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 thetwo 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, andvice 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 ofa 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 partsas 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 fomentationapplied 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, thewarmfull 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 individualon 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:—
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 employedas 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 facilitatingthe 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:—
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 ofboiling 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.
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 thetemperature 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. Atsuch 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, itshould 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 bevery 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.
27. 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 somewhatcustomary, 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.The dangers of over-treatment are not so great as some imagine, however, who take the opposite extreme, and advocaterestas 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.
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.
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.
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 duringthe 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.
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 of75° 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.
Weakly 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.
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.In 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,to 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 ofthe 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.
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 isimportant 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 andlengthwise 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 shouldbe 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.
The 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.
In many cases of fever in which the temperature rises so high as to produce delirium, the ordinarypack 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.
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.
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.Place 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. Thehot 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.
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.
Of this bath there are two varieties;sitting shallowandstanding shallow.
Sitting shallowdiffers from the half bath in employing less water, and being much more vigorous.Its 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.
TheStanding Shallowis in some cases preferred by some to the preceding. The patient standserect 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.
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.
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 watermay 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.
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.