, is a valuable means of removing foreign bodies and insects. The warm douche has proved very serviceable in restoring the hearing by removing hardened ear-wax. In administering the douche, the head should be inclined over a basin, while the stream of water is allowed to issue from the nozzle held close to the external opening of the ear. Violent syringing of the ear should never be practiced, as it may occasion irreparable injury.

NOSE BATH.

This bath is administered either by drawing water into the nose while the mouth is closed, or by injecting it by means of a fountain syringe. 128Great care should always be exercised to apply the water gently, as a forcible application will cause pain and irritation. Injection should never be practiced with a piston syringe, as there is liability of forcing the water into the Eustachian canals and producing deafness. The temperature of the water should be warm or tepid for most applications.

Much benefit may be derived by the proper use of this bath in case of acute or chronic catarrh. The addition of a slight portion of salt to the water does no harm, and a slightly saline fluid is sometimes less unpleasant than pure water, probably because it is more nearly like the mucous secretion of the nasal mucous membrane. Drawing cold water into the nose is sometimes recommended for hemorrhage from the nose; but it is of doubtful utility, because the application cannot be continuous, and transient applications of cold water are always followed by an afflux of blood to the part so exposed. There are better remedies for nose-bleed.

COMPRESSES.

The compress is a wet cloth or bandage applied to a part. The object may be to cool the part under treatment, or to retain heat. The compress may be used with equal success for either purpose. When the part is to be cooled, a compress composed of several folds should be wet in 129cool, cold, or iced water, as required, and placed upon the part after being wrung so it will not drip. It should be changed as often as every five minutes. This is often neglected to the injury of the patient. A very cold compress may be prepared by placing snow or pounded ice between the folds of the compress. This will not need renewal so frequently; but its effects must be carefully watched, as injury may be done by neglect. In applying cold to such delicate parts as the eye, a very thin compress is better. It should be renewed once in five minutes, at least.

When accumulated warmth is required, a thick compress is applied, being wrung out of tepid water, and covered with a dry cloth to exclude the air. Soft, dry flannel is an excellent covering. Rubber or oiled silk may be employed when the compress is not to be retained more than a few hours; but if it is to be worn continuously, they will be injurious, as they are impervious to air and thus interfere with the function of the skin. The effects of a compress thus applied are identical with those of the poultice, and the application is a much more cleanly one.

Compresses are applicable in all cases in which poultices are commonly used. They may replace the old-fashioned plasters with profit and comfort to the wearer. The wet-sheet pack, half pack chest pack and wrapper, leg pack, and wet girdle are all large compresses.

130When applied continuously in the same place for a long time, the compress occasions a considerable eruption of the skin, and sometimes boils and carbuncles. There is no particular advantage in these eruptions, and they sometimes do much harm by producing a great degree of general irritation. The notion that they purify the system, though a very popular one, has really a very slight foundation. The discharge is largely made up of elements which would be of great utility if retained in the system, and the amount of foul matter eliminated in this way is certainly infinitesimal compared with the amount thrown off by a few inches of healthy skin. The skin can always do more and better work when healthy than when diseased. The eruptions are no doubt due to debility of the skin, produced by a too long continuance of the very abnormal conditions supplied by the compress. Yet, strange as it may appear, there are those claiming to be physicians who directly aim to produce inflamed and irritated surfaces by the continuation of the compress for months and even years.

The wet head cap is a compress made to fit the head. It should consist of several thicknesses of cotton or linen cloth, so as to retain moisture for some time. It is a good temporary appliance in diseases of the scalp, and for headache; but it should never be worn continuously for the purpose of relieving congestion, as it will have an 131effect just the opposite of that desired. In eczema of the scalp it may be worn until the disease is cured, being frequently rewetted. It is an excellent means of preventing sun-stroke and other effects of heat when worn beneath the hat in summer; but even for this purpose its use should be temporary, the cap being worn only during the hotter portion of the day.

FOMENTATIONS.

The fomentation is a local application analogous to such general appliances as the hot pack, vapor bath, and hot-air bath. It consists in the application of a cloth wet in hot water. It may be considered as a hot compress. Fold a soft flannel cloth twice, so that it will be of three or four thicknesses. Lay it in a basin, pour boiling water upon it, and wring it dry by folding it in a dry towel. Or, if only one end of the cloth is wet, it may be wrung by folding the dry portion outside of the wet; in wringing, the whole will become equally wet. Apply it to the patient as hot as it can be borne. The second application can usually be made much hotter than the first. Frequently dipping the hands in cold water will enable the attendant to wring the cloth much hotter than he would otherwise be able to do. The most convenient way is to heat the cloths in a steamer; by this means they are made as hot as boiling water, and yet they are more easily 132handled, not being saturated with water. When no hot water is at hand, a fomentation may, in an emergency, be quickly prepared by wetting the flannel in cool water, wringing it as dry as desired, folding it between the leaves of a newspaper, and laying it upon the top of the stove, or holding it smoothly against the side. The paper prevents the cloth from becoming soiled, the water protects the paper from burning, and the steam generated quickly heats the cloth to boiling heat. For a long fomentation, the heat may be made continuous by applying over the wet cloth a hot brick or slab of soapstone.

The hot cloths should be re-applied once in five minutes. Two cloths should be employed, so that the second may be applied the moment the first is removed. To retain the heat, a dry flannel, rubber, or oilcloth should be placed over the fomentation. The application may be continued from ten minutes to half an hour, or longer in special cases. This appliance is very powerful, and should not be employed to excess. Alternate hot and cold fomentations are frequently more efficient than the continuous fomentation. Hot applications should always be followed by a cool or tepid compress for four or five minutes, at least.

The uses of the fomentation are very numerous. It is indicated whenever there is local pain without excessive heat, or evidences of acute inflammation. Local congestions, neuralgia, toothache, pleurisy, pleurodynia, and most local pains 133vanish beneath its potent influence as if by magic. For indigestion, colic, constipation, torpid liver, dysmenorrhea, and rheumatic pains, it is a remedy of great power, and is used with almost uniform success. In relieving sick headache by application to the head, neck, and stomach, its efficiency is unrivaled.

When applied to the head for some time without intermission, it will often occasion faintness; hence, a cooler application should be made after the use of the hot cloths for fifteen or twenty minutes.

If the applications must be continued for a long time, it is well in most cases to apply them at a temperature slightly lower than when they are to be used for only a few minutes.

This remedy may well replace the blisters, plasters, cataplasms, scarifications, rubefacients, and other irritating measures so long used for relieving pain, local congestions, and inflammations.

REFRIGERANT APPLICATIONS.

A freezing mixture which will reduce the temperature to 4° is made by mixing equal parts of salt and pounded ice. The ice and salt should be stirred together very quickly and applied at once to the part to be frozen. Two parts of dry snow and one of salt make an equally good mixture. Freezing is more conveniently performed by the rapid evaporation of ether or rhigoline.

134Freezing is a useful process in numerous cases. By its use, excrescences—as warts, wens, and polypi—fibrous tumors, and even malignant tumors, as cancer, may be successfully removed. Small cancers may sometimes be cured by repeated and long-continued freezing. Their growth may certainly be impeded by this means. Felons, if treated early in their course, may be cured by two or three freezings.

For freezing a felon, place the finger in a mixture ice and salt, or surround it with cotton, saturate the cotton with ether or rhigoline, and blow it very strongly with a pair of bellows. This is a very good method when an apparatus for producing a fine spray is not at hand. The latter instrument facilitates the freezing very much if used with the bellows.

No harm results from repeated freezing if proper care is used in thawing the frozen parts. They should be kept immersed in cool water, or covered with cloths kept cool by frequent wetting with cold water, until the natural feeling is restored.

The application of ice is found extremely serviceable in many inflammatory diseases, and in some nervous affections. In inflammation of the brain, the ice cap is of inestimable value. Ice applied to the spine will check the convulsive spasms of chorea and hysteria when other remedies fail. In putrid sore throat, or malignant diphtheria, 135ice is a sovereign remedy. It should be applied to the neck externally, and held in small bits in the mouth. Small bits swallowed will sometimes relieve the pains of gastralgia.

Rubber bags are very convenient for applying ice or iced water; but their place can be very well supplied by dried bladders filled with pounded ice. The ice cap is a double head cap stuffed with pounded ice.

Some physicians recommend the application of ice to the spine in cases of congestive chill and paralysis, and in inflammation of the stomach, kidneys, uterus, and other internal organs. The real worth of such applications in these cases has yet to be determined by careful and repeated observations. We would not recommend an unskillful person to attempt to relieve a violent ague chill by rubbing ice on the patient’s back, and we have some fears that a very skillful operator would hardly succeed to his entire satisfaction and that of the patient.

The snow bath, applied by rubbing the part vigorously with snow, is a useful application for restoring the circulation to frosted parts. In cases of extreme chilling or absolute freezing, there is perhaps no better remedy. Powdered ice may be used when snow cannot be readily procured.

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MISCELLANEOUS BATHS, ETC.

VAPOR BATH.

This bath can be readily and successfully administered with such conveniences as every family possess. Place the patient in a cane-seat chair, having first taken the precaution to spread over the seat a dry towel. Surround the patient and the chair first with a woolen blanket, and then with two or three thick comfortables, drawing the blankets close around his neck, and allowing them to trail upon the floor so as to exclude the air as perfectly as possible. Now place under the chair a large pan or pail containing two or three quarts of boiling water. Let the blankets fall quickly so as to retain the rising vapor. After a minute or two, raise the blankets a little at one side and carefully place in the vessel a very hot brick or stone, dropping the blankets again as soon as possible avoid the admission of cold air. Before the first brick or stone has cooled, add another, and so continue until the patient perspires freely. The amount of perspiration must be judged by the face and forehead, as much of the moisture on the skin beneath the blankets is condensed steam. Should the bath become at any time too hot, a little air may be admitted by raising the bottom of the blankets a little, being careful to avoid chilling the patient in so doing. The bath should seldom be continued more than half an hour, 137and fifteen to twenty minutes will usually accomplish all that is desired by the bath. If too long continued, it induces faintness. A too high temperature will be indicated by a strongly accelerated pulse, throbbing of the temples, flushed face, and headache. The head should be kept cool by a compress wet in cool water and often changed. The temperature of the bath should be from 100° to 115°. Unpleasant effects are sometimes produced at 120°.

After this bath, apply the tepid spray, rubbing wet-sheet, pail douche, or full bath. No time should be allowed to elapse after the blankets are removed before the concluding bath is applied, as the patient will chill. He should not be allowed to become chilly by exposure to cool air before the application of the spray, douche, or other bath, which should be followed by vigorous rubbing.

For “breaking up a cold,” relieving rheumatism, soreness of the muscles from overexertion, and relaxing stiffened joints, this is a valuable agent. It may also be used to advantage in chronic diseases in which there is torpidity of the skin; but great care must be exercised to avoid excessive use, as too frequent repetitions of the bath produce debility.

This is a milder application than the hot-air bath, unless employed at a high temperature, 120° or more, when it becomes more severe.

In institutions where the bath is in daily requisition, 138a permanent arrangement for giving the bath is usually employed. It sometimes consists of a box in which the patient sits upon a stool, his head being allowed to remain outside by a suitable opening. A wet towel is placed around the neck to prevent the steam from rising about the head. Others prefer a box or small room large enough to admit the whole person, the whole body being subjected to the warm vapor. An opening guarded by a curtain is made in one side to allow the bather to inhale cool air if he should wish to do so, and to give the attendant access to the patient without chilling him by the admission of a large quantity of cold air. As in the simpler form of vapor bath, the head should be kept constantly cool by a cool wet compress often re-applied. Patients troubled with “rush of blood to the head,” should be further protected by a large cool compress placed around the neck and the upper part of the chest.

Steam may be generated for these larger baths by boiling water in the box with a spirit-lamp or a gas-burner, or it may be conducted into the box by a rubber tube connected with a tight boiler.

RUSSIAN BATH.

This is essentially the same in effect as the vapor bath. It consists of a room filled with vapor, and so arranged that by transferring the patient from one point to another the heat may be gradually increased. It has no advantages 139not afforded by the simpler vapor bath. It is now much used in the larger cities. Probably as much harm as good results from the indiscriminate and reckless manner in which it is employed. Patients have been known to die in the bath of apoplexy induced by the excessive heat. It is followed by shampooing and cooling baths of various sorts.

HOT-AIR BATH.

In administering this bath, prepare the patient precisely as directed for the vapor bath. Instead of placing under the chair a vessel of hot water, place a large alcohol lamp or a small dish containing a few ounces of alcohol. When all is ready, light the lamp or alcohol, and carefully exclude the air. It is hardly necessary to suggest the propriety of putting the lamp in such a position as to insure safety from fire. If alcohol is used in an open dish, it is important to wipe the outside of the vessel quite free from any trace of the fluid, as otherwise it might be communicated to the floor or carpet. Also avoid spilling any portion in putting it in place, for the same reason. It is a very good precaution to place the dish containing the burning alcohol in a plate or shallow vessel containing a little water.

This bath should be conducted in the same manner as the vapor bath. A temperature of 140° to 160° is not at all disagreeable to the patient. 140At 170° or 180° the same effects are produced as in the vapor bath at 120°. The bath should be followed by cooling baths as directed for the vapor bath.

This is a very valuable remedy for the same class of diseases for which the vapor bath is recommended. It is of very great service in cases of dropsy, Bright’s disease with poisoning from retained urea, and all cases in which a vigorous elimination by the skin is desired. It should not be continued longer than the vapor bath, and much harm may result from its too frequent employment. Like the vapor bath, this may be conducted in a suitable box with an opening for the head.

TURKISH BATH.

This is entirely analogous to the hot-air bath, though on a much more elaborate plan. The patient is gradually conducted from a temperature of 120° to that of 160° or even much more than 200°. The bath is concluded by shampooing, rubbing, cooling baths, and gradual cooling in a room maintained at a temperature of 70°.

The uses of this bath are the same as those of the hot-air bath. It has no advantages over it of very great importance, and is much more liable to produce injury by prolonged and frequent application. It generally occupies an hour, and by those who resort to it as a luxury, as did the ancient Romans, it is often prolonged to several hours.

141The long-continued application of excessive heat to the body is a very unnatural process. It tends to produce permanent relaxation and debility of the cutaneous tissues, and the manner in which this bath is administered in Turkish bath establishments is productive of great harm. It is often presented to invalids as almost a panacea; and is given alike to the strong and vigorous, and the weak and debilitated.

The bath is certainly good in its place, but it is decidedly bad when abused. Many consider the hot-air bath greatly preferable since it obviates the necessity of inhaling superheated air, the effects of which upon the lungs are said to be injurious. The hot-air bath is doubtless safer.

ELECTRIC BATH.

Electricity may be more efficiently applied in connection with water than by itself. Water is a better conductor of electricity than the dry skin, and hence facilitates its communication to the body. The ordinary method of applying electricity is by attaching one pole of the battery to a metallic plate, placed in contact with some part of the body, while the circuit is completed by the application to the patient of a moist sponge connected with the other pole. The operator often holds one pole in his hand and applies the other hand, moistened, to the part to be treated. He is in this way enabled to judge very accurately of the strength of the 142current applied. The metallic plate is frequently placed at the feet of the patient, sometimes in a foot bath. The sponge may be applied to various parts of the body while the patient is in a sitz bath. For a general application of electricity the full bath is most convenient.

This bath is applicable to a very large variety of conditions. To describe them all would be to give nearly all the uses of electricity as a remedial agent, which does not come within the scope of this work. The electric full bath has been strongly recommended for the removal of mineral poisons from the body. Just how efficacious it is in this respect, we cannot confidently affirm. Probably its value has been somewhat exaggerated. Only the primary or galvanic current could be of any service in this direction.

Electricity is generally acknowledged to be a powerful remedial agent; but its use requires costly apparatus and much skill in application. It is necessary that the operator should not only understand the nature of diseases and the proper methods of applying electricity in treating them, but he must also thoroughly understand the general laws of electricity. The electric bath is as badly abused by quacks and charlatans as the Turkish bath. It should not be employed by unskillful persons; and for this and other reasons given, it is not well adapted to home use.

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ELECTRO-VAPOR BATH.

This is a combination of the electric and the vapor bath, the electricity being applied to the body by means of the sponge, and metallic plates covered with moistened cloths. It is a valuable appliance if carefully used; but, like all effective modes of treatment, it is very liable to excessive use, which becomes abuse. It has been very highly lauded by certain specialists, and doubtless its value has been unstintedly exaggerated. It is perhaps not well proven that its effects are greatly superior to the effects of the vapor bath and electric bath administered separately; and the latter mode would be more convenient, though consuming a little more time.

DRY RUBBING-SHEET.

Cover the patient with a soft, dry sheet in the same manner as directed for applying the wet sheet in the rubbing wet-sheet bath. Then rub lightly but briskly upon the outside of the sheet with the flat hand. Do not rub with the sheet, but over it. Continue the rubbing ten or fifteen minutes, going over the whole body several times, and not neglecting the arms, the hands, and the feet. This application may be administered daily with profit to nearly all patients. It should always follow any form of general bath in which water is employed, as a means of drying the body. It promotes activity of the skin, and equalizes the circulation.

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DRY HAND-RUBBING.

This application is much the same in effect as the preceding, though a little more soothing, and hence better adapted to nervous patients. It consists in rubbing the body gently with the palm of the dry hand. The force of the rubbing should be nicely graduated to the condition of the patient. When employed to excite considerable activity of the skin, the rubbing may be accompanied with kneading of the abdomen, and light percussion of the surface.

Gentle rubbing of the skin is a very soothing process. It will frequently induce sleep when other means are ineffectual. Rubbing the back and limbs downward, and gentle rubbing of the temples, are very soothing to children and nervous invalids.

AIR BATH.

The air has a very soothing effect upon the body when allowed to come in contact with the entire surface. It answers a very valuable purpose when a water bath is impossible, or when the patient is too feeble to endure the application of water. A sleepless person will often fall into a sound and refreshing slumber after walking a few minutes in his room with the whole body exposed to the air. The effects of night labor upon literary people may be partially counteracted by the air bath. Benjamin Franklin was accustomed to pursue his writing to a late 145hour after divesting himself of his clothing, and he recommends the practice to others compelled to labor late with the pen.

SUN BATH.

The value of sunlight as a hygienic agent is so universally recognized—theoretically if not practically—that we need not devote space to its consideration in this connection. Sunlight is essential to the healthy performance of the vital functions, and must be equally important as an aid to remedial processes. This fact has been amply demonstrated by hospital experience, which shows a much larger percentage of recoveries in rooms abundantly exposed to the sun than in those secluded from its rays.

That the sun has a powerful influence upon the skin is shown by the great increase of pigment in that structure when freely exposed to the sunlight. This results from an increased activity of the cutaneous tissues.

Experience has shown that the sun bath can be employed to advantage in most chronic diseases. The patient simply lies in a position in which the naked skin can be freely exposed to the rays of the sun. The head should be shaded. The bath should not be continued so long as to produce unpleasant effects either upon the skin or the general system. It may be accompanied and followed with the dry hand-rubbing.

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SEA-BATHING.

Bathing in the sea is much practiced by fashionable people who make annual visits to the sea-coast for this purpose. It is no doubt useful, though many who participate in it would doubtless receive quite as much benefit if they took as many baths at home during the whole year as they take at the fashionable watering-places in a single week. It is a fine thing to be well washed once a year, however, if not more often.

As generally conducted, sea-bathing is not more beneficial than harmful. The dissipation accompanying it more than counterbalances what good might be gained. It is rather absurd to attribute any specific virtues to sea-water, as many do. Quite a large business is carried on in the evaporation of sea-water and the sale of the dirty residue, which is again dissolved in water and used in bathing by those who live too far inland to enjoy the benefits of bathing in the sea, or who prefer to take their sea-bath in their own private bath-room. Everything must have a counterfeit, and so this seasalt is imitated by base swindlers who prepare a mixture of chemicals just as powerful, but not quite so complicated, and less dirty, though certainly equally good. All of this trouble and swindling might be saved if people would only consider for a moment the fact that all the benefit they obtain from bathing is derived from the exercise, the temperature, 147and pure water, and not from any impurities which the water may chance to contain.

Sea-bathing is usually overdone. More benefit will be gained by one or two daily baths than by a half-dozen. Fifty baths in a single week are not equivalent to a single bath each in fifty weeks.

MEDICATED BATHS.

We have no faith in medicated baths in general. They are occasionally useful for the destruction of vermin, animal parasites, and perhaps in certain cases of skin disease. Generally, it is far better to take the limpid element “Simon pure,” unadulterated. Many medicated baths have acquired great celebrity by the performance of cures really wonderful, but wholly attributable to water only, in spite of, rather than in conjunction with, the foreign medicament added.

OIL BATH.

Inunction was greatly practiced by the ancients in connection with the Roman and Turkish baths. It consists in rubbing the skin very thoroughly with some unctuous substance. Olive oil may be employed, but cosmoline or vaseline, two refined products of coal oil, are in some respects preferable. Olive oil cannot be obtained pure, except at almost fabulous prices. That sold in the drug stores as olive oil is really cotton-seed oil and mixtures of lard with various other vegetable oils.

148A warm bath should first be administered. Then dry the patient, as usual, and apply the unguent, taking care to rub it in thoroughly. Simply greasing the surface is not the object sought. The skin and flesh should be worked, rubbed, and kneaded until the oil nearly disappears from the surface.

The object of this application is to supply the place of defective natural secretion of oleaginous material, to increase the activity of the skin, and to diminish susceptibility to cold. How this is accomplished, readily appears. The oil is a simple substitute for the sebaceous secretion, which is, in a certain class of diseases, notably deficient. The thorough manipulation of the skin which is necessary in applying the oil, and which is facilitated by a lubricant, directly promotes cutaneous activity. Whether the oil itself has any direct effect in increasing the functional activity of the skin cannot be positively affirmed, although it is reasonably supposable that the skin will act more nearly normal when a deficient element is supplied than when it is wanting. Oil is an excellent non-conductor; and invalids who are especially susceptible to cold may be rendered comfortable by the application of the oil bath.