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M<53 \9n^,oi

HARVARD COLLEGE
LIBRARY

From the Library of

HORACE FLETCHER

THE GIFT OF

WILLIAM DANA ORCUTT

January ii, 1921

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y/^O^^- /y^V;--LC^_ ^-- ^^^^^

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RATIONAL

HYDROTHERAPY

A MANOAL OP

The Physiological and Therapeutic Effects of Hydriatic
Procedures, and the Technique of Their Appli-
cation in the Treatment of Disease

By J. H. KELIXXK>, M. D.

Mrmker cf the Briiisk Gynecological Society ; ike Jntemaiianal PerioScsl
Compress of Gynecology and Obstetrics; the British and American Asso-
ciations for the AdDOsuement of Science; the Soci/t/ d* Ifygihu of
France; the American Society of Microscopists ; the Ameri-
can Medical Association; Superintendent of the Battle
Creek (Mich,) Sanitarium; Author of the
" Art of Massage; " etc,^ etc.

WITH TWO HUNDRED NINETY-THREE ILLUSTRATIONS
EIGHTEEN IN COLORS

Phii^dblphia

Thb F- a. DAVIS COMPANY, Publishers

1901

HARVARD C;LL=Jt LIBRARY

FROM THE LiBKARY OF

HORACE FLfeTCIiER

THE GIFT OF

WILLIAM DANA ORCUTT

JANUARY 11, 1921

A

Botered according to Act of Congress, 1900,

by

J. H. KELLOGG, M. D..

In the office of the Librarian of Congress, Washington, D. C

Also entered at Stationers* Hall, London, England.

Ai^i, Rights Rksbrvsd.

■V.A

I s

MiCROFILMEO
ATHARVMRO

TO HIS FRIEND,

gr. TOiltelm TO. TOinternitZt

Professor of nervous diseases in the Royal and Imperial

University of Vienna, and founder of the

first hydriatic clinic,

the author respectfully dedicates this volume.

f

I

PREFACE.

WHEN the famous Sydenham wrote his treatise on
fevers, he apologized for departing so far from the
current practice of his day as to recommend the
employment of hydriatic measures as being preferable to
bleeding in the treatment of febrile disorders. This inno-
vation was made with much fear and trembling on the part of
the famous old physician, who expressed his expectation
that his advocacy of water as a febrifuge would render him
so unpopular with the members of his profession as to
destroy his practice and reputation.

Thanks to the progress made in the development of
rational medicine within the last century, and especially
within the last twenty-five years, it is no longer necessary to
offer an apology to scientific medical men for the recommen-
dation of a remedy which, though the simplest of all ele-
ments, has come to be recognized as one of the most powerful
means of influencing the varied functions of the animal body,
having by careful clinical observation and patient laboratory
research, been thoroughly rescued from the limbo of blind
empiricism and placed upon a scientific and rational basis.

F'or years excellent scientific treatises on hydrotherapy
have existed in the French and German languages, but for
nearly ha'f a century not a single systematic English work
on the hydriatic treatment of disease has appeared with the
exception of the translation of the article by Winternitz in
Ziemssen's System of Therapeutics, and a recent excellent
work by Baruch.

The author's purpose in the preparation of this work has
been to present in a more systematic and comprehensive way
than has heretofore been undertaken, the *• rational" hydro-
therapy which has been built up within the last century
chiefly through the efforts of Currie, Fleury, and Winternitz.

I.

Vi PREFACE.

whose great labors have been supplemented by others too
numerous for other mention than that made in the various
footnotes and references which will be found in the body of
this work. It has also been a part of the author's purpose
to record some of the fruits of his own experience and observ-
ations within the last twenty-five years, during which time, as
superintendent of a large sanitarium, he has had opportunity,
with ample facilities, to make a careful study of hydriatic
principles and methods.

The general order of the book is as follows: First, a short
historical sketch and a- brief r<Ssum6 of the physical, anatomical,
and physiological facts which are especially related to the
subject ; second, a study of the physiological effects of thermic
applications; third, a description of the technique of all use-
ful hydriatic procedures; and fourth, a section on hydriatic
prescription making, in which is presented a brief summary
of the indications presented by the diseases most commonly
encountered in practice and of the hydric measures required
to meet the same. The author hopes to publish later another
volume, the manuscript of which is already nearly completed,
in which the rational hydriatric treatment of individual
diseases will be more fully and systematically discussed.

The number of procedures described in the work is about
two hundred. Many more might have been mentioned, but
the writer's design has been to describe only typical hydriatic
processes, each possessed of a definite and characteristic ther-
apeutic value. Of those procedures which are the outgrowth
of his own experience, the author has mentioned only such as
have acquired a recognized value by extended use. * Of these,
the most worthy of mention are the electric-light bath, the
percussion douche, cold mitten friction, cold towel rub, alter-
nate spinal sponging, a number of forms of hot and cold
compress and the hot and cold pack, and the simultaneous
hot and cold douche.

The author's interest in hydrotherapy and his practical
acquaintance with many of its procedures date back to his

PREFACE.

vn

boyhood, more than forty years ago, as the empirical meth-
ods which were popular in this country at that time were in
common nse in his father's family* His scientific interest in
the sobject began iis 1874^ when he had the pleasure of listen-
ing to a paper read before the New York Academy of Medi-
cine by his teacher, Dr, Austin Flint, of Bellevue Hospital
Medical College^ entitled * * Currie's Ideas and Methods Re-
specting the Use of Water as a Febrifuge/* The interest
created by Dr. Flint's paper led to the purchase and study
of Currie's work, the excellent work by Bell, and every other
work prociirahle in the English, Frenoh, and German lan-
guages. Some eighteen years ago (i383) the author equipped
a iaborator)*, and began the systematic study of the physio-
logical effects of water. Many hundreds of experimental ob-
servations have been made by the aid of the calorimeter,
the plethysmography the ergograph, and various other instru-
metils adapted to the purpose. The results of some of these
obserrations are reported in this work for the purpose of pre-
Mittng to the reader tangible evidence of the rational basis
of this important branch of therapeutics. An earnest effort
has been made to present in this work a comprehensive view
of hydrotherapy as it is practiced at the present day in sci-
tfiliTic hydriatic institutions, and especially in the extensive
sisterhood of medical institutions under the supervision of the
international philanthropic medical association with which the
ctetl, which embraces more than forty estab-

. ^:^:^ .,.:;:ly scattered throughout the United States and

thirteen foreign countries.

The writer has used for the foundation of this work a
series of lectures which he delivered before a class of medical
students in the summer uf 1S90. Similar courses have been
gtirefi almost yearly since, to classes of increasing number.
and there has been a growing demand for a text-book em-
bodying the essentials of the subject-matter presented, and
adapted for nsc by medical students and nurses, as well as
practtliatirrs who desire lo obtain a knowledge of the founda-

viii PREFACE.

tion facts and principles of rational hydrotherapy. The first
section of the manuscript was prepared for the press in 1897,
but urgent professional duties prevented the completion of the
work until an opportunity was afforded by a vacation trip to
Mexico in the winter of 1899- 1900.

It has been the constant effort of the writer to make his
statements of facts and principles, and his descriptions of
technique, as concise as possible, and to avoid burdening the
work with novel and unproved theories, but rather to make it
a simple, lucid, and systematic presentation of all that has
been scientifically established in relation to the use of water
in therapeutics. Almost no space has been devoted to clin-
ical reports, although it would be easy to select from the more
than forty thousand cases which have been submitted to
hydriatic treatment under the author's supervision, a very
large number of interesting illustrative cases.

Modern scientific Research has placed upon a sure founda-
tion the great truth dimly recognized by the earliest physi-
cians,*but wholly lost sight of during the Dark Ages, that
healing power is not possessed by physicians nor by reme-
dies, but that the curative process is simply a manifestation
of the forces which dwell within the body and which are nor-
mally manifested in creating and maintaining the organism,
in other words, that the body heals itself. Water, applied
externally or internally, and at such temperatures as may be
required, is a natural agent more capable than any other of
co-operating with the healing powers of the body in resisting
the onset and development of pathogenic processes. There
is no other remedy by which the movements of the blood
and the blood supply, both general and local, and in fact
every form of vital activity, may be so readily controlled as
by hydriatic applications.

While water is recognized as without doubt one of the
most valuable of all natural agencies, the writer has never
permitted himself to be classed with those enthusiasts who
place their trust in it as an exclusive measure. It is best

I
I

I

connectioQ with the use o! electricity, massage,
ajid medical fymnastics. Rational diet is as essential in the
tieatmeot uf the majority of cases of acute and chronic dis-
as IS water. In the treatment of cbrontc disorders the
Itgulation of exercise, dress, and of other habits of hfe, is
iJso a matter of paramount importance, also the disuse of tea,
coffee, tobacco, and alcoholic beverages, which are often
found to sustaJD a very direct causative relation to the
patient's maladies and are without doubt responsible for many
failures in which the fault has been unjustly charged to the
inefilideacy of water as a therapeutic agent.

In the preparation of the physiological part of this work
the writer has found of special service the splendid work of
Landois and Sterling, the excellent ** Trmte dc Pkysi&hgie,''
by Moral and Doyon, and the *' Traitc de Pkyswhgie Com-
p^r€^ d€s AnimaHx\'' by jColin. In addition, the works of
Wifilemitz, Bell, Currie, Fleury, Beni-Bardc, Bottey, and
omnefous other French and German authors, besides a
l^at mass of periodical literature, and many hundreds of
m*"- '*^ ' Its which have been accumulated during the last
thv 4 have been studied and consulted. Several visits

have been made to the great medical library at Washington,
10 which is to be found a rich collection of literature upon
tliis interesting and practical subject, and to the large libraries
at New York, Boston, and London.

A most earnest effort has bsen made to exclude from this
work cver>^ procedure and every method for which a thor-
oiighty scientific and physiological foundation could not be
preseoted. The author dares not, however, entertain the
hope that his work will be found altogether faultless, and
solicits the candid criticism of those who may do him the
honor to peruse these pages, trusting that he may have the
privilege of correcting in future editions such errors as may
have escaped attention in this, and to record such new facts
as future experience and research may develop,

In conclusion I must not omit to express my obligations

X PREFACE.

and gratitude to my colleagues of the faculty of the Battle
Creek Sanitarium, and of the American Medical Missionary
College, particularly Drs. David Paulson, Chas. E. Stewart,
George Thomason, and Elmer Otis, for invaluable assistance
in abstracting the stenographic notes of my lectures to
medical classes, and for supervising and personally conduct-
ing experimental work, and to Dr. Eshelman for assistance
in preparing an exhaustive index. I have also profited by the
experience of my friends and colleagues for many years, Drs.
Lindsay, Riley, Kress, Rand, and others, and owe much to
the patient and painstaking work of a large number of my
students in the experimental laboratory. I am also under ob-
ligations to my friend, Alois Strasser, M. D. , assistant Professor
in the Medical Department of the Royal and Imperial Univer-
sity of Vienna, for painstaking revision of the proof sheets and
for numerous valuable suggestions. Most of all I am indebted
to my friend of many years, Dr. W. W. Winternitz, Profes-
sor of Nervous Diseases in the -Medical Department of the
Royal and Imperial University of Vienna, to whose laborious
investigations and acute observations the world is indebted
more than to any other living man for the scientific data
upon which modem rational hydrotherapy is based, and tc
whom I am proud to have permission to dedicate this volume.

J. H. Kellogg.

Battle Creeks Aug. /, i^Oi.

CONTENTS-

PART ONE.

Hlstekal, 21

Hydrolherafiy annoiig the Elgypdans, Chinese, and Other An-
cieot Nations (21) — Hippocrates on the Use of Water (22) —
The Medical Use of the Bath by the Romans and Arabs (23> —
The Popolar Use of Water 150 Years Ago (24) — CoUen's Use
of Water in Fevers (27) — Hydrotherapy in Enrope (2S) — Hy-
drotberapy in England (29) — The Work of Carrie and Jacksoa
(30) — Hydrotherapy in America (32) — The Hydropathy of
Priessnitx (35) — Scientific Hydxotherapy (37).

Tl« Pbysics of Water, Air, Heat, and Lislit in Brfrtiin

to tlydrotlierai^, jS

The Specific Heat of Water (38) — Tbe Solvent Properties of
Water (41) — Tbe Atmospbere (42) — Heat (44) — Thermome-
ter Scales and Heat Units (46) — Medical Tbermometry (48) —
Mode of Determining and Regnlating tbe Temperature of Water
without a Thermometer (49) — An Emergency Thermometer
(50) — Calorimetry (51).

Anatomy and PhysMogy in IMation to Hjdrotlwrafyy, 53

Pbysiology the Basis of Hydrotherapy (53) — 77U CircMlaHon
(54) — Circulatory Systems (55) — Tbe Mechanism of tbe Cir-
culation (56)— The Blood Current (59) — Tbe Pulse (60) —
The Skin and Its Functions (62) — The Sweat (63) — Condi-
tions that Control the Secretion of Sweat (64) — Toxins of tbe
Sweat (65) — The Sebaceous Glands (66) — Absorption by tbe
Skin (67) — Cutaneous Respiration (67) — Nenroos Functions
of the Skin (67) — The Tactile Sense (68) — Tbe Temperatnre
Sense (69) — Vasomotor and Secretory Nerves (71) — General
Vir-jf of the Nervous System as Related to Hydrotherapy (71) —
Tbe Superficial Reflexes (73) — The Vasomotor Centers (73) —
Tbe Visceral Motor Nerves (75) — The Sympathetic Nervous
Sjrstem (75) — Tbe Splancbnics (75) — Functions of the Sym-

xi

xn CONTENTS.

pathetic (76) — Animal Heat (77) — Sources of Animal Heat
(77) — Cold-Blooded and Warm- Blooded Animals (78)— The
Normal Temperature in Man (79) — Surface Temperatures (79)

— Internal Temperatures (80) — Heat Production (80) —
Conditions That Increase Heat Production, and the Tendency
to Temperature Rise (81) — Conditions That Decrease Heat
Production (82) — Heat Regulation (83) — The Mechanism of
Heat Regulation (83) — Heat Production and Heat Dissipation
Associated (86) — A Simple Calorimeter (87) — The Author's
Fever Calorimeter (88) — The Fever Calorimeter of Wiutcrnitz
(89) — D'Arsonval's Calorimeter (89) — Fever (90) — Influence
of a Warm Atmosphere upon Heat Production (90) — Relation
of Heat Production to Temperature (91) — Modifications of the
Thermic Functions which Cause Change of Body Temperature
(92) — Control of Heat Functions (93) — Heat Production after
Death (94).

The Physiological Effects of External and Internal

Application of Water, 95

The General Effects of Thermic Irritation upon the Circula
tion (96) — The Physiological Effects of Cold (98) — Is Cold a
Sedative or an Excitant ? (98) — Hibernation (98) — Hydriatric
Measures Consist Chiefly of Thermic Applications (99) — Classi-
fication of Temperatures (100) — Prunary and Secondary Ef
fects of Cold (100) — EffcQts of Peripheral Irritation (102) —
The Effects of Cold upon the Skin (104) — i. Contraction of
the Small Blood- Vessels (104) — 2. Decrease or Suspension of
Perspiration (105) — 3. Decreased Heat Elimination and
Increased Heat Production (105) — 4. Diminished Tactile Sen-
sibility ^(106) — The Effects of Cold upon the Circulation (107) —
The Effects of Cold upon Respiration (no) — Respiratory Move-
ment (no) — CO a Elimination (in) — The Effects of Cold
upon the Muscles (in) — The Muscular Sense. Muscular Irri-
tability (in) — The Involuntary Muscles (112) — The Effects
of Cold upon the Nervous System (112) — The Neuron (113)

— Nervous and Mental Activity (114) — Reflex Effects of Cold
Applications (116) — Special Effects of Applications to Muscu-
lar Reflex Areas (117) — Special Skin Areas in Reflex Re lation
with the. Internal Viscera (117) — Summary of Methods for
Reflexly Influencing the Internal Viscera (119) — The Effects of
Cold upon the Blood (120) — The Effects of Cold upon Absorp-
tion (121) — The Effects of Cold upon Secretion and Tissue

COHTENTS.

inu

I

Ommge (til) — The Effects q/ Ce/d upon Exereimn (124) —
!%€ Ejfrit$ &/ Coid AffpikatwHS upon Temperaiurt (125) —
PrDlonged Cold mod Suppressed Reactioo (127) — Tlie Elfects
€j| Local Cold Applicatioas upon Uie Body Temperature (1^7)—
The Efftcii &f Cpid up&m Ike TherfHo-EUcMcai Curnnis of the
Tmufi (129^ — Th£ Phefuime'na tmd Raii&mile a/ Rmcii&n (129)
^ Suppression of Reaction (139) — DefioilioD of Reaction {130)

— The Reaction of Cdd (130) —Second Reaction (lit) —
Incomplete Reaction (ija) — Cooditions That Favor Reaction
(133) ^ Cooditiona that Discourage Reaction (134) — Thennic
Reaction (135) — Modifications of Thennic Reaction (136) —
CounterbalaDcing Reaction (i5S)^-^ Thermic Reaction a Useful
Indicator (139) ^Thermic Reaction and Metabolism (140) — The
fVtysi&i&gicmi EffecH #/ Hemt (141)— Heat & Vital Stimulant
(142) — The Effects of Heat upon the Skin\\At%) — i. Dilatation
o{ the Capiliary VesseU (142)^2. Increase of Cutaneous
SecretioQ and Respiration (144)^ — B* Increased Loss of
Heal by the Skin (145)-— 4. Decrease o! Tactile Sensibility
i'45) — 5* Preparation of the Skin for the Application of
Cold ((46) — The Effects of Heat upon the Circulation (146)
— ^locreaied Activity of the Heart {i^j)-^Tke Effects of
fie^i uppn ih^ Respiration (149) — The Effects of Neat upon
the Muscles H50) — Lessened Irritability of the Voluotary
MBScJeo (150) — Increased Irritability of Involuntary Mus*
cka (152) — The Effects of Heat upon the Nervous System
(151) — Heat Stimulates Frotoplasniic Activity (153] — ReBex
Effects Produced by Hot Applications (154) — The Effects of
Hemtupon the Blood (1^6) « The Effects of Heat upon Nutri^
H^m (156) — The Effects of Heat upon the Stomach, Li^ftr^ and
OtJUr Digestive Organs (15K) — The Effects of Heat upon Body
Temperature and Heai Production ( 1 58) — Reaction Following
M Apfpl' ' H^cii (159) -^ The Neutral Bath (160) — The
^firU v. Ud Hot and Cold Applicatiom to the SJtin (161)

— Tb© Scotch Douche (161} — General Vital Reactions Result*
img fr^m Hydric Procedures {\bt) -^ Summafy of Organic
Changes Prpiiuced by Heat and Cold (163),

Tlie Ptiyslolof icat Effects of Friction ar Mechanical Irrl-
tatioa of the Skin,

FrictioD (1164) — fhywalugical Effects {164) — Dermograpbism
The PhyslQlocicai Effects of Light,

164

16S

XIV CONTENTS.

PART TWO.
The General Principles of Mydriatics, i8i

Summary of the\Physiological Effects of Cold Applications (i8i)

— General Effects (i8i) — Effects upon the Skin (iSi) —
Effects upon the Circulation (182) — Effects upon Respiration
(182) — Effects upon the Muscles (182) — Effects upon the Nerv-
ous System (183) — Reflex Effect of Cold Applications (183)
The Blood (184) — Effects upon Absorption, Secretion, and
Nutrition (184) — Effects upon Animal Heat and Temperature
(185) — Summary of the Effects of Hot Applications (185) —
General Effects (185) — Effects upon the Skin (186) — Effects
upon the Circulation (186) — Effects upon Respiration (187) —
Effects upon the Muscles (187) — Effects upon the Nervous
System (187) — Effects upon the Blood (188) — Effects upon
General Nutrition (188) — Effects upon the Stomach, Liver,
and Other Abdominal Organs (188) — Effects of Hot Applica-
tions upon Heat Production and Body Temperature (188) —
Comparative Summary of the Chief Effects of Cold and
Heat (188).

The Therapeutic Effects of Hydriatic Applications, . 190

Classification of Hydriatic Effects (191) — General Principles (192)

— Respecting Hot Applications (192) — Respecting Cold Appli-
cations (193) — Respecting Neutral and Intermediate Applica-
tions (193) — I. Excitant (Action) Effects (194) — A. Primary
Excitant Effects (194)— General Primary Excitant Effects (194)

— When to Employ Excitant Measures (196) — Contraindica-
tions (197) — Hemostatic Effects (197) — Indirect Hemostatic
Effects (198) — Hydriatic Heart Tonics (200) — Uterine Exci-
tation — Emmenagogic Effects (206) — Vesical Excitation (206)

— Intestinal Excitation (206) — B. Secondary Excitant (Reaction)
Effects (207) — Restorative Effects (208) — Tonic Effects (209)

— Cold Water vs. Medicinal Tonics (2 10) — Nervous Energy
(211) — Cold Water a Physiological Tonic (212) — Tonic Effects
of the Cold Bath Due to Repetition (213) — Indications for
Tonic Applications (215) — Suggestions and Precautions Re-
specting Cold Applications (216) — The Cold Douche to the
Chest to Be Avoided (218) — The Cold Bath in Anemia (218)—
The Tonic Bath in Cerebral Congestion (220) — The Tonic
Bath in Hypochondria and Rheumatism (221) — Calorific Effects
(222) — Sudorific Effects (223) — Importance of Attention to the

CONTENTS. XV

Skin in Chronic rHaeases (224) — Neglect of Heatti^ Prooe-

dares by Hydrotberapeatists (225) — Alterative or Spoliattve

£8ects (227) — Hot Baths Must Be Used Carefully ill' Dropey

(228)— The Hot Bath in Bright's Disease (229) — The Sweat*

ingBathin Dropsy (231) — The Cold Bath in Renal Disease

(ill) —The Sweating Bath in Icterus (254) — Sorgical Uses of

the Sweating Bath (234) — Depurative or Eliminattve Effects

(235)— Eliminative Baths in Toxemia (236) — Ei^iectoraot

Effects (237) — Diuretic Effects (238) — Cbolagogie Effects

(239) — Peptogenic Effects (239) — Emmenagogic Effects (240)

— Revulsive and Derivative Effects (241) — Fluxkio (242;^
Revulsive Methods for Combating Superficial Anemia ^242)

— Methods Adapted to Anemia of Deep-seated Organs (243) —
Mydriatic Measures for Relief of Deep Congestions (245) —
Simple Revulsive Effects (247) — Revulsion by Means of Hot
and Cold Applications (250) — Revulsion as an Analgesic
Measure (251) — Analgesic Effects of the Scotch Doocbe ^252)
—The Hot and Cold Compress of Wintemitz (252) — General
Revulsive Effects (253) — Derivative Effects (254I ^ Uemjihtai
Effects (257) — Alterative Effects (257) — Calorific Effects
(258) ~C. Sedative Effects (260) — Sedatives of the Ctrcnla-
tory System (262) — Sedative Applications Useful Only When
Well Borne (263) — Nerve Sedative EttecU (264) ^ Local Anal-
gesic Effects (265) — Hemostatic Effects (271) — Anesthetic
Effects (271) — Antispasmodic Effects (271) — Antiphlogistic
Effects (^72) — General Antiphlogistic Effects (2bo>— Use of
Cold in Pneumonia, Pleurisy, and Other Acute Dm/rdet% (26 tf

— Antithermic Effects (283) — Antipyretic Effects (287^ —
Effects of Cold on the Heart in Typhoid Fever izbH) -— Auiipy'
retic EffecU of Hot Applications (288) — Relation of Heat Fro-
duction and Heat Elimination to Antipyretic Methods (289) —
Heat Elimination by Evaporation from the Skin (290) — Indi'
cations of a Condition of Increased Heat Production (29 1^ —
Symptoms Indicating Decreased Heat Elimination (291; —
Principles That Govern the Application of Hydriatic Measures
for the Reduction of Temperature in Fevers (293) — Metliods
That May Be Efficiently Employed in the Various Morbid C<m'
ditions Accompanied by a Rise in Temperature (295) — i. The
Cold or Tepid Affusion (295) — 2. The Cold Immersion Bath
(296) — Therapeutic Substitutes for Alcohol (297) — 3, The
Cold Friction Bath (301) — 4. The Tepid or Neutral Bath (y/2f

— 5. The Graduated Bath (30^) — 6. The Cooling Wet- Sheet

xvi CONTENTS.

Pack (304) — 7. The Cold Shower Pack (305) — 8. The Cold
Compress (306) — 9. The Cold Sponge Bath (307) — 10. The
Wet-Towel Rub (307)— 11. Cold Wet Friction (308)— 12. The
Cold Evaporating Sheet (308) — 13. The Hot Evaporating
Sheet (309) — 14. The Hot Sponge Bath (309) — 15. The Hot
Blanket Pack (310) — 16. Fomentation to the Spine (311) — 17.
Fomentation to the Abdomen (311) — 18. The Hot and Cold
Bath (312) — 19. Cold Applications to the Head, Spine, Heart,
and Abdomen (313) — 20. The Cold-Air Bath (313) — 21. The
Graduated Compress (317) — 22. Water-Drinking (318) — 23.
The Tepid or Cold Enema (318) — 24. Partial Cold Applica-
tions (321) — Conditions Giving Rise to Elevation of Tempera-
ture (321) — Suggestions and Cautions Respecting the Use of
Water for Antipyretic Effects (329) — Conditions in Which
There Is Disturbance of the Heat- Regulating Functions with
Depression of Temperature (334) — Contraindications for the
Cold or Brand Bath (335) — i. Sweating (335) — 2. Goose-
Flesh Appearance (336) — 3. Cyanosis (337) — 4. Pronounced
Cardiac Weakness (337) — 5. Myocarditis (338) — 6. Intestinal
Perforation (338) — 7. Peritonitis (338) — 8. Pleurisy and
Pneumonia (339) — 9. Tuberculosis (339) — 10. Infancy (339)
— II. Old Age (339) — 12. Late or Neglected Cases (340).

General Rules, Principles, and Suggestions Relating to

the Practical Employment of Hydrotherapy, 343

General Directions for the Use of the Cold Bath (344) — The
Therapeutic Significance of Reaction (346) — Conditions that
Control Reaction (347) — Oscillatory Reaction (347) — Suppres-
sion of Reaction (348) — Exercise in Connection with Mydriatic
Applications (348) — Exercise before the Bath (349) — Exercise
after the Bath (350) —Avoid Excessive Heat (353) — A Thorough
Scientific Examination Necessary as a Foundation for a Mydri-
atic Prescription (354) — Physical Coefficients (356) — Adapta-
tion to Individual Cases (358) — Organotherapy and Sympto-
matic Treatment To Be Avoided (359) Exaggeration of Symptoms
under Treatment (361) — Why Real Progress Must Be Slow
(363) — General Indications and Contraindications (369) —
Nervous Disorders (369) — Cardiac Diseases (371) — The Field
of Hydrotherapy (373) — The Method of Graduation (377) —
Training by the Scotch Douche (378) — Incurable Maladies

(381) — Untoward Effects of Hydrotherapy (382) — Headache

(382) — Vertigo (383) — Insomnia, Palpitation, etc. (383) —

)

CONTENTS. xvii

Neurasthenia and Hysteria (384) — Taking Cold (384) — Rheu-
matic Pains ; Skin Disease (385) — Crises or Fever of Reaction
(385) — The Hygienic or Prophylactic Employment of Hydro-
therapy (388) — Cold Bathing in Infancy and Early Childhood
(390) — The Cold Bath for Adults (390)— The Cold Bath for
WcMnen (391) — The Cold Bath in Old Age (392) — The Sweat-
ing Process (393) — The Neatral Bath (395) — Precautions (396).

Hydriatic InsUtutions and Their Equipment, end tlie

Oenerml flanagement of Cases, -397

General Rules and Suggestions (403) — The Average Tempera-
ture of Baths (422).

PART THREE.

The Technique of Hydrotiierapy, 423

Douches (426) — Localized Douches (428) — Visceral Douches
(428) — The Horizontal Jet (432) — The Hot Douche (446) —
The Neutral Douche (451) — The Percussion Douche (453) —
The Scotch Douche (456) — The Graduated Scotch Douche
(459) — The Simultaneous Scotch Douche (460) — The Revul-
sive Douche (466) — The Alternate Douche (470) — The Rain
Douche or Shower Bath (472) — The Horizontal Rain Douche
or Spray (479) — The Ascending Douche (480) — The Caliper
Douche (481) — The Collar Douche (482) — The Fan Douche
(483) — The Filiform Douche (485) — The Fog Douche (486) \ ,^^

— The Massage Douche (486) — Localized Douches (49 1) — The
Cephalic Douche (493) — The Dorsal or Spinal Douche (495)

— The Lumbar Douche (496) — The Shoulder Douche (497) —
The Thoracic Douche (497) — The Epigastric Douche (498) —
The Hypogastric Douche (499) — The Abdominal Douche (500)

— Douche to the Feet (501) — The Plantar Douche (502) —
The Perineal Douche (503) — The Anal Douche (504) — Visce-
ral Douches (505) — The Cerebral Douche (506) — The Cerebro-
spinal Douche (507) — The Pulmonary Douche (508) — The
Cardiac Douche (509) — The Gastric Douche (509) — The
Enteric Douche (510) — The Hepatic Douche (510) — The
SplenicDouche (511) — The Renal Douche (512) — The Genito-
urinary Douche (513) — The Articular Douche (513) — The
Ikfuscle Douche (514) — The Vapor Douche (515) — The Affu-
sion, *Pail Douche, or Pouring Bath (515) — The Immersion
Bath (522) — The Cold Plunge (523) — The Full or Immersion

XVlil CONTENTS.

Bath (526) — The Cool or Cold Full Bath (527) —The Cold Full
Bath as a Hygienic Measure (531) — The Cold Bath an Anti-
dote for Alcoholic Intoidcation (533) — The Graduated Bath
(535) — The Tepid Immersion Bath (538) — The Hot Immersion
Bath (539) — The Neutral Bath (548) — The Continuous Bath
{556) — The Effervescent Bath (562) — The Surge Bath (567)

— Sea Baths (567) — Mud Baths (569) — The Brand Bath (569)

— The Question of Alcohol with the Cold Bath (586)— The
Shallow Bath (594) — The Wct-Sheet Pack (600) — The Cool-
ing Pack (615) — The Cold Shower Pack (616) — The Sweat-
ing Pack (617) — The Dry Pack (619) — The Half- Pack (622)

— The Hot-Blanket Pack (623) — The Evaporating Sheet (625)

— Wet-Hand Rubbing (627) — The Sponge, Ablution, or Towel
Bath (634) — The Salt Glow (641) — Cold Friction (642) — The
Cold Towel Rub (647) — The Wet-Sheet Rub and the Dripping
Sheet (653) — Dry Friction (663) Percussion (681) — Dry Sham-
pooing (683) — Oil Rubbing (684) — The Hot-Air Bath (687) —
The Local Hot- Air Bath (692) — The Turkish Bath (694) —
The Russian Bath (698) — The Vapor Bath (701)— The Local
Vapor Bath (706)— The Electric- Light Bath (707) — The Sun
Bath, or Insolation (722) — Locator Partial Mydriatic Measures
{y24) — Cutaneous Areas Which May Be Utilized for Derivative
Effects (733) — The Cold Foot Bath (753) — The Shallow Foot
Bath (755) — The Running or Flowing Foot Bath (755) — The
Hot Foot Bath (756) — The Alternate Foot Bath (758) — The
Leg Bath (758) — The Arm Bath (759) — The Hand Bath (760)

— The Partial Continuous Bath (760) — The Sitz Bath (761) —
The Cold Sitz Bath (762) — The Prolonged Cold Sitz Bath (764)

— The Cold Rubbing Sitz Bath (767) — The Very Hot Sitz Bath
(769) — The Neutral Sitz Bath (770) — The Compress (771) —
The Very Cold Compress (772) — The Cold or Cooling Com-
press (780) — The Cooling Coil (787) — The Evaporating Com-
press (788) — The Irrigating Compress (789) — The Proximal
Compress (790) — The Fomentation (791) — The Hot- Water
Bag (812)— The Syphon Hot-Water Bag (812) — The Thermo-
phore (813) — The Mustard Fomentation (814) — The Neutral
Compress (814) — The Alternate Compress (816) —The Revul-
sive Compress (818) — Alternate Applications to the Spine (820)

— Alternate Applications to the Head (823) — The Heating
Compress or Pack (824)— The Wet Girdle (827) — The Ab-
dominal Heating Compress (835) The Dry Abdominal Bondage
(838) — The Head Pack (839) — The Spinal Pack (839) — The

CONTENTS.

XIX '

Hot and Cold Compress (840) — The Hot aad Cold Head Coiq
press (843) — Tbe Hot and Cold Lung Compress (844) — The
Hot aed Cold Renal Compress (846)— -The Hot and Cold Gas-
tro- Hepatic Compress (846)— The Hot and Cold Ititt^stlnal
Cosiipr^&s (847) — The Hot aud Cold Pelvic Compress (847) —
Tljc Hot aod Cold Heating Compress or Pack (847) — TUe Hot
and Cold Chest Pack (849)-- The Hot and Cold Abdominal
Pack (84gJ — The Hot and Cold Lumbar Pack (S51I — Tbe
Hot mud Cold Spinal Pack (8511— The Hot and Cold Pelvic
Pack (851) — Special Forms of Compress {853) — The CephaJic
CoatiN^ess (853)— The Cold Spinal Compress {8 56)— The Che^
Pack (857) — The S<|uare Chest Pack (858) — The Triangular
Cbeel Pack (859) --The Towel Chest Pack (860)^ The Half
Chest Compress (86 1) — The Hot Chest Pack (S64) — The
throat Compress (865)— The Neck Compress (866) — The
Precordial or Cardiac Compress (867) — The Joint Compress
jaj3)_Tiie Cotton Poultice tSyi) — The Hip Pack (873) — The
Pdvic Pack (873) — The Leg Pack (879) — The Foot Pack (880J
—The Perineal Compress (88i) — Irrigation (881) — Irrigation
oi The Ear (88t) — Nasal Irrigation (882) — Post Nasal Irriga-
tioo 188 3I — Irrigation of the Eye (883) — Irrigation of the
Throat (S83I — Irrigation of the Stomach, or Gastric Lavage
I^J^The Water Emetic (890) — Irrigation of the Colon —
tlie Eoema (891) — The Coloclyster, or Eateroclyster {897) —
The Graduated Enema {90 1) — Rectal Lavage, or Irrigation
(902) — Irrigation of the Bladder (903) — Irrigation of the
Urethra (907)— Vaginal Irrigation (908) — Intra^uterine Irri*

I g^Hoxi i9t2)^lfeAtis of Making Hot, Cold, and Alternate Ap<
plicalioDs to the Mucous Passages (9 r3} — Steam Inhalation
(915) — The Sieani Jet (919)— Water Drinking (920) — Ei^c^
iridty as a Camp/mmenf ta Hrdmiherapy in the Treatment &f

I Ckr»mu iMM^ai£ (934) — The Elcctrohydric, or Electro -thermal
' tfO'vapor Bath (947)^ — Thermo-electric Bath

1^^ . . '. Lrietnkal Bath {i}j^^) ^ Massage mitk lfydr<^-

iktr^^f (949) — Friction (950) — ^Percussion (gsr) — General

\\^^ MisceUanroHs ^^rMi (954) ^Emollient Baths

uiie Baths (954) — Saline Baths (935) — Pine-

0 BatrM955>-= Mustard Bath (956)— Alcohol Sponge

Bath (956)— The Salphur Bath (956) — The Carhon Dioxide

r&alb (956)— The Air Bath (959) — The Outdoor Bath (960)
;! Bath {96 2) — The indoor Air Bath (963) — The Air
^H Fan Bath<9f>i).

XX CONTENTS.

PART FOUR.
Hydriatic Prescription iVlaking 964

The Natural Defenses of the Organism (965) — Procedures for
Increasing Vital Resistance (968) — Procedures Which In-
crease Oxidation (971) — Procedures Which Excite the Central
Ganglia (972) — Measures Which Encourage General and Local
Metabolic Processes (973) — Procedures Which Increase Gen-
eral Blood Movement and Local Blood Supply (974) — Meas-
ures Which Increase Heat Production (975) — Measures
Which Increase the Elimination of Heat (975) — Measures
Which Relieve Pain and Nervous Irritability (976) — Measures
Which Combat Bacterial Development (976) — Means of Con-
trolling Blood Movement and Volume (977) — Measures Which
Lessen Heat Production (977) — Measures Which Lessen Heat
Elimination (977) — General Metabolic Activity Is Diminished
(978) — Hydriatic Incompatibilities (978) — The Adaptation of
Hydriatic Prescriptions to Individual Diseases (979) — Typhoid
Fever (979) — Malarial Fever, Remittent, Intermittent (990)

— Scarlet Fever (994) — Measles (996) — Erysipelas (997) —
Smallpox (998) — Cerebrospinal Meningitis (999) — Mumps
(1000) — Diphtheria and Tonsilitis (looi) — Lobar Pneu-
monia (1003) — Acute Articular Rheumatism (1006) — Chronic
Rheumatism (1009) — Typhus Fever (loio) — Yellow Fever
(ioii)^Influen2a, La Grippe (10 12) — Cholera (1014) — Dengue,
Breakbone Fever (1015) — Plague (1016^ — Complications
Common to Acute Febrile Disorders ( 10 17) — Pulmonary
Tuberculosis (1019) — Tuberculosis of the Lymph Glands,
Scrofula (1020) — Whooping Cough (1021) — Lithemia, Uric
Acid Diathesis (1021) — Gout (1023) — Acute Muscular Rheu-
matism (1025) — Diabetes (1025) — Obesity (1027) — Emacia-
tion (1028) — Rachitis, Rickets (1029) — Scurvy, Purpura (1029)

— Acute Gastric Catarrh (1030) — Chronic Gastritis (1030) —
Hypopepsia and Apepsia (1032) — Hyperpepsia (1032) — Dila-
tation of the Stomach (1033) — Constipation (1035) — Enterop-
tosis (1037) — Gastric Ulcer (1038) — Nervous Dyspepsia
(1039) — Acute Gastro-intestinal Catarrh in Children, Cholera
Infantum, Summer Diarrhea (1040 — Chronic Intestinal
Catarrh, Diarrhea (1041) — Acute Dysentery, Colitis (1042)

— Chronic Dysentery, Chronic Colitis (1042) — Cholera
Morbus (1042) — Appendicitis (1043) —Jaundice (1043) — Cir-

XXIV LIST OF ILLUSTRATIONS.

Fig. Pack.

32. Diagram of Author's' Douche Apparatus .... 427

33. The Douche — Horizontal Jet 434

34. Broken Horizontal Jet 454

35. Diagram of Author's Percussion Douche Nozzle . 453

36. Percussion Douche 454

37. Rain Douche 47^

38. Combined Rain Douche, Horizontal Jet, and Multiple Cir-

cular Douche 473

39. Combined Rain Douche and Bath Tub .... 476

40. Horizontal Rain Douche or Spray • . . . . 479

41. Spray Nozzle 479

42. Ascending Douche 480

43. Caliper Douche 481

44. Circle Douche 482

45. Fan Douche 483

46. Fog Douche 486

47. Massage Douche 486

48. Cephalic Douche 493

49. Dorsal Douche 495

50. Lumbar Douche 496

51. Abdominal Douche 500

52. Plantar Douche 502

53. Hepatic Douche 510

54. Splenic Douche 511

55. Normal Fatigue Curve of Man Aged Twenty-four Years 514

56. Fatigue Curve of Same Subject after a Cold Douche . .514

57. Vapor Douche 515

58. Affusion 515

59. Local Affusion 517

60. Affusion Pail 518

61. Plunge Bath 523

62. Immersion Bath 526

63. Improvised Immersion Bath 526

64 (a). Japanese Bath Tub Containing Heating Oven . 541

64 (b). Japanese Bath Tub with External Heating Chamber 541

65. Bathing at Leukerbad, Switzerland 552

66. Continuous Bath 556

67. Outline of Dilated Heart (a) before Treatment, (b) ^fter

Treatment 566

68. Outline of Dilated Heart (a) before and (b) after Effer-

vescent Bath 566

69. Outline of Dilated Heart (a) before and (b) after Treat-

ment by Effervescent Bath 566

USrr OF ILJ^USTKATIOlfS.

7a Surge Bath ^

7L Brand Bath . . 369

72 faj. Shallow Bath — First step 51^

72 f bj. Shallow Bath — Second step 5^ |

73. Standing Shallow 5|6 |

7+ Wct-shcct Pack — First step tei \

75. Wct-shcct Pack — Second step tei \

TdWct-shect Pack — Third step ksk\

Th Wct-shcct Pack — Fourth step 60c

78. Wct-shcct Pack — Fifth step 601 ,

79. Wct-shcct Pack — Sixth step 601

80. Wct-shcct Pack — Seventh step foi

81. Wet-sheet Pack — Eighth step, application complete .601

82. Method of Protecting Shoulders of Feeble P^dccts . . 6k6

83. Shomer Pack 617

84. Shower Pack 6kS \

85. Half Pack ^02 :

8S. Hot Blanket Pack 603 |

87. Wringing Blanket for Hot Pack 624 I

88. Eraporating Wet Sheet ^ ^

89. Evaporating Sheet — Exnplo3riiig Electric Fan . . 6i0C^ \

90. Wet-hand Rub (faj

91. Wet-hand Rub — Protection of Hair and Ears ^r;

92. Wet-hand Rub — Drying Arm 6iai

93. Sponge Bath f/^

94. Sponge Bath in Bed ^

95. Salt Glow f^

96. Cold Mitten Friction ^42

97. Friction Mitt ^^

98. Cold Mitten Friction to Arm ^4^

99. Cold Towel Rub to Ann <4r>

lOD. Cold Towel Rub to Arm — Patient Holduig Ton»^ . ^^ry

loi. Cold Towel Rub to Chest and Abdomen ^

102. Cold Towel Rub to Leg <4r>

105. Cold Towel Rub to Back — Patient Ucldtmg Irjwtl :-

Place ^

104. Cold Towel Rub W/

105. Cold Towel Rub to Feet ^.-r.

loS. Drying Patient after Cold Towel Rub . . . , ^^c

107. Dr^-ing Patient after Cold Towel Rub 'C^c
Ifl8. U'ct-sheet Rub — Sheet Ready for Wetting - ^-«^

109. Wet-$bcct Rub — Wringing Sheet . . . - <^4

XXVi LIST OF ILLUSTRATIONS.

fiG. PaGS.

no. Wet-sheet Rub — Applying Sheet 654

111. Wet-sheet Rub — Finishing Application of Sheet . . 654

112. Wet-sheet Rub 654

113. Friction of Spine 663

114. Centripetal Friction 664

115. Circular Friction 664

116. Spiral Friction 664

117. Rotary Friction 665

118. Friction — Emptying Veins of Forearm .... 665

119. Friction — Emptying Veins of Forearm . . 665

120. Friction — Emptying Veins of Upper Arm . . 665

121. Friction — Emptying Veins of Leg .... 665

122. Cutaneous Areas which are Seat of Reflex Pain. (Dana) 677

123. Cutaneous Areas which are Seat of Reflex Pain. (Dana) 677

124 (a). Percussion — Tapping 681

124 (b). Percussion — Clapping 681

124 (c). Percussion — Hacking 681

124 (d). Percussion — Beating 681

125. Dry Shampoo with Flesh Brush 683

126. Friction with Hair Glove 683

127. Hot-air Bath 687

128. Hot-air Bath in Bed 688

129. Local Hot-air Bath Applied to Knee Joint . . 692

130. Turkish Bath — Shampooing 695

131 (a). Vapor Bath 701

131 (b). Vapor Bath in Bed 701

132. Portable Vapor Bath 702

133. Electric-light Bath 707

134. Horizontal Electric-light Bath 708

135. Electric-light Bath for Spine 708

136. Electric-light Bath for Trunk 708

137. Electric-light Bath for Feet and Legs .... 708

138. Electric-light Bath for Joints 708

139. Electric-light Bath and Cold Douche Combined . . . 709

140. Arc-light Bath (Kellogg) 711

141. Finsen's Apparatus for Phototherapy . . . .721

142. Lens-bottle for Filtering out Heat Rays . . . 721

143. Cooling Compressor 721

144. Case of Lupus before Treatment (Finsen) . . 721

145. Case of Lupus after Treatment (Finsen) . . .721

146. Sun Bath * .... 722

J47. Cutaneou*s Areas Reflexly Associated with Internal Viscera 725

LIST OF ILLUSTRATIONS.

xxva

14& Cutaneous Areas Reflexly Associated with Internal Viscera

149. Diagram Showing Collaterally Related Vascular Areas,

Skin Overlying Muscle, both Supplied by Common
Artery (colored) . . . . . ^ .

150. Hyperemia of Skin Produced by a Hot Application, with

Collateral Anemia of Underlying Muscle (colored)

151. Anemia of the Skin Produced by a Cold Application, with

Collateral Hyperemia of Underlying Muscle (colored)

152. Diagrams Illustrating Co-operation of Reflex and Fluxion

Effects (colored)

153. Diagrams Showing Co-operation of Reflex and . Fluxion

Effects in Pelvic Inflammation (ice-bag over uterus,

with hot hip and leg pack) (colored)
(a) Before Application, (b) During and after Applica-
tion of Cold

^54 (0). Diagram Illustrating Gastric Congestion (colored) .
154 (b). Diagram Illustrating Effect of Ice-Bag in Relieving

Gastric Congestion (colored) ....
'55 (<^)- Visceral Congestion (colored) ....
'55 W- Diagram Illustrating Influence of Hot and Cold Trunk

Pack Relieving Visceral Irritation and Congestion

(colored) ........

156. Cold Foot Bath

157. Leg Bath .

158. Arm Bath .

159. Elbow Bath

160. Partial Continuous Bath

161. Partial Continuous Bath

162. Sitz Bath

163. Cold Rubbing Sitz

164. Ice Cap .

165. Aluminum Cooling Coil to
Irrigating Bag to Head
Ice Bag to Head .
Diagrams Illustrating Superficial Fluxion Effects from Hot

and Cold Applications (a) and (b) Cold Compress, (c)
and (d) Fomentation (colored) ....

Diagrams Showing (a) Pulmonary Congestion, (b) Bene-
ficial effects of Cold Chest Compress (colored)

Aluminum Cooling Coil .......

Evaporating Cephalic Compress . . . , .

(Langenbeck)

166,
167.
168.

169.

Head

170.
171.

Pack.

731

731

731

732

732

732
732

732
732

732
753

758
759
759
761
761
762

763
772
772
772
772

784

784

787
788

XXVUl

LIST OF ILLUSTRATIONS.

Fka
172.

173-
174.

175-
176.
177.
178.
179.
180
180
181.
182.

183.
184.
185.
t86.
187.
188.
189.

190.
191.
192.

193.
194.

195.
196.
197.
198.
199.

200.
201.
202.
203.
204.
205.
206.
207.

208.
209.

Irrigating Compress

Proximal Compress ....

Fomentation to Chest

WringingJ«'omentation Cloth in a Towel

Wringing Fomentation Cloth .

Hollow Cone for Application of Heat in Acne

Hot-water Bag ....

Application of Siphon Bag to Spine

(a). Alternate Applications to Spine

(b). Alternate Applications to the Head

Abdominal Heating Compress — Unprotected

Abdominal Heating Compress — Protected with Mackin

tosh

Wet Girdle . ...

Hot and Cold Head Compress

Hot and Cold Renal Compress

Hot and Cold Chest Pack .

Hot and Cold Abdominal Pack

Cold Cephalic Compress

Roller Chest Pack — First step

Roller Chest Pack — Second step

Roller Chest Pack — Complete

Roller Chest Pack — Complete

Square Chest Pack — First step

Square Chest Pack — Second step

Square Chest Pack — Third step

Square Chest Pack — Fourth step

Square Chest Pack — Complete

Triangular Chest Pack — Ready for appl

Triangular Chest Pack — Complete

Towel Chest Pack

Half Chest Compress

Half Chest Compress — Applied

Compresses for Throat .

Throat Compress — First step

Throat Compress — Second step

Neck Compress .....

Sphymographic Tracing Showing Effects

Compress, (a) Before Application.

cation ....
Joint Compress ....
Cotton Poultice

ication

Pagb.

789
790

791

793
793
809
812
812
822

823
824

82s
829

843
846

849
849
853
858
858
858
858
858
858
858
858
858
860
860
860
861

86'
865
865
865
866

of Cold Cardiac
(6) After Appli-

868
872
873

LIST OF ILLUSTRATIONS.

XXIX

Itaw

210, Hip Pack

211. Pelvic Pack — First step
21 z Pelvic Pack — Second step

213. Pelvic Pack — Third step

214. Leg Pack

215. Foot Pack

216. Irrigation of Ear

217. Irrigation of Eye ....

218. Gastric Lavage ....

219. Gastric Lavage — Emptying Stomach

220. Gastric Lavage — Withdrawing Tube

221. Gastric Irrigator

222. Enema Apparatus — Metal Fountain

223. Enema Apparatus — Siphon Bag

224. Bulb Syringe ....

225. Knee-chest Position for Coloclyster

226. Rectal Irrigator (Kellogg) .

227. Instrument for Cooling Prostrate

228. Instrument for Bladder Irrigation

229. Irrigator for Urethra and Bladder

230. Urethral Irrigator, Hydrophore of Schutz

231. Marble-covered Couch for Vaginal Irrigation
2^ Psychrophore (Wintemitz)

233. Hollow Sound for Making Thermic Applications to Uterus

234. Hollow Cylinder for Making Thermic Applications to

Vagina (Kellogg) ......

^35- Hollow Cylinder for Making Thermic Applications to

Rectum (Kellogg) .......

2^6. Steam Inhaler ........

2^2. Apparatus for Alternate Applications of Steam and Cold

Air to Face and Nasal Passages .....
2^ Steam-jet and Nozzle for Hemostasis (Kellogg) .

239. Gacertner's Tonometer .......

240. Gaeertner's Tonometer ......

241. Electrohydric Bath ......

242. Carbonic Acid Douche .•••..

243. Ombrophore (Winternitz)

244. Outdoor Gymnasium — Swimming Bath

245. Outdoor Gymnasium — Wood Chopping . . . .

246. Air Bath

247. Air Bath

248. A Corner in the Battle Creek Sanitarium Laboratory of

Experimental Hydrotherapy .....

Pack.

873
873
873
873
879
880
881
883
884
884
884

886

891
891
891
897

902
902

903
904
907

909
913
913

914
914

916

918
920

931
931
946

957
958
960
960

963
963

1 107

7* "

XXX LIST OF ILLUSTRATIONS.

Fig. Paob.

249. (Exp. 16.) Plethysmographic Tracing Showing Shrinkage

of Blood-vessels in Hand Produced by Ice Applied to
Opposite Hand 1114

250. (Exp. 17.) Sphymographic Tracing Showing Contraction

of Vessels of Arm Produced by Applications of Ice to
Axilla. (The application of cold across the trunk of an
artery produces contraction of its distal portions.) . 11 14

251. (Exp. 18.) Sphygmographic Tracing of Radial Pulse

Showing Contraction of Vessels of Forearm Resulting
from Application of Ice to Bend of Elbow . . .1114

252. (Exp. 19.) Plethysmographic Tracing Showing Diminu-

tion in Volume of Forearm Resulting from Application

of Ice to Elbow 1114

253. (Exp. 44.) Universal Dynamometer* (devised by the

author) 1122

254. (Exp. 44. Physical Chart Showing Effect of a General

Hot Bath in Diminishing Muscular Capacity . . 1123

255. (Exp. 45.) Mosso's Ergograph 1123

256. (Exp. 4S) Ergogram Obtained by Means of Mosso's

Ergograph, Showing Normal Fatigue Curve of a Young
Man, R. A. S 1123

257. (Exp. 45.) Ergogram Showing Fatigue Curve of R. A. S.

after a Spray at 113** for Fifteen Minutes . . 1123

258. (Exp. 45.) Ergogram Showing Fatigue Curve of R. A, S.

after a Cold Spray Following a Hot Bath . . .1 124

259. (Exp. 50.) Normal Fatigue Curve of A. E. L. . . 1125

260. (Exp. 50.) Ergogram Showing Fatigue Curve of A. E. L.

after Application to Forearm of a Douche at 60° for
One Minute 1125

261. (Exp. 54.) Normal Fatigue Curve of the Young Man

Who Was the Subject of the Experiment , . .1127

262. (Exp. 54.) Fatigue Curve Obtained from Same Subject

as Preceding after a Douche at 55° for Fifteen Seconds 1127

263. (Exp. 54.) Fatigue Curve Obtained from Same Subject

after a Douche at 115** for Five Minutes . . . 1127

264. (Exp. 55.) Normal Fatigue Curve of A. E. L. . . 1127

265. (Exp. 55.) Fatigue Curve of A. E. L. after a General

Douche at 60® for Three Minutes .... 1127

* This instrument is in use in the leading gymnasiums of the United States and
fn the Military School at West Point, and affords the only accurate means of esti-
mating the strength of all the principal groups of muscles of the body.

lAST OT^ II.X.USTRATIOHS. ZXXl

K Pacs.

266. (txp. g6a.^ Kormaik "Fatigue Curve of A. E. L. . . 1127
±j. {Ix^ ^(saS) FsLtigne Curve of A. E. L. after a General

Doacbe at sG"* for Fifteen Seconds . .1128

a6^ (Exp. sGa.") , Fatigue Curve of A. E. L after a General

Douche at 112' for Fifteen Minutes .... 1128
269. (Exp. sGb.^ Kormal Fatigue Conre of a Young Man, the

Subject oi the Experiment 1128

27a (Exp. 56b.') Fatigue Curve Obtained from Same Sub-
ject after Immersion Bath at 104^ for Twenty Min-
utes 1 127

271. (Exp. 58.) Normal Fatigue Curve of A. E. L. .1128

272. (Exp. 58.) Fatigue Curve of A. E. L. after General Hori-

zontal Jet at 55^ for Fifteen Seconds .... 1128

273. (Exp. 58.) Fatigue Curve of A. E. L. after Neutral Im-

mersion Bath I128

274. (Exp. 59.) Normal Fatigue Curve of W. P. L. . 1129

275. (Ejq). 59.) Ergogram of W. P. L. after Shallow Bath at

65' for Two Minutes 1129

276. (Exp. 60.) Normal Fatigue Curve of W. P. L. . 1129

277. (Exp. 60.) Fatigue Curve of W. P. L. after Wet-sheet

Pack at 60' for Twenty Minutes . .1129

mmkl HTDROTHERAPr.

Tart &nt^

HISTORICAL.

WATER is without doubt the most ancieot of all rtme-
dial agents for disease. This lact is evidenced by
the frequent reference to its use in the eariiest mtA-
ical literature, as well as by the habits and customs ct the
most ancient peoples as brought to lig^t more Inlty wilMm
recent years by the study of the old Assyrian and Egrptias
records. The reason for this is clearly to be fbond in the fact
that water is a means not only usoally found ready at hand,
but one which adapts itself to almost every imaginaUe patiio-'
logical condition in a remarkable manner, thns approaching
more nearly to a panacea than any other known remedy*
No other agent is capable of producing so great a variety of
physiological effects, no other is so universally present^ and
hence none is so readily adaptable for meeting the varioos
exigencies and indications arising from accident and disease.

The ancient Egyptians, Hebrews, Greeks, Per'
f^i»^>*^CT^py sians, and Hindus all employed water in the

treatment of disease, as do the representatives

of these peoples at the present time.

According to a Chinese record dating back

several centuries before Christ, a physician
prescribed for a woman of that country one hundred affusions
of ice- water, each followed by wrapping in a linen sheet, — a
treatment in principle resembling the wet-sheet pack.

SI

22 RATIONAL HYDROTHERAPY.

The Tokio Medical Journal (1881) states that the cold
bath has been in use in Japan for nearly eight hundred years,
especially among the native country physicians, and that
nearly three hundred years ago a small treatise on the med-
ical uses of the cold bath was published by Dr. Nakagami, in
which it was especially recommended for acute mania, hys-
teria, asthma, and convulsions in children.

Among the Spartans of ancient Greece cold bathing was
made obligatory by law. The bath in various forms is also
frequently referred to in Grecian mythology.

Hippocrates evidently had an excellent under-
on^^^Use standing of the physiological properties of

of Water. water, both hot and cold, which he employed

in the treatment of fevers, ulcers, hemor-
rhages, and a variety of maladies both medical and surgical,
giving many directions for its use which the experience of two
thousand years has not improved upon. For instance, he
directed that cold baths should be of short duration, and
should be preceded and followed by friction; and he evidently
understood the phenomena of reaction, since he records the
observation that after a cold bath the body quickly recuper-
ates its heat and remains warm, while a hot bath produces
the opposite effect.

Under the Romans the bath attained a very high degree
of development. Emperors vied with one another in erecting
magnificent public baths, capable of accommodating thousands
of persons daily. In studying the interesting ruins of some of
these structures at Rome and Pompeii, the author was aston-
ished to find the perfection attained in every detail of the
equipment of these ancient bathing establishments. Hot or
cold water baths, hot-air and vapor baths, might be enjoyed
at will.

Asclepiades employed water in nearly every form, — hot
and cold baths, douches, compresses, etc. One of his dis-
ciples, Antonius Musa, attained great fame by curing the
Emperor Augustus of a chronic catarrh by means of the cold

HISTORICAL. 23

bith, as a reward for iwliicli his statue was ordered to be
erected in the temple of Elscalapius ; but a lack of discrimi-
oatioo in the use of tliis po^iverf ul agent led to his downfall.
Beiog called Qpon to treat the emperor's nephew, Mar-
cdlos, a popalar f a.vorite, he adopted the measures which
had lesolted so a-dmir^bly in the cure of the athletic old
soldier, bat they proved too powerful for the effeminate
yoQth, and he ^was prostrated to such a degree that he
died soon after a.t Naples, where he had gone to receive
treatment at the hot baths of Baiae. This enthusiastic apos^
deo( hydrotherapy succeeded later in redeeming his reputa-
tion by the cure of the poet Horace.

Pastor Kneipp. the Bavarian water-cure empiric, a few
years ago had a similar experience. Being called upon to
visit the pope, who was suffering from chronic rheumatism,
he was received with great honors ; but the first cold bath
pftn the aged prelate, entirely unaccustomed to such heroic
treatment, occasioned such an exacerbation of his suffering^
that the poor priest was peremptorily dismissed in disgrace;
Had the patient been a sturdy young German peasant instead
of a feeble Italian gentleman, the prescription might have
sacceeded better. A similar lack of discrimination, whether
by a charlatan or a legally qualified practitioner, is always
attended by disastrous results. The untoward effects thus
produced should not, however, be attributed to scientific
hydrotherapy, but must be charged to the «6tupid audacity of
quackery, or to the lack of information or experience of the
otherwise competent physician.

According to Pliny, the bath was almost the
The Medical exclusive method of treatment employed in
^ ^1^ Romaiis Ronic during five centuries. Celsus and other
mmi Affste. prominent Roman physicians highly extolled

the bath in their works, Celsus later making
it one of the three essentials of what he called a perfect
therapeutic system, termed •* apotheraphia,** the other two
being exercise and friction.

24 RATIONAL HYDROTHERAPY.

During the middle ages the Arabic physicians, the most
learned men of their time, were enthusiastic advocates of the
bath, especially in fevers, and their directions for the treat*
ment of smallpox and measles could scarcely be improved
upon at the present time. Rhazes recommended drinking
ice-water to the extent of two or three pints within half an
hour, as a means of reducing the temperature in fevers. Avi-
cenna recommended cold water for the relief ot constipation.

M. Barra, of Lyons, published in 1675 an interesting little
volume entitled, **L* Usage de la Glace, de la Neige, et du
Froid" (The Use of Ice, of Snow, and of Cold). In this work
the author anticipated many of the therapeutic uses of cold
which have, by scientific experiments within the last half
century, been placed upon a sound therapeutic basis. He
calls attention to the fact that the Hebrews made use of
melted snow for drink, and cooled water by exposing it to the
action of the wind, afterward keeping it in vessels covered
with straw. He pronounced cold water to be the best of all
remedies for continuous fever, and especially recommended it
for ''erysipelas, pestilential fevers, contagious boils, frost
bite, dysentery, pleurisy, the plague, inflammation of the
throat, and tightness of the stomach. "

Lanzani, an Italian physician, wrote an elaborate thesis
on the internal use of water for the treatment of fevers, in
the early part of the last century. Fra Bernardino, about
the same time, acquired the name of <<the cold-water doc-
tor " by the use of iced water in the treatment of indigestion,
nervous disorders, hemorrhages, etc. He required his pa-
tients to drink from three to six glasses of ice-water daily.
He avoided sweating, and aimed to stimulate the bowels
and kidneys.

We quote below a few interesting extracts

Use of W te ^^^^ ^ small work entitled, * * Primitive

150 Years Ago. Physick," by John Wesley, M. A., the founder

of the Methodist Church, published in 1747,

which aSord ample evidence of the existence at that period

HISTORICAL.

25

1^ the comrnon people of a very considerable amount of
howJedge respecting the use of water in a variety of ail-
iFJetJts, as iveJl as for the preservation of health, since the
Emedies recotn mended in Weslej's work were all such as he
fooad in successful use among the people.

fffr a^ue or inttrmitteHi /€%*er, '*go into the cold bath
JQSt before the cold fit " (this method is still in use in
GtmtEny and France); or» " drink a quart of cold water just
before the cold fit, and then go to bed and sweat,"

F^r a tertian agur^ it is recommended to "use light and
spaiing diet on the day between," ••or use the cold bath
f unless you are of advanced age or extremely weak [a wise
(ifccaation, showing no little experience]). But when you use
tUs, cm ai^y account whatever* it is proper to go in cool ; to
immerge at once, but not head foremost ; to stay in only two
or three minutes (or less at first); never to bathe on a full
ttotiaach ; to bathe twice or thrice a week at least, until you
have bathed nine or ten times ; to sweat immediately after
it (going to bed), in palsies, rickets, etc/*

••Before the cold ftt begins, go to bed, and continue a
(mge sweat by [drinking] lemonade for six or eight hours.
This usually cures in three or four times. If it does not, uses
the cold bath between the fits/* The writer found this
method in ose among the laity of the western part of the
[United States more than a quarter of a century ago, and
with success in cases in which quinine and other antiperiod-
ics had failed to effect a cure.

For ap^phxy^ **to prevent, use the cold bath, and drink
ooty water.**

For asthma, *"tak€ a pint of cold water every morntng,
washing the head therein immediately after, and using the
cold bath once a fortnight/' ** For present relief, vomit with
a quart or more of warm water. The more you drink of it
the better/'

For drf ^r €0nvuish>e asikma, *^use the cold bath thrice
a week/'

26 RATIONAL HYDROTHERAPY.

* * To prevent swelling from a bruise^ immediately apply
a cloth five or six times doubled, dipped in cold water, and
new dip when it grows warm."

* * To cure a swelling from a bruise^ foment it half an
hour, morning and evening, with cloths dipped in water as
hot as you can bear."

For a bum or a scald, ** immediately plunge the part into
cold water. Keep it in an hour ; or if not well before,
perhaps four or five hours."

**7i? prevent the rickets, tenderness, and weakness [in
children], dip them in cold water every morning, at least
until they are eight or nine months old.'*

For whooping-cough, **use the cold bath daily."

For cholera morbus, "drink two to three quarts of cold
water, if strong, or of warm water, if weak."

For a cold, * * drink a pint of cold water lying down in bed. "

For colic, ** drink a pint of cold water, or a quart of
warm water, or [apply] hot water in a bladder, or steep the
legs in hot water, a quarter of an hour."

For hysteric colic, **use the cold bath. Using the cold
bath two and twenty times a month has entirely cured hys-
teric colic fits and convulsive motions."

For chronic headache, **keep your feet in warm water a
quarter of an hour before you go to bed, for two or three weeks. "

For headache from heat, * * apply to the forehead cloths
dipped in cold water, for an hour."

For one seemingly killed by lightning or suffocation,
** plunge him immediately into cold water."

For mania, •* apply to the head, cloths dipped in cold
water, or pour cold water on the head out of a teakettle, or
let the patient eat nothing but apples for a month."

For rheumatism, * * use the cold bath, with rubbing and
sweating."

For rickets, * * wash the child every morning in cold water. "

For sciatica, **use cold bathing and sweat, together with
flesh-brush twice a day; or drink half a pint of cold water
daily in the morning and at four in the afternoon."

HISTORICAL. 27

For st4me, to prevent its occurrence, ** drink a pint of
wann water daily just before dinner."

Fw swelling of the joints^ **pour on the part daily a
stream of warm water, or a stream of cold water one day
and warm water the next.*'

**It is also useful to use the hot bath a few days before
yoQ use the cold.'*

Wesley recommended cool bathing for the cure of nearly
all the affections of childhood, all chronic diseases, and
many surgical cases.

Although Wesley was not a physician, but simply de-
scribed in his work such successful remedies as he found in
common use, one can not but note the sagacity and wisdom
displayed in many of these recommendations, which in many
instances could scarcely be improved upon at the present day,
and certainly evince extended and accurate observation of
the effects of hydriatic applications.

CuUen made some very practical observations
€irfln*s Use . respecting the therapeutic uses of water. In
^J^**^ ^ his treatise on fever he commended water as a
sedative when used in such a manner as to
'* moderate the violence of reaction," and as a tonic when
used for ' * supporting and increasing the action of the
heart and arteries." The action of cold he described as
follows : —

1. Diminished temperature and pallor of the skin.

2. Weakened action of the heart and arteries, observing
that in cold countries the pulse is uniformly slow.

3. Weakness and inactivity, effects observable in the
inhabitants of cold countries.

4. Prolonged and very cold applications ' ' are capable of
entirely extinguishing the vital powers," cold combined with
moisture chilling the body much faster than dry cold.

5. Cold applications prepare the body for applications of
heat, • ' producing accumulation of sensibility to the stimulus
of heat"

28 RATIONAL HYDROTHERAPY.

Cullen used water according to Dr. Darwin's rule — ••to
warm the patient in the cold fit, and to cool him in the
hot one."

It is very interesting to observe how few of
our modern methods of employing water are
really new. The moist compress was well
known to the ancient Greeks under the name of •• epithem."
According to Sir John Floyer, who wrote in the latter part of
the seventeenth century, the wet-sheet pack was employed
in his time by sportsmen who wished to diminish the weight
of their jockies. The method is thus described : —

•• Dip the rider's shirt in cold water ; and after it is pot
on very wet, lay the person in warm blankets to sweat him
violently, and he will after lose a considerable weight, a
pound or two."

The same method was used in the treatment of various
maladies, particularly rickets in children. The child, being
prepared for bed with a gown and nightcap, was quickly
immersed in cold water, then put to bed closely wrapped in
warm blankets, and left in this condition all night, sweating
profusely, a portion of the clothing being removed toward
morning so that the body might be gradually cooled. That
it was the custom to employ this method with great per-
severance is evidenced by the following suggestion made
by the learned author: ''If one year's dipping proves not
successful, it is repeated the next year, which generally
answers expectation."

Floyer also mentions that in Staffordshire and other parts
of England it was a custom with the people **to go into the
water in their shirts, and when they come out, they dress
themselves in their wet linen, which they wear all day, and
much commend that for closing the pores and keeping them-
selves cool ; and that they do not commonly receive any
injury or catch any cold thereby, I am fully convinced from
the experiments I have seen made of it."

The leading features of the so-called ''Kneippism" are

HISTORICAL,

n

amply a revival of these nide practices of tgnorant English
peasants a century and a half ago.

ISif John Sinclair in his "Code of Health and Longevity/'
gives ao account of an English nobleman, born in the year
i;oo, who for a great part of his life was accustomed, imme-
diately on arising in the morning, to wrap himself in a sheet
jttit dipped in cold water — a wet-sheet pack.
In the fifteenth century, Savonarola, an Italian physician,
tnade a systematic use of the cold bath, and B^rizzi employed
the cold vaginal douche in uterine affections. Cold affusions
md general douches were employed by Baccio in Italy, while
lading Spanish and German physicians recommended cold
ippitcattons for insomnia.

Seplala, in the seventeenth century, employed the cold
Amche for the relief of headache and sunstroke*

Heraiaii. a Belgic physician, resorted to the use of cold
water at the same period for the relief of constipation,
nll^ne, paralysis, and mania, — maladies in the treatment
of which cold water still holds its own against all other
single retnedies.

Sir John Floyer, in 1697, published a history
HydmOi^rmpy q| ^^i^ bathing, in which he directed that the
patient should be made to sweat before taking
the cold bath, by wrapping him in a wet sheet with blankets,
precisely the same method employed more than a century
later by Priessnit^, and now known as the wet -sheet pack,
Floyer also erected a water-cure establishment at Litchfield,
England, in the latter part of the seventeenth century. Two
rooms were provided, one of which was used for hot baths
and dry packs to produce sweating, while cold baths were
administered in the adjoining room.

John Hancock published a work entitled **Febrifugum
Magnom/' in 1723, in which he demonstrated the value of
water^drinking as a means of treatment to scarlet fever,
smallpox, and measles. He cured ague by having the patient
dnak large quantities of cold water while wrapped in blan-
kcts^ thus inducing profuse sweating.

30 RATIONAL HYDROTHERAPY.

Sir John Chardin, a celebrated English traveler of the last
century, had bilious remittent fever when in Persia. His
companion, a French surgeon, thinking his case hopeless, a
native physician was called in, who made the patient fast five
days, and drink large quantities of water previously cooled
with snow, causing him to lie meanwhile upon a mat wet
with water, and keeping the skin constantly wet with water.
Water was also poured at intervals over the patient while
two men supported him. In two days the fever disappeared.

This Persian physician evidently had a knowledge of the
value of water-drinking, of the evaporating bath, and of affu-
sion as a means of combating fever, — invaluable measures, of
which Western physicians are scarcely yet making any con-
siderable practical use.

The native physicians of Mohammedan countries still gen-
erally follow Galen, and so make use of water in many mala-
dies in a very effective and practical way.

Two English physicians, Currie and Jackson,
P0j^^*^^ in the latter part of the last century, made a
Jackson. most intelligent and scientific study of the use

of water in fevers, and with results which for
a time commanded much attention from the profession in
England. Currie discovered many important principles rela-
ting to hydrotherapy, some of which have not always been
kept in mind by his successors in the use of water. For
example, he says that the indications for the use of water in
fevers, especially intermittent, are as follows : —

1. To diminish cold in cold stages.

2. To diminish heat in heat stages.

3. To diminish spasm of blood-vessels.

4. To support the powers of life till the diseased associa-
tions die away from the ceasing of their causes.

5. To unload the bowels.

He also advised cold water drinking in large quantities,
immersion instead of effusion in warm countries, where the
water is seldom at a lower temperature than 70^ F., and sug-

:sbnikll!e<
he oockd H^
oitlKi

bee

the heat of tlie

."^ He otserv^ tint a cold
saJdNrtiBn oold sposiging, for tlie
'an tJttupliL fODedr,^ asd ^*the srstem
abca aocxxiiiDodatcs itself to a cold vlixli is general and

from a cold vliicfa is dow and

occasioned by too mocfa
diat after tbe bath the patient
Aoild be diied '^hastily Mtdk toveis»'* and leoommended
that when too acieie effects had been obtained, cansinc too
gieat depiessioo, the extremities should be rubbed* and **a
bladder of hot water apfdied to the stomach.**

Canie also noted the erfl effects of reaction in fever, and
taught that diort coM applications should not be made in
cases of high fever, on account of their tendency to increase
the fever. He also taught that great mischief might result
bom the use of hot applications immediately after cold in such
eases. He made use of the ' ' wet blanket, ** or pack, in f eveis,
and observed that it relieved delirium. He also applied cold
to the feet in hemorrhage of tbe lungs, and in a case of pul«-
monaxy hemonhage suddenly plunged the patient up to the
hips in cold water, a method previously successfully used by
Dr. Darwin for relief of hemorrhage from the kidneys.

Even before the time of Currie, Crawford, in 1781, had
recognized as one of the physiological effects of cold, its
influence upon oxidation, observing that cold ' ' increases the
difference in color between arterial and venous blood, while
heat lessens this difference in color.'*

For some reason not easily understood, the work of Currie
and Jackson, the ablest of the early pioneers of a truly scien-

32 RATIONAL HYDROTHERAPY.

tific method of inestimable value in iebrile disorders, was lost
. sight of, and it was not until the attention of the whole
civilized world was attracted by tlie fame of an uneducated
and blundering, but still successful, cold-water empiric, that
the profession began to g^ve this agent the serious attention
that was its due ; for the modem popularity of water as
a remedy must without doubt be largely credited to the
enterprise and ingenuity of a Silesian peasant, Vincent
Priessnitz, born in the little village of Graefenburg, in Aus-
trian Silesia, in 1790.

At a very early period. Dr. Benjamin Rush,
"yjJ'^J?™Py of Philadelphia, used cold water with success
in the treatment of rheumatism, gout, small-
pox, measles, and many other maladies, including yellow
fever. Currie declares that he found cold water ''a most
agreeable and powerful remedy . . . applied by means of
napkins to the head, and to be injected into the bowels by
means of the clyster, also washing the face and hands, and
sometimes the feet, with cold water." In 1794 Rush intro-
duced the use of broken ice in a bladder applied to the head
in fevers, and claimed great advantage from the employment
of this remedy.

Drs. Bard and Hosack, of the New York Hospital, began
the use of cold water in fevers about the year 1795, three or
four years before Currie's book on the medical uses of water
appeared in America.

In 1799, Peter Edes, of Augusta, Me., published an inter-
esting little work on the use of water, summarizing Currie's
volume, and adding observations of his own.

Another American writer ingeniously su^ested, in 1808,
the employment of moistened clay as a cooling application
for inflamed and congested parts. He used cold in the early
stages of fever, but forbade its use in the latter stages.

Among the earliest scientific observations respecting the
effects of the bath as regards both the physiological and
the therapeutic effects of water, must be noted the careful

HISTORICAL. 33

opcriments conducted "by Henry Wilson Lockette, of Virginia.
These experiments vrere f>ublished by him in the year iSoi in
*'An InanguraV Dissertation on the Warm Bath, presented
•to the Trustees of tlie Medical Faculty of the University of
Pennsylvania for the Degree of Doctor of Medicine." In
this treatise, a copy of which the author is so fortunate as to
have in his library. Dr. Lockette details with great perspi-
cacity the eSects upon the pulse and general functions, of
baths of difierent duration at varying temperatures. Among
the observations that he made, were the follbwing: —

1. That a foot bath at i lo^ F. increased the pulse from 76
to 92 beats a minute, the redness of the l^s and the enlarge-
ment of the veins of the feet and legs and the slight but
temporary pain in the head showing clearly the exciting effect
of this treatment.

2. That a full bath at 107^ F. raised the pulse from 72 to
114 beats, producing congestion of the veins, drowsiness,
and profuse perspiration. The excitation continued for more
than a quarter of an hour after the bath.

3. That a bath at 96^ F. diminished the pulse from 79 to
64 beats in ten minutes, whereas an elevation of temperature
to 100- raised the pulse to 80 beats, and a greater in-
crease of temperature (to 105^) increased the pulse in fifteen
minutes more to 92 beats. ''The patient sweat freely and
yawned after dressing, and was much debilitated, complain-
ing of weakness in the legs," — a very good description of the
depressing effects of the hot bath.

4. That a bath at 90^ F. lowered the pulse, in five min-
utes, from 80 to 64 beats. An elevation of temperature to
ICO' raised the pulse in ten minutes to 73 beats ; and rais-
ing the temperature to 105- in twenty minutes more raised
the pulse to 118 beats, with difficulty of breathing and pro-
fuse perspiration.

He noticed, among other effects, that a bath in which the
temperature was gradually raised to iio^ raised the pulse
from Si to 153 beats, producing intolerable pain in the head,

3

34 RATIONAL HYDROTHERAPY.

partial delirium, confusion of thought, inability to speak, dim-
ness of sight, vesical tenesmus, andi *' sensations which are
commonly present in a violent state of fever.** On leaving
the bath, the experimenter nearly fainted, and sweat pro-'
fusely for some time.

A bath at 95^ F. for an hour lowered the pulse from 78 to
75 beats. Fifteen minutes after the bath the pulse-rate was
68. The experimenter says, ''I experienced a considerable
degree of lassitude, with an inclination to sleep,*' — an ex-
cellent description of the effects of the neutral bath.

A bath at 92^ lowered the pulse, in five minutes, from 84
to ^^ beats. At the end of thirty minutes the pulse-rate
was 76.

As the result of his investigations. Dr. Lockette con-
cluded : —

1 . That a temperature below 98 "" F. does not increase the
frequency of the pulse, and may slightly lower it, and does
not produce sweating.

2. That a temperature of 98^ to 105^ F. ** accelerates the
pulse and induces free perspiration, but produces no distress-
ing symptoms."

3. That a temperature of 105- F. **is a powerful stimu-
lant, and should never be advised or practiced in inflam-
matory diseases or states of fever or violently morbid action. "

Dr. Lockette made similar experiments with the steam
bath, which led him to conclude it to be a more convenient
method of securing perspiration than the water bath. His
brochure is concluded by a chapter relating to the medical
uses of the warm bath, and among the most interesting
observations upon the medical uses of water are found
recommendations respecting its use for the relief of sick or
nervous headache, which he remarks* had previously been
* * very little attended to by physicians. " He recommends the
warm foot bath, fomentations to the head, and the daily
cold bath, which measures, he affirms, on the authority of
Dr. Dwight, have effected a cure in many cases.

HISTORICAL. 35

During the middle decades of the present century hydrop-
ithy flourished to a ccmsiderable extent in America, and
half a century ago we were much nearer the front in this line
of progress than at the present time. Many institutions
de/oted to the carrying out of these measures were established
indifferent parts of the United States, and scientific hydro-
therapy was ably advocated by Dr. John Bell, of Philadel-
phia, whose work on "Baths " has, up to the present time,
remained the most complete and able treatise on the subject
in the English language, though it has long been out of print,
and seems to be quite unknown to the profession of to-day.

When seventeen years of age, Priessnitz met
J*^ with an accident whereby he received numer-

Pflf Mnlti ^^^ bruises and other injuries, including the

fracture of two of his ribs. Local physicians
gave him no hope of recovery ; but having been accustomed
to use water in the treatment of the domestic animals for which
be cared, it occurred to him to try the same remedy for
himself. He covered the affected parts with cloths kept wet
with cold water, and also drank freely of water, with the
result that he was in a short time completely cured. This
incident made so profound an impression upon the mind of
Priessnitz that, although an unlearned peasant, he deter-
mined to make a thorough investigation of the merits of
water as a remedial agent, used both internally and exter-
nally. He seems even to have undertaken some experiments
on animals, one of which was for the purpose of determining
the relative effects of hot and cold foods. Two pigs were
fed, one upon cold, the other upon hot, foods ; and when the
animals were killed, he made a careful examination of the
intestines, and asserted that in the case of the animal fed
upon cold foods the intestines were well contracted, pale,
and of firm resisting structure, while in the case of the ani-
mal fed upon hot food, the intestines were red, relaxed,
and so easily torn that they could not be used for making
sausages.

36 RATIONAL HYDROTHERAPY.

The basis of the system of Priessnitz was perspiration,
followed by cold applications. His methods were exceedingly
crude and were administered with comparatively little dis-
crimination, the natural result of his total lack of medical
knowledge. However, his native tact and sagacity soon led
him to recognize a difference in the ability of his patients to
react to cold applications, and he accordingly made it a
practice to observe in each case the effects of the first appli-
cation, the readiness with which the patient yielded to the
means adopted to induce perspiration, and the promptness
with which .reaction took place on the application of cold
water.

Priessnitz discovered little, perhaps,' but he succeeded in
calling general attention to the efficacy of various simple
methods of applying water as a remedial agent which had
previously been little appreciated. And he accomplished
more than this. He aided to recovery a vast number of
chronic invalids whose maladies were practically incurable by
the measures in common use by the medical profession of that
time ; and though at first denounced and opposed by scien-
tific physicians because of his empiricism, the more sagacious
among them, after a tipie, became convinced of the genuine-
ness of the cures effected, and many visited him for the pur-
pose of studying his system, such as it was.

Priessnitz found nearly all the methods of employing
water which entered into his system, in use among the peas-
antry of his country, by whom they were commonly employed
at l^ast as early as 1737, and probably even before that time.
Priessnitz, however, was one of the first to organize the use of
these various measures into a system, for which he deserves
much credit. Crude and empirical though his system was, his
success was sufficient to compel attention, and he commanded
an extensive following.

The attention thus attracted led to a careful study of the
physiological effects of water in its various modes of applica-
tion, for the purpose of finding a scientific foundation for its

HISTORICAL.

37

Sdeotific
Hydrotberapy.

therapeutic use. Among the first to undertake this study was
Fleury, who published in 1852 the first extended scientific
treatise upon hydrotherapy, under the title, * * Traits Pratique
ct Raisonn^ d'Hydroth^rapie."

Liebermeister, Brand, and Ziemssen in Ger-
many, and above all, Wintemitz, of Vienna,
reviewing, compiling, and greatly extending
the work of Fleury and other pioneers, have within the last
half century built up a scientific hydrotherapy, which is based
upon definite and accurate data. Before Fleury, the use of
water was for the most part empirical ; at the present time,
however, thanks to the labors of the eminent investigators
whose names have been mentioned, supplemented by those
of Jurgensen, Rosbach, Bouchard, Delmas, Robin, Beni-
Barde, Bottey, D'Arsonval, and others, it may be fairly stated
that there is no therapeutic agent whose use rests upon a
more thoroughly rational and scientific basis than water. It
has thus been rescued from the hands of empirics and charla-
tans, and is now recognized by eminent medical men as one
of the most potent of all remedial agents.

Hartshome, of Philadelphia, published in 1847 a sugges-
tive and thoughtful treatise on the use of water. In 1850,
Bell, of the same city, published the best and most compre-
hensive work on the subject which had appeared in English
before the translation and publication of the masterly treatise
by Wintemitz as a part of Ziemssen's therapeutics in 1883.
The work of Wintemitz in establishing hydrotherapy upon
a sound scientific basis so greatly exceeds that of all other
investigators in modern times that we have given, at the close
of this work, a complete list of the contributions to hydro-
therapeutics made by this eminent pioneer in this line of
medical research, which Dr. Wintemitz, at the author's
request, has kindly furnished him. .

}

THE PHYSICS OF WATER, AIR, HEAT, AND LIGHT
IN RELATION TO HYDROTHERAPY.

Iff OFFMAN, whose authority commands universal respect,
I I declared water to be more nearly a panacea for all
human ills than any other known agent. This fact,
which has never been disproved, is largely due to the
peculiar physical properties of this very versatile element.
Water owes its value as a therapeutic agent chiefly to three
most remarkable properties : (i) Its great power for absorbing
and communicating heat; (2) its solvent properties, water
being the one universal solvent; (3) the facility with which
its physical state may be changed from a liquid to a solid or
a gaseous form. These properties give to it the most perfect
adaptability to the various modes of application which are
required in hydrotherapy. It will be worth while to consider
briefly each of these several properties, as follows : —

2 Water absorbs more heat for a given weight
Heat ofWater. ^^^^ ^"^ Other body, and is hence taken as

the standard of ** specific heat." A pound
of water contains five times as much heat as an equal weight
of glass ; about ten times as much as the same weight of iron,
zinc, copper, or brass ; and thirty times as much as the same
quantity of mercury, gold, or lead. The specific heat of the
human body is nine tenths that of water.

3 The readiness with which water absorbs and communi-
cates heat and the great amount of heat which it is capable
of communicating or storing, exactly adapts it for use in
making thermic applications of either heat or cold to the
human body. There is no other substance which is at alj
capable of replacing it for these purposes.

4 Because of the large amount of water entering into the
composition of the human body, its specific heat is near that
of water, viz., .9^. A pound of water at 10^ will raise the tem-

38

poitoitcA out fCKmA gC

A (joantity ol water eqiKa^rng tbe bodr 31 '

of tempentmc tfaxoo^h cocxtact vith tfe ^oi^ ^ s> Sx3* '

wi& raise tbe tempexatine of tbe bodr & 2erie

taldng no aooomit ol anj cbaage m hesi pra

diminalkMi.

Intfaesoiidifjiiie and freeziap of wsrer a Ssse sKne «C S
heat is rendered latent, as
of ice in melting absorbs.
peratcre, beat enoo^ to
temperature, tbe temperature of the
ice remaining at 32- or digfatly above k.
melted

Water, in passii^ from die fiqmd to
likewise absorbs a ronstdrrabie amoaat of beat-
depends somewbat opon die prcssHe. bat
oned at about 930 beat ooits, or the asaoa
raise 950 poonds of water i^ in ffuipfuti
amoimt of beat reqoired to raise a pocnd of
ordinary temperatnre to tbat of steam is aboat 1.150
miits. This beat reappears wben tbe
at the ordinary temperature.

In hjrdrotherapy. water is most ccmaacaLj jotd 3Z as 2c^
nid state, bat it is also employed in the iors of icaeL £2kf 3
the form of steam, thoi^ as steam, water is merer tppbed
directly to the body. Wlien steam is wrt^wmi* as =£ the
Russian or vapor bath, the body is not actcalj exposcrf tis
steam, bat to the fc^ or mist formed by the coodssssrim ii
tbe steam throogh contact with tbe atmospbcFe. i= a rapsr
or Russian bath the patient is not heated by tbe ^^^ bst
by tbe hot air and the suspended particles d W2r=: water
which come in contact with tbe body. As tbe ^^^^ ^"^^n
tbe air of the apartment from the steam-pipe cr cdbcr *snrre.
it is at once condensed into a mist, giring up *o ^ijt <zz tzgt
ten or eleven hundred heat units which it contani?. 2^i ti:^
beating the air. A pound of steam is capable c^' t22szz4^ fr-c:

40 RATIONAL HYDROTHERAPY.

the ordinary temperature to 130^ eighty-seven pounds oi
air, or i , 1 00 cubic feet of air, the amount contained in an
apartment 10 x 10 x 11 feet in size. One pound of stearo
applied to the body would be capable of raising the tem-
perature of a man weighing 150 pounds nearly 8^, or ten
pounds of flesh to a temperature of over 212°. It is for
this reason that steam can not be brought in contact with
the tissues without destroying them.

8 A pound of ice, on the other hand, is capable of removing
from the tissues of the body with which it is brought in con-
tact 142 heat units while melting. It will not, however,
lower the temperature of the tissues below 32^, unless its
own temperature should happen to be considerably below the
freezing point, which might be the case in very cold weather.
It is apparent that in the use of ice great care must be exer-
cised in order to avoid damaging the tissues by prolonged
contact.

9 The temperatures employed in hydrotherapy are practi-
cally within the limits of 32^ and 140^ F. Applications are
occasionally employed at a lower temperature, and very hot
water may sometimes be applied, at a temperature as high as
160^, as a means of stopping hemorrhages; but great care
must be used. Live steam has recently been suggested as a
means of checking hemorrhage, and may possibly prove to be
of service in this capacity. Vapor and hot air may be tol-
erated at higher temperature.

10 Water is a fairly good conductor of heat. Its conductivity
is much greater than that of air, but far inferior to that
of the metals. Copper conducts heat one hundred times
better than water. As a conductor of electricity, copper is
immensely better than water. It is for this reason that
water at any given temperature, hot or cold, makes a much
more intense impression upon the skin than does air at
the same temperature. On the other hand, metals of all
sorts feel colder or hotter than does water of the same
temperatures.

THE PHYSICS OF WATER, AIR, HEAT, AND LIGHT. 4 1

Ordinary water is a good conductor of electricity, a fact 11
which enables it to render valuable service in most percu-
taneous applications of electricity and in such combined
procedures as the hydrofaradic, the hydrogalvanic, and
similar baths.

As before remarked, water is the one uni- 18
ProuertiMof versal solvent. In the body it is the medium
Witer. ^y whi^h the foods rendered soluble by diges-

tion are conveyed to the tissues to be assimi-
lated, and thus rendered insoluble, while the effete matters
rendered soluble by disassimilation are dissolved and con-
veyed back into the blood * current, to be acted upon or
eliminated by the liver, the kidneys, the skin, and the other
excretory organs.

It is interesting to note that sugar and peptone, the 13
two chief constituents of digested food, are among the most
soluble of substances. Carbonic acid gas, a product of the
oxidation of carbohydrates and hydrocarbons, is a/so highly
soluble in the saline medium which constitutes the serum of
the blood. Urea, a product of proteid oxidation, has a high
degree of solubility in water. Uric acid, oxalic acid, and
other abnormal products are, on the other hand, less easily
soluble than the normal waste products, and hence, as has
been shown by Haig, readily accumulate in the body, espe-
cially in those portions in which the circulation is least
active.

Thus the value of water as a detergent agent, not only for 14
the surface of the body but for its interior as well, is apparent.
This is, mdeed, one of the most important therapeutic uses
of water. It may be applied by means of water drinking, the
enema, or the coloclyster (this term seems to the author pref-
erable to the French cntcroclyster), gastric lavage, and by
sabdermic injection of the normal saline solution.

Water in the liquid form readily lends itself to application 15
to the body in numerous ways, both active and stable,
by the different forms of immersion, compresses, douches of

42 RATIONAL HYDROTHERAPY.

various sorts, etc. The ease with which its temperature may
be varied enables us to secure by its means every degree of
thermic effect desirable, while its weight renders possible
various mechanical or pressure effects which are also highly
valuable, as will appear later in this work.

16 The relation of air to the thermic effects
Atmosphere employed in hydrotherapy is perhaps less

direct and important than that of water, yet
it is by no means insignificant. Air as well as water is capa-
ble of absorbing heat. Although its specific heat is scarcely
more than one fifth that of water, the ease and rapidity with
which it circulates about the body, its continuous contact
with the skin, the variability of its temperature, and espe-
cially the fact that it is concerned in the evaporation of
moisture from the skin, whereby an enormous amount of
heat is constantly removed from the body, render its relations
as a thermic agent important.

17 The influence of the air upon the body depends not only
upon its temperature but also upon the amount of water
which it contains. A cubic foot of air at 32^ is capable of
absorbing slightly more than two grains of water. A cubic
foot of air at 96^ is capable of absorbing eight times as much,
while air at 72^ absorbs four times as much, or eight grains.
It is thus apparent that air which has had its temperature
raised without the addition of moisture is capable of pro-
moting evaporation from the skin to a high degree. This
fact must be taken into consideration in the management of
patients at the different seasons of the year. In the summer-
time the air is often completely saturated with moisture,
while in the winter-time saturation of the heated air indoors
rarely if ever occurs, except by the aid of artificial means.
The more completely saturated the air is, the less rapidly
does evaporation take place. Patients are much more likely
to complain of chilliness after baths in the winter than in the
summer, for the reason that the extreme dryness of the air
gives rise to rapid evaporation of the small amount of mois-

THE PHYSICS OF IVATER, AIR, HEAT, AND LIGHT. 43

tore left on the skin after leaving the bath-room, giving
rise to dulliness, and occasionally resulting in a cold. On
this account, patients must in the winter-time be dried with
special thoroughness before leaving the bath-room, and must
afterward be particnlarly careful about exposing themselves.

The rapid rate at which heat is removed from the body 18
by evaporation when dry warm air is brought in contact with
it may be easily shown by a simple illustration : Suppose an
apartment (20 x 13 x 10) contains 2,600 cubic feet of air at
96-, the temperature out of doors being 32^. The indoor air
is capable of absorbing nearly fifteen grains of water, in ad-
dition to that which it already contains, for each cubic foot,
or more than five and one-half pounds of water. The
absorption of less than one half of this (two pounds) through
evaporation from the surface of the patient's body will
abstract from the body something like 2,000 heat units, and
would be capable of reducing the temperature of the body
more than 1 3^, provided no heat was in the meantime pro-
duced. The same air, if saturated with water, would
absorb little water, and would take very little heat from
the body. The relation of different conditions of the atmos-
phere to the rate of evaporation from the skin is a ques-
tion which should perhaps receive more consideration in
connection with hydrotherapy than has generally been
accorded it.

It is also important to note that the respiratory processes 19
of both the lungs and the skin are diminished by an exceed-
ingly dry atmosphere. Interchange of gases in the lungs
is also interfered with by an atmosphere saturated with
moisture-
Atmospheric pressure is likewise a matter well worthy of 20
attention in connection with hydrotherapy. In institutions
located at an altitude of several thousand feet above the level
of the sea, this is of special importance, on account of the
tendency to pulmonary congestion due to the rarity of the
atmosphere. Under such circumstances extreme care must be

44 RATIONAL HYDROTHERAPY.

taken to avoid the application of the cold douche and similar
measures in such a way as to provoke disturbance of res-
piration ; in other words, cold applications must be made to
the chest only with the greatest care, and after applications
have been made to other portions of the body, so that the
effect may be generalized.

21 Cold air produces a less intense sensation of cold than
does cold water, for the reason that its ability to absorb heat
is only one fifth as great, and its conductivity of heat is enor-
mously less. The thermic effect produced upon the skin by
an object brought in contact with it is due both to the spe-
cific heat of the object and to its conductivity. Iron, copper,
and other metals are such excellent conductors of heat that
they may feel colder than water at ordinary room tempera-
ture even though their specific heat is many times less.

22 Most of the effects of hydrotherapy are ob-
tained by means of methodical thermic applica-

. tions to the skin. In other words, the specific effects of
hydrotherapy are not chiefly due to water per se, but to the
impressions of heat or cold made by this agent when brought
in contact with the skin. So far as these same effects may
be produced by other means, precisely the same results may
be obtained.

23 Heat and cold are relative terms, what is termed a cold
application being simply one that is of a temperature a defi-
nite number of degrees lower than the so-called warm or hot
application. The impression made upon the skin, as else-
where remarked, depends not only upon the temperature of
the application, but upon the relation existing between the
temperature of the application and the temperature of the
skin.

24 The science and art of hydrotherapy include not only
applications of water in its various forms, but thermic appli-
cations made by means of hot or cold air, vapor, and various
heated objects, also heat and light.

THE PHYSICS OK l^TAXER, AIR, HEAT, AND UGHT. 45

VaiioQS soQTces of heat may be adlized in making thermic tt
ai^plkatioQS to the human body for tfaerapeatic purposes.
While water is generally the most conToiient agenc there are
coDdhkos to which it is not adai>te<t and in which other
means may be more advantageously employed. Heated air,
4e vapor oi water, or rather the fog resohing from the coo-
densation oi steam in air at a temperatore near that €d the
body, the snn's rays, and lastly the electric ray icay all be
utilized. The use of hot air in the form of the Turkish bath
dates from remote antiquity, and the hot-air badi and the
vapor bath have been used by many primitive people. The
electric ray is, however, one of the most interesting sources
of thermic energy : and while only recently introduced to
practical therapeutics, it is certain to prove itself of the great-
est practical utility. Both forms of the electric lamp, the
incandescent and the arc, may be utilized as sources of heat

The sun*s raN-s, which the electric ray closely resembies in 26
its action as a thermic agent, have been utilized in the treat-
ment of the sick from the most ancient times. The zmozjit
of heat received hourly upon each square foot of the earth^s
surface is about equi\-alent to that produced by the bomine o^
a sufficient amount of coal to produce one fourth of a horse-
power of mechanical energy. The ph}-sical and therapeutic
properties of sunlight and of the electric ray will be considered
at greater length elsewhere in this work <'597>.

This means has the advantage over others in that the rajrs 27
of radiant energ>* received from a luminous source peneiz^tt
the skin and the tissues to a great depth, in fact, reaching
whout doubt, the ven- innermost portions of the body.

^\^len electricit}' meets with resistance, as in passing over 2S
a poor conductor, it is converted into heat. The same |>rin-
ciple holds in relation to light. WTien light passe? throTizh a
perfectly transparent medium, no heat phenomena are mani-
fested. Very little heat accumulates in pure white rfass
when the sun's rajrs fall upon it ; but if the same glass be
colored or painted black, it is very quickly heated.

46 RATIONAL HYDROTHERAPY.

29 As the luminous rays are intercepted by opaque particles
in the tissues, they are converted into heat. Thus heat is
generated in the depths of the tissues, the very place where
this form of vital stimulus is required, instead of being applied
only to the skin, as when hot water, air, or other media are
employed. This fact renders the electric-light bath or the
sun bath superior to all other heating procedures.

30 The centigrade scale divides the temperature
Scales and range from freezing to boiling into one hun-
Heat Units. dred degrees, making the freezing point zero,

whereas the freezing point is 32 in the Fahren-
heit scale, and the boiling point 212. The Fahrenheit scale
thus divides the range of temperature between freezing and
boiling into 180 degrees. It is apparent that 100 degrees ot
the centigrade scale is exactly equal to 180 degrees of the
Fahrenheit scale, and that one degree Fahrenheit equals
IH» or 5-^ths, degree centigrade; while one degree centigrade
equals |fj, or 9-5ths, degree Fahrenheit.

31 To find the number of degrees Fahrenheit which a given
number of degrees centigradp will equal, we have only to
multiply the given number by 9-5ths, or what is the same
thing, but a shorter method, we may multiply by two, and
subtract one tenth.

32 Example : Suppose the difference in temperature be-
tween two objects is 40^ C. ; what will be the difference
expressed in Fahrenheit degrees.^

8

Answer: 40 x -| = ^^-^ = 72; or,

40 X 2 = 80 — 8 (80-4-10 =8) =72.

33 To ascertain the number of degrees centigrade which will
equal a given number of degrees Fahrenheit, we have only to
multiply the number of degrees centigrade by S-gths, or what
is the same thing, divide by two and add one ninth.

THE PHYSICS OF WATER, AIR, HEAT, AND LIGHT.

4>

Example : Suppose the difference in temperature between 34
two objects is 72^ F. ; how may the same difference be ex-
expressed in centigrade degrees?

8

Answer: 72 x~= !^ =40; or,

72 -5-2 = 36 -I- 4 (36 -f. 9 = 4) = 40.

But in converting Fahrenheit or centigrade temperatures 35
into equivalent expressions, we must generally take account
of the fact that the zero point is not the same in both. So
before beginning the calculation of converting a given fixed
temperature, as shown by a Fahrenheit thermometer, into an
equivalent expression in the centigrade system, we must first
subtract 32 ; and in converting centigrade to Fahrenheit, we
most add 32 at the end of the calculation.

For example: If we wish to convert 104° F. into an

equivalent expression centigrade, we first subtract 32, then

proceed as above (33). If we wish to convert 40^ C.

into an equivalent expression Fahrenheit, we proceed as in

31, then add 32.

In the modem French system there are the greater and 36
the lesser calorie. The greater cal9rie simply represents the
amount of heat required to raise the temperature of one
kilogram of water one degree centigrade in temperature.
The lesser calorie represents the amount of heat necessary to
raise one gram one degree centigrade in temperature. In
other words, the lesser calorie is the one thousandth part of
the greater calorie. In the English system, which is not
much in use at present, but is convenient in popularizing the
principles of hydrotherapeutics, a heat unit represents the
amount of heat required to raise the temperature of one
pound of water one degree Fahrenheit in temperature.

To convert kilogram centigrade calories into gram centi- 37
grade calories it is only necessary to multiply by one thou-
sand by moving the decimal point three places to the right.

1

48 RATIONAL HYDROTHERAPY.

88 To convert kilogram centigrade calories into pound
Fahrenheit units, it must be remembered that the kilogram
equals 2.2 pounds, and the centigrade degree 1.8 Fahren-
heit degrees ; hence the converting factor will be f JX"Jg=||,
or, approximately, 4 ; that is, we may for practical purposes
simply multiply by four, to convert greater calories into an
equivalent expression in pound Fahrenheit heat units. To
be absolutely exact, we must subtract one per cent.

Example : We wish to convert 425 kilogram calories into
pound Fahrenheit heat units.

425 X 4= 1700 — 17 (i per cent, of 1700) = 1683.

39 To convert pound Fahrenheit heat units into greater
calories we may multiply by §|, or, what is practically the
same thing, divide by four, and add one per cent.

Example: We wish to convert 400 pound Fahrenheit
heat units into an equivalent number of greater calories.
400 X iJ = loi.oi ; or,
400 -^- 4 = 100 ; 100 -f- I (one per cent, of 100) =101.

40 The expert hydrotherapist will give minute
Thermometry* attention to the temperature of the patient,

and of the air of the sick-room, as well as that
of the water employed in remedial applications. The ther-
mometer must be in constant requisition. It is not prudent
to trust to the sensations, as these are too fickle and decep-
tive to serve as a reliable guide.

41 The temperature of the room must be maintained at about
65^ F. In fevers a temperature of 60^ is best. The sick-
room is generally too warm, a fact which greatly increases
the depression of the patient, and often excites a rise of
temperature.

42 The temperature of the bath may be accommodated some-
what to the patient's sensations and predilections, but the
exact temperature must be known, notwithstanding, and
should be recorded. In an emergency, if a thermometer is
not at hand, the temperature may be approximately deter-
mined by the following method : —

THE PHYSICS OF WATER, AIR, HEAT, AND LIGHT. 49

The hand gives unreliable information respect- 48
. ing the temperature of water, but a more ac-

Retnhtliistlie curate judgment may be formed by plunging
Tenperatora of the whole arm to the elbow into the water, as
I Itenome^M- ^^^ ^^"'^ ^^ usually protected by the clothing.

and hence its temperature is more equable.
When the temperature of the water iscso high as to produce
redness of the skin, it may be said to be hot. . .When there is
simply a comfortable sensation of heat, it is warm. A slightly
lower temperature is tepid. When the temperature is low
enough to produce a goose-flesh appearance, it is cool ; and a
lower temperature is cold ; while a temperature which within
a few seconds produces pain or numbness of the parts im-
mersed, is very cold. Water the temperature of which is so
high that the hand can be held in it but a fraction of a
second, perhaps, is very hot.

A method somewhat more accurate than the preceding, 44
and which, with modifications, is applicable to all climates
and altitudes, is as follows : The boiling-point of water at sea-
level, as is well known, is 212^. In all countries the temper-
ature of the water found in deep wells and springs is practi-
cally the same as the average of the air for the whole year.
In temperate climates this is about 53^. Knowing the tem-
perature of the well or spring water and that of boiling wa-
ter, it is only necessary to combine measured quantities of
water from these two sources in the necessary proportions to
the amount desired. While this method is not exactly accu-
rate, it answers for practical purposes. The following table
§ives the quantities to be mixed for different temperatures : —

45

Temp. 53»

F.

Temp

. aia

« F.

2 qts

. added

to I

qt.

equals

3

qts.

at

106° F

2% **

it Y

li

Z%

98° *'

3

t ( Y

(i

4

93°-

4

•** I

i(

5

850 »'

5

t ( *

««

6

80° -

6

(( Y

«i

7

76^ **

8

(( J

i(

9

71° •'

r

so RATIONAL HYDROTHERAPY.

46 When larger quantities are needed, it is only necessary to
multiply each of the combining quantities by the same nam-
ber. For instance, if a gallon and a half of water is needed
for a foot bath at io6^, pour into a pail or bath-tub four
quarts of fresh well water and then add two quarts of boiling
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 o( fresh well or spring water, and add one gallon
of boiling water. Thus any required quantity may be ob-
tained 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. The exact measure-
ment is not necessary ; it is only that the proper proportion
should be maintained, the same measure being used for both
hot and cold water, with both of which it is filled an indicated
number of times.

47 In elevated regions, the boiling point is. of course lowered,
but this, being fixed, may always be known after it has once
been ascertained. The temperature of deep well water or of
spring water also varies little. This temperature may be
ascertained, and borne in mind for use when necessary.

With ice-water and boiling water it is possible to deter-
mine the temperature of water obtained from a well, lake, or
any other natural source. It is only necessary to make a
mixture of ice-water and boiling water which shall have the
same temperature as is noted by the hand, and to observe the
percentage of each employed. For example, suppose that
the proportions required are ten parts of ice-water (o° C.) to
two of boiling water (loo^ C). The result would be obtained
thus : 10 + 2 = 12; 200 -f- I2 = i6.6^ C, or 62° F.

48 In Fig. I will be seen a simple thermometer
An Emergency ^vhich may be successfully used in regulating
Thermometer. . ^ ^ ^ t i ^w ^ £ -

the temperature of baths, and if necessary, m

determining whether or not the patient's temperature is above
normal, and approximately to what degree. The instrument

THE PHVSICS OF WATER, AIR, HEAT; AND LIGHT,

SI

consists simply of a small, thin-walkd bottle^ the mouth ol
Iwiiicb is closed with a cork, through which passes a tube
I bnng aa opening of about one sixteenth of an inch. The
tube should be about ten inches in length. In the bottom
i^olthe bottle should be placed about half an inch of a colored
olutioo. Some aniline color dissolved in water or alcohol
oswers the purpose well The tube should be passed through
he cork to such a distance that when the cork is inserted in
^Ihe mouth of the bottle, by pressing the cork in a little the
luvd will be made to rise in the tube, and by a little manage-
neat Uie liquid may be made to stand in the tube just at the
^topof Iba cork. Grasping the bottle in the hand, the air in
sttibc will be warmed and, expanding, will force the liqtiid
[^farther up the lube. It is only necessary to place a foot rule
behiad the tube, letting the lower end rest upon the cork,
and we have a very delicate thermometer with a scale which
wi answer a very practical purpose in the absence of a bet*
^ter isstmrneiit. The normal point is determined by applying
heiostmment to the axilla of a healthy person.
In the use of the clinical thermometer the temperature of 49
[lie patient should be taken in the rectum, if possible^ unless
^cemas are being administered for cooling or nutritive pur-
poses. U the temperature is taken in the mouth or the
i!a« peat care must be used to see that the lips are kept
«^btly closed or the arm in contact with the body.

Ctirrie noted the fact that temperature observations made 50
^f pltdng the thermometer in the mouth are sometimes
^Jideitd inaccurate when cold applications are administered,
brthedr^ /of the teeth and consequent separation of
Ibclips, ;l :- air.

In the technical study of hydrotherapy it is 51
absolutely necessary to take into consideration
^ol only the indications of the thermometer, or the tempera-
f of the body as a mass, but it is of even greater impor-
^nte to know what are the capabilities and the conditions of
dy as a generator of heat- Information of this sort is

CHortinetry.

52 RATIONAL HYDROTHERAPY.

not afforded by the thermometer alone. The data. rM|aind
must be obtained by means of the calorimeter. This: iflMlni-
ment determines the number of heat units which escape fiom
the body in a given time, and thus, as the temperatiue.^the
body remains practically uniform, the amount of heat adiallj
produced in the body is known (Fig. 2).

In the absence of a calorimeter, it is still possible to .form
a very close approximate estimate of the rate of heftt loss
from the surface of the body. The chief means by whidi the
body loses its heat is by radiation, in common with all other
bodies, and by the contact of its surface with atmospheric air.
There is a slight loss by conduction, but for practical pdiposes
this may be ignored. A considerable loss also occurs through
the evaporation of the sensible and the insensible perspiration
from the skin. A dry skin gives off heat very slowly, being
a poor conductor; an oily skin radiates heat fifty per cent
more rapidly than a dry or unoiled skin. This fact the aothor
believes he was the first to point out, although it seems as if
the fact ought to have been suggested long ago by the custom
of the natives of tropical Africa, who smear themselves with
oil when exposed to the hot sun, and take special care to
cover the head well with melted fat.

The loss of heat by evaporation ordinarily amounts to
about 100 heat units per hour. By means of formulae given
elsewhere (733) it is made clear that the rate of heat loss both
by radiation and by air contact may be determined by mathe-
matical calculation based upon the laws of heat dissipation.

A consideration of the heat loss sustained by the body as
determined in this manner quickly discloses the important
influence of clothing, as it shows that the amount of heat
actually produced and eliminated by the skin each twenty-
four hours corresponds to the heat loss which would occur
with the body unprotected in an atmosphere at a tempera-
ture of 78^ F., — a temperature which the primitive tribes
of men readily endure without other clothing than the smallest
amount necessar}- to satisfy the demands of savage modesty.

ANATOMY AND PHYSIOLOGY IN RELATION
TO HYDROTHERAPY.

THERE is no remedial agent the scientific use of which 58
demands so thoroughgoing and practical a knowledge
of physiology as does hydrotherapy. Used empiric-
ally, water is certainly less likely to lead to disastrous results
than some medicinal agents, the consequences of their unsci-
entific use being only too forcibly illustrated in the terrible
damage resulting from the use of patent medicines. Never-
theless, water as a remedial agent is, like powerful drugs,
a two-edged sword, and its unscientific use has not infre-
quently produced most untoward results. Indeed, it may
well be believed that the very general prejudice prevailing,
among physicians as well as the laity, against the employ-
ment of water in treating disease, is largely due to the ~ >p
injurious effects which have followed its bungling and unsuc-
cessful use by so-called water-cure doctors, and well-mean-
ing, but unfortunately not well-informed, enthusiasts, who,

having themselves experienced good results from the use of f* r r^

this simple and versatile therapeutic agent, have unwisely ^iV. i?

undertaken to cure all their sick friends by means of the
same prescription through which they were themselves
benefited.

It is only by an exact knowledge of the 53
theBtti^^f human body, its normal functions, and the

Wy<irotherapy. modifications of tissue and function resulting
from disease, that water can be therapeu-
tically employed with the unrivaled results which this agent
IS capable of rendering. Not all cases, of course, are cur-
^We, but even in those that are incurable, it is marvelous to
note the wonderful degree to which pain and various other
^niptoms may be mitigated by accurately adapted hydri-
atic prescriptions.

53

^ >

I

54 RATIONAL HYDROTHERAPY.

64 To use water intelligently, one must be a thorough physi-
ologist, and must have an especially good understanding of
the anatomy and physiology of the skin and the nervous
system. Thus, for the convenience of the student, and
that he may have freshly in mind those anatomical and
physiological facts that are most essential to an understand-
ing of the general principles of hydrotherapy, this chapter
is devoted to a brief summary of the anatomy and physiology
of the circulation, the skin, and the nervous system, so far
as they are particularly concerned in the physiologic and
therapeutic effects of hydriatic procedures.

THE CIRCULATION.

55 We have neither the space nor the purpose to review the
whole subject of the anatomy and physiology of the circula-
tion, but desire to recall simply the leading facts and to
emphasize a few points which have a special relation to
hydrotherapy.

56 The organs of the circulation are the heart, the blood-
vessels (arteries, capillaries, and veins), the lymphatics (glands
and ducts), and perhaps the spleen also may be included.

57 The heart is a muscular organ, having in its walls nerve
ganglia which give origin to motor impulses whereby its
activity is initiated and maintained. The heart's action is
regulated by nerves from the cerebrospinal system : (i) The
accelerator nerve, consisting of non-meduUated fibers; (2) the
inhibitory nerve (vagus), consisting of fine, medullated fibers.

58 The arteries, especially the smaller ones, and the smaller
veins, though to a less extent, are also muscular structures
capable of contracting, and, like the heart, controlled by au-
tomatic ganglia, the distal ganglia of the sympathetic system,
which, like those of the heart, are capable of emitting motor
impulses which cause contraction of the involuntary muscular
fibers, and thus lessen the caliber of the artery. In addition,
the arteries are, like the heart, controlled by two sets of
nerves: (i) The vasoconstrictors, corresponding to the accel-

ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 55

crator nerve of the heart, consisting of fine non-medullated
fibers which pass out from the spinal cord with the anterior
thoracic nerves ; (2) the so-called vasodilators, which are
simply inhibitory nerves, capable of retarding or counteract-
ing the action of th6 vasoconstrictors, or of the muscles con-
tracting under their influence. The vasodilators, like the in-
hibitory nerve of the heart, consist of fine, medullated fibers.

The capillaries are narrow tubes, the walls of which are 59
composed of nucleated cells, which, like the muscles of the
heart and the small arteries, are capable of contracting, the
seat of contraction being apparently in the nuclei of the cell.

It thus appears that the blood-vessels, arteries, veins, and 60
capillaries simply constitute an enormously extended and
branching heart, just as the neuraxons and the nerve trunks
are simply extensions of the brain and spinal cord.

The lymphatics consist of small vessels which exist in the 61
cellular spaces outside of the blood-vessels, and form a net-
work extending throughout the entire body. The lymphatic
channels connect at definite points with the lymphatic glands,
which act as filters, by means of which foreign particles,
germs, and other infectious elements are removed from the
lymph. The walls of the lymphatics also are contractile.

The spleen is closely associated with the portal circula- 62 ^.,^

tion, and is also a contractile organ. It does not contract ^^^v': T j .

synchronously with the heart, but makes a cycle about once ^ r

^rninute. Its circulation is independent of blood pressure.* I- ". ^^

There are four so-called systems of circula- 63 ^

Circulatory ^. :' :

Systems. ^^^"• —

I. The systevtic circulatioi, consisting of

^he arteries, capillaries, and veins, by which the blood is

propelled from the left side of the heart to the periphery, and

^s brought back to the right side of the heart. [>

2. The pulmonary circulation^ by which the impure blood 64 ^-

s^nt out from the right side of the heart passes through the

'"ngs, and is returned to the left side of the heart, to be again

distributed throughout the body.

L

K; -

^t] ■■■

56 RATIONAL HYDROTHERAPY.

65 3. The lymphatic circulation^ by which the lympll
escapes from the blood-vessels through the capillary
gathered up from the connective tissue spaces and retur
the circulation through the lymph channels and the tl
ducts which empty into the subclavian vdins.

66 4. The portal circulation, which consists of veins only^^
venous blood from the stomach, spleen, pancreas, intesti
and liver being gathered up in one large vein and condud
to the liver, where it is filtered before being introduced ii
the general circulation through the hepatic vein. The 1

^ \ companying diagram shows clearly the relation between 1

\ systemic, pulmonary, and portal circulations (Fig. 3).

\ 67 The amount of blood contained in the body is about ei{

ll or nine pounds, and of this about one fifth is found in t

pulmonary circulation, and four fifths in the systemic circu
tion. The capacity of the veins is at least twice that of t
arteries. The sectional area of the capillaries is about f
hundred times greater than that of the aorta, but their <
pacity is very small because of their short length, which
only about one twenty-fifth of an inch. The contents of 1
lymphatic vessels is about three or four times the quant
of the blood ; that is, the lymph constitutes about one th
the body weight.
68 Landois and others have shown that the fo

The Mechanism of the heart-beat is sufficient to account
tloi*!^ ^*"'"**' ^^® circulation of the blood through the en
circulatory system. The chief cause of
movement of the blood is evidently the difference in the bl
pressure existing in the aorta at the heart and that in
vena cava at its junction with the right auricle. The p
sure in the aorta is equivalent to about six inches of mere
while that in the vena cava is never more than half an ii
and during inspiration, is negative. The heart is comp^
to do something more, however, than simply to move
blood around the circuit of the blood-vessels. It must m
tain a certain pressure, or tension, within the vessels, this

56

RATIONAL HYDROTHERAPY.

65 3* The fympkatic drculatimi, by which the lymph that
escapes from the Wood-vessels through the capillary walls is
gathered up from the connective tissue spaces and returned to
the circulation through the lymph channels and the thoracic
ducts which empty into the subclavian veins,

66 4. The portal circulation, which consists of veins only, the
venous blood from the stomach, spleen, paocreaSp Intestine,
and liver being gathered up in one large vein and conducted
to the liver, where it is filtered before being introduced into
the general circulation through the hepatic vein. The ac-
companyixig diagram shows clearly the relation between the
systemic, pulmonary, and portal circulations (Fig. 3).

67 The amount of blood contained in the body is about eight
or nine pounds, and of this about one fifth is found in the
pulmooary circulation, and four fifths in the systemic circula-
tion. The capacity of the veins is at least twice that of the
arteries, The sectional area of the capillaries is about five
hundred times greater than that of the aorta, but their ca-
pacity is very small because of their short length, which is
only about one twenty-fifth of an inch. The contents of the
lymphatic vessels is about three or four times the quantity
of the blood ; that is, the lymph constitutes about one third
the body weight,

68 Landois and others have shown that the force
The Mechanism Qf ^^^ heart-beat is sufficient to account for

the circulation of the blood through the entire
circulatory system. The chief cause of the
movement of the blood is evidently the difference in the blood
pressure existing in the aorta at the heart and that in the
vena cava at its junction with the right auricle. The pres-
sure in the aorta is equivalent to about six inches of mercury^
while that in the vena cava is never more than half an inch»
and during inspiration, is negative. The heart is compelled
to do something more^ however, than simply to move the
blood around the circuit of the blood-vessels. It must main-
lain a certain pressure, or tension, within the vessels, this be-

of the CIrcula
tlon.

MY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. $7

of the means by which the various processes of secretion
tier forms of metabolism are maintained and regulated.
)od pressure results chiefly from the force of the heart- 69
md the peripheral resistance at the distal end of the
ar loop in the small arteries, venules, and capillaries,
[h the narrowing of these parts by the contraction of
[nuscolar walls under the influence of nerve impulses
d by various conditions and agents. In the light of
It knowledge it is not, however, possible to regard the
as the only source of energy in the circulation of the

For more than a score of years physiological facts
3een coming to light which point with much certainty to
uscular coats of the smaller vessels, the arterioles, pos-
the venules, and very probably also the capillaries, as a
J of propulsive energy in maintaining the movement of
ood. Schiff showed long ago that there is a rhythmical
iction of the muscles in the arteries in mammals as
5 in amphibians, the latter fact having long been recog- *

Strieker observed the contraction of the capillaries,
everini considered the contractility of the capillaries, at
of their nuclei, as of great importance in ** influencing
>lood stream." Roy and Graham Brown have also
1 that the capillaries are contractile.* The writer has
ig been thoroughly convinced of this fact, that in 1879,
scribing the forces of the circulation in a popular work
lysiology and Hygiene, he remarked : * * The contrac-
i the heart, which gives the blood a propulsive impulse,
owed up by the contraction of the arteries. The small
BS are supposed to be specially active in assisting the
atinn. Some observers rJaim that the small arteries, or

58 RATIONAL HYDROTHERAPY.

esses ; (2) to a certain extent the control of the heart'
action by maintaining just the right degree of tension or in
travascular pressure through the narrowing of the arteria
outlet ; (3) an active rhythmical contraction which acts like j
combined suction- and force-pump at the periphery of th(
circulatory system, relieving the heart of a part of its burden
while at the same time aiding in maintaining the prope
standard of blood pressure.

71 This action of the small vessels is of course not confine(
to the ejcterior of the body, but is doubtless present in th<
blood-vessels in all parts of the body, especially in the mus
cles. That an action of this sort is also maintained in th<
skin is altogether probable, as it has been observed in the ea
of the rabbit. The capillaries of the skin are for the mos
part arranged in simple loops, which would favor a propul
sive action of this sort. It is true, the arterioles of the skh
have little muscular tissue in their walls ; however, this lacl

* is to a large degree compensated for by the peculiar arrange
ment of the yellow elastic tissue which surrounds the vesseL
and by the obliquely placed involuntary muscle fibers, botl
of which favor contraction of the vessels if they do not ai<
in the automatic or rhythmical action above referred to.

72 The rich vascular area of the muscles, which is capable o
holding one half of all the blood in the body, may be nor-
mally more active than the skin in aiding the systemic circu-
lation ; but the remarkable readiness with which the skir
responds to vascular stimuli, both those which excite the vaso-
dilators and those which bring the vasoconstrictors intc
activity, shows very clearly that there is in the skin ar
enormous body of muscular structure connected with tht
circulatory system which is under the control of the nerve
centers.

73 Another force which is by no means insignificant as an aid
to the circulation is the inspiratory activity of the lungs acting
upon the heart and the large vessels in the thorax. The neg-
ative pressure induced in the chest cavity during respiration

^KATOiiy AKD PHYSIOLOGV IN RELATION TO HYDROTHERAPY. 59

accelemtes the movement of the blood through the heart to a
marked degree. This infiuetice is especially helpful to the
portal circulation, and to the venous circulation of the brain.

tThe rhythmical contractility of the spleen, already referred 74
to, constitutes it a sort of heart for the portal circulation,
WTicn the spleen is contracted, the liver is slightly enlarged^
showing an increase of tension in the portal circuiation which
latist accelerate the movement in this portion of the venous

ij*stem, hedged in as it is at each end by a capiHarj' network-
The pumping action of the spleen is doubtless service-
iblc as a means of regulating the blood flow through the
WcT and in maintaining the necessary pressure to secure
he highest degree of functional activity of this large and
important gland.

1^ Bkmd
urreitt*

Heart

Force
Force

coostamt. . .
constnnt. ,

iocfea&ed , ,
diminished.

At^teHnlca

Resistance increased, .
Resistance dimimshed.

Resistance constant. , .
Resist aDCe constant . , -

Resistauce dituiaistied.
Resistance increased. .

Resist a tice increased. .
Ecststance diiiiioisbed^

Pressure*

Blood
Flow."

+

+

+

+

+ -
- +

+ +

+ +

+ -

— —

— +

75

When the blood leaves the heart, its move-
ment ts at the rate of severaJ feet per sec-
ond, while in the capillaries the rate of move-
ot is reduced to one inch in two minutes. The rapidity of
" nt of the blood in the vessels is constantly changing
_- chajiges in the relative conditions of the heart and
e contractile walb of the small vessels. The following
able from Waller represents the several modifications which
ay occur, and the conditions which give rise to them. Tbe
able is so nearly self-explanatory that it is only necessary to
add thai in some conditions the blood pressure and the blood
iow may be neither increased nor diminished, but normal,'

• Thm fjUv «!© {4-3 indicate* increase ; the n^^gfttive kipi {^), decrc**??

6o RATIONAL HYDROTHERAPY.

'^' Th P 1 ^ ^^^ ^°^^ knowledge of the pulse may be

obtained by its study with the finger, in the
usual way, but the record afforded by the sphygmograph makes
clear many peculiarities in the pulse which are difiicult to
understand without this graphic representation to the eye,
and adds greatly to the knowledge obtained by examination
with the finger.

78 The accompanying cuts (Figs. 4 and 5) show both Dudg-
eon's and Mortimer Granville's sphygmographs. The latter
is more convenient for clinical purposes. It is, I think, very
little known in this country. Figs. 6 and 7 will aid in
understanding both the graphic record of the pulse and the
pulse itself. The tracing is obtained by means of an arrange-
ment which enables the upward movement of the artery to
operate upon the short arm of a lever, the long arm of which
rests upon a strip of smoked paper. The paper is moved
along by clock-work while the instrument is in use, making
a record such as is shown in Fig. 8. The curved lines
between the dotted lines X and Y represent one heart-beat.

The meaning of the several parts of this curve is as
follows : —

79 The first portion of the curve represents the upward
stroke produced by the lever, due to the expansion of the
artery under the impulse of a wave of blood sent from
the heart. This is called the primary, or percussion^ wave.
The maximum of expansion is maintained for only a brief
period, the length of which depends upon the condition of the
arterial walls. At the end there is sometimes a slight rise.

80 This interruption of the decline or elevation of the curve
is known as the tidal wave. This is followed by a slight
depression, which is again followed by a slight rise, the so-
called dicrotic wave. The depression between the dicrotic and
the tidal waves often amounts to a very sharp notch, which
is sometimes very deep, and is known as the aortic notch,

SI After the dicrotic wave there is usually one, sometimes
several, small waves, which are commonly due to oscillations

fic lo. PULSE OF AORTIC REGLTRGITATION (p. 6i>

SFUVCiMOtiRAPHlC TR.\CINC OF A HARD iHiiMetwtnnj PULSE

DIAGRAMS OF PULSE- i, Xtinnal; 3, Low Tcmijon and Soft l^ulac; 3. High
T«sj>ii<M anti Hard PtiJ&e; 4. Soft Pylse fmlJy thcrtiric; % Very
Soft Pybe aind HypcnJicrotii^ (LAaiioiji & Stertng).

AMTOm AND PHYSIOLOGY IK RELATION TO HYDROTHERAPY. 6 1

of the instrument. The three points of importance to be
obsmed to the curve are the primary, the tidal, and the
dicrotic waves.

The primary u^az^^ marks the expansion ot the artery 8S
under the impulse of the wave of blood from the heart. It
meaBnres in a geoeral way the force and amplitude of the car-
diac impulse ^ the iidai wavt\ extending from the apex to the
''aortic ootch/' represents the sustained propulsion of the
blood resulting from the energy stored up in stretching the
irtcries- As the stretched arteries contract, the pressure or
tension ts more or less maintained, according to the degree
o( elasticity lo the vessel walls. With a rigid » atheromatous
iftfty, the pressure quickly falls.

The rigid arteries of old age produce a marked but short 83
tidal wave, followed by a very marked fall (Fig, 9), Id aortic
rtgurfitaiion, the fall is equally marked (water-hammer pulse)

ause of the sudden emptying of the artery into the ventri-

(Fig. 10), In the high-tension pulse (Fig. 11 }, there is a
ilower and more gradual decline after the tidal wave, which is
very well marked (Fig, la). To the finger, the pulse of old
<g« and of regurgitation feels *' empty* between the beats.
The pulse of high tension feels **full"

The dkr&tic wave is little marked in high tension, but in 84
low tension is so marked that the low-tension pulse of higk
ff^fr is often termed the dicrotic pulse. In such a case the
tiicroiic wave is so much exaggerated that it may be easily
(til tiuder the finger (Fig. 1 3).

h the low-tension pulse the tidal wave, if present, will 85
^ below a line drawn from the apex to the bottom of the

tic notch (Fig. 14). In the high-tension pulse the tidal
^ve is marked^ and rises above the line described The high-
lension pulse is hard to the touch ; the low-tension is scfi.

^frcqiunt patse is one in which the number of beats per 86
We ts abnormally great. In fever the pulse-rate increases
tiifcHU* (approximately) for every degree Fahrenheit rise of
■ft^ptrttore.

62 RATIONAL HYDROTHERAPY.

87 A quick, or short, pulse is one in which the beat itsall
seems very sharp and quick beneath the finger. These temift
are unnecessary, as the quick pulse is always a soft^ or low-
tension, pulse.

88 A long, or slow, pulse is the opposite of the quick palse^
These terms are not needed, as the long pulse is always a
hard, or high-tension, pulse.

89 In the irregular pulse, the beats do not occur with
rhythmical succession, but the intervals are irregular (Fig. 1 5).

90 An intermittent pulse is one in which a pulse-wave is now
and then lacking, a heart-beat being omitted. Sometimes
a pulse seems to be intermittent when there is no actual
omission of beats, but the occurrence at regular or irregular
intervals of a beat too feeble to be recognized by the finger.
The sphygmograph shows the presence of pulse-beats not
otherwise recognizable (Figs. 16 and 17).

The accompanying cuts of sphygmographic tracings are
chiefly copied from the author's collection of many hundreds
of tracings, representing a great variety of conditions, nor-
mal and pathological.

THE SKIN AND ITS FUNCTIONS.

91 Since in by far the greater share of the medical uses of
water the skin is involved, it will be profitable to devote a
few paragraphs to a cursory review of the anatomy and physi-
ology of this remarkable organ.

92 Anatomically, the skin is a structure about one eighth of
an inch in thickness, consisting of a framework of white and
yellow elastic fibers, in which are suspended a countless num-
ber of glands, blood-vessels, and nerves. The whole is cov-
ered with cells joined by a cement-like substance (Fig. 18).

93 The deeper layers of the skin contain, in certain portions
of the body, especially on' the extensor surfaces, and con-
nected with the hair follicles, an abundance of smooth
muscular fibers, which are capable of contracting the skin.

ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 63

The area of the skin covering the whole body is about 94
seventeen square feet.

The sweat-glands are, in man, present almost 95
everywhere in the skin, but are largest and
most numerous in the skin covering the palm of the hand,
the sole of the foot, the forehead, and the axilla. There are
very few sweat-glands in the skin covering the back.

Each sweat-gland receives an artery and a number of 96
nerve filaments, and has a duct through which its product is
discharged upon the surface.

The perspiratory ducts present an aggregate surface of 97
nearly eleven thousand square feet.

The amount of perspiration produced daily is about two 98
pints, or one sixty-fourth the weight of the body, this be-
ing double the amount of water thrown off by the lungs.
The usual rate of sweat secretion is one ounce or an ounce
and a half per hour.

Three degrees of activity of the sweat-glands are recog- 99
nizable; viz.: (i) Ordinary, so-called insensible perspiration,
in which the quantity is so small in amount that the water
and volatile constituents of the sweat are evaporated as
rapidly as formed ; (2) sensible perspiration, in which the
activity is so great as to produce slight moisture of the skin ;
'3i profuse perspiration, in which the quantity of secretion
produced is so abundant that it appears in drops or minute
streams coursing over the surface, and may amount to two
or three pounds an hour.

The function of perspiration presents some interesting JOO
variations in different animals. A horse sweats, as does man,
over the whole surface of the body. The same is true of the
ox, but to a less extent. In the cat and the hedgehog,
svveating is confined to the soles of the feet. Apes sweat in
^^e palms of their hands. In the pig it is the skin covering
the snout which sweats. The goat, rabbit, rat, and mouse
do not sweat.

64 RATIONAL HYDROTHERAPY.

101 The secretion of sweat is increased by the

Conditloiis following agents and conditions : —

the Secretion ^' ^^^creased temperature of the surround-

of Sweat. ing medium, as by the contact of hot air, hot

water, or other heated substances with the
skin. Water at 122^ F., or above, arrests the action of the
sweat-glands.

2. A diluted condition of the blood, such as results from
the copious drinking of water, especially warm water.

3. Increased action of the heart, with rise of blood
pressure.

4. Increased temperature of the blood. The sweat
centers are excited by a rise of temperature amounting
to .70 F.

5. Exercise, which increases the activity of the skin not
only by increasing the activity of the heart, but by raising the
temperature of the blood, and thereby stimulating the sweat
centers. The temperature may be raised by violent exercise
to 104^ F.

6. Percussion and friction.

7. Certain drugs.

8. Stimulation of the secretory nerves by electricity or
other means.

Physiological experimentation has shown that there are
special sweat centers and nerves. The sweat nerves of the
hind leg of a cat lie in the sciatic nerve. Stimulation of
this nerve has caused sweating in the sole of the foot of
a cat forty-five minutes after death. Mustard held in one
side of the mouth will cause perspiration of the skin of
the face of the same side. The centers of the sweat nerves
for the palms lie in that portion of the cord that gives origin
to the brachial plexus. Stimulation of the cervical sympa-
thetic of one side causes sweating of the face and arm of the
corresponding side.

The small blood-vessels are usually dilated in conjunction
with sweating through excitement of the vasodilator nerves ;

hrOUr AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY, 65

but sfveatitig may occur with a pale skin, — the result of fear,

pai/i, collapse, shock* or the death-agony.

Stiaiulatton of a motor nerve causes sweating of the skin

over the mi^scles supplied by the nerve, and of the same area

of the opposite side of t4:ie body, and independently of any

change in the circulation.

9. Mental excitement, as in hysteria and neurasthenia,

often gives rise to sweating, especially of the head, palms,

tid soles, mod sometimes of only one side of the face.

10, Proftise perspiration occurs as a symptom in certain

s, as intermittent malarial fever, phthisis, and acute

natfem,

iL The appearance of sensible perspiration is encouraged

[by i moist, warm atmosphere, in consequence of the lessened

rapidity of evaporation.

Perspiration is dtcreaud by — 102

* Cold.

2 A profuse watery discharge from the kidneys orbow-

The skin and the kidneys seem to act reciprocally,

the secretion of one organ is increased, that of the

oiler is decreased. In warm weather the volume of urine is

^ailvfliifiinished ; in cold weather, increased. The opposite

r ts true of the cutaneous secretion.

^^^. Certain drugs, as atropia.

^^^B* Certain forms of disease, as in some cases of paralysis,

^IRnbctes, cancer, and many cases of chronic dyspepsia,

■ Pcrspii^tlun is one of the most important means by 103

H ^hrcli the danger of excessive accumulation of heat within

~ ^ ksdy is averted. When the skin fails to perform this

^ "^poftant function, as it not infrequently does in fever, the

B ^y temperature often rises to a most dangerous degree,

* ^ Not onlv uric acid and urea, but more subtle 104

rottai of the *

%m^^ and potent poisons are found in the sweat, as

shown by the investigations of Bouchard. Per-

hipsmost important of these is a peculiar substance which

AUoifests its properties by inducing a fall of temperature.

S

66 Rational hydrotherapy.

The retention of this poison in the body may cause death,
as has been proved by varnishing the skin of animals.

105 In diabetes the sweat frequently contains grape-sugar.
Sweat from bad-smelling feet contains leucin, tyrosin, and
ammonia. The sweat of rheumatism may contain albumin,
and that of puerperal fever, lactic acid. Bloody sweat some-
times occurs in yellow fever, and bile pigments are found in
the sweat in cases of jaundice.

106 Chromogenic microbes may give rise to red, blue, and
yellow coloring matters in the perspiration. Mercuric chlo-
ride and other toxic substances have been found in the sweat
after their internal administration. Pathogenic microbes
have been found in the perspiration after a hot bath in in-
fectious maladies.

107 Fat-making glands are found in connection

The Sebaceous ^j^j^ j^oth the coarse and the fine hairs of the
Qlands*

skin. They are absent only from the palms

of the hands and the soles of the feet, and are largest in
the skin of the nose and the labia. The purpose of these
glands is to oil the hair and skin. The layer of oil cover-
ing the skin protects it to some degree. Anointing the skin
with oil hinders conduction. It is a method adopted by
swimmers and mountaineers for protection.

108 A minute band of involuntary muscular fibers is connected
with each hair, one end being attached near the bottom of
the hair pouch, the other to the skin in such a way as to
form an acute angle with the hair. The sebaceous gland
connected with each hair lies in the angle between this
muscle and the hair. By contraction of the muscle, the
hair is slightly straightened and lifted up, gently elevating
the skin near the hair and compressing the gland, thus
emptying it of its secretion. This action of the involun-
tary muscles may be excited by both heat (536) and cold
(328). Heat not only causes contraction of the muscle,
but softens the contents of the sac, and thus aids in their
expulsion.

ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 6/

The skin absorbs substances in watery solu- 109
2J^^j|^" ^ tion with difficulty, on account of the oil lying
upon and in the epidermis and in the ducts.
Solutions administered in a fine spray, and substances dis-
solved in oil and rubbed in, are more readily absorbed.
Absorption takes place readily after the oil of the skin has
been removed by ether, chloroform, or alcohol. By means
of a galvanic current, absorption of watery solutions of iodide
of potash, strychnia, and other drugs may be effected. This
process is technically known as cataphoresis.

Respiration by the skin in man varies in 110
Rcipintioa different individuals, from one half to one per

cent, of the total amount of oxygen taken in
by the body being received in this way. A somewhat less
proportion of CO, is eliminated through this channel. In
irogs and some other closely related animals the skin elimi-
nates from two thirds to three fourths of the total amount of
CO, excreted, thus becoming a more important respiratory
organ than the lungs. Dipping a frog in oil and thus sus-
pending cutaneous respiration will kill it more quickly than
ligature of the trachea. Some creatures, as the earthworm,
breathe wholly by the skin.

Respiration by the skin occurs through the thin walls of 111
the perspiratory tubules, which present a surface of ii,ooo
square feet. Cutaneous respiration is most increased (i)
by rise of internal temperature, (2) by increased cutaneous
circulation, (3) by circumstances that hinder lung respiration,
as asphyxia or dyspnea, and (4) during digestion. The amount
eliminated at 94^ F. is double that at 92^ F.*

The skin is without doubt one of the most 112
Nervous important and interesting of all the sense or-

the Skin. g^ins, being provided with a greater variety of

nerves than any other portion of the body.
The nerves which supply the skin are the following : —

I . The nerves concerned in the tactile sense ; viz. , those
which recognize pressure and locality.

68 RATIONAL HYDROTHERAPY.

2. The two sets of nerves concerned in the tempera
sense, which terminate in the skin in the so-called hot sj
and cold spots.

3. Nerves which recognize pain,

4. Vasoconstrictor nerves.

5. Vasodilator nerves.

6. Sympathetic nerves.

In all, at least seven distinct sets of nerves, which
connected with corresponding nerve centers.

113 In making thermic applications to the skin, the eff
upon each one of these several sets of nerves must be ta
into consideration. It is evident that those areas of
skin which possess the richest nerve supply must be n
profoundly affected by hydriatic applications, and most
pable of producing reflex effects through their . connec
with the internal viscera by means of their centers of ori

114 The acuteness of the pressure sense in diffe
The Tactile p^^^^ ^j ^^ j^^^^ j^ j^^ ^j^^ following or

beginning with the most sensitive : The f
head, lips, cheeks, and temples, the back of the fingers
forearm, the anterior surface of the leg and thigh, the I
of the feet, the toes, the soles of the feet, and the postc
surface of the leg and thigh. The extreme delicacy of
pressure sense is shown by the fact that vibrations ma;
felt when exceeding the rate of i , 500 per second. This
emphasizes the importance of giving careful attention to
exact regulation of pressure as well as temperature in hyi
therapeutic applications, a matter which has generally
ceived less consideration than is necessary for accurate
reliable results.
116 The nerves of touch are connected with the motor cen
controlling the muscles of the corresponding part. Ru
has shown that increased sensibility of one part, whether ;
duced by an application of heat or otherwise, is accompai
by a lessening of sensibility in the corresponding regio
the opposite side.

AJ^ATOMV AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY, 69

The Tempera*
Hire Sense*

This is one ol the most interesting of the fuoc- 116
tions of the skin, and the one most directly
involved in hydrotherapy, as many of its
most profound effects are the result of the influence of ther-
mic applications upon the temperature nerves^ and through
them, upon the cerebrospinal and sympathetic systems.

The temperature sense is not uniformly distributed 117
throughout the skin, but is confined to certain spots, of which
tberietre two kinds,— Ao/ sp&ts and caid spats. These are
aitaoged in curved lines or chains, starting from the hair
loots, Dear which temperature spots are always to be found

Menthol excites the cold spots, and so produces a sensa- 118
tion of cold CO, excites the warm spots, and thus gives
rise to a sensation of heat.

These hot and cold spots are not sensitive to impressions 119
of pain or pressure.
A *' sleeping** limb recognises heat only, and not cold. 120
The acuteness of the thermal sense differs in diSerent 121
poftioas of the body, and in the following order, the most
smitive being named first: Tip of finger* eyelids, cheeks,
% neck, arm, back of hand, palm, thigh, leg, back. The
back of the foot, the breast, and the palm of the hand have
the same d^iee of acuteness*

The more acute areas recognize a difference in tempera- 182
tore of less than . t'^' F« Regions situated in the median line,
^ lite tiose, are least sensitive.

Tkf Umfrraiure is esiimatcii higher when a large surfaa 123
f> €Tp0Sid. Water at 85^ feels warmer if the whole hand is
immersed than water at 90° in which the finger alone is
dipped ; but sudden immeision of the whole body in cold
water produces a less unpleasant effect than when the body
IS introduced gradually.

Ccld bodies frel keavier than warm ones. The pressure 124
ol a stream of water, as in a horizontal jet douche, feels
greater when cold than when warm.

70 RATIONAL HYDROTHERAPY.

125 The skin is tnore sensitive to cold than to heat, impressions
of cold being felt at once, while the sensation of heat develops
gradually.

126 Thermic sensations are felt as warm or cold according as
the temperature of the object or medium brought in con-
tact with the skin is greater or less than that of the skin
itself ; hence the temperature of the skin is the zero of the
temperature sense. Objects of a higher temperature than
that of the skin are felt as warm or hot ; those of a tem-
perature below that of the skin, cool or cold.

127 Thermic impressions are most intense when the difference
between the temperature of the application and that of the
skin is greatest.

128 Objects that are good conductors of heat feel warmer ot
cooler than poor conductors at the same temperature. It ii
doubtless for this reason that hot or cold water makes i
very much stronger impression than air of the same tem
perature.

129 The temperature sense is most delicate at temperature
near or a little below that of the blood (8o° to 90^ F.). I
is less delicate at temperatures below 80° and above tb
temperature of the body. Impressions of pain only are mac
by a temperature of ijo^ or above.

130 Rapid variations of extremes of temperature produce mo\
marked effects than gradual changes. The strongest impre
sions are made by alternations of very hot and very co
applications.

131 The sensibility of the temperature sense improves wi
practice and with diminution of the blood supply, Veno
congestion of the skin diminishes the temperature sense.

132 Patigue of the temperature sense develops quickly; hen
marked tolerance within quite wide limits is quickly ests
lished.

133 The nerves of the temperature sense are associated w
the heat-generating and heat-regulating centers of the br;
and spinal cord.

AHATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY, 7 I

^_ The blood-vessels are supplied with both con- 134

maStcr^baT¥ strict ing and dilating nerves, which arise from
Nefvtsw different centers, located at various levels in

the spinal cord. It is through impressions
. tnade upon the§e nerves either singly or in succession that
ome of the most important effects in hydrotherapy are pro-
doced. The relation of the principal vasomotor centers to
ithe principal surface areas and to the viscera of the chest and
aroen, is briefly stated elsewhere (1S3-166)*
Each one of the several million sweat-glands and seba- 185
ceous glands of the skin is supplied with secretory nerves
which are connected with the great sympathetic centers and
with centers in the spinal cord.

OEMERAL VIEW OF THE NERVOUS SYSTEH AS RELATED TO
MVDROTHERAPY.

The skin, as has been aptly remarked, is a harp of a thou- 136

saad strings, upon which one who is a master of the necessary

^_ metnsmay pfay in such a manner as to produce almost any

^P&^ircd physiological or therapeutic effect* The skin is the

keyboard, and the nerves and nerve centers are the internal

inecfaaiiisfn. An understanding of the relation of the skin to

the nerves and nerve centers is as essential to the physician

who desires to employ hydrotherapy intelligently as is a

knowledge of the rales of musical harmony and technique

to (he pianist.

It is necessary to understand not only the relation of the 137

Ipi^e endings in the skin with the nerve centers in the

Train and spinal cord, but also through them the relation

of the skin with the internal viscera supplied with nerves

from the same or associated centerSp and hence in special

reflex relation.

Applications to the skin arc sometimes made for the pur- 138
pose of infloencing the nervous system as a whole, but not
iolrcqaently it is desirable that the application should be lim-
ited ID its effect to some single internal region.

72 RATIONAL HYDROTHERAPY.

t89 There is no other class of therapeutic agents that requires
so profound a knowledge of physiology, especially the physi-
ology of the nervous system, and such constant employment
of this knowledge, as do the various procedures included
under the general term ** hydrotherapy.*' We have space
here only to call attention briefly to such physiological and
anatomical data as are essential to a proper comprehension
of the facts rehearsed in the chapters devoted to the physio-
logical and therapeutic effects of water.

140 While every nerve center in the body is more or less
profoundly affected by general applications to the skin, there
are four sets of centers that are especially involved, as
follows : —

1. The sensory centers, located in the brain.

2. The heat centers, located in the brain and spinal cord.

3. The vasomotor centers, located in the spinal cord.

4. The secretory centers, located in the spinal cord and
the sympathetic system.

141 As most of the nerves connected with these ganglia are
closely connected with the spinal nerves, it is of importance
to bear in mind a few facts respecting the relation of the
several spinal centers to the spine itself or to the vertebrae.
These relations may be briefly stated as follows: —

1. The eight cervical ganglia correspond to the seven
cervical vertebrae.

2. The twelve dorsal ganglia correspond in general to the
several dorsal vertebrae, ending, however, with the eleventh.

3. The five lumbar ganglia are located at the level of the
twelfth dorsal vertebra.

4. The ganglia of the five sacral and the coccygeal nerves
are found at the level of the first and second lumbar vertebrae.
No ganglia are found below this point because of the forma-
tion of the Cauda equina.

In making applications to the spine, intended to influence
the centers directly, it is essential to keep in mind the above
facts respecting the location of the spinal ganglia.

JUSATOMY AND PHYSiOLOGY IN RELATION TO HYDROTHERAPY, 73

m Stipefficiftt

As hydrotherapeutic applications are capable 142
of exciting each and all the classes of reflexes
that may be set up by stimulation of the cuta-
neous oerves, it is useful to bear in mind the location of the
several reflex areas, and their relation to the spinal centers.

The scapular rtfitx area (the skin between the shoulder- 148
blades), tfi relation with the first to the fourth dorsal ganglion.

The ffii gas trie re/rar area (the skin overlying the lower 144
lateral portion of the chest), in relation with the fifth to the
seventh dorsal ganglion.

The abdominal refiex area (the skin lying along the bor- 145
dors of the recti muscles), in relation with the eighth to the
Iwellth dorsal center.

The ^/i#/irtf/ rjf/r^r rfirra for lower portion of the nates in 146
relation with the fourth and fifth lumbar.

The cremasteric reflex area (inner and upper portion of the 147
t%h), in relation with the fourth and fifth lumbar ganglia.

The pfantar refiex area (the soles of the feet), in relation 148
vith the five sacral and the coccygeal ganglia.

In the application of the douche with strong pressure, the
location of the several reflex areas as described above may
with advantage be kept ui mind, especially in cases of organic
lEscase of the spine.

The cont roiling ifasomotor centers, both con- 149
stricting and dilating, are located in the
medulla. Subordinate vasomotor centers are
located in the spinal cord. The vasoconstricting centers are
found chiefly in the cervical and thoracic regions ; the vaso-
dilator centers are scattered throughout the cord*

Strong stimuli act on the vasoconstricting nerves ; mod- 150
eratCt on the vasodilator fibers.

The veins and the lymph- vessels are also supplied with 161
vasomotor ner%*es ; and though at the present time nothing
more is known ol these oenes than that they exist, it is rea*
sociable to suppose that they obey the same general laws as
tliooe connected with the small arteries.

The VascMiiotor

74 RATIONAL HYDROTHERAPY.

152 The vasodilators differ from the vasoconstrictors in that
they are made up of medullated fibers, and that they pass
directly to the visceral ganglia of the blood-vessels without
passing through the prevertebral ganglia. Their relation to
the blood-vessels is the same as that of the vagus to the heart.

153 The blood-vessels of the head are controlled by vasomotor
nerves from a center in the medulla, which pass to the head
through the cervical sympathetic.

154 The lungs receive vasomotor nerves from the second to
the seventh dorsal ganglion.

155 The intestines and abdominal viscera receive their vaso-
motor fibers through the three splanchnics. The great
splanchnic is the largest vasomotor nerve in the body. Par-
alysis of the splanchnics causes death from accumulation
of blood in the portal circulation, being equivalent to a
hemorrhage, or ligature of the portal vein.

156 The principal vasoconstrictor and vasodilator nerves of
the kidney leave the spinal cord with the last three dorsal
nerves.

157 The liver receives its vasomotor fibers from the splanch-
nics and the vagus.

158 The spleen receives vasoconstrictor and vasodilator fibers
from the splanchnics.

159 The pelvic organs in both sexes receive vasoconstrictor
fibers from the lumbar nerves and vasodilators from the
sacral nerves.

160 The arms receive their vasoconstrictor nerves from the
middle dorsal region, through the first thoracic ganglion of
the sympathetic.

161 The vasomotor nerves of the lower extremities pass
through the lumbar and sacral plexuses to the sympathetic,
thence to the lower limbs.

162 The skin of the trunk receives vasomotor fibers through
the dorsal and lumbar spinal nerves.

163 The muscles receive their vasodilators through the trunks
of the motor nerves.

ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 75

The larger proportion of vasomotor nerves leave the spinal 164
cord between the fifth cervical and the first dorsal vertebra.

The richest vasomotor areas are found in the skin cover- 165
ing the palms, fingers, soles, toes, and ears.

,^ .„ . The nerves that excite the peristaltic move- 166
Tlie Visceral

M«ior Nerves. ^^^^^^ of the esophagus, stomach, and intes-
tines (excito-motor) leave the spinal cord in
the upper part of the cervical region, reaching the intes-
tines through the pneumogastric.

The ssonpathetic nervous system (Fig. 20) con- 167
2*J^°^' sists of three distinct sets of ganglia ; namely: —
Sy^^ I. The lateral^ or vertebral^ g(if^gliO'% con-

sisting of a series of ganglia arranged along on
either side of the anterior surface of the vertebral column,
<Iistributed as follows : three cervical, twelve dorsal, four
luihbar, five sacral, one coccygeal. These two chains of
^nglia form an ellipse, the ends being joined at both top
Aod bottom in a single ganglion.

2. l\i^ prevertebral ganglia, ox gangliated plexuses, con-
sisting of the cardiac, solar, and hypogastric plexuses, or the 168
tkoracic, abdominal, and pelvic prevertebral ganglia, and the
Dmbilical ganglia.

3. Still farther removed from the vertebral chain of gan- 169

glia are the visceral, terminal, or automatic ganglia, which

are found in the several viscera, — the liver, kidneys, spleen,

pancreas, intestines, and blood-vessels. In the intestines

there are two sets of these ganglia, — one between the two

muscular layers, Auer bach's plexus, controlling the intestinal

muscles ; and another lying beneath the mucous membrane,

Meissners plexus. The latter controls both the intestinal

glands and the involuntary muscular fibers of the villi.

The vertebral ganglia are connected with the 170

SbU h fax three sets of prevertebral ganglia by visceral

or splanchnic nerves, which may be properly

termed the thoracic, the abdominal, and the pelvic splanch-

nics. The splanchnics are in the chest known as the

76 RATIONAL HYDROTHERAPY.

three cardiac nerves; in the abdomen, as the great, lesser,
and least splanchnics,

171 A rich supply of sympathetic nerve branches connects the
prevertebral ganglia with the automatic ganglia, following
the blood-vessels in their minutest ramifications.

172 Every ganglion is a brain, and stores up energy
Functions of the ^ , ^^ , . . . ,^.
Sympathetic. *^ ^® afterward used m some way m exciting

or controlling some form of vital activity in
the subordinate structures associated with it.

173 The prevertebral ganglia, or gangliated plexuses, act,
perhaps, as reorganizing centers, receiving impulses from all
parts of the body and sending them out again to the same
and other parts, thus maintaining a constant universal reac-
tion to all sorts of physical impressions received from without.

174 The distal, automatic, or visceral ganglia preside over the
minute details of vital work, each controlling its own little
sphere of activity.

175 The sympathetic nervous system presides over the proc-
esses of secretion and excretion, all gland action, and also
the circulation. This fact alone gives to the sympathetic
practical control over all the processes of nutrition and
organic change, as well as of voluntary activity. Through the
grasp of the sympathetic upon the cerebral circulation, men-
tal activity, even consciousness, is under its control.

176 The automatic ganglia of the heart, the intestines, the
blood- and lymph-vessels, the Fallopian tubes, and the uterus
are capable of independent activity, and may perform their
functions when cut off from all connection with other nerve
centers, although they are, under ordinary conditions, influ-
enced in the direction of either inhibition or excitation by
nerves received from the central nervous system.

177 It is through the influence upon the great sympathetic of
thermic and percutient applications to the skin that the most
remarkable effects of hydrotherapy are obtained. Through
the powerful impressions that may be made upon this portion
of the nervous system by external and internal applications of

ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. TJ

water, every nutritive process, indeed every vital process
taking place within the body, may be modified, being aug-
mented or retarded as circumstances may require.*

ANIMAL HEAT.'

Since hydrotherapy consists, for the most part, in proce-'178
dures which have for their object the making of thermic im-
pressions upon the skin, it is evident that a correct knowledge
of the phenomena and mechanism of heat production and
regulation in the human body is essential to a proper appre-
ciation of the methods and principles of hydrotherapy.
Recent advances have been made toward the solution of the
numerous diflBcult problems involved in the subject of heat
production and regulation, which render this study especially
important, interesting, and profitable from a practical point
of view.

The heat of the body is wholly derived from 179
Aidoial Heat. ^^ods, which, as has been shown by careful
calorimetric studies, produce, when completely
oxidized within the body, practically the same amount of heat
and energy that would be generated by their combustion out-
side the body. The actual caloric value is about twenty per
cent, less than the estimated amount.

A study of the heat-producing properties of the various 180
elements of food shows that an ounce of dried albumin pro-
duces in the body sufficient heat to raise nearly 680 pounds
of water one degree in temperature ; an ounce of fat produces
eighty per cent, more heat, or sufficient to raise i , 200 pounds
of water one degree ; and an ounce of starch produces a little
more than four fifths as much as an ounce of albumin, or
sufficient to raise 550 pounds of water one degree F.

The combustion, or oxidation, of food is not direct in the 181
body, as in a furnace, but occurs as a process of disassimilation,
under the influence of special ferments which operate under
the control of nerves and nerve centers. Oxygen is assimi-
lated, CO, is excreted. Heat is the result of the tearing

78 RATIONAL HYDROTHERAPY.

down of molecules, and the reappearance in the form of
molecular vibration of the energy that was previously em-
ployed in holding the molecules together in the organized
state. These changes take place in all the tissues, and
even, as recently shown, in the blood to some extent*

182 The total amount of heat produced in the body each
twenty-four hours is 2,500,000 gram centigrade calories, or
sufficient to raise 10,000 pounds of water one degree F. in
temperature, or to raise from the temperature of freezing to
the normal body temperature, the body of a man weighing
1 70 pounds. This amount of heat would be obtained by the
complete oxidation within the body of eighteen ounces of
starch or a little less than half that quantity of fat. The
generation of this large amount of heat within the body is
necessary in order to maintain its temperature.

183 Cold-blooded animals take the temperature of
Cold-Blooded the medium in which they exist, or maintain
Blooded""" ^^^ ^ slight difference between the body tern-
Animals, perature and the surrounding medium, the

temperature rising and falling with that of the
water or the air. The frog, in water of 68^ F. or less, main-
tains a temperature of from two or three degrees to a few
tenths of a degree above the water. In warmer water its
temperature is a little below that of the water.

184 The temperature of mollusks and fish may fall to 33° F.,
or scarcely a degree above the freezing-point, in ice-water.

185 Most mammals have a normal temperature near that of
human beings ; namely, 98.6°. There are a few exceptions.
The mouse has a normal temperature of 100° ; birds, from
107^ to 1 1 1°.

186 A warm-blooded animal maintains its normal temperature
independently of the temperature of the surrounding medium
within the limits of its usual conditions of life ; and even when
exposed to extreme or unusual temperatures, its organism
struggles against any marked change of temperature until its
powers of heat regulation or production are exhausted.

ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 79

A young child approaches somewhat the condition of a 187

cold-blooded animal in its susceptibility to the influence of

external temperatures. This fact should be kept in mind in

the employment of hydriatic processes with infants and

young children. The ability to react to cold, and to adjust

the body temperature to that of the environment, increases

with age during the early years of life.

Different observers report varying figures, 188
Tv^iM^!ii°*'. ^^^ ^^^ normal temperature of man is gener-
bi nn. ally considered to be approximately 98.6° F.

in the axilla, the normal limits of variation
being 97.2^ and 99. 5°. The temperature of the mouth is
about . 5^ higher than that of the axilla, and that of the rec-
tum and the vagina a degree higher than that of the mouth.

The temperature of the surface varies considerably; that 189
of the various internal organs varies less, yet to a marked
extent.

^^^ With the temperature of the room about 68°, 190

Teomenitiiies. Kunkel found the temperature of various parts
of the body surface to be as follows : —

Ctntigradg, Fahrenhtit.

Forehead 34- 1-34-4° 93-38-93-92°

Cheek 34-4° 93-92°

Tip of ear 28.8° 83.64°

Back of hand 32.5-33.2° 90.5 -91.76°

Hollow of hand (closed) 34-8-35. 1° 94.64-96. 18°

Hollow of hand (open) 34.4-34.8° 93-92-94-64°

Forearm 34-3° 93-74°

Sternum 34-4° 93-92°

Pectoral region 34.7° 94-46°

Right iliac fossa 34.4° 93-92°

Upper part of thigh 34.2° 93-56°

Calf 33-6° 92.480

The temperature of the skin is higher over muscle than
over bone ; over an artery than over a tendon ; over an
active organ than over an organ at rest. The skin of the
forehead has a higher temperature than that of the occiput.

8o RATIONAL HYDROTHERAPY.

191 Internal Davy and others give the following as the tern-
Temperatures, peratures found in various internal parts : —

BraiD •. . 104® F,

Left ventricle 107® F.

Right ventricle io6<> F.

Liver 106. 5® F.

Rectum 100® F.

192 The average temperature of the blood is about 102° F.
The average temperature of the venous blood is nearly two
degrees lower than that of the arterial blood. The tem-
perature of the blood in the carotid artery is from one to
four degrees higher than that in the jugular vein; in the
crural artery it is from one and a half to two degrees above
that of the crural vein. The coolest blood in the body is
that coming from the nose and the ears. The external tem-
perature is ten or twelve degrees below the internal (Senator).

193 The temperature varies with age ; that of the infant cw
child is normally about one degree higher than that of the
adult. After the age of thirty, the temperature gradually
falls to about one degree below the average standard, while
in very advanced age it rises one degree.

HEAT PRODUCTION.

194 Heat production in the body is the result of vital work.
Every organ and cell participates in the work of generating
animal heat. The higher the degree of activity, the greater
the rate of heat production. Those organs that are most
active functionally produce the greatest amount of heat.

195 In the hepatic vein during digestion the temperature is 3®
or 4° F. higher than in the portal vein. The blood leaving a
muscle when in a state of rest is ordinarily about .4^ F.
higher than that supplied to it. When the muscle is active,
the difference is three times as great, or about 1.3° F.

196 The body of the average man produces each minute
sufficient heat to raise seven pounds of water i^ F. in
temperature. In the horse and the dog, the rat« of heat

AKATOUY AND PHYSIOIjOGY IN RELATION TO HYDROTHERAPY. 8 1

prodoction per pound of body weight is about the same. In
a child weighing fifteen pounds, the heat production is twice
as great ; in the guinea-pig, five times as great. In the
mcmsc the rate of heat production is twelve times greater,
and in the sparrow, twenty-four times greater, than in man.
The rate of heat production in an animal appears to increase
with the extension of its superficial surface.

Heat production is more active in strong and robust than 197
in weak persons. It is more active in young persons or young
animals than in adult persons or full-grown animals, because
of the larger proportion of radiating surface and the conse-
quent necessity for greater heat production to retain a nor-
mal temperature.

rommionj thai Th^r® ^.re various conditions that profoundly 198
lacrease Heat afffect the process of heat production, each of
ProdocUoa, and which must be recognized and remembered
to T{mi^-^ ^° dealing with febrile cases. These condi-

Qse. tions may be enumerated as follows : —

I. Glandular Activity. — Freshly secreted saliva is found 199
to have a temperature of 2.7^ F. above that of the blood in
the carotid artery. The blood of the renal vein is warmer
than that of the renal artery. Blood in the hepatic vein
daring digestion may have a temperature three or four
degrees higher than that of the portal vein, though at other
times the difference is but one degree, or even les§.

2. Muscular Activity. — The temperature of an oarsman 200
was found to be 104^ after rowing one and one-fourth miles
(Experiment i). Heat production is increased by exercise,
according to Helmholtz, from 7.5 to 18. i heat units per
minute. Strong shivering also increases heat production.

3. Mental Activity. — Mental activity has less effect on 201
temperature than muscular or glandular activity, but an
increase of one half a degree has been observed as the result

of vigorous mental effort.

4. Digestive Activity. — Langlois proved that heat pro- 202
duct ion is increased thirty-five or forty per cent, during
digestion. The body temperature often rises half a degree.

82 RATIONAL HYDROTHERAPY.

The contents o{ the stomach may have a somewhat lower
temperature during digestion, owing to the fact that heat is
rendered latent by the changes taking place in the food, and
the low temperature at which a considerable proportion of
the food is usually eaten.

203 5. Brief Applications of Cold Water (Exp. 2).

204 6. A Low External Temperature. — A temperature of
40^ F. and below causes increased heat production when the
body is so exposed as to cause shivering or a goose*flesh
appearance. If these symptoms, which are due to muscular
action, do not appear, heat production is not increased, and
may even be diminished. Prolonged cold applications lessen
heat production in fever.

205 7. A High External Temperature, — This causes, for a
time at least, increased heat production through the increased
tissue activity induced. The rate of heat production begins
to rise slowly at 60° F., although temperatures between
60^ and 70^ F. may be regarded as practically neutral in
their effects. Voit fixed the exact neutral point in men at
58^ F. Page found the neutral point in dogs to be J7^ F.
With an external temperature of 104^ F. the rate of heat .
production was three and one-half times the normal.

The influence of external temperature upon heat produce
tion is a matter of great practical importance in dealing with
many classes of morbid conditions, and especially fevers.

The following conditions decrease heat pro-
CondWoiw that duction : —

206 Production. '• Fasting, — Abstinence from food has

a decided influence upon the temperature.
At first the temperature falls one or two degrees, then marked
emaciation is developed, and shortly before death the tem-
perature declines rapidly. Fasting and badly nourished
patients have little heat-making power, and bear cold
applications badly.

207 2. Sleep, — The temperature falls half a degree or more
during sleep. It is for this reason that the temperature is

AKATOMY AKD PHYSIOLOGY IN RELATION TO ByDRDTHERAFY, 83

usually h^her at night than in the morning. The morning
temperature is higher in a person who works at night and
skeps during the day. In hibernation the beat production is
dimioished to such an extent that the absorption of oxygen is
less than one fortieth as much as during normal activity, and
the dimination of CO^ only one seventy-fifth the normal
amount According to Helmholtz, the amount of heat pro-
duction is only one third that during rest when awake, or 2.4
beat Qikits p^r minute as compared with 7, 5.

3, Short applications of heat lessen heat production 208
vhile increasing heat elimination, and thereby cause a dechne
10 the body temperature.

HEAT REGULATION.

\(odem researches apon this subject apparently demon- 209
^t n € that the heat -producing and heat-regulating mechanism
Ji Llic body consists of three elements, — tAermo^enic ceniers^
lienmgenic mrves^ and tkermogenu tissues.

Of the thermogenic centers there are three classes : —
r, Tht autmnatic cenifrs, located in the spinal cord, which 210
have immediate charge of the thermogenic tissues, and
ander the contm) of which the process of heat production
carried on.

2, Accelerator centers^ located in the brain, which in- 211
crease heat production by stimulating the automatic centers.

V Inhibitory centers, also located in the brain, which 312
restrain the action of the automatic centers.

The automatic centers appear to be entirely uninfluenced 218
by the various forms of stimuli which influence the body
temperature, while the regulating centers in the brain are
eJctremely sensitive to such stimuli.

The inhibitory thermogenic centers of the 214
TlM MtchflittiM braiin appear to rule in a remarkable manner
RrcuUildii * g^c»up of important functions which are

oliiized in heat dissipation when it is neces-
sary to eocnbat a tendency to temperature rise. These are —

84 RATIONAL HYDROTHERAPY.

1. Diminished production of heat through inhibition of
the automatic thermogenic centers.

2. Increased activity of the heart.

3. Dilatation of the surface vessels.

4. Increase of cutaneous secretion.

5. Increased rate of breathing.

315 Heat applied to the skin acts reflexly through the nerves,
and a blood temperature above normal acts directly upon the
nerve cells. These two causes excite the inhibitory centers.
Cold applied to the skin, and a lower temperature of the
blood, in like manner excite the accelerator centers. These
centers in turn 'diminish or increase the activity of the auto-
matic centers of the cord, as may be required to maintain the
particular temperature which the system itself seems to estab-
lish as the standard for i given set of conditions or circum-
stances. In sleep, for example, the temperature is lower
than during waking hours, and in fever the standard for the
body temperature is set higher than normal.

216 The blood is a circulating medium which is used not only
to convey nutrient material from the stomach to the tissues,
and excrementitious matter from the tissues to the excretory
glands, but for the purpose of equalizing the temperature,
conveying the surplus heat of the interior of the body to the
surface, where it may be dissipated by conduction, radiation,
and evaporation. Nearly nine tenths of the daily heat loss
occurs from the skin. By the increased rate of heart beat,
the complete exchange of blood between the center and the
periphery takes place more frequently, and the blood is thus
more rapidly cooled.

217 By active dilatation of the surface vessels a larger surface
is exposed to the cooling influences that act upon the skin.
The surface over which the blood is spread is not fully repre-
sented by the seventeen square feet of skin surface, but rather
by the eleven thousand square feet of surface over which the
capillaries are spread in the walls of the perspiratory tubules,
. — six times the surface presented by the lungs.

AHATOMV AKD PlIYSlOLOGy IN RELATION TO HYDBOTHEKAPY 85

One seventh o( the total heat loss by the skin is due to 218

cvaponitiofi* Evaporation of the increased amount of water

brought to the surface by profuse sweating enormously in*

creases the heat loss. Each ounce of water evaporated from

the skin absorbs heat sufficient to raise the temperature of

about seventy pounds of water one degree Fahrenheit. By

vanous means the amount of perspiration may be increased

to two or three pounds an hour.

The increase of respiratory activity increases heat loss, 219
itt)tonly by the ijicrcased amount of the air that is wanned,
but by the evaporation of water from the two thousand
square feet of surface presented by the pulmonary mucous
nwmbrane.

In like manner the thermogenic centers control a number 220
ol mechanisms by which heat production is increased and
kcat loss lessened. When cold is applied to the surface, or
^'hcnlhe temperature of the blood is lowered, the accelera*
Tor (h<L I r center is exxited, and as the result —

J 1 _ .[vtmatic thermogenic centers of the spinal cord
an; excited to increased heat production*
2* The heart's action is slowed.
J, The surface vessels contract.

4. Pejsjaration is checked.

5, The erector pili and other involuntary muscles of the
skin contract, lessening the conductivity of the skin.

6- The respiratory movements are slowed.
The automatic thermogenic centers of the spine are 231
ited by the accelerator center of the brain, and stimulate
ilhi-r c tissues to increased activity, thus increasing

pi Li ; the decreased activity of the heart lessens

rate at which the blood is sent to the surface ; the con-
tracted vessels of the skin diminish the area of blood exposed
iling influences, thereby lessening evaporation and heat
the contraction of the erector pili, by increasing the
firmness o( the skin, decreases its conductivity ; the diminished
re^iratory niovemeiit lessens the amount of air heated by the

and Heat

DlsslpatlQii

Associated*

lungs, through which more than ten per cent, of the total loss
of heat occurs. Thus, by the combined action of these vari-
ous mechanisms, loss of heat is diminished while its produc*
tion is increased,
282 It is interesting to note that the functions of

Heat Productjon ^^^1 production and heat dissipation are recip-
rocaL If heat dissipation is suddenly increased
by a reflex influence acting upon the heat-
regulating center, heat production is also at
once increased^ and measures are set in operation to conserve
the body heat ; while, on the other hand, if heat production
is unduly increased, heat dissipation is immediately increased.
Every agent that tends to increase heat dissipation, at the
same time reflexly excites heat production ; and whatever
diminishes heat dissipation, likewise, by reflex action, dimin-
ishes heat production. This action of the thermogenic cen-
ters, whereby heat production is increased or diminished,
occurs independently of any effect upon the circulation.
8S3 A simple illustration will make clear the necessity for this
apparently paradoxical relation of heat production and heat
elimination. A healthy man, whose temperature, heat pro-
duction, and heat elimination are normal, is made to perspire
so freely that water is evaporated from the surface of his skin
at the rate of one and a half pounds an hour The amount
of heat absorbed by the water in evaporation would be about
i.SOOpound Fahrenheit heat units. At the normal rate of
heat production — seven heat units per minute — there shoul
have been produced within one hour 420 units of heat Sub
tract ing this from i , 500, we have a net loss of i ,080 heat units,
provided there were no increase of heat production. Sup*
pose the patient's weight to be 160 pounds, his temperature
would be lowered 6.75^, Upon examination of the patient's
temperature^ however, we find it to be normal It is evident^
then, that he has produced within the hour 6. 75 heat units
for each pound of his body weight, in addition to the usual
amount, thus preventing the fall of temperature*

i

AMATOIIV AND PHYSIOLOGY IN ILELATIOK TO HYDROTHERAPY. 8/

W«t^^B«lll

714^ special thermogenic iissues are found in the mtiscles, 234
in whteb heat production is constantly taking place through
the connection of these tissues with the automatic centers of
the spioe by means of the thermogenic nerves. Heat is con-
stantly produced in the muscles even when at rest. When
the muscle is active, four fifths of the energy consumed
appears as heat, and only the remaining fifth as muscular
eaergy. The muscles are the chief seat of heat production.
They store op glycogen for heat and work.

In the clinical study of the phenomena of 225
animal heat there has long been need for a
t^alorimeter which could be used at the bed-
side. Several years ago (1890), while engaged in instructing
I class of medical students in hydrotherapy, the author em>
ployed a common bath-tub for this purpose.*

The method is a very simple one. Water is placed in 226
a common full bath-tub, in a room of nearly constant tern-
atisre, in quantity sufficient to immerse the patient, all but
*iht head. The water should be carefully weighed, and its
.Icmperature accurately determined. This may be fixed at a
Bventent poiut. It must be some degrees below the body
Bmperatiire» and should not be too far removed from the
temperature. The temperature of the room should
about 70^ to 80"^ F., and as constant as possible.
After placing the water in the tub, it should be thoroughly
rfor fifteen minutes with a wooden paddle having a
leter attached. Careful note should be taken of the
temperature of the water every five minutes. By this means
the rate of the cooling may be ascertained. It is evident
the body of a person placed in the bath will give off
It to the water, and the rate of cooling be thus diminished.
By a simple calculation the rate of heat elimination by the
body may be readily estimated in both normal and patho-
:al conditions. This is a vefy practical and accurate
oethod (Exp. 3* 4. S)

*S^Ctt vffiliac lb« ib^vc. the author liw Levned thiil LiebenDctttcr exaplofed the une
pit «aiflfia»»f«r ihtn^r y«ar% ifo.

RATIONAL HVDKOTHERAPY,

The Author's
Fc%cr Calo-
rimeter.

227 The Author's The author has recently (1899) devised a cc
venient instrument for determining quickly ?
approximately the rate of heat eUmination
a patient under examination as compared with a norma]
individual. The instrument may be briefly described
follows : —

It consists of two parts (Fig, 21, a and d) ; first, a gla
cyUiider one inch in length, and of such diameter as to gii
its bottom an area of three square inches, making its cnb^j
capacity three cubic inches. This cylinder is protected by
solid wooden case an inch in thicknesSp which may be readilj
removed. It is connected with a small bettle filled with'
colored liquid, through the cork of which is passed a piece of
barometer tubing 75 cm. in length, which serves as an indi-
cator. A scale placed behind the barometer tubing marks
the height to which the column of colored liquid rises.

This instrument is extremely sensitive. When applied to
the surface of the body, the column of liquid rises with great
rapidity, to a greater or less height according to the tempera-
ture uf the surface.

In the use of this calorimeter, the temperature of the sur-
face is taken at the same time by a suHace tharmometef.
The time for reaching the maximum is noted. This deter-
mines the time required to raise a given quantity of air-
three cubic inches — a determined number of degrees in tem-
perature (the difference between the room temperature and
the surface temperature) by the heat thrown off from a defii
nite area of the skin — three square inches. By means
the data thus obtained and the use of the formula given else-
where (page 316) for determining the skin area of a body
given weight, a pumerical basis is found for comparison of thd
amount of heat loss by a person who is in a febrile state
compared with that by a healthy person. In one patient
examined with this instrument, heat elimination was found
to be nearly double the normal, although the tempera tore
was 102^ F-

AKAttBfY AND PHYSlOLoaY IN RELATION TO HYDROTHERAPY. 89

CAiorimtttt of

trArs<»iivmr»

C^lofitncter.

This iDStmrnent (Fig, 22) consists of two ther- 228
mometers placed in a chamber with thick
wooden walls, about four inches square on
the inside. The chamber is open on one side,
and one of the thermometers rests upon the skin when the
insirument is in position with the open side next the skin.
The other thermometer determines the temperature of the air
io the chamber. With this instrument Winternitz has made
a series of most interesting observations respecting the influ-
ence of (fiction and other measures upon heat elimination.
This insirument, of which the writer learned on a recent visit
to Vienna and Kaltenleutgeben (summer of 1S99), is of great
use, and renders invaluable service in the prosecution of
physiologii^al researches respecting heat elimination (Fig, 23).

D' Arsonval. of Paris, has devised a convenient 229
and portable calorimeter (Fig. 24), which, while
less exact than the water-bath calorimeter, is
90 eoQ^enient and portable that it should be briefly described,
as it is an appliance which the writer has found of service in
the scientific study of hydrotherapy. A cylindrical chamber
made of pasteboard or binder's pressboard receives the sub-
ject The chamber is about two and one-half feet in diame*
ler, and about six feet in height. An opening of proper size is
made in the top, and in this opening a small anemometer is
placed.

The patient to be tested stands up while the cylindrical
chamber is lifted over his head (Exp.6,7). Through a few
openings in the bottom of the cylinder a current of air is
allowed to pass in and through it. Coming in contact with
the patient, the air is warmed and made to pass upward; and
in passing out through the anemometer, its mechanism is set
in operation, and a record is made upon the dial which
indicates the rate at which the air current travels in passing
through the instrument. ft is also easy to estimate the
volume of the air that has passed through the cylinder in
a given tune. The greater the amount ot heat eUmination,

90

RATIONAL HYDROTHERAPY.

230

331

Fever.

the more rapid will be the movement of the anemometer, an
in a given time the greater the amount of heat eliminated. i

This instrument is a convenient and interesting one^ bt^^f
we have found it much less accurate and more cumbersome^
than the fever calorimeter previously described, and it is cer-
tainly considerably less exact than the bath-tub calorimeter.
Fever is due to the disturbance of the heat -regulat-
ing centers. Such disturbances may result from three
classes of causes; vi^., (i) toxic substances, (2) nervous im-j
pressions, (3) changes in the temperature of the blood. Feve^f
is no longer, as formerly, regarded in the light of an unmiti-
gated evil, and to be combated irrespective of other symp-
toms, as it has been clearly shown that a rise of temperature
iSi at least in some cases, curative in its tendency. It is
the result of a curative effort on the part of the body.
It is not the fever, but the cause of the fever, that we must
combat. An infected frog dies without rise of temperature.

The temperature has been known to rise as much as t J^
above the normal in pathological conditions, and even a
higher temperature has been noted just before death. Recov-
ery rarely occurs when the temperature exceeds 107^ F, I

Id fever, the functions of the heat -regulating centers are
so greatly disturbed that influences which, under ordinary
conditions, would not affect the body temperature^ may occa-
sion a rise of temperature of several degrees. In other words,
there is, in fever, a disablement of the heat -regulating centers
of such a character that the generation and elimination of
heat are not properly controlled, and there is a marked loss
of resistance to the causes of thermic disturbance in both
directions.

A warm atmosphere in febrile conditions tends
far more than in health to cause rise of tem-
perature, both by decreasing heat elimination
and by increasing heat production* Under

Influence of a
WAfin Atnias
ptiere iii;Kiii
Heat ProductlQD.

normal conditions an atmospheric temperature
continuously above 60° F., as elsewhere remarked, t^nds t|

A!4ATOMV AND PHYSIOLOGY IN RELATION TO MVDROTHERAPy, 9I

mcre^Be heat prodoction, and at a temperature of 104^ F,
heat production is increased to more than three times the
nonnal amount. In health this increase of heat production
is ol course very largely balanced by increased heat elimi-
nalioc; byt in fever this balance is not maintained. The skin
10 fever is commonly dry under conditions which in health
woold induce profuse perspiration. Hence heat eliniination

l^eatly diminished. Fortunately, heat production is in-
much less in fever than in the normal state, when
an equal rise of body temperature is induced by exposure to
hot air or by exercise. If heat production were increased
in fever to anything like the degree that the elevation of
temperature might lead us to expect^ the temperature would
rise much higher than it does, because of the disproportion-
ately small increase of heat elimination.

From the foregoing, the importance of proper regulation
of the temperature of the air surrounding the patient in fever
cases is apparent. A cold atmosphere, that is, air at a
tentperatttre below 60'^ F. , increases heat production in fever^
but to a I^s degree than in health. The neutral temperature
for atr is from 58^ to 68 ^p while for water it is from 92^ to 95"^,

Exercise, either muscular or mental, even so slight as sit- 233
ting up in bed or conversing with a visitor^ w^ill affect the
temperature by increasing heat production, sometimes to a
Jiery iin usual degree, and may even cause relapse when a
liatient is just convalescing from a fever.

Although the body is at rest in bed^ there is usually in 234
fever great activity to the thermogenic tissues. The pre*
domtiialtJig feature In fever is increased heat production.

For each degree centigrade (1,8^ F.) elevation 235

of body temperature there is ordinarily an
increase of heat production of six per cent.,
according to Liebermeister, or 3.3 per cent,
for each degree Fahrenheit. The following table represents
the percentage increase for each degree Fahrenheit within
the ordiJiafy range of fever temperatures : —

92 RATIONAL HYDROTHERAPY.

Ptreentagg Imeremse ^ Ihmt IhrtdmKiimm
Temperature, tkhevt S0rmmL
98.6*^ F O

100° F 4.6

101° F 8.0

102° F 1 1.3

103° F 14.7

104° F 18.0

105° F 21.3

106*^ F, . . 24.7

107° F a8.o

236 j^ -m ^. - Heat dissipation is generally increased in
the Thermic fever, but in less proportion than heat pro-
Functions duction. When the skin is red and moist^
Which Cause \i^^\, elimination is more than three times the
Temperature. normal. The body temperature represents not
the amount of either heat production or heat
elimination, but the balance that is at the moment main-
tained between these two functions.^

The following table shows the various relative conditions
that may result in increase or decrease of the body tem-
perature : —

337 CONDITIONS UNDER WHICH RISE OF BODY TEMPERATURE MAT OCCUS.

1. Increased heat production with increased heat elimination.

(Heat production increased more than heat elimination.)

2. Increased heat production with normal heat elimination.

3. Increased heat production with decreased heat elimination.

4. Normal heat production with diminished heat elimination.

5. Diminished heat production with diminished heat elimination.

(Heat elimination diminished more than heat production.)

CONDITIONS UNDER WHICH DEPRESSION OF BODY TEMPERATURB
MAY OCCUR.

1. Diminished heat production with diminished heat elimination.

(Heat production diminished more than heat elimination.)

2. Diminished heat production with normal heat elimination.

3. Diminished heat production with increased heat elimination.

4. Normal heat production with increased heat elimination.

5. Increased heat production with increased heat elimination.

(Heat elimination increased more than heat production.)

?IATOMTf AND FHVSlOLCXiY IN RELATION TO HYDROTHERAPY, 93

CQatftil of Heat

FtlQCtlOliS-

339

240

The temperature may be reduced in fever 288
either by diminishing heat production or in-
creasing heat eliminatioa, or by both means
combined ; and therapeutic applications m^y be made in
stich a manner as to influence cither of these processes,
w both of them.

U may not be out of place just here to mention the leading
pbysiologica] means by which fever may be controlled; viz.,
f«sl, fasting, water drinking, regulation of air temperature,
hydiotherapy,

II A careful study of the influence of cutaneous irritation,
thcnaic applications, and changes in the condition of the
blood-vessels of the skin has been made by PospischiL The
Allowing are some of the interesting results obtained: —
L Shorty cold shower baths increased heat eUminatton to the
lEniotuii of from twenty-five to stxty-six per cent* . according
m the patient rested or exercised after the application; cold,
ftt rubbing catted increased heat ehmination to the extent of
T ■ rcent,; mechanical irritation or friction produced a
i . ler heat loss,— ninety*five per cent.; agents produ-
cmg a ** goose flesh" appearance of the skin were found to
diminish heat ehmination more than forty-four per cent*;
ireak chemical irritants produced increased heat elimination
to the extent of forty per cent. , five times more than strong
chemical irritants*

Both heat production and heat dissipation may be infln- 241
enced by various antipyretic drugs, but the effect thus
pcodnced is purely toxic in character, and involves not
simply the heat-producing or heat -regulating centers, but
other nerve centers as well, and thus lessens the resistance
ai the body and the activity of the reparative processes by
which the remedial forces of the system seek to effect a cure*
U is enc' : to note that the pernicious effects of fever-

cootfolhn^ -: -^3 of all kinds are being recognized by phy-
iictans at the present time, and that reliance is being placed
aa those physiological antipyretic measures whereby the end

94 RATIONAL HYDROTHERAPY.

soQght may be safely and far more efficiently attained than
by the use of drugs. It is safe to predict that when these
rational means of combating fevers of all types are more
thoroughly understood and more generally used, the mor-
tality from this class of diseases will be reduced to less than
one third the present rate.

The experimental researches of MaragUano have shown
that quinine, antipyrine, thallin, and salicylic add cause
reduction in temperature by inducing a most pronounced
dilatation of the cutaneous vessels. Alcohol operates in the
same way. All of these drugs depress the heart as well as
the vessels, and seriously interfere with the healing process^
and therefore their use is irrational and unphysiologicaL

Incidentally it may be mentioned that in dealing with fever
by any method, it is always important to give attention to
the cause of the condition, which may be simple exposure to
excessive heat, sunstroke, violent exercise, exhaustion (fatigue
fever), a cold (retained excretions), toxemia from the use of
decomposing food or the decomposition of food by long reten-
tion in the alimentary canal, uric acid, toxins produced in
infectious disease, local inflammation, gastritis, peritonitis, in-
fected suigical wounds, nervous impressions, etc.

The temperature may rise four or five degrees
Heat Production ^^ , ^, ^ ^ ^ t , u u- •

after Death. ^^^^ death from tetanus or hydrophobia, oxi-
dation and heat production continuing until
all the oxygen remaining in the tissues has been consumed

THE PHYSIOLOGICAL EFFECTS OF EXTERNAL
AND INTERNAL APPLICATIONS OF WATER.

AS ekewhere remarked, Currie was the first to observe 243
and study the physiological and therapeutic uses of
water iti a thoroughly scietitiBc way. he having the
I advantage over his predecessors in possessing a thermome-
I tcr, the inventton of John Hunter, whereby the temperature
d the smimal body might be accurately ascertained.

Soon afler (1801), Henry Wilson Lockette, of Virginia, 243
||Qbtisbed a report of important observations and experiments^

Nexl^ Fleury, in France, conducted an extensive series of 244
[lesearches as to the efiects of water upon internal and exter-
na! temperatures, making a special study of its tonic effects*
His labors placed the use of the cold douche upon a scientific
baiis. Indeed, the efforts of Louis Fleury in this direction
were so extensive and thorough that although Scoutetten, a
military physician who was sent by the French government
to study the work of Priessnitz, and who introduced the sci-
ence of hydrotherapy into France, remarked in 1843, ** Hy-
drotherapy is not a new medical system, but it may be made
SfKh/* Raige Delorme wrote less than ten years later^
** Thanks to U Fleury, hydrotherapeutic medical practice
roust take its place in rational therapeutics.**

Dr. John Bell, of Philadelphia, published in 1850 his re- 245
tnarkable work on *« Baths/'

SchDller published in 1874 the results of a remarkable 246
series of experiments made upon trephined rabbits, in which
be demooslrmted the effects upon the internal circulation of
tbefmtc and mechanical applications to the surface.

Vinaj, in iSga, reported experiments upon a man whose 247
had been exposed by an accident, which confirmed the
irations of Schiiller on trephined rabbits, respecting the
mfloence upon the brain and circulation of thermic applica-

95

96

RATIONAL HYDROTHERAPY*

tions to the skin in various parts and under various tempera
tures. These experiments of Schuller and Vinaj laid the
foundation for our exact knowledge of the effects of cutaneous
thermic and mechanical applications upon the circulation oIh
the viscera, V

248 The physiological effects of water are due to those quali-
ties which enable it to be used^

1, As a nutrient, entering into the composition of even^
structure, and serving a useful purpose in nearly every fun^H
tion, especially as a vehicle for conveying food material to the
tissues and removing wastes.

2, As a means of abstracting heat from the body by ^^
tact and by evaporation.

5- As a means of communicating heat to the body,
4 As a means of producing certain mechanical or perc
tient effects.
B49 Similar effects may be obtained by other agents which are
capable of impressing the system in like manner, as, for
example, hot and ::old air, hot vapor, the electric light, sun-
light, and friction or percussion of the skin administered
either by the hands of an attendant or mechanically. These
means, because of the kindred effects produced by them, are
universally employed in connection with water in hydro-
therapy, and hence will be considered in connection with
measures which are more strictly hydriatic in character.
S50 A very large proportion of the applications of

water made to the surface of the body depend
for their efficiency upon the fact that the skin
is reflexly connected with the interior of the
body, each portion of the skin periphery being
associated, through the nerve centers which supply it with
nerve filaments, with some special visceral periphery or vas-
cular area,
251 In the study of the reflex effects of water upon the internal
structures, it should be noted that whatever effect is pro-
duced upon a vascular area of the skin« is likewise produced

The General
Effects of
Thennlc IniUi
tion upon tfte
CircuiAtion,

THE PHYSIOLOGICAI- EFFECTS OF WATES. 97

in the internal vascular area associated with it. The iDten-
sity of the effect produced in the internal area, is. boweirer,
generally less intense than that produced opoo the ssrface.
ahhoogfa this is by no naeans always the case.

It most be remembered, however, that in additioc to the 352
reflex effect produced, there is also prodnced a mechanical
effect, which is conmionly the reverse of the reflex eflecL
The real effect is the sum of these two effects, and drpmds
opoo the relative intensity of the two actions. The effects
of external applications of water may this be simply divided
into two classes, — reflex and mechanicaL

Any sort of irritation of the cotaneoos nerves which gives S33
rise to contraction of the blood-vessels of the surface, whether
cold, heat, friction, percnssicm, pinching, or mechanical ini*
tation, likewise causes contraction of the small Uood-i
of the interior of the body, stimulating the accelerator i
of both the blood-vessels (vasoccxistnctcMs) and the heart.

The doration (rf the reflex effect depends upon the inten- 2M
sity of the stimulant and* of the irritant, and also upon the
area involved. When the cutaneous vessels of a large por-
tion of the surface of the body are excited to contraction by
cold, heat, friction, or otherwise, the contraction of the inte-
nor vessels is exceedingly brief. It may, indeed, be of so
short duration as to escape notice. The reason for this is
the development of the mechanical effect (252).

If the surface area to which the application is made is 3ai
small, the reflex effect may b^ confined to the internal area
in sympathetic relation therewith (349), and wiU be greater
and more prolonged for the reason that the reflex influence
being concentrated upon the circumscribed area, the mechan-
ical effect is distributed over the rest of the body, so it does
not overshadow and wipe out, so to speak, the reflex effect
on the smaller area involved.

The mechanical effect is necessarily the reverse of the 256
reflex ; for when the blood-vessels of the skin are made to
contract as the result of the application of an irritant of any
7

gS RATIONAL HYDROTHERAPY.

sort, there is an inrush of blood to the interior of the body
causing mechanical distension of the internal parts. This
effect follows more or less quickly the primary, universal con-
striction of the small vessels according to the intensity of the
irritation and the extent of the application. A knowledge of
these facts, to which we are chiefly indebted to Schtiller and
Vinaj, affords us a rational basis for the explanation of nearly
all the phenomena resulting from hydriatic procedures.*

THB PHYSIOLOGICAL EFFECTS OF COLD.

257 Cold is a vital depressant. Under all circum-

Is Cold a stances and in all modes of application this is

Sedative or ao

ExcltaDt? '^^ primary and intrinsic effect. The discussion

of the question whether cold is primarily a
stimulant or a depressant began soon after the first publica-
tions of Currie, and waxed especially warm half a century
ago. The controversy doubtless grew out of the fact that
those who maintained cold to be a stimulant, failed to
observe that its so-called tonic, or stimulant, effects were
reflex and secondary results.

258 A low temperature, in whatever way produced, checks
cell or protoplasmic activity. This may readily be seen by a
microscopic study of the pond ameba, the white blood-cor-
puscle, or the heart of the embryo of a chick, the movements
of which are at once suspended when the temperature is
lowered, but begin again with • the application of heat by
means of the warming stage.

259 --I- The life processes of warm-blooded animals

are slowed when the body temperature falls a
few degrees below the normal standard of temperature for
the individual class or species of animals under investigation.
This accounts for the phenomena of hibernation. In a bear
in the state of hibernation the temperature has been found as
low as 35^ F., the pulse eight per minute, and the respiratory
chest movements entirely suspended, showing almost com-
plete cessation of vital activity. In this state, little waste of

THE PHYSIOLOGICAL EFFECTS OF WATEB. 99

tissue takes place, so that the animal may pass seveial weeks

without eating or drinking.

hi fishes, whose temperature is generally only a degree or

two above the water in which they live, the temperature may

be redaced so low that actual freezing takes place, when

there seems to be complete suspension of vital activity, but

not actnai death, the animal living in this condition for weeks

and even months.*

The depressing influence of cold upon vital activity is SCI

utilized in the preservation of food, the germs which give rise

to putrefactive processes being unable to multiply and produce

their peculiar ferments and toxins at a temperature of 32"-^ F.

It is through this depressing influence also that diphtheria,

phlegmon, and other localized maladies, even cancer, may

often be beneficially controlled by applications <rf ice to the

affected parts. The activity of the perspiratofy glands is at

once checked by the application of cold to the skin, and so

also is the secretion of gastric juice by the peptic glands

when cold water is swallowed, as witnessed by Beaumont in

his observations upon the stomach of Alexis St. Martin.

u^^M^M.^^ 1° t^^ study of the physiological effects of 262

njMinric ,._

neumts water at different temperatures upon the

ComM various structures and organs of the body,

^^^tOy €i ^[jg fact must be kept in mind that as em-

^^ ployed in hydrotherapy, water is chiefly useful

as a means of communicating heat to the body
or abstracting heat from it. In its internal use, the thermic
effects of water are supplemented by effects arising from
its solvent and nutrient properties. In its external use, cer-
tain mechanical effects are added to its thermic effects in
some forms of application, particularly the several varieties
of the douche.

Heat and cold, as before remarked, are relative terms, 263
objects being recognized as cold when they have a tempera-
ture less than the zero of the temperature sense, — that is, the
temperature of the skin, — and the reverse. For convenience.

lOO RATIONAL HYDROTHERAPY.

however, in the study of the physiological effects of water, as
well as in directing its therapeutic application, it is necessazy
to make use of terms more accurately indicative of the
approximate temperature of the application. Those which
have been most commonly applied are the following : Very
cold, cold, cool, tepid^ warm^ hot^ very hot.

264 The terms "temperate," "nauseating," "excessively
hot," and " excessively cold " are used, especially by French
hydrotherapeutists, but the utility of these terms is so re-
stricted that we have eliminated them.

265 As the classification proposed is necessarily
Classification of ^.^ , .-^ J- ^ ^ n ^1/
Temperatures, artificial and arbitrary, it is not easy to fix the

exact limits of temperature to which each term

should be applied, and this fact has given rise to considerable

discussion and to a diversity of views. The following table

is used by the author, and is found to be very convenient in

practice : —

Very cold 32** to 55® F.

Cold 55^ to 65* F.

Cool 65° to 8o« F.

Tepid So*' to 92° F.

Warm (neutral, 92°- 95°) 92*^ to 98® F.

Hot 98° to 104® F.

Very hot 104*^ and above.

266 The effects of applications at these various temperatures
differ according to the part of the body to which the applica-
tion is made, and the extent of surface involved.

267 Whether or not the final effect of a cold application
is sedative or excitant, depends much on the mode of appli-
cation and the temperature employed, but most of all on the
length of the application and the state of the patient.

268 When a cold application is made to the body
Primary and j^^ ^^^^y form, whether internally or externally,

" fects of Cold. ^^® ^^^ effect is a lessening of the activities

of the living structures with which the cold

medium comes in immediate contact. If the application is

THE PHYSIOLOGICAL EFFECTS OF WATER.

lOJ

continued for a long time, this vital depression continues
iiieewisep and is maiDtained for a time after withdrawal of the
ipplication. The longer the application, the longer the de-
pression that follo^^. Sooner or later, however, the parts
return to their norma] condition ; and if the depression has
iwt Iteen so great and so prolonged as vitally to damage the
ptrtei in the return to normal activity the pendulum swings,
M to speak, beyond the normal line, so that for a time a
hjigber degree of vital activity is maintained than before the
application. This increased physiological activity is termed
m%tii>H: or as the writer will undertake to show later (435),

When the cold application is a short one, the reaction 269
ows quickly, and is as much more intense as the applica-
OQ made is energetic ; that is, Imv in iemperature and with
considerable pressure, as in the form of the douche.

The application may be so managed that the primary effect 270
or action*— in other words the sedation — may be diminished ;
or the secondary effect — the reaction or state of excitation
— may be diminished ; or both may be lessened.

Cold appiications may be made by means of ice, cold 271

water, cold air, or by the evaporation of water or other

volatile liquids from the surface of the body» which may be

I either spontaneous or increased by a current of air. Alt these

I means are employed in hydrotherapy. The same principles

apply, f: ^ r, whatever the mode of application.

In *i :it( the physiological effects of cold applications, 272

^itrrie very well says ('* Medical Reports," page 68) that it is

*• fiat the cold that stimulates, but the sensations which the

cold produces/' This may at first seem like a distinction

ithotit a diSerence, yet it seems to the writer that Currie

ras eight. The intrinsic effect of cold is depressant, while

of heal is sitmtilant. Nevertheless, a recognition of the

uc impressions made upon the temperature nerves of

skin« through reflex influence provokes vital activities

'which serve to antagonize the depressing influence of the

cold* which may in a given case so far overbalance these

lOi ftATlONAL HYDROtHfeRAPY.

effects that the effects which are actually apparent are those
of excitation instead of sedation.
278 All discussion respecting the mode of "action" of cold
must cease with the recognition of the fact that it really has
no vital action whatever, serving only as a physical agent to
lower the temperature of those parts with which it comes in
contact. Its so-called physiological action is wholly due to
the action of the body itself, — first, in recognizing the pres-
ence of an agent that interferes with its functions, and is
capable of injuring the integrity of its tissues ; and secondly,
in rall3dng its forces to repel the invader, or to avert the
danger arising from its presence. While cold is primarily
a depressing agent, its first contact with the skin gives rise
to irritant phenomena through the protective reflex activi-
ties above referred to.

274 A series of interesting experiments upon ani-

Efffecto of j^^g^jg reported by Wertheimer, in 1893, showed

Peripheral

IrritatloD. ^^^^ ^^^ general effects of excitation of the

sensory nerves of the skin by cold are in
accord with the general law relating to the reflex influence of
peripheral irritants of all sorts, — chemical, electrical, etc.;
namely, short and intense applications cause a brief prelimi-
nary contraction of the vessels of the internal viscera, which
is quickly followed by dilatation of the same ; while a pro-
longed, more moderate application of cold to the surface
results in a renewed and prolonged contraction of the small
vessels in the internal regions of the body.

275 This contraction is one of the several methods by which
the body defends itself against injury from the loss of heat
through the application of cold. By the slowing of the rate
at which the blood passes through the internal organs, these
organs are deprived of less heat than if the circulation
were continued at the usual rate. The vessels of the skin
being contracted at the same time, it is apparent that by this
wise provision of nature the body is most efficiently pro-
tected against injury from cold.

THE FHVSIOLDGICAL EFFECTS OF WATER.

103

Natimann, operating upon frogs, detached all portions of 876
one of the hind legs with the exception of the sciatic nerve,
aid then applied cold and irritating substances to the skin of
the iepftrated leg, and noted with the microscope the eflfects
Qpcm ike roesenleric circulation. He observed that gentle
initation of the skin of the teg produced contraction of the
vessels and quickened heart action, while strong irritation
pmdaced dilatation and slowed heart action from excitation
of the vagus, the inhibitory nerve of the heart, and of the
rasodilalors, the inhibitory nerves of the vessels. These
eSects are general in the body."

Schiiller * found that the application of cold water to a 277
ocire tmcik caused contraction of the vessels of the brain ;
wbiit warm water caused dilatation of the cerebral vessels, his
observations agreeing in this regard with those of Naumann.

General applications to the skin by means of compresses 378
and full baths were found to produce opposite effects. A
warm bath produced di/aiaiiau of the surface vessels, but
i*^Hiraftian of the vessels of the brain ; while a cold bath
produced contraction of the vessels of the skin, with dilatation
of the cerebral vessels.

Tliese observations show clearly that two classes of efiects 279
are produced in applications of water to the surface ; vi^,,
(t) refitXi (2) mtchanicaiy or dcrivaiive.

Doubtless both of these effects are always produced* 280
WbeQ the application is general, the mechanical effect is
dominant ; when the area involved is limited, the reflex
eRect is most prominent. In general applications the primary
reflex effect is quickly effaced by the succeeding mechanical
effect due to the in-rush of blood from the periphery. This
diversion of blood from the surface vessels to the interior of
Ibe body ts termed rtiroshtsis* Marked retrostasis is pro-
docei* ' hen the cold application is made simultaneously
to a v.- , :^'- cutaneous area.

^AnMrfh^ StHmitikg Median, Vol. 14, 1^74^ Lei pile, page $6$.

I04 RATIONAL HYDROTHERAPY.

281 The effects of general warm (99°-ioo° F.) and cold (52^
applications were observed to be transient, lasting not oaore
than ten minutes, usually less, whether the application was
continuous or' interrupted. Secondary effects of an opposite
character then appeared; viz., contraction of the cerebral
vessels after cold and relaxation after a warm bath.

282 Dilatation of the vessels of the viscera after a short,
intense general cold application follows so quickly that this
may be recognized as practically its primary effect. The sub-
ject is further discussed in paragraphs 669-672, and 1256-
1292.

THE EFFECTS OF COLD UPON THE SKIN.

The surface phenomena observed to follow an application
of cold water to the skin are as follows : —

283 A short application of cold or very cold water
1. Contraction (from 32° to 65^) produces pallor and coldness

Blood-Vessels. ®^ ^^® ^'^^^' ^^^ ^^ ^^^ contraction of the small

vessels (Exp. 8)."

284 When the application of cold is long continued, the sur-
face becomes blue, because the muscles of the small veins,
being weaker, soon become exhausted and relaxed, while
those of the arterioles are still active. The capillaries being
contracted, the pressure in the veins is lessened, the flow
of blood is slowed, and the venules are thus distended with
blood the hemoglobin of which has been reduced ; and the
skin consequently shows a blue or purplish color. This is
the primary effect of cold, or rather of the vital action or
resistance against it developed during its application.

285 When the application is withdrawn, if it has not been too
greatly prolonged, the pallor or blueness quickly gives place
to redness, the result of active dilatation of the small
arteries of the skin. This is the secondary effect of cold, or
so-called reaction^ one of the most interesting and important
phenomena connected with the application of water (429).

TH£ PHYSIOLOGICAL EFFECTS OF WATER.

105

Percussion, or slapping, and friction have much the same 286

on the small vessels as cold water, causing first excita-
Oft of the vasoconstrictors, and later the reverse (Exp. 9).

The almost instant suspension of the glandular 387
tlkcreueor action of the skin as the result of the action
Suspetisloti ©r ^^ ^^ij jg gyen njore remarkable than the exci-

tation of these glands by the apphcation of
beat tExp, 10). It is evidently a purely reflex phenomenon,
IS suspension of sweating takes place before the application
ol cold has continued long enough to occasion a lowering of
the general temperature of the blood, the cessation of the

I action of the perspiratory glands thus taking place while the
sweat centers are still experiencing the stimulating effect of a
blood temperature sufficiently high to provoke intense action
^i the glands*

It is noteworthy that suspension of the action of the sweat-
fhods of the entire skin surface may be brought about by a
ooM apphcation to a very small area, as the feet, the shoul-
dei^ and tn some cases the hands or other equally limited
surfaces, — evidently a reflex effect.

This sudden checking of perspiration as the result of cold
a|»plicaiions is injurious or dangerous only when the body is in
a state of fatigue, or when the perspiratory activity is the
Lp»ilt of aci effort on the part of the system to antagonize a
Hkbriie movement, as in the sweating stage of malarial fever,
^B sweating. sickness, etc.

W With the occurrence ol reaction, the action of the iweat-
glands is resumed, and may be greatly increased.

Cold applications, by causing contraction of
the small vessels, lessen the amount of blood
circulating through the skin, and thus diminish
heal elimination, during the application. At
the same time, the reflex effect upon the
ceoters controlling heat production stimulates the develop-
ipenl of animal heat in the body.

288

289

290

Kcst EUniljM*

I06 RATIONAL HYDROTHERAPY.

291 When reaction occurs, however, the result is an accelera-
ted circulation of blood through the skin, whereby an increased
quantity of blood is exposed to the cooling influences that act
upon the surface of the body, so increasing heat elimination.

292 If the application of cold is long continued, the tempera-
ture of the muscles lying beneath the skin, as well as that of
the skin itself, is lowered, thus checking the heat-producing
processes that are active in the muscles, where about one
half of the heat of the body is produced.

293 Applications of a temperature below 02^ to
4. Diminished ^oo i *u ^ r ^u * xi
Tactile ^ lessen the acuteness of the tactile sense

Sensibility. (Exp. ii). Even a very brief application

of ice or very cold water will abolish tactile

sensibility, and the same effect is obtained by a prolonged

application of cold water. This fact is taken advantage of

by dentists, who freeze the gum by the application of ether

or rhigolene spray, as a means of obviating the pain of teeth

extraction. Other operations are also thus rendered painless.

294 Applications below 32° F. do not excite the temperature
sense, but give rise to pain. Even moderately cold applica-
tions are to most patients at first painful and shocking.

295 The impression made by a cold bath is more painful if
the cold water is gradually brought into contact with the
body than if the application is brought to bear upon the
whole surface at once, as in the plunge bath. By sudden
immersion the sensation is generalized, whereas in gradual
applications it is concentrated upon the limited surface that
is at each instant coming in contact with the water.

296 A fine spray feels cooler than a douche at the same tem-
perature, for the reason that the douche stuns the skin by its
mechanical effect, and thus lessens its sensibility. Immer^
sion in cold water, for the same reason, gives rise to greater
shock or pain than the douche, though at the same time it is
less excitant, because of the lack of percussion effect.

297 A curious fact not infrequently noted is that more distress
is experienced from the application of water at a temperature

THE PHYSIOLOGICAL BFPECTS OF WATER. IO7

of 55° to 65° F. than at 45^ to 55°. This effect is perhaps
due to the more prompt reaction at the lower temperature, as
well as to the lessened sensibility.

THE EFFECTS OP COLD UPON THE CIRCULATION.

Cold slews the circulation and diminishes the frequency of 298
the heart beat. The shock occasioned by a sudden appli-
cation of cold water increases momentarily the activity of
the heart, but the pulse-rate quickly returns to normal,
and is soon perceptibly slowed, the effect depending upon
the intensity and the duration of the application. This effect
is the result of the reflex influence of the stimulation of the
skin npon the nervous mechanism of the heart, and is due
to the fact that the accelerator nerves of the heart are first
excited, and later the pneuiQOgastric, whereby the heart's
movements are slowed. It should be remembered also that
m the reaction following a short cold application the increased
activity of the small vessek aids the heart, while by the con-
tinuous contraction during a cold application the labor of
the heart is greatly increased.

It thus appears that very short applications of cold pro- 299
duce increased activity of the hearty while prolonged appli-
cations slow its action (Exp. 12, 13, 14, 15) (Roehrig).

A shorty very cold (40^ to 55^ F.) application produces 300
a very brief contraction of the visceral vessels, which is fol-
lowed by dilatation lasting for a few minutes (3 to 10), which
later gives rise to contraction. Through all these vascular
changes, however, there is a constant elevation of blood
pressure.

A prolonged cool or cold application (60° to 80^ F.) with- 301
out percussion produces vasoconstriction in the parts which
are in reflex relation to the area operated upon.

Local cold applications produce varied effects, some of 302
which may be regarded as reflex, others as due to the direct
influence of cold upon the sympathetic g^tiglia in the vessel

I OB

RATIONAL HYDROTHERAPV,

walls. Some of the most important of the effects of local
cold applications are the following : —

303 Plethysmographic experiments made by Frarick showed
that a piece of ice held in one hand causes shrinking of the
other within two or three seconds, with a return to the nor^^
mal at the end of a minute (Exp. i6).'* ^|

S04 Snow rubbed on the inside of the arm at the bend of the
elbow, or ice applied to the subclavian region diminishes the
height of the pulse tracing ( Win tern it Ji), showing a contrac-
tion of the distal portion of life radial artery, *fl

305 A compensatary effect is sotneiimes a^served. Winlemitz
has noted that placing the elbow in water at 50^ F, for 30
minutes gives rise to an elevation of temperature in the axilla,
showing an increase in the internal temperature coincident
with a lowering of the external. ^

306 Waller observed that the application of ice over the cu*"
bital nerve at the elbow produces a rise of temperature of
7^ F- in the fourth and fifth digits, while the temperature of
the other fingers falls an equal number of degrees. The muscles
of th^ hypothenar region are at the same time paralyr^d.
The phenomena developed by this interesting experiment are
closely akin to those observed to follow the division of the
sympathetic nerve of the ear of a white rabbit, which occa
sions reddening of the ear of the side operated upon, whili
the opposite ear becomes pale*

307 Cahi applicati&ns made across (he trunk of an artery cause
cant r action in its distal portions. An ice-bag applied to the
axilla lessens the circulation in the arm (Exp. l%\ An ice
cravat, or an ice* cold compress applied about the throat,
lessens the cerebral circulation, through its influence upon
the carotid and the vertebral arteries. The vertebral arteries
alone may be influenced by an ice-bag applied to the back of
the neck. An ice-bag over the femoral artery in like manner
lessens the circulation in the leg. The circulation in the
hand or the foot may be controlled by the application of an
ice-bag to the bend of the arm or of the knee, (Exp. 18, 19)

1

no RATIONAL HYDROTHERAPY.

The effect is, of course, less marked in health, which is also
true of other applications of cold water (Exp. 22).

316 In this depressing effect of cold water when taken into the
stomach, we have the explanation of the results that some-
times occur from drinking cold water when the body is in a
state of fatigue. The power of reaction being diminished,
chill and internal congestion are produced, often resulting
in great injury. Cold water drinking is not contraindicated
by active perspiration, but rather by fatigue, and this is true
whether the skin is in a state of excessive activity or not

THE EFFECTS OF COLD UPON RESPIRATION.

317 The observations reported by Halle, Fleury, Ricbter,
Johnson, and others seem to indicate no regularity in the
efiPects of cold upon the respiratory movements. One reports
no appreciable effect ; another, quickening of the respiratory
activity, with slowing of the heart ; another, sometimes quick-
ening, sometimes slowing, of respiration. This confusion
seems to be the result of failure to note the difference in
the effect produced by different modes of application.

318 When the cold application takes the form of

Respiratory ^j^^ douche, the effect is to produce at first
flovement. , " , .

short, gaspmg respiratory movements, this

effect being more pronounced the lower the temperature, the
more abrupt the application, and the stronger the pressure
employed. If, however, the patient is immersed in a cold
full bath, respiratory movements after the first instant are
slowed to a marked degree, and are decidedly fuller and
deeper ; that is, the amount of tidal air is increased.

319 The effect of the cold douche or spray in increasing the
rate of the respiratory movements is especially pronounced
when it is applied to the chest or upper part of the body.
Thus employed, an unpleasant sensation of constriction in
the chest is also produced, the very opposite of the effect
following an application of warm water. These effects are
clearly indicated in the tracings made by means of the author's
pneograph (Figs. 25, 26) (Exp. 23).

lis property of cold water must be borne in mind in the 320
itment of ^thmatics. in whom a cold douche to the chest
will generally produce a paroxysm of asthmatic breathing,
and sometimes a most distressing sense of suffocation. The
tmlmonary ¥^sels being made to contract suddenly by the
powerful excilation of the vasoconstrictor centers of the cord^
the area of blood presented for gaseous interchange in the
pulmonary macoiis membrane is very greatly diminished,
while at the same time the demand for oxygen and for the
eltmtnaljon of CO^ is increased, thus producing the painful
sensation experienced in suffocation.

This sensation of suffocation ordinarily disappears at once 331
when reaction occurs, and the quickened respiratory move-
ments are succeeded by slower and fuller movements, accom-
panied by increased absorption of oxygen.

An examination pf the expired air shows that 3S3
an increased amount of oxygen is absorbed
and an increased amount of COa is exhaled
Etbe influence of cold applications.
Crawford showed more than a century ago (17S1) that 323
cold increases the difference in color between arterial and
rmom bloody tbe result of increased oxidation.

The oxidation of organic waste substances which lakes 324

place in the lungs is doubtless also increased, as is the

ozklation of sugar in the blood of the general circulation.

Liebtg obser\*ed more than half a century ago that cold 326

, cold water^ and exercise, habitually employed, are the

^mo^ powerful of all means of stimulating tissue activity.

CO,

THE EFFECTS OF COLD UPON THE MUSCLES.

Tte M^isciilar

^

Prolonged applications of water at a low tem- 336
perature decrease muscular irritability and
muscular energy. This is shown in the stiff-
ness and clumsiness of the fingers as the result
of exposure to a low temperature.
A short, cold bath, as a douche or a spray, lasting for a 327
lew second^» augments muscular energy and tone to a very

IfrHaMlllr^

112

RATIONAL HYDROTHERAPV*

The

Invotuittary
Musdes.

remarkable degree. The exaggerated tonicity thus induced '
is the cause of shiveriEf* The cold bath, if short (i to 2 sees*)
and given with much pressure (25 to 35 lbs J, is a p^owtfrful
restorative in fatigue resulting from severe muscular effort,
but it must be immediately preceded by a short hot bath, and
must be followed by rubbing and warm wrapping* The re-
storative effects of the cold bath are well shown in Exp. 24.'*

328 1^ *^ ^ curious and interesting fact that while
cold lessens the irritability of the voluntary
muscles, it excites the activity of the smooth
muscular fibers of the skin, thus giving rise to

the appearance known as goose-flesh. It also causes contrac-
tion of the smooth muscles of the small blood-vessels ; and
when applied to a large area of the skin or over special
regions^ as the feet or lower abdomen, may excite the invol-
untary muscles of the bowels and bladder, causing evacuatioo^
of these cavities.

329 Shivering is due to an Involuntary action of the voluntary'
muscles, set up automatically as a means of combating the^
influence of cold by increasing heat production.

330 The application of cold water to the feet, as by means of
the spray or stepping into a cold bath, may produce a goose-
flesh ^appearance over the entire surface of the body, with
shivering. The application of a cold spray or douche to one
side of the body will produce a goose-flesh appearance on the
opposite side, together with the usual phenomena attending
the application of cold to the entire surface of the body, thus
demonstrating that the powerful reflexes set up by cold appli-
cations are universal in extent within the body*

THE EFFECTS OF COLD UPON THE NERVOUS SYSTEH,

331 Nearly all the phenomena arising from applications of cole

water are illustrations of the effect of cold upon the nervous
system, whereby special effects are produced in various
organs, as described under their respective heads. In this

THE PHYSIOLOGICAL EFFECTS OF WATER

n

TtieNcyron*

section attention will be called especially to those effects of
cold that are chiefly confined to the nervous system itself.

Recent discoveries in the minute anatomy of 332
the nervous system throw much light upon the
method by which the nervous functions are influenced by cold
as well as by other agents. The discovery of the fact that
each nerve cell, or neuron, is an independent entity, con-
nected with other nerve cells by contact only, and not by
actual continuity of structure, and the further discovery that
in its activities the nerve cell actually executes movements
and undergoes distinct changes in form, retracting or protract-
ing its dendrites and the delicate filaments constituting the
end^tuft of its neuraxon, has afforded a rational explanation
lor much that was before mere surmise or conjecture.

The neuron is by these discoveries found to be subject to 333
precisely the same laws that govern protoplasmic structures
elsewhere than in the human nervous system. A careful study
oi the influence of heat and cold upon the ameba and the while
blood-corpuscle shows that the influence of heat is to cause
increased activity of the cell, with extension of protoplasmic
pfixesses, or arms, while cold diminishes its activity, causing
' -ses. We may thus justly conclude that

.... s are made in such a manner as to influ-

ence tr us system directly, similar effects are produced.

It is hejd, for example, that insensibility is due to
retraction of the dendrites, or protoplasmic processes, of 334
the neurons, thus cutting off connection with the rest of the
oervotis system by breaking contact at the points at which
coimeclioa is necessary for the maintenance of the state of
consciousness. The same principle applies to all other nerv-
ous functions. Increased nervous activity of any particular
sort means simply increased movement of the neurons, act-
ive protraction of their dendriteSf and an increased number
o! contacts with other neurons by means of the neuraxons
wilb their collateral branches, end-tufts, and innumerable
gemmiiles« or contact globules*
s

XI4 RATIONAL HYDROTHERAPY.

335 With these facts in mind, it is not difficult to anderstand
that cold applications to a nerve trunk may greatly diminish
or even entirely abolish its functions, paralyzing the parts
to which it is distributed, as Waller showed by an appli-
cation of ice to the cubital nerve at the elbow.

336 Helmholtz showed that the application of cold

Nervous ^^ ^ nerve may diminish the rate of transmis-

and Mental . . "^ . , . ^ ._^.

Activity. ^^^^ ^^ nervous impulses over it to one sixth

the normal rate (Exp. 25). After sach an

application of cold to a nerve trunk and its withdrawal, the

nerve quickly recovers, unless the application has been very

intense and prolonged, and the part to which it is distribated

becomes the seat of pain, sometimes very intense in charactefv

showing that nervous sensibility is heightened in the reaction

that follows the benumbing effect of a cold application.

337 If the application of cold is more intense in character and
less prolonged, the sedative effect may be so slight as to be
unnoticed, and the effect observed be that of excitation,
which, however, as previously shown, is simply the rebound,
or reaction, that naturally follows vital depression, owing to
awakened resistance.

338 In like manner a short, cold application to the head results
in increased cerebral activity, the reaction effect completely
overshadowing the brief depression first produced. A pro-
longed application of intense cold to the head results, how-
ever, in a decided lessening of cerebral activity, and may
give rise not only to stupidity and drowsiness, but to abso-
lute unconsciousness, a fact which has for centuries been
made use of in prisons, cold water being poured upon the
head as a means of subduing refractory prisoners.

339 Schtiller showed (1874) by experiments upon trephined
rabbits the following interesting facts in relation to the effects
of thermic applications upon the brain : —

340 I. Water at neutral temperature (92°-95^ F-) applied
directly to the brain produced no effect.

THE PmSIOLOGlCAL EFFECTS OF WATER.

IIS

2. Ice applied to the brain coverings caused contraction 341
of bath veins and arteries, the contraction continuing for a
short time after the withdrawal of the ice.

3. Ice applied to the scalp caused contraction of the 342
cerebral vessels when carried to the point of producing general
dulliness and shivering,

4. A cold compress applied to the spine or abdomen, or a 343
coMfuU bath caused instant dilatation of the cerebral vessels,
lasttiig from 3 to 10 minutes, then giving place to con-
tnction^

5* Hot compresses or a hot full bath caused contrac- 314
tioD of the cerebral vessels, later followed by dilatation.

6* Cold and warm applications applied to a nerve trunk 345
pioduced an eflect exactly opposite to that produced by the
sam« applications made to the skin ; that is, a cold applica-
tion to a nerve trunk caused contraction of the cerebral
vessels, while a warm application caused dilatation. Un-
qtiestionably the samfe effects, which are evidently reflex in
cbaf after, occur when the sensor)^ nerves of the skin are in-
fluenced by thermic applications, but they are overwhelmed
iDd quickly wiped out by the mechanical dilatation of the
ceifbral vessels, resulting from the elevation of blood pres-
snuB and the displacement of a large quantity of blood to-
ward the center of the body through the contraction and
partial emptying of the vessels of the skin.

7. A heating compress or moist trunk pack of three hours' 346
doraiion caused, firsts dilatation, then contraction, of the cere*
bral iresselSy and bulging of the membranes from accumula-
tion of lymph.

8. Pinching the skin produced the same effects as hot
applications*

These interesting experiments, which have since been con- 347
by observations made upon a man whose brain had
exposed by accident, laid the foundation for a scientific
therapy of the braiti, which has received far less attention than

11 6 RATIONAL HYDROTHERAPY.

it deserves at the hands of medical men. These experiments
show most clearly how cerebral congestion may be successfully
combated by properly managed applications, and explains the
relief afforded in insomnia by the moist girdle and the tonic
effects of the cold douche.

348 Attention may be especially called to the effect of the
moist abdominal bandage upon the blood and lymph circula-
tion of the brain. There is normally maintained a constant
balance between the blood supply of the brain and the
amount of lymph present in the ventricles. The more blood
in the brain, the less lymph in the ventricles and the nerves,
an arrangement necessary for the protection of the delicate
cerebral vessels, from the fact that the brain is inclosed in ac
inelastic case. The moist bandage so influences the lymph
and blood circulation of the brain that the quantity of blood
is notably diminished, while the quantity of lymph is greatly
increased, as shown by the bulging of the membranes, thus
supplying just the condition needed for normal sleep.

REFLEX EFFECTS OF COLD APPLICATIONS.

349 Edwards showed that immersion of one hand in cold
water causes a lowering of temperature in the other band.
The experiments of Winternitz, and later those of Franck,
showed by means of the plethysmograph that cold applied to
one hand causes contraction of the vessels in the other hand.

The interesting facts already presented in relation to the
influence of cold applied to the skin, both locally and upon
distant parts (339) are examples of reflex eflects. These ef-
fects include not only dilatation and constriction of the blood-
vessels, but also contraction of the smooth muscles found in
the bowels, bladder, and other hollow organs of the body.
The muscular walls of the minute air-tubes of the lungs, the
so-called ligaments which support the viscera, the secreting
structures, — the liver, kidneys, digestive glands, and other
allied organs, — are also influenced reflexly by applications
of cold to the external areas in relation with them.

THE fm

aCAL EtFECTS OF WATER.

tf7

Special Elf eas of ^^ accordance with the facts just mentioDed. 350
WIcxtloits to it becomes apparent that to produce reflex
HiBcuiif forOejc eflects in the muscles we have but to make
* cold applications to those areas the stimula-

tion o( which is capable of developing muscular contraction.
The$e areas, as elsewhere pointed out, are : —
The inlra-scapular (space between the shoulder-blades).
The epigastrk (the sides of the chest at about the level of
Ihcfoyrth rib).
The abdaminal (the borders of the recti muscles).
The cremasteric (the inner and upper surface of the thigh).
The ptaniar (the sole of the foot).

By gentle irritation of the skin of these several areas, the 351
petter portion of the several muscular groups may be brought
ioto activity. This is particularly true of the plantar surface.
Short, very cold applications, at high pressure, made upon
these surfaces may be very serviceable in all cases in which
Jtj$ desirable to stimulate the nutrition of the muscles, as in
J muscular weakness, paresis or paralysis, progressive
Sl^tilar atrophy, and other maladies in w^hich there is wast-
ig of the muscular structures. Although muscular action
ay not be induced, the nutritive processes in the muscles are
Baenced favorably by applications made to these reflex
Most important of all is the plantar surface.
An application of a jet of either cold or very hot water to 352
the ftbdomen causes instant and vigorous contraction of the
abdominal muscle, and is likewise a most valuable means of
idling intestinal peristalsis.

Cold applications to the face and neck, short 353
and intense, cause dilatation of the cerebral
vessels.

A prolonged contraction of the cerebral 354
vessels is produced If the application is greatly
lengthened, and vertigo and even nncon-
may result This is true, however, only of very
roos appHcations, as the long cold **head pour."

Skin
In Reflex
RrUtion with
tte toteroftl
Vteecm*

Il8 RATIONAL HYDROTHERAPY.

355 Short applications of intense cold to the neck and chest
produce an acceleration of the pulse and of the respira-
tory movements, followed by a slowing of the heart and
the respiration.

356 Prolonged immersion of the hands in cold water causes
contraction of the vessels of the brain and of the mucous mem-
brane of the nose. This measure is thus useful in combating
cerebral hyperemia.

357 A prolonged cool foot bath causes contraction of the
vessels of the uterus, and may thus be useful in combating
uterine hemorrhage.

358 Very cold applications to the breasts, abdomen, hands,
and feet cause contraction of the involuntary muscles of the
bladder, bowels, and uterus. It is more than probable that
the muscular structures of the liver, spleen, and other viscera
are likewise influenced by such applications, as well as by
applications made to the overlying areas of skin.

359 A short, very cold douche to the feet, with strong pressure
(25 to 35 lbs.), dilates the vessels of the uterus, and is hence
useful in amenorrhea.

360 A prolonged cold application to the upper dorsal region
relieves congestion of the nasal mucous membrane, and is
thus useful in nosebleed. The popular practice of apply-
ing cold metal to the spine to check nosebleed shows the
relation of this surface to the nasal mucous membrane.

361 A prolonged cold application over the upper dorsal and
lower cervical region causes contraction of the pulmonary
vessels, and is useful in pulmonary congestion and hemorrhage.

362 A prolonged cold application to the occiput and neck
shows the action of the heart.

363 Application of the ice-compress or ice-bag to the lumbar
region produces dilatation of the vessels of the uterus and
lower extremities, if prolonged, and is useful in amenorrhea.

364 A cold lumbar douche at moderate pressure, and con-
tinued from 15 to 45 seconds, produces contraction of the
vessels of the uterus.

THE PHYSIOLOGICAL EFFECTS OF WATER.

119

A very cold and very short douche (2 to 4 sees.), with 366
strong pressure (25 to 30 lbs.), to the lumbar region, produces
dilatation of the uterine vessels. This measure is accordingly
useful in amenorrhea.

Prolonged cold applications to the breasts and the inner 866
surface of the thighs produces contraction of both the vessels
and the muscles of the uterus.

Wintemitz has shown that cold applications to the thighs 367
also influence the pulmonary circulation, combating con-
gestion.

A short, cold douche applied to the lower portion of 368
the sternum stimulates the kidneys, increasing the flow of
urine.

A short, cold douche, with strong pressure, over the liver, 869
stoaiach, spleen, or bowels, produces dilatation of the blood-
vessels, with increased activity in these organs.

G)ntraction of the small vessels may be produced in the 370
fiver, spleen, stomach, bowels, and other internal viscera by
prolonged cold applications of moderate intensity (60° to
75^ F.) to the skin overlying these organs. This measure is
of great service in the treatment of pathological conditions
involving congestion of these organs.

Cold applications to a reflex area often give rise to a sense 371
of constriction in the part^ reflexly connected. When a cold
douche is applied to the feet, a strong sensation of constriction
is felt in the lower abdomen ; while cold applied to the chest
occasions a sensation of constriction in the thorax.

The vessels of the important viscera may be 372
caused either to dilate or contract by cold
applications to the skin, according as the
application is short and intense (i to 4 sees.,
temp. 40^ to 60° F., pressure 25 to 35 lbs.)
(dilatation), or long and moderate (contraction), by the fol-
lowing methods : —

The brain f by applications to the head, neck, face, hands, 373
and feet.

I

Sammaiy off
nethods ffor
Reflexly In-
ffhiencingtheln
teraal Viscera.

I . . ji

f

X20 RATIONAL HYDROTHERAPY.

374 The nasal mucous membrane, by applications to the neck,

face, upper dorsal spine, hands, and feet.
875 The stomach, by applications to the lower dorsal spine

and the epigastrium.

376 The kidneys, by applications to the lumbar region, the
lower portion of the sternum, and the feet.

377 The bowels, by applications to the feet and the abdomen.

378 The bladder, by applications to the feet and the lower
abdomen.

879 The liver, by applications to the lower right chest.

880 The spleen, by applications to the lower left chest.

381 The lungs, by applications to the chest and the thighs
(Winternitz),- and to the upper dorsal region.

382 The uterus, by applications to the lumbar region, the
abdomen, the breasts, the inner surfaces of the thighs, the
feet, and to the cervix uteri, through the vagina. Applications
made to the cervix uteri are usually very hot rather than cold.

THE EFFECTS OF COLD UPON THE BLOOD.

883 In 1893, Professor Winternitz, of Vienna, called attention
to the remarkable influence of cold applications in increasing
the number of blood-corpuscles, both red and white, and also
the amount of hemoglobin, it being noted, however, that the
white blood-corpuscles were increased in much greater pro-
portion than the red corpuscles. In one case reported by
Winternitz, the increase of blood-corpuscles by a hot bath
followed by cold was 1,860,000 per c.mm. The number of
white corpuscles was sometimes increased three hundred per
cent. In a case observed by the writer, the increase was
more than half a million. " " "

884 This remarkable phenomenon is due, according to Winter-
nitz, not to the sudden creation of new blood-corpuscles, but
to the contraction of the vessels of the viscera, caused by the
application of cold to the surface, whereby great numbers of
corpuscles, which have been collected in the vessels of the
liver, kidneys, spleen, and other internal viscera, are driven

THE PHYSIOLOGICAL EFFECTS OF WATER.

121

into the circnlation. That this explanation is not entirely
complete, however, is shown by the fact that local applica-
tions of cold water are followed by an increase in the number
of corposcles and of the hemoglobin at the seat of the applica-
tion, though no such increase is observed elsewhere (Exp. 26).

According to Henocque, both hot and cold applications 385
increase the rate at which the oxyhemoglobin of the blood
is reduced. A freezing temperature reduces the rate one-half.

Crawford, of England, showed in 1781, in a paper pub- 886
lished in the ** Transactions of the London Philosophical
Society," that cold baths increase the contrast of color
between the arterial and the venous blood, the natural result
of increased tissue activity and oxidation.

D'Arsonvai and others have shown by the estimation of 387

the gases contained in the blood at different points of the

body simultaneously, that the interstitial combustions are

increased by cold applications. These observations have

been confirmed by others, who have shown that the gaseous

exchanges are decidedly increased by cold applications, so

that a greater amount of oxygen is passed through the body

in a given amount of time.

Strasser {Deiitch, Med.-Zett., June 15, 1896) has shown 388
that general cold applications increase the alkalinity of the
blood, the diminution in acid phosphate amounting sometimes
to fifty per cent.

THE EFFECTS OF COLD UPON ABSORPTION.

By introducing belladonna into the rectum and observing 389
the length of time that elapsed befqre dilatation of the pupil
and other characteristic physiological effects appeared, Fleury
showed that absorption from the alimentary canal is very
greatly accelerated by the cold douche. His experiments and
those of others show clearly that cold applications to the
surface stimulate absorption by the gastric and intestinal
mucous membrane, and consequently that such applications
must favor nutrition by promoting alimentation.

122 RATIONAL HYDROTHERAPY.

THE EFFECTS OF COLD UPON SECRETION AND TISSUE CHANGE.

390 A short, very cold douche, administered with strong pres>
sure (25 to 35 lbs.), over the stomach and liver, has the effect
to increase the secretory activity of these organs by dilating
their vessels, thus bringing a larger quantity of blood in con-
tact with the secreting cells, and also by directly exciting cell
activity.

391 The cold douche and the ice-bag or compress over tbe
region of the stomach, increases the amount of hydrochlmc
acid formed by the stomach, and is thus exceedingly useful in
hypopepsia (Exp. 27).

392 Experiments made upon the rabbit and the dog show.
that intense general applications of cold give rise to increased
production of sugar, the sugar appearing in excessive quan-
tity in the blood, and if the application is of sufficient
intensity, in the urine also. Similar effects of very cold
applications have been observed in man.

393 As it is generally conceded that the glycogenic function of
the liver may be taken as an indicator of its activities in
other directions, it is evident that cold applications may be
made in such a manner as to produce greatly increased
activity of the hepatic functions.

394 It is evident that all applications of water which increase
the activity of the liver in the destruction and elimination
of tissue poisons and pathological toxins, must be capable
of rendering valuable service in the treatment of diseases in
which there is an excessive production of these elements,
as in typhoid fever, malarial fever, the malarial cachexia,
''biliousness,'' many forms of dyspepsia accompanied by
chronic toxemia and resulting neurasthenia, and in chronic
liver disorders, — congestion, sclerosis, hypertrophy, — and other
morbid states which so often accompany chronic indigestion.

396 The most pronounced effects upon the liver and stomach
are to be obtained by the use of the alternate circle or hori-
zontal douche and the percussion douche.

THE PHYSIOLOGICAL EFFECTS OF WATER.

123

General cold applications, especially the cold douche, 396
increase the production of HCl, and hence improve the
quality of the gastric juice. The alternate circle douche
is perhaps the most efficient of all means for promoting
peptic secretion.

Thermic applications to the skin unquestionably produce 397
the most profound effect upon the thermotaxic centers, but
this influence is to a considerable degree masked by the fact
that there is little disturbance in the body temperature. By
the aid of the author's bath calorimeter, it is easy to observe
that these thermic applications influence heat production and
dissipation to a most profound degree (Exp. 28).

In an observation elsewhere described (Exp. 29), made 398
by the author with his bath calorimeter in 1 890, and many
times repeated since with the same results, it was found that
the patient lost, during the bath, 103,354 heat units within
fifteen minutes. This represented four per cent., or one twen-
ty-fifth of the total amount of heat produced in twenty-four
hoars. As the patient's temperature remained the same at
the close of the bath as at the beginning, it is evident that the
increase in heat distribution was compensated for by an equal
increase in heat production, which must of course involve the
destruction of tissue, at least the oxidation of carbohydrate
material in the form of glycogen.

Dr. Strasser, assistant to Professor Winternitz, of Vienna, 399
in a paper contributed to a volume published in commemora-
tion of the fortieth anniversary of Professor Winternitz's
graduation in medicine (Vienna, 1897), gave an account ''of
a classical and exceedingly interesting study of the effects of
cold water upon tissue change. ^^ Strasser found, for example,
that a cold bath increases the amount of urea, uric acid,
ammonia, earthy phosphates, the xanthine bases or extract-
ives, and the total nitrogen, which proves conclusively that
short so-called tonic applications have the effect of stimulating
to a high degree the processes of tissue change in the body.
A very interesting and notable fact observed was that while

124 RATIONAL HYDROTHERAPY.

before the bath the quantity of imperfectly oxidized extract-
ives constituted about 8.7 per cent, of the total amount
excreted, under the influence of the bath the amount of
imperfectly oxidized extractives produced was but 1.5 per
cent.

It is also worthy of note that the increased amount of
phosphates eliminated was almost altogether in the form of
earthy phosphates, which, as Strasser states, is derived from
the food, thus affording an evidence of the improved absorp-
tion due to the application of cold water to the surface.
These facts account for the wonderful effects observed in the
application of the cold bath in rickets, the increased absorp-
tion of earthy phosphates contributing in these cases to the
development of healthy bone structures.

THE EFFECTS OF COLD UPON EXCRETION.

400 Short cold applications to the skin, being followed by
dilatation of the surface vessels, favor perspiration ; while
prolonged cold applications have the opposite effect.

401 As a rule, an increase in the quantity of fluid eliminated
through the skin is accompanied by a decrease in the quantity
of urine. This is not universally the case, however ; and it
should also be remembered that the quantity of urine is not
the true measure of renal activity, but rather the quantity of
poisons removed from the system.

402 Applications of ice-water to the skin of a dog cause
teipporarily a decided decrease in the size of the kidneys, due
to contraction of their vessels and tissues. The reaction
following a cold application gives rise to dilatation of the
vessels, relaxation of the tissues, and increased functional
activity.^'

The effects upon the kidneys of cold applications to the
skin are so profound that they must sometimes be interdicted
in cases of renal disease. In experiments upon animals^
prolonged and very cold applications have caused the appear-
ance of albumin in the urine.

THE PHYSIOLOGICAL EFFECTS OF WATER.

125

Short general cold applications increase the elimination
of CO, and the absorption of oxygen, a fact which agrees with
the influence of cold upon heat production; while prolonged
cold applications lessen heat production and CO2 elimination.

Cold applications which give rise to increased heat produc- 403

tion and a corresponding increase of CO, do not give rise to

an increase in urea unless they afifect the body temperature.

The production of urea seems to be regulated, to a degree

at least, by the body temperature. An increase in the body

temperature is accompanied by an increase of urea, as in

fever; while with a depression of the body temperature, urea

production and elimination are decreased.

Cold applications to the lower third of the sternum (the 404
renal douche) excite renal activity. Cold immersion and
other baths also increase the amount of urine and the total
solids. In cases of fever treated by the cold bath the toxicity
of the urine may be increased sixfold, thus proving the great
iofluence of cold in increasing renal efficiency.

me EFFECTS OF COLD APPLICATIONS UPON TEMPERATURB.

Currie showed (** Medical Reports,'* London, 1797)

405

by thermometric observations that applications of cold
water to the surface are capable of lowering not only the
surface temperature, but also the internal temperature of the
body. This was the beginning of scientific hydrotherapy.

In an experiment related by Currie, a healthy man was 406
put into a bath at 40^ F., his temperature at the time being
97.5^. His temperature, according to the observer's state-
ment, quickly fell to 83.1^, but rose at the end of fifteen
minutes to 91.9°; at which point it remained for nineteen
minutes, when it again rapidly descended, reaching in three
minutes 84.9°. The subject was then removed from the cold
bath, where he had been for thirty-seven minutes, and placed
in a full bath at 96'^. As he continued to shiver vigorously,
the temperature of the bath was raised to 109°. At the end
of twenty-eight minutes the body temperature was found to
be normal. These observations may have been inaccurate.

i* i

126 RATIONAL HYDROTHERAPY.

407 The uniform testimony of careful observers has been that
general applications of cold to the surface of the body not
only lower the surface temperature, but the internal tempera-
ture as well.

408 Fleury observed a lowering of seven degrees in tempera-
ture in a man by immersion in a bath at 50^ F. for 35
minutes. "

409 Jurgensen observed a reduction of 6. 5^ in temperature as
the result of a cold bath.

410 The majority of observers have not noted so great lower*
ing of temperature from local applications as those named
above. Draper obtained a fall of 1.5^ from an hour's immer-
sion in a bath of 73.5° to 75^.

411 The effect of the cold bath in lowering the temperature of
the body is increased as the temperature of the bath is lowered
and its duration prolonged. The effects of cold applicatioiis
upon the body temperature are much more pronounced in
fever than under normal conditions.

412 The surface often continues cold for some time after it
has become reddened by reaction, — an evidence that cooling
of the blood is still going on.

413 Fleury was the first to note that the body temperatoie
sometimes does not begin to fall until some minutes after
the subject has been removed from the bath.

414 The reduction of temperature in the cold bath is greatly
increased by friction of the surface, as by this means the sur-
face circulation is maintained, so that a larger amount of blood
is brought under the influence of the cooling medium. The
experiments of Winternitz showed that the rate of heat
elimination from the skin in the cold bath may be increased
30 per cent, by vigorous friction of the surface (Exp. 30).
Pospischil showed an incresise of more than 44 per cent

415 It must be remembered, however, that by very vigoroos
friction, heat production may be increased to such a degree
that the antithermic effect of the bath may be undesirably
diminished.

THE PHYSIOLOGICAL EFFECTS OF WATER*

127

Probflj^ed Cold
iffd SsppKsse4

The necessity for the prolonged application of cold grows 416

oat of the fact that when a cold application is made* the

&3fces of the body instantly rally to resist its influence, heat

prodnctiOQ being increased and heat elimination diminished*

The sj^tem thus endeavors to maintain the normal tempera-

tmt. If the application is withdrawn before this effort is, in

a measure, at least, suppressed or exhausted, the normal

temperature will be quickly recovered, and may be even

exceeded. This, with the other phenomena of reaction, will

be discussed elsewhere-*"

When a cold application is considerably 417

prolonged, the tendency to reaction is, to a

large extent, suppressed, as a result of the

exhaustion of the nerve centers involved, the

iessotiikg of Iha sensibility of the sensory nerves concerned in

the reflex inovement upon which reaction depends, as well as

hy the exhaust ion of the powers of calorificatian. Thus the

system gradually loses its power to resist the depressing

effects of ^d* and its antithermic effects are developed.

If the application is continued for a very long time,
the thermal and other vital activities of the body are
depressed to such a degree that two or three hours may
elapse before the normal temperature is restored.

Edwards, an English investigator, has shown that repeated 418
chilling of an animal increases the length of time required for
return of the normal internal temperature; hence the value
of repeated cold baths in typhoid fever.

Applications of water at a temperature below 419
that of the body always lower the temperature
of the part to which the application is made.

Circumscribed local applications of cold 480
water, such as immersion of the hand or foot,
reduce the temperature of the part, but have
no appreciable effect upon the general temperature, unless a
considerable amount of surface is involved, as in the employ-
ment oi large cold compresses to the trunk, except in case of

Hie BHecU of
Local Cold
Appllcmtiofss
opM the Body

128 RATIONAL HYDROTHfeRAPY.

internal applications or applications to special regions, as
the head.

421 Brown-Sequard showed that immersion of the hand in
cold water gives rise to lowering of the temperature of the
other hand.

These local applications of cold were, however, found
to be without influence upon the general temperature.

422 Winternitz showed that the application of snow to the
forearm produces, first, a lowering of temperature in the
hand to the extent of 2^ and then an elevation of 1.3^ F.
(Exp. 31).

423 Ice held in the mouth causes a lowering of the tempera-
ture of the cheek of the corresponding side. Copious drink-
ing of ice-water likewise produces a fall in the temperature
of the skin of the epigastrium (Exp. 32). This lowering of
temperature is so marked that it may be used as a method
of locating the stomach by the aid of the surface thermom-
etet. This fact was first shown by an experiment made
under the writer's supervision, by one of his students, in 1898.

424 The application of cold water to the soles of the feet,
especially if in the form of a spray, lowers the temperature.

425 An ice-cap applied to the head is an efficient means of
lowering the general temperature, through exercising a de-
pressing effect upon the thermogenic centers.

426 The application of an ice-bag over the heart lowers the
general temperature, slowing the circulation, and cooling the
blood (Exp. 33).

427 Copious cold water drinking and the large cold water
enema, although local applications, have a very decided
effect in lowering the general temperature, especially in febrile
conditions (Exp. 34).

THE PHYSIOLOGICAL EFFECTS OF WATER. 1 29

THE EFFECTS OF COLD UPON THE THERMO-ELECTRIC A L
CURRENTS OF THE TISSUES.

Gautrelet has made the interesting suggestion that the 428
difference of temperature created between the exterior and
the interior of the body by cold applications to the surface
must directly augment the intensity of the organic thermo-
electrical currents which are constantly playing within the
body, thereby modifying, in an important way, various nutri-
tive processes, and perhaps especially those concerned in the
storing and discharge of nervous energy. This is a subject
which deserves further investigation.

THE PHENOMENA AND RATIONALE OF REACTION.

Reaction, using the term as it is employed in hydro- 429
therapy, is one of the most complex and interesting of
physiological phenomena. The term is perhaps somewhat
misleading, as it suggests the idea of a single process, whereas
there is a series of complicated actions and reactions. The
most important of these are two, which may be distinguished
as the circulatory action and reaction and the thermic action
and reaction. Ordinarily we speak only of the circulatory
reaction, as this is the one most commonly sought. Gener-
ally, however, they occur together. These reflex activities
come into play in most of the process of hydrotherapy,
but especially in those employed for general effects.

Applications designed exclusively for local 430
of^Ro^ " effects are usually managed in such a way as

to suppress reaction, either partially or wholly ;
as, for example, when it is desired to restrain local inflam-
matory processes, — pain, congestive headache, or hemor-
rhages, — reaction is suppressed as much as possible by
continuous applications of cold of the necessary degree of
intensity.

On the other hand, in the employment of the cold or cool 431
shampoo to the scalp for baldness, the cold douche to stimu-
late ?-; r^piration, or the heating compress to a rheumatic
9

I30 RATIONAL HYDROTHERAPY.

joint, reaction is encouraged by means of friction, strong per-
cussion, or high pressure, or by protection from evaporation.

432 In some general appHcations, also, reaction is suppressed
as much as possible, as in the employment of the tepid
bath for the reduction of temperature, or the neutral bath
for insomnia ; whereas; in other applications it is encouraged,
as in the cold full bath with friction, for reduction of the
temperature, and the short, cold spray or douche administered
for tonic effects.

433 ^ ^, ,^, ^ Reaction consists of a series of vital processes
Definition of ,.,,,, , , . r . , ,
Reaction. which follow the making of either hot or cold

applications to the skin or the mucous mem*
brane. The reflex vital activities induced by cold applications
are much more pronounced than those produced by heat, and
differ in character ; nevertheless, the vital reactions produced
by applications of heat are clearly defined and constant in
character, and may be most advantageously utilized in
hydrotherapy. In view of these facts, it is indeed remark-
able that the reaction of heat has been almost absolutely
ignored by writers upon hydrotherapy.^ Even Hippocrates
observed that a cold bath warms the body by reaction, while
a warm bath cools it.

434 The reaction following the application of heat or cold to
the skin is much more pronounced than that resulting from
similar applications to the mucous membrane through the
stomach and the colon.

4^35 We have here to consider only the reaction

of Cold following short cold applications, the reaction

of heat being left for consideration elsewhere
(577). The phenomena resulting from a very cold applica-
tion to the skin, with strong pressure and of short or moderate
duration (3 to 30 sees.) may be divided into three classes: —

1. The immediate effects that accompany the application,
which may be called the primary effect, or action,

2. The secondary effects, which constitute the phenomena
of r cacti 071.

THE PHYSIOUX;iCAL EFFECTS OF WATER.

131

3. The remote eflfects, that is, the final result of the
application or series of applications in modifying normal or
pathological nutritive processes. These later effects, being too
varied and numerous to be presented in tabulated form, will
be referred to elsewhere under the head of "Tonic Effects."

The most clearly defined of the phenomena included in 436
these primary and secondary effects may be summarized as
iollows : —

ACTION.

1. Contraction of the small
blood-vessels of the skin, with
dilatation of internal vessels after
a very brief contraction.

2. Pallor of the skin.

3* Goose-flesh appearance and
roaghness of the skin.

f Sensation of chilliness.
. 5* Trembling, shivering, chat-
tering of the teeth, in some cases
decidedly painful and distressing
sensations of ** constriction,** etc.

6. First quickening, then slowing
of the pulse, with increase of tension.

7. First checked, then quick,
dcrp, gasping respiration.

S. Cooling of the skin.
9. In most cases slight rise of
internal temperature.
10. Perspiration checked.

REACTION.

I. Dilatation of the small blood-
vessels of the surface, with con-
traction of internal vessels.

Redness of the skin.
Skin soft, smooth, and sup-
Sensation of warmth.
A sensation of comfort and

2.

3.
pie.

4-
5-
well-being.

6. Slowing of the pulse, with
increased tension.

7. Respiration free, slower, and
deeper.

8. Heating of the skin.

g. Fail of internal temperature.

10 Increase of perspiration.

The initial symptoms following an application of cold 437
water are evidence of a protective effort on the part of the
system to prevent undue loss of heat by contracting the
blood and lymph channels of the skin, thus decreasing its
conductivity, and by increasing heat production through the
muscular action of shivering.

If the application is very cold, at high pressure, and of 438
short duration, the phenomena of reaction begin immediately
when the application ceases.

132 .RATIONAL HYDROTHERAPY.

439 If the patient has exercised actively just before the bath^
or if vigorous friction of the skin or a hot bath has been
administered, and not infrequently in healthy persons without
the preparation referred to, the phenomena of reaction begin
even before the termination of the application, as shown by
reddening of the skin, and by the disappearance of goose-
flesh and other unpleasant symptoms.

440 If, after reaction has set in, a renewed appli-

Second cation of cold is made, a second reaction will

Reaction. « i • i

occur m most cases, but the vital movement

will be much less prompt and pronounced ; and if the subject
is feeble or fatigued, a second reaction may not occur. In
some very vigorous subjects, even a third or a fourth re-
action may be secured by as many successive cold appli-
cations, but each time with diminished vigor; apd sooner
or later a point will be reached at which no reaction will
occur, or only after a very long delay.

441 If» instead of administering a short, cold douche, the
patient is placed in the cold bath, essentially the same thing
occurs. After the first contact with cold water, the tend-
ency to reaction appears, amounting in some cases to actual
reddening of the skin, especially if the patient is rubbed.
The continued contact of the water with the surface, how-
ever, prevents the complete development of reaction, and
sooner or later a second chill occurs, reaction from which
may be entirely suppressed.

442 The symptoms experienced by a person when
R^!tion prompt reaction does not occur are exceed-
ingly unpleasant. The most prominent are

prolonged chilliness, a disposition to nausea or faintness, gid-
diness, weakness, and great depression. The surface remains
pale and cold, and the internal temperature also may be
below normal, as the chill indicates the beginning of a
decline of temperature below the normal level. These symp-
toms show that tlic energies of the body, by which it is
naturally able to combat the disturbance created by the

THE PHYSIOLCXJICAL EFFECTS OF WATER.

133

CMMtttioiis that
Fbvot Reactioa.

application of cold to the surface, are unable to respond to
the demand made upon them under existing conditions.

The phenomena of reaction will seldom fail 443
if the cold application is made in a proper
manner. There are various controllable con-
ditions and measures by means of which the energies of the
body may be aided in developing prompt and vigorous reac-
tion. By the employment of these in connection with the
proper adaptation of the modes of applying cold to different
cases, it is possible to modify at will the degree of intensity
of the reaction effects obtained in any given case.

These conditions and measures may be classified thus: — 444

1. Those applicable before the bath.

2. Those that influence the condition of the patient
during the bath.

3. Those that may be employed after the bath.

These several conditions and applications may be enumer-
ated as follows : —

1. Measures and Conditions which Favor React ion^ to be 445
Employed before the Bath : —

(i) Warm clothing.

(2) Exposure to the air of a warm room.

(3) A hot bath of some sort.

1 4) Drinking hot water or some other hot beverage.

(5) The hot enema.

(6) Exercise more or less vigorous in character, according
to the strength of the patient, but never carried to the degree
of even incipient fatigue.

(7) Friction of the skm until warm and well reddened
(Exp. 35).

(8) A warm, dry, or slightly moist skin.

(9) A state of general health and vigor.

2. Conditions Pertaining to the Bath Itself or Acting in 446
Conjunction with It : —

(i) A very low temperature; the lower the temperature
the more prompt the reaction.

'j

ft

134 RATIONAL HYDROTHERAPY.

(2) Short, sudden applications.

(3) Pressure or percussion effects, as in some form of the
douche or spray (Exp. 36).

(4) Friction in the full bath, the half bath, the massage-
douche, or the rubbing wet sheet (Exp. 37).

(5) Alternating and revulsive spray or douche, the differ-
ence in temperature employed being as great as possible.

447 3. Measures that Encourage Reaction after a Bath: —
(i) Heat in the form of hot, dry air, warm clothing, or

hot-water drinking. It is even possible to induce reaction in
frozen parts by rubbing with snow or ice in a warm room.
The lumberman in the north woods warms his feet by taking
oflF his ^hoes and stockings, and rubbing his bare feet with
snow, immediately dressing them again. A high external
temperature favors reaction, both by lessening heat elimina-
tion and by increasing heat production.

(2) Exercise as vigorous as the strength of the patient
will allow (Exp. 38).

(3) Friction of the surface with the hand, rough towel, or
flesh-brush, practised by the subject or the attendant, or both.

448 Omitting many of the specific conditions of

Conditions that disease that hinder reaction and contraindi-
Discourage

Reaction. cate cold applications to the skin, the follow-

ing may be enumerated as among the most
important conditions which prevent or delay reaction, and
must therefore be taken into consideration in the employment
of general cold applications: —

449 I . Old Age, It is well to bear in mind the adage formu-
lated by an eminent French writer, *• A man is as old as his
arteries." Subjects in whom arterio-sclerosis has begun,
react with difficulty, and thus require special care. Very
cold baths must be avoided altogether, unless the area
involved is very small.

450 2. Infancy, Very young children react badly.

451 3. Exhaustion, either of a temporary nature from excess-
ive exercise or loss of sleep, or extreme nervous exhaustion.

THE PHYSIOLOGICAL EFFECTS OF WATER. 1 35

owing to the weak condition of the nerve centers upon which
prompt reaction depends.

4. Obesity, owing to relative anemia of the skin. 452

5. Rheumatic diathesis, owing to the weakening influence 453
of uric-acid poisoning and resulting inability of the body

to adjust itself readily to change of temperature.

6. Unhealthy or inactive skin. 454

7. Profuse perspiration, but only when accompanied by 455
great fatigue.

8. Extreme nervous irritability, 456

9. Very low temperature of the skin, 457
ID. An immediately preceding or impending chill. 458
U. Extreme aversion to cold applications, 459

,. As the previous observations relate chiefly 460

jguUjj^^ to that portion of the phenomena of reaction

designated as circulatory reaction, it may be

profitable to consider briefly by itself the interesting series of

vital activities which constitute what is known as thermic

reaction.

Thennic reaction to cold may be defined as the effort 461
of the body to replace the heat which has been lost by
exposure to cold, and to restore the equilibrium of the body
temperature.

All general cold applications of whatever sort, whether 462
made to the skin or to the mucous membrane, lower both the
temperature of the surface to which they are applied, and the
internal or general temperature of the body. This has been
abundantly proved by Fleury, Liebermeister, Bottey, and
others. In a considerable proportion of the cases, however,
the ultimate lowering of the internal temperature is preceded
by a slight rise, which begins almost simultaneously with
the cold application, and continues for lo or 12 minutes
afterward.

After the initial rise and subsequent lowering of the tern- 463
perature, there is a gradual return to the normal tempera-
ture.

136

RATIONAL HYDROTHERAPY.

This vital movement is very well shown in the fol-
lowing diagram, which is modified from that given by
Bottey : —

Pfeactiofx

Diagram indicating the vital movement following a general cold application.

In this diagram, which represents the effect obtained
from a short, very cold jet douche or spray applied to the
skin with high pressure, the line x:^ represents the normal
temperature, 98. 6^ F. ; the line ab represents the brief eleva-
tion of internal temperature which follows the receding of the
blood from the surface the first insfant after a cold applica-
tion; the line bed represents the fall in internal temperature
which immediately succeeds the rise; and the 'line de repre-
sents the reaction by which the normal temperature is restored.
The line abed may be said to represent the action which pre-
cedes reaction.

464 Vigorous exercise or a hot bath taken just
before a cold bath increases the initial rise of
temperature, which is doubtless due to the fact
that muscular activity increases heat produc-
tion to so marked a degree that the cold application finds the
thermogenic processes in full play, and hence more able to
produce a strong thermic reaction.

465 Warm or tepid baths (80- to 92*^ ) do not produce the
initial rise of temperature. The following diagram represents
the thermic action and reaction accompanying and following
a tepid bath.

Modifications
of Thermic
Reaction.

THE PHYSIOIjOGICAL EFFECTS OF WATER. 1 37

t
1

Diignin representing the vital movement following a warm or tepid batn.

In this diagram, xx* represents the normal temperature,

9*6° F. The line ab represents the action whereby the

lody is cooled; the line be, the reaction. The perpendicular

dotted line is the point of division between the two classes of

phenomena.

A tepid or neutral bath causes lowering of the body tern- 466
peratore purely in a physical and mechanical way, indepen-
dently of any reflex action. The surface blood-vessels do not
contract, and hence the blood is rapidly cooled as it comes in
contact with the water at a temperature a few degrees below
the body temperature, and by the circulation of the blood
current the internal temperature is lowered.

Not infrequently the rise of body temperature produced by 467
the thermic reaction after a cold bath does not cease at the
normal point, but rises slightly above it. Several oscillations
of this sort may occur before the normal point is permanently
gained.

The cause of the initial rise of temperature produced by a 468
short, intensely cold application to the skin is evidently the
slowing of the blood current. The blood is heated in the
internal viscera, and cooled at the surface of the body. A
complete circuit of the blood through the heart is effected by
every twenty-seven or thirty heart-beats, or in a little less
than half a minute. It is evident that the more rapidly the
blood is passed through the skin, the more heat will be given

138 RATIONAL HYDROTHERAPY.

up to the skin and the air, and hence the greater will be the
cooling of the whole mass of blood, and the lower will be the
internal temperature, the rapid blood current tending to equal-
ize the temperature of the body, warming the surface and
cooling the interior.

469 It is equally evident that slowing of the circulation must
have exactly the opposite effect : the blood, remaining longer
in the skin, loses more of its heat, and the skin is accordingly
cooled to a greater extent ; whereas the blood which traverses
the viscera, in which the thermogenic processes are most
active, will remove a smaller amount of heat, thus occasion-
ing a rise of temperature in the interior of the body, and so in
a double manner increasing the difference between the exter-
nal and the internal temperature. General intense cold
applications to the surface cause contraction of the small
arteries in every part of the body, in the viscera as well as in
the skin (M. Wertheimer). The contraction of the vessels of
the viscera is much briefer in duration than in the skin, but is
long enough to check the movement of the blood current,
thus momentarily encouraging the fall of temperature in the
skin and the rise of temperature in the internal parts, as just
explained.

470 Simultaneously with the development of the internal rise
of temperature, there occurs an increase of heat production
as the result of reflex action through the sympathetic nervous
system, accompanied, as shown by Liebermeister, with
increased production of CO 2, as shown by Winternitz.

471 Curiously enough, the influences which give
i ""r*^ ctkm ^*^^ *^ ^" increase of internal heat are antago-
nized by a reflex action effected through the

sympathetic, or vasomotor, system, which tends to cool the
body either by inhibiting the automatic thermogenic centers of
the cord, or through the intervention of a special refrigerating
center.
47? The initial rise of temperature in the interior of the body
is very brief in duration, for the reason that by the circulatory

THE PHYSIOLOGICAL EFFECTS OF WATER.

»39

\

reaction which dilates the surface vessels, heat elimination is

greatly increased, both through the enlargement of the area

of blood exposed to the cooling influences acting upon the

skin, and through the increased rapidity of the blood current,

whereby the skin is rapidly warmed and the interior cooled.

When the minimum temperature is reached, which may be

from a few tenths of a degree to three or four degrees below

the normal, a rise in temperature takes place, and continues

until the normal point is reached, or even surpassed.

The thermic phenomena following an intense application 473
of cold to the surface may be briefly epitomized as follows: —

1. Cooling of the skin by conduction and evaporation. 474

2. Cooling of the skin and of the viscera by reflex refrig- 476
erating influences due to the action of the sympathetic nerves.

3. Elevation of the internal temperature in consequence 476
of the slowing of the blood current following contraction of

the small blood-vessels throughout the body.

4. General increase of temperature internally and exter- 477
Dally through reflex stimulation of the thermogenic centers.

The thermic reaction is a useful indicator both 478

f» ^1 11 of the extent to which the bodily functions
Reactloii a Use- -^

M Indicator. rnay be modified by hot or cold applications
to the surface, and of individual susceptibility.
The author has found the following a useful means of testing
the reactive power of an individual: —

A vessel of sufficient size to receive the arm immersed to 479
the elbow is provided with water at a temperature of 50^ F.
The patient immerses the bared hand and arm to the elbow
for one-half minute. Note is taken of the surface tempera-
ture of the arm before immersion and every five minutes after
removal, until the original temperature is restored (Exp. 39).

The appearance or non-appearance of goose-flesh and the 480
length of the continuance of this phenomenon are noted,
and also the appearance and duration, or non-appearance, of
reaction, as indicated by increased surface temperature and
redness.

oi

f

,.. ^:-

I40 RATIONAL HYDROTHERAPY.

This test is a valuable means of determining the condition
of the nervous system as regards the tone of the spinal and
sympathetic centers, and also gives important information
concerning the general vital resistance of the patient, or hia
power to resist disease.

A more convenient and practical, though somewhat less
accurate, method of applying this test is the following : Dip
the corner of a towel in ice-water, hold the saturated towel
against the bared forearm of the patient for one minute, cov-
ering a surface of at least ten or twelve square inches. Do
not rub the surface, simply maintain contact of the cold wet
towel with the skin. On withdrawing the towel, dry the
surface by light pressure with the dry end of the towel, cover
to prevent slow cooling by evaporation, and note the length
of time required for the occurrence of reaction, as shown by
the return of redness and natural heat. General chilliness
produced by this application indicates an extreme irritability
of the vasomotor nerves and nerve centers and undue activity
of the reflexes. A mottled blueness shows great cardiac
weakness and a dangerous threatening of collapse. This fact
renders this method valuable as a means of ascertaining a
patient's ability to take an anesthetic without undue risk of
heart failure. Good reaction ought to occur with distinct red-
dening of the surface, within i or 2 minutes after the appli-
cation of ice-water.
481 It is through thermic reaction that the cold

tlon'^and ^*^ h^th produces its marvelous, renovating and
Metabolism. alterative effects. The tissue activity set up
in the thermogenic tissues of the muscles as
the result of exposure of the skin to a cold medium for a short
time, is participated in by every cell and tissue in the whole
body. Tissue building is accelerated to keep pace with the
increased rate of oxidation; and thus more food is required,
more blood is in circulation, more oxygen is absorbed, more
COj and urea are eliminated, and all the vital functions are
quickened, thus causing the stream of life to flow at a more
rapid rate. This is tonic thermic reaction.

THE PHYSIOLOGICAL EFFECTS OF WATER. I4I

THE PHYSIOLOQICAL EFFECTS OF HEAT.

Heat may be applied to the body for therapeutic purposes 482
in a variety of ways, as by means of hot water, steam, hot
air, or by radiation from an incandescent body. Illustra-
tions of these several modes of application are to be found
in the full bath, the fomentation, the Russian or vapor
bath, the vapor douche, the hot air or Turkish bath, and
the electric-light bath.

The effects produced in the application of heat to the 483
body depend upon (i) the mode of application, (2) the tem-
perature, (3) the duration, and (4) the condition of the subject.

Water is recognized as hot when above the temperature of 484
the surface of the body, or between 98^ and 104*^ F., and is
termed very hot when above 104°. At a temperature of 120°
a full bath becomes unendurable, although small areas, as in
the hand or foot bath, or in the application of a fomentation,^
may be gradually trained to endure a temperature ten or fif-
teen degrees higher.

The mucous membrane readily endures a temperature ten 485
or fifteen degrees higher than can be tolerated by the skin.

A full bath of 120^ can not be prolonged beyond 2 or 486
3 minutes without danger to life, and for some persons it
would be hazardous for even a few seconds.

In the vapor or Russian bath, a temperature of from 1 12^ 487
to 120"^ F. is not uncomfortable, and 130^ to 145^ can be
tolerated for a short time.

The ordinary temperature of the Turkish bath is from 488
140^ to iSo'^F., but it is often raised to 220° or even 250'-'
without ill effects. Temperatures much higher than this have
been endured for a short time in dry air by specially trained
persons.

In the employment of the electric-light or radiant-heat 489
bath, the body is subjected to the influence of radiant heat.

142 RATIONAL HYDROTHERAPY.

A thermometer exposed upon the surface of the body in a
bath of this kind has been seen by the writer to register a
temperature of ii6.6^, although that of the air about the
patient, as measured by a thermometer protected from the
direct rays of the incandescent lights, was but 95° F. .

490 The body expands under the influence of heat, in this
respect behaving like most other bodies. The rate of expan-
sion is very nearly the same as that of water. The body of
a man weighing 132 pounds expands 21 c.c. for every degree
centigrade, or .6 cubic inches for every degree Fahrenheit,
elevation in temperature, or three cubic inches for evexy
5*^ F., an amount inappreciable under ordinary conditions.

491 White fibrous tissue expands under the influence of heat,
while yellow elastic tissue, like rubber, contracts. The liga-
ments of joints are composed of white fibrous tissue, hence
they are relaxed by hot applications.

492 Heat is without doubt one of the most power-
"®** • ful of all vital excitants. The heat of the
Stimulant. ^^" ^^ ^'^® direct source of all animal and

vegetable life. Heat stimulates protoplasmic
activity, as shown by many laboratory experiments. A
clinical illustration of the same fact is found in the remarlc-
able pigmentation of the skin produced by the prolonged
use of fomentations or poultices.

In the following pages we shall consider the effects of heat
as applied to the body by means of water in its ordinary or
liquid state, except when otherwise stated.

THE EFFECTS OF HEAT UPON THE SKIN.

493 The effects of heat applied to the skin differ somewhat
according to the intensity and the mode of application, but
they may, in general, be stated to be as follows: —

494 1. Dilatation of ^ he effect of moderate heat, that is, water
the Capillary applied at a temperature of from 100^ to 104^
Vessels. p ^ jg ^^ produce a reddening of the surface,
more or less intense according to the thickness or natural com-

THE PHYSIOLOGICAL EFFECTS OF WATER. 1 43

plexion of the skin and the temj>erament of the subject. This
reddening of the skin is due to the influence of heat upon the
vasomotor nerves, which is to paralyze the vasoconstrictors
and stimulate the vasodilators; while cold produces the op-
posite effect (Exp. 40).

Currie observed * that water at moderate heat (99° to 496
101° F.) relaxed the surface vessels, while very hot applications
(104^ and above) gave rise to vascular contraction in the skin.

The application of a higher temperature (iio^ to 130° 496
F.) produces, at first, pallor of the skin, due to stimulation of
the vasoconstrictors. At the same time the surface is rough-
ened, presenting a goose-flesh appearance, due to contraction
of the involuntary muscle fibers connected with the hair
bnlbs. Slight shivering may also be produced, as from an
application of cold, which proves that the phenomenon of
shivering is not due exclusively to the influence of cold, but
is, to some extent at least, connected with the excitation of
the vasoconstrictor nerves from whatever cause.

The pallor and other phenomena due to excitation of the 497
vasoconstrictors from very hot applications are of but short
duration. The pallor soon gives place to a dusky redness
and the other appearances which accompany a hot applica-
tion of more moderate degree. If the application is increased
gradually in temperature from moderate heat, as from 100^
to 104° F., a final temperature of 130^ or even higher may
be reached without excitation of the vasoconstrictors, the
surface remaining reddened.

Some time after the end of a hot application, if continued 498
from 1 5 to 30 minutes, vasoconstrictor phenomena occur.

The effects of heat upon the circulation of the mucous 499
membrane are the same as upon the skin, except that a some-
what higher temperature is required to produce parallel results.

The stimulating effect of a high temperature upon the 600
vasoconstrictors renders very hot water useful as a means of

♦ ■' Mrdical Reports,'* 4th cd,, pp. 99-iot.

144 RATIONAL HYDROTHERAPY.

checking hemorrhage, and in capillary oozing from sui^cal
wounds. It must be remembered, however, that when ap-
plied for such purposes, the water should be at a tempera-
ture of from 120^ to i6o° F., or hot enough to cause pain;
and some allowance must be made for lowering of tem-
perature during the application.

501 A blast of highly heated air has been successfully used as
a means of checking hemorrhage in cases of metrorrhagia,
also a jet of steam. The author makes use of a metallic
instrument, really a hollow uterine sound, through which a
stream of hot water is passed at a temperature of 170^ F.
The small vessels are thereby sealed up, and the hemor-
rhage is thus checked.

502 It is useful also to remember that hot applications to the
skin produce not merely dilatation of the arteries, but especially
the small veins, and a like dilatation of the lymph channels.

503 A general hot bath or even the application of
2. Increase of heat to a comparatively small area of the sar-
cretlorand ' ^^^^ produces a general increase of activity of
Respiration. the glands of the skin, both perspiratory and

sebaceous. Perspiration may be induced either
to the degree of producing slight moisture of the skin or pro-
fuse sweating, according to the -length or intensity of the
application made. The ordinary rate at which moisture is
thrown off by the skin is from one to one and one-half ounces
per hour ; but by application of heat in the form of a very
hot bath at a temperature of from 110° to 115^ the rate
of perspiration may be increased to more than an ounce a
minute, or from fifty to sixty times the ordinary amount.
The most pronounced effects possible may be secured by the
' electric-light bath and the sun bath.
50'!: These facts str^gly emphasize the importance of admin-
istering water internally in connection with applications of heat.
Loss of fluid from the blood has a depressing effect upon the
heart similar to that produced by bleeding, though somewhat
less marked ; hence the vital necessity for making good the

THE PHYSIOLOGICAL EFFECTS OF WATER. 1 45

amount removed, by drinking water during as well as before
and after the bath, if prolonged, or, if necessary, by means of
rectal injections.

Prolonged and repeated perspiration induced by artificial 505
means weakens the skin, and thus lessens its power to react
and to resist cold impressions unless counteracted by frequent
cold applications.

It is interesting to note in this connection that while the 506
absorption of oxygen and the elimination of CO, by the lungs
is diminished as the result of hot applications to the surface,
the opposite effect is produced upon the skin. Ordinarily the
skin performs about one per cent, of the total amount of
respiratory work done by the body, but under the influence
of heat this proportion is often doubled. This fact is evi-
dently due to the dilatation of the blood-vessels of the skin,
and to the moistening of the horny layer, whereby the inter-
change of gases between the skin and the air is facilitated.

A brief application of heat to the surface 607

■^^r^7?Viit increases the loss of bodily heat by the skin in
hy the Skio. several ways : —

(i) By dilating the surface vessels, thus 608
increasing the area of the blood exposed to the cooling influ-
ences operating upon the surface of the body.

(2) By increasing the rate of the blood current in the skin
through the stimulation of the vasodilators and the heart.

(3) By increasing the amount of evaporation from the
surface through increased activity of the sweat-glands and
increased osmosis, and by heating of the skin.

(4) By increasing the conductivity of the skin, thereby
increasing loss of heat by radiation.

The tactile sensibility of the skin is greatest 509
4. Decrease of liom 950 ^q ggo qj. |.j^g normal temperature

Tactile SeiMl- . .u _r 1. . i- .• / o j

IjHH of the surface, very hot applications (113° and

upwards) having the effect to lessen sensi-
bility (Exp. 41). This fact explains the special value of the
alternating douche, or the so-called Scotch douche, which

146 RATIONAL HYDROTHERAPY.

renders such marked service in the treatment of sciatica and
other forms of neuralgia. At a temperature of 130^ and
above, the tactile sensibility seems to be abolished, though
the sensibility to pain still remains. It is a curious fact that
the sensation produced by the application of intense beat is
practically the same as that from intense cold.

610 The thermic impression made by an applica-
^ ^Sh"^^" ^*^" ^^ ^"y ^^^ depends primarily upon the
the Application difference between the temperature of the
of Cold« skin and that of the application. By begin-
ning the application at about the temperature

of the skin, and gradually increasing it, a very high tempera-
ture may be borne without pain, as the zero of the tempera-
ture sense is thus gradually raised. This raising of the
temperature of the skin has a special valile in hydrotherapy
as a preparation for the application of cold, the skin being
thereby not only rendered more susceptible to the influence
of cold, but likewise prepared to react after a cold application
by reason of the increased nervous and vascular activity, and
the large amount of heat stored up. For these reasons, the
hot bath, contrary to what might naturally appear to be the
case, prepares the skin for cold applications, — a fact which
is of great importance in therapeutic applications of water.

611 When the skin is cold, or in cases of fatigue, in rheuma-
tism with painful joints, in neuralgia, in anemic and feeble
persons, and in many other conditions elsewhere indicated
(1028), this preliminary heating of the skin is of the greatest
importance.

THE EFFECTS OF HEAT UPON THE CIRCULATION.

612 In studying the influence of heat upon the circulation,
we must consider not only the heart, as the center of this
system, but especially the three great vascular areas, — the
muscles, the portal system, and the skin, particularly the
latter. Each of the parts named may be regarded as a great
reservoir, capable of retaining a large share of all the blood

THE PHYSIOLOGICAL EFFECTS OF WATEK-

147

the body. The portal area is excited and filled by digestive
tivity; the muscles, by vigorous exercise; and the skin, by
icussion, (riction, reaction from cold and heat, especially
ihe latter*

It is impossible fur each of these vascular areas to be 613
excited to fall activity or completely filled with blood at the
same time. When one of these areas is in a state of con-
gtslba, the others must be in a condition of more or less
ked anemia. This explains the pallor often occasioned by
ively violent exercise, and the pallor and giddiness
wfeicb samelimes follow almost immediately upon the taking
of food to certain forms of indigestion, also the faintness which
Dot infrequently overcomes a person subjected suddenly to a
%li d^ree of heat in a vapor bath while sitting in an up-
tight position. A bath at 102"^ F. produces venous conges-
tlQO of the brain for the first three or four niinntes* then
rebraJ anemia, which continues for some time after the
tb, notwithstanding marked acceleration of the pulse. The
effect upon the cerebral circulation, though less pits-
may bo obtained by a foot or leg bath at from 104*^

to 108=* F-»

The effect of a general application of heat is to 614

produce at once a notable increase in the force

with temporary slowing of the heart's action

(Exp, 42). This diminishes, however, as soon

^k free perspiration begins, owing to the lessening of the arte-

^■llgMgton by the dilatation of the cutaneous vessels, and the

^HHHIe established through fatigue of the temperature

sense. The final effect of a hot application is to lower arte-

rial tension while quickening the pulse.**

The first effect of a very hot application to the skin, as 515

already remarked (496), is to stimulate the vasoconstrictors,

hich results in contraction of the small blood-vessels of the

rface; and this, together with the reflex stimulus received

y the heart from the periphery, accounts for the sudden

crease in the force and frequency of the pulse* This effect

Activity of

148 RATIONAL HYDROTHERAPY.

is greatly increased if the water is applied in the form of a
spray or a jet douche, owing to the mechanical effect thus
added.
516 The first effect of a hot application to the surface is to
produce a very transient contraction of the internal blood-
vessels simultaneously with the surface contraction. This
instantly gives way to a marked dilatation, which is in turn
replaced by contraction as soon as the surface vessels are well
relaxed.

617 This temporary excitation of the heart in connection with
stimulation of the vasoconstrictors of the skin is liable to give
rise to intense congestion of the internal viscera, especially
the brain, hence the danger of administering this form of
bath to plethoric persons, those who have suffered from apo-
plexy, or who have symptoms of incipient arterio-sclerosis.
This condition of internal congestion is often indicated by a
sensation of throbbing and fulness in the head, and the visi-
ble beating and pulsation of the vessels of the throat and
temples, with flushing of the cheeks.

618 The reason for this increase of cardiac and vascular activ-
ity as the result of the application of heat is apparent when
we consider the relation of the heart action to the condition of
the surface vessels as regards heat elimination. One of the
most important functions of the skin is the cooling of the
blood. Now it is evident that if the temperature of the skin
is raised, these cooling processes will occur at a slower rate;
and thus, to secure an equal amount of cooling, the blood
must be passed through the surface vessels more rapidly.
Hence the nervous reflexes which regulate heat elimination
are so arranged that an increase in the temperature of the
skin or the media to which it is exposed, results in a quicken-
ing of the cardiac activity as well as an increase in the size of
the blood-vessels of the skin, whereby a larger area of blood
is exposed upon the surface of the body.

519 The very opposite of this occurs, of course, in connection
with cold applications (283). Very hot applications also

THE PHTSIOLOGJCAL EFFECTS OF WATER.

'49

toduce* at fiist, a protective contraction of the surface ves-
sels (497)- This compensatory arrangement is continiiatly
broQgbt into activity in the practice of hydrotherapy.

Various physiologists have noted that when a limited por- 680
tton of the body is warmed, a reduction of temperature takes
place in contiguous parts. This effect is purely a mechanical
CMie. The overfilling of the blood-vessels of one porrion of
the area supphed by a single arterial tmnk naturally results
to robbing another portion of the same area, the vessels of
which are not distended.

THE EFFECTS OF HEAT UPON THE RESPIRATION,

General appUcations of heal increase the rate and factHty 521
of the respiratory movements. This is true, however, only of
moist heat, so called, as dry heat^ or rather the inhalation
of dr)' hot air, produces the opposite effect, through its exci-
ting intlaence upon the small air-tubes. Excessive dryness of
the air also hinders the gaseous exchanges in the lungs» while
moderate dr>n€ss promotes them. The increase of the chest
movements in moist hot air does not indicate an increase of
oxidation in the body, but is probably due to a lessened rate
of CO^ elimination.

Nothing so quickly relieves an asthmatic patient as a hot 522
full bath or a vapor or electric-light bath ; but an examina-
tiofi of the products of respiration shows a decided decrease
in the amount of CO 2, the natural result of diminution in
vital combustions from the influence of heat upon the ther-
mogenic centers.

It should be noted, also, that while the respiratory move* 523
ments are made with greater ease and frequency under the
influence of heat, the depth of movement is considerably de-
creased; that is, the amount of tidal air is lessened. (Exp, 43).

The effect observed after a hot bath is a temporarily 524
diminished rate and depth of respiration.

Such general applications of heat as raise the temperature 526
of the blood excite the heat-controlling centers, and bring into

^$o

ttATlQilAL BYmtXyTBEBAFf,

iU

521

528

fi2»

play the processes o( heat dissipation, which include an if

of lao^ activity, as well as of skiQ perspiration and n^ptratioii.

Thb fact eicplains the rapid respiration in higfi fe%'er.

The tnfloence of the hot bath npon respiration is in some
respects quite similar to the effects of cold* With quite high
temperatures (i lo^ to i tz^ F.) a sense of constrictjon is felt
when the body is immersed to the bead in the fall bath ; the
abdominal walls are contracted. The effect b most markc
if the application is made t^ the aid of a douche with conti
siderabte pressure.

TttE EFFECTS OF HEAT UPON THE MUSCLES,

Prolonged applications of heat, tliat is temperatnres above
lOO^, diminish mnscular excitability and capacity for muscular
work to a notable extent. Kfagglori and Vinaj have demon-
strated this very clearly by an extended series of experiments.
In one instance the muscular capacity, as shown by th€
results obtained by means of Mosso's ergograph, was dimin-
ished S.043 kilogram meters. It is this weakening of the mus*
cics which gives rise to the very sensible enervating effects of
a long hot bath. The i^Titer has noted results in accord with
those of these investigators (Fig. 27, A and B).

A vigorous young man experienced such great weakness
after a hot full bath (Exp. 44) that he felt hardly able to walk-
It is indeed surprising that the available cnergj^ of the bodj
should by this means be so greatly reduced within so short a1
time. It can not be supposed that the actual store of force-pro-
ducing material in the muscles or nerve centers is exhausted
I)y the bath ; hence we must conclude that the results observed
arc due simply to lessened muscular excitability.

Muscular irritability lessens very rapidly undeffl
the influence of a water bath at a temperature
of I 20"' F. and above, and even at somewhat
lower temperatures it is decidedly lessened.
This phenomenon may be observed veryfl
readily in cold-blooded animals, in which a temperature of

tm^sentd IrrJ-
Ulillliy of UiQ

Votaittary
Muicles*

THE PHYSIOLOGICAJU EFFECTS OF WATER,

15 »

ft Tew degrees above that of the medium in which the animaJ
liv^, produces almost complete paralysis, and a (ew degrees
higher at once gives rise to absolute muscular inactivity,
throt^h heat-stiffening of the muscles. Very prolonged hot
appltcatioRg at temperatures not much above the normal
body temperature similarly give rise to muscular weakness in

I Doa:
^B maf

^^^^ Notwithstanding these lacts, experience shows that ver)*

^^^mcrt h&t appiicaiii^ns are the best of ali means for recovering

^1 a person exhausted by prolonged or violent exercise. This

measure has often been employed for the relief of exhausted

soldiers^ An eminent English army surgeon made use of the

hot enema for this purpose more than a century ago. The

nerve centers of a person in a state of extreme exhaustion do

^H not readily respond to the stimulation of cold; in other words,

^" a person in that condition will not react to cold, hence the

^ necessity for an application of heat. The restorative effects

H of an application of heat in such cases is perhaps due in part

" to the elimination of the fatigue poisons which is thereby

encouraged, as well as to reflex stimulation of the nerve

I centers. The good results are rendered much more decided
and lasting if the hot application is succeeded by a short cold
appticattoti, such as a broken cold horizontal jet to the spine
for 3 or 4 seconds* or a rubbing wet sheet, or a cold fnc-
tioQ bath.
It is worth while to note in this connection that the
exhausting effects of a hot bath may be readily neutralized
bj' an application of cold water in the form of a douche or a
shower bath^ since the sensation is not due to an absolute
loss of strength or cnerg> in either the muscles or the nerve
centers, but is a purely nervous phenomenon, expressing the
pcctiltar effect upon the nerve centers of impressions of heat
communicated through the peripheral nerves. The restora-
tive effect of a cold bath administered after a hot bath, the
^Qthor has demonstrated frequently by clinical experience as
well as by laboratory experiment (Exp, 45}.

&30

S31

152 RATIONAL HYDROTHERAPY.

532 A young man of twenty years, when subjected to a care-
ful dynamometric test, was found to have a total strength of
8,550 pounds, as shown by a on the accompanying chart.
After a hot bath at a temperature of from 1 10° to 1 18° F. for
ten minutes, the total strength was found to be 6,840 pounds.
The details of this test are shown in the tracing marked b on
the accompanying chart. After a cold shower bath for one
minute, followed by vigorous rubbing, the same dynamometric
test was again tried, with a total strength result of 8,195
pounds, as shown by the tracing c on the accompanying
graphic.

533 To secure the maximum of restorative results, the hot
bath should not be continued more than five minutes, and
should be followed by a cold shower or spray douche from
5 to 20 seconds, ending in a very cold broken douche to the
spine for 2 seconds.

534 Excessive muscular irritability, as in a person sufiFering
from cramps, fidgets, or irregular muscular twitchings, is
quieted by a prolonged neutral full bath (92° to 95° F.).

535 The effect of very hot applications in lessening muscular
irritability is often utilized therapeutically in the treatment of
deformities resulting from muscular contraction, for the relief
of vaginismus, and in cases of contraction of the anal muscle.

536 Very hot applications increase the irritability
Increased Irri- q£ ^j^^ smooth, or non-striated, muscles. This
tability of la vol- ., t_.i_r.^i_^ .. ,. .
untary Muscles. ^^ shown by the fact that very hot applications

to the skin cause contraction of the muscular
walls of the small blood-vessels and the minute muscles con-
nected with the hair bulbs, giving rise to goose-flesh and
pallor. This physiological property of heat is utilized in the
application of hot water to the uterus by vaginal injection for
the relief not only of hemorrhage but of chronic catarrh and
congestion of this organ, and in the condition known as sub-
involution.
637 Hot rectal irrigation is one of the best means of combat-
ing chronic congestion and enlargement of the prostate.

154 RATIONAL HYDROTHERAPY.

matic thermogenic centers. The result is an accumulation
within the body of tissue poisons, which produce phenomena
similar to those resulting from prolonged or violent exercise,
— the so-called ** fatigue poisons,'' which have been shown
to p>ossess properties almost identical with those of curari.

542 In harmony with this idea is the interesting fact recently
ascertained that sunstroke is really a toxemia resulting either
from the excessive accumulation of poisons within the body,
or the development of special poisons under the influence of
heat. May it not be possible that the well-recognized debili-
tating influence of excessive heat is, in part at least, due to
the same cause?

543 Special reflex effects are obtainable by hot
ProduK:ed by Hot ^tpplications to certain areas of the skin, which
Applications. sustain a known reflex relation to the internal

viscera. These effects are obtained through
impressions made on the ganglia of the great sympathetic
and the vasomotor and other ganglia of the cord. To obtain
effects of this sort, heat may be applied either alone or in
conjunction with cold water in the alternating douche. The
reflex effects thus obtained are either those of vasodilatation or
vasoconstriction, according to the degree of heat employed.
Warm or hot water stimulates the vasodilators, while very
hot water (i 15^ to 130^ F.) produces Vasoconstriction.

544 Winternitz, Brown-Sequard, Tholozan, Rosbach, and
others have experimentally worked out the topography of
this reflex action with reference to all the more important
internal viscera, pointing out the exact area of the surface
which must be operated upon in order to obtain the effects
desired. Among the most important of these associated areas
are the following: —

545 I. The face and the back of the neck, which are in rela-
tion with the brain.

64G 2. The upper portion of the spine, the chest, and the

shoulders, which are intimately associated reflexly with the
lungs through the pneumogastric.

THE PHYSIOLOGICAL EFFECTS OF WATER.

U5

3. The hands and feet, which are associated with the 54 J
bram. the macotis membrane of the nose, and the organs of
the chest.

4. The middle dorsal region, with the stomach* 548

5. The breasts, with the uterus. 549

6. The skin covering the lumbar region, with the 550
ktdne>^.

7. The lower lambar region, with the uterus and the 65i

I lower extremities.
8, The internal surface of the thighs, with the uterus. 652
9. The plantar region, with the uterus. 563

10. The feet, with the kidneys, 554

II. The skin covering the lower third of the sternum, 555
with the kidneys,

12* The skin surface over the liver^ spleen, stomach. 556
bowels, and bladder, with the corresponding organs.

Very hot applications made over these surfaces stimulate 667
simultaneously the vasoconstrictors of the area to which the
application is made, and those of the internal rei^ion which is
^10 reflex relation with it, as just designated. The explanation
^■of these interesting relations will be found in a study of the
^r anatomical relations of the vasomotor centers of the spine
" aod other special ganglia with the areas inner^^ated by them*

The reflex eflects of these localized applications at a high 658
tempermlure are of great service in hydrotherapy ; for ex-
^Kampte, cerebral congestion may be relieved by the hot foot
^Bbath, w^hich, as Mosso proved by experiments on a man a
^P portion oi whose skull had been removed* is capable of pro-
ducing even cerebral anemia* The temperature should be
faoni 105' 10 110 F. A hot full bath at 102"^ F. is often
most effective in relieving cerebral hyperemia. Bathing the
lace with veiy hot water is a most effective means of checking
nosebleed* Hot sponging of the head and neck often gives
complete rcltef in insomnia from cerebral congestion.

Splenic aod hepatic congestion, the usual accompaniment 669
oi malaria] disease, is relieved by very hot fomentations

156 RATIONAL HYDROTHERAPY.

applied over these organs. Uterine hemorrhage may often
be checked by a short, very hot foot bath (105^ to 115° F.),
although the warm foot bath (92^ to 100° F.) causes dilatation
of the uterine vessels. Relief from congestive headache is
frequently obtained by very hot sponging of the back of the
neck, a result evidently due to the fact that the circulation of
the brain is controlled by the vasomotor centers situated in
the cervical region (353).
660 In employing heat to the spine for the relief of pulmonary
hemorrhage, the best effects are obtained by making the
application to the skin overlying the first dorsal vertebra, as
the vasomotor center controlling the vessels of the lungs is
situated at this level of the spinal cord (360).

THE EFFECTS OF HEAT UPON THE BLOOD.

561 Winternitz and many other observers have p>ointed out
the interesting fact that under the influence of hot baths the
blood count is considerably diminished, through detention of
blood cells in the viscera, as shown by Breitenstein's experi-
ments upon animals.

562 There is also observed a diminution in the percentage of
hemoglobin present in proportion to the decrease of red
blood-corpuscles. Winternitz has also pointed out the
remarkable fact that the decrease in the number of leuco-
cytes is much greater than that of the red blood-corpuscles,
while Henocque has observed an increase in the rate of
reduction of oxyhemoglobin.*"*

563 Strasser showed {Detitch, Med.-Zeit,, 1896) that gen-
eral hot applications increase the acidity of the blood by
increasing the amount of acid phosphate, often to the extent
of double the normal quantity.

THE EFFECTS OF HEAT UPON NUTRITION.

664 The stimulating effects of heat upon cell life may be eas-
ily studied under the microscope by the application of heat
to the ameba, or the white blood-corpuscle. Nothing could
be more interesting than to note the readiness with which

TUE PHYSIOLOGICAL EFFECTS OF VVATEH,

[57

cells respond to the very slightest iDCrease of tempera-
! tore. When heat is applied to the surface of the body, not
only the skin, but the entire body is to some degree excited
tbereby, both through the transmission of heat by the con-
^Kdnctivjty i^l the tissues to the internal parts, and its iranspor-
^Vtation by the blood current from the skin to the viscera* The
^1 result is an increase of the activity of the cell life of the body
^■so far as is possible without increased absorption of oxygen.
^VOidd4].tion is diminished, as is indicated by the diminished

absorplion of oxygen and exhalation of CO3. But the

I bca

increase of cell activity is nevertheless shown by the greater
amount of nitrogen eliminated, largely in the form of uric acid.

The diminution of oxidation may occur to such a degree 505

as to produce an increase of sugar in the blood, and may even

ive rise to its appearance in the urine. It is for this reason

that hot baths mast be nsed with great discretion in diabetes

and in all other maladies characterized by deficient oxidation.

That heat stimulates vital activity is clearly shown by its a66
nflnence upon the skin. A patient who has worn the moist
*ab<lomitial bandage for some time, or has been subjected to
the daily application of fomentations to some portion of tlie
body for a tew weeks, will present a mottled appearance of
the skin of tlic part to which the application has been made,
— a verj' striking illustration of the stimulating effects ol heat
upon the pigment cells- The heat from the direct rays of the
produces a similar effect, giving rise to freckles, and
the color of the complexion often to a remarkable
The same effects are likewise produced by the
lectric Kgbt, and even by the newly discovered X-ray, The
slimiilatiiig effect of the electric light upon the growth of
plants and the ripening of fruits affords further evidence that
beat and light act powerfully in stimulating vital activity.

Elevation of the body temperature above normal increases 567
oxi* ^ 1 nitrogen. This is shown by the increase of
r protcid wastes, and accounts for the rapid
wasting of the muscles during febrile dtecasc under the infiu-
cfice of high temperature.

158 RATIONAL HYDROTHERAPY.

THE EFFECTS OF HEAT UPON THE STOMACH, LIVER, AND
OTHER DIGESTIVE ORGANS.

568 It has been experimentally proved that the amount of
hydrochloric acid secreted by the peptic glands may be very
perceptibly increased by means of fomentations placed over
the stomach for an hour or two after eating. A hot water
bag may be more conveniently employed for this purpose.

569 The hot douche over the stomach and spine opposite
diminish the secretion of HCl in hyperpepsia. General hot
baths produce the same effect (Simon), perhaps from excess-
ive loss of sodium chloride in the perspiration.

570 Hot applications made over the region of the liver by
means of hot compresses or fomentations also unquestionably
increase the Sow of bile, and doubtless stimulate all the other
activities of the liver.

571 Applications of heat over the abdomen may also increase
the activity of the digestive processes in the intestines and
the functional activity of the pancreas and the spleen.

THE EFFECTS OF HEAT UPON BODY TEMPERATURE AND
HEAT PRODUCTION.

572 The immediate effect of a general application of heat to
the body is to occasion a rise of temperature; in fact, immer-
sion of the body in a bath at the body temperature will in the
course of an hour cause a rise of temperature of 1.8"^ F.,
while water at 104° F. may occasion a rise of three or four
degrees within fifteen minutes (Exp. 46, 47).

573 An interesting observation first made by Hippocrates, and
verified by all students of hydrotherapy, is that a short appli-
cation of heat to the body is followed by a lowering of the
temperature, with increased susceptibility to the influence of
cold. Modern calorimetric studies have shown that the effect
of short applications of heat to the body is to diminish heat
production, while at the same time heat elimination is encoor-

THE PHTfSIOLOGtCAL EFFECTS OF WATER.

ISO

aged, as ^hown by increased perspiration, rekxation of the
stirCace vessels, and increased activity of the heart. This is
the mtmii€ nacthn of heat.

Prolonged applications of heat always give rise to increase 574
of temp<Erature, both by diminishing heat eliniination and by
increasing heat production. Heat stimulates vital activity ;
indeed, there is perhaps no other agent capable of exerting so
reoiarkable an influence upon vital processes* By a prolonged
bath at a few degrees above the normal temperature, heat
production and heat accumulation may be so increased as to
become dangerous to hfe in a few miniites.

Even warm air increases heat production to a most remark- 675
able degree. An external temperature a few degrees above
the body temperature may increase heat production more than
300 per cent. This fact b illustrated by the prevalence of
heat-stroke, or thermic fever, during a period of hot weather,
€S|>ecjaIly in damp climates. Whatever causes a rise of the
body temperature increases heat production, at least in all
physiological conditions, although there may be exceptions in
some conditions of disease. So also whatever increases heat
elimination tends to increase heat production.

A rise of 20^ F, in external temperature occasions an ele- 576
vatiofi of 1' F* in body temperature, and a further elevation
o( 1^' lakes place for each additional rise of 20^ F,

It is not necessary in order to obtain the effects of heat 577
that the application made should be above the temperature of
the body. A bath at the exact temperature of the body will
cause a general rise of temperature (Exp. 48*)

REACTION FOLLOWING AN APPLICATION OF HEAT,

For most purposes it is doubtless tme that the reaction 678
eGTects resulting from cold are to be preferred to those from
hot a| : ' ' nfi : nevertheless, the peculiar effects obtainable
trom 1. N sometimes be found better suited to the case

in hand than those arising from cold Indeed, not infre-
qtusotly the dread of cold water on the part of the patient

i6o

RATIONAL HYDROTHERAPY.

579

is so intense as to make its use inadmissible without a course
of gradual training. In these cases, the effects obtainable
from heat are particularly serviceable, and its employment
may prevent the development of a positive idiosyncracy
against cold.

The general reaction effects produced by intense, short,
general applications of heat are as follows : —

REACTION.

1. Vasoconstriction.

2. Pallor.

3. Skin smooth, soft, and
moist.

4. Pulse frequent, tension low.

5. Respiration frequent, free,
superficial.

6. Perspiration lessened.

7. Gradual cooling of the skin.

8. Depression of internal tem-
perature from increased heat elimi-
nation and decreased heat prodnc-
tion.

g. Diminished nervous and
mental irritability, drowsiness,
and depression.

10. Muscular weakness and
indisposition to muscular effort.

From the above it will be readily apparent that the gen-
eral and usual reaction effects of heat are of an atonic or
depressant character.

580 The Neutral ^ ^^^^ which is absolutely neutral is practi-

Bath. ^^^ly impossible, for the reason that a bath

exactly at the temperature of the skin checks

the elimination of heat, and hence occasions a rise of the

ACTION.

1. Brief contraction, then dila-
tation of tlie surface blood-vessels,
especially of the small veins.

2. Slight pallor if previously
red, followed by dusky redness.

3. Sometimes goose flesh ap-
pearance and slight shivering.

4. Slowed, then quickened
high-tension pulse.

5. Respiration at first checked,
then frequent, CO^ diminished.

6. Perspiration at first checked,
then increased.

7. Heating of the skin.

8. Rise of internal tempera-
ture from diminished heat elimi-
nation.

9. General nervous excitation;
at moderate temperature, sense
of comfort and relief.

10. Increased muscular irri-
tability.

THE raVSlOLOClCAL EFFECTS UF WATER,

l6l

>dy temperature, while a bath a few degrees below the
femperattire of the body excites the temperature sense, and
thus gives rise lo increased heat production and other reflex
cflects.

The vital perturbations set up by the warm bath, how- 5** I
ever, are so slight as to be scarcely perceptible^ and the char*
acteristic effect of the bath is its calmative or quieting effect.
This result is not obtained by any depressing action, biu by
the protection afforded by the medium of water so employed
as to be absolutely un irritating, without percussion, and ol
Sijch a temperature as to shield the body from the continued
excitation resulting from the contact of the skin with the
clothing, constantly changing temperature, force of move-
ment, and various otficr disturbing influences.

As the result of this protection, the nerve centers, being
completely at rest^ are afforded an opportunity to accumulate
a store of energyt so that the warm, or so-called neutral, bath
is, after all, not really neutral in its physiological effects, but
is recuperative and energizing through promotion of the
outrttive processes, and the accumulation of force- producing
material in the nerve ceils. The irritability of the cutaneous
nerves is perhaps lessened by the imbibition of water.
THE EFFECTS OF ALTERNATE HOT AND COLO APPUCA-
TIONS TO THE SKIN.
In this fonn of application the skin is first 582
heated considerably above its normal tem-
perature, then the temperature is lowered by
the use of cold water. In alternate applications the heating
and cooling are several times repeated » The reaction
which takes place as the result of the Scotch or the alter-
nating douche may be made chiefly circulatory in character,
or both circulatory and thermic. This form of application is
Ihcrcfore a most efficient means of stimulating nutritive
cbafiges^ obtaining derivative effects, etc., and that without
creating Uiermic disturbances of any kind in the body.

The Scotch
Pcmchc.

II

1 62 RATIONAL HYDROTHERAPY.

583 Pfliiger found that a short hot bath following a cold bath
increased the reduction of temperature."

584 Vinaj based upon this observation the recommendation
to follow the cold bath employed for reducing temperature in
fever with a hot bath, continued for two or three minutes.
For further considerations respecting alternate applications,

. see paragraphs 677, 681, 1300.

GENERAL VITAL REACTIONS RESULTING FROM HYDRIC
PROCEDURES.

585 As previously intimated, the circulatory and thermic
reactions which occur from cold applications to the surface
are only two of a considerable number of distinct reactions
resulting from the cutaneous excitation occasioned by an
intense application of cold. A consideration of the efiFects of
this form of stimulation in the light of modem physiological
research, leads at once to the conclusion that the reactions
produced involve not only the nerve centers, blood-vessels, and
involuntary muscles, but every cell and tissue in the body.

686 A careful study of the effects of local application leads to
the conclusion that there are many subtle and not easily ob-
served reactions to which many of the effects of hydrotherapy
may be properly attributable. Doubtless every viscus, even
every gland and probably every individual cell has its own
mode of reacting to the powerful stimulus of thermic impres-
sions made upon the skin.

587 The profound effects produced upon the nervous S3rstem
by the application of water to the skin enables us through
this agent to influence every bodily function, for, as one has
well said, ** The nervous system dominates all the phenomena
of organic life directly or indirectly ; all depends upon it
Nothing transpires in the body of the animal without its
intervention. The cells are the artisans in the organic work-
shop, but the nerves are the overseers. *'

588 Whatever agent affects the heat-producing processes of
the body, affects, likewise, in a most pronounced degree, all
the vital processes. As Lubansky has well said: "To touch

TM£ PHirSIOLCM^IGAl. EFFECTS OF HEAT.

163

calorificatioti is, m a certain sense» to touch the springs of
eiusteiice ; and disturbance of the heat-making functions of
the body produces a corresponding disturbance in the most
jmpoTtaBt functions of the system. It is to create the neces-
sity lor repair, and to impress directly and profoundly the
general nervous system/*

» SUMMARY OF ORaANIC CHANGES FRODUCED BY HEAT
B AND COLD.

I. Elevation of body temperature is accompanied by 589
increase of metabolism,
2. A fall of temperature is accompanied by decreased
metabolic change.

3. Short cold applications cause rise of temperature and
increase of metabolism.

4. Prolonged cold applications cause fall of temperature
and dtminished metabolism.

5. Short hot applications cause fall of temperature with
diminished metabolism.

6* Prolonged hot applications cause rise of temperature
and increased metabolism, especially increased oxidation of
albuBitn.

7. No disturbance of metabolism occurs as the result of
baths at neutral temperatures, or while the body temperature

E remains nornmi
8, Strasser showed increased alkalinity of the blood after
cold baths, and diminution after hot baths.
91 Jardet has shown that the acidity of the urine is
decreased by warm baths, and may even become alkaline.
lo febrile conditions, when heat production is increased,
antipyretic applications do not lessen the heat production
unless applied in such a way as to cool the muscles and pro-
duce a diminution io the general body temperature.

The primary effect of cold applications is to increase CO,
prodoction. In the reaction period there is elevation of tem-
perature, which, it sufficiently pronounced, is accompanied
by an increased oxidation of albumin.

THE PHYSIOLOGICAL EFFECTS OF FRICTION
OR MECHANICAL IRRITATION OF THE SKIN.

M'

»90 n /I ECHANICAL irritation of the skin produces effects so
closely allied to those of hydric applications, and in
the practical employment of hydriatic measures is so
constantly and so intimately associated with the use of water,
that it is proper to devote a few paragraphs to the considera-
tion of the physiological effects of this powerful means of
vasomotor excitation, which may be properly classed as me-
chanical rather than chemical or thermic stimuli.

The forms of mechanical stimulation especially utilized in
hydrotherapy are friction and percussion.
^®^ Pri ^^^^ procedure consists in rubbing the surface

of the body with the bare hand, or with the
hand reinforced by a mitt, glove, or towel, either dry or
moistened with water at any desired temperature. Percus-
sion may be applied by the hand, usually in connection with
friction, but this mechanical effect is usually obtained in con-
nection with water in the different forms of the douche.

The effects of friction and percussion are
Effects. essentially the same, the magnitude and the

intensity of the effect depending upon the
force employed and the duration of the application. The
effects of percussion as connected with the douche will be
described elsewhere (1015). The physiological effects of fric-
tion have been carefully studied by Naumann (1867), Roh-
rig (1873), Winternitz, and other eminent investigators.
Three grades or degrees of friction are recognized; namely,
*' light," ** energetic," and **very vigorous." Briefly sum-
marized, their effects may be described as follows : —
592 I. Light Friction. — Light centripetal friction applied to

the surface accelerates the circulation, causing rise of blood
164

PHYSIOLOGICAL EFFECTS OF FRICTION.

165

presmire, increases the force and frequency of the pulse, and
lessens the frequency of respiration.

Very light friction continued for some time gives rise to
contraction of the small blood-vessels, which may persist for
several hours. There is also a slight rise of temperature,
doe to a small increase of heat production and a slight ditni-
Qution of heat elimination.

2, Entrgfti€ friction causes first very marked contraction 593
of the blood-vessels, which is quickly followed by dilatation
of the vessels, arteries, veins, capillaries, and lymphatics,
with great acceleration of the blood current.

The increase of heat elimination reduces the temperature
feral tenths of a degree.

J, V€ry vigorous friciion, or violent irritation of the 5f)4
"sBb, produces almost instant and very marked dilatation of
cutaneous vessels, the preliminary period of contraction

ag so brief as be practicaHy imperceptible*

The heart's action is slowed, as is also the respiration.

Heat diminalion is increased nearly fifty per cent {Win-
temtlz, Pcispischil), and the temperature may fall as much
as 1^ or 2^ F* (Mantegai^)*

Examination of the products of respiration show marked
of CO3 (Pfltiger), which would indicate increased
prcMJuction, notwithstanding the lowered temperature,
sbovring that the increase of heat elimination is much greater
in proportion than that of heat production.

There is, also, according to Pfltiger, a marked increase in
the production of urea» showing that there is a general in-
crease ol catabolism, since both nitrogenous and carbona-
ceotts lA^stes are augmented.

Ver>' violent friction or irritation produces marked weak-
ness of the heart, dyspnea, and in rabbits, albumin in the
urtne ' tstcin), in which again we see an effect identical

\\l.^^ -.ii.*:h follows an excessively severe cold application.

All the functions of the skin are stimulated by friction.
Under its application a dry skin becomes moist and oily.

1 66 RATIONAL HYDROTHERAPY.

through the increased activity of the perspiratory and seba-
ceous glands. It is also a common observation that friction
promotes the development of hair upon the parts to which it
is applied. Weyrich and Wintemitz have shown that by the
application of friction to the skin, the amount of moistare
thrown off may be increased more than fifty per cent. Under
the influence of friction the temperature of the skin is raised
to a very marked degree, through dilatation of the surface
vessels, which brings an increased amount of blood to the
surface. This is, of course, the cause of the increased heat
dissipation under the influence of friction. This fact explains
the interesting observation of Wintemitz, that friction of the
patient in the cold bath very greatly increases its tempera-
ture-lowering power. In experiments made by the writer, a
rise of surface temperature amounting to 2^ F. has been
observed as a result of friction of the skin of a healthy person
(Exp. 49). This would represent an increase of heat elimina-
tion of at least eight per cent. In a person with a cold skin
the increase may be sixty or even seventy-five per cent.

The mechanical effects of friction vary with its direction.
When the friction is applied in the direction of the blood cur-
rent in the veins (centripetal friction), the movement of blood
toward the heart is accelerated, and thus the activities of
the part are increased. The circulation of lymph is also
encouraged, there is an increase in the rapidity of the vital
exchanges, and a promotion of all the metabolic processes.

On the other hand, friction made in the direction opposite
to that in which the blood moves in the veins (centrifugal
friction) slows the circulation, diminishes metabolic activity,
and thus produces a sedative effect.

The foregoing facts demonstrate most clearly the potency
of mechanical irritation as a means of vasomotor stimulation,
and through this powerful influence upon one of the most
vital functions of organic life, its importance as a rational
therapeutic procedure. The practical application of the prin-
ciples thus set forth will be dwelt upon elsewhere (1209).

PHYSIOLOGICAI- EFFECTS OF FRICTION.

167

[keraiosFft p blsm •

The pheaomenon to which the term ''dermo-
"" graphism ** is applied is closely allied to orlica-
ria* Pressure made upon the skin, as in drawing a line with
the tip of the finger or the end of a lead-pencil, ordinarily
prodoces but a very slight effect, merely a temporary pallor,
qttickly followed by a barely perceptible redness of the skin.
Id certaiQ persons, however, a simple stroke with the finger
tip produc€!S a raised white or rose-colored area correspond-
iog 10 Ihe surface touched.

Permo^aphism indicates a disordered state of the vaso-
motor nerves or nerve centers. These structures are affected
fcby some poisonous substance, received from without or pro-
f duced in tbe alimentary cana], and in such a manner that the
^vessels have lost their tone, or are unable to maintain their
!ioniial equilibrium. Demographism also aSords information
cting the condition of the nervous system in general. It
ites that there exists in the body of the patient some
toxic agent against which the nervous system has ceased to
I able to defend itself.
This curious symptom is most often present in certain
hfomts of iieuiastheoia, especially gastnc neurasthenia, in hys-
Iteria, diabetes, rheumatism, stomach dilatation, and gastro^
intestinal fenneutations.^

This test is one of the means whereby the physician may
judge ol the susceptibility of his patient to hydric applica-
tiocuk The test should be applied to eacli patient received
for treatment as a means of determining his power of reac-
ikm to mechanical stimulation* Persistejit spasm of the ves-
zls, as shown by pallor remaining for some minutes, indicates
abnormal irritability of the vasomotor nerves or of the
ganglia of the small vessels. A quickly appearing
and prutonged redness indicates that tbe vessels lose their
>ne with abnormal readiness. All these facts should be
and considered in the hydriatic treatment of invalids.

595

THE PHYSIOLOGICAL EFFECTS OF LIGHT.

T

596 ^ I ^HE therapeutic use of light is so closely associated with
hydriatry that it seems proper to make here a brief
statement of the physiological effects of this powerful
agent, which, though in use from ancient times, has never
been scientifically studied until within recent years. Limited
space will, however, permit nothing more than an exceed-
ingly brief summary of the important fundamental facts bear-
ing upon this subject.

Considered from the standpoint of physics, light is not a
force, but a mode of motion, — a movement of the ether par-
ticles resulting from the energy set free by the sun or some
other incandescent body. For a minute study of the physical
properties of light, and for purposes of spectrum analysis, and
in the study of the physiology of vision, light is considered as
being composed of three primary colors, — red, green, and
violet; but in a study of the question from a therapeutic
basis, another classification of the nature of the sun's rays
is more practical and useful. Thus, the sun's rays may be
divided into three classes; viz., Jicat rays, luminous rays,
and actinic, or chemical, rays. The whole gamut of li^ht rays,
if considered analogous to the musical scale for the purpose
of comparison, is found to extend through about four octaves,
of which the luminous rays occupy as much space as
would be represented by the interval of the sixth in music.
Two of the four octaves are found below the luminous rays,
and another octave above. The heat rays occupy the lower
two octaves, and include also the red and ultrared, while the
chemical rays include the violet, the ultraviolet, and the
upper octave of non-luminous rays.

Of these three classes of rays, the heat rays and the
chemical rays are those of special interest in therapeutics.
The heat rays while in the form of radiant energy passing
l68

) •■

PHYSIOLOGICAL EFFECTS OF LIGHT.

i69

through space do not manifest heat, but when they come in
contact with objects which offer resistance to their passage, —
in other words, objects opaque to heat rays, — they are trans-
formed into heat, and the temperature of the opaque object
is raised. So likewise the actinic, or chemical, rays manifest
their special properties only when they come in contact with
substances in which they are capable of setting up molecular
changes, the radiant energy being then transformed into
chemical enei^.

It has long been known that the three sets of rays may
be separated by the employment of glass of different colors.
Red glass, for example, gives passage to rays which are
almost wholly thermal in character, while blue or violet
glass allows only the chemical, or actinic, rays to pass through
it. Yellow and green glass, on the other hand, while trans-
parent to the luminous rays, permit also the passage through
of a few of the thermal and actinic rays.

The art of photography illustrates the action of the chem-
ical ray upon various chemical substances. Its action may
also be observed in the coloration of flowers and leaves and
other phenomena in the animal and vegetable world. One of
the most interesting illustrations of the action of the actinic
ray upon animals is to be observed in the curious phenom-
enon known as '* sunburn." That this is not really a burn,
but erythema due to the noxious action of the actinic rays, is
shown, first, by the fact that the swelling, redness, and pain
do not appear until several hours after exposure to the
sun's rays; and secondly, by the fact that exposure of the
skin to light from which the actinic rays have been separated,
but which present the heat rays in all their original intensity,
prevents entirely the ordinary effects of the intense rays of
the sun upon nude surfaces unaccustomed to such exposure.
The term ** solar erythema" is preferable to the expression
'* sunburn."

Within the last few years numerous experiments have
been made by Arloing, d'Arsonval, Geislcr, and others, for

■■V'^

11

697

f V

I70 RATIONAL HYDROTHERAPY.

the purpose of determining the influence of different classes
of rays — luminous, thermal, and actinic — upon microbic
life. Investigations have shown that the chemical rays —
violet and ultraviolet — are unfavorable to the growth of
bacteria, at least such pathogenic bacteria as the bacillos
anthracis, the bacillus pyocyaneus, and the typhoid bacillus.
Graber showed that the earthworm, which habitually hides
itself away from the light, behaves toward a red light as
toward absolute darkness, while the violet and ultraviolet have
the same effect upon it as ordinary light. Experiments made
by Paul Bert, Du Bois, and others have given similar results.
The influence of light in producing pigmentation of the
skin in human beings is a matter of common observation.
Solar erythema, or so-called sunburn, is always followed
by a deepened color of the skin; after this pigmentation
has taken place, the surface involved is less subject to sun-
burn, and may be wholly protected so long as this deepened
color is retained. This process in the skin may accordingly
be looked upon as a protective action for the purpose of pre-
serving the deeper and more important structures of the
body from injury through the noxious influence of the chem-
ical rays. Negroes and other dark-skinned races are not
subject to solar erythema, their skins having by long resi-
dence in a hot climate, and through the action of heredity,
acquired a natural protection against the chemical ray. We
are doubtless unaware how much our ordinary life depends
upon the action of the thermal and actinic rays of the sun,
especially the latter. The fact that an excessive action of the
chemical rays gives rise to an acute inflammatory process in
the superficial layers of the skin, is sufficient evidence of its
powerful influence upon animal life. *In conditions of disease
persons have been found so sensitive that exposure to even
the diffused light of day was sufficient to give rise to a marked
erythema of the face.
598 A most remarkable and interesting fact, first pointed out by
Picton in 1832, and more recently studied by Black and Barlow

PHYSIOLOGICAL EFFECTS OF LIGHT.

171

III England, Undholm of Norway, and Finsen of Copenhagen,
is the Q03dous mfluence of the actinic ray in smallpox. It
has been found Ihat if the chemical rays are excluded by
hanging thick red curtains before the windows of the sick*
rootn daring the suppurative sta^e of the eruption and the con-
sequent seeoodary fever, ulcerabon may be almost uniformly
averted. Finsen has within the last half dozen years under-
taken an extensive series of observations for the purpose
q( stndjifig more accurately the physiological effect of the
actinic ray, making numerous experiments upon flies, worms,
embryos, ^nd other forms of animal life. These experiments
haiie demonstrated very clearly that the chemical ray is an
e»citaiit o{ the nenous system ; and that under ordinary cir-
omistajices it may be considered as one of the most impor-
tant promoters of animal life and energy* The importance
of the thermic influences derived from heat rays need not
be emphasised, as this has long been well known and appre-
ciated; bat the fact that the actinic ray is a direct stimulant
of the (unctions of animal and vegetable life, and thus a
means ol supporting vital energy in all its forms, is a discovery
of the highest importance, and one which will doubtless
IJTove of great utility in the future To the chemical rays
ratlier than to the thermic rays must in all probability be
attributed the greater part of the wonderful results which
fcave long been recognised as following the proper employ-
ment of the sun bath, or so-called insolation.

Upon the discovery of the electric light and practical 699
methods of producing it, numerous experiments were under-
taken for the purpose of ascertaining whether this excellent
artificial substitute for sunlight possessed the property of
stimulating the vital processes of plant life in a manner
analogous to the action of sunlight. An interesting paper by
Wm^ Siemens, published in March, 1S80, contained a detailed
accoont of experiments made tor the purpose of determining
the influence of the electric hght upon vegetation, with the
fcXkming conclusions: —

172 RATIONAL HYDROTHERAPY.

1. That the electric light is efficacious in producing
chlorophyl in the leaves of plants and in promoting growth.

2. That an electric center of light equal to 1,400 candles,
placed at a distance of two meters from growing plants,
appeared to be equal in effect to average daylight at this
season of the year (March), but that more economical effects
may be attained by more powerful light centers.

3. That the carbonic acid and nitrogenous compounds
generated in diminutive quantities in the electric arc, produce
no sensible deleterious effects upon plants enclosed in the
same space.

4. That plants do not appear to require a period of rest
during the twenty-four hours of the day, but make increased
and vigorous progress if subjected during the daytime to sun-
light, and during the night to electric light.

5. That the radiation of heat from powerful electric arcs
can be made available to counteract the effect of night frosts,
and is likely to promote the setting and ripening of fruit in
the open air.

6. That while under the influence of the electric light,
plants can sustain increased stove heat without collapsing, —
a circumstance favorable to forcing by electric light, and
showing the influence of light as a vital stimulant.

Similar experiments have been made by others, the pioneer
in this line of investigation being Herve-Mangon (Compt.
Rend. 53, 243). These experiments showed that the electric
light is capable of causing the development of chlorophyl and
inducing heliotropism, or the phenomenon of turning or bend-
ing toward the light.

Prillieux (Compt. Rend. 69, 410) showed that the electric
light is capable of promoting assimilation in plants, or decom-
position of carbon dioxide and water.

Siemens found that plants exposed to ordinary daylight
and six hours of electric light in addition ** far surpassed the
others in darkness of green and vigorous appearance gen-
erally." Strawberries and other fruits were fully equal to

w\

PHYSIOLOGICAL EFFECTS OF LIGHT.

173

those raised under ordinary conditions, and grapes were of
stronger flavor than usual. Melons were remarkably large
and aromatic, and bananas were pronounced by expert
judges to be ** unsurpassed in flavor."

Many of these experiments have been repeated in this
country with similar results. The most important experi-
ments were those conducted at the Cornell University Agri-
cultural Station in 1889-90. The results obtained showed
dearly —

1. That the electric light may be used under such condi-
tions as to make it fairly comparable to sunlight in its power
to promote protoplasmic activity.

2. That the electric light acts as a tonic to plants, so that
they are able to endure adverse conditions which otherwise
would cause them to collapse.

3. That the electric light is a true vital stimulus, since the
effect of its use at night, upon plants, is essentially the same
as that of the longer day of the Arctics upon plants growing
in that region.

De Fontaine, in an article in Semaine Medicate, 1888,
entitled ''Coup de Soleil l&lectrique,*' gives an interesting
account of the results of exposure to a powerful electric
li^ht, undertaken for experimental purposes by a physician,
.M. Maklakow, surgeon to a large factory near Moscow, in
which the electric arc is employed in soldering metals. The
first symptoms felt were tingling of the skin ; a few moments
later, pronounced coryza and lachrymation, the eyes being
swollen so that they could not be opened. There was marked
photophobia, and a sensation of burning heat upon the right
side of the face and neck. After a short sleep, the experi-
menter awoke with all his symptoms aggravated. By evening
of the same day the face had become brick-red in appearance,
was very much swollen; there was marked chemosis of the
conjunctiva, and all parts which had been exposed to the light
were greatly inflamed, the investigator sufifering much during
the entire night. An interesting fact noted was that while the

1 5

m

RATIONAL HYDROTHERAPY-

tiOO

174

whole conjunctiva covering the ball of the eye was iateosely
inflamed, the mucous lining of the lids was not at all affected,
evidently because not directly exposed to the light rays. The
following day the erythema increased, becoming edematous,
hot, dry, and painful to the touch. The night of the second day
the symptoms began to abate considerably, and toward night of
the following day the epidermis began to separate, and a few
days later desquamation of the skin took place in lai^e scales,
as after scarlet fever. The pigmentation of the skin remained
for some time after the acute symptoms had disappemred
The amount of heat to which the individual was subjected in
this experiment was not sufficient to occasion any inconve-
nience, and the painful symptoms did not appear until some
bonis after the exposure.

This experiment proves veiy clearly not only that the
noxious effects of light are due to the chemical rays, but that
the electric light is capable of producing results identical with
those produced by the sun*s rays.

According to Dolbear, the earth receives in the form of
sunlight about one -fourth horse-power for each square foot
of its surface, or about one forty-thousandth of the amount of
energy thrown off by the sun from each square foot of its
surface. The ordinary electric arc light presents an intense
radiating surface having an area a little less than one tenth
of an inch square. The temperature of this radiating surface
is more than 6,000^-' F. If this area could be increased so as
to present a square foot of surface^ the amount of energy
would be practically the same as that emitted from an equal
area of the surface of the sun. It thus appears that the elec-
tric arc light is an exceedingly efficient source of light, and
that it may be used as a substitute for sunlight, over which it
enjoys the advantage of being more easily controlled and
manipulated, and always available.

The influence of sunlight upon the vital processes has
been recognized from the most ancient times. The old
Greeks and Romans employed the sun bath, ur tnsola-

PHYSlOLCfcGICAL EFFECTS OF LIGHT,

T75

irery frequently in the treatment of chronic maladies
all sorts. The natives of the South Sea Islands and
et primitive peoples still utilize this powerful agent in
treatment of the sick. The natives of the ferrt caiiente
Mexico have long practiced exposure to the sunlight on the
$ea-beach, partially covered with sand, as a means of treat-
ment for S3rphilis, the patients thas treated heing made to
drrnk large quantities of infusions of leaves of various sorts
whik exposed to the sun. The natives of Haiti are said by
M. Delow to employ similar practices.

All physicians place the highest value apon exposure to

the son by an out*of-door life as a means of stimulating the

nutritive proc^ses of the body in many chronic disorders, as

anemia, clilorosts* tuberculosis, in convalescence from fevers,

and other similar conditions* The value of the sun bath as a

therapeutic measure will be readily appreciated by noting the

facts respecting its remarkable physiological influence, which

' f be very largely attributed to the actinic ray, although a

^..iic of it Tnust be attribated to the calorific effect of the

's ray's. But though its value has been so long and so

ly recognized, the various practical difficulties in the

y of otiHjting the sun's rays for therapeutic 'purposes, and

the great uncertainty of sunshine in the larger part of this

and other civilized countries, have been so great obstacles

that iiltle use has thus far been made of this powerful agent,

even in institutions kigely devoted to the use of physiological

laeasures*

tThe atithor has made more or less use of the sun bath
tog the twenty-five years in which he has been engaged in
Itutional medical work, but the difficulties encountered,
g ago led him to the study of the electric light as a substi-
tute for sunlight. The most definite and practical e.\peri-
mcots along this line were begun by him about ten years ago*
In a paper read before the American Elect rot herapeutic
Association at its meeting in New York City, in September,
1894, he presented a description of a new method of apply-

61)1

1/6 RATIONAL HYDROTHERAPY.

ing heat to the body, in which the incandescent electric light
was utilized as the source of heat. This paper gave the
details of many experiments which had been conducted for
the purpose of determining the physiological effects of this
bath, and also a comparison of the effects obtained by this
bath with those obtained by the Turkish and Russian baths.
The general conclusions resulting from his investigations were
as follows: —

1. The electric-light bath stimulates the elimination of
CO 2 in a very marked degree. In an electric-light bath last-
ing 30 minutes, the percentage of CO 2 elimination during the
last ten minutes was 5.13 as compared with 3.60, the aver-
age of CO 2 elimination before the bath. In a Russian bath
the percentage of elimination was 3.96. In a Turkish bath
of 30 minutes' duration, the percentage of CO, elimination
was 4.01, while the elimination of urea was diminished.

2. The elimination of nitrogenous wastes represented by
urea, and also the elimination of total solids, was greatest in
the Russian bath, and least in the electric-light bath.

3. The amount of perspiration produced by the electric-
light bath was fully double that induced by the Turkish bath
in the same length of time. The time required for the first
appearance of perspiration was, in the electric-light bath,
about one half the time of that in the Turkish and Rus-
sian baths. The reason for this is apparent when one recalls
the fact observed by Bouchard, that perspiration begins when
the temperature of the blood has risen .7^ F. above the nor-
mal. In the study of the physiological effects of the electric-
light bath in 1891, when the author made his first experi-
ments upon this subject, he found the internal temperature
was raised by the bath 1.6^-' F. in five and one-half minutes,
the surface temperature rising, in the same time, 2.3° F.

602 From these facts it is evident that the electric-light bath
raises the temperature of the blood more quickly than any
other form of bath. The reason for this is apparent when it
is remembered that the skin and other structures of the body

PHYSIOLOGICAL EFFECTS OF LIGHT.

177

readily permit the transmission of the radiant energy of the
^ectric light, which, entering the body as Ught, becomes, by
the resistance which it meets, transformed into heat. Thus
heat is developed in the deeper tissues instead of being slowly
carried in by conduction from the surface. The skin is, Uke
glass, a poor conductor, but at the same time allows the
passage of radiant energy in the form of light. This fact
explains the readiness with which perspiration is induced by
the electric-light bath.

Prior to the author's experiments upon this subject, there
had been no scientific study of the physiological effects of the
incandescent electric-light bath upon human beings. He had
constructed, as early as 1891, various experimental forms of
baths, which he has gradually perfected. Some of these
admit the whole body in a sitting posture, others lying down.
Some are adapted to the application of heat to a circum-
scribed portion of the body, as the trunk, the feet, or the
spine. The photo-reproductions show the principal forms of
the bath in use at the present time. These baths are now
employed in various places in this country and in foreign
lands. Fig. 133-138 (P- 707, 708).

The electric-light bath has been received into special 603
fa\ or in Germany. Professor Winternitz, the greatest living
authority on hydrotherapy, speaks as follows respecting it in
his recently published treatise, ** Physiologische Grundlagen
der Hydrotherapie : " —

'* The electric-light bath is a method of recent origin, and
equal to the sun bath. It was at first employed empirically.
[Only the arc light was thus employed, and in the most ineffi-
cient and unscientific manner.] Dr. Kellogg (Battle Creek,
Mich., U. S. A.) has constructed one for the entire body as
well lis for the separate parts thereof, various-shaped cabinets
which are supplied with mirrors internally and a great number
of electric lights.

'* It has been undoubtedly demonstrated that radiant heat
penetrates the tissues much better than conducted heat, and

ir

ftAtWlTM. IWT>ROTHERAPy

178

it is quite probable that cellular activity is powerfully modified
by these rays of heat (either qualitatively or quantitatively).
The effects of the vapor bath can be brought about in the
cabinet, and the differences thus far determined are the
following:^ —

**Thc giving off of the CO3 is more abundant than in the
vapor bath, and what is especially noteworthy is that the per-
spiration appears very soon and at a very low temperattire, and
is very profuse. We notice the earlier appearance at 95'^ F,
(Kellogg averaging 85^ F.), while in the vapor bath a much
higher temperature is generally required to produce the same
effect- The time at which perspiration in the electric-light bath
appeared averaged three and one-half minutes, while in the
vapor bath almost five minutes was required. Finally, the
quantity of perspiration in the electric-light bath is consider-
ably larger That the rays of heat here play the most
important part, and that it is not on accotmt of the tempera-
ture of the air in the cabinet, is further shown, for instance,
by the fact that the external surfaces of the thighs, which were
directly opposed to the light, perspired much more rapidly
and profusely than the inner surfaces, which received only re-
flected rays. Within ten to thirty minutes, the temperature
reached 104"^ F., pulse 160, respiration 42* with symptoms of
fever-like condition. We have, thus far, employed the electric-
light bath like the vapor bath in only a few disorders, such
as chlorosis, chronic rheumatism, and goot, and have ob-
tained satisfactory results. More extensive experience is
wanted. Kellogg reports very favorable results in the treat-
ment of chlorosis, gout, and a number of cases in which there
is need of increased metabolism. I^hmann reports regar«ling
psoriasis*

**As we now possess a thermic method in the electric-
light bath by means of which we are able to measure the
uxact dose, and knowing the powerful influence on cell life
and the entire organism, we believe this method of thennic
application should receive an important place. It enables us

PHYSIOLOGICAL EFFECTS OF LIGHT. 1 79

to influence a number of maladies much more rapidly, better,
and more intensely than we have heretofore been able
to do/'

The skin, as well as the air, is to a large extent trans- 604
parent to light, and the same is true of all the living tissues.
This is evidenced by the phenomenon of trans-illumination.
By a speculum placed in the vagina or rectum, and a suitably
arranged electric light of 16 or 32 candle-power placed
over the abdomen, one may see the interior of the pelvis
illuminated and glowing with a bright red light, the red color
being due to reflection from the red corpuscles of the blood.
Even the bones when in a living state are translucent to light.
This is clearly shown by placing the hand between an electric
%ht and the eyes, with the fingers in close contact. The
hand being placed near enough to the light, the whole of
each finger will be seen to be illuminated by the light, and
Dot simply the soft part. Light penetrates the body in the
same manner as it penetrates any other transparent or trans-
locent medium.

That the actinic ray penetrates the body to a considerable
depth is readily shown by the following experiment: —

The hand is placed over a piece of sensitive film, such as
is used by photographers, the opaque object being placed
between the hand and the paper, and exposure made in such
a manner that the lif^ht which reaches the sensitive tissue
must pass through the hand. The fact that the chemical
rays are transmitted is shown by their action upon the sensi-
tive paper beneath the hand, and the complete absence of
their action upon the surface protected by the opaque object
placed between the hand and the paper.

In case of the water bath, the Turkish bath, the vapor
and hot-air baths, heat reaches the interior of the body by
conduction, passing through successive layers of living tissue,
which, while affording great resistance to the conduction of
heat, readily allow the passage of the luminous rays from the
incandescent film.

l8o RATIONAL HYDROTHERAPY.

The electric-light bath does not depend for its effect upon the
heat of the air surrounding the patient, but upon the radiant
energy which passes in straight lines from the incandescent
filament into the patient's body without heating the air, the air
about the patient being of the ordinary temperature; just as a
person standing before a log lire, out of doors on a frosty
night may expose one side of his body to intense heat, while
the other is chilled by the zero atmosphere which sur-
rounds him.

The incandescent-light bath enjoys a great advantage over
other methods of applying heat in that it produces strong
tonic effects at the same time that it encourages powerful
elimination.
605 The electric arc-light bath has been used more or less
both in this country and in France, but its physiological
effects have not thus far been accurately ascertained. The
author is at the present time engaged in a series of studies
of this subject, the results of which, it is hoped, will place
the use of this form of bath upon a sound scientific basis.
The apparatus employed is described elsewhere in this work
(1251).

The technique of the incandescent electric-light bath and
of the electric arc-light bath will be found in the section de-
voted to the technique of hydric applications.

Tart Tvcax.

THE GENERAL PRINCIPLES OF HYDRIATICS

B

EFORE entering upon the consideration of hydrothera-
peutics proper, it will be profitable to review briefly
the physiological effects of hydric applications.

SUMMARY OP THE PHYSIOLOQICAL EFFECTS OF
COLD APPLICATIONS.

I . Cold is primarily depressant or sedative in 606
Oeoeral Effects, its effects, lowering the temperature and less-
ening vital activity (257, 261, 267, 268).

2. A secondary excitant effect follows a short cold appli-
cation, as the result of the reaction of the body against the
depressing influence of cold; hence the practical result of a
short cold application is exciting (269, 273).

3. Short cold applications cause contraction of the small
vessels both of the skin and of the internal organs, quic kly
followed, however, by active dilatation, the internal dilata-
tion occurring almost instantaneously, the external later.

4. A prolonged moderately cold application to the skin
(65 to 80^) causes prolonged contraction of the vessels of
the internal part in reflex relation therewith (274*).
Effects upon J- General cold applications first diminish,
the Skin. then increase, the perspiration (287, 289).

2. Cold applications cause first pallor from spasm of the
smaller arteries, veins, and capillaries of the skin, later (with
reaction) flushing from active dilatation of the vessels.

3. Cold causes contraction of both the muscular and the
connective tissues of the skin.

4. Prolonged very cold applications to the skin lessen its
sensibility and diminish reflex effects (293-296).

181

«

i V

1 82 RATIONAL HYDROTHERAPY.

5. The mucous membrane, though less sensitive, reacts to
cold in essentially the same manner as does the skin (313),
both local and general effects resulting.

I . General cold applications first quicken, then

E ects upon ^j^^ ^^^ heart-beat, increase tension, and cause
the Circulation. ' ,, ^

active dilatation of the small vessels (298).

2. Cold applied to one hand causes contraction of the
vessels of the other hand. Similar relations exist between
other symmetrically related organs (303, 4f21).

3. Cold applied over an arterial trunk causes contraction
of its distal branches (307).

4. A continuous cold application over the heart depresses
its action, and lowers arterial tension.

5. Short cold applications over the heart at first increase
its activity and force, then lessen the pulse-rate and raise the
arterial tension (309).

6. Short cold applications to a limited area of any ]x>rtion
of the body temporarily increase the pulse-rate (312).

7. A compensatory effect sometimes appears in increased
heat production. A thermometer placed in the axilla shows
increase of temperature when the elbow is held in water at
50^ F. for some time (305).

I . A general cold douche causes quick, gasp-
Effects upon
Respiration. ^"8 respiration.

2. A non-percutient cold application causes
deepened and slowed respiratory movements (318, 319).

3. Oxidation of the tissues is increased by cold applica-
tions, and the amount of CO^ in the expired air is correspond-
ingly increased (322).

4. An atmospheric temperature of 40^ F., or below,

causes increase of heat production and CO2 elimination

when the body is so* exposed as to cause shivering.

I. Prolonged cold applications decrease mus-
Effects upon , . . , ...^ , ,ort^\

the Muscle*. ^"'^^ irritability and energy (327).

2. A short cold application, general or local,

increases the excitability and capacity of striated muscles.

THE OENBRAL PKINCIPLES OF MYDRIATICS.

1^3

y Cold applications excite the smooth muscular fibers,
as those of the skin, blood-vessels, bladder, bowels, etc.
(328^

4. Cold applications to a relatively small area, as the
skin ol the back or the feet, may cause general pallor, goose-
flesh appearance, and shivering (330)*

1- Cold applied to a nerve imnk paralyzes

^!^;^ the parts supplied by it (335).

Sysimi. ^* Cold diminishes the rate of transmission

ol nerve impulses (336).

3. Prolonged very cold applications to the head diminish

mental activity, and may produce unconsciousness, while

short apphcatiuns are in a high degree excitant to the brain

I {my

I. Shorty very cold applications, vdth high
vfCotd Atn>ir< pressure, to a reSex area, cause vasodilata-
tion in the related viscera (372) »

2. Prolonged non-percutient cold applica-
is produce internal vasqconstrictioti (372).
J, Short applications to the face and neck stimulate the
ircnlaiian and activity of the brain (373)t

4- A diorlt very cold douche to the chest first excites,
ben slows, the pulse (355)^

|. Prolonged immersion of the hands in cold water causes
cootraction of the vessels of the brain and of the nasal
>tts membrane (356).

6, Short, very cold applications to the hands cause con
action of the uterine muscles (358).

7, A short, verj* cold douche to the feet, with strong pres-
re, dtl ' vessels of the uterus (359).

8, Ii: u of the legs in cold water causes contract
of the Vessels of the lungs and the kidneys.

g. Short cold applications to tlie mammae pve rise to vig-
cOT^' ' n of the muscles of the uterus. This simple
ire I I utilized ior this purpose in obstetrics.

1 84 RATIONAL HYDROTHERAPY.

10. Short, very cold applications to the abdomen, the
hands, and the feet cause contraction of the muscles of the
bladder, bowels, and uterus (358).

11. Prolonged applications of cold to the upper dorsal
region cause contraction of the vessels of the nasal macons
membrane and of the lungs (360).

12. An ice-bag to the dorsal region causes contraction of
the vessels of the stomach.

13. A cold lumbar douche at moderate pressure (duration
from 15 to 45 sec.) causes contraction of the uterine vessels
(364).

14. A very short, cold douche to the lumbar region (dura-
tion from 2 to 4 sec.)> with strong pressure, causes dilatation
of the uterine vessels (365).

15. A short cold douche to the thighs causes dilatation of
the vessels of the uterus (366).

16. A short cold douche to the lower portion of the ster-
num causes increased activity of the kidneys (368).

17. Short cold applications, with strong pressure* over the
stomach, liver, spleen, and bowels, cause first contraction, then
active dilatation, of the vessels of these organs (369).

18. Prolonged cold applications over an internal organ,

without pressure, produce contraction of its blood-vessels

(370).

I . The reaction following: cold applications in-
The Blood. . u f 1 • • w

creases the number of corpuscles m circulation.

2. Cold applications increase the amount

of oxygen absorbed by the blood, and the rate of oxidation,

the result of which is increased reduction of oxyhemoglobin

(385.387).

I. General cold applications increase absorp-
Effects upon tion from the alimentary canal (388).
Secr«tton^"iind ^' Short general and more prolonged Iocs

Nutrition. cold applications increase the activity of th

glands of the stomach, liver, kidneys, ar
other secreting viscera (390).

THE GENERAL PRINCIPLES OF HYDRIATICS.

I8s

Effects upon
\iiliiial tlest
■ad Tempera-
ture.

3. Short general cold applications to the skin cause a
quickening of all the vital functions, hastening the blood and
lymph currents, stimulating assimilation and disintegration,
and augmenting vital resistance.

I. General cold applications diminish the tem-
perature of the skin and the general tempera-
ture.

2. A cold spray to the soles of the feet
produces sUght lowering of the general tem-
perature (425).

3. Cold applications to the head lower the temperature
by depressing the thermogenic centers.

4. Cold applications to the surface increase the thermo-
elcctrical phenomena (428).

5. Short cold applications stimulate heat production
(416).

6. Prolonged cold applications at first 'increase, then
decrease, heat production (411-418).

7. General shivering under an application of cold is an
evidence of lowered internal temperature and the beginning of
increased heat production.

8. Circulatory reaction is produced by the reflex influence
of cold applications upon the vasomotor centers and perhaps
also by direct action upon the visceral sympathetic ganglia
of the blood-vessels.

9. Cold applications produce thermic reaction by lowering
the temp>erature of the skin and of the blood.

I

t ,,.

SUMMARY OF THE EFFECTS OF HOT APPLICATIONS.

Water is said to be warm at a temperature of 92'^ to 98^ 607
F., hot at 98'^ to 104^ F. , and very hot at 104^ F. or above.
I. Heat is primarily an excitant. It is,
indeed, one of the most powerful of all vital
stimulants. It increases vital activity, ele-
vates the temperature, and excites the brain and nerve
centers (492, 564, 566).

■■]■

Oenerai
Effects.

%

1 86 RATIONAL HYDROTHERAPY.

2. The secondary effect of heat is depressant througli
atonic reaction. The temperature is lowered through reflex
action, which produces lessened heat production and increased
heat elimination, with generally diminished tissue activity.
Long-continued applications of heat increase heat production.

3. Short hot applications to the surface cause passive
dilatation of the small vessels (venules) of the skin, with
strong revulsive effects upon the internal parts (516).

4. Prolonged hot applications may give rise to mixed

effects of excitation and exhaustion, either of which may

predominate.

_ I. Contraction of the yellow elastic tissue,

Effects upon , . , , . \.,

the Skin. relaxation of the white fibrous tissue.

2. Goose-flesh appearance from contrac-
tion of the smooth muscle fibers (496).

3. Reddening of the skin, or, if suddenly applied at a
temperature of from 1 10^ to 130^ F., brief pallor, from strong
stimulation of the vasoconstrictors, followed by reddening of
the skin due to dilatation of the small veins.

4. Contraction of the vessels of the skin with pallor after
the heat is withdrawn, when the application Jias been pro-
longed (498).

5. Increased perspiratory and respiratory activity (503).

6. Increase of tactile sensibility at 98^, decrease at 113^,
extinction at 130^.

7. Increased heat elimination from the skin (a) through
dilatation of the surface vessels, (/;) increase of the flow of
blood through the skin, (/) increased evaporation of moisture
from the surface, and (t/) increased conductivity of the skin
(508).

8. Heat prepares the skin for cold applications (610).

I. A general application of heat first slows,
the Circulation. ^'^^" quickens the pulse. Pulse rate and tension
diminish when free perspiration begins (514).
2. Very hot applications (115-^ F. and upwards) cause
slight contraction of the small vessels of the skin, soon fol-
lowed by relaxation. Warm and hot applications cause dila-

THE GENERAL PRINCIPLES OF HYDRIATICS. 1 87

tation of the surface vessels, especially of the small veins.

3. Hot applications raise blood pressure when accompan-
ied by friction, percussion, or other mechanical effects.
^Xl^cts ^' ^ general application of moist heat (air or
upon Respini- vapor) increases the rate and ease of respira-
^^- tion.

2. Hot dry applications (hot air) hinder respiration (521) •

3. After the withdrawal of a very hot application there is
for a time diminished rate and depth of respiration (524).

4. An external temperature above 60° to 70° F. increases
COj elimination, while a temperature below 40° F. also
decidedly increases CO3 elimination.

I. Short hot applications (98'^ to 104^ F.)

effects ODOO

the Muscles. increase the excitability and energy of striated,
or voluntary, muscles (529).

2. Prolonged hot applications (106^ to 120^ F.) lessen the
energy and excitability of the voluntary muscles (529).

3. Very hot applications increase the excitability of the
non-striated, or involuntary, muscles, as shown by the goose-
flesh appearance of the skin following a very hot application,
and the contraction of the small vessels of the skin (527).

4. Neutral temperatures (92^^ to 96'^ F.) have no influence
upon the excitability of the striated muscles. The sedative
effect produced depends upon the influence on the cutaneous
nerves.

I. Very hot baths produce various nervous
upon disturbances, as sleeplessness, nervousness,
System. headache, and other symptoms of nervous

excitation and exhaustion (54-0).

2. Extreme heat, as in sunstroke, may give rise to the
development of special poisons, which act upon the nerve
centers of the brain and cord, producing grave and even fatal
collapse. Hence the danger of a very hot bath if prolonged.

3. A short hot application powerfully excites the nerves
and nerve centers.

4. The excitant effects of heat are followed by depressant
effects or atonic reaction (579).

i88

RATIONAL HYDROTHERAPY.

Effects upon
the Blood.

Effects upon

General

Nutrition.

Effects upon
the Stomach,
Liver, and
Other Abdom
Inal Organs.

Hot applications, unless followed by cold,
decrease the number of blood-corpuscles in
circulation (561).

At very high temperatures, heat is a powerful
vital stimulant or excitant. It increases CO,
production, and the formation of urea by oxi-
dation of nitrogen.

I. Prolonged applications of heat over the
region of the stomach after eating, either fo-
mentations or dry heat, increase the amount
of hydrochloric acid secreted by that organ.
2. Short hot applications, especially the
short hot douche, diminish the secretion of
HCl, at least in cases of hyperpepsia (569).

3. Prolonged applications of heat over the region of the
liver and other viscera increase their activity.

4. Short hot applications, especially the short very hot
hepatic douche, relieve visceral congestion.

I. General applications of heat cause imme-
diate rise of temperature. This is true even
when the temperature of the bath is no higher
than that of the body itself (572).

2. An external temperature above 60° to
70^^ F. occasions increase of heat production.
An atmospheric temperature of 104^ F. increases heat pro-
duction three hundred and fifty per cent, in dogs.

3. An application of heat is followed by a fall of tempera-
ture, the result of atonic reaction (578).

Effects of Hot
Applications
upon Heat
Production and
Body Tempera-
ture.

COMPARATIVE SUMMARY OF THE CHIEF EFFECTS OF COLD

AND HEAT.

COLD.

GetieraL
Primary,, depressant.
Short, excitant by tonic reaction.
Prolonged^ depressant.

special.
Skin: Action, diminished activity.
Reaction, increased activity.
Diminished sensibility.

HEAT.

General,
Primary y excitant.
Short, depressant by atonic reaction.
Prolonged, mixed, excitant, and de-
pressant.

special.
Skin: Action, increased activity.
Reaction, diminished activity.
Diminished sensibility.

THE GENERAL PRINCIPLES OF HYDRIATICS.

189

COLD.

Heart: First quickened, then
slowed.

Increased force.
Vessels: Action, contraction.

Reaction, dilatation.

Increased tone and activity.

Local anemia, collateral hyper-
emia.

Witk reaction, local hyperemia,
collateral anemia.

Short, reflex dilatation of vis-
ceral vessels.

Nerves: Benambs and paralyzes.

Excites by tonic reaction.
Muscles: Short, increased excita-
bility and capacity.
Prolonged, lessened excitability
and capacity.
hiHgs: Slows and deepens respi-
ration.
Increased amount of respired air.
Increased CO,.
Increased respiratory quotient.

Stomach: Increased HCl and mo-
tor activity.
Kidneys: Congests and excites.

Animal Heat: Short, increased
heat production.
Prolonged, diminished heat pro-
duction.
Blood: Increased blood count, es-
pecially leucocytes.
Metabolism: Increased CO,.

Increased urea, and improved
oxidation.

TONIC REACTION.

1. Vasodilatation.

2. Skin red.

3. Pulse slowed.

4. Arterial tension increased.

5. Skin action increased.

6. Temperature lowered.

7. Feeling of invigoration.

8. Muscular capacity increased.

9. Amount of respired air in-

creased.
10. Heat production increased.

HEAT.

Heart: First slowed, then quick-
ened.
Decreased force.
Vessels: Action; contraction, then
dilatation.
Reaction, contraction.
Lowered tone — paralysis.
Local hyperemia, collateral an-
emia.
With reaction^ local anemia,

collateral hyperemia.
Shorty reflex fluxion and deriva-
tive effects.
Nerves: Excites.

Depresses by atonic reaction.
Muscles: Shorty lessening fatigue
effects.
Prolonged, diminished capacity
and excitability.
Lungs: Quickens and facilitates
respiration.
Diminished am*t of respired air.
Decreased CO^.
Diminished respiratory quo-
tient.
Stomach: Decreased HCl and mo-
tor activity.
Kidneys: renders anemic and less-
ens activity.
Animal Heat: Short, diminished
heat production.
Prolonged, increased heat pro-
duction.
Blood: Decreased blood count, es-
pecially leucocytes.
Metabolism: Decreased CO^.
Increased urea aud general pro-
teid waste.

ATONIC REACTION.

1. Vasoconstriction.

2. Skin pale.

3. Pulse rate increased.

4. Arterial tension diminished.

5. Skin action decreased.

6. Temperature lowered.

7. Languor.

8. Muscular capacity decreased.

9. Amount of respired air de-

creased.
10. Heat production decreased.

THE THERAPEUTIC EFFECTS OF HYDRIATIC
APPLICATIONS.

T'

608 'T^HE classification of hydrotherapeutic procedures has
given rise to much discussion among writers and prac-
titioners, growing out of the fact that thermic applica-
tions are capable of producing a great variety of effects, which
are not infrequently so intermingled that it is not easy, in all
cases, to decide which is the dominant effect.

It has also been observed that an application of water
made in a definite manner and of a definite temperature may,
at one time and under one set of circumstances, produce an
effect radically different from that produced by an identical
application at another time and under different circumstances;
for example, an application which in one patient might prove
to be exciting or tonic, in another would produce decidedly
sedative or depressing effects, and the reverse.

This characteristic, however, is not peculiar to water; it
applies to all classes of therapeutic agents. No two persons
arc exactly alike, and the state of the system in every indi*
vidual is constantly varying from hour to hour and from day
to day, the condition at each moment differing from that of
every other moment, past or future. Particular individuals
also present special puculiarities or idiosyncrasies of constitu-
tion, which must be taken into account in the employment of
thermic applications as well as in the use of other therapeutic
measures. Nevertheless, amid this apparent confusion, there
is a sufficient amount of stability and unity to permit a basis
for a simple and coinprehcnsive classification of the effects
which may be expected from definite and exact hydric
applications under clearly and accurately defined conditions.
009 From a careful study of the physiological effects of water,

it is evident that, in general, two classes of effects are pro-
duced. These arc excitation and (fc/>?'cssiofi. This naturally
190

E

THERAPEUTIC EFFECTS. I9I

ads to a simple grouping of therapeutic applications of
ater into two general classes: (i) Excitant; (2) Sedative,

These two groups of effects may be almost indefinitely 610
ibdivided, but the leading and essential subdivisions the
uthor believes will be found included in the following table,
vhich is offered as an attempt at a scientific classification of
he therapeutic effects which may be obtained from hydriatic
procedures : —

CLASSIFICATION OF HYDRIATIC EFFECTS.

I. Excitant.

II. Sedative.

I. Excitant Effects.

A, Primary effects.

B, Secondary effects.

A, Primary Excitant Effects.

1. General.

2. Local.

-"'^"'-'^«'^lS;t or Reflex.

b. Cardiac.

c. Uterine.

d. Peristaltic.

/J Secondary Excitant Effects.

I General. ;■,

a. Restorative. *, 45

h. Tonic. -'^

c. Calorific. i 'j

2. Local. '.i!

^ 1 'c \ {a) Spoliative or Reducing.
a. Sudorific | ^^^^ Efi^i^ative.

b. Expectorant.

c. Diuretic.

d. Chol.igogic.
^•. Peptogenic.

/. Emmenagogic.

f^. Revulsive.

h. Derivative.

/*. Resolutive.

/. Alterative.

k. Calorific.

192 RATIONAL HYDROTHERAPY.

II. Sedative Effects.

1. Circulatory.

a. Antiphlogistic.

(a) Vascular.
{P) Cardiac.

b. Hemostatic.

2. Nervous.

a. Hypnotic.
h. Calmative.

c. Analgesic.

d. Anesthetic.

e. Antispasmodic.

3. Thermic.

a. Antithermic.

b. Antipyretic.

4. Secretory.

GENERAL PRINCIPLES.

611 The following brief statement of the general principles
which determine the effects of hot, cold, and neutral applica-
tions, may be found of service : —

612 I. The primary effect {action) of an applica"
Respecting Hot ^ .^^ ^^ ,^^^^ .^ excitant.

Applications. -^

2. The secondary effect {reaction) of an

application of heat is depressant, sedative, atonic.

3. The actual effect of a?i application of heat depends
upon many factors, as the condition of the patient^ the
intensity and length of the application, the form of the
application, etc. In general, it may be said that —

(a) The effect of a very short application at very high
temperature is strongly excitant, the depressant effects being
practically imperceptible.

{b) The effect of a less intense and slightly prolonge
application of heat is moderately excitant during the appi
cation; after the application, decidedly depressant effec
appear, resulting from a lessening of thermic and other tiss
activities through atonic reaction.

{c) The effect of a prolonged application of heat a,
high temperature is both excitant and exhausting or deprt

194 RATIONAL HYDROTHERAPY.

means which favor or delay reaction, applied before^ during^
or after the bath, such as exercise^ artificial heat^ etc. (443^

I. EXCITANT (Action) EFFECTS.

615 The excitant effects of thermic applications are chiefly
reflex in character. They may be divided into two classes:
(A) Primary; (B) Secondary.

A. PRIMARY EXCITANT EPPECTS.

616 Primary excitant effects are those which are the immedi-
ate results of the motor impulses sent out by the nerve cen-
ters under the stimulus of the impression produced upon the
skin or mucous membrane by the application made. All
thermic applications, whether at a temperature above or
below that of the body, which produce decided sensations or
impressions are excitant in character ; but only those applica-
tions are classed as excitant which are managed in such a way
that the excitant effects are the sole or dominant effects;
hence as will readily be seen by a study of the foregoing state-
ment of principles, applications for excitant effects must neces-
sarily be short (from 2 or 3 sees, to i or 2 min.). As a rule,
the shorter the application, the more purely excitant will be
the effect, provided the temperature is very hot or very cold.

Excitant effects may be produced by either hot or cold
applications. Very cold applications are much more excitant
than cold or cool applications. Likewise very hot applica-
tions arc more highly excitant than applications which are
simply hot or warm. The greater the difference between the
temperature of the application and that of the skin surface
to which it is applied, the more highly exciting will the effect
be, whether hot or cold applications are employed.

Applications producing excitant effects may be subdivided
into general and local applications.
61 7 /. General Primary Excitant Effects. — General applica-

tions arc usually employed for general excitant effects, the most
important of which are the very hot douche — shower, spray,

196 RATIONAL HYDROTHERAPY.

produced by the succeeding hot application. This rendeis
possible an almost indefinite extension of the effect.

Although the strongest excitant effects may be obtained
by the alternate douche, very powerful excitant effects may
be made by alternate hot and cold sponging, compresses,
affusions, etc.

The sun bath is a most valuable and practical exciting
measure. It owes its properties to the three sets of rajrs of
which it is composed, viz., heat, luminous, and actinic or
chemical rays. The heat and luminous rays are directly
stimulating to the cells of the tissues, causing a development
and accumulation of heat, while the actinic rays (597) act
upon the nervous system in a most powerful manner.

The electric-light bath possesses the same properties as
the sunlight; hence the importance of utilizing this simple
measure especially in countries blessed with little sunlight and
at seasons of the year when sunlight is uncertain. By the
use of colored lamps or screens the patient may be exposed
to the action of the red or heat rays only, or to the chemic
or violet rays, or to the full-light rays. The actinic rays may
be used when stimulation of the nervous system is especially
desired, independently of any calorific effect. When the heat-
ing effect alone is desired, the red rays should be employed.

In the employment of such non-percutient applications as
the compress and the fomentation, or hot and cold friction,
greater extremes of temperature may be employed than with
the douche. As a rule, the temperature should be as extreme
as can be borne without actual pain, except, of course,
with extremely nervous patients, who may easily be over-
excited by a too strong stimulation of the sensory nerves.
The general excitant effects of heat or of al-

« ,^ -. ternate applications of heat and cold are
ploy Excitant . ,. , . , , .

-- . _ mdicated m cases of extreme exhaustion,

collapse, surgical shock, collapse under anes-
thesia, drowning, suffocation, and syncope from hemorrhage,
fright, or any similar cause.

THERAPEUTIC EFFECTS. 197

The excitant effect of cold may be occasionally used with
advantage in cases of collapse or asphyxia. The reaction
roust be qaick and general; hence the colder the water and
the greater the force with which it is applied, the better will
be the effect produced. Cold friction may be used instead
of the dojiche when more convenient.

As a rule, the excitant effect of heat is to be preferred to

that of cold in conditions of collapse or pain. Depressant

effects from heat may be prevented by making the application

short and by a very short cold application following.

^^^^ In the employment of the hot full bath and

1^ .^^ the hot douche, great care must be taken

to avoid cerebral excitement. To accomplish

this, apply a cold compress or an ice-cap to the head when

hot applications are being made to any large area of the

skio. Care must also be taken to avoid overexcitement of

the heart. General very hot applications are contraindi-

cated in cases of weak heart, arteriosclerosis, advanced age,

aod infancy (below seven years), also in cases of previous

iojory from sun-stroke or heat-stroke.

2. Local Primary Excitant Effects, — The primary exci- 618
tant effects of thermic applications may be usefully employed
for numerous local therapeutic effects, the most important of
which are the following : —

The hemostatic effects of thermic applications 619
Effects. "^^y ^^ obtained either directly through appli-

cation to the bleeding vessels, or indirectly
through reflex action.

To obtain direct hemostatic effects, either very hot
(140' to 160^) or very cold (32° to 40°) applications must
be employed.

Of hot applications, the hot douche (1024) and the hot
compress (1289) are the most valuable. A jet of hot steam
has been used with success (14'22).

Of cold applications, ice, ice compresses, and the ether or
rhigolene spray are the most convenient methods of checking

19^ RATIONAL HYDROTHERAPY.

hemorrhage by the direct application of co]d to the bleeding
part, or across the trunk of a main artery supplying a bleed-
ing part, as the ice-collar or cravat for nosebleed.

This method of checking hemorrhage is, of coarse, not
adapted to cases of bleeding from large vessels, and applies
rather to cases of capillary oozing than to those in which the
hemorrhage occurs from arteries or veins which have been
cut or otherwise ruptured.

Other methods which are found efficient are the following:
The hot nasal douche and sponging the face with very hot
water for nosebleed ; the hot vaginal douche for menorrhagia,
hot uterine irrigation in metrorrhagia and post-partum hemor-
rhage; the hot bladder irrigation in vesical hemorrhage.

Cold applications to the upper spine consti-
Indirect ^ute a most excellent measure for checking

Effects nosebleed. Placing the hands in ice-water,

and the application of ice to the base of the
cranium, and especially to the cervical and the upper dorsal
portion of the spine, are also very effective means of checking
nosebleed when other measures have proved futile. Placing
the feet in cold water constricts the blood-vessels of the
nasal mucous membrane, and may be advantageously com-
bined with the other measures mentioned.

For pulmonary hemorrhage there is no better remedy than
cold compresses over the chest and very hot fomentations
between the shoulders. Care should be taken to cover both
the lower cervical and the upper dorsal region. The vaso-
motor nerves which supply the lungs find exit from the
spine in this region, and hence applications made at this point
will act with the greatest possible energy upon the blood-
vessels of the lungs.

In cases of hemorrhage from the stomach, lumps of ice
may be swallowed, and large ice compresses should be placed
over the epigastrium.

In apoplexy, the ice-cap (1314) and ice-cold compresses
to the head, face, and neck are most appropriate and valu-
able measures.

620

200 RATIONAL HYDROTHERAPY.

same time, with the result that the hemorrhage ceased at
once, and by continued and repeated application of the cool
sitz bath for a few weeks, the difficulty was relieved.

The great value of this principle as a means of controlling
hemorrhage was recently illustrated in a case of menorrhagia
in which the author was consulted by a medical colleague.
The patient had been flowing continuously for a month, the
hemorrhage following a curettement. The usual remedies
had been employed most assiduously, but without result,
tamponment of the uterine cavity having failed to control the
hemorrhage even temporarily. The application of a cold
pelvic pack controlled the difficulty at once, and completely
for twenty-four hours, when a slight return of the flow
occurred; another application of the same simple measure,
however, resulted in permanent relief.

This measure will not control a hemorrhage due to vege-
tations, a uterine fibroid, or malignant disease, though even in
cases of this sort it will often be found of value ; but for men-
orrhagia or metrorrhagia due to uterine or ovarian conges-
tion, it is a most valuable resource. In cases of hemorrhage
accompanied by severe neuralgic pain or by acute pelvic in-
flammation of any kind, very hot rather than very cold applica-
tions should be made to the inside of- the thighs and the
lumbar region. The application should be brief, and the
temperature sufficiently high to be somewhat painful. It is
most satisfactorily made by sponging the parts with water at
a temperature of 140^ F., or by the application, for i or 2
minutes, of cloths wrung from water of the same temperature.
This measure acts in the same way as the hot nasal douche,
or bathing the face with hot water, in relieving nosebleed.
There is no more powerful means of exciting
Heart Tonics increased activity of the heart than hydri-
atic applications. Short, very hot fomenta-
tions over the heart, the application of large, very hot or
very cold compresses over the entire chest and trunk or to
other large areas, hot and cold applications to the spine,

THERAPEUTIC EFFECTS. 2OI

hot water drinking, and the hot enema are all efficient means
of stimulating a flagging heart to increased action. The
measures named are especially serviceable in cases of col-
lapse under chloroform.

Prolonged cold quickens, then slows and energizes the
heart. Prolonged heat slows, then quickens and weakens it.

Hot applications over the heart should be avoided where
there is any considerable degree of cardiac dilatation, as in
cases of this kind the indication is for withdrawal of the blood
from the heart, through dilatation of the surface vessels by
means of revulsive applications to the general surface, as the
effervescing bath, cold friction, and carefully graduated pass-
ive exercises, rather than for excitation of the heart muscle.

A very short application of cold to almost any part of the
body, but especially to the face and chest, stimulates the
heart. The common practice of sprinkling cold water upon
the face of a fainting person affords an excellent illustration
of the primary exciting influence of cold in rousing the flag-
ging energies of the heart to increased activity. The most
excellent effects may be obtained from the application of
cold over the heart in cases of cardiac insufficiency.

Cold applications excite the vasomotor constrictors, or
accelerator nerves of the blood-vessels, as is clearly shown in
the ordinary phenomena of reaction to cold, in which there is
first a spasmodic and continuous contraction of the small ves-
sels, later an active dilatation, accompanied by a vigorous
rhythmical action of the vasoconstrictor muscles, whereby the
movement of the blood is accelerated. The heart participates
in this action. Its accelerator nerves, like those of the ves-
sels, are derived from the sympathetic. Whatever affects
the activity of the peripheral heart, — the small vessels, —
affects in Hke manner the central heart.

Cold applications, through their influence upon the nerve
centers which control the heart and vessels, cause an increased
outflow of energy to the muscular structures of these organs,
whereby they are brought into more effective activity. The

202 RATIONAL HYDROTHERAPY.

heart contracts with greater force, and more completely
empties itself. The small vessels contract more vigorously,
while at the same time dilating more fully, thus acting more
efficiently in their capacity as a peripheral pump ; and so the
movement of the blood is hastened by increased activity at
both ends of the vascular loop.

The most powerful effect upon both the heart and the vessels
results from an application of cold to the whole cutaneous
surface. Marked effects may also be produced by applica-
tions to the mucous surface, as by hot or cold water drinking
and the hot or cold enema. For effects purely cardiac, the
application should be confined to the precordia, the cutaneous
surface overlying the heart, which is in special reflex relation
with it. Cold applications made to this surface powerfully
excite the accelerators of the heart, whereby the force of its
contractions is greatly increased. The pneumogastric is also
acted upon in such a manner that while the force of the heart-
beat is increased, its frequency is diminished, thus giving
greater efficiency to its action, by allowing more time for
rest and repair of its tissues between beats. A continuous
feeble action of the heart soon wears it out by depriving it of
rest and interfering with its nutrition, while a slower action
enables it to maintain its vigor and freshness. Cold applica-
tions to strengthen the heart action may consist of the follow-
ing measures : —

I. The ice-bag or ice compress over the heart. The
application must not be continuous, as the cutaneous nerves
will soon become insensitive, whereupon the stimulating reflex
effects will cease, and effects the very opposite of those de-
sired will be produced. Thus the cold applications must be
withdrawn frequently, and long enough to allow the nerves of
the skin to regain their sensibility. An ice-cold application
may be made for half an hour three times a day, or in cases
requiring more vigorous treatment, once in two or three
hours. Friction should afterward be applied to the cooled
surface to maintain the circulation and normal sensibility.

THERAPEUTIC EFFECTS.

203

2. The cold compress, consisting of a folded towel or
half a dozen thicknesses of cheese-cloth, of sufficient size to
cover half the front of the chest, and wet in water at the
ordinary living-room temperature (60° to 70^ F.). The com-
press should cover the cardiac area, extending over a portion
of the chest wall contiguous. In cases of cardiac weakness,
accompanied by pulmonary congestion, the compress may
with great advantage cover the entire front of the chest.
This moderately cold application maintains a constant stimu-
lation of the cardiac centers, thus sustaining the heart tone
and activity, as indicated by a slowed and strengthened pulse,
and shown in a graphic manner by the sphygmograph. The
increased cardiac force may be easily measured by the sphyg-
modynamometer. I have seen as the result of the cold car-
diac compress, an increase of tension from 12 to 20 in a normal
subject, and from a tension too low to be measured to 8 in
a patient suffering from great cardiac weakness. The longer
upstroke shows also that the arteries are better filled, as the
result of a strong ventricular contraction.

To obtain from hydric applications the best results in
energizing the heart, it is necessary in almost all cases to
apply at the same time such measures as will lessen the per-
ipheral resistance, and increase the movement of the blood in
ihe vessels by stimulating the contractile activity of the per-
ipheral heart (the small vessels). This is best accomplished by
cold applications to the skin of such a character as to produce
pronounced circulatory reaction. Cold friction, the rubbing
shallow, the cold douche, the Scotch douche, the rubbing
^■vet sheet, and the wet-sheet pack are all excellent means for
^his purpose. In cases of extreme cardiac weakness with
^•^Jjeneration of the heart muscle, or valvular disease, cold fric-
tion is the best of all measures, for the reason that complete
general reaction is produced, but without sudden displace-
rnent of blood to the interior. In some cases the ice-bag
protected by a single thickness of flannel may be applied over
the heart continuously for several hours with advantage.

204 RATIONAL HYDROTHERAPY.

This measure is equally superior in cases in which cardiac
weakness sometimes complicates apoplexy, intestinal hemor-
rhage in typhoid fever, ulceration of the stomach, uterine
hemorrhage, and hepatic, renal, and other visceral con-
gestions.

The very shojjt hot bath, the short hot-blanket pack,
the hot and cold immersion bath, and moderate dry friction
are all efficient means of stimulating the action of both the
central heart and the peripheral heart.

In cases of nephritis with uremic poisoning and cardiac
failure, I have seen most striking results from' the cold trunk
pack. In one case the patient was unconscious, pulse i6o,
and almost imperceptible at the wrist. The hot-blanket pack
had been administered to relieve the renal congestion. Being
consulted with reference to the cardiac weakness, I sug-
gested the application about the trunk, excluding the arms,
of a half-sheet wrung as dry as possible from very cold water.
The result was magical. The pulse became strong, was re-
duced in frequency from i6o to loo, and the patient's entire
condition rapidly improved. Such an application may be
safely made even in cases of renal and other visceral con-
gestions when preceded by a general hot application. With
this preparation the cold application does not produce the
usual intense internal congestion while the cutaneous reaction
is being established, but the reaction of heat is simply con-
verted into the reaction characteristic of cold, in which the
cardiac and vasoconstrictor centers are powerfully energized
and the circulatory functions accelerated and regulated.

When cardiac weakness demands therapeutic interfer-
ence, there are three things to be done : (i) Increase the
power of the heart; (2) Decrease the amount of work it
has to do; and (3) Remove the cause or causes of the mor-
bid conditions of the heart and vessels. In other words, we
must, if possible, simultaneously lessen the work of the heart
while we increase its ability to work, and remove the causes of
the increase of work and the decrease of cardiac power. By

THERAPEUTIC EFFECTS. 205

means of appropriate hydric applications, all these indications
may be simultaneously and most efficiently met. The heart
is energized, the small vessels dilate widely and contract more
vigorously, behaving in this respect in the same manner as
does the heart. At the same time the increased movement
of blood secures better oxidation and elimination of the
poisons which depress the heart and cause contraction of the
small vessels, and thus increase the work of the heart while
lessening its ability to work.

It will be in place to devote a few lines just here to the
consideration of the remedies most commonly used in cases
of cardiac weakness or failure ; viz., alcohol and digitalis.
While alcohol lessens the power of the heart, as shown by
the experiments of Hare and other observers, it at the same
time weakens the constrictors of the vessels, and so dilates
the small vessels and lessens the blood pressure. In other
words, alcohol, while lessening the power of the heart, at the
same time lessens the amount of work it has to do. If the
work is lessened more than the cardiac power is weakened,
there may be a temporary gain to the patient in a given case.

Digitalis produces an effect the opposite of that of alcohol,
causing the heart to contract with greater vigor, and also
lessening the caliber of the small vessels, thus increasing per-
ipheral resistance in the blood circuit. In other words,
digitalis increases the vigor of the heart, and at tTie same
time increases its work. If in a given case the heart's power
is increased more than its work is increased, then there may
be a temporary gain, but this advantage is not always secured

It is most profitable to note the difference between the
effects of water and those of alcohol and digitalis. Alcohol
diminishes the work, but also the working power. Digitalis
increases the working power, but at the same time increases
the work. Cold increases the working power ^ while dimin-
ishing the work. Moreover, alcohol and digitalis, both be-
ing toxic substances, add to the toxemia which is often a cause
of cardiac inefficiency, while, on the contrary, hydric appli-

208 RATIONAL HYDROTHERAPY.

626 A single short application of cold water in the

Effects. form of a douche, affusion, nibbing wet sheet,

immersion, or any other measure in which
cold water is brought in contact with the general surface of
the body, is always restorative and invigorating in its influ-
ence. A man who has been exhausted by laborious effort
in a highly heated atmosphere, finds his muscular strength
wonderfully re-enforced by an affusion of cold water,
cold immersion, a cold shower bath, and especially by a
cold douche.

The application of cold water to the face and head has
a wonderfully refreshing effect. The brightened expression,
the increased vigor, and the relief which follows a simple
bathing of the head, face, and neck with cold water when
exhausted, are the result of the reflex stimulation of the
nerve centers of the brain and spinal cord and the tonic
reaction which follows such an application. When the whole
surface of the body instead of a small area is acted upon, the
effect is proportionally greater.

During the heated term, thousands of lives have been
saved in our great cities by the timely opening of free shower
baths in crowded tenement-house districts, whereby the
depressing and exhausting effects of a superheated atmos-
phere have been successfully antagonized and antidoted by
the restorative influence of the cold bath.

In this connection it is important to mention the necessity
of exercising care in the use of the general cold bath in cases
of extreme exhaustion from violent exercise, and when, either
with or without exhaustion, a sensation of chilliness exists.
A general cold application should never be made when the
surface is cold, blue, or covered with cold perspiration, nor
when the body is in a state of extreme fatigue from violent
exertion of any sort, nor when the patient is chilly.

When the surface is hot and dry, a cold bath may be
administered without risk, and usually the presence of perspira-
tion, even though it may be quite profuse, is not a contra-

THERAPEUTIC EFFECTS.

209

indication to cold applications, provided, however, that the

patient is not at the same time suffering from an infectious

fever; but the application must be short, and must be

followed by sufficient exercise or friction to secure proper

reaction. Care must . be taken, however, to see that the

exercise be not such as to produce too violent a reaction,

especially in cases in which the skin is hot and perspiring.

In cases of extreme exhaustion in which it is not prudent
to administer a general cold bath, cold applications may be
made to the head, face, neck, and spine, with advantage.
The hands and feet may also be bathed in cold water, care
being taken to keep the remainder of the body covered if
there is cold perspiration. General cold friction may be
applied safely in nearly all cases.

A short hot bath (2 to 4 min., 104^ to iio^) followed by
cold friction is one of the most efficient means of combat-
ing a state of collapse, such as often occurs in fever.

Tonic measures are such as increase vital 627
activity in a healthful direction. The most
powerful tonics are the most powerful excitants, it being
understood that by excitants is meant exclusively physiolog-
ical means, such as thermic influence, light, and electricity.
It must be remembered, also, that an excitant may be em-
ployed in such a manner as to. exhaust the nerve centers, and
thus produce effects the very opposite of those desired.

The tonic effect of cold water is its most constant and
regular effect, this tonic influence being exerted whenever
water is applied at a temperature below that of the body.
Trousseau defined a tonic as an agent having for its object
to give tone to the tissues, to restore the functions of nutri-
tion and assimilation, and to increase vital resistance. A
more modern definition of a tonic would be an agent which,
when systematically employed, aids in the restoration of
normal tissue activities, both constructive and destructive,
thereby promoting a renewal of the body and a recuperation

of its forces, and an increase of vital resistance.
•14

210 RATIONAL HYDROTHERAPY.

The tonic effects of water are, of all the remarkable
therapeutic properties of this versatile agent, the most impor-
tant and the most extensively used. They are obtained by
the repetition of excitant measures, and are due to the reac-
tion which, under ordinary conditions, always follows a short
cold application.

Water, by its accessibility, its convenience in use, and its

high specific heat, more readily lends itself to the assistance

of the physician in producing restorative and permanent tonic

effects than any other agent.

628 The numerous medicinal tonics, so called, are

^^^^It^f^ n universally toxic in character. Whatever
vs. Medicinal . rr t «

Tonics. tome effects they may seem to produce are

due to the fact that the system is aroused to

resist their influence and to expel them from the body ; and

while a certain amount of benefit is perhaps derived from the

use of such agents, there is always a possibility of serious

damage ; and doubtless in all cases a considerable amount of

harm is done through the toxic influence of the drug, which

falls with especial weight upon those organs which are most

concerned in its elimination, — the liver and the kidneys.

A medicinal stimulant is a mortgage placed upon the vital
capital of the body, which must be paid sooner or later. It
is a draft upon the constitution. A stimulant is simply a
means by which the nerve centers are made to give up a
little more of the energy which they have stored up ; and
unless the stimulus is of such a character that the storing
power as well as the expending power of the nerve centers is
increased, there must be a loss from its employment.

A toxic agent like strychnia may provoke the expendi-
ture of nervous energy, but it does not replenish energy; while
it does lessen the activity of the kidneys in eliminating tis-
sue poisons and the efficiency of the liver in the destruction
of toxins and leucomains, thus encouraging the development
and maintenance of a condition which is, in itself, an indica-
tion for the necessity of employing tonic measures ; in othe^B

■ , 3Utnulaol aggravate.

■^a medicinal lon^<^ J ^^,. ,i l.b<>- 6^9

KUoo it fe '"rttaiu^btncnt in modem ^ „,,,ological
1'^'° Tlie estabi. ^^^iog>eal an^ ^^xviiig

^- search ^*^ ^^„t3l and nerv ^^^.^^^^

.Yemenis lound n tbe .^ ^ o^^ r ^^^^^ ^ be

pk, a oefv^ . i^raniJ^^* ^<* ol energy » ..

Lbet ci e"^t J *ith tbe storage oi .^ ^.^^^ ^ ,Uy

,o tbe g'*"*^^,,; to discharge unde ^f ^^ J,

tha«ed battery. rt-W joaximum oi ^^^^ cell «

'»S^ -'- '"?rta -^'- "* '" "" , ,,,

found to be very te ^.^derstand why

214 RATIONAL HYDROTHERAPY.

physician should ever undertake the use of the cold bath as
a tonic without an exact knowledge of the principles and
methods of hydrotherapy and the most precise and complete
information respecting the condition of the patient to whom
the application is to be made.

All applications of water of a temperature low enough
to provoke vital resistance are tonic; hence tonic effects are
produced by all temperatures below 90^ F.

It should be remembered that those forms of hydric
application which are tonic when of short duration, become
sedative when sufficiently prolonged. The sedative effect is
accompanied and indicated by the lowering of the rectal
temperature a few tenths of a degree. The length of time
required to render a cold application sedative in character
depends, of course, upon the condition and the susceptibility
of the patient.

Although all baths at a temperature below 90° may be
employed for tonic effects, the most certain and pronounced
results are obtained from the douche in every form, which
adds mechanical impact to the thermic cfTects of cold.

The tonic effects of non-percutient baths may be increased
by vigorous friction during the bath.
632 The most durable tonic effects are obtained by the fre-

quent use of very cold and very short baths. Short tonic
baths may, in many cases, be employed twice daily with
advantage.

Of the several forms of douche, the rain douche, or
shower bath, is the most strongly refrigerant, since it im-
presses at each instant the largest portion of the surface.
The next most vigorous purely hydriatic measure is the hori-
zontal jet. The massage douche combines with the mechan-
ical and thermic effects of the douche, the powerful influence
of massage upon circulatory reaction and metabolism.

The horizontal ji't, the spinal douche, the circle douche,
the pail douche or affusion, the wet-sheet rub, the towel nib,

THERAPEUTIC EFFECTS. 21/

In feeble patients a very unpleasant and discouraging 635
sense of fatigue is often experienced after tonic applications,
especially at the beginning of a course of treatment. This
arises from a deficiency in vital capital to support the loss of
beat and the expenditure of nervous energy required by the
reaction. The irritable condition of the nervous system occa-
sions a very quick reaction, whereby heat dissipation, through
the increased surface circulation, begins before the produc-
tion of heat has proceeded far enough to repair the loss occa-
sioned by the contact of cold water, and thus an unpleasant
nervous perturbation continues, sometimes accompanied by
chilliness and various nervous symptoms which only too
clearly indicate the fact that the patient's vital resources
are at a very low level. In such cases the greatest care is
demanded to avoid producing so great a degree of exhaustion
as to discourage the patient and blight his prospects for
recovery. It must never be forgotten that cold water is a
most powerful therapeutic agent, and potent for mischief as
^'ell as for good, and that an application which, if wisely
managed, may produce powerful tonic effects, may, from
iack of care or judgment, become equally depressing and
hio^hly injurious.

It must be remembered, also, in making tonic applica-
tions of water, and especially in the use of the cold douche,
that the skin is abundantly supplied with sympathetic nerves ;
that these nerves are connected with the great ganglionic
system, including the abdominal brain, which controls every
vital process in the body, and that there is an intimate asso-
ciation between the sympathetic nervous system and the
pneumogastric nerve, which exercises so profound an influ-
ence upon the functions of the lungs and heart.

The coughing, oppression, and distress experienced in the
region of the chest as the result of a very cold application to
this part of the body, are indicative of the profound influence
thus exerted upon the respiratory center. This fact must be
kept in mind in the treatment of persons of a nervous tem-

2l8 RATIONAL HYDROTHERAPY.

perament, especially those subject to asthmatic attacks^
or suffering from dyspnea or cardiac weakness.

636 Mechanical stimulation of the pneumogastric
Douche to the stimulates the inspiratory movements. This
Chest to be fact explains the effect of the douche with
Avoided. strong pressure when applied to the upper

part of the chest ; hence the necessity for
avoiding strong percutient applications in cases in which
there is an irritable and congested condition of the pulmonary
structures, or a hypersensitive state of the pulmonary area of
the pneumogastric.

Applications of the cold douche over the stomach, loins,
and abdomen should be avoided in cases of hyperpepsia,
ulceration of the stomach, hemorrhage from the bowels, or any
form of uterine hemorrhage, as menorrhagia or metrorrhagia.

Very anemic persons, such as convalescents from fevers
and other wasting diseases, or those who have suffered severe
hemorrhage, and especially those who are greatly emaciated
as well as weak, must be treated with careful regard for the
precautions suggested.

Extremely nervous or neurasthenic patients invariably
rebel at the application of very cold water. Such persons
must be humored at the start until their confidence is secured.
The author has found it a very good plan to prescribe at first
for such a patient a hot bath, as the electric-light, vapor, or
warm electro-hydric bath, which is likely to please the pa-
tient, especially as the immediate effect is usually quieting
and comforting. But the application is made short (3 to 10
min.), and immediately followed by a cold application, from
65"" to 70'^ F. , very short (4 or 6 sees.), or if at a more mod-
enitc temperature, as from 75 - to 80", for 10 to 20 seconds.

637 For very feeble and anemic patients the Scotch
g^.. j^ douche generally secures the best effects, as
Anemia. in such cases the heat-producing powers are

weak. This is especially true with patients
who arc very susceptible and excitable. The bath should be

THERAPEUTIC EFFECTS. 219

graduated by extending the length of the concluding cold
application each time until it is well borne for ten to thirty
seconds.

If the patient is so sensitive that the douche can not be
tolerated, employ the wet-sheet rub, fomentations to the
spine followed by affusion with water at 80° F. , the electric-
light bath, followed by affusion at the same temperature, or the
hot-air or vapor bath, also followed by the tepid affusion or
some similar measure. The patient must, however, be pro-
gressively trained to employ water at lower and lower tem-
peratures until short applications of very cold water can be
borne (55^ to 60° from i to 3 sees.).

It is sometimes a good plan to have the patient, while
taking the cold jet or spray douche, stand in a foot bath with
the water so hot that he can scarcely stand still in it. His
attention is thus diverted to his feet, and the impression of
beat is so generalized that a brief general cold application is
tolerated without complaint.

Or, the patient may be prepared for the cold application
by a very hot spray or shower (110^-120^) lasting from one
to three minutes, and of gradually increasing temperature.
The hot shower may be instantly succeeded by the cold
douche to the spine, or to the spine and lower extremities,
or the temperature may be gradually lowered to 70^ or 60^.
Care must be taken to avoid the abdomen, the chest, and
particularly the region of the heart in nervous cases, espe-
cially those in which hysteria is a well-marked symptom, and
in cardiac disease and asthma. The author finds an arrange-
ment of the electric-light bath in combination with the shower
and douche very excellent in these cases.

In anemia, and especially anemia of the brain, whether 638
accompanying general anemia or an independent condition,
there is an excessive accumulation of lymph in the ventricles
and between the dura and the brain substance. As a result
of this stagnation of the lymph, the nutrition of the brain is
seriously interfered with, waste matters accumulate, the

220 RATIONAL HYDROTHERAPY.

nerve cells are unable to store energy, and chronic mental
and nervous exhaustion is the result. Tonic applications of
water afford the most efficient of all means of correcting this
condition. As long ago shown by Schullcr. cold applications
to the surface cause a sudden filling of the blood-vessels of
the brain, whereby a vigorous movement of the lymph cur-
rent is produced; and when the applications are so managed
as to create strong respiratory movements, as in applications
to the chest, rapid fluctuations are induced in the volume of
the brain, which are attended by a simultaneous agitation of
the lymph, which can not be experienced without a salutaiy
effect in cases of this sort.

The observations of Virchow, however, should be borne
in mind in dealing with these cases. He showed that chronic
anemia is liable to be accompanied by degeneration of the
heart and blood-vessels, so that care must be taken to avoid
violent measures whereby such strong reflex impressions may
be made upon the weakened structures as to paralyze the
heart or produce irreparable injury to the vessels. Cold fric-
tion, the sitz or shallow bath, and the tonic pack, with the
water at a moderate temperature (70' to 80^), are the meas-
ures most suitable for these cases.
639 In most cases of chronic congestion of the

The Tonic brain, the difficulty is really due to a paralysis

Cerebral ^' *^^ vasoconstrictors, though possibly in

Congestion. some cases the difficulty may be due to

irritation of the vasodilators. In any case,
the normal balance of action between these two sets of
nerves is disturbed. It is evident that the most effective
measures for securing permanent relief must be those
whereby the caliber of the ccrcbnil vessels may be less-
ened. By means of general warm baths, a large quantity
of blood may be drawn to the surface, and the cerebral
vessels contracted. But this effect is purely mechanical.
Better effects are obtained by cold applications to the
lower extremities (the broken douche, rubbing wet sheet, cold

222 RATIONAL HYDROTHERAPY.

in diabetes with emaciation, in both acute and chronic
Bright's disease, in locomotor ataxia, in persons who have an
idiosyncrasy against cold, in conditions of fatigue from
extreme exhaustion, as violent muscular exertion, or exhaus-
tion from loss of sleep, or excessive expenditure of nervous
energy in other ways, — in all these conditions viery cold baths
must be avoided, as also in the case of very young (children
under seven years of age) and very aged persons. These
remarks respecting the contraindications for the cold bath
must be understood, however, as applying only to the very
cold douche, the cold immersion, and like vigorous proced-
ures. Cold applications are useful and necessary in all these
cases, and may be safely made by means of cold friction, the
cold rubbing sheet, the graduated Scotch douche, and other
mild tonic measures.

It should be here noted that age must be judged not
entirely by the number of years lived, but by the evidences of
senile decay. One person may be older at iifty than another
at seventy. An elderly person who has been in the habit of
taking a cold bath daily may be able to tolerate the cold
douche without injury, while another person of the same age,
who has not been accustomed to cold bathing, might be
greatly harmed unless gradually trained to it. The presence
of arteriosclerosis is always an evidence of senility.

All tonic and restorative procedures are accom*-
Effects^ panied by general thermic or calorific effects-

It is necessary, however, in some cases, tc^
secure stroiiii^ calorific effects independently of other effects-^
or at least to emphasize thermic reaction and the resulting
calorification. The short cold immersion bath (20 sees, to
2 min.), the cold douche with little pressure, cold aflusiocm,
and especially the wet-sheet pack prolonged to beginning
perspiration, are most efficient calorific measures
641 2. Local Secondary {Reaction) Excitant Effects — AppK-

cations of water at suitable temperatures may be made in
such a manner as to affect the function of any organ or set

THERAPEUTIC EFFECTS,

223

gans 10 the body. The chief local effects, however^
o which it is here desirable to call attention, are the foU
Ictwing : Sudorific, expectorant, cholagogic, peptogenic, em*
iago^ic, hemostatic, revulsive, derivative, resolutive, alter-
ed and calorific. We will briefly consider each of these
excitant effects, which, as previously intimated, are for
most part to be obtained by applications of cold water,
by itself or tn connection with heat

Sudorific effects, or stimulation of the perspir*
atory function, are obtained by various means
""' * which are capable of raising the body tem-

pcfatarc Bouchard has shown that an elevation of the
lempefittire of the blood . 7^ F. is suffident to induce gen-
's^ sensible perspiration by stimulation of the sweat centers.
Local perspiration may be induced by circumscribed hot
appliations or by retention of the natural heat of the part
t)y rarm or imper\ious coverings.

The measures which may be most conveniently employed
for tbe production ol active perspiration are, the' electric-light
^th, the Turkish bath, the Russian bath, the hot-air bath,
tk v3f»oj bath, the hot full bath, the wet-sheet pack, the
dry pack, the hot douche, the vapor douche, the hot blanket
pafk, ihe hot sitz bath, hot water drinking^ the hot enema,
M fomentations to the spine* and the sun bath. Any one
^ the*c measures may be found the most convenient and
SBviccable in individual cases, and under special conditions.
The electric-light bath is without doubt the most efficient
^i satisfactory of all modes of inducing perspiration, as it
P'^aces such powerful stimulation of the perspiratory glands
■ tljcrstjucturcs of the skin as to cause the perspiration
10 appear in a remarkably short space of time, thus avoiding
ty of subjecting the body to the exhausting effect
,. i^i.^ed exposure to heat. Profuse perspiration geuer-
% appears in the electric-hght bath in from three to five
fn^itcs, and often when the temperature of the air surround-
%lJie patient is not above 85- F, Winternitz has noted a

6ii

224 RATIONAL HYDROTHERAPY.

case in which sweating began at a still lower temperature.
The dry pack not infrequently fails to produce perspiration
within less than an hour and a half or two hours.
643 When the extent of secreting surface pre-

Importance of sented by the skin is taken into consideration
th^ski^"i*^ (the area of the perspiratory ducts being more
Chronic thB.n eleven thousand square feet)» it appears

Diseases. evident that this organ is the most extensive

of all the eliminating structures of the body.
The skin throws of! each hour from an ounce to an oanGe
and a half of insensible perspiration in the form of invisible
vapor. Practically, the whole skin takes part in the function
of perspiration, acting essentially in the same manner as
does the mucous membrane lining the lungs, which the skin
still further resembles in its ability to eliminate carbonic
acid gas. In profuse perspiration, the sudoriparous glands
are brought into vigorous activity, sometimes pouring out
their secretion at the rate of from thirty to sixty ounces per
hour, or from twenty to forty times the normal amount.

The secretion produced by the sweat-glands closely resem-
bles urine in its character, containing urea and various other
toxic matters, and particularly, as has been shown by
Bouchard, a ptoniain or toxin capable of causing a fall of the
body temperature when injected into the veins of an animaL
Formic acid, butyric acid, and various other acid substances
and poisonous matters are also eliminated in the perspiration.

The healthful activity of the skin is one of the conditions
most essential to physical well-being. The state of inactivity
and disease of this organ found present in nearly all chronic
maladies is not only a consequence but a cause of a large
number of serious morbid conditions of the body; and it is
in a great majority of cases quite impossible to effect a cure
until the skin has, by patient and persevering treatment and
training, been brought into a healthy state.

The dry, sallow, dingy skin so often observed in the
chronic dyspeptic — indeed, in most forms of chronic disease
— is not only a symptom of the disordered bodily state, bat

226 RATIONAL HYDROTHERAPY.

there are a large number of those employing baths, in this
country at least, who make excessive use of hot applications,
particularly the Turkish bath, the Russian bath, hot mineral
baths, mud baths, etc. A vast deal of harm has unques-
tionably been done by the depressing effects of frequently
repeated and prolonged hot baths without the association
therewith of the cold douche or some other means of jwo-
ducing tonic effects whereby the excessive sedative and
spoliative effects of the hot applications may be antidoted
or antagonized. This very serious fault exists almost uni-
versally in the methods employed at mineral bath establish-
ments and other popular bathing resorts, especially those
connected with natural sources of hot water.

The author was pleased, however, in visiting various Euro-
pean bathing establishments some years ago, to note an
exception to the general rule, in the practice prevalent at
Leukerbad, Switzerland. At this quaint old resort, the
patient sometimes spends six or eight hours *• soaking" in
a great tank filled witl^ alkaline waters derived from ar?
tesian wells at a temperature of about ioo° F., but on
leaving the bath the massage douche is employed, and pro-
duces decidedly tonic effects. The massage douche con-
sists of the application of a jet douche chiefly to the spine
and the posterior parts of the body and over the region
of the liver, the water being applied with high pressure
while the attendant vigorously rubs and kneads the tissues
with the hand covered with a hair mitten. In taking the
massage douche, at the end of an hour's seance in the
tank, I found it necessary to lay fast hold of a strong iron
bar arranged for the purpose, and to keep my feet firmly
braced, to avoid being thrown down and carried away by the
force of the large stream of cold water directed upon me by
the attendant. By a powerfully tonic application of this
sort, the debilitating effect of the warm bath is prevented;
but it is certain that equally good effects might be produced
by less tedious means and milder measures.

228 RATIONAL HYDROTHERAPY.

to add to the spoliative effects of the hot bath the still more
positive effects of prolonged muscular exercise.

647 In administering a sweating bath for the purpose of redu-
cing flesh, it is an excellent plan to interrupt the hot applica-
tion at intervals by a cold application, a cold shower bath,
a cold horizontal douche, or an affusion being best employed
for this purpose. The temperature should be from 50^ to
60^ F. , and the application continued not only long enough
to remove from the skin the surplus heat which has been
absorbed, but from five to twenty seconds longer, so as to
produce a strong reaction. The atonic reaction of the hot
bath, whereby heat production and tissue activity in general
are reduced, will thus be antagonized, oxidation will be en-
couraged, and effete matters and surplus tissue broken down
and prepared for the elimination which will be effected by the
succeeding application of heat. By the adoption of this plan
the hot bath may be prolonged to two or three times the
period otherwise admissible.

648 In the application of hot baths for the relief
Hot Baths of dropsy, great care must be exercised, espe-

"*. n l^ cially in cases of cardiac disease. The appear-
Dropsy. ancc of dropsy in a case indicates that the

small blood-vessels have lost their power of
active contraction, and the heart is weak and dilated. The
stimulating effect of strong applications of heat may cause
still further dilatation of the heart, which is already so weak
as to be unable completely to empty itself of its contents,
while the depression resulting from the atonic reaction of
heat will still further weaken the organ, and may result
in so embarrassing it as to induce grave symptoms. Death
from cardiac weakness has not infrequently occurred in
Turkish bath establishments. The danger is even greater in
tlie Russian bath, and the vapor bath is not wholly free from
danger.

Attention should be called to the fact that in cases of
edema due to anemia, especially when associated with obea-

232 RATIONAL HYDROTHERAPY.

weakness resulting from the impoverished condition of the
blood and the general interference with nutrition. Here
again the electric-light bath shows itself superior to other
measures for applying heat to induce perspiration, for the
reasons already pointed out.

In these cases the sweating bath is particularly serviceable
as a means of preparing the body for an application of cold,
the combination of these two measures having been shown
by Wintemitz and others to be among the most effective
means for the enrichment of the blood, if not by the actual
production of blood-corpuscles, by bringing into the blood
current a vast number of blood cells previously hidden away
in the vessels of the liver, spleen, and other internal viscera,
perhaps exposed to excessive destruction, as these organs
have, for one of their functions, the destruction of blood cells.

The sweating bath may be advantageously employed in
many cases of dropsy of the abdomen and of the chest. Not
infrequently absorption takes place at such a rapid rate that
within a few days there is a very marked diminution or a
complete disappearance of the effused fluid, which had pre-
viously resisted with stubbornness tapping, counter-irritation,
and all other ordinary means of treatment. The sweating
bath is certainly not a panacea for cases of this sort, but it
is a most serviceable measure.
664 It must be remembered that a cold application should

always be administered after a sweating bath when employed
for spoliative purposes, as well as in most other cases. Great
care, however, is needed in the adaptation of the cold appli-
cation at the conclusion of the bath to the serious morbid
conditions which are almost invariably present in connection
with dropsy, whether local or general in character. The
remarks previously made with reference to cold applications
after the sweating bath in cases of obesity are equally appli*
cable to cases of dropsy. Respecting the application of cold
in cardiac cases, it is only necessary to add that usually
the cold-towel rub or cold friction, and, in persons sufficiently

234 RATIONAL HYDROTHERAPY.

may retire at once. By morning the normal equilibrium will
have been so completely established as to obviate the risk of
taking cold.

In cold applications following a sweating bath in cases
of abdominal dropsy and dropsy of the chest, special r^^ard
should be paid to the local condition present. In abdominal
dropsy, cold applications should be made first and chiefly to
the arms and the upper portion of the back, while in dropsy of
the chest the chief part of the application should be made
to the lower half of the body, the purpose of this being to
prevent too strong a reaction in the congested and disabled
parts by first producing reaction in the parts of the body most
remote from the diseased structures.

The Sweating ^^e sweating bath is of great value in icterus,
Bath in both as a means of relieving the intolerable

Icterus. itching, and of aiding the elimination of bile.

The electric-light bath is especially useful for this purpose.
The sweating process should, however, in these cases be em-
ployed only until profuse perspiration is induced. The neu-
tral bath should then be administered for twenty or thirty
minutes, at a temperature of from 92^ to 95*^ F. Very hot
sponging frequently relieves pruritus when other measures faiL
656 Sweating baths may be advantageously used

Surgical Uses ^g a means of producing general muscular
Sweating Bath, relaxation for the purpose of aiding in the
reduction of a hernia or a dislocated limb.
The relief thus afforded by a hot bath is partly due to the
diminished muscular tone, which lessens the tension of the
muscles controlling the joint, and in part to the peculiar
influence of heat upon the white fibrous tissues, the chief
constituent of the ligaments which bind together the bony
structures entering into the formation of a joint. Heat
expands white fibrous tissue, thus relaxing the tissues.

The general sweating bath should be employed in cases
of hernia not readily reducible by skilful taxis without the
bath. The hot immersion bath is perhaps the most appro-

THERAPEUTIC EFFECTS. 235

priate measure for this purpose, and has often proved very
effective. The patient lies in the bath with the head (not the
shoulders) raised, and the knees well drawn forward.
After the bath has been continued long enough to induce
active perspiration, the physician employs the usual means
for reducing the hernia, the patient still remaining in the
bath.

In case of dislocation, the general sweating bath is not
always required. It is usually sufficient to apply a large
fomentation or a hot pack over the joint and the muscles
controlling it, to secure the necessary relaxation of the
muscles and ligaments.

The value of the sweating bath as an elimina- 657
Depnrative or ^jye measure is perhaps not so great as it has
m^^ ^ been popularly believed to be, as the percent-

age of urea and other toxins contained in the
sweat, especially when profuse perspiration is induced, is
small, — indeed, very small when compared with the per-
centage of these tissue poisons ordinarily found in the urine.
That a considerable amount of the waste elements ordinarily
eliminated through the urine may be, however, under some
I circumstances, carried off through the skin, is evidenced by
j the peculiar urinous odor noticeable when profuse perspira-
tion is induced in a patient suffering from renal insufficiency.
The author has often seen most excellent results from the
application of a hot-blanket pack and other forms of the
sweating bath in cases of uremic poisoning arising from
sudden suppression of renal activity as a complication of the
latter stages of pregnancy, and in urinary suppression occur-
ring in surgical cases, especially after a severe abdominal
operation, as a hysterectomy or a prolonged operation for
the removal of diseased uterine appendages.

The sweating bath is occasionally valuable as a means of 658
averting or aborting a threatened attack of uremic convul-
sions. A patient under the author's care many years ago,
who had for some years suffered from chronic Bright's

236 RATIONAL HYDROTHERAPY.

disease, discovered for himself that the characteristic symp-
toms of incipient uremic poisoning might be thoroughly
controlled by a hot bath, and had, accordingly, fitted up in
his own home a vapor bath, into which he entered whenever
threatened with an attack of convulsions, remaining in the
bath until the symptoms had entirely disappeared. He stated
that he sometimes remained in the bath more than forty-eight
hours continuously. Such prolonged applications are not,
however, to be commended as generally useful, at least not
without interruption every hour or two by the application of
cold in the form of a cold trunk pack, applied by means of a
single thickness of linen wrung very dry out of very cold
water and well covered, so as to secure prompt reaction;
by cold over the heart, or by cold friction.
659 The climinative effects of the sweating bath

Bath8"lfi^^^ may be resorted to with advantage in all

Toxemia. forms of chronic toxemia due to the retention

of tissue poisons, as gastric neurasthenia, mi-
graine, jaundice, and chronic ** biliousness.** To be of the
greatest service in these cases, however, the sweating bath
should not be too prolonged, and should be immediately fol-
lowed by short tonic applications of cold water, in the form
of the cold douche (1020), cold wet-sheet rub(12J6), or cold
plunge (1108). The electric light (1250) is one of the most
suitable means of applying heat in cases of this sort, as it
induces profuse perspiration without long exposure of the
body to a hi^h temperature, and produces tonic as well as
eliminative effects.

Sweating applications may be made to a limited portion
of the body when desirable, as in the treatment of exudates,
the enlarged and stiffened joints of chronic rheumatism, plu-
ritic adhesions in the chest, chronic peritonitis, and in cer-
tain forms jof neuralgia, as sciatica.

The most serious objection to the application of heat in
many of the cases mentioned, especially in rheumatism and
gout, is the danger of diminishing the general bodily resist-

THERAPEUTIC EFFECTS. 237

ance, leading to the contracting of colds through slight expo-
sures, by which the good effects of the treatment may be more
than lost. With care,* however, this may be avoided.

In diabetes with emaciation, and when the perspiration
does not contain sugar, the sweating bath must be avoided,
or at least used with extreme care. In cases of skin disease
accompanied by painful eruptions, furuncles, or other evi-
dences of extreme excitation and irritation, if the sweating
bath must be employed, it should be in the form of the
vapor, the Russian, the hot-water, or the electric-light bath.
The Turkish and dry-air baths irritate the skin, while the
wet-sheet pack is too exciting.

The mucous membrane is closely allied to the 660
^^^ skin in its structure and functions. Thus,

applications which produce general perspira-
tion of the skin at the same time encourage increased activity
of the mucous membrane, through its close sympathy with
the skin. This explains the great relief experienced by
persons suffering from a severe cold and obstruction of the
respiratory passages within a few moments after entering a
F Russian- or vapor bath. A dry, painful cough is quickly
loosened and relieved under the influence of a warm bath ;
but if great care is not exercised, the condition is likely to be
decidedly aggravated by a fresh cold acquired through the
diminished vital resistance naturally resulting from the atonic
reaction of heat. Persons suffering from hay fever, so called,
and other forms of asthma are often quickly relieved by the
Russian bath, but the distressing symptoms are very likely to
return with redoubled force as the result of some inadvertent
exposure, unless the cutaneous activity is maintained, which
is likely to be very exhausting if long continued. This meas-
ure is useful only as a palliative. Cold applications are re-
quired for the tonic effects absolutely essential to permanent
relief from chronic asthma. Hay asthma, of course, requires
change of climate and the services of a specialist, as well as
general tonic baths.

238 RATIONAL HYDROTHERAPY.

Local applications o( vapor in the form of steam inhala-
tions are also of great value in the treatment of those forms
of throat, ear, and nose affections in which increased secretion
is desirable, the expectorant effects of these measures being
very marked.

The chest pack (1373) is an invaluable means of favorably
influencing the pulmonary nmcous membrane. In a febrile
state, Off acute congestion, do not cover with oiled muslin or
other impervious material; but if chronic passive congestion
is present, as in bronchial catarrh, apply an impervious cov-
ering, so as to procure more decided revulsive and derivative
effects.

The expectorant effects of water, particularly in the form
of the sweating bath, are often of service in breaking ap a
hard cold, if it is taken at the beginning. If, however, several
days have elapsed since the exposure, the sweating bath is
not likely to effect a radical cure, but it may be the means
of shortening the attack, provided, of course, that sufficient
precaution is taken against exposure to chill subsequent to
the bath.

Water drinking, and especially the free use of hot water
internally, is of the highest value as a means of encouraging
activity of the skin and mucous membranes. A copious
draft of hot water should always be taken before entering a
sweating bath of any kind. Cold water may be substituted, if
greatly preferred, provided it is not swallowed so rapidly and
in such (luantity as to produce a chill.
OGl The cold douche applied over the lower por-

Eff t ^ ^'^" ^^ ^^^ sternum has long been recognized

as a means of stinmlating the kidneys to ac-
tivity. A short cold douche to the loins is effective in the
same way. *'

The cold trunk pack is also a very efficient methoa of
stimulating activity of the kidneys. When used for this
purpose, the pack may be confined to the central and lower
portions of the trunk, the sheet with which it is applied

THEKAPEUTIC EFFECTS-

239

Cbnlifoglk

ing wrung as dry as possible out of veiy cold water. The
fttck may be allQwed to remain in place for two or three
hoors^ or antil diy. It may be renewed every hour or two in
cases ID which active diuresis is required.

Fomentations to the lumbar region may be advantageously
employed in cases of renal insufficiency, and for the purpose
ol obtaining revuisive effects in cases of pain in the kidneys.

The cold hepatic douche is certainly one of 663

the most effective means of stimulating the

liven Both the circulation and the functional

activity of the liver may be profotmdly intltienced by the

application of cold water by means of the horizontal jet,

with considerable pressure, over the lower portion of the

Rght cbe-st and the epigastrium. The alternating douche

, is z more agreeable and in most cases an equally exciting

I measure. Where congestion or pain is present, the hot

or Scotch fan douche* without pressure, may be substituted

forthe cold or the alternate douche (104-4), or if the douche

^jnot be conv^eniently administered because of the feeble-

|fof the patient, or for any other reason, the fomentation

^5^ be substituted- The effect of the fomentation will be

pfoloiiprd ;in<i intensified if followed by the heating compress.

In painful affections of the liver, fomentations repeated

«my two or three hours, with the heating compress applied

during the interim, may be commended as a most efficient

i&eaits of relieving pain and restoring the organ to its normal

fjtite. The hot douche and fomentation followed by the wet

lie, are of the highest value in cases of infectious jaun-

5. gall-stones, and in all acute congestions and inflamma-

of the liver

The cold douche (JO^ to 70^ F,) applied over 663

the ret^ion of the stomach by means of the

horiisontal jet with considerable pressure (ao

to 30 lbs,)* is the most efficient means of stimulating the pro-

duction of an abundant quantity of g^istric juice of efficient

qaality. This is the measure par excellence to be employed

240 RATIONAL HYDROTHERAPY.

in the treatment of hypopepsia. The alternate douche may
be employed to better advantage than the cold douche in
many cases. The author makes use of the circle douche
or the percussion douche, which produces more pronounced
effects than the ordinary horizontal douche. The percussion
douche should be employed if possible, especially in the cold
application, as the mechanical effects of percussion contribute
to the effects produced.

664 The ice-bag over the stomach for an hour before eating
is a most powerful peptogenic procedure, and is of the highest
value in cases of atonic dyspepsia or apepsia and hypopepsia.
The good effect of the treatment is quickly shown in im-
proved appetite and digestive vigor.

The application of heat over the stomach for an hour or
two after eating is also a peptogenic measure of high value.

665 In cases of hyperpepsia in which it is desirable to diminish
the secretion of hydrochloric acid or lessen the production
of gastric juice, as in gastrorrhea, it is necessary to employ
measures of a character opposite to those used for peptogenic
effects; in other words, to secure antipeptogenic effects.
This may be best accomplished by means of the hot douche
over the region of the stomach. The heating trunk compress
and the hot and cold trunk pack (1367), applied just before
eating and retained for an hour or two afterward, are most
excellent means for relieving gastric irritability and combat-
ing painful hyperpepsia.

666 „ , Of all methods whereby the menstrual func-
hmmenagogic , • i i , , .

Effects. ^^^" ^^^y "^ stmiulated, hydric measures are

the safest, and at the same time the most
effective.

Perhaps the most powerful of all excitants of the men-
strual function is the cold douche to the loins (horizontal jet
or spray, temperature, 50^ to 70 ' F. ; time, 2 to 10 sees. ;
pressure. 20 to 40 lbs.).

The prolonged hot foot bath (temperature, 100*^ to 104^
F.), the hot sitz (temperature, 100- to 104 ), the hot

THERAPEUTIC EFFECTS. 24 1

enema (temperature, 105^), the hot immersion, the tonic hip
pack daily in the intermenstrual period, and the hot hip
pack (temperature, 110°, 10 to 15 min.) are among the best
measures for use in cases of this sort. General tonic meas-
ures are, of course, needed when the amenorrhea is due to
anemia.

The revulsive effects obtainable by water con- 667
Rewkive and stitute one of its most interesting and valuable
gH^glj^ therapeutic uses. This effect is nothing more

nor less than a strong circulatory reaction
localized in accordance with the indication present. The
anatomical basis of this therapeutic action is the association
of vascular areas in the skin with definite and well-understood
visceral vascular areas. These associations have been else-
where carefully pointed out, so that we need not here devote
space to a lengthy description of them. It will only be nec-
essary to point out the principle upon which the revulsive
method rests, and the best methods of utilizing it.

As previously stated, applications of cold water to the
surface of the body set up both circulatory and thermic reac-
tions. In revulsion pure and simple, it is desirable to obtain
only the circulatory reaction; hence the application should
be so managed as to avoid thermic reaction except in those
cases in which the excitement of tissue activity by the aid of
the thermic reaction will not interfere with the results sought,
^incases of passive congestion without pain (673).

When this circulatory reaction is produced in an area 668
0' the skin supplied by an artery, a branch of which supplies
some deeper structure, as in the case of an inflamed mus-
cle or joint, a congested nerve, or an alveolar abscess, a
considerable amount of blood may be by this means diverted
^^ay from the inflamed or congested part, thus affording
^^lie{ from urgent symptoms by producing a local hyperemia
^' the skin and a collateral anemia of the affected part. By
^^^ntinuous cold applications, local anemia and collateral hy-
peremia may be produced.
16

242 RATIONAL HYDROTHERAPY.

669 Fluxion, or movement of the blood, is one of

the most important of all the functional modi-
fications which may be affected by hydric applications. The
permanency of chronic disease is generally due to a disor-
dered state of the blood-vessels of the affected parts.

The most important thing that can be done therapeutic-
ally in relation to a chronically congested organ is to increase
the supply of healthy blood, not necessarily by augmenting
the volume of blood which the organ contains at any moment,
but by quickening the rate at which the blood passes through
it. This may be accomplished by increasing the energy and
activity of the heart as well as the activity of the blood-
vessels of the affected parts, and by concentrating the blood
in the diseased organ by the use of appropriate measures.

The blood is the great healer. In the words of Holy
Writ, **The blood is the life." It washes out of the tissues
the waste and toxic products which they contain, and brings
new vitalizing and energizing elements to take their place.
The only way in which a diseased organ can be restored to
permanent health is by complete renovation in its tissues,
since function depends upon structure. This requires a tear-
ing down and a rebuilding through increased movement of
the blood and lymph.

gjQ Some of the measures most useful for this pur-

M thods^ pose are, first, short cold applications followed

for Combat- by vigorous rubbing. The cold application
ing Superficial must not be too long, otherwise the anemia
Anemia. ^,j|j j^^ increased ; but the rubbing should be

sufficiently prolonged and vigorous to insure thorough circu-
latory reaction, which is the end sought. The cold percus-
sion douche, temperature 20 to 60'-', duration 4 to 10 seconds,
is most cflicicnt. Cold affusion and other measures are effi-
cient just in the proportion in which mechanical and thermic
effects are combined. When the anemia is general, the cold
bath should be preceded by the incandescent electric-light
bath or some other form of hot bath, from 3 to 5 minutes, or

THERAPEUTIC EFFECTS.

243

a sufficient time to heat the skin, as in these cases the heat-
generating powers of the body are lowered, and the abstrac-
tion of heat is not well borne. The application should be
intense, as a douche at high pressure, vigorous wet-sheet rub-
bing, or a vigorous shallow bath, of short duration. The
temperature may be, for the general douche, 60^ to 70^ F. ;
the shallow bath, 70^ to 75^ ; the wet-sheet rub, 60^.

The hot and cold compress is a powerful revulsive meas-
ure; the heating compress, preceded by a fomentation or
nibbing of the parts sufficiently prolonged, is also very effi-
cient The compress should be covered with flannel, but
with no impervious covering, so that the slight cooling effect
produced by evaporation may maintain vigorous skin activity,
and prevent superheating and resulting vascular paralysis.
Fomentations at a temperature of 104^ to 106^, prolonged from
15 to 20 minutes, is another valuable means in many cases.
The fomentation should not be too hot, as Max Runge has
shown that prolonged application at a temperature above
^04^ produces paralysis of the small vessels, with turgescence
from slowed movement of the blood. What is desired is not
M paralysis and congestion, but activity of the vessels. In ane-
I niia there is intense tonic spasm, which is ordinarily overcome
/ by the relaxing effect of heat; but if the heat is at too high a
f temperature, or the application too prolonged, the vessels of
the parts may be paralyzed instead of energized. Increased
activity through vital stimulation of the tissues is the end
sought by hydric applications, and this object may be read-
ily attained by the varied means suggested, which individ-
ually meet the peculiarities encountered in the treatment of
special cases.

In deep anemias, general cold applications are
of special service, especially when many of
the large viscera are involved in the morbid
state, a condition which, though generally
overlooked, is, in the opinion of the author, of
very frequent occurrence. Tonic spasm of the vessels set up

Adapted to Ane-
mia of Deep-
Seated Orgaas.

ii

244 RATIONAL HYDROTHERAPY.

by the irritation resulting from these anemias is usually due to
a strain upon the sympathetic nerves occasioned by prolapse of
the stomach, colon, viscera, and other forms of visceral dis-
placement. Contraction of the muscular walls of the hollow
viscera, such as the colon, resulting in obstinate constipation,
as well as contraction of the visceral blood-vessels, is not an
uncommon condition due to this cause.
671 Renal insufficiency, hepatic inactivity, and functional fee-
bleness of all the viscera are also conditions due to this cause.
Amenorrhea is another illustration often encountered of ane-
mia due to vascular spasm. In these cases the condition of
the viscera is precisely the same as that of the feet and hands
of the nervous dyspeptic, which are often pale, cold, and
bloodless, not because of feebleness of the heart, but because
of vascular spasm.

For the relief of conditions in which there is general vis-
ceral anemia, as in entcroptosis, nephroptosis, gastroptosis,
and atony of the pelvic viscer^, general cold applications,
such as the douche at 80 for 30 to 60 seconds, the shallow
bath at So- to 85^ for 5 to 6 minutes, the tonic half-pack,
cold fiiction, and the wet-sheet rub, are means possessed of
wunilerful curative power. Very low and ver}' high teminira-
tures must be avoided on account of excessive excitation of
the skin. What is desired is moderate fluxion between the
surface and the interior of the body, with general increase in
the movement of the blood and moderate concentration of
the blood in the internal viscera. This rctrostasis, if exces-
sive, may bo followed by reaction, leaving the parts in a con-
dition of greater anemia than before.

Such local anemias as occur in amenorrhea, and also in
general atony of the genitals, indicated by coldness of the
external parts, and infantile uterus, are combated by ice-bags
and ice compresses to the spine. A very cold lumbar douche,
a cold douche to the hypogastric region and the inner surfaces
of the thighs, and the tonic pelvic pack may be advanta-
geously used in most cases, in amenorrhea, the best results

THERAPEUTIC EFFECTS.

245

Hydrintic
Measures for
Relief off Deep
Gontestloiis.

will be obtained from the measures named, supplemented by
vaginal irrigation at iiO'' for 10 minutes and 80^ for i min-
ute. In the treatment of these visceral anemias it is not only
important to concentrate the blood in the affected part, but to
increase the activity of the entire circulation of the body by
improvement in its general conditions, so that the whole vital
tone may be elevated and the blood supply increased.

Visceral congestion is illustrated in gastro-
duodenal catarrh, intestinal catarrh, infectious
jaundice, splenic and hepatic congestion, con-
gestion of the spinal cord, menorrhagia, sub-
involution and general relaxation of the uterus
and appendages, congestion of the prostate, catarrh of the
bladder, catarrh of the rectum, hemorrhoids. Congestion of
the sympathetic ganglia, giving rise to hyperesthesia and
vascular spasm of the parts supplied by these ganglia, as indi-
cated by tenderness of the epigastrium and the umbilical
points (168), is a condition responsible for a great variety of
tnorbid phenomena expressed for the most part in remote
\ symptoms rather than by local indications.

For pelvic congestions, very hot fomentations or a hot
douche administered to the lumbar spine and the inner sur-
faces of the thighs, render invaluable service. For congestion
of the spine, fomentations, followed by the heating spinal
compress (1355) covered with flannel only, is an excellent
measure, especially in cases in which spinal congestion and
/rritation coexist.

In deep passive congestions, alternate hot and cold com-
presses may be applied to the related cutaneous area, fol-
/owed by a heating compress covered with flannel, to be
changed once in 40 minutes. By this means the dilated
blood-vessels of the congested parts are made to contract
and relax alternately, so that the organ is emptied of its
venous blood, and the muscular walls of its vessels, being fed
by fresh blood, are better prepared for vigorous and sustained
contraction under the influence of the cold compress.

672

246 RATIONAL HYDROTHERAPY.

In the treatment of acute inflammation, whether near the
surface (but not involving the skin) or affecting a deeply
seated vise us, great care must be observed to avoid such pro-
cedures as may cause increased Tfluxion of blood toward the
inflamed organ. For example, in inflammation of a muscle,
a cold application over the affected part will cause local
anemia of the skin and collateral hyperemia, of the inflamed
tissues, thus aggravating the condition, unless the application
is very intense in character, as an ice-bag or an ice poultice
long continued. The fomentation, on the other hand, by
producing hyperemia of the skin, causes collateral anemia of
the muscle, and so relieves pain. A simple compress at 60^,
changed every half hour or every hour, succeeds better thaiL
very cold applications, maintaining after fluxion througl^
reaction, while to a degree reflexly affecting the inflamecS.
area in a favorable way through vasomotor influence.

In the case of deeply seated inflammations, prolonged
applications to the associated cutaneous areas, with renewals
every 20 to 40 minutes, succeed better than continuous very
cold applications, as renewed contraction is produced at eacft
renewal, thus maintaining both the vessel tonus of the affected
part and an active fluxion of healing blood through its vessels.

The term revulsion is perhaps most properly applied
to effects produced in an internal organ, as the abdominal
viscera or the brain, by applications to a cutaneous area
in reflex relation therewith. In relation to these effects
it may be sufficient here to remark that the vessels of the
internal area are, in general, affected in the same manner
as those ol the skin. A short cold application causes tem-
porary contraction of the vessels of the skin, and likewise
of the associated internal vascular area, and is quickly
followed by reaction, with dilatation of the vessels of both
areas.

A prolonged cool application causes continuous contrac-
tion of the vessels of both the external and the internal
associated areas.

THERAPEUTIC EFFECTS. 247

Very hot applications produce effects similar to those
ol cold applications. Warm applications produce little
or no reflex effects.

Very hot applications to the abdominal surface afford

the most efficient revulsive means of relieving visceral pain

in this region of the body, whether the pain is neuralgic

or inflammatory in character; but the application must be

very hot (115"' to 130°), and the high temperature must

be maintained by frequent renewal of the application. The

soriace vessels become filled with blood by exhaustion of the

constrictors through the accumulation of heat in the skin; but

the internal associated vascular area is constantly cooled

by the l)lood currents passing through it, so that the first,

or vasoconstricting, effect is maintained.

From the above it is evident that we must depend upon
very cold, cold, cool, hot, or very hot applications for pro-
ducing revulsive effects. Neutral or warm applications are
incapable of awakening the nervous activities which are the
essential factor in this class of hydriatic effects,
g^ For purely revulsive effects, we seek to obtain 673

Re>'nl8ive results very different from those which follow

Effects. a short cold application, but we depend upon

the same reflex activities and the same exciting
nieasures for accomplishing the desired end. We are able to
do this by a carefully managed combination of the atonic
reaction of heat with the tonic reaction of cold, so manipu-
lating the measures employed as to secure the strongest pos-
sible circulatory reaction while wholly suppressing thermic
reaction. "

As inflammation involves increased cell activity, it is evi-
dent that the suppression of thermic reaction in obtaining
revulsive effects is a matter of primary importance; but,
singularly enough, it is a thing which has generally been
entirely overlooked, and hence the frequent failure of at-
trinpts to employ water for revulsive effects. The physician
or attendant who knows how to apply, under varied circum-

248 RATIONAL HYDROTHERAPY.

Stances, hydriatic measures so as to produce the best revulsive
effects, is an adept in the employment of water for curative
purposes, and is entitled to be called a hydrotherapeutist.

674 The true revulsive application invariably begins with an
application of heat. The application may take the form of a
douche, a fomentation, dry heat, as a hot bag, an electric-
light bath, immersion, affusion, etc. Powerful revulsive
effects may be obtained from the application of heat alone,
provided the temperature is sufficiently high. The tempera-
ture required is from i lo^ to 130^ F. If the surface involved
is very small, even higher temperatures may be used. The
effect of such an application is to dilate the surface vessels,
particularly the venules, and thus to divert to the surface a
considerable amount of blood.

The revulsive effect of heat is often inconvenient, how-
ever, in cases in which it is necessary to extend the appli-
cation to a very large area, or to the whole surface of the
body, for the reason that such extensive applications of heafc^
give rise to excitation of the cerebral and spinal centers*
which interferes with the application, and produces untoward
effects.

07 5 Revulsive effects are also obtainable by the application 0/

cold, but in revulsion by cold a strong thermic reaction is set
up in connection with the desired circulatory reaction, which
is often most undesirable and injurious. By a proper combina-
tion of heat and cold, we are able to obtain not only a more
powerful circulatory reaction, and hence more powerful revul-
sive effects, but the thermic reaction may be either wholly
suppressed, or may be permitted to any degree, more or less,
as may be advantageous to the results sought.

When a hot application is made to the surface, a consid-
erable amount of artificial heat is absorbed by the skin and
underlying tissues. If the hot application be followed by a
suitable cold application so adjusted and manipulated as to
absorb just the amount of heat which has been absorbed by
the skin, — in other words, so as to antidote and neutralize the

THERAPEUTIC EFFECTS. 249

artificial heat to which the skin has been subjected, — the skin
is left at its normal temperature. Thermic reaction is set up
only when the temperature of the skin is lowered below the
normal point ; hence, if the application of cold is barely suf-
fident to bring the skin to the normal temperature, no ther-
mic reaction will take place.

How may this be accomplished ? It is certainly apparent
that it is practically impossible to make such use of a ther-
mometer as to enable one to apply cold in just the measure
to balance exactly the previous application of heat. But, for-
tunately, nature has given us a perfect indicator whereby this
maybe accomplished. The reaction produced by heat results
in a dilatation of the surface vessels, but this dilatation involves
the small veins to a much greater degree than the small arte-
ries; in other words, heat relaxes the venules more than the
arterioles, thus giving rise to a disproportionate increase of
venous blood in the skin. The result is a dusky or purplish
red color, as a characteristic effect of hot applications to the
skin. The reaction induced by cold, on the other hand, pro-
duces an active dilatation of all the surface vessels, both
arterioles and venules, thus producing a quickened circulation
through the skin rather than stagnation.

This effect of cold, in increasing the circulation of the 676
Wood through the skin and dilating the small arteries as well
as the veins, gives rise to a crimson or bright-red color, which
is easily distinguished by a practiced eye from the dusky hue
resulting from a hot application.

It is evident that if an application of cold follows an appli-
cation of heat upon the same surface, a change of color will
appear. This change of color begins the instant the heat
communicated to the skin has been absorbed by the cold
application ; hence the change in the color of the skin be-
comes a perfect guide in the employment of revulsive meas-
ures, showing just the right instant to check the cold appli-
cation in order to secure a purely circulatory reaction and
wholly to suppress all thermic reaction.

250 RATIONAL HYDROTHERAPY.

A little practice is required to enable one to distinguish, at
a glance, the color produced by reaction to heat from that
produced by reaction to cold. It is, of course, evident that
the effect of the cold application must be watched with the
greatest care, and must be interrupted the instant the looked-
for change in color appears. The time usually required with
the cold douche is ten to fifteen seconds.

In the employment of heat for revulsive effects, the result
will be (within certain limits) as much more intense as the
temperature is high and the application prolonged. The
maximum effects are usually reached in from ten to fifteen
minutes.

In the employment of cold applications for revulsive
effects, the effect will be as much more intense as the tem-
perature is low and the percussion strong.
(J77 In the production of revulsive effects by the

Means of Hot combined use of heat and cold, the effects will
and Cold be more intense the greater the difference in

Applications. temperature between the hot and the cold ap-
plications ; hence, for the strongest effects the
hot application should be as hot as can be borne. If the area
is small, the temperature maybe from 115"' to 130^^ F.,
though a temperature of from 1 10' to 120"^ is generally safer.
The higher temperature may be readily used if the horizontal
jet or spray is employed instead of the immersion bath, since
the current of water may be applied with aspersions, and
made in rapid succession upon different portions of the
surface. In the alternate douche a temperature of from 50^
to 60^ for the cold application is desirable, and a still lower
temperature may sometimes be employed, though ice-water
and ice are seldom used except when the application is con-
fined to very limited areas.

Revulsive effects may be produced either by percutient or
non-percutient applications, or by a combination of percutient
and non-percutient means ; for example, revulsion to the
lower extremities may be obtained by a very hot foot or leg

THERAPEUTIC EFFECTS.

251

bath followed by a cold douche, as well as by the hot and

cold douche. The leg or foot bath may be of seven to ten

minntes' duration, but generally an exposure of the surface

to an application of heat for four or five minutes is sufficient

to obtain the effects desired.

During the application of the cold spray, the color of the
surface acted upon must be carefully watched, and the
instant the bright red produced by the reaction of cold
begins to make its appearance, the cold application should
cease. By subsequent friction the circulatory reaction
may be increased. Equally good effects are obtained, and
somewhat more speedily, by the employment of the hot
douche, especially the vapor douche, preceding the cold
douche. Three or four minutes will suffice for the hot appli-
cation, and from ten to fifteen seconds for the cold application.
When neither hot immersion nor the cold douche can be
employed, a fomentation followed by a cold compress or
cold friction may be used. The latter is an excellent measure
in the case of bedridden patients. When the skin surface
to be acted upon is so sensitive that percutient applications
can not be tolerated, a towel wrung as dry as possible out
of very cold water should be applied for twenty to thirty
seconds after a fomentation.

One of the most generally useful of all the various re-
vulsive applicatio/is which can be made is the revulsive
^tch douche, which consists of a very hot horizontal jet
or spray for three or four minutes, followed by a very cold
douche from five to fifteen seconds."

Revulsion is perhaps most valuable as a means 678
of relieving pain. When analgesic effects are
desired, the greatest care must be taken to
avoid all thermic reaction, by the methods
been already explained. The Scotch douche

l^«vul8ioo as
>■ Analgesic

^fcich have

^^ been used with fi^reat success in hundreds of cases of
sciat/c neuralgia, to the relief of which it seems to be espe-
^^lly adapted.

252 RATIONAL HYDROTHERAPY'.

The Scotch douche may be used with equal success in
neuralgia in other regions, though sometimes with less con-
venience. In cases of neuralgia accompanied by extreme
sensitiveness of the skin, strong pressure must be avoided ; in
some cases, also, extremes of temperature give pain. In such
cases the neutral douche with little pressure (3 to 5 lbs.) must
be used until the surface pain is lessened, as a preparation for
the Scotch douche, which should at first be employed at ver>'
moderate temperatures, and with little pressure, both tem-
perature extremes and pressure being progressively increased
as tolerance is established.
679 In spinal irritation, in intercostal neuralgia, in

Analgesic lumbago, in crural neuralgia, and even in cases

Scotch I>ouche. ^^ facial neuralgia, the Scotch douche may be
relied upon as a sovereign remedy, though the
application must be more or less modified to suit the varying
conditions under which it may be employed. For enteralgia
and gastralgia, apply the fomentation for 10 or 20 minutes.

In chronic visceral congestion, the Scotch revulsive douche
may be administered to those areas of the skin which are in
reflex relation with the several viscera. When it is desired to
draw the blood away from the upper part of the body, it is
necessary to localize the application to the lower extremities
by means of the Scotch douche or by a hot leg or sitz bath,
followed by a short cold application.

When it is desirable to produce revulsion in the opposite
direction, the Scotch douche may be administered to the up-
per part of the back and the arms. Such an application is
often useful is cases of pelvic congestion or hemorrhage, while
at the same time efforts are being made to reduce the con-
gestion of the affected parts by other suitable measures.
The Hot and This ingenious hydriatic application, first de-
Cold Trunk scribed by Winternitz, is one of the most valu-
Pack. able of all revulsive measures. It is especially
serviceable as a means of relieving gastric irritability as-

THERAPEUTIC EFFECTS. 253

sodated with hyperesthesia of the great abdominal sympa-
thetic centers. The various forms of the hot and cold com-
press, and their several applications, will be found fully
described elsewhere.

General revulsive effects may be advanta- 680
iK© Effects geously employed in such disorders as cholera,
chronic rheumatism when the joints are uni-
?ersally affected, and in cases of heat-stroke in which the
surface is pale. It is a useful measure in all forms of shock
and collapse, as a means of combating internal congestion.
Revulsion in these cases may be sought without care to sup-
press the thermic reaction ; hence it is not always necessary
to precede the cold application by a hot one, although as a
nile this is desirable when it can be accomplished without too
much delay, and the cold application may be continued long
enough to obtain the excitant or tonic effect.

The lumberman brings the blood to his blanched and freez-
ing feet by pulling off his boots and socks and rubbing the
parts with snow. The Persians combat the collapse from
cholera by vigorously rubbing the surface with cold water.
In accordance with this idea, it has been the practice from
t'nie immemorial in Persian cities to place upon every street-
corner vessels of water during epidemics of cholera; and if
a person falls upon the street, the bystanders immediately
deluge him with water, and rub the whole surface of the body
H'ith the greatest vigor.

The author has for many years made use of similar means
in collapse under anesthesia, in surgical shock, and in similar
cases, preferring, however, whenever possible, to make the
cold application short, and to precede or alternate it with a
bot application. In this manner both an excellent circulatory
eaction and simultaneously a calorific effect may be obtained.
The hot immersion bath may sometimes be used with
idvantage as a revulsive measure for the relief of visceral
rongestion, as in acute nephritis, especially in the nephritis

254 RATIONAL HYDROTHERAPY.

of scarlet fever. It is equally useful in cerebrospinal menin-
gitis. The hot-blanket pack may be successfully used in the
same conditions. Care must, however, be taken to guard
the head by a large towel saturated with cold water; and
if the heart is feeble, or seems unduly excited, it should
be protected by an ice-bag placed over it during the bath,
or by a cold chest compress.

681 When the suppression of thermic reaction is not nec-
essary, as when purely revulsive effects are not required, the
alternate douche may be employed instead of the Scotch
douche. In this douche, as elsewhere explained, the appli-
cations of heat and cold are ol equal length. The extremes
of temperature are as great as can be borne, provided the
exciting effects of such an application are not contraindi-
cated; the alternations should be eight or ten in number.
The application may be renewed several times a day, or as
frequently as required.

In place of the alternate douche, the alternate foot bath,
alternate affusion, alternate compresses, and various other
forms of applying heat and cold in alternation may be used,
the measure being adapted to the case in hand.

The alternate douche differs from the Scotch douche in
that it is primarily exciting rather than calmative or seda-
tive in its effects. It is one of the most exciting of all
hydriatic applications. Nevertheless, it often relieves pain
by its powerful revulsive effects.

682 So-called derivative effects do not differ
Effects ^^ essentially from revulsive effects, except that

they are generally somewhat less intense in
character, and the term is applied to the relief afforded a
congested organ by diverting the blood into a distant part, as
in relief of cerebral congestion by a hot foot bath. All the
measures suggested for producing revulsive effects are equally
useful for inducing derivative effects. Ordinarily, however, it
is not necessary to avoid thermic reaction in producing deriva-
tive effects. Any measure whereby the l>lr)0(l can be drawn

THERAPEUTIC EFFECTS*

255

distant from the congested part to be relieved
Fmay be utilized for this purpose. Tbe most generally useful
proc^ures are the following: The hot leg bath; hot sitz;
short cold sttz; rubbing sitz; leg pack; half pack; hot, cold,
or alternate douche to legs or arms, as may be indicated;
cold friction; rubbing shallDw pelvic pack; heating abdomi-
I nal compress. General derivative effects may often be ad-
vaatigeously procured by the wet-sheet pack, the rubbing
wet sheet, and general cold friction. Derivative measures
area! the greatest possible service in the treatment of insom-
nia, piilinonar>^ congestion or hemorrhage, apoplexy, acute
mania, and cerebral congestion.

By a reversal of the method, cerebral anemia may be 683
combated as successfully as the opposite state. For example,
* short cold douche to the feet powerfully stimulates the circu-
lilion of the brain, and the short cold douche to the lumbar
r^n and feet is an excellent means of combating amenorrhea.
In Ibis connection may be properly mentioned an impor-
lant application of the principle of derivation which may be
utilized by one skilled in hydriatry to most excellent advan-
taireiethe use of the cold douche and many other general
cold applications,

It will be recalled that tbe contraction of the surface ves-

icbsel up by the application of cold water is accompanied by a

limfJar but more brief contraction of that particular vascular

iftft which is in reflex nervous relation with the area operated

trpocu An application made to the entire surface of the

fcody causes a momentary contraction of the peripheral ves-

tds Ihrotighotit the entire body, raising the blood pressure

uid focciog the surplus blood into the large venous channels,

eq^^ally those of the portal circulation and the associated

viscera, — the spleen, the Hver, the stomach, the pancreas,

id the intestines. Reaction and dilatation quickly follow if

3c cold application is a short one,— more quickly, in fact,

iotcmal parts than at the surface, for the reason that

ic tiitertuU tissues are surrounded by heated organs, and are

256 RATIOIJaL ttVDilOTHERAPV.

not exposed to the continued influence of cold through evapo-
ration, and because of the inrush of blood from the surface to
the interior of the body.

When the application is made to a circumscribed portion
of the surface, the reaction which follows, both external and
internal, is likewise circumscribed, and particularly as regards
the viscus or viscera associated with the area operated upon,
which may be the stomach, the liver, the kidneys, the brain,
the uterus, or some other internal part. The circulatory ac-
tivity of the skin following such an application, indicated
by redness and heat, is an outward indication of the quick-
ened activity in the internal parts under the influence of
the application.
684 While this vascular and cellular activity is sometimes
desirable, it must often be suppressed as much as possible.
When, in such cases, general cold applications must be made,
any part that is likely to be damaged by the congestion follow-
ing th6 first contact of cold water with the skin, may be
protected by the application to the cutaneous area associated
reflexly with the part, of water at a lower temperature than
that to be used in the general application, or in case the
douche is used, both lower temperature and higher pressure
maybe employed. The effect is to cause so Vigorous a pri-
mary contraction of the visceral vessels that the part will
be protected against the mechanical distension arising from
the sudden inrush of blood from the surface when the gen-
eral application is made. The brain should be always thus
protected before either a cold or a hot bath, by bathing
the face, neck, and scalp with cold water, and applying a
cold wet towel. The liver, when congested, may be pro-
tected by a short hepatic douche before the general douche.
Congested pelvic viscera should be protected by the douche
to the lumbar region and the thighs. In pulmonary con-
gestion, the douche should be first applied to the arms, and
then generalized. The brain and lungs may also be pro-
tected by a preliminary Scotch douche to the legs. The

THERAPEUTIC EFFECTS.

257

Resotvent
eNKto.

hydriatist must have in mind all these interesting and im[>or-
tant principles of protection and adaptation, and the facilities
ior applying them at command, if he would avoid many
most unnecessary and unfortunate failures in the use of gen-
eral cold applications.

The alternate douche is extremely useful as a 685
means of stimulating the absorption of ex-
udates in joints or muscles and about tendons.
The resolvent effects obtainable by means of it are highly
valuable. Similar effects, though less vigorous, may be ob-
tained by non-percutient applications, such as the fomenta-
tion followed by the heating compress, or by alternate hot
and cold compresses, the alternate pail douche etc. In the
employment of alternate hot and cold compresses or other
applications for resolvent effects, the length of the hot and
the cold applications should usually be approximately equal,
about fifteen seconds each.

When the part under treatment is painful, the hot appli-
cation should be somewhat prolonged, the times of duration
king as follows: Heat, 60 seconds, cold, 15 seconds; or heat.
2 minutes, cold, 15 seconds. By this means strongly resolv-
ent effects may be obtained, while at the same time pain is
niitigated if not wholly relieved.

The multiple reflex activities set up in the 686
glj^^l^ body through the agency of therapeutic appli-

cations of water to the surface, may give rise
to effects to which the term *' alterative " has been applied;
and these are quite unequaled by any other known thera-
peutic agent. An alterative effect may be roughly defined as
an agitation, a change, a disturbance. The beneficial effects
of such an application are perhaps not easily explained, but
there may be something more than a rhetorical figure in the
suggestion of Fonssagrives, that such an application lifts the
patient out of an abnormal state by untying a bundle of
pathological habits, thus giving nature, relieved of embarrass-
ing obstacles, an opportunity to organize her resources and to
17

258 RATIONAL HYDROTHERAPY.

set in operation favorable vital processes or recuperative
actions.

The alterative effects of water are obtained by the cold
douche, the alternating douche, the wet-sheet pack, the full
or immersion bath, sweating procedures, and in fact nearly
all general applications, both hot and cold. The most
effective, however, are cold applications, and especially those
accompanied by strong percussion, as the horizontal douche
or spray. The percussion douche and the massage douche
are perhaps the most powerful of all means for producing
general alterative effects.

Local alterative effects are likewise produced by circum^
scribed applications, such as the various forms of specia.1
douches which have been elsewhere described, — the hepatio
douche, the splenic douche, etc.

The general alterative effects of water are the most efiB-
cient of all means of treating refractory cases of malarial
infection, a variety of chronic neuroses, neuralgias, head-
aches, and neurasthenias. In fact, the alterative effects of
cold water may be regarded as among the most important aod
fundamental means by which this agent proves serviceable in
the treatment of the majority of chronic affections.
687 Local heating or calorific effects may be ob-

Effects^ tained by various hydric procedures, one of

the most efficient being the short cold douche
with strong pressure. The colder the water and the higher
the pressure, the greater the calorific effect produced. If the
application be greatly prolonged, the ability of the tissues to
react may be exhausted, and then the effect becomes sedative
instead of exciting. The aim in an application of this sort is
to produce as decided thermic reaction as possible (460).
Short cold applications produce local calorific effects.

The heating compress is an excellent measure for this
purpose. The compress must be wrun^ very dry, out of very
cold water, and should be well covered first with flannel and
then with mackintosh or some other impervious material.

THERAPEUTIC EFFECTS,

259

3g compress managed thus not only stimulates heat
>tit but diminishes the local elimination of heat» and
itbos very appropriately named.

Cold friction ol a part, either with the hand or with the
thction mitt, is an efficient means of stimulating local heat
podiiction>

IiDmersioD of a part in cold water for a short time (ij
sees, to 3 min*) is a successful calorific measure if accom-
pinied by constant and vigorous friction.

Prolonged hot appHcations, as the hot bag or the fomen-
UtioQ, are important means not only of accumulating heat,
bttt of siimulating local heat productioo. The local hot
lii, vapor, or clectric*light bath are also invaluable means
0! local calorificaUori* The special apparatus required for
this purpose are described elsewhere in this work (1250).

tn the use of the local electric-Iight bath for purely
calorific effects, lamps with red globes or covered with red
Screens may be used instead of the ordinary clear-glass globe
sotsta exclude the chemical rays; but this is scarcely neces- »
laiy, as the acdnic effects of the incandescent ray is very
f«cble. (Il may perhaps be questioned whether hot applica-
titjQs are not direct or primary rather than secondary exci-
la^itsof thermic action. This is a matter for further study.)

Applications capable of producing local calorific effects are &HH
iodicated in all cases in which it is desired to quicken the
'/onctional activities of a part Heat production is so inti-
I liiately associated with all other lurms of vital activity that it
rjtiay be considered as a good measure of vital action In
A subnormal temperature means vital depression,
fbether general or local. By increasing the calorification of
^a part, we at the same time increase its activities in all direc-
^■oos,^ — glandular, nervous, catalytic, etc. Calorific measures
^Bfe thus applicable in all cases in which there is need of
^Vicreased local activity of any kind. They are very gen-
eially ttsaful, and form tfic basis of many of the most impor-
taiit ol the various therapeutic uses of hydric procedures.

26o RATIONAL HYDROTHERAPY.

Calorific measures, both general and local, are of great
service in preparing the body for cold applications. For this
purpose, heat is generally preferable; but we may also em-
ploy friction with water at a temperature lower than that of
the proposed application.

C. SEDATIVE EFFECTS.

689 A sedative is an agent which moderates the abnormally

increased action of an organ or set of organs. There are
three general classes of sedative effects which are therapeu-
tically indicated : —

A -.• ui • A- < W Vascular.

1. Sedativf of thei^' Antiphlogistic | ^ ^^^^^^^

circulatory system. \ b. Hemostatic.

(a. Hypnotic.
I b. Calmative.

2. Sedative of the nervous system, X c. Antispasmodic.

d. Analgesic.
\ e. Anesthetic,
i a. Antithermic or

3. Sedative of metabolic activity. I Antipyretic.

( c. Antifebrile.

Sedative applications and effects may be either general
or local. Antiphlogistic and hemostatic remedies are usually
employed for local effects. The same is true of anes-
thetic and analgesic measures; while antithermic and anti-
pyretic measures are necessarily general in character, owing
to the nature of the indications to be met. There are, how-
ever, cases in which a general febrile state may be combated
by local means applied to subdue the pathological processes
to which the rise of temperature is due.

Sedative or depressant effects may be produced by pre-
cisely the same means as are employed for excitant and tonic
effects, differently managed. Whether a particular applica-
tion of water at a given temperature is to prove tonic or seda-
tive, may also depend as much upon the temperament of the
patient and the special conditions in which he may happen to

THERAPEUTIC EFFECTS. 26 1

be for the time being, as on the particular method of proce-
dure itself. The only hydriatic procedure which is immedi- ♦
ately, directly, and always sedative is the full or immersion
bath, at 92° to 97^ F., — the neutral bath.

Sedative effects may be either immediate or remote.
Remote sedative effects may often be produced by the
application of excitant or tonic measures, whereby the irri-
tation which exists, — the condition which an eminent clinical
teacher has so well defined as ' * irritable weakness, " — is made
to disappear under the tonic influence of cold applications
systematically employed.
Sedative effects may be obtained — 690

1. By cold applications.

2. By warm applications; and in two ways by each class
of measures.

Sedative effects may be obtained by co/d applications : —
(a) By restoring nerve tone through the use of tonic
applications systematically employed for the necessary length
of time (remote effect); and —

(i) By the prolonged application of water at some tem-
perature below 92^ (immediate effect). Water at a tempera-
tare below 92'^ produces at first an excitant effect, through
arousing the resistance of the body, the thermic reaction pro-
voked extending to every cell and tissue of the body. If the
application be short, as has been elsewhere shown, the exci-
tant effect is dominant; but if the application is sufficiently
prolonged, the reactive powers of the system are at last
exhausted, and after many oscillatory attempts at reaction of
gradually decreasing intensity, the ability to react is finally
wholly exhausted, and a decidedly sedative effect is estab-
lished.

Sedative effects from warm applications may be produced
in two ways, as follows : —

{a) Short applications of hot water, which produce an
excitant or stimulant effect, followed by an atonic or asthenic
reaction, the reverse of the reaction produced by cold.

:?62 RATIONAL HYDROTHERAPY.

(6) By prolonged applications of water at a neutral tem-
perature, from 92° to 97° F.

The leading sedative effects which are obtainable by
water, and the most convenient methods for obtaining them
are the following : —
691 The effect of cold, when directly applied to

the Circulatory ^^^ ^^^^* ^^ *° cause contraction of the small
System. blood-vessels throughout the body, thereby

diminishing the blood current. Cold applica-
tions of sufficient intensity may even absolutely arrest the
blood stream in the small vessels. In order, however, that
this effect may be obtained, it is necessary that reactioQ
should be wholly suppressed, for in the state of reaction
which follows an application of cold there is active dilatation
of the small vessels, both venules and arterioles, giving rise
to a greatly increased rate of flow of the blood current
throughout the whole system.

For the suppression of tonic reaction, it is necessary —

1. That the cold application should be prolonged.

2. That percussion and friction should be avoided in the
mode of application, since these mechanical stimuli encourage
tonic reaction.

Cold causes at first a strong contraction of the blood-
vessels, which is quickly followed by a dilatation of all the
small vessels of the skin, continuing for a considerable time,
as illustrated by the ruddy nose and cheeks of the woodchop-
pcr. On the other hand, the application of heat produces,
after the first instant, strong dilatation of the small veins,
which after withdrawal of the heat is followed by prolonged
contraction. A prolonged application of cold and a short
application of heat are alike in producing at first stimulation,
later sedation. The fully developed effect of coM is sedative,
while that of /icaf is stimulant. The subsequent, or reaction,
effect of cold is excitant, or tonic; of heat, depressant^ or
atonic. This is true of all forms of functional activity, since
all vital activity depends upon blood supply and blood pressure.

THERAPEUTIC EFFECTS.

263

\Mid aoiy
irliea WeU

Sedative baths are beneficial only when well
borne. Weakness after the bath, secondary
chill, headachep and nervousness are evidences
of too low a temperature or too prolonged an
application; or in case the hot bath has been
employed, the indication is that the hot application was too
iotense cic prolonged, or that the concluding cold applica-
tioo was not employed for a sufficient length of time to
(Aliterate the exciting effects of the heat.

Water, properly employed, is superior to all other reme-
dial agents as a sedative. Of the various classes of seda-
^im, — hypnotics, kear^ sedatives^ and pain st'datives or
m^fynts,^^ those of a medicinal character are all powerful
toiica^nts. Bromide of potash, chloral, su I phonal, paral-
dehyde, and all the rest of the long list of hypnotics are each
and all productive of most pernicious eflects when employed
far any considerable length of time, and often untoward
effects follow immediately upon their use.

lo a recent discussion of this subject in the British
Mtdicai J&urtiai, most pronounced views against the use of
medicinal hypnotics of any sort were recorded by leading
English and American authorities. It was shown by indubit-
Mt e%ndence that all hypnotic drugs are poisons, and capa-
ble of doing great mischief if habitually used. The neutral
tatb at bedtime is worth more as a genuine and eflficient
iypnolic than all the medicinal agents known to pharmacy.
All the medicinal heart sedatives are toxic agents, which
may produce highly untoward or even fatal effects. There
is no dmg sedative which can be used for any considerable
leo^h of time that will not produce injurious effects.

Water, on the other hand, may be made to produce
prmnpl and highly sedative effects without leaving behind any
damaging influence.

By cold applications the pulse rate may be reduced from
I JO to 100 t>eats per minute, and the volume of blood in a
part reduced zo tii les.

264 RATIONAL HYDROTHERAPY.

693 Those measures which are sedative to the cir-

Sedative culation, and which have been described as

Effects. antiphlogistic, are without exception also seda-

tive in their effect upon the nervous system,
as the circulatory system is controlled by the vasomotor and
sympathetic nerves. It is not easy, in fact, to distinguish
definitely between circulatory and nerve sedatives, though
for convenience we may specially designate by the latter
name those measures which are particularly helpful in less-
ening the activity of the cerebrospinal system of nerves.
Measures of this sort are usually classed as hypnotic^ calma-
tivCy antispasmodic^ analgesic^ and anesthetic.

For hypnotic or general sedative effects there is no meas-
ure superior to the warm bath, which should be employed at
a temperature of 92^ to 97° F. , and may be continued from
thirty minutes to two hours. It should be taken at bedtime.

The wet-sheet pack is very similar in its effects. It
should not be given very cold, but at a temperature of
from 70^ to 75^ F. The sheet should be wrung very dry,
and the patient should not be too warmly covered, in order
that the tendency to perspire may be avoided.

The broken jet douche at 85^ to 92^ F. for three
minutes, the ice-cap or cold compress to the head, the
evaporating head-cap, revulsive compresses to the spine, arc
measures of the highest value. The alternate application to
the spine may consist of compresses, hot and cold sponging,
the alternate hot and cold pour, or the alternate hot and
cold douche. Avoid percussion effects or shock from too
strong impressions, the effect being to excite the nerves.

The moist girdle, or heating compress, applied over the
abdomen and worn at night, and in some instances during
the day, is also a measure of great value, and one which is
much relied upon in Germany as a brain sedative for the
relief of insomnia. The wet girdle, or Neptune*s girdle,
owes its hypnotic effects to the diversion of a large amount of
blood into the portal veins, whereby the brain is relieved.

THERAPEUTIC EFFECTS. 265

The wet-sheet pack is a very effective means of relieving

sleeplessness due to nervousness or ** fidgets." It is also a

▼aiaable remedy in acute mania, often quieting the patient

when other measures fail, and obviating the need of drugs also

in the delirium of typhoid fever, especially when the skin is

hot and dry, but the temperature not excessively high.

The spinal pack (1355) is a valuable means of combating
iosomnia, when spinal irritation is a marked symptom.

For local quieting effects the neutral rain 594
^Ainalfeslc ^Qy^^i^g^ fj-Qj,^ 5 to 1 5 minutes, with little pres-
sure, is a means of great value. In cases of
locomotor ataxia, sclerosis of the spine, and in neurasthenia
with marked exaggeration of the deep reflexes, the warm
fan douche (92^) to the spine, from 3 to 1 5 minutes, will usu-
ally be found highly useful. The heating compress also proves
h%hly serviceable in cases in which a circumscribed irrita-
tion exists without inflammatory action or active congestion,
as in hyperesthesia of the lumbar ganglia of the abdominal
sympathetic or of the solar plexus.

The pain of circumscribed acute inflammations and certain
neuralgias accompanied by inflammatory conditions is fre-
quently relieved in an almost marvelous manner by the
prolonged cold compress, the ice pack, or the evaporating
compress. As a rule, the cold application should be mod-
erate in degree (60^^ to 70^), and continued for several hours
if necessary. After the acute stage of the onset is passed,
fomentations should be employed for 10 to 15 minutes at
intervals of from 2 to 6 hours, and the cold compress should
be exchanged for the cool compress (60^) every hour, well
covered with flannel.

For chronic pains, revulsive applications (678) are the
most generally useful. Derivative applications are useful in
both acute and chronic painful conditions (134-1).

Hot applications may be continued for hours, if necessary
to control pain, in nearly all cases except those in which the
pain is located in the head or the eyes. As a rule, however.

266 RATIONAL HYDROTHERAPY.

it is wise to remove the hot application once an hour, apply-
ing in its place a tepid compress for a time, or, what is better
in many cases, a towel wrung as dry as possible out of veiy
cold water, for half a minute. In applications to the head
and eyes the hot application should be interrupted by a short
cold compress at least once every thirty minutes, and often
better results are obtained by a change every ten minutes.

The pain of pleurisy is best relieved by very hot applica-
tions, as fomentations, a rubber bag filled with hot water,*
hot bricks, hot sand-bags, or similar means. The same
means may be employed for the relief of pain in the stomach,
as in colic, gastralgia, gastric crises, also in hepatic colic, renal
colic, and other painful affections. For the relief of pain, the
fomentations should be as hot as can be borne (140^ to 160^).

In chronic cases and in deep-seated acute inflammations
the heating compress renewed every half hour (60°) with
fomentations for 1 5 min. every two to four hours is a better
method than continuous heat.

Pain in the bowels, when not due to inflammation, gen-
erally yields to large fomentations ; the hot enema, however, is
highly useful in a large proportion of cases in which the pain
is not of an inflammatory origin, as in the case of intestinal
colic, enteralgia, and pain due to hyperesthesia of the
abdominal ganglia, also in renal and hepatic colic.

Fomentations are also useful when the pain in the bowels
or abdominal region is due to local inflammation of some
sort, as enteritis, colitis, peritonitis, or other inflammatory
affections of the abdominal or pelvic viscera, but should not
in these cases be long continued. The temperature should
be as hot as can be borne; but the application should not
be continued more than 15 or 20 minutes, when the cool
compress should be applied for an hour or two, after which
the fomentations may be again renewed.

The hot enema is valuable in some cases in which the
pain is due to inflammation, as in inflammation of the ova-
ries or tubes. This application may be repeated two or three

THERAPEUTIC EFFECTS,

267

a day. The quantity of water introduced at once should

be more than one or two pints after the bowels have been

piled, as the appUcation is designed for the lower pelvis.

The water should be retained for five minutes, when it may

be allowed to escape, and a fresh quantity introduced,

this being repeated from 3 to 6 times* It is not necessary

to remove the rectal tube. By detaching the tube from the

iountain, and lowering the end* the water may be allowed to

to a suitable vessel, as directed for the cold enema.

patient should lie upon the back, to avoid filling the

colon at a higher level than is necessary. In most cases hot

irrigation by means of the author's rectal irrigator (page 902)

is prelemble to the enema.

The pain of hemorrhoids and rectal ulcer generally yields
to loinenlations applied over the inflamed region. A very hot
aiU bath is also effective in cases of this sort. Tlie water
need not be more than two or three inches deep, but should
ht as hot as can be borne, the temperature being gradually
nised, after the patient enters the bath, to 115^ or I20^ F,
The pain of inflamed hemorrhoids is sometimes best relieved
by 10 alternation of heat and cold. In cases in which there
is jfTcat pain at stool, relief is often experienced by sitting
oTcr a pail or slop-jar half filled with boiling water while
mming the bowels. The hot steam relaxes the muscles, and
eterciscs a powerful analgesic effect upon the painful tissues,
A short, very hot sitz bath (112^ to i20'^)isa most ex-
cellent means of relieving chronic pelvic pain. The dura-
tion should be from 3 to 5 minutes, and it should be in-
ftantly followed by a dash of cold water upon the hips or
^^aptd cold friction of the parts. This is a most excellent and
^^kwiccable analgesic measure, and may be advantageously
^Blpl<^^y^<^ ^" chronic ovarian and uterine pains^ painful affec-
tiods ol the rectum, and chronic inflammation of the prostate.
^K The pain of sciatica and other forms of neuralgia is best
^^clteved by either revulsive applications, which may consist
of very hot fomentations continued for 15 or 20 minutes.

268 RATIONAL HYDROTHERAPY.

{oUowed by a well wning» very cold compress for 30 to 60
seconds, or by cold friction. The Scotch douche is, however^
probably the most effective of all means which can be em-
ployed for the relief of sciatica. The hot fan douche should
be applied with moderate force at a temperature of 120° to
1 30^' F. , or as hot as can be borne, over the lower part of
the back and along the track of the affected nerve. The hot
application should continue for 4 or 5 minutes, being imme-
diately followed by a very cold jet (50" to 60^), broken when
the skin is sensitive, or the fan douche, continued from 6 to
10 seconds.

The prolonged leg pack following a fomentation (1313) is
an analgesic measure of great potency and value in cases of
sciatica and crural neuralgia.

The pain of congestion, as congestive headache, is best
relieved by rubber bags filled with ice, or the ice compress.
The application may be made not only to the head, but to
the face and about the neck, with excellent effect. Indeed,
ice-cold water is in all cases an excellent remedy for the relief
of inflamed parts, as inflamed hemorrhoids, painful wounds,
burns, etc. Cold irrigation with water at a somewhat higher
temperature, 60'-^ to 70""^ F., is almost equally effective, and
often more convenient and agreeable.

For the pain of sprains and bruises administer very
hot applications, followed by cold compresses or ice-bags.
The fomentation may be renewed every two or three hours
for 15 minutes, cold compresses being maintained in the
interval.

For the relief of painful affections of the eye, either hot
or cold applications may be employed, according to the case
In pain due to inflammation of the lids, very thin cold com-
presses are most eflicacious, the compress being kept cold by
evaporation, stimulated by fanning, either with an ordinary
fan or the electric fan, or by dripping on ice-water. A very
good plan is to have two sets of compresses, cooling them by
laying upon a block of ice, so that a fresh cool compress is

THERAPEUTIC EFFECTS. 269

ready for immediate use when the one in contact with the
tissues, having become slightly warm, is removed.

Painftd affections of the eyeball are generally best relieved
by very hot applications; but heavy fomentations, bags filled
with hot water, and similar hot masses should never be
applied to the eye. Instead, thin compresses should be em-
ployed, not more than five or six thicknesses of cheese-cloth,
three or four inches square; the^e should t}e wrung out of
Twy hot water and applied to the eye, covered, and changed
every i to 2 minutes. The application should not be con-
tinued long without a brief cold application. A good plan
is to apply heat for 3 to 5 minutes, then cold for 1 5 to 30
seconds. By these applications to the skin over and
about the eye, a vigorous revulsive effect with collateral
byperemia of the skin is produced, and the pain thus re-
lieved.

The analgesic effect of cold applications is well illustrated
in the use of a continuous cold compress in the case of burns.
On one occasion in which the author was involved in a
serious railway wreck in a Mexican desert, he succeeded in
bringing almost immediate relief to two badly scalded por-
ters by wrapping their burned legs in wet sheets, which
were kept cool by pouring water over them continuously.
In ten minutes the poor fellows, who had been writhing and
groaning in agony, were almost entirely at ease, and both
secured a good night's rest.

For the relief of pain in conditions unaccompanied by
inflammation, fomentations, the local hot douche, the revul-
sive douche, and other revulsive and derivative applications
are generally most effective. Dry heat is sometimes more
serviceable than moist heat. Occasionally, alternate applica-
tions are most efficient. The fomentation, followed by a
heating compress to be worn overnight or for several hours,
is also a means which can be highly commended in this class
of cases.

270 RATIONAL HYDROTHERAPY.

695 It is unnecessary to do more than call atten-
A»Mthetlc ^j^jj ^Q ^j^g well-known anesthetic effects of
bfffects.

cold. When the temperature of the skin is

lowered very much below normal, the sensibility of the
numerous classes of nerve filaments which it contains, and
especially of the sensory nerves, is diminished to a marked
degree. Thus the application of ice for a few minutes will
almost completely abolish sensibility in the part. By the
employment of freezing mixtures of salt and ice or an ether
or rhigolcnc spray, the skin and subjacent parts may be so
benumbed as to render minor operations painless.

696 For true antispasmodic effects we are obliged
EffecuT*" ^ ^^ ^®'y wholly upon applications of such a

temperature that the exciting effects of both
heat and cold arc avoided. The neutral full bath is pre-
cisely adapted to the indications presented in cases of hysteria,
extreme nervous agitation, insomnia from restlessness, etc.
The full or immersion bath should be employed at a tempera-
ture of 92° to 97"^, duration from 1 5 minutes to an hour or
more. This is a sovereign remedy for hysteria, and will
usually avert a threatened attack i*^ perseveringly employed.

The neutral fan douche, which is especially serviceable in
cases of nervous agitation with insomnia, should be given at
a temperature of 95^ to 97^, duration i to 5 minutes.

The neutral fan douche and the hot bath should be
employed only as an introductory or palliative measure, to be
followed by tonic applications as rapidly as the patient can
be trained to endure them.

Local antispasmodic effects may be obtained by the appli-
cation of the neutral douche, warm (not hot) compresses, the
neutral pour, and when the extremities are involved, by the
neutral spinal douche, without pressure, or the spinal pour.

In constipation due to spastic contraction of the colon or
the anus, and in gall-stones and renal colic, hot fomentations,
the hot sitz, and the hot enema are measures which rarely
fail to give satisfactory results.

THERAPEUTIC EFFECTS.

271

Hcmostatk

The sedative influence of cold may be
employed as an efficient means of checking
hemorrhage, as in the application of ice to a
^ponocl to check capillary oo^mg, plugging the nostrils with
ie« in epistaxis, the ice-cap in apoplexy, swallowing ice pills
tn bemoTi'bmge from the stomach, the application of the ice
pdck lo the loins in bemoiThage from the kidneys, the ice-
bag or compress over the abdomen in case of hemorrhage
^^m the bowels, and the application of ice-cold compresses
^pitbe vulva and perineum in uterine hemorrhage.

It must be remembered that in the use of cold for the
purpose of controlling hemorrhage, great care must be exer-
cised to prevent reaction, since this involves dilatation of
the vessels, and defeats the object souf^ht. Hence the appli-
aiioTis must be absolutely continuous* If compresses are
^CJiiployed, a freshly cooled compress must be ready for
Hbistint application when the warm one is removed.

Very hot as well as very cold applications of water are
|tlective means of controlling hemorrhage. A sponge or nap-
I saturated with water at a temperature of 140 " to 160 F.
U most efficient means of checking capillary oozing. This
leaiis of eontroUing hemorrhage is very generally used in
openiioos involving the peritoneal cavity, and is not infre-
fteiitly of very great service in shortening the time required
the completion of an operation by facilitating the prepa-
an of wounds for closing. The application of water at a
apcratnre of from 125" to 130-' F. to the interior of the
otents will almost instantaneously control uterine hem-
orrhage. The application must not be longer than 4 or 5 min-
utes^ loTp as shown by Runge, prolonged very hot applications
l^ralysis of the uterine vessels, with stasis. Cold
licalions following hot often produce the best results.
Heat may also be applied to the uterine cavity by means
, a hollow metal sound (14-16), through which a stream of
water is allowed to tlow. The author has made use in
way of water at a temperature of 160^ with advantage,
may be applied in the same manner

«»7

272 RATIONAL HYDROTHERAPY.

698 Under this head are included applications

Antiphlogistic which have for their purpose to suppress or
combat a local acute congestion or inflamma-
tion, such as a boil, a felon, an acutely inflamed joint, a
pneumonia, a pleurisy, a peritonitis, an iritis, a phlebitis, an
erythema, and also a circumscribed erysipelatous inflammation.
In the use of antiphlogistic measures, the various condi-
tions involved in local congestion or hyperemia must be
constantly kept in mind. The hyperemia may be due either
to mechanical injuries or obstructions, or to vasomotor dis-
turbances. The several conditions which should be especially
noted and provided for in the arrangement of a hydriatic pre-
scription, together with the appropriate measures for use in
the conditions named, maybe briefly mentioned as follows:—

1 . Mechanical congestion of the viscera in cardiac insuffi-
ciency and certain forms of valvular incompetency.

2. Congestion of the organs connected with the portal
system from hepatic sclerosis.

3. Hyperemia from the pressure of a tumor or other mor-
bid growth, or mechanical obstruction, as in congestive head-
ache due to overloaded bowels from enteroptosis or other
cause.

4. Vasomotor spasm in some other portion of the body,
proximate or remote, causing congestion by rctrostasis.

5. An atonic or paretic state of the vaso constrictors oi
the affected part, as in solar erythema, erysipelas, and othtf
inflammations.

6. Overstimulation of the vasodilators through visceral
irritation or some other reflex influence, as in cerebral conges-
tion duu to digestive disturbance or to pelvic disorder.

Each of these conditions requires a careful adaptation of
special hydriatic measures, either palliative or curative as
may be possible in a given case. According to the indica-
tions in each of these several classes of cases the following
among other means may be suggested: —

PPb the chest (60^), the alternate hefmi^^nche (loo-^
p), and the heating compress, and drain off a portion of
k>ftal blood into the lower extremities by means of
l^ami leg bath, the heating leg pack, or the Scotch
i^D the legs.

^B this class of cases» hydrotherapy offers small asstst-
Id a curative way, but great relief may often be secured
|gh the use of very simple measures, such as increasing
fmc of the congested parts by means of cool compresses,
enabling them better to resist the disturbing cause.
Hpation. if present, must be combated by special means*
^uiasrn of the vessels of the feet and legs, causing con-
^peadacbcs. may be relieved by the Scotch douche,
pronged hot leg or foot bath, and the heating pack
pe legs- Fomentations to the abdomen, followed by
eating abdominal compress, will remove the cause of the
Jar spasm of the legs by relieving the irritation of the
tic ganglia in which the disturbing reflex influence

Iged cold compresses (60'^ to 70'^), alternate hot

[applications, or very hot compresses or douches, are

by which the vascular tone of the affected part may

tand the stagnattid blood moved on to make room
U3C oi pure blood with its supply of normal nutrient
ig properties,
inging the hot and cold compresses, great care must
•to^^^tt^U^lkht^s^kky^^h^oc^^

274

RATIONAL HYDROTHERAPY.

ready to replace the warm one the instant it is removed, or
the desired temperature may be attained by irrigation, the
cold water being trickled in a small stream upon the affected
part protected by a suitable compress of cheese-cloth or linen.
Make changes with the g^reatest care, to avoid irritating the
inflamed or congested surface*

6. Cold to the congested part by means of the frequently
renewed cool compress or the evaporating compress, while at
the same time soothing applications are made to the affected
ganglia by the abdominal fomentation, the heating com-
press, or a wet girdle; the prolonged neutral bath; derivative
applications to the feet and legs, such as the leg pack, the
Scotch douche, and the prolonged leg or foot bath at 104^ to
1 10^, are measures applicable in this class of cases.

In the application of cold for antiphlogistic effects, it is, as
above stated, of the highest importance to avoid percussion
and friction, and to make the applications continuous until
the desired effect is obtained. Compresses saturated with
cold water, rubber bags filled with ice or iced water, cold
immersion, and the evaporating compress are the chief
and most convenient methods for producing antiphlogistic
effects by means of cold.

It must be always borne in mind that if a cold application
becomes warmed by contact with the skin, it is because reac-
tion has occurred, and to the extent to which there has been
reaction, the antiphlogistic effect has been neutralized. Thus
care should be taken to renew the cold compress as soon as
it begins to approach the temperature of the skin. A large,
thick, well-saturated compress may retain its efficiency for
five minutes, or even a little longer; while a compress of two
or three thicknesses of cotton or linen cloth will need to be
renewed every minute.

In the use of the ice-bag or the ice-compress, a piece of
rather thick, well -saturated woolen cloth should generally be
placed next the body to avoid excessive chilling of the skin.
If this precaution is omitted, great care must be exercised

THERAPEUTIC EFFECTS. 275

to prevent injury, and the application must be removed
for a few minutes every half hour, so that partial reaction
may be allowed to occur, thus maintaining the vitality of
the part.

In cases in which there are acute inflammatory conditions
involving the hands and feet, the proximal compress may be
used to good advantage.

This compress has the advantage over direct applications
to the part affected, in that it avoids irritation of the part.
In the use of the proximal compress, cool applications should
be made to the inflamed part, and cold or very cold applica-
tions applied between the part and the heart. For example,
in applications to control inflammation in the hand, the arm
should be wrapped in cloths wrung out of very cold water,
while cool water is applied to the hand. Both applications
should be made continuous by allowing a stream of water of
the proper temperature to trickle upon the parts, or by
frequently drenching the parts with water at the right tem-
perature. The compress upon the hand may be kept cool
by evaporation, if not too thick. No more than four to
six thicknesses of cheese-cloth should be employed. These
f should be moistened as often as necessary, and should never
i be allowed to become dry. An ice poultice may be applied to
t the arm, or wet cloths may be laid next the skin, and the
ice-bags laid over these. The ice-collar or ice-bag applied
over the carotid in this manner is a most excellent method of
reducing cerebral hyperemia. In cases of cerebral menin-
gitis, the ice-collar may be used in conjunction with cold
applications to the head.

In the case of organs lying within the trunk, as the kid-
neys, liver, and other viscera, a different principle must be
employed. By the warm bath (92^ to 98^), dilatation of the
surface vessels with contraction of the internal vessels may be
produced. This should be followed by an application of
water at 60^ to the affected part. If a very cold application
is made, it must be removed at short intervals, particularly in

2/6 RATIONAL HYDROTHERAPY.

the treatment of visceral inflammation, so that there may be
opportunity for full reaction and complete dilatation of the
surface vessels in reflex relation with the interior. When
this occurs, there is doubtless a reactionary contraction of the
dilated vessels of the inflamed viscus ; whereas, when a very
cold application is continuous, the cutaneous nerves are be-
numbed, the reflex stimulation ceases, and the result is pass-
ive dilatation. For best effects apply compresses at 60°
and change every 10 to 40 minutes, or when warm.

Revulsive measures may be brought into service in con-
junction with other means by making cold applications to the
reflex cutaneous area connected with the affected part. Cold
to the feet causes contraction of the vessels of the brain, with
lowering of the temperature of the mouth and of the axilla.
The cold running hand- bath causes contraction of the vessels
of the chest ; cold to the lumbar region causes contraction of
the uterine vessels, as do also cold applications to the but-
tocks, the perineum, the vulva, the hypogastrium, the inner
portion of the thighs, and the soles of the feet.

For derivative effects in relieving congestion of a hyperemic
part, the vessels of a large area in some remote part of the
body are dilated by suitable hydriatic procedures, and thus
the blood is drawn off from the congested part. It should
always, when possible, be ascertained whether anemia does
not exist in some part as the result of a disturbed distribution
of blood; if so, the application should be made in such a way
as to influence this anemic part, restoring to it its normal-
blood supply. For example, congestion of the brain is com-
monly connected with coldness of the hands and feet through
excessive contraction of the vessels of these parts. The cir-
culation should be restored by short cold applications followed
by vigorous rubbing, the Scotch douche or hot baths, the par-
tial vapor bath, the hot-air bath or the electric-light bath,
dry friction, or the hot-blanket pack, followed by vigorous
friction.

Lowering the temperature of the blood helps to diminish

THERAPEUTIC EFFECTS. 277

congestion by influencing favorably the central nervous sys-
tem and the heart. General or local refrigerating measures
may be used for this purpose, as the cool enema, the cooling
bath, the wet-sheet pack, the half pack, the cold precordial
compress.

The mesenteric circulation is a blood reservoir which may
frequently be used as a means of regulating the blood supply.
The almost instant relief from headache which is sometimes
experienced from taking food is due to dilatation of the mes-
enteric vessels under the stimulation of the food. The mes-
enteric circulation may be stimulated by massage, especially
by hacking movements, by short applications to the abdomen
or tnink, and by the enema. A very short cold enema results
in reaction in the portal circulation and filling of these vessels.
The large enema of water (100^ to 104^), retained for a few
nuDQtes, produces dilatation of the portal vessels.

By bringing these various measures to bear in concert,
most powerful effects may be produced, as, for example, in a
case of cerebral hyperemia, a bath of 92° for a half hour to
an hour may be administered, care being taken by gentle
nibbing to keep the surface vessels well dilated, so as to avoid
the slightest tendency to chilliness, which produces excitation
of the central nervous system. This will reduce the tempera-
ture. The same may be accomplished by the wet-sheet pack
of 30 minutes' duration or continued to the end of the neutral
stage. Either of these procedures should be followed by a
Scotch douche to the feet and legs, the patient afterward
being put to bed with the heating abdominal bandage, and an
evaporating compress to the head. The whole may be pre-
ceded by an enema of a pint and a half to two pints of
water at 70". The evaporating or cool compress should be
applied to the head during the neutral bath, to insure lowering
of the cerebral temperature.

Application of cold should be confined to the early stages
of inflammation. Passive hyperemia, which appears after the
most acute stage of the inflammatory process, favors exudate

2/8 RATIONAL HYDROTHERAPY.

and morbid changes in the structure and functions of the
parts. A good supply of healthy blood is the best means of
antagonizing this condition and bringing the part to a normal
state. The blood is a sort of traveling physician, which,
moving from part to part, repairs injuries by the same mar-
velous methods by which it builds up and maintains the body
in health, — through normal nutritive processes. Recovery
from diseased conditions is effected by means of the cell and
tissue activities by which the ordinary functions of the body
are maintained.

The cure for inflammation after the first stage is passed is
accomplished by improving the circulation ; hence continuous
cold application should cease after the first stage, which
in erysipelas and pneumonia never includes more than the
first day or two, and in some cases but a few hours. Hot
applications should be made once in two or three hours, with
simply cool or tepid applications during the intervals to main-
tain active fluxion through the aflected part. It is necessaiy
to study each case carefully to know just when to cease the
employment of antiphlogistic measures, and to introduce those
calculated to induce active congestion or fluxion. After the
first onset of the disease is passed, the heating compress may
be applied. At first, change every hour; later, every three or
four hours, increasing the intervals from day to day. Thus
employed, the heating compress, by aiding the circulation in
the diseased part, may aid in bringing the morbid process to
a favorable termination without suppuration. The cotton
poultice similarly employed still later may aid in establishing
resolution. These measures are very valuable in the treat-
ment of pleurisy, either with or without affusion, and in
lobar- and broncho-pneumonia, greatly aiding the absorption
of morbid products and in restoring normal conditions.

By the repetition of a cold application as soon as reaction
begins, a new contraction of the small blood-vessels of the
parts and of the internal associated area is produced. For
this reason a frequently renewed cool or cold" applicatioi^^

THERAPEUTIC EFFECTS,

279

ly sometimes produce better effects than continuotjs cold in
the hydriatiG management of deeply seated congestions or
inflammatioos.

In the use of cold, care must be taken to avoid producing
a harrolut collateral hyperemia in cases of deeply seated
iaflammatioQ by prolonged cold application to the surface

To obtaio the atonic antiphlogistic effects of heat (642),

IIomcDtations, the cotton poultice, the hot- water bag, hot irii-
gatioQ, and hot immersion are the chief me^ures. The neu-
tral pour or irrigation and neutral immersion are also highly
JiS^lnl Fonssagrives maintains that the relief obtained
Vy warm or emollient applications in acute congestions and
inflammations may be in part attributed to dilution of the
blood by absorption of the fluid from the moist mass in con-
tot mth the skin, producing a local hydremia, whereby the
blood is rendered less stimulating to the irritated tissues.
This idea, expressed more than a dozen years ago, seems to
1j€ Sttstained by our present notions respecting the part played
^toxins of bacterial origin in provoking and maintaining local
stive and inflammatory processes. The dilution and
aed removal of these poisons must certainly tend to
lessen the intensity of the morbid changes set up by them,
aad to aid the tissues in their efforts to combat the disturbing
elements present, whatever they may be.

Recent obser\ations have developed the interesting fact
that nervous irritability is notably lessened when a nerve is
n»dc to take up a quantity of water. This may be the true
explanation of the relief always afforded by warm com-
prcss<^ the neutral bath, and many other sedaUvc hydriatic
procedures.

It seems reasonable, also, that dilution of the blood may
«i^c to l^sen the activity of morbid processes in a congested
orjaflamed part, by diminishing the proportion of blood cells
P»eni and diluting the blood serum

The employment of the hot foot bath for the reUei and

^Q^

280 RATIONAL HYDROTHERAPY.

prevention of congestion and inflammation in sprains of the
ankle and other joints affords an excellent illustration of the
antiphlogistic effect of hot applications.

Prolonged immersion (for several weeks if necessary) of a
part in water at a temperature of from 95^ to 97*^ F. is a
most effective means of preventing inflammation in cases of
badly contused and lacerated wounds. Dr. Frank Hamilton,
of Bellevue Hospital, New York, when the author was a stu-
dent in that institution twenty-five years ago, made large use
of the neutral immersion bath in the treatment of injuries
resulting from street railway accidents, and demonstrated the
value of this method by saving a large number of badly
bruised limbs which his colleagues had condemned to ampu-
tation.

This is also a most excellent method of preventing inflam-
mation and other complications in case of severe burns.
Some seventeen years ago the author, while visiting the great
Hospital for Skin Diseases at Vienna, learned of a patient
who had suffered from a severe burn, and who had been kept
immersed in a full bath for a number of months. He ulti-
mately made a good recovery from an injury which, without
the advantage of this measure, would probably have proved
fatal.
699 Qeneral For general antiphlogistic effects, that is,

Antiphlogistic £^j. subduing a condition commonly known as
feverishness, but without actual rise of tem-
perature, the neutral bath at 92^ to 95^ for 20 minutes to
an hour or more has been found a sovereign remedy. The
excessive action of the heart is controlled, the bounding,
feverish pulse becomes soft and returns to the normal rate,
the flushed face acquires its normal hue, and the patient
finds complete relief.

Care should be taken to avoid friction in the bath or after
it (1130), and the patient should also avoid exercise soon
after the bath. Immediately on removal from the bath, the
patient should be wrapped in a Turkish sheet and woolen

THERAPEUTIC EFFECTS. 28 1

blanket, and dried by allowing the moisture upon the surface
to be absorbed by the sheet, without any friction whatever.
He should remain quiet (or some hours after the bath, in
order that the tendency to reaction may be suppressed.

Tepid sponging and the evaporating compress are anti-
phlogistic measures of value in feverish states, whether of
inflammatory or non-inflammatory origin.

In cases of acute inflammation accompanied 700
UfeofColdIa by exudate, as in pneumonia the frequently
Jj^JJ*^^^ renewed heating compress (1284, 1318)
Other Acnle should be employed during the early stages
DlMrden. of the disease; but after the acute inflamma-

• tory stage is passed, the cold application
should be exchanged for intermittent hot applications.
Fomentations and equivalent measures may be applied regu-
larly every two or three hours, the heating compress being
employed in the interval.

In the transition stage between the first and second pe-
nods of the disease, the cold applications may be interrupted
every two or three hours by hot applications for 10 or 15
minutes. This method the author has found eminently suc-
cessful in the treatment of pneumonia, erysipelas, acute
arthritis, and similar conditions. Care must be observed,
however, in making continuous cold applications at very low
temperatures, not to destroy the vitality of the tissues by com-
plete interruption of the circulation. To avoid this, the appli-
cations, if the temperature employed is below 50^, should be
removed every hour or two for a short time, so as to allow
partial reaction for restoration of the circulation.

After the very first onset of an acute inflammatory affec-
tion ; that is, after the first twelve or twenty-four hours, hot
applications may be made for 3 or 4 minutes with advantage
every two or three hours. The application of heat in such cases
must be short, and the temperature as high as can be borne.
Of sedative measures especially applicable to particular
regions of the body, the most useful are the following: —

282 RATIONAL HYDROTHERAPY.

701 Applications for the relief of cerebral congestion^ — cold

to the back of the head and about the neck; cold compress
to the scalp and face; evaporating compress to the head and
face; heat to the upper spine; cold to the (ace and top of
head; the short cold douche to the hands, arms, feet, and
legs; leg or hip bath at 105° to 1 10° for 3 or 4 minutes, fol-
lowed by a cold douche for 15 or 20 seconds; heating pack
to the trunk; heating half-pack to legs and hips; heating wet-
sheet pack at 70^, followed by wet rubbing sheet, cold pour
to the head or back of neck, i or 2 minutes, at 60° to 7q^.
To diminish cardiac activity and blood pressure^ ice-bag
over the heart continuously. The heart's action may also
be lessened by cold water drinking, the water being sipped
slowly.

703 Congestion of the stomach, as in hyperpepsia and chronic

gastritis, is best relieved by the prolonged hot douche over
the stomach and the spine opposite, or by the revulsive cir*
cle douche or revulsive compresses.

As a general sedative measure, applicable to almost all
classes of cases and all parts of the body, there is no better
procedure than the cool compress, consisting of a folded linen
towel or a half dozen thicknesses of cheese-cloth saturated
with water at a temperature of 60° to 70° F. This compress
should be changed about once in twenty to thirty minutes
when much heat is present, or once an hour when the morUd
process is less active. The effect of an application of this
sort is to cause a maintained contraction of the vessels of the
skin surface with which it is in contact, and of the correspond-
ing internal visceral area. When applied to the chest, it
causes contraction of the pulmonary vessels; applied to the
abdomen, the mesenteric vessels are contracted ; applied to
the lower abdomen, upper thighs, perineum, and external
genital organs, the pelvic viscera are de-congested ; applied
to the head and neck continuously, cerebral congestion is
relieved; while application to the spine contracts the vessels
of the cord; application to a congested or inflamed part

THERAPEUTIC EFFECTS,

283

Antitheftiilc
I EtIecU.

relief from pain, and controls inflammatory processes
a wonderful niannen The cool or cold compress applied
over the heart is a heart sedative of inestimable value.
Ice-cold or very cold applications provoke powerful reac*
Son effects, dilating the vessels; but cold and coo! applica-
aons induce a sustained contraction.

When a procedure is such as to abstract heat,
it is antiihcr$m€. When it not only abstracts
heat but lessens heat production, it is anti-
ffrttk. The effects of antithermic applications are often
ddcftted by imperfect methods. A passive cold application,
as a cold immersion bath, stimulates heat production to a
greater extent than heat etimination, so that the tempera-
lure after the bath may be higher than before* Many per-
sons have for this reason been led to renounce water treat-
ment altogether, not understanding that the lack of success
^ was due to the faulty method rather than to failure of the
hydriatic principle.

In combating fever, the principal point to be borne in

^toind is so to manaf^e the antithermic measures employed as

to avoid the thermic reflex; that is, the automatic increase of

ieal production. The method of accomplishing this was

pointed oat by \Vinternit2 more than twenty years ago, but

been too httle appreciated, unfortunately, by those who

ive ottdertaken to use water in fevers* - The method is

trople: tl consists in maintaining dilatation of the cutaneous

bIs and active movement of blood through the periphery

^nicaiis of friction. Thus accumulation of blood in the mus-

atid the thermic reflex set up by cooling of the nerves in

fskin, which cause increased heat production, are prevented.

WTiatever measure is employed it should be long enough

doration to produce a decided effect upon the patient*s

trmpemture. A single wet-sheet pack, for example, would

certainly increase heat production, and elevation of tempera-

(719) A short cold bath has the same effect*

703

284 RATIONAL HYDROTHERAPY.

Winternitz has shown that the wet-sheet pack, continued
for 30 minutes, the sheet being renewed every 5 to 8 min-
utes, reduces temperature more effectively than any other pro-
cedure. For example, in a test case, during the second week
the average results obtained for the half-bath were .87^; for
the wet-sheet pack, 1.21^; for the half-bath, followed by the
trunk compress, .73°. At the end of five hours after the
half-bath the patient's temperature was .4° above the origi-
nal temperature, while after the wet pack and the half-bath,
followed by cold compresses, the temperature was still below
the original. During the fourth week the same results were
obtained. The wet-sheet pack produced a much more de-
cided and durable reduction of temperature than the half-bath
alone or the half-bath accompanied by the trunk compress.

Next to the pack, the best measure is the graduated or the
Brand bath, followed by the abdominal or trunk compress
changed every half hour. By means of the trunk compress
the refrigerating effect of the half-bath is prolonged. It is not
sufficient to abstract heat at intervals in febrile cases. We
must constantly maintain heat discharge by maintaining dilata-
tion of the surface vessels. In combating fever, care should be
taken to keep the temperature down during the whole course
of the disease. Every threatened exascerbation of the tem-
perature should be met with prompt measures. When
neglected, the fever acquires a sort of momentum, so to
speak, which greatly increases the difficulty of controlling it.
The gastric secretion ceases when the temperature is very
high, and the gastric juice loses its power to act upon albu-
minous substances during the existence of high fever (Winter-
nitz). When the temperature is very high, the action of the
salivary glands is also suppressed; the mouth is hot, dry, and
parched; the lips and tongue are covered with dried secretion,
while with the lower temperature which may be maintained
by proper hydriatic procedures, the mouth is moist, the
stomach continues to secrete an active gastric juice, thus
changing the whole aspect of the case.

a86

RATIONAL HYDKOTHERAPY.

of pneumonia reported by Fenwick, in which the treatment
was entirely by cold applications, the mortality was only ten
per cent. ; while in another series of nine hundred cases in
which the ordinary methods were employed, the mortality was
twenty per cent.

Any of the varions applications of water, used at a tem-
perature lower than that of the body, may be utilised for
combating a tendency to excessive heat production,

A few general principles should be borne in mind in the
application of water for the reduction of temperature: —

1. The greater the difference in the temperature of the
body and that of the water, the more decided the effect^ other
things being equal,

2. The appiicationt to be of permanent value, must be
prolonged. The length of the application may vary from ten
or fifteen minutes to half an hour or even longer, according to
the nature of the application. The average time of a cold
bath for lowering the temperature, as in typhoid fever, is about
twenty minutes. The time, of course> must be made to
depend upon the condition of the patient, the degree of the
elevation of his temperature above normal, and the tempera-
ture of the bath. The tepid (8S^ F.) bath may be prolonged
to the extent of from one to several hours, if necessary.

3. All forms of the bath which are accompanied by percus-
sion effects must be avoided^ as must also friction after the
patient is removed from the bath, unless there should be very
pronounced shivering or other symptoms indicating the need
of assistance to produce sufhcient reaction to insure the vis-
cera against injury from prolonged congestion.

4* Friction should always be employed while the patient
is in the cold bath^ as by this means the circulatory reac-
tion is promoted, and, while the lowering of the body tern*
perature is encouraged, shivering is prevented, and thus
increased heat production is avoided, Winternitz has
shown that friction in the cold bath increases the rate of
heat elimination more than thirty per cent.

288 RATIONAL HYDROTHERAPY.

Indeed, as the result of the antipyretic applica-
on the Heart ^^^^ ^^ water, the heart's action is improved, the
In Typhoid vital resistance of the patient is strengthened.

Fever. the eliminative action of both the skin and the

kidneys is encouraged, and all the graver symptoms of the
disease are mitigated, often to such a degree that the disease
is scarcely recognizable from the symptoms as set forth in the
text-books, which frequently describe not natural diseases, bat
maladies aggravated by artificial and irrational therapeutics.
705 Antipyretic From the practice and the teachings of most

Effects of Hot hydrotherapeutists, it would appear that anti-
Applications, pyretic hydriatic means consist wholly in ap-
plications of cold water. It is probable that in the first
attempts to combat febrile conditions by means of baths, coM
water was exclusively employed; but modern laboratory re-
searches and clinical experience have demonstrated the fact
that hot water as well as water at a temperature below that
of the body, may be employed in such a manner as to secure
a considerable reduction of temperature in febrile states.
Short, very hot applications stimulate the surface circylation,
and thus aid heat elimination, while lessening heat produc-
tion. By a judicious combination of very hot and cool or
cold applications, the most energetic antipyretic effects may
be produced.

It should be noted that in the febrile state the thermo-
genetic and thermotaxic mechanisms of the body are always
profoundly disturbed, and in such a manner that they are
influenced by causes which may have no effect whatever
upon the body temperature in the non-febrile state. A rise
of a few degrees in the temperature of the air of the sick-
room, sitting up in bed, talking with a friend, reading, taking
a slight excess of food, — these and other similar causes
are sufficient to occasion a considerable rise of temperature
in a febrile patient, and sometimes even to give rise to a
relapse in a patient recently become convalescent.

Likewise, hydric applications which are not capable of

THERAPEUTIC EFFECTS. 289

cing a marked lowering of temperature in a well person

have a decided effect in the febrile state.

A general rise of the body temperature may 706
Uoo of result (^i) from increased heat production, {b)

i Prodnc* from diminished heat elimination, or {c) both
I nd tieat increased heat production and diminished heat

Anipy. elimination may be present, or still other dis-

lic Methods, turbances of the thermogenic or thermotaxic
functions may exist (227).
In the majority of cases there are, in fact, both increased
heat production and increased heat elimination, the rise of
temperature being due to the fact that the heat production
is greater than the heat elimination. In many cases, as
shown by Rosenthal, Botkin, Leyden, and Winternitz, the rise
of temperature is due to diminished heat elimination alone.
There is always a disturbance of the thermotaxic, or heat-
regulating, function in fever. It is important in any given
case to ascertain as nearly as possible the conditions present;
and ti^fore making a hydriatic application of any sort, it
should be determined, if possible, whether the rise of tem-
perature in the case is chiefly due to increased heat produc-
tion or to diminished heat elimination. The neglect to do
this is responsible for many failures in the use of hydriatic
measures in fever.

The temperature in fever may be reduced either by dimin-
ishing heat production or increasing heat elimination, or by
both means combined, and by hydric applications either or
both of these processes may be influenced.

Conditions are sometimes present in which there is a
/^eat increase in both heat production and heat elimination,
and in which it is apparent that nature is doing all that
can be done to combat the rise of temperature; therefore,
interference on the part of the physician would be not only
unnecessary, but possibly injurious. This is practically true
in cases of fever in which there is profuse perspiration. In

such a case, neither hot nor cold applications are needed for
19

290 RATIONAL HYDROTHERAPY.

temperature control. It is only necessary that the perspira-
tion should be gently removed every few minutes by means of
a soft linen cloth. By keeping the surface free from sen-
sible perspiration or visible moisture, evaporation will be
greatly promoted, and thus a cooling effect be produced. To
apply a cold wet-sheet pack, a cold bath, a cold sponge bath,
or in fact any other measure than the simple means men-
tioned, in such a case, would be to run great risk of inflicting
serious, and possibly irreparable, damage.
707 An enormous amount of heat is absorbed by

Heat Ellmlna- ^j^g evaporation of water from the surface, the
oration from ordinary amount being about one to one and
the Skin. one-half ounces per hour. Suppose this to be

increased to sixteen ounces per hour, as might
possibly be the case ; if the perspiration were completely evapo-
rated, the result would be the removal by evaporation alone
of nearly one thousand heat units. In case of a patient
weighing i6o pounds, this would be equivalent to a fall of six
degrees in temperature. The normal rate of heat voduc-
tion is about 1.8 calorics, or 7.2 pounds Fahrenheit heat
units, per minute, or 432 heat units per hour. If heat pro-
duction were doubled, the total for the hour would be 864
heat units. Subtracting (1000 — 864), we have 136. Dividing
by 160, wc have .85. Hence there would be an actual reduc-
tion of temperature to the amount of nearly one degree.

Of course the rate of heat production may be more than
doubled, and such profuse sweating can not always be in-
duced; but when present, it must not be interfered with.
When not present, we see how much may be accomplished
by applying to the skin the moisture that nature fails to
supply. It has been shown that in fever there is retention of
water by the tissues, and that by friction the loss of water
maybe increased more than fifty per cent (Wcyrich). Hence
the value of this mensurc when the skin is cool and dry.

It should be remembered that cold applications, while
aiding heat elimination in some ways, in other ways diminish

THERAFEDTIC EFFECTS*

291

as by lessening the conducting power of the skin» hy
Basing the blood supply, and by checkijig perspiration.
It is consequently evident that to give a general cold bath in
, case in which the surface is pale, cold, and dry, — ^in other
"words, when there is a decided diminution in heat elimina-
lioo,— would be ill-advised, and likely to do harm. Indeed,
the persistent application of such a measure in a case of that
kind might induce a fatal result

It is true that in persons possessed of considerable vitality,
T cold bath might awaken such vigorous resistance on the
part of the system as to produce reaction to the surface, thus
increasing the heat elimination, and so restoring the heat-
tliminating poijer of the skin. Indeed, it is more than
l^robablc that this result might occur in quite a large pro-
puitioD of cases ; so that the danger from the application of
cold water in a manner theoretically wrong would not always
W &o great as might at first seem; nevertheless, it is far
better to recognise the exact condition present, and to select
th^ " * ropriate measures for meeting existing indications.
Tf, lan who depends upon the reserve forces of the

Myauid the versatile powers of nature to avert the conse-
1'icnccs of his blundering methods in the therapeutic uses of
^kt, can hardly be regarded as a scientific hydriatist.

In cases presenting an abnormally high tem-
perature, the following symptoms may be
regarded as indicating that the elevation of
temperature is the result of increased lieat
production : —

1. A flushed face, with full pulse.

2. A warm, moist skin*

3. A hot, dry skin.
The following symptoms accompanying an
elevation of temperature may be rej:^arded as
indicating that the rise in temperature is, at
the moment at least, associated with decreased
heat elimination : —

^mkm off
'flcnttM^H^t

|jr|D|lC01II^

■ling De-
' crrascd I1e«t

708

709

292 RATIONAL HYDROTHERAPY.

1. Cold, dry skin.

2. Cold, moist skin.

3. Goose-flesh appearance.

4. Blueness of the skin.

5. Chilly sensations.

6. Shivering.

Both heat production and heat elimination are often in-
creased in fever, but heat production more than heat elimina-
tion. When heat production and heat elimination are equally
increased or equally diminished, no change in temperature
occurs. Winternitz has shown, however, that the deviations
from the normal in febrile states may be almost wholly
accounted for by disturbance of heat elimioation.

Increase of both heat production and heat elimination, bat
with excessive increase of heat production, is a condition
present in sthenic fevers and inflammations. In this condi-
tion the skin may be cither flushed, hot, and dry, or warm
and moist. A similar condition is found when an elevation
of temperature results from violent exercise.

A condition of increased heat production, associated with
normal or diminished heat elimination, exists in cases of
fever in which the skin is cool and dry.

In the febrile condition resulting from sunstroke (thermal
fever), the rise in temperature is in part, at least, due to the
diminished heat elimination. A similar rise of temperature
occurs in the Turkish bath and other sweating procedures
before perspiration begins. The decrease of heat elimination
is due to spasm of the small vessels of the skin, a condition
which is best combated by cold friction or by a short hot
application, as a hot affusion, for example, followed by cold
friction.

When elevation of temperature occurs without increase of
heat production, there must be an accompanying diminution
of heat elimination. This condition sometimes exists in con-
nection with an ordinary cold.

Exposure to an overheated atmosphere, as during a

THERAPEUTIC EFFECTS. 293

•

prolonged period of hot weather, is often productive of a vast
number of cases of febrile disease, especially in infants.

When a person is in a hot bath or a dry pack, although the
rate of heat production may remain normal, there will be
diminished heat elimination and rise of temperature.

An elevation of temperature may occur while both heat

production and heat elimination are diminished, in case the

heat elimination is diminished to a greater extent than heat

production. This condition is often found in fever cases in

which the patient is bordering on collapse, with a cold, pale,

dry, or moist skin, and when present, calls for the immediate

employment of vigorous measures, before the symptoms of

coUapse shall have reached so serious a stage as to render

recovery impossible.

I. A general cold application increases both 710
rj'5^^** heat production and heat elimination. Which
AfpUcatioo of ^^ these effects is dominant depends upon the
Hydriatic Meas- duration and intensity of the bath.
vesfor the 2. k general cold application, if very brief,

TcBDenitiire causes no perceptible loss of heat, and may
•i fevers. occasion, by thermic reaction, a slight tem-

porary rise of temperature.
3. A prolonged cold application lowers the temperature
ljy increasing heat elimination, and also finally by diminish-
ing heat production, through the general sedative effect upon
the nervous system and the cooling of the thermogenic tissues
in the muscles.

4. The prolonged tepid bath lowers the temperature, by
increasing heat elimination without increasing heat pro-
duction.

5. The appearance of chill and shivering marks the
beginning of the lowering of the body temperature, and
diminished elimination accompanies it as a conservative
measure, while increased heat production begins.

6. Coldness and dryness of the skin, goose-flesh appear-
ance, chilliness, blueness of the surface, are indications for

294 RATIONAL HYDROTHERAPY.

•

the use of measures to increase heat elimination; that is,
means to encourage the cutaneous circulation.

7. A short general hot application (^ to 2 min.) dimin-
ishes heat production by its reflex effect upon the heat centers,
and increases heat elimination by increasing the skin circu-
lation and the production and evaporation of perspiration.

8. A long hot bath raises the temperature by heating the
body and increasing heat production.

9. In general, tonic thermic reaction should be, so far
as possible, suppressed in fever cases by avoiding short cold
applications and measures involving mechatiical effects, such
as the douche.

10. Gentle friction during a cold bath increases heat elimi-
nation by stimulating the surface circulation, and controls
heat production by maintaining the skin temperature and
thus preventing shivering.

Laschkiewitsch showed that death after varnishing is due
to excessive cooling from paralytic dilatation of the cutaneous
vessels.

The notion that hydrotherapy is chiefly useful in fevers as
a means of lowering the temperature is based upon a very
superficial knowledge of the rationale of this marvelous
therapeutic agent. Winternitz wrote nearly twenty years
ago : —

**The hydriatic antipyretic method consists in an antither-
mal procedure, together with applications which act upon
the nervous system and the circulation in a manner analo-
gous to nerve tonics and sedatives, and in tonic-raising
features which influence nutrition in a favorable manner as
well as in local measures, or reducing hyperemia and con-
gestion, whereby morbid processes maybe controlled."

In view of this important fact, which is still quite too
rarely recognized, it is evident that a routine practice, even
in the treatment of fevers, is quite impossible. The pro-
cedure must be carefully chosen, and adapted to the needs
of the individual case. In certain cases of fever, thermic

THERAPEUTIC EFFECTS.

295

btiDo must be wholly suppressed, or as nearly so as pos-
sible; in others a moderate amount o( thermic reaction will
prove beQefictaJ, In threatened collapse, thennic reaction
mast be encouraged.

Of the various measures which may be em-

9iMm43thAt ployed for the reduction of temperature, the

WUy be Em- following may be mentioned as having been

ployed to the t^^^^d '" actual cHnicat experience, not only by

Vvioiit Martrid the author, but by numerous able clinicians.

^•■*****'** All have been found useful and efficient, some

byi Rbe to being best adapted to one particular set of cir-

Temperature. cumstances» others to other conditions, but

each having its particular utility ; for rational

h}drutherapy gives no countenance to routine methods, and

leoapizes uo panacea : —

1. Tir Cifid or Tepui A ffusi on, ^Xhis method, first em-
f'bycd by Htppocrates, and in recent times revived by Currie
*od Jackson, is efficient in lowering temperature. The mor*
t:% rate in scarlet and typhoid fevers is reduced by its
Mse ifom thirty or forty per cent, to almost nothing. The
pafii'at simply sits in a large tub, while several pails of
tier at the ordinary tempemture, or about 70^ F., are
Orcd over him, this procedure being repeated as often
as the temperature reaches 102^ F*

Currie observed that the warm affusion (87^^ to 97^ F*)
w more effective in reducing temperature than the cold,
affering in proof the following excel fent reasons, which are
certainly highly creditable to the sagacity and medical knowl-
edge of this pioneer of rational hydrotherapy, considering the
fad thai his observations were made more than a hundred
ago: —
'*I find that* in many cases at least, the heat of the
living body is lowered as speedily by the affusion of tepid
natcr as by the affusion of water that is cold. If I mistake
loi, in some cases the heat is lowered more speedily by the
tepid water/*

711

296 RATIONAL HYDROTHERAPY.

The priticipal reason for the greater effect of the tepid
bath in lowering the temperature, Currie finds in the fact that
it is "little if at all stimulating, and does not, like the cold
affusion, arouse the system to those actions by which heat is
evolved and the effects of external cold are produced. If the
object is to diminish the heat, this may be obtained with great
certainty by the repeated use of tepid affusions."

He further makes the following very wise observation:
•• I have accordingly employed the tepid affusion very gener-
ally in those feverish affections where the morbid actions are
weakly associated, depending rather on the stimulus of preter-
natural heat than upon contagion, miasmata. ... It is also
applicable to every case of fever in which the cold affusion is
recommended." *

Currie also used the **cool bath" (75^ to 85^), but em-
ployed it most in chronic diseases. He preferred, however,
the cold bath in contagious and infectious fevers, evidently
for the reason that baths of this temperature are the most
effective in arousing the vital forces of the body to resist and
antagonize disease.
712 2. The Cold Inwicrsion Bath(\\\2). — This bath was first
systematically employed by Brand, who by its means reduced
the mortality from typhoid fever more than two thirds. The
method of Brand requires that the patient be placed every
three hours, day and night, in a bath at 68^ F. for fifteen
minutes. Brand requires the administration of the bath
whenever the rectal temperature of the patient reaches 102^
F. At the beginning of the bath, he directs that an affusion
of water at 59^ F. should be slowly poured upon the back of
the patient's neck for two minutes, and that the patient
should drink freely of water during the bath.

After the bath, the patient is placed in a sheet in which
he is wrapped and carefully dried, but without rubbing the
abdomen. The patient is only slightly covered after drying,

* •*Me<1ical Reports on the Effects of Water, Cold and Warm,'* by James
Currie, Vol. I, pp. 64, 65.

THERAPEUTIC EFFECTS. 297

and may continue to shiver slightly for some time after the
bath, as an indication of the actual lowering of the body tem-
perature occasioned by the bath. Twenty minutes after the
bath the temperature is taken and recorded.

The amount of reduction of the temperature by the cold

bath may be from half a degree to three or four degrees,

seldom more than one or two degrees, and not infrequently

tbere is a slight rise immediately after the bath. This

is especially true at the beginning of a fever. Later the

efiect is greater.

The question of the use of alcohol in connec-
ItS^ tion with the cold bath is one which is deserv-

for Alcohol. ^^S o^ more than mere passmg mention. Most
German and some American authorities who
recommend the use of cold water insist that just before put-
ting the patient into the cold bath, at least in febrile cases,
alcohol should be administered. The idea upon which this
practice is based is evidently the supposition that alcohol is a
stimulant, at least that it in some way sustains the heart or
the vital powers. But this theory was long ago rendered
thoroughly untenable by a multitude of carefully conducted
experiments upon healthy subjects, showing that alcohol is
aiways and in all doses a narcotic, and not a stimulant; that
It depresses, and does not excite the heart and other vital
organs; that it lessens vital resistance to disease; and that it
is a toxic agent which the body must cast out, and not a food
to be assimilated, nor a source of energy or aid to any vital
organ or function.

The relation of alcohol to the heart and the circulation is
a matter of most profound importance in the class of cases in
which the cold bath is most frequently employed. In rela-
tion to this point the fact should be recalled that the heart is
not the only force involved in the circulation of the blood.
It is doubtless the great engine of the circulation, but it has
been clearly shown by Schiff and numerous other physiolo-
gists that the movement of the blood is greatly aided by

298 RATIONAL HYDROTHERAPY.

a rhythmic action of the small vessels, both arterioles and
capillaries. These contractions are not simultaneous with
those of the heart, hence do not interfere with its action;
but as the pressure in the veins is very much below that
of the arteries, these contractile movements serve most effi-
ciently in pushing the blood along toward the veins. The
heart keeps the large arteries pumped full of blood, while
by means of the contractile movements of the peripheral
vessels, the blood is, so to speak, milked out into the
veins. We may say, in fact, that there are two hearts con-
cerned in the systemic circulation, the work of the central
organ being supplemented by the peripheral heart, — the small
vessels, — working at the distal end of the vascular loop,
where the resistance is greatest.

Active congestion, or hyperemia, is simply a state in
which the movements of the small vessels are very vigorous,
and have a wide swing, so that a large amount of blood is
passed through the tissues. In passive congestion there is
dilatation of the small •vessels without increased activity.
One condition results from increased action of the vessels
through stimulation of both the vasodilators and the vasocon-
strictors ; the other from paralysis of the vasoconstrictors
or excitation of the vasodilators, or both, resulting in dilata-
tion of the small vessels, with stagnation of their contents.
In active congestion, the aid afforded by the rhythmic move-
ment of the small vessels is increased. In passive congestion
this action is greatly diminished or entirely lost. The differ-
ence in the rate of the movement of the blood gives rise to
the difference in color, — scarlet in active hyperemia or con-
gestion, cherry red in passive congestion. In the one case
a rich supply of fresh, oxygenated arterial blood is passing
through the small vessels into the veins, the movement of
the blood is rapid, and all the vital processes are quickened;
the heart, as well as all other organs, is thus better nourished
and energized. In passive congestion and all conditions of the
circulation in which a cyanotic appearance is present, the

THERAPEUTIC EFFECTS.

299

aal condition in slowed circulation. The blood current is
jw through cardiac weakness, or the lack of the active as-
sistance of the peripheral heart; as a consequence, an insuffi-
cient amount of oxygen is introduced into the body; the blood
is charged with COj and other tissue poisons, and all the
vital processes are depressed. To aid the heart and the
circulation the thing needed is not simply an increased rate
of activity of the heart, or an increased volume of the pulse,
but an increased movement of the blood current throughout
the entire system.

Pallor is due to contraction of all the vessels of the skin. ^^^
Local cyanosis is due to greatly slowed movement of the
blood, either from passive congestion or spasm of the arteri-
oles, resulting in excessive absorption of oxygen and accumu-
lation of CO2 in the blood.

In the application of any agent for the purpose of reliev-
ing conditions of this kind, the peripheral heart as well as
the heart itself must be taken into consideration. In fact,
the whole circulatoiy system must be regarded as one. The
heart and the arteries are composed of essentially the same
kind of tissue, and have practically the same functions. The
arteries and capillaries as well as the heart are capable of
contracting. Both the heart and the arteries are controlled by
excitoiy and inhibitory nerves. These two classes of nerves
controlling the heart and the vessels respectively are kin-
dred in structure and origin, the vagus and the vasodilators
being medulla ted and of spinal origin, while the accelerators
of the heart and the vasoconstrictors of the arteries are non-
medullated.

Winternit;? and other authorities have frequently called
attention to the value of cold as a cardiac stimulant or tonic,
The tonic effect of this agent is greater than that of any
medicinal agent which can be administered.

The cold compress applied over the cardiac area of the 714
chest may well replace alcohol, as a heart tonic. The thing
necessary to encourage the heart's action is not mere relaxa-

300 RATIONAL HYDROTHERAPY.

tion of the peripheral vessels, but, as Winternitz has shown,
increased activity ot the peripheral circulation in the skin,
muscles, and elsewhere. Alcohol paralyzes the vasoconstric-
tors, and so dilates the small vessels and lessens the resist-
ance to the heart action; but at the same time it lessens the
energy of the nerve centers which control the heart, dimin-
ishes the power of the heart muscles, and lessens that rhyth-
mical activity of the small vessels whereby the circulation is
so efficiently aided at that portion of the blood circuit most
remote from the heart. A cold application to that portion of
the chest overlying the heart reflexly stimulates and ener-
gizes the heart through the cardiac nerves. This reflex action
is not confined to the heart muscle; the stimulation of the
activity of the cardiac vessels improves the circulation through
the heart structure, refreshing and energizing it in the same
manner in which a voluntary muscle is energized by a cold
application, as is so well shown by the ergograph (Exp. 50).

It is well to remember that the vasoconstrictor nerves are
one in kind with the excitor nerves of the heart, while the
vasodilators are in like manner associated with the vagus.
With this in mind, it is easy to see that while alcohol par-
alyzes the vasoconstrictors, it at the same time weakens the
nerves and the ganglia which initiate and maintain the
activity of the heart. Cold, on the other hand, excites to
activity these nerves and centers, and thus produces the
opposite effect.

The apparent increase of strength which follows the
giving of alcohol in cases of cardiac weakness is delusive.
There is increased volume of the pulse for the reason that
the small arteries and capillaries are dilated, thus lessening
resistance and cardiac work; but this apparent improvement
is very evanescent, as naturally results from the fact that
while the heart is relieved momentarily by the sudden dilata-
tion of the peripheral vessels, the accumulation of blood in the
venous system through the loss of the normal activity of the
peripheral heart, gradually raises the resistance again by in-

THERAPEUTIC EFFECTS. 3OI

creasing the load of blood which has to be pushed along in
the venous system. This loss of the action of the peripheral
heart thus in the end more than counterbalances the tempo-
rary relief secured by the paralysis of the vasoconstrictors.
This accumulation and sluggish movement of blood in the
venous system is shown by the purplish hue of the skin in a
person under the influence of alcohol, — a wide contrast to
the ruddy glow presented by the sktn in which the small
vessels are actively engaged in pumping the blood out of the
arteries into the veins, an action in which the whole body
may be made to participate by a general cold douche or other
suitable application of cold water to the surface. Cold appli-
cations, general and local, may be safely affirmed to be the
true physiological heart tonic.

It is evident, then, that in the use of alcohol in connec- 715
tion with the cold bath, we are not enhancing its effects, but
are simply lessening its influence. If it is desired to mitigate
the tonic or excitant effect of cold water upon the heart or
vessels, this may be accomplished by employing water at a
higher temperature, or, if it is desired simply to get the
patient over the preliminary shock of the application, we
may accomplish this much more efficiently by a preliminary
heating of the skin, as by a fomentation to the spine, a hot-
blanket pack, a hot enema, or even hot-water drinking.

3. The Cold Friction Bath (1150).— The utility of the cold 716
bath as originally practiced by Brand can not be questioned;
but Winternitz has shown that the rate of heat elimination
may be very greatly increased by rubbing the patient continu-
ously during the bath. At the present time Brand and his
followers, who are adepts in the use of the cold bath in fever,
uniformly employ vigorous friction during the entire bath.
Those authors who forbid friction during the bath because of
the supposition that heat production may thereby be increased
evidently do not recognize the fact that by the maintenance
of a vigorous surface circulation the rate of heat elimination is
increased out of proportion to the slight increase of heat pro-

302 RATIONAL HYDROTHERAPY.

duction, so that there is a decided gain to the patient by fric-
tion employed during the bath; and especially do these writers
neglect the important fact that the greatest benefit derived
from the cold bath is not the simple heat abstraction, but the*
general rousing of the vital powers, the increase of resistance,
and the quickening of the recuperative and reparative activi-
ties of the body.

Another advantage of this method is that the patient is
much more comfortable in the bath, and will tolerate the
application for a longer time and at a lower temperature as
well as more frequently than when it is administered without
friction. As elsewhere shown, friction also averts increase of
heat production by preventing shivering (200, 1151).

The claim made by some authorities that friction during
the bath lessens the permanency of its effect in temperature
reduction, is perhaps correct, to a degree, but this only neces-
sitates the more frequent use of the bath, which the friction
renders readily tolerable.

How, then, may we explain the good effects obtained
by the method of Brand ? The explanation is to be found,
not in the subtraction of heat alone, but especially in the
tonic effects of cold water, and in the sedative influence
upon the nervous reflexes concerned in the febrile process
and in the powerful diuretic effects of the bath.
717 4. The Tepid or Neutral Bath (1130). — A bath at 92^
to 95^ F. would produce little or no fall of temperature in a
healthy person, but experience has shown that by the employ-
ment of the neutral bath in fever cases, a marked fall of
temperature may often be induced. The reason for this is
that when the patient's temperature is three or four degrees
above the normal, the difference in the temperature of the
body and that of the bath is much greater than under ordi-
nary circumstances, and consequently the temperature-
reducing effect of the bath is proportionately greater.
Riess made a special study of this bath (1136).

The late Professor Dujardin-Beaumctz, the eminent French

THERAPEUTIC EFFECTS,

303

clinician, a few years ago expressed himself in very decided
terms against the cold bath as a means of reducing tempera-
ture. He remarked: '* Relying exclusively upon physiological
experimentation, the method of cold baths applied for anti-
thermic effects in the treatment of febrile phenomena is an
irrational practice. It subtracts heat from the patient, bet
increases organic disintegration."*

Laur, of Lyon, in 1874, and later other French clinicians,
showed the superiority of tepid baths over cold baths as a
means of reducing temperature and relieving the nervous phe-
nomena characteristic of typhoid and other continued fevers.
The temperature of the bath was 86'' to 95-' F., or ten or
twelve degrees below the temperature of the body, contin-
ued for a half or three quarters of an hour,

A bath administered at a temperature of S8^ to 92*^ is
higbly effective in reducing temperature if sufficiently pro-
longed, and a bath of this temperature has the decided advan-
tage that it does not provoke thermic reaction to any
considerable degree, and hence does not increase heat pro-
duction, either during or after the bath. A temperature of
88*^ to 92'^ F* is often tolerated %vithout difficulty by a feeble
t^'phoid fever patient who could not support a more vigorous
application, and is found to be most effective in lowering the
body temperature. It must be remembered, however, that a
temperature of 80^ or 85^ makes upon the hot skin of a
nervous fever patient an impression very little different from
I hat produced by water at a temperature five or even ten
degrees lower in a normal person. In other words, the
neutral zone is raised in febrile conditions. If the tempera-
ture is three or four degrees above normal, the neutral zone
is raised to about the same extent.

5. The Graduated Bai/i.— Zlemssen first, and later Glen-
ard, recommended in high terms the so-called graduated bath,
in which the patient is placed in an immersion bath, the

718

• •* I * Hygiane Th^rapeuUquet" by Dujirdin-Bcaumei?, Pans* i8SS.

304 RATIONAL HYDROTHERAPY.

temperature of which is 3. 5^' to 4^^ below that of the body.
The temperature is then steadily lowered at the rate of about
one degree every three minutes, until a temperature of 86^
is reached. This method has the advantage that no shock is
produced, as when the patient is placed in water at 68^, by
the Brand method. There is, accordingly, no marked thermic
reaction. If desirable, the temperature may be lowered
still more, or until the patient becomes slightly chilly, but he
should not be allowed to shiver. The bath should be accom-
panied by gentle friction for the purpose of preventing chill
and to increase heat elimination (Exp. 51).

With feeble patients who chill easily, the lowest tempera-
ture of the bath may be made 90^ or 92^ F. in the first
application, the bath being more prolonged than when the
lower temperature is employed. In such cases the tempera-
ture of the bath should be lowered one or two degrees at each
application until the temperature of 70° or 75^ is reached.

The graduated bath obviates the danger from syncope,
which is one of the inconveniences of the cold bath. It
may be employed in cases in which the cold bath is contra-
indicated, as in cases of typhoid with serious renal or
cardiac complications.

The results in temperature reduction obtained by the
graduated bath are more permanent than those obtained
from the cold bath of Brand or the cold affusion of Currie;
and after several years* experience with this bath, the author
considers the graduated bath one of the most efficient and
satisfactory of all the methods employed for reducing tem-
perature in fever. Unfortunately, it is much less convenient
for use in the ordinary home or in private practice than in
hospitals. There are, however, other means by which very
similar, and perhaps equally good, effects may be secured.
719 6. The Cooling Wet-Sheet Pack (1189).— When employed
for the reduction of temperature, the sheet should be wet in
cold or cool water, and should be wrung out slightly, then
wrapped about the patient in such a manner as to come into

THERAPEUTIC EFFECTS. 305

immediate contact with every part of the body, being tucked
in closely around each limb and about the neck. The patient
should be covered very lightly if at all. In a few moments
the temperature of the sheet will be raised to nearly that of
the body» when it should be renewed, a fresh pail of cold
water being employed each time for wetting the sheet,
which should be wrung out as dry as possible, in order to
remove the warm water which it contains, before dipping into
the cold water for the second application. It is better to use
two sheets, having the freshly prepared sheet on another '
couch.

The application may be renewed in this manner five or
six times in succession, or even more. When the tempera-
ture of the body is very high, the sheet is so rapidly heated
that it must be renewed every five to seven minutes, to make
the cooling effect continuous. The applications should be .
renewed until the temperature has been lowered one degree
or more, or until reduced to loi^ or less, each successive
application being longer than the preceding. There should be
good circulatory reaction to maintain an active cutaneous
circulation. It is often well to secure this by friction
with the hand outside the sheet.

7. The Cold Shower Pack (1190).— Instead of removing 720
the sheet from the patient, the same effect may be accom-
plished by opening the sheet and sprinkling the body as well
as the sheet with cold water. The patient should be made
to turn, first upon one side and then the other, so that the
back and whole body may be exposed to the cold application.

A better method still is to place the patient upon a cot
covered with oilcloth, so arranged in relation to a tub placed
at the foot of the cot that any surplus water may be caught
as it runs away; then the water may be turned upon the
patient from a watering-pot or poured over him either from a
dipper or other convenient vessel. By this means the cool-
ing effect of the sheet may be made continuous, and almost
as intense as that of the cold bath.

306 RATIONAL HYDROTHERAPY.

The late Dr. Austin Flint introduced this form of cooling
bath in 1874, when the author was a pupil under him in
Bellevue Hospital. In a paper read by him before the
Academy of Medicine at that time, he reported several obsti-
nate and protracted cases of remittent malarial fever with
vexy high temperature, that were rapidly cured by this
measure repeated daily.

Water at any desired temperature may be used. If the
patient does not well tolerate cold applications, water at a
temperature of 80^ or even 85° F. will be found efficient in
lowering the temperature, provided the application is con-
tinued for a sufficient length of time.

When vexy cold water is employed, the disposition to
chill may be prevented by friction with the hands applied
outside the sheet.
721 8. The Cold Compress (1318).— The cold compress may
be efficiently used for reducing temperature in cases in which
the febrile action is not so intense as to require more vigorous
measures. The compress should consist of two or three
thicknesses of linen, or twice as many thicknesses of cheese-
cloth. The fabric should be soft, so that it will fit the
surface perfectly. It is necessary that the compress should
be changed and recooled as soon as it approaches the body
temperature. It should not remain long without change.

The compress should be wet in cool or cold water, and
should be but slightly wrung. The more water it contains,
the less frequently will a change be required. The compress
must be large enough to cover more than one fourth of the
skin surface, or about five square feet for a person weighing
one hundred and eighty pounds. Several compresses may
be used, one for the front of the trunk, another for the back,
and one for each limb. Nervous patients and children often
tolerate the compress better than the wet -sheet pack, and it
may be changed more easily than the wet sheet. The com-
press may be covered with dry flannel, or, if desired, it may
be left uncovered, and will thus cool by evaporation.

THERAPEUTIC EFFECTS. 307

9. The Cold Sponge Bath (1204) — This is an exceedingly 722
useful measure in cases of fever in which the temperature is
not very high, but the skin flushed and dry, and the patient
restless and uncomfortable. If a sponge is used, it should be

as wet as possible, so that the surface will not be simply
moistened, but thoroughly wet. The intensity of the bath is
increased if a large amount of surface is exposed at one time.
If the patient is very sensitive to cold, and complains much
of the disagreeable sensations produced, small areas, as a
single limb, may be sponged in succession, each part being
covered as soon as gone over with the sponge. When a
stronger effect is desired, the whole body may be sponged,
and left uncovered to cool by evaporation. In general this
is not an efficient or satisfactory method of combating eleva-
tion of temperature. It is useful only when the skin is hot
and dxy.

10. The Wet-Towel Rud (1213).— The cold towel bath 728
is essentially the same as the cold sponge bath, only applied
somewhat differently. A towel of ordinary size is wrung out

of cool or cold water, and spread out quickly over as large an
area as possible. The hands are applied with a rubbing
movement, outside, not under, the towel, first one part, then
another, until the whole towel is slightly warmed, when it is
quickly renewed by dipping in cold water and wringing
slightly, and applied to an adjacent or corresponding sur-
face; and so on, until the entire body has been gone over,
the operation being continued as long as may be necessary
to procure the desired results. This method is applicable
only to cases in which there is but a slight rise of tempera-
ture, or where the patient is too feeble to be subjected to
more vigorous measures. Each part must be quickly dried,
rubbed, and covered after the application before proceeding
to the next.

The cold-towel rub, the towel being wrung as dry as
possible, is of great service in cases in which the patient is
in an adynamic state, with cold extremities, pinched features.

308 RATIONAL HYDROTHERAPY.

and marked depression. Especial attention should be given
to the limbs, and the application must be short and instantly
followed by vigorous rubbing. Partial cold rubbings test the
patient's reaction and preparation (or more vigorous applica-
tions, such as the cooling pack and the graduated bath.

724 II. Cold Wet Friction (1209).— This bath, administered
by means of the cold friction mitt, as elsewhere described,
is a most useful measure in cases of fever in which the condi-
tion of the patient demands a cold application to lower the
temperature, energize the heart, and increase vital resistance,
but in which there are conditions that contraindicate the ordi-
nary cold immersion, or Brand bath. It is a most valuable
antipyretic measure, and is always indicated in fever, except
in cases in which cold applications must be forbidden alto-
gether, as when the patient is perspiring freely. It may even*
be employed when the skin is cold or cyanotic. It is possible
to use water at a very low temperature, even ice-water, in
administering this treatment. It is of the greatest possible
service in the adynamic or ataxo-adynamic conditions of typhoid
fever, in cases in which serious cardiac or renal complications
have appeared, in intestinal hemorrhage, and in collapse from
hemorrhage or perforation. ' It rouses the vital powers in a
wonderful manner, brings to the surface the blood which is
stagnating in the viscera, awakens the lethargic brain, slows
and strengthens the fluttering pulse, and completely changes
the aspect of an apparently desperate case, and that often
in a very brief space of time, a few hours, even. The bath
may be perfectly graduated. At first the mitt should be only
moistened. As the circulation improves, it may at the next
application be saturated, and later it may be filled.

725 12. The Co/d Evaporating- S/ieet (1200). — A linen sheet
should be wrung out of cold water and wrapped about the
patient, who is left uncovered. The skin is cooled by evapo-
ration of water from the sheet, which may be encouraged by
vigorous fanning with an ordinary fan or by means of a cur-
rent of air from an electric fan. By this means a degree of

THERAPEUTIC EFFECTS. 309

refrigeration as intense as the patient is able to endure may
easily be produced. It is only necessary to keep the sheet
moist to continue the effect as long as may be desired.
Moderate friction should be employed by the hands applied
outside the sheet. Leyden has shown that the dryness of
the skin and retention of water in fever is a cause of dimin-
ished heat elimination. Hence the value of this and other
similar hydric measures.

13. The Hot Evaporating Sheet (1200).— This measure 726
is precisely the same as the preceding, except that the sheet

is wrung out of hot water. The temperature of the water
should be as high as can be borne, 130^ to 140^^ F. The pur-
|X)se of the hot evaporating sheet is to obtain the combined
effects of heat and cold. The impression of heat which lasts
#for a few seconds at the beginning of the application produces
an atonic thermic reaction, diminishing heat production, and
preparing the way for the largest benefit to be derived from
the cold impression which quickly .follows as the sheet is
cooled by the rapid evaporation. Evaporation may be stimu-
lated by fanning, as in the case of the cold evaporating sheet.
Rej>eat in five to eight minutes, or as soon as chilly sensa-
tions are felt. Apply gentle friction as the sheet is cooled.

This measure is especially valuable in cases in which the
patient is very nervous, and dreads the contact with cold
water. In one such case the temperature was lowered two
degrees during an hour as the result of repeated applications
of the hot sheet.

14. The Hot Sponge Bath. — The hot sponge bath is an 727
application sometimes useful in febrile conditions. The brief
impression of heat produces an atonic reaction, with dimin-
ished heat production, while the evaporation taking place
from the moistened surface subsequently produces cooling
effects. This method is of comparatively limited value, but

it nevertheless often proves useful in special conditions, as
in cases in which there is cyanosis, shivering, chilliness, or a
dread of cold water, and in mild febrile cases.

3IO RATIONAL HYDROTHERAPY.

The hot sponge is of the greatest service in connection
with cold friction or the cold-towel rub. It should be ap-
plied to each part just before the cold application, as a prep-
aration for it. It promotes the reaction whereby the surface
vessels are filled, and thus encourages the antip3a*etic effect
desired, also refiexly acting to reduce heat production. The
water employed should be as hot as can be borne, 130^ to
140°. The sponge should be squeezed quite dry, and should
be applied quickly, and to a small area, as an arm, a thigh,
or a leg. The hot sponging should be continued, rewetting the
sponge every half minute, until the surface reddens slightly.
Then the cold application should be instantly applied with
rubbing, allowing no interval for chilling.
728 1 5. The Hot-Blanket Pack (1197).— This is a very useful
means for reducing temperature in certain cases in which cold*
applications can not be employed without serious risk, and
hence are contraindicated. The hot-blanket pack acts, of
course, by producing an^atonic reaction, thus lessening heat
production, and is in some cases especially useful as a prepa-
ration for a subsequent cold application, the heat preparing
the skin for rapid heat elimination.

The hot-blanket pack is of the greatest service as a means
of aiding the reduction of temperature in cases in which there
is decreased heat elimination (237). The duration, however,
should be brief — 3 to 10 minutes — and as hot as can be
borne.

The following instance illustrates very clearly the advan-
tages of the hot-blanket pack in cases requiring increased heat
elimination : A number of years ago the author was called in
consultation in the case of a child of four years, who was
suffering from malignant diphtheria. The patient was found
with a temperature of 106*^, comatose, the skin pale and cold.
A hot-blanket pack was ordered immediately, which quickly
brought the blood to the surface. In fifteen minutes the
patient was revived to consciousness, and in two hours the
temperature had fallen to 102°. The recovery was rapid and

THERAPEUTIC EFFECTS,

311

excellent. Numerous similar cases might be cited, in which a
high temperature with diminished heat elimination accom-
panying typhoid fever and other febrile states has been
promptly relieved by a preliminary hot application followed
by cool compresses, the wet-sheet pack, and allied means.
It must be remembered, also, that heat is a sedative of
great power; hence the presence of cardiac weakness, a con-
dition very commonly accompanying the adynamic state in
which the hot pack is indicated, must be most carefully con-
sidered in making an application of heat of any sort. Fortu-
nately, short hot applications are depressing only in very
slight degree, and very short applications (i to 3 min.) are
stimulating in their effects. Any depressant effect arising
from the hot-blanket pack may be overcome by means of the
cold precordial compress, or an ice-bag over the heart during
the application.

16. Fomeniaiion to the Spine (1328). — It would perhaps '29
be more proper to describe this measure as a fomentation to

the back, as the application should not be confined to the
spine, but should extend to the whole posterior surface of the
trunk. A fomentation to the spine acts in a manner similar
to the hot-blanket pack, but its effect is of course less intense.
The application often produces profuse perspiration, whereby
a considerable amount of heat is carried off. The hot pack
is also a good preparation for a cold application, and is espe-
cially useful when the cold bath is contraindicated.

In some cases, alternate hot and cold compresses to the
spine are more effective in producing perspiration than fomen-
tations alone, and hence greatly promote heat elimination. A
hot application to the spine encourages heat elimination by
stimulation of the sweat centers.

17. f&mentation to the Abdomen, — ^This procedure, in 730
combination with other measures, aids in reducing tempera*
ture. When the patient complains of chilliness or is inclined

to shiver, the abdominal fomentation will at once dissipate
these unpleasant symptoms, and prevent the increased heat

312 RATIONAL HYDROTHERAPY.

production which would otherwise result from the muscular
action induced. The fomentation aids in maintaining the
surface circulation, and is an excellent means of preparing
the patient for the cooling pack and the cold bath. In cases
in which the cold bath produces abdominal pain or cramps,
the fomentation for ten minutes just before the bath relieves
this inconvenient symptom. The fomentation may be use-
fully employed in connection with the cold enema when this
measure causes unpleasant shivering. It is useful, likewise,
as a means of increasing tolerance for the cool abdominal
compress, for which purpose the compress should be removed
once in two hours and the fomentation applied for ten or
fifteen minutes at as high a temperature as the patient can
bear. Used in this manner, the fomentation materially aids
the compress as a means of combating visceral congestion.
731 1 8. The Hot and Cold Bath. — In many cases, and espe-

cially in persons in whom the surface circulation is sluggish,
more pronounced antipyretic effects may be produced by
immediately preceding the cold bath with a hot bath at a
temperature of 105^ to 107^ for 3 or 4 minutes, than by the
use of the cold bath alone. Galen treated fever cases by rub-
bing with cold water after a warm bath.

Vinaj claims that the hot bath for three minutes, fol-
lowed by a bath at 95°, gradually lowered to 80^ during 5
to 1 5 minutes, is more effective in lowering the temperature
than the cold bath of Brand, and produces more permanent
results. The author has confirmed this in certain cases.

Pfliiger found that greater refrigerant effects were pro-
duced by the hot spray for one minute, followed by a short
cold spray, than by the cold spray alone. Finkler con-
firmed these results in experiments upon febrile rabbits.

This result is doubtless attributable to the increased heat
elimination due to dilatation of the surface vessels, and
to the atonic thermic reaction.

The observers mentioned noted also that a greater effect
was produced by a short cold bath, if the body was sprinkled

THERAPEUTIC EFFECTS.

313

with ver>^ hot water at the moment of emerging from the bath
than if the cold bath were prolonged. This may prove an
excellent method. The heat impression made upon the skin
indnces lessened heat production, without communicating
a sufficient amount of heat to the body to cause a rise of
temperature,

19. Coifi Appihatiom to the Head, Spine, Heart, if mi 733
Abdomen.— 'Yh^ application of the cooling compress (1318),

ice bag or cap, or the cold coil to the head or abdomen or
to both regions, is a powerful means of reducing the general
temperature, and was successfully employed by Spencer
Wells and others in the treatment of patients suffering from
a high temperature due to peritonitis. Benjamin Rush used
an ox-bladder filled with broken ice in yellow fever more than
one hundred years ago.

Cold applications to the head should never be neglected
in fever cases, care being taken to wet the hair thoroughly, as
it is an excellent non-conductor unless saturated with moisture*

A continuous application of cold to the head and abdomen
produces in some cases such marked effects that no other
measures are required for controlling febrile action. Care
ranst be exercised, however, in the application of cold to the
head, that too pronounced depressing effects are not pro-
duced,

Winternitz has shown that the prolonged application of an
icebag or an ice- water coil over the heart cools the blood,
and thus lowers the general temperature. This measure may
be advantageously associated with others in the treatment of
fever cases.

Neale advocates the use of the ice-bag to the spine as a
means of lowering the temperature. The antipyretic effect
of this measure is doubtless due, in part at least, to its in-
fluence upon the circulation, as it dilates the surface vessels
of the extremities.

20. The Cidd'Air Bath.— The temperature of the air 733
in the sick-room has a most decided influence upon the body

314 . RATIONAL HYDROTHERAPY.

temperature in the case of a fever patient, an increase of a
few .degrees in the temperature being often responsible for a
rise of temperature in the patient which could not other-
wise be accounted for. The fever patient is somewhat in
the condition of the so-called cold-blooded animal, whose
temperature rises and falls with that of the surrounding
medium; for the body has lost the power of regulating its
temperature, as it does when in a normal condition.

It should be remembered that while atmospheric tempera-
tures below 58° F. cause increase of heat production, air at
a temperature above 60^ has a like tendency. Air is practi-
cally neutral between 60° and 70°, while at 104° the heat
production may be three and one-half times the normal
amount. Whenever the body temperature is above normal,
tissue metabolism and heat production are increased.

Breathing air of a low temperature, as well as exposing
the skin to cold air, has a decided effect in lowering the tem-
perature. This method has been adopted as a definite pro-
cedure, the patient being made to breathe artificially cooled
air, brought to him through a tube. It is interesting to recall
in this connection that Currie relates a case of fever treated
in 1 80 1 in which the temperature was reduced from 104^ to
loi*^ by an air bath at 65^. The patient's body was exposed
uncovered to the air, being placed between an open window
and a large chimney. The pulse fell in a short time from 120
to 114. He also relates the case of an Arab traveler suffer-
ing from the plague who escaped from a caravan during a
violent delirium, and wandered naked in the desert for three
weeks, until he finally recovered. He subsisted during this
time on sorrel.

The lungs present a surface of about two thousand square
feet, while the skin has a surface of only seventeen square
feet. It should be noted, however, that the surface presented
by the perspiratory ducts of the skin aggregates more than
eleven thousand square feet. All the blood in the body is
spread out just beneath the lining surface of the air-cells of

the lungs every two and a half minutes, making this a very
important cooling surface. But, unfortunately, the amount
of air which can be introduced into the lungs is so small that
the effect obtained, even when the rate of breathing is
doubled and the volume of tidal air considerably increased,
can not be very large, i have, however, succeeded in lower-
ing the temperature in fever cases by means of re-enforced
respiration, causing the patient to breathe deeply of cold air
while the arms were raised above his head to aid the respira-
tory effort.

By making a patient breathe very cold air. say at $^ F.,
taking in 125 cubic inches at a breath, and breathing fourteen
times a minute, he would take into his lungs about sixty cubic
feet of air per hour. To raise this air from 5^ to the tempera-
ture of the patient, supposing the patient's temperature to be
105'^, would require the addition of about 120 heat units, rep-
resenting an equal amount of heat abstracted from the body,
or a lowering of the temperature of i^ F, in a person weigh-
ing 12a pounds* So good a result can not be obtained in
practice, however, for the reason that the air inhaled at 5"^ F.
does not reach body temperature before being exhaled, and
ordinarily the temperature of the inspired air is much higher.
Yet a considerable degree of cooling may be effected through
the breathing of cold air, provided pains is taken to increase
the volume of air inspired. It is apparent, however, that the
breathing of cold air is by no means so powerful a refrigerative
measure as the exposure of the surface to cold air or cold
water. Its benehcial action is doubtless largely due to the
stimulation of the pulmonary circulation and the tonic reflex
influence upon the heart.

The human body obeys the same physical laws as do other
bodies as regards cooUng by contact with air or radiation of
neat toward masses of lower temperature. From the formulae
dedticed from actual experiments by Peclet, the author has
calculated that the body cools by radiation at the rate of about
one heat unit for each degree of difference between the tem-

3l6 RATIONAL HYDROTHERAPY.

perature of the skin and the temperature of the walls of the
room in which the patient is exposed, while the rate of heat
loss by contact with moving air is about one-half heat unit
for each square foot of skin surface exposed to each degree
of difference between the temperature of the skin and the
temperature of the air in contact with the body. From these
facts one may easily deduce the probable amount of cooling
which will result from the administration of a cold-air bath.
Suppose the temperature of the walls of the room to be
about 60°, the temperature of the air 70^, the average skin
temperature 95°, and the amount of skin surface exposed 10
square feet. We shall have, by application of the aboVe
rules, a loss of 350 heat units by radiation and 125 heat units
by contact with the air, or 475 heat units in all. Supposing
the weight of the patient to be 160 lbs., there would be a loss
of 3 heat units per pound, or a lowering of the general body
temperature of about 3 degrees. If the patient lies upon
a hard surface, the amount of skin exposure will be greater
than if the body rests upon a hard mattress. By frequently
changing the position of the patient, turning first on one side
and then on the other, the cooling surface may be consider-
ably increased.

If it is desired to calculate the amount of skin surface
actually active in a given case, it may be done by means of
a simple formula: A man weighing 180 pounds has a skin
surface of about 17 square feet. Applying the well-known
law pertaining to the relation of the contents of a solid body
to its surface, we obtain the following proportion, in which IV
represents the weight of the patient under consideration, and
5 the skin surface : —

iSo:W:: lyliSi

This may be simplified into the following formula : —

70 W= 180 Si; or, -i^ = 5i
2.57

Or, if we divide the weight by 2.57, and square this quo-

THERAPEUTIC EFFECTS 317

tient, and extract the cube root of the result, we shall have
the number of square feet of skin surface in a person of
given weight.

If the patient weighs 1 30 pounds, the skin area would be
thirteen square feet. Supposing the amount of surface ex-
posed to be three fourths of the whole, or about nine square
feet ; we require to know further only the surface tempera-
ture of the patient, the temperature of the walls of the room,
and of the air about the patient, to be able to determine the
rate of heat loss during an air bath of one hour's duration.
This rate of cooling may be sufficient to compensate for heat
production of nearly double the normal rate.

Since the heat production, as shown by the experiments
of Winternitz, is rarely or never increased to this extent in
febrile conditions, it is evident that the continuous cold-air
bath, accompanied by rubbing to prevent chilling, is a most
efficient antipyretic means.

Continuous moderate rubbing greatly enhances the effect
of the air bath by maintaining a vigorous surface circulation.
If the skin becomes cooled, the rate of heat elimination is
greatly lessened. Under ordinary conditions, the skin elimi-
nates 66.6 per cent, more heat with a surface temperature of
95*^ than with one of 85^. The employment of olive-oil,
cocoa butter, or vaseline as a lubricant facilitates the rubbing,
and increases the rate of radiation to the extent of perhaps
forty or fifty per cent.

21. The Graduated Compress. — The compress (1313), as 734
well as the full bath, may be graduated. The first applica
tion should be made at a temperature a few degrees below
that of the body, the temperature of each succeeding appli-
cation being lowered two or three degrees. In patients who
are very sensitive, the first compress may be wrung out of
water at 130^. Apply for 3 minutes. Such a compress, by
producing an atonic thermic reaction, prepares the way for
the fullest effect to be derived from the cold applications to
follow.

3l8 RATIONAL HYDROTHERAPY.

786 22. Water-Drinking (1423).— The free drinking of cold
water is an efficient means of lowering the temperature.
Drinking two or three pints of water at a temperature of 40°,
within ten minutes, has caused a fall of temperature of one
and one half to two degrees. This method, first empir-
ically used by John Hancocke nearly two centuries ago, has
been employed by a number of observers, with interesting
results, but its chief utility is as an accompaniment of other
antipyretic measures. Water-drinking lowers the temperature
not only by absorbing heat, but by diluting the blood, and thus
promoting evaporation from the surface and exciting the kidneys
to increased activity, thereby encouraging the elimination of
the toxins to which the rise of temperature is due. A glass
of cold water every hour is an excellent rule for fever patients
when the febrile action has any considerable degree of inten-
sity. Cantani considered water-drinking superior to all other
means of reducing the temperature, and Beverly-Robinson,
after an extended experience, highly recommends it, directing
that the patient should swallow not less than six or seven
quarts every twenty-four hours.

736 23. The Tepid or Cold Enema (1405).— The enema
affords a much more convenient means of introducing cold
water into the alimentary canal than does water-drinking, for
the reason that the patient usually refuses to swallow the
amount of water required to produce any decided effects.
Two or three pints of tepid or cool water may easily be intro-
duced into the colon, if care be taken to avoid the introduc-
tion of air and to allow the water to flow in slowly and with
little pressure. The water should be retained from 5 to 10
minutes, or as long as the patient does not suffer great incon-
venience. The amount introduced should not be so large as
to produce uncomfortable fulness or a painful desire for evacu-
ation, but the patient should be instructed to make forcible
efforts to retain the water, and, if necessary, assistance should
be rendered by pressure with a napkin (Exp. 52). A long
rectal tube should be used in introducing it.

V.

THERAPEUTIC EFFECTS. 319

The principle of graduation may be employed with the
enema as with the cold bath. Beginning with a temperature
of 98^, the vrater introduced may.be steadily cooled until
it is reduced to 70° or even lower. As a rule, however, a
temperature of 80^ is sufficient to accomplish the desired
result

A simple illustration will show the efficiency of the
enema as a means of lowering the temperature. Suppose,
lor example, the quantity of water introduced to be five
pounds (pints), and its temperature 70^, the patient's tem-
perature being 105^, and his weight 1 50 pounds. If, on the
withdrawal of the water, its temperature is found to be increased
to 85^. the water has absorbed 75 pound Fahrenheit heat units
(5x15=75), which would be an equivalent of one-half heat
onit to each pound of the body weight, or . 5^ of temperature
fall for the whole body. In other words, if there had been,
in the meantime, no increase of heat production, the tempera-
ture of the body would be lowered .5^. By repeating the
enema every fifteen minutes for an* hour we may remove in
four applications three hundred heat units, whereby the tem-
perature of the body would be lowered 2°; but as the e£fect
of a cool application of this sort is to stimulate heat produc-
tion to some extent, we should not always expect quite so
great effects as this, but rather a reduction of one to one
and one-half degrees, which would certainly be an excellent
result.

If water of a higher temperature — say 80^ to 85° — is
employed, which is sometimes necessary to avoid shivering
and other discomforts to the patient, the rate of heat abstrac-
tion would be less; but on the other hand, the increase of
heat production would also be less, and the measure may
be continued for a longer time, and thus the net result may
be equally great. On the whole, the results of clinical
experience are decidedly in favor of long applications of
moderate temperature, rather than short applications at a
low temperature, as a means of temperature reduction.

320 RATIONAL HYDROTHERAPY.

Halm and Stolz reduced the temperature 3.6*^ and the
pulse twenty-five beats per minute by using the cold enema in
quantity of one liter, at a temperature of 46^, repeating eight
times in succession, at intervals of from 5 to 10 minutes.
Jacques employed the cold enema and water drinking in fever
cases in 1839 with great success.

A very convenient method of administering the enema
is to supplement the ordinary tubing of the fountain syringe
by a shorter piece of tubing two or three feet in length, con-
nected to it in such a way that it may be easily disconnected.
It is better to have the short piece of tubing somewhat larger
than the ordinary size, so that it will not be easily obstructed.
After being slowly introduced, the water should be retained
for 5, 10, or 15 minutes if possible. Then, by disconnect-
ing the short tube and without removing the rectal tube,
the water may be allowed to escape into a suitable vessel,
and another portion of cool or tepid water may be imme-
diately introduced. In a fever case under the author's care a
number of years ago, the cold enema was employed in this
manner continuously for two or three hours, and with the
result that the temperature of the patient, which was at the
beginning of the treatment between 105° and 106^, and had
proved refractory to every other measure, was reduced to
102°, and was thereafter readily controlled by a repetition of
the same procedure.

The author has constantly made use of the enema at
different temperatures in the treatment of fever patients
during the last twenty years, and finds it, when properly used,
one of the most efficacious of all antipyretic measures.

The larger the quantity of water introduced, the greater
will be the cooling effect, for the reason that it will come
in contact with a larger extent of surface. With the pa-
tient lying on his back, it is generally difficult to introduce
more than one or two pints of water; but by placing him upon
the left side, with the limbs drawn up, or by elevating the
hips six or eight inches, a much larger amount of water may

THERAPEUTIC EFFECTS.

321

be introduced, as by this means the liquid may be made to
enter the transverse colon and even the caecum. It is thus
easy to introduce two or three quarts of water. If no more
than one quart of water is used, the amount of surface with
w*hich the water is brought in contact is so small that com-
paratively slight effects are produced.

24, Partial Cold Appiicaiions. — When the general feb- 1'37
rile action is the result of a local inflammatory process* as in
many pelvic inflammations, appendicitis, pneumonia, pleu-
risy, peritonitis, acute arthritis, phlegmon, felon, and otitis
media, the temperature may be best reduced in many in-
stances by a very cold circumscribed application made to the
affected part. Cold irrigation, the cold compress, and the
ice-bag are among the most suitable measures in these cases,
employed either alone or in combination with fomentations
or other hot applications, used either as a preliminary meas-
ure or at intervals, as special conditions may indicate.

In certain cases, as in compound fracture of the limbs, in
which the surgical dressing k r maintenance of the parts in
proper position prohibits the employment of cold water to
the affected part, the principle of the ** proximal com-
presi** (1327), so much used by Priessnitz. may be employed.
In head injuries, apply the ice-collan In injuries of the
hand, employ the cold elbow bath. In injury or inflamma-
tion of the foot, apply an ice-bag to the groin or the bend of
the knee. This method is based upon the well-known fact
that an application of cold to tlie trunk of an artery causes
contraction in all its branches beyond the point of application.
Condi ttons ^^ previously pointed out, elevation of tem* 738

Olvlit? Rise to perature may occur in five different cases as
Blevatloa of regards the condition of the heat-regulating
Temper.t««. f„„^jio„, (237).

In the application of measures for the reduction of tem-
perature, it must first be ascertained to which of the several
classes the case in hand belongs. It may be that no hydri-
atic application of any sort should be made, or that hot

31

RATIONAL HYDROTHERAPY,

instead of cold applications are required. It may be profit-
able to note briefly the special indications in each of these
classes of cases: —

In cases in which there is very great increase of heat pro-
duction, with heat elimination increased, but to a less extent,
by noticing the skin, the condition of which gives the best indi-
cation of the state of the patient as regards heat elimination,
we may find any one of the following conditions: (n) Per-
spiring skin; (6) warm, moist skin; (t) hot, dry skin. We
certainly would not find a cold skin, for heat elimination is
increased.

What is to be done in cases of this sort ? Certainly, if
the skin is hot and the patient is perspiring freely, heat
elimination is taking place as rapidly as possible, and usually
no hydriatic applications should be made* We should sim-
ply dry the skin by wiping frequently with a soft warm
cloth. If the skin is cold^ even though it may be covered
with moisture, elimination is not increased, for water will
not evaporate quickly from a cold skin. The application of
a cold bath, a cold enema, or any other refrigerating meas-
ure would be in the highest degree detrimental in cases of
this sort, for it would check the perspiration and thus further
diminish heat elimination, and would probably produce a
chill, with internal congestion. This is a matter of great
importance^ especially in the treatment of pneumonia, and
other fevers accompanied by an internal inflammation, and
in dealing with such disorders as sweating sickness, which
has prevailed so extensively in the southern part of the
United States, in the West Indies, and in Tiiany other
countries. Wiping frequently with a soft linen cloth pro-
motes the cooling process by removing the surplus water
and thus increasing the amount of radiating and evapora-
ting surface.

In cases in which the skin is warm and slightly moist,
but not perspiring freely, perspiration may be promoted by
hot- water drinking, by hot sponging of the spine, and by a

THERAPEUTIC EFFECTS*

3^3

small hot enema. The patient should otherwise be treated
the same as when perspiration is profuse. If the skin is
cold and moist or perspiring, hot appHcations should be
made. The hot application may consist of a fomentation to
the spine, a hot enema, a short hot-blanket pack, or an
immersion bath at 1 02^ for 5 or 4 minutes. Cold friction
may be applied with great advantage immediately after
the hot apphcation in most cases*

Heat elimination may be encouraged by two general 739
methods: (i) By the application of cooling measures; (2) by
employing measures to induce perspiration. It is by no
means easy to induce perspiration in cases of continued fever,
the condition of the perspiratory glands being such that it is
generally impossible to induce active sudation. When the
patient does perspire, it is generally an indication of an im-
proved condition, usually of a lowered temperature, except
when other grave symptoms appear coincidently* On the
other hand, the skin may be cooled at will, and to any Extent
desired; no matter how active may be the production of heat
in the body, it is possible to apply to the skin cooling meas-
ures of such intensity that the heat produced within the body
may be eliminated as rapidly as it is generated. The thick
stove-cover becomes red* hot, but the temperature of the
boiling kettle does not rise above 212^, the rate of heat
elimination in the boiling kettle keeping pace with the rate
at which the heat is communicated to its bottom.

Three different methods may be conveniently employed for 740
the encouragement of heat eHmination by cooling the skin.
These are (i) the application of cold water; (2) the applica-
tion of cold air; (3) evaporation of moisture from the skin.

Cold water may be applied by various hydriatic measures,
of which methods 1 to 19 (74*) are most appropriate and
convenient for a case in which there is fever, with increase
of both heat elimination and heat production.

The mtithod of cooling the body by contact wnth cold air
has been elsewhere described (733).

3M

RATIONAL JIYDROTHERAPY.

To cool the skin by evaporation it is only necessary to
substitute ordinary water for the perspiration which nature !s
unable to produce. The evaporating sheet (725) and the
sponge bath are the most efficient means of accomplishing this.

In cases in which there is an iDcrease of heat production
with normal heat elimination, there is evidently a greater
need for an increase of heat elimination than in cases in
which there is less active heat production, and conse-
quently less necessity lor the application of vigorous cold
procedures. The first indication in cases of this sort is to
stimulate activity of the peripheral circulation. This may
usually be accomplished by friction of the skin; but if the
temperature is high, vigorous friction will not be desirable,
as mechanical irritation of this sort may stimulate heat
production as well as heat elimination. Those measures
most serviceable are the graduated bath, the tepid bath,
the cold friction bath, and the graduated compress.
741 Friction should accompany all cold applications made in a
case of this sort» as it is desirable to produce circulatory
reaction, while thermic reaction should as far as possible be
suppressed. The graduated bath and the tepid bath, with
friction, are especially to be commended in cases of this class.
The cold friction bath and cold immersion bath^ cold alTusion*
the cooling shower pack, and other cold applications may be
employed, provided a hot bath of some sort, as the hot-
blanket pack for g minutes, hot immersion for 3 to 5 min-
utes, or some similar procedure is administered just before
the cold application. The hot application must be short and
intense (105 to 1 10 ), and must be instantly followed by the
cold application before the skin has been chilled by evapora-
tion or contact with the air.

In cases of increased heat production with diminished
heat ehmination, the most important indication is to increase
heat elimination. Heat production can not be so easily con-
trolled, but heat elimination is entirely under the control of
the physician, if the proper measures are employed.

THERAPEUTIC EFFECTS-

32s

At the same time that heat elimination is increased, ther-
mic reaction must be avoided^ or there will be heat increase.
However, the elevation of temperature in a ^ven case of
this kind may be due as much to diminished heat elimination
as to the increase of heat production. The most suitable
measures to be employed for restoring the normal tempera-
ture are essentially the same as those recommended above.
Care must be taken, however, in cases of this sort, to avoid
too long-continued cold applications. The patient should
be well covered after the bath, and must be well rubbed in
the bath to insure vigorous surface circulation^

In cases in which heat production is normal, with heat
elimination decreased, — a condition comparatively rare, —
the skin is always cooL A hot skin generally implies
increased heat elimination, although Herz, of Vienna, has
shown that dryness of the skin greatly lessens heat elimi-
nation. Clamminess of the skin may be present, but this
does not necessarily involve an increase of heat elimination
by evaporation. The measures most serviceable in cases of
this sort are, the Scotch douche, the hot-blanket pack fol-
lowed by a short cold immersion bath with friction, or
fomentations to the spine, followed by general cold friction.

In cases in which there is diminished heat production with 7i2
diminished heat elimination, but to a lesser degree, a hot
bath (s to 10 min.) followed by a short cold bath (^ min.)
will be found a most efficient means of restoring the tempera-
ture equilibrium. The cold bath should be accompanied by
vigorous rubbing, to secure thorough circulatory reaction.
Rubbing should also be practiced in the bath to encourage
both circulatory and thermic reaction. H the bath is con-
tinued too long, thermic reaction may be suppressed In
cases of this sort both thermic and circulatory reaction are to
be encouraged. The hot enema, or fomentations to the spine,
followed or accompanied by cold friction and dry friction after-
ward« are also valuable measures. The important thing is to
increase the surface circulation. Pallor, blueness, or coldness

326

RATIONAL HYDROTHERAPY.

are aJways indications for the application of heat and frictioo
to the skin. The effect of hot applications in stimulating the
surface circulation, however, is transient; hence the impor-
tance of following the hot application by a very brief cold
application, thereby exciting circulatory reaction, by means
of which the blood is more permanently fixed in the skin and
heat elimination encouraged. No harm is done if the appli-
cation is carried to the extent of slight chilliness, provided
the patient is afterward quickly warmed up by rubbing.
Reaction must necessarily be encouraged by wrapping the
patient warmly for a few moments after the cold application.
Cold friction is a measure well adapted to cases of this sortj
the pack following a fomentation to the spine or abdomen,
the short hot full bath, or any other measure whereby the gen*
eral surface of the body has been thoroughly heated.

In the treatment of febrile disorders it is important to take
into account in each case and on each occasion, whether or
not the dominant condition is increased heat production or
diminished heat elimination. Winternitz has shown that
variations in heat elimination may be sufliciently eKtensive to
account for all changes in body temperature; nevertheless, it is
quite certain that variations in heat production are also an
important determining factor in deviations from the normal
temperature mean.

In addition to the subjective and objective indications
relating to the processes of heat production and elimination,
there are calorimetric and other means by which more defi-
nite and exact information may be obtained. For example,
by means of the formulae given elsewhere (pp, 315, 316), we
may determine the rate of heat elimination by radiation and
air contact. Let us suppose, for example, in the case of a
febrile patient, that the surface of the skin feels cold, and has
an average temperature of 80'- F., while the temperature of
the walls of the room is 70*^ and that of the air 70'', By the
formulae the heat loss per hour for each square foot of surface
will be IS heat units. The weight of the patient is 120

THERAPEUTIC EFFECTS.

327

pounds. By the formula already given (p. 316) we find the
skin area to be 13 square feet (180: i20::jo:S*i 5 = 13).
At the rate of 1 0,000 heat units' daily loss for a skin area
of 17 square feet, the normal heat loss for a skin area of 13
square feet would be about 7,600 heat units. But the actual
loss is only 4,680 (isx 13x24^4,680). a diminution of 2,920
heat units, or 38 per cent, less than the normal rate of heat
eHmination* By this simple mathematical calculation it is
possible in any case to determine approximately the rate of
heat elimination to normal; and if the loss is found less than
norma) p while the rectal temperature is above normal , it will
be at once evident that the febrile temperature may be readily
accounted for by the retention of heat, and that the thera*
peuUc indication is for the use of such measures as will
increase heat elimination. In such a case, the Brand bath
would of course be contraindjcatedj the measures required
would be dry friction, or short hot baths followed by partial
cold applications with vigorous friction* The use of the friction
mitt with water at 50'^ to 60' would be especially indicated.

Let us suppose, on the other hand, that the patient*s sur-
face temperature is found to be high, hot to the hand, and
indicating too° by the surface thermometer* The heat loss
will be at the rate of 14,040 heat units per diem (4Sx 13x24
= 14,040), or an increase of 85 per cent. The rectal tem-
perature being above normal, it is evident that there nuist be
at lea^t an equal percentage increase in heat production; and
vigorous measures to diminish heat production and to increase
heat elimination are required.

The use of the author's calorimeter and of the bath calo-
rimeter first employed by Liebermeister more than thirty years
ago, have been referred to elsewhere (225, 226).

Hydriiitic Appiicatwns to br Emphyed in C^ses in which 744
BQik Ihai Production and Heat Eiiminaiimi are Increased.
— In the following list the aim has been to arrange the
various therapeutic measures suggested in the order of their
greatest efficiency, naming the most valuable first: —

328 RATIONAL HYDROTHERAPY.

1. The graduated bath (718).

2. The cooling wet-sheet pack (719).

3. The Brand, or cold friction, bath (716).

4. The prolonged tepid immersion bath (88^ F.) (717).

5. The cold immersion bath (712, 731), followed by a
short hot immersion, affusion, or sprinkling.

6. Tepid affusion (711).

7. Cold affusion (711).

8. The shower pack (720).

9. The cold compress (721)

10. The graduated compress (734-).

1 1. The evaporating sheet (725).

12. Cold to head and neck (732).

13. Cold to spine (732).

14. Cold to abdomen (732).

15. Cold over heart (732).

16. Cold irrigation (1294-).

1 7. The tepid or cold enema (736).

18. Cold water drinking (735), a measure that should be
combined with all the other measures named.

19. The cold air bath (733).

745 Mydriatic Measures to be Employed in Cases in which Heat

Elimination is Diminished or not Increased. — The following
list comprises the most serviceable measures for increasing
heat elimination when fever is present and the cold bath
contraindicated : —

1. Hot bath (2 to 3 min.) followed by a cold bath with
friction (i min.) (731).

2. Hot-blanket pack (728).

3. Hot evaporating sheet (726).

4. Hot sponge bath (727).

5. Fomentation to the back (729).

6. Fomentation to the abdomen, followed by the cold
enema (730, 736).

7. Fomentation to the back, followed by a cold wet-
sheet pack (719).

THERAPEUTIC EFFECTS.

329

Suggestions
and Cautions
Rf^pectJng: the
Use af Water
for Antipyretic
Effec^ts.

8* Hot-blanket pack, followed by graduated bath (718).
9. Hot -blanket pack followed by prolonged tepid bath,

0. Hot-blanket pack followed by cold friction.

1. Dry friction,

2. Cold friction*
Cold applications alone are contraindicated in
fever cases in which the skin is cold, the lips
or skin blue, when goose- fleshy pt^rspiration,
general shivering, or chilliness are present,
and when cold applications are particiilariy
disa^eeable to the patient. In most cases of

this sort, however, the contraindication may
be made to disappear by a short general hot application, by
which both the skin and the nervous system are prepared to
receive beneficial effects from refrigerant measures.

When the cold enema produces colic pains or chilliness,
a fomentation over the abdomen may be employed at the
same time.

The same measures may be employed after any appli-
cation the refrigerant effects of which appear to be more
intense than was desired.

General cold applications, especially prolonged applica-
tions, must be avoided in cases in which there is a general
febrile condition due to some internal local inflaniniation, as
in acute ovaritis or salpingitis, or other pelvic inflamtnations,
gastritis, nephritis, etc. The inrush of blood produced by
the cold apphcation in cases of this sort increases the conges-
tion which already exists in the affected parts, and tiius adds
to the intensity of the inflammatory processes. Prolonged
neutral and tepid applications or local revulsive applica-
tions are to be preferred in these cases. The general tem-
perature may be most eflicicntly lowered by controlling the
local inflammatory processes by appropriate measures.

Currie well recognised the importance of avoiding general
cold applications in cases of general fever due to some local
inflammatory affection, and recommended the tepid bath in

746

RATIONAL HYDROTHEitAPY,

these conditioDS, with carefal avoidance of the cold afftisioo
or other applications Ukely to produce excitation or stimula-
tion, remarking, *' It appears to me probable that in the pro-
portion of this stimulation is the difficulty of reducing the
actual temperature/'*
747 In the employment of the hot-blanket pack, fomenta-
tions, and the hot bath, care must be taken to avoid too
prolongid applications. In an experiment, one of my assist-
ants, a healthy young man, found that his temperature rose
two degrees in half an hour in a hot-blanket pack. In a full
bath at the temperature of the body, or a few degrees above,
the temperature is found to rise at about the same rate.

In febrile conditions, the effect of a long hot bath in caus-
ing elevation of temperature will be still more pronounced.
It is clearly evident that such an application, if prolonged,
might become seriously dangerous in a case in which the tern*
perature was already elevated. For example, if a patient
with a temperature at 105 - were kept in a hot-blanket pack
or a hot bath for half an hour, the result might be an eleva-
tion of the temperature to 107^ or \o%\ with serious if not
fatal results. The writer has known of several cases in which,
under similar circumstances, the patient became delirious from
the hyperpyrexia, and though quickly restored by the with-
drawal of the heat and the application of cool sponging and
cold compresses, was greatly excited for some time, remain-
ing in a state of very great exhaustion for several hours.

The duration of a hot-blanket pack or hot bath of any sort
for the purpose of warming the surface and exciting vascu-
larity of the skin should be usually not more than five or ten
minutes-

Hydrotherapy, to be effective as an antipyretic, must be
employed with vigor and unremitting perseverance. An ordi-
nary sponge bath two or three times a day may afford a Httle
comfort to a patient burning up with fever, but it is of no

t"*Medlcftl Reports,** ith edition, p. ^04.

THERAPEUTIC EFFECTS.

331

value whatever as a means of lowering the temperature or of
combating the causes of the disease.

The readiness with which a high temperature yields to an 748
application will depend upon the time of day and the stage
of the disease, as well as upon the thoroughness of the appli-
cation. The regular typhoid fever curve shows a rise of
temperature from 7 a, m. to 3 p. m. After 3 p. m. a decline
Dccuxs, with another rise having its maximum at midnight,
and followed again by a dechne. It is evident that a bath
g^iven when the temperature is rising may have no other effect
than to lessen the rate of the elevation of temperature and to
lower the maximum point reached, while a bath given while
the temperature is naturally falling will have the effect to
accelerate the fall, and thus seem to be more efficient and
beneBcial, when the actual influence, of the bath may be pre-
cisely the same in the two cases. This fact must be taken
into account in estimating the value of any particular mode
of treatment or any particular application.

The effect of the treatment upon the temperature must be 749
judged not only by the immediate effect, but by the effect
upon the daily curve, which should be carefully watched. A
case rightly managed ought to show a steady declint in the
maximum temperature for each day, after the first week, and
the physician and nurse should consider it their duty to see
that the temperature of the patient does not at any time rise
above the maximum for the day on which treatment was
begun. This result is nearly always possible except in those
rare cases in which the patient is under observation from the
very beginning of the malady, when there may be a grad-
ual rise for the first few days, in spite of all measures to the
contrar>% due to the development of the disease. But every
case seen at so early a period ought to be brought to a favor-
able issue.

Most authorities resort to the bath whenever the tern- 750
parature reaches 102', even though this may require the
application of the bath six or eight times a day- This rule

332

RATIONAL HYDROTHERAPY.

may be a good one for the first week, but alter that time, in
the author*s opinion* the temperature may easily be kept at a
lower point by the inteihgent employment of efficacious meas-
ures, in harmony with the principles which have been pointed
out, with less frequent applications*

By the end of the second week, the temperature is much
more easily controlled than during the first week, and if the
fever continues for three or four weeks, the heat-producing
powers of the body may be so much reduced that the more
vigorous applications must be employed with the greatest
care* if not wholly interdicted^ because of the readiness with
which the patient's temperature may be made to fall. In
these cases the prolonged graduated bath lowered to a tem-
perature of 92*^ or 88"^' is sufficient to control the temperature.
The cold enema, the hot, evaporating sheet, and the wet-sheet
pack arc often to be preferred to stronger measures.

The temperature is more easily controlled in mild than
in severe cases. Unnecessarily extreme or severe measures
should not be employed.

When hydro therapeutic measures are properly directed
and efficiently administered, the effect upon the temperature
will be not only to lower it at the time of the bath, but to
cause it to fall for half an hour or more after the bath,
the effect being apparent for two or three hours. When
the temperature is excessively high (104-* 106^ and above)
and when normal or nearly normal (99" -100"), it is very
difhcult to lower it; hut febrile temperatures between 100 '
and 104 generally yield quite readily to the persevering
application of suitable measures.

As a rule, one need not expect to see all the characteris-
tic symptoms of typhoid or other grave fevers present when
hydriatic measures are thoroughly employed from the begin-
ning, since the course of the disease is likely to be so favora-
bly modified that the worst symptoms will not appear. This
is especially true of coma, delirium, and other adynamic and
atonic symptoms*

THERAPEUTIC EFFECTS,

333

Hemorrhages sometimes appear as the natural result of
the separation of the sphacelated structures when the ulcera-
tion happens to involve vessels of considerable si^e, but the
danger of hemorrhage is in nowise increased by hydrotherapeu-
tic applications, neither is it a contraindication for the use of
these measures^ except as regards certain of the more severe
general cold applications.

The influence of hydrotherapy in lessening the frequency
of grave symptoms is clearly indicated by the fact that when
the bath has been systematically and efficiently used in cases
of extensive epidemics, the mortality has uniformly been
reduced to a small fraction of the usual rate.

Hydrotherapy is entirely sale when judiciously employed,
and its use is free from serious objections; while the use of
medicinal antipyretics is attended by many objectionable
features, of which the following are but a few: —

1. In the use of antipyrin and other temperature-lower-
ing drugs, tlte depression is usually followed by an elevation
to a point higher than before*

2. The depression of temperature is short, and the
patient's condition while under the influence of the drug is
often one closely bordering on collapse. When the use of
quinine as an antipyretic w^as advocated by Dr, Austin Flint,
some twenty-five years ago, the author made trial of its use
in comparison with baths, and found that though it produced
a fall of temperature, the effect was very transient. Bou-
chard pointed out a few years later that after obtaining an
antipyretic effect with quinine, the second dose, even though
a large one, produced practically no effect unless a period of
three days was allowed to elapse after the first.

Hydrotherapy shortens the duration of febrile disease^
renders grave cases mild, and lowers its mortality from twenty
per cent, to three or four per cent. , or even less.

The numerous other advantages of the hydriatic method
of dealing with all febrile disorders will be further discussed
in other chapters of this work.

334

RATIONAL HYDROTHERAPY.

752 As conditions of temperature depression are oc-

Condltlfiits In casionaily encountered in connection with the

which there Is treatment of fevers, it is important to know

Pu^*»'**!"^''''* their significance and the remedies which
the neat -Re^ii- , , , f i . , . i

tatinf Functions should be employed to combat them,

wfth Depres- In conditions in which there is a depres-

sion of Tern- 5jp^ qI temperature while heat elimination is
increased, it is evident that heat production
must be, if not normal or less than normal, at
least increased to a less extent than heat elimination. This
is a condition which naturally results from exposure to a low
temperature without proper protection. Prolonged profuse
perspiration from any cause, particularly night sweats and the
perspiration following the chill and fever of ague, is often a
cause of subnormal temperature.

There may be a lowering of temperature with diminished
heat production, and with either normal, diminished, or
increased heat elimination. All these conditions are some-
times encountered in cases of starvation from obstruction of
the esophagus and in cases of semi-starvation due to chronic
indigestion with anorexia.

In surgical shock or severe vital collapse of any sort, we
may find both heat production and heat elimination dimin-
ished.

In every case a careful inquiry should be made to deter-
mine as nearly as possible the relation of heat production and
heat elimination to each other, to the normal degree of activ-
ity, and to the abnormal rise of temperature. All the symp-
toms and the conditions of the patient should be carefully
considered, so that a correct judgment may be formed with
reference to the therapeutic indications of the case, and that
the appropriate remedy may be employed. %

If a patient^s temperature is subnormal because of excess-
ive heat elimination, nothing more may be required than
additional protection, a few blankets, hot water bottles, an
elevation of the room temperature, hot drinks, the hot

THERAPEUTIC EFFECTS,

335

enema, and dry rubbing. The application of oil to the
suriace is a measure not to be neglected as one of the
most efficient means of lessening heat elimination, so long
as the body is covered.

If the temperature depression is due to coHiquative
sweating, hot saline sponging is indicated.

If the subnormal temperature is due to diminished heat
production from the results of starvation from any cause, the
remedy here again is clearly indicated, — such food must
be selected as will furnish heat-supporting elements in
abundant quantity and in a form easy of assimilation ;
nutritive enemas may be employed ; and the patient should
be given absolute rest, with sufficient protection, hot water
bags, etc., to restore the balance between heat elimination
and heat production.

Temperature depression from shock requires artificial
heat, internally and externally. A large hot enema (736),
fomentations to the spine (729), hot bags, hot blankets, and
rubbing of the surface are especially indicated.

The cold bath is a measure capable of much 763
mischief as well as much good. It is of the
highest importance to understand its limita-
tions and contraindications. The conditions
which forbid its use or which render necessary
the most extraordinary caution and circumspection in its
employment^ may be brieily stated as follows:^-

I . Sweating. — Under ordinary circumstances the presence 754
ol perspiration is evidence either that the febrile action is
subsiding or that nature is doing all that can be done to
lower the temperature and eliminate the toxin which is the
disturbing element.

In the disease known as sweating sickness a persistent
high temperature long continued renders necessary the use of
cold as a heart tonic and to promote vital resistance; it is not
best, however, to resort to so severe a measure as the Brand
IHEtb- The desired effect may be secured by means of cold

GoAtraindlca-
Uons for the
CcHit, or Brmiid
Bath,

336

RATIONAL mDROTHRRAPV.

friction (1209). At first, water at the ordinary temperature
(70 to 75 ) should be employed, and the mitt should be moist-
ened only* not filled with water, as in ordinary cases of fever.
Care should be taken to apply the friction to small areas suc-
cessively, and to secure reaction as quickly as possible, and
to avoid provoking general chilliness* The application may
be repeated every two or three hours, but two or three daily
applications will be found sufficient in ordinary cases. If the
application ot cold friction to the whole surface is not well
tolerated, it may be confined to the back and chest. The
application to the chest stimulates the heart action in a most
powerful manner, while the application to the back arouses
the central nervous system, and promotes general vital resist-
ance almost as much as an application to the general surface.
The surface should be dried and rubbed before the cold mitt
is applied.

?65 2. Gmse-F/t*s/i Appearance. — This physiological evidence
of chill and a lowered temperature of the blood is sometimes
present when the internal temperature Is several degrees
above normal, as the result of the action of toxic substances
in the circulation. This symptom indicates that there is a
persistent contraction of the small blood-vessels of the skin
which directly antagonizes heat elimination. To put a
patient in such a condition into a bath at 65 ^ F* or even at
75 is not only an irrational but a hazardous proceeding, and
is as unnecessary as it is unwise* Every indication which
would be met by the cold bath can be better answered by
other perfectly safe and efficient means. Rubbing with the
friction mitt moistened in water at a temperature of 60^ to 70^
is usually sufficiently exciting, but ice-water may be used
when more po%verfully excitant effects are required. The
same precautions must be observed as when perspiration is
present. It is always desirable to precede the cold friction
by a fomentation or some other hot application to the spine.
Cold friction produces reaction by a powerful thermic inipreS'
sion combined with the mechanical effect.

THERAPEUTIC EFFECTS-

337

3. Cjfafiosjs.^- Here afrain the cold bath of Brand is 75fi
decidedly contraindicated. This symptom is an indication
that the movement of the blood is slowed as the result of
cardiac weakness, and the heart is not prepared to sustain the
shock of sadden and prolonged contact of cold water with

the whole surface of the body, while the internal viscera,
already profoundly congested in consequence 0/ the cardiac
inefficiency, would be endangered, especially the lungs, liver,
and spleen. Administer a short hot bath, a hot enema,
or a fomentation to the spine followed by cold friction, begin-
ning with the chest, then the back^ and last of all the legs.
In these cases appHcations of cold by means of the fric-
tion mitt are of the greatest service, not only in lowering
the temperature, but in stimulating cardiac action, arousing
the peripheral heart to activity, exciting increased renal ac-
tivity, and promoting oxidation and increased vital resist-
ance. By its use most of the advantages of the cold bath
may be secured, with none of its disadvantages,

4. Prmnmnced Cardiac Weakness. — The dicrotic pulse, 737
marked weakening of the first sound of the heart, and espe-
ciaUy the '* pendulum *' action of the heart, in which the two
silent periods of the heart's action are equal or nearly equal,

arc indications of an asthenic state of the heart, in which it
is wholly unprepared to meet the tremendous demands tem-
porarily made upon it by placing the patient suddenly in a tub
of cold water- By means of the cold precordial compress, hot
and cold sponging of the spine, and general cold friction, the
energy of the heart may be re-enforced and its work dimin-
ished by increased activity of the peripheral heart. Under
this simple treatment the pulse rapidly improves, the tempera-
ture is lowered as the result of the increased movement of the
blood, and the general improved appearance of the patient,
his easier breathing, and the disappearance of various nervous
symptoms afford evidence that he is better.

Areolar cyanosis following a local cold application is
an indication of great cardiac weakness and impending

A3

338

RATIONAL HYDROTHERAPY.

collapse, which may, by aid of this warning symptom, be
foresee D and prevented by general cold friction and the
768 cardiac compress often repeated.

5. Mfotardifis,—^ The remarks respecting cardiac weak-
ness apply with added emphasis to conditions in which the
heart is the seat of an inflammatory process, as in endocar-
ditis, pericarditis, and especially myocarditis. The last-named
complication, which is not infrequently encotmtered in typhoid
and other continued fevers, especially requires circum-
spection in the use of the cold bath. The sudden inrush of
blood attending a general cold bath may easily overwhelm a
• heart whose muscular structures are crippled by an inflamma-
tory process, while its nerve centei^ are depressed by the
toxins characteristic of the general maladies present. If such
patients escape alive, notwithstanding the severe treatment
to which they are subjected by overi^ealous disciples of the
hydriatic method of dealing with febrile disorders, the fact
must be attributed to the wonderful energizing properties of
the cold bath, and the marvelous resources of nature.

759 6. tnh'Siinal Perforation. — ^The cold bath, when em-
ployed from the beginning in typhoid fever, greatly lessens
the liability to this grave complication. When begun late in
the disease, however, perforation sometimes occurs in spite
of the ameliorating influence of cold bathing. When the
symptoms of perforation occur, the general cold bath must be
suspended, as its use not only involves considerable disturb-
ance of the patient, but powerfully excites intestinal peris-
talsis, thus increasing the dangers incident to the perforation.
Cold friction to the chest, the cold precordial compress, and
general cold friction, carefully applied, may be employed to
meet pressing symptoms of heart failure or collapse, and to
improve the patient's resisting powers.

760 7. Peritonitis. — It maybe said of this complication, as
of the preceding, that it rarely occurs in typhoid fever when
the cold bath is systematically employed from the beginning.
It is, in fact, practically unknown in such cases* When

THERAPEUTIC EFFECTS*

339

present in connection with general fever, it is a contraindi-
cation for the genera! cold bath. Fomentations, revulsive
applications, and the cooUng compress may he applied to the
abdomen, but the general cold bath is decidedly contra-
indicated. The prolonged tepid bath (88^)and the short hot
bath followed by cold friction are suitable measures for meet-
ing the indications to which the cold bath is applicable under
other circumstances.

8. Phiipisy and Ppietwmnia. — Both of these conditions, 761
when occurring in connection with typhoid fever, smallpox, or
any other continued fever, are a contraindication of the cold
bath. The neutral bath, the hot bath followed by cold
friction, the cooling pack carefully managed, and especially

the cooling chest compress with fomentations to the chest
every two or three hours, are proper hydriatic measures to
be employed in connection with these complications.

9. Tubercuhsis. — When this complication occurs in con- 762
nection with typhoid fever, as it occasionally does, or in con-
nection with any other continued fever, the cold bath must

be interdicted on account of the intense visceral congestion
occasioned by it. The wet-sheet pack and cold friction with
the mitt well filled with water when the temperature is high,
are suitable measures for a case of this sort. The cooling
chest compress should also be employed.

10. /?f/iiwfj, — The immersion bath at low temperature is 768
contraindicated in infancy because of the small heat-making
capacity of the young child and the large radiating surface as
compared with the weight. The vital powers of an infant,
that is. a child under seven years of age, are not suflSciently
vigorous to react to the ordinary Brand bath. The tepid
bath, the cooling pack, and cold friction are suitable measures

for this condition-

1 1. Old Age. -^Th^ conditions in old age. while decidedly 754
different from those in infancy, also constitute a contraindica-
tion to the use of the cold bath. The presence of arterio-
sclerosis is always a contraindication for the cold bath, what-

340

RATIONAL HYDROTHERAPY,

ever the age of the patient. The condition of the arteries,
rather than the number of years» constitutes the physical con-
dition referred to in this connection by the term '*old age,*'
The inactive skin, the weak heart, the general sluggishness
of the bodily functions, low vital resistance, the dimin-
ished heat-making capacity, — these conditionSp characteristic
of senility, afford sufficient grounds for forbidding the use of
the Brand bath, even though the person is not advanced in
years. The prolonged tepid bath, the repeated wet-sheet
pack, cold friction, the rubbing wet sheet (recUning), cold
water drinking, are the measures to be employed in old age,
With proper management these procedures may afford as
good results as those obtained from the use of the Brand
bath, and without the danger involved in the use of this
vigorous procedure*
76& 12. Laic or Neghcied Cases, — ^ While cold baths may be
used with impunity in ordinary cases of fever in which the
general resistance of the body is good, and before the vital
forces have been depressed by the long continuance of the
disease, this is by no means true in cases in which hydriatric
treatment has been neglected during the first week or ten
days of the malady; hence great care must be taken in the use
of the cold bath in cases which come under observation at an
advanced period of the disease. In these neglected cases the
condition of the patient is generally one of great nervous
exhaustion, with cardiac weakness, not infrequently beginning
degenerations; the nerve centers are weakened through star-
vation and malnutrition and the long-continued action of the
toxins characteristic of the disease; heat production is lim-
ited, while heat elimination is deficient through spasm of the
surface vessels. Ataxia or adynamic symptoms arc marked,
and not infrequently these conditions arc found associated.
There is a tendency to hypostatic congestion of the lungs,
and, indeed, this condition may be already present. The
liver, spleen, and other viscera are intensely congested, their
functions are thereby seriously impaired, and their structure

THERAPEUTIC EFFECTS.

34T

may be injured. To plunge such a patient into a bath at 65^
to 70^ and retain him there for 10 or 15 minutes will most
certainly ijnperil his life. The tonic influence of cold is in the
highest degree desirable, but the patient is too weak to react
to so powerful an impression as is made by the contact of cold
water with the entire surface of the body at the same instant,
[By means of partial cold rubbings applied to different por-
rtions of the body successively, the cutaneous circulation may
be marvelously improved without increasing, even momen-
tarily, internal congestion. By increasing the movement of
the bloodp and especially by producing a hjperemic condition
of the skin, the internal congestion may be definitely relieved.
The heart is reflexly energized at the same time its labor is
lessened, by the increased activity of the peripheral heart
accompanying the reaction resulting from the cold friction*
Similar though vigorous effects may be obtained by rubbing
the skin with dry, warm flannels. The prolonged neutral
bath (92^ to 95"^) and a hot-blanket pack for lO minutes* fol-
lowed by cold friction* are the best measures for aiding heat
elimination. Hot and cold sponging of the spine, or, better,
the alternate hot and cold spray to the spine, produces an
excellent effect upon the central nervous system. The bed-
sores likely to be present in these late cases render the full
bath inconvenient, but do not interfere with the appHcation
of packs, compresses, cold friction, and allied measures.
The hot enema followed by cold friction is a most effect-
ive means for aiding heat elimination, through stimulation of
ihe kidneys and arousing of the depressed energies of the
patient to resist the disease.

In the management of these grave cases, in which the life
of the patient depends so much upon the exact and judicious
employment of effective therapeutic procedures, it is important
lo remember that death in these cases, when attributed to
so-called heart failure, is really due to general collapse of the
vital powers. The weak condition of the heart is a true index
to the condition of the body as a whole. The heart continues

342

RATIONAL HYDROTHERAPY.

its work until the body as a whole is ready to surrender^ then
fails with the rest.

It may be remembered with advantage, also, that cardiac
weakness is not the only, nor always the chief, cause of the
feeble circulation in adynamic conditions in fever. The blood
movement depends upon several other important factors in
addition to the cardiac activity: respiratory movements, rhyth-
mical action of the small vessels, the caliber of the small
vessels, the tone of the tissues, cell activity, the mass of the
blood, — each and all of these factors maybe modified by
hydric applications ov^erthe heart and to the general cutaneous
and mucous surfaces* as has been pointed out elsewhere*

A brief cold application to the skin stirs the whole bodily
fabric to its deepest foundations. Every cell and fiber
vibrates in response, so to speak, and quivers with a new life,
a reinforced enerf^, which appears not only in the surface
reaction which follows, but in the quickening^ of its own
proper functions as well as improvement in the quality of the
work performed. Tonic applications of water are the most
eflcctiva of all known means for setting in motion and main-
taining those renovating and restorative processes in which
the recovery of the sick chiefly depends.

Secret dry Cold applications made in such a way as to

Sedative EffecU lower the temperature of the secreting struc-
tures of a gland, produce an important and very marked
diminuation in secretory activity while heat produces the oppo-
site effect. The activity of the mammary glands may be by
this means controlled to a remarkable extent, and salivary
activity may likewise be to some degree influenced. The
most striking illustration of this action is seen in the instan-
taneous control of profuse perspiration by cold application to
the surface- The activity of an internal gland is reflexly
excited by cold applications made upon the overlying skin.
The opposite effect, or sedation, is produced by neutral and
hot applications (92-104"). Very hot applications may pro-
duce excitant effects allied to those resulting from cold
applications*

«

GENERAL RULES, PRINCIPLES, AND SUGGES-
TIONS RELATING TO THE PRACTICAL
EMPLOYMENT OF HYDROTHERAPY.

IN the employment of water as a therapeutic means, it is
first of all important to keep in mind the principle that it

is the patient, not his disease, who is to be treated*
The fundamental idea in hydrotherapy, as with all rational
measures of treatment, is that the curative force resides in
the body, and that the office of the physician, aided by intelli-
gent and trained assistants and nurses, and by the co-opera-
tion of the patient, is to supply such conditions as will aid
the natural forces of the body in combating the disease. It
is hence of the utmost importance that the general plan of
treatment adopted for the relief of any particular case shall
first of all take into account the causes by which the
patient's maladies may have been induced. These will
usually be found to exist in some wrong habits of life, of
which the patient himself may have been wholly ignorant, at
least as regards their deleterious character

All cases of chronic disease may be roughly divided into 7(i6
two general classes: —

1, Those in which the scat of the disease is a local irrita-
tion of mechanical or other origin, such as eye-strain^ catarrh
of the nose, stomach, liver, or bladder; or in which there is
a local mechanical or tissue injury, as in dilatation or pro-
lapse of the stomach, floating kidney, displacement of the
pelvic organs, ulceration of the stomach, etc,

2. Those due to a diathesis, or a constitutional condition,
as in diabetes, obesity, migraine, neurasthenia, chronic uric
acid poisoning, Bright*s disease, and the various degenera-
tions.

In order, then, to form an intelligent idea of the proper
course to be pursued in the treatment of any given case, there

343

344

RATIONAL HVDROTHERAPY*

General
Direct lans for
the Use of the
Bath.

must be a careful scrutiny of the causes which have led up to
it, and of the exact pathological conditions existing. For
example, in indigestion we must ascertain with accuracy, in
order to employ the proper measures, whether or not a
patient is suffering from apepsia^ hypopepsia^ hyperpepsia, or
simple dyspepsia, and whether or not there exists so-called
chronic or subacute gastritis or a condition of increased or
diminished sensory or motor irritability. Insomnia may be
due to local irritation of some sort, to chronic toxemia, or to
cerebral anemia or congestion. An anemia found present
may be the result of a recent hemorrhage from a wound, of
profuse menorrhagia, hemorrhoids, gastric ulcer, a surgical
operation, a fever, tuberculosis, malaria.
7C7 I. Before beginning a course of general appH-

cations of cold water, careful investigation
should be made respecting the condition of
the heart, the nervous system, the liVer, the
kidneys, and other viscera, so that all contra-
indications may be at once apprehended and the proper
allowance made therefor. It is also important to ascertain
in each case a patient's reaction power by means of a partial
cold bath of some sort, and by the dermographic test.

In very feeble patients, there may be sufficient nervous
energy to react well when an application of cold is very lim-
ited in extent, but not enough to secure prompt and vigorous
reaction wTien the application extends to the entire surface uf
the body; in such cases, the effects produced by the first bath
should be carefully noted, and the prescription should be
arranged in accordance with the indications thus obtained*
If any of the symptoms of imperfect reaction occur, those
measures necessary to encourage reaction should be adopted,
as elsewhere indicated (4-43)* If the reaction is excessive,
less strongly stimulating measures should be employed; that
is, (^) raise the temperature a few degrees; {^) substitute a
non-percutient form of bath for the douche, as a cold friction
bath, a wet-sheet or a towel rub, a sitz, immersion, or aflusion;

GENERAL RULES AND StrGGESTIONS*

345

(<-) have the patient exercise less long or vigorously before
or after the batk; or (d) follow the cold apphcation by a short
cool or tepid non-percutient application, as a wet-sheet mb or
affusion at 75 ^ or 80 - F-, cover less warmly in bed, or other-
wise modify the measures which promote reaction.

2. After short, very cold applications, watch carefully for
the appearance of the bright-red color which indicates nor-
mal reaction- If this does not, under vigorous friction,
appear within one minute or less, it will usually be found wise
to precede the cold application by the hot rain or jet douche*
hot bath, steam bath, or some other general hot application.
The hot application should be continued from three to five
minutes, followed by a cold apphcation, when a good reaction
will be assured, even in patients whose power in this direction
is quite limited* The application of heat in this manner
greatly diminishes the unpleasant impression of cold applica-
tions, while at the same time promoting to a high degree the
circulatory reaction. After a very hot bath it is sometimes
weil to diminish the shock resulting from the contact of very
cold water by an intermediate tepid or cool application.

3. The Duratian of Appiicati&ns, — The lower the tem-
perature of the water, the shorter should be the application.

For very cold applications, the duration should be 1 to 5
seconds. The duration of the cool douche may be 10 to 30
seconds.

Tepid, warm, and hot douches may be much more pro-
longed, especially when nioderate pressure is employed. The
duration may be from 1 or 2 minutes to to or 15 minutes.

Very hot apphcations should be of moderate length, rarely
more than one minute.

When employed to reduce the temperature in fever, and
for antiphlogistic effects, non-percutient, cool applications
may be prolonged to 1 5 or 20 minutes.

The neutral bath may be continued as long as circam-
stances require. It may be made practically continuous for
several months^ if care is taken to regulate the temperature

768

346

RATIONAL HYDROTHERAPY-

SO carefully that thermic reaction is wholly suppressed. For
sedative effects, from 30 minutes to i on 2 hours is the
usual time required.
*69 ^, The Tvmpcrature 0/ Appiications, — In general, it
should be the constant aim to train the patient progressively
to react to water at as low a temperature as possible, the
temperature of the water being steadily lowered day by day.

5. The best and most durable effects are produced by
short cold applications, frequently repeated.

6. Long cold applications may be too exciting by pro-
ducing a too strong reaction, or the effect may prove to be
sedative or exhausting instead of tonic. This is especially
true of emaciated and anemic persons, and those suffering
from sclerosis. In emaciated persons the amount of fuel for
heat production is diminished, and the amount of oxygen
taken into the blood is also below the normal standard; hence
the calorific, or heat-making, powers are deficient and easily
exhausted, so that a too prolonged cold application may
result in an excessive loss of heat, as indicated by delayed
reaction, prolonged chill, or the frequent recurrence of chill
or chilliness after the application*

7. In persons suffering from nervous exhaustion, espe-
cially, the reaction ability of the nerve centers is speedily
exhausted; hence the Importance of making cold applications
very short in duration.

770 , . The phenomena of reaction under physio-

Si£iilf!aince of l^^g^cal and pathological states is a subject
Reactian. which must be thoroughly understood by the

hydriatist. Elsewhere (4-29-480, 577, 578)
the rationale of reaction under physiological conditions has
been fully explained; here the subject will be considered
briefly from the standpoint of practical therapeutics.

First of all, it may be remarked that a large share of the
therapeutic applications of water require either the produc-
tion or the suppression of reaction, or the production of atonic
reaction effects. Hence it is of the utmost importance not

GENERAL RULES AND SUGGESTIONS.

347

CociilttJans
that Control
Reactioti,

only that every patient should be carefully studied in relation
to his ability to react at the beginning of a course of hydriatic
treatment, but that the reaction of the system to each differ*
ent procedure employed, and to each daily application, should
be carefully noted, and any necessary readjustment of the pre-
scription made at once. Hydriatic treatment must be under
the immediate supervision of a competent medically edu-
cated person, and must never be left to the inaccuracies of a
bath attendant, no matter how well trained.

The intensity of the reaction effects following 771
a given application depend upon —

I* The method of application, especially
whether percutient or non^percutient (Exp* 53)-

2, The temperature of the water.

3. The length of the application,

4* The condition of the patient, whether (a) febrile or
non-febrile, (i^) weak or strong, (t) fat or thin, [d] rested or
fatigued, (r) warm or chilly.

5. The ability to develop animal heat.

6. The ability to repair quickly the loss of heat, and to
support its loss without serious inconvenience to important
vital processes.

7. The condition of the nervous system at the time of the
application.

S. Whether accustomed to cold bathing.

9, The mental state of the patient, whether apprehensive
and fearful, or resigned, cheerful, and in a condition of mind
to co-operate with the treatment.

It is well to recall that in cases in which a patient does
not react well to low temperatures, the reaction effect desired
may be encouraged by strong friction or by increased pres-
sure if the douche is employed.

Several oscillations of reaction are sometimes 772
Osctltatory observed following a cold bath, each recur-

rent reaction bemg weaker than the prece-
ding. These oscillations are doubtless due to the swift rush

34^

KATIONAL HYDROTHERAPY.

Suiipressflon of
Reaction,

of blood to the skin during the first reaction, whereby it is
rapidly cooled by evaporation from the moist surface which
has perhaps been insufficiently dried, and also through the
consumption of heat energy by its conversion into mechanical
work by friction and exercise.
773 While it is usually the aim to promote reac-

tion, there are cases in which the suppression
of reaction (432) is of the highest importance.
Sometimes reaction must be suppressed altogether, — when
sedative effects are desired, as in cases of fever, inflamma-
tion, nervous irritability or insomnia^ bums, wounds of various
sorts, and hemorrhages. The means by which reaction may
be diminished or increased have been fully described else-
where (44-3-459).

6XBRCISE IN CONNECTION WITH MYDRIATIC APPLICATIONS,

I

774 From the days of the earliest cold-water cures, the impor-
tance of exercise in connection with water treatment, espe-
cially apphcations of cold water, has been fully recognized,
Priessnit^ kept his patients sawing and chopping wood a
considerable part of the time when they were not occupied
with the multitudinous drin kings, packings, douchings, cold
plunges, etc. , to which they were subjected under the heroic
regimen in vogue at Grae fen berg. It is more than likely
that a large share of the benefit obtained from treatment
under the old water-cure system was the result of the
muscular activity required in connection with the routine of
baths to which each patient was required to submit himself.
Extended trips along the steep paths of the neighboring
mountains and hard work at the wood*pile were required of
all patients able to endure any considerable degree of phys-
ical exertion, those who were not able to exercise being con-
sidered too weak to be subjected to cold-water applications.
No doubt many persons were damaged by the excessive
amount of muscular work required of them ; but as a large

GENERAL RULES AND SUGGESTIONS.

349

Exercise before
the Bmth>

share uf the patients who visited Priessnitz were persons of
robust constitation who were suRering chiefly from the effects
of high living, sedentary habits, and wine drinking, the meas-
ures employed were for the most part successfaL

Exercise not only encourages circulatory reaction, but
especially stimulates thermic reaction. It has been clearly
demonstrated by experience that the temperature lowering
which begins from five to fifteen minutes after a cold bath is
contimied and increased by exercise, so that the maxiuium
diminution is fully half a degree greater with moderate exer-
cise than without it.

In persons able to take exercise^ a suBicient
amount of physical activity to produce slight
perspiration before a bath favors the tonic
effect of the application, and re-enforces it to a very con-
siderable extent. Care should be taken, however, to avoid
profuse perspiration in feeble persons, for the result would be
so great an expenditure of energy that both circulatory and
thermic reaction might fail, producing a secondary chill and
most unfavorable effects. The bath should be taken imme-
diately after the termination of the exercise, and before there
has been opportunity for cooling of the skin by evaporation,
which takes place with great rapidity when the skin is exposed.
If there must be even the slightest interval between the
removal of the clothing and the administration of the douche,
the body should be protected by wrapping in a blanket or
Turkish sheet

Exercise should not be sufficiently vigorous to induce
excessive action of either the heart or the lungs, as a cold
bath should never be administered when these organs are
excited. The best forms of exercise are walking, Swedish
gymnastics, bicycle riding, dumb-bell exercise, club swinging,
self-resistive exercises,* and moderate exercise with chest-
weights.

• For de$cnptioii of s s^fstcm of iclf-rcsisUve exercises, aec paper by the
bor, m Afodern Meditifu for December, iS^.

7?a

350

RATIONAL HYDROTHERAPY.

776

persons who are unable to take exercise may be prepared
for a cold bath by massage^ by vigorous friction, by manual
Swedish movements, or by an application of heat.

A preparation by exercise, either active or passive, is to be
preferred to a preparatory hot bath; but when necessary, the
hot douche, hot immersion, vapor douche, Turkish bath, or
best of all, the electric-light bath, may be employed. The
electric-light bath is preferable to all other means of heating
the skin, aside from exercise, for the reason that it quickly
warms the skin, and does not produce a depressing effect
The douche should be applied before profuse perspiration has
been induced.

Violent exercise should always be avoided, for the reason
that the skin and the body become thereby so strongly over-
heated that the absorption of the surplus heat requires so
prolonged an application of the cold douche or other cold
application that the nerve centers are apt to be quite ex-
hausted by the too strong reflex activities set up, especialty
in feeble persons, resulting in incomplete reaction and
depression.

Imperfect reaction after the cold bath is in
the highest degree injurious, and lack oJ
knowledge as to how to avoid this exceedingly
disagreeable and inconvenient accident is responsible for
much of the prejudice existing against the employment of
the cold bath as a hygienic or therapeutic measure.

Incomplete reaction not only frequently results in a second-
ary chill, but in successive chills or an almost continuous chill,
not only for an hour or two, but often for several hours, after
the bath. The hands and feet arc cold, there is headache, not
infrequently diarrhea, and other evidences of intamal conges-
tion, such as abdominal and ovarian pains, rheumatic pains in
the joints, neuralgic pains in various parts of the body, vertigo,
lassitude, and an increase of catarrhal discharge from the
nose, throat, lungs, or other mucous surfaces, w^hen there is
actively present a catarrhal affection of these parts*

Ejce/clse after
the' Bath.

GENERAL RULES AND SUGGESTIONS,

351

As a rule, exercise should always be taken after a cold
bath when the patient is sufficiently strong to walk.

Reaction may be favored by covering the patient with blan-
kets or surrounding him with hot-water bags or other means
of artificial heating, or by his remaining in a warm room; but
the reaction effects obtained are far less beneficial than those
which result from exercise. The reason of this will nppear
when it is remembered that exercise favors thermic reaction,
and that thermic reaction means activity, not only in the
nerve-muscnlar thermogenetic apparatus, but in every cell
and tissue of the body, and an exaltation of function.

The apphcation of artificial heat, on the other hand.
lessens thermic reaction by the atonic reaction effect which is
connected with hot applications of all sorts. Thus exercise
promotes the most efficient element of the reaction following
cold applications when tonic and reconstructive effects are
desired, viz., the thermic reaction, whereas artificial heat
diminishes this most important factor.

Exercise immediately following the bath favors regular
and complete circulatory and thermic reaction, thus increas*
ing the fall of temperature, and making the bath more
thoroughgoing and efficient in its effects upon the system*
The fall of temperature produced by exercise following a cold
bath may amount to nearly one degree Fahrenheit.

An interesting fact has been pointed out by Delmas, to
which attention should be called in this connection. Increase
of blood pressure, whether induced by exercise or other
agentSi ordinarily causes a slowing of the pulse rate; but
under the influence of cold, the increased blood pressure
induced by stimulation of the heart and contraction of the
peripheral vessels is accompanied by a quickened pulse.

The reason for this is obvious. When the blood pressure
is raised by cold applications to the surface, nature increases
the rate of the heart's action through the specific influence
of cold upon the heart-regulating mechanism, so that an
increased amount of blood may be carried to the surface,

352

RATIONAL HYDROTHERAPY.

thus compensating, to some degree, for the diminished
caliber of the surface vessels, and protecting the parts, so far
as possible, from the evil effects of refrigeration. When
reaction begins, and the blood pressure falls (though not
below normal) with the dilatation of the surface vessels, the
heart's action is slowed — the reverse of what ordinarily hap-
pens under diminished blood pressure.

The result of this slowing of the circulation is to delay
reaction, which under ordinary conditions is desirable, for
otherwise slight changes in the atmospheric temperature might
result in excessive and exhausting perturbations of the nerv-
ous and vascular systems ; as it is the purpose of therapeutic
applications which promote reaction to produce systemic
perturbations and metabolic and catabolic changes* it is
desirable that the tendency to slowing of the heart's action,
which sets in with the beginning of reaction * should be
antagonized by means of exercise whereby the heart's action
will be quickened and the blood promptly forced to the sur-
face of the body.

The increased vascularity of the skin thus induced, en-
courages heat dissipation, and both thermic and circulatory
reaction. If the exercise is moderate in degree, the heat
elimination developed by it exceeds the heat production re-
suiting from the muscular activity; but if it is too violent in
character, heat production may be in excess of heat elimina-
tion, in which case there will be a rise in temperature^ and
the effect of the bath will be antagoniised. It is thus appar-
ent that exercise after a bath, in order to be effective and
helpful, must be moderate in character

Walking at a moderate rate for twenty to sixty minutes
after a vigorous^ cold douche is the most generally useful form
of exercise. Very vigorous exercise for a short time can not,
however, be substituted for moderate exercise for a longer
time, for the reason that time must be allowed for heat elimi-
nation; besides, vigorous exercise for even a short time might,
by overexciting heat production, place the balance between

GENERAL RULES AND SUGGESTIONS.

553

heat production and heat elimination on the wrong side, and
thus occasion a rise of temperature^ and to a considerable
degree destroy the good effects of the bath. It is for this
reason, in the author's opinion* that better results are
obtained from reaction when the process takes place regularly
and slowly, as has long been known to be the case from cljn*
ical obaervation.

There are, of course, cases in which cold applications are
indicated, but in which the patient is too feeble to take the
necessary amount of exercise by walking or by other means.
In such cases, vigorous massage, especially friction and percus-
sion movements, or manual Swedish movements and deep
breathing, may be employed until the return of warmth to the
surface » indicating that active reaction has begun.

Occasionally cases are met in which the patient is so fee-
ble that he can not react spontaneously, even by the aid of
massage, and it is necessary to employ artificial means to
assist the reaction. The patient should be wrapped in a
Turkish sheet as quickly as possible after the bath, covered
with blankets, and dried by vigorous rubbing underneath the
blankets. The moist sheet should be removed, the woolen
blanket placed next the body should be tucked carefully
around each hmb and close about the neck, and hot bags
placed to the feet and the sides, extra blankets being thrown
over all. The patient must be carefully watched by observing
the condition of the skin of the face, and noting the pulse,
and the hot bags and blankets carefully withdrawn as rcac-
rion sets in, so that excessive reaction with sweating may be
prevented, as this will destroy the tonic effect of the cold
application.

A rule which was insisted upon by Priessnitz,

and which is quite universally followed by

hydrotherapeutists, is that the sun, excessive

clothing, heated rooms, and especially stove heat or other

artificial heat, should be sedulously avoided after a bath.

By this artitkial heating of the skin the heat elimination and

23

Avoid Excessive
Heat.

(77

778

354 RATIONAL HYDROTHERAPY.

thermic reaction necessary for a general systemic vital per-
turbation, upon which the tonic and restorative effect of cold
applications depends, are arrested before being fully devel-
oped by atonic thermic reaction.

Great care should be taken after a cold bath to avoid any
circumstance or condition which will cause perspiration,
which, when produced in any manner after a cold bath, is
followed by an undesirable sedative effect, whereby vital
resistance is lessened, the tonic effect desired is antagonized,
and the patient is exposed to the risk of taking cold.

Many times patients imagine that they have taken cold in
a bath from the application of cold water, when the untoward
efifects are really the result of either incomplete reaction after
the bath or a reaction accompanied by perspiration.

A THOROUaH SCIENTIFIC EXAMINATION NECESSARY AS
A FOUNDATION FOR A MYDRIATIC PRESCRIPTION.

779 I. A careful investigation of the urine is necessary in

every case, not merely for the determination of the presence
or absence of albumin, sugar, blood, urinary casts, or other
f morbid elements, but for the determination of the coefficient

^ of elimination of nitrogenous wastes. Careful note must be

t taken of the relation of the total solids to the urea, as an in-

2 dicator of the relative activity of destructive tissue processes.

V 2. An examination of the blood is essential for a deter-

«

I mination of the color coefficient, the blood-count, and the

f relative proportion of white and red cells. It is also impor-

tant, in cases of anemia, to note the relative proportion of
the different varieties of white cells. There is no means by
t which the blood-count and the quality of the blood can be so

profoundly and so quickly modified as by the resources of
hydrotherapy.

3. Headache may mean cerebral congestion, cerebral ane-
mia, or simple sympathetic nerve irritation. Fever may be the
result of toxins of bacterial origin, as in typhoid fever, pneu-
monia, septic infection; or it may indicate the presence of an

ah

%

GENERAL RULES AND SUGGESTIONS.

355

excess of ordinary tissue poisons, or leucomains, either from
dimiiiished excretion, as from cold, or from overproduction,
as in exhaustion or fatigue fever from muscular exertion.
Neurasthenic symptoms of various sorts may be due either to
the presence in excess of nitrogenous wastes, the so-called
uric acid diathesis, or sympathetic irritation arising from
enteroptosis,

4, Every case must be carefully investigated with reference
to the existence of pathological changes, either functiona) or
structural

(1) The functional disturbances which it is especially
important to note arc hypopepsia, apepsia, or hyperpep&ia;
local congestion or irritation of the bowels, bladder, uterus,
or ovarii; irritability of heart or lungs or s3?Tnpathetic cen-
ters; cardiac weakness; catarrh of respiratory or digestive
tracts; hyperesthesias of the skin, of the joints, or of the
internal viscera* Each of these conditions requires special
adaptation of the measures of treatment employed so as
to avoid untoward effects which might at least discourage
the patient, and not infrequently be the cause of more serious
damage.

(2) Structural changes, such as those which are com-
monly found present in advanced cases of lithemia, in arte-
riosclerosis, Bright's disease, hepatic enlargement or sclerosis,
must be carefully considered in arranging a hydrotherapeutic
prescription. The same may be said respecting other struc*
tural changes, such as those found present in paresis or par-
alysiSf from apoplexy or organic changes in the brain and
spine; neuritis, chronic muscular spasm; epilepsy; chronic
affections of the heart; varicose veins in the legs or other
parts; fatty degeneration of the heart, liver, spleen, etc.

5, The general physical state of the patient must be con-
sidered ; Is he fat or lean ? Is he weak or strong ? Has he
a thin or a thick skin ? Is he a person of resolution and
strong will, or a weak-willed, irresolute individual? Is he
of a persevering, reliable disposition ? or is he unstable, vac-

3S6 RATIONAL HYDROTHERAPY

illating, easily discouraged? The treatment must be care-
fully planned with reference to all these considerations.
780 6. It is of immense advantage to make a care-

Coefflclents ^"' study of the patient's physical coefficients.

By means of a graphic representation of the
principal physical coefficients, more may be learned at a glance
respecting the general vital capabilities and the physical
peculiarities of a patient than by weeks of **cut-and-try**
experience.* The chief practical deductions to be drawn
from physical coefficients are the following: —

(i) A high height-weight coefficient indicates an excess of
reserve tissue or fat, and hence ability to endure reducing or
spoliative measures, if otherwise indicated.

(2) A low height-weight coefficient gives contrary indica-
tions as regards the prolonged use of tissue- wasting measures,
though not forbidding their temporary or carefail use.

(3) A high strength-weight coefficient may indicate either
a deficiency of fat or an unusual muscular development. This
coefficient must accordingly be considered in connection with
the height-weight and strength-weight coefficients.

(4) A high strength-weight coefficient with normal height-
weight coefficient, indicates a good foundation for thermic
reaction to cold applications, a constitution not greatly im-
paired, nutrition well sustained.

(5) A high strength-weight coefficient with high height-
weight coefficient indicates the ability to bear vigorous redu-
cing measures and a probable constitutional predisposition to
obesity, that ought to be combated by frequent sweating baths,
followed by cold baths.

(6) A high strength-weight coefficient, with low height-
weight coefficient, indicates that with a deficiency of reserve
tissue and hence lack of ability for sustained resistance to cold
applications, there is at least fairly good vitality and power to

•See paper entitled ** Physical Coefficients," by the author, published in
Modern Medicine^ July, 1895.

GENERAL RULES AND SUGGESTIONS.

557

effect a good reaction; but the cold applications must be short
and not too frequent.

(7) A itnv strntgih-umghi coefficient with a normal htighi*
zveight coefficient indidates diminished muscular and nervous
energy and the need of great care in the use of hydro thera-
peutic ineasures. Very short cold applications will be best
borne, especially douches with high pressure. Hot baths and
all spoliative measures must be avoided^ except in cases of
toxemia in which short sweating baths accompanied by
copious water-drinking may be employed, especially the elec-
tric-light bath; but care must be taken to follo%v the hot
application with a short cold douche at high pressure,

(8) A Icnv siratg/k^weig-ht coefficient with a high height-
weight coefficient indicates in general the need of spoliative
measures, but small ability to bear general hot applications
or sweating baths. There being good ability for sustained
heat production, the patient should have frequent cold baths,
with abundance of exercise. Sweating baths may be em-
ployed later, as the strength increases, and may be used at
the beginning if very short, and not too frequently adminis-
tered, provided the actual total strength of the patient is not
much below the normal average for a person of his height, and
provided also that the strength- weight coefficient is nearly
normal,

(9) A lm0 strengtk'Weighi coefficient with a imi* height^
weight coefficient indicates a state of great debility and im-
pairment of nutrition, little power to support either the seda-
tive effect of hot baths or the calorification required by cold
baths. Strongly tonic measures are needed, with careful
avoidance of spoliative procedures; but the patient will toler-
ate cold badly and will be easily overstimulated. The very
short hot douche will be invaluable as a preparation for the
stiort cold douche. Neutral baths may be needed to encour*
age elimination without depression, also the cold hepatic and
renal douches and the epigastric douche (cold in hypopepsia
and hot in hyperpepsia)-

35^ RATIONAL HYDROTHERAPY.

(lo) The Strength-height coefficient is a good indication of
the general neuro-muscular condition of the patient. A nor-
mal or high strength-height coefficient indicates a good store
of nerve energy and good power of circulatory and thermic
reaction, the muscles being the seat of the most active heat-
making processes. The nerve tone and muscular development
are good, and, unless otherwise contraindicated, all kinds of
rational hydriatic means will be well tolerated.

(i i) A law strength-height coefficient indicates a low state
of nerve and muscular energy, little reaction power, and
necessity for the use of all precautions in the arrangement of
a hydriatic prescription. Tonic applications are specially
needed, but any form of cold application must be preceded
by a short hot application, preferably the hot douche or the
electric-light bath. Strongly percutient measures must be
used, or in the absence of a douche apparatus, cold friction
or the wet-sheet rub may be employed. The patient should
have vigorous rubbing after the bath to promote reaction, but
should not be required to exercise very freely until the mus-
cular power is considerably increased.

Other deductions may be drawn from physical coefficients,
as will be obvious without further elucidation here.
781 7. The patient's physical aptitudes or tem-

I di'^uml Cases P^^^"^^^^ must also be carefully considered.
Is he phlegmatic, nervous, or sanguine ^ Is
he afraid of cold water, or has he any idiosyncrasy against it }
Has he good powers of calorification; that is, has he good
ability to endure cold, or does he become easily chilled by
exposure to cold air or water ^ Has he good reaction powers }
Determine this by a test (^SO, 596). Before prescribing
treatment for a new patient, Priessnitz invariably made a care-
ful examination of the skin, and was always present at the ap-
plication of the first bath, noting carefully the intensity of the
reaction produced and the rapidity with which it occurred.
Although an empiric, he was a remarkably sagacious one,
and his success was largely due to his acute powers of ob-

GENERAL RULES AND SUGGESTIONS.

3S9

servation. For example, he reasoned that if chillmg the feet
will cause congestion and inflammation of the internal organs,
there must be some important relation existing between these
parts capable of use in the treatment of diseased parts. This
he accomplished by studying and utilizing the principle of
reaction*

8. It is impossible to make a routine prescription of
hydriattc measures. These powerful agencies must be regu-
lated with even greater nicety than medicinal agents, as
the dilTtirence of a few degrees of temperature or a few sec*
onds in the length of an application may not only negative
the results expected, but produce results the very opposite in
character, which, under some circumstances^ might inflict
irreparable injury upon the patient.

9. The patient's habits of life, — whether he has been
accustomed to cold bathing and regular active exercise; what
have been his habits as regards clothing, especially whether or
not excessive clothing has been habitually worn; the length
of time he intends to remain under treatment, — these and
other kindred matters must be carefully considered.

to. Before making a prescription in any case.
OfgaiiotherApy ^ j^ ^^^^ necessary to determine which most
and Sympto* , , ,.

matic Tix-atfticnt ''*^^*^'^^ immediate attention ^ — some urgent
la be Avoided, symptom, or the fundamental morbid condi-
tion which furnishes the background for the
pathological picture presented. In general, the treatment
must be both palliative and curative. Patients generally need
to be encouraged by the relief from distressing and annoying
symptoms, even though the measures employed therefor may
not be radically curative in their character; at the same time,
there must be a systematic employment of those measures
which, if perseveringly used, may ultimately result in abolish-
ing the symptoms altogether. It is above all things impor-
tant to avoid falling into the error of making the course of
treatment merely a running fight with the ever-changing
symptoms presented in most cases of chronic disease.

782

360 RATIONAL HYDROTHERAPY.

Of all the so-called systems of treatment which have
appeared and disappeared within the last century and which
have been so prolific with novel medical ideas, * * organop-
athy '* has perhaps the least to commend it to rational con-
sideration. Dyspeptics never get well by the treatment of their
stomachs only; neurasthenics never get well by the treat-
ment of their nerves alone. Equally futile is the exclusive
treatment of the skin in most forms of cutaneous disease. It
is the patient himself who is sick, not some circumscribed
portion of his anatomy. The organ which seems to be the
chief seat of the disorder is simply that portion of the body
which, being the point of least resistance, suffers greatest dis-
turbance of structure or function, or both, and thus becomes
the medium through which the morbid condition is most dis-
tinctly expressed.

Patients usually clamor for the relief of those symptoms
which most urgently obtrude themselves upon their attention,
and judge of their progress toward recovery by the extent to
which a chronic pain, a palpitation, a gastric acidity, a
chronic discharge, or some other definitely recognizable symp-
tom, is relieved by the measures of treatment employed.

The fact that certain symptoms, and, in particular, painful
symptoms, such as neuralgia, migraine, and nervous attacks,
which have been aptly termed ** nerve storms," sometimes
become more frequent during the first few weeks of treatment,
often presents a perplexing problem to the inexperienced
hydriatist, and occasions him much inconvenience because
of the necessity of maintaining the patient's courage, so
that he may be induced to persevere in his efforts. But
that some patients under a course of treatment by physiolog-
ical measures which are addressed to the removal of causes,
the reconstruction of disordered tissues, and the reorganiza-
tion of disordered functions, must thus pass through a period
in which many symptoms and various functional disturbances
appear to undergo a temporary exacerbation, is a matter of
common observation.

GENERAL RULES AND SUGGESTIONS.

361

of Symptoms

under

Treatment.

In French and German hydropathic estab-
lishments the more experienced patients often
encourage novices with the remark, * * Yoa
must expect to feel worse before you feel
better. ' * After carefully studying this question
in thousands of cases during a quarter of a century of experi-
ence 10 the use of hydriatic measures, the author feels con-
firmed in the view which he formulated many years ago;
namely, that this exaggeration of symptoms and the occa-
sional appearance of symptoms quite new must be attributed
Iq the intensity of the visceral activity set up by the strong
stimulation of the sympathetic nervous system produced by
hydriatic applications. This being true, it is evident tliat the
increased intensity of symptoms occurring within the first few
weeks after the patient begins a course of treatment need not
necessarily be regarded as an indication that he is getting
worse, or that his treatment does not agree with hinu It is
only an indication that* the treatment is producing a power-
ful effect upon the system, and that a reorganisation of
functions and forces is taking place.

Haig has observed that when a highly nitrogenous diet is
exchanged for a strictly non-flesh diet in a case of chronic
migraine, for example, there is likely to be, within the first
few wecks^ an increased frequency in the occurrence of tlie
paroxysms. This he explains by the supptjsition that a
change in the character of the blood results in the dissolving
out of the tissues of a larger amount of tirtc acid, which, being
brought into the circulation, irritates the nerve ends with
which it conies in contact, particularly those of the sympa-
thetic, thus giving rise to recurrence of the paroxysms.

This explanation seems rational, and the principle may
aid us in explaining the exaggeration of other unpleasant
symptoms which not infrequently occurs during the first
few weeks of a systematic course of hydriatic treatment.
Whatever the explanation may be, experience shows that if
the patient can be induced to persevere, and the treatment is

783

362 RATIONAL HYDROTHERAPY.

properly managed, the unpleasant symptoms soon disappear,
and usually do not reappear, although it sometimes happens
that they disappear in an oscillatory manner, being less pro-
nounced at each reappearance until they finally pass away
entirely. This is likely to be the case with such disorders
as epilepsy, hysteria, periodical migraine, chronic malarial
affections with intermittent paroxysms, and other maladies
in which periodicity is more or less marked.

It is well to encourage patients to dwell less upon symp-
toms and to consider more the fundamental morbid conditions
out of which they grow. Symptoms are nothing more than
the leaves and fruit of the pathological tree, the roots of
which are deeply seated in the intimate recesses of the tissues,
and consist in disturbed nutritive processes.

If too much attention is given to the treatment of symp-
toms, the results may be so great exhaustion of the vital
resources of the patient that he will not be able to respond
to the more thoroughgoing measures' which look toward the
actual eradication of his real malady.

Let us suppose, for example, that a patient is suffering
from spinal irritation, a pain in the region of the liver, epi-
gastric pain or tenderness, or from general muscular pain.
He finds applications of heat very comforting; indeed, the
Turkish bath, the hot spray bath, fomentations, the hot bag
to the spine, and similar measures afford such great comfort
that the patient is likely to resort to them to such an extent
as to suffer seriously from the depressing effects of heat;
while, on the other hand, cold applications may temporarily
aggravate some of these symptoms in spite of the greatest
care that can be exercised. The patient will naturally feel
very sure that hot applications do him good, and that cold
applications do him harm; whereas, the former afford only
temporary relief, while the latter, by increasing the general
nerve tone, improving the character of the tissue processes
and of visceral activity, are laying the foundation for ultimate
cure. No small degree of tact, scientific knowledge, and

GENERAL RULES AND SUGGESTIONS.

3«3

intuitive judgment are required so to combine local and sys-
temic measures with palliative and systematic treatment that
tlie greatest degree of comfort to the patient shall be secured
simultaneously with the most rapid progress toward recovery.
It must not be forgotten, however, that though symptoms
are only the voice of nature declaring the existence of patho-
logical conditions, yet the intensity of a symptom or of a group
of symptoms is, on the whole, the best measure of the
pathological state which gave rise to it; so that one can not
consistently say to a patient for an indefinite period that
the condition which gives rise to a certain symptom is being
removed when the symptom itself is steadily becoming more
pronounced. No encouragement even should be given unless
there is some reliable diagnostic means or data at hand
whereby the fundamental pathological condition in question
may be measured, and an improvement definitely recognised.
There are also cases in which symptoms maybe so urgent
in character as to require, for the time at least, the principal
or even exclusive attention of the physician, as in the hemor-
rhage of pulmonary tuberculosis, ulcer of the stomach, hem-
orrhoids, metrorrhagia, or menorrhagia. In many cases, also,
fever, though ordinarily demanding attention only secondarily,
reaches so high a point that vital damage is threatened, making
this the capital feature which should attract the attention of the
physician, just as a carpenter engaged in repairing the roof of
a house or in replacing a shattered window or door, might leave
his work to assist in putting out a fire on the premises.

IK In the organization of a plan of treatment
in a given case, it is necessary to determine
not only the course of treatment to be em-
ployed, but the length of each treatment and
the number of daily applications, and the time of day when
the applications should be made. The settlement of each
of these questions depends upon the object to be accomplished
by treatment, upon the mode of treatment employed, upon
the strength and susceptibility of the patient, etc.

Why Real
Progress Must
he Slow«

784

3^4

RATIONAL HVDROTHIRAPY.

A general plan should be made also respecting the length
of time during which the course of treatment is to be con-
tinued. If the patient can devote but a few days or a few
weeks to treatment, the plan employed may be quite different
from that which would be pursued if he were willing or able
to devote a sufficient amount of time to render possible a
more thoroughgoing renovation of his system and reorgani^a-
tion of his vital processes.

Patients should be made to appreciate the fact that in the
employment of rational and physiological measures of treat-
ment* the co-operation of the system is required; that what-
ever real progress is made is the result of a growth which
takes place within the body, just as growth takes place in a
tree or a flower* Recovery from a chronic disease is simply
the growing out of a condition of disease into a state of health.
Time is required tor the development of health just as for the
growth of a crop of grain. The physician tills the soil and
plants the seed, to use an agricultural illustration » but nature
grows the crop; and the patient must be content to wait for
the harvesL

It may be said, however, for the encouragement of patients,
that in not a small proportion of cases, immediate relief is
ejcperienced from those symptoms which have occasioned the
greatest distress and inconvenience. There is certainly no
therapeutic agent, or class of agents, which so promptly affords
such real and permanent relief as may be obtained from the
diversity of the resources of hydrotherapy.

If there is at first an increase in intensity of symptoms, it
is usually due to the leaving off of opiates, hypnotics, medici-
nal tonics, and other remedies which have simply obscured
the patient *s condition by hiding his symptoms; in other words,
by silencing the voice of nature, of which pain and a vast
number of other symptoms recognized as evidence of disease,
constitute the vocabulary. An opiate may cure a pain, but it
does not remove the cause of it ; and when it is withdrawn,
the patient will of course be made to appreciate his real con-

GENERAU RULES AND SUGGESTIONS,

36s

dition* The brief interval which elapsts between the with-
drawal of symptom-obscuring remedies and the amehuration
o! symptoms which come from the accumulation uf hydri-
atic applications is sometimes a pretty severe ordeal for the
patient to pass through; but with proper moral support and
encouragement, he may be carried along until he begins to
appreciate for himself that he is making real, not fancied »
progress toward health, that the fetters of his morbid condition
are being loosened, and that he himself is being recon-
structed upon a sounder foundation — that he is growing out
of disease into health*

n the patient can remain under treatment but a few days,
or two or three weeks, perhaps the best that can be done for
him is to teach him how to correct his wrong habits of Hfe, how
to adjust diet, exercise, work, etc., to the morbid condi-
tions which exist in his system, how to employ such palliative
means as vrill give him some relief, and encourage him to con-
tinue in a direction which may ultimately result in his cure.
Moderately tonic measures may be added, but measures of
treatment calculated to produce a high degree of perturbation,
such as frequently repeated very cold applications, strongly
eliminative treatment, and other powerful measures, should be
used only with the very greatest care.

With patients who are undertaking a systematic course of
treatment for tonic effects, applications should be made daily,
in some cases twice daily, very rarely three t lines a day. In
acute disorders, applications may be repeated liourly, or many
limes a day, as when antipyretic effects are sought » and in
many instances continuous treatment is required, especially
when local antiphlogistic effects are desired.

12, Patients should be taught that they can not usually
expect to realise the best results of treatment during the first
few weeks, if there is no unpleasant exacerbation of symp-
toms, there may be no diminution in the intensity of the
chronic symptoms for some trine, a fact which is often a
source of great discouragement to the patient.

366

RATIONAL HYDROTHERAPY.

It is astonishing, however, how obstinate and distressing
symptoms will in some cases seem to disappear all of a sud-
den, after many weeks in which there has been no perceptible
change for the better. In many instances, a patient who has
been under treatment for several months without apparent
relief, will arise on a certain morning entirely free from
annoying symptoms which have been incessantly present for
months or even years. Sometimes this result will take place
after only a few weeks of treatment In one case, a patient
who had suffered for several years with pain in the back,
after a few weeks' treatment, while bending forward one day,
felt, as he expressed it, a sudden ** letting up** in the back,
and from that moment he was entirely free from the pain
which had obstinately resisted the efforts of the most eminent
physicians of the United States and Europe, And this relief
was permanent.

It is not easy to explain what happens in a case like this;
nevertheless, in this instance something did happen which
brought deliverance to the patient; and the thing which hap-
pened was without doubt the sudden culmination of the bene-
ficial effects which had been developed during the preceding
weeks of treatment. Chronic symptoms often yield to thera-
peutic blows persistently administered by the physician, just
as does the rock to the sledge-hammer of the stone-mason*
Even after long and persistent hammering upon the same spot,
there may be no evidence of progress; but at the very next
blow the rock may be shattered. It is true, however, that
in a majority of cases gradually progressive reUef from symp-
toms is experienced from the first.

It is very important for the permanency of the effects
obtained that the patient under treatment tor chronic disease
should continue treatment until there has been a disappear-
ance of all the symptoms of his malady, and not only this,
but until the body has been so fortified by an increase of its
vital resistance that the symptoms will not again return, pro-
vided, of course, that the patient pursue such a course of life

GENERAL RULES AND SUGGESTIONS*

367

regarding diet, exercise, and other matters of regimen, as his

[particular malady may require.

13, It is important for the physician, as well as (or the
tient, to remember that chronic disease is rarely entirely
ted; in fact, we may almost say that a complete cure of a
chronic malady never occurs. The symptoms may disappear,

l^but the patient's constitution has been permanently weakened
certain directions, so that his condition is analogous to that

fot a steam-boiler which has been strained by overpressure.
There is a weak spot somewhere, which is likely to give way,
and it can not be safely used except at low pressure. A
person who once succumbs to the causes of chronic disease
will ever afterward be liable to another break-down of the
same sort Hence, he should sedulously guard himself against
those causes which his system has lost the power to resist.

The chief benefits to be derived from a course of hydro
therapeutic or other rational treatment are the result of con-
stitutional changes which require a considerable length of
time for development, and consequently the best results of
treatment are not experienced for some time, often many
months, after it is begun.

Not infrequently, in fact, the patient does not really appre-
ciate the full benefit which he has received until some months
after the course of treatment has been discontinued. This,
however, should not lead the patient to abbreviate his course

loi treatment, which is almost certain to be quite too limited,
)ut should rather encourage him to lay a broad foundation in
a prolonged and thoroughgoing course, which may be expected
to develop large and excellent results subsequently, when the
processes of regeneration of tissue and reorganization of (unc-
tion have been completed by those natural curative forces
within the body which it is the purpose of rational hydriatic
treatment to organize and set in operation*

It sometimes happens that the prolonged use of tonic
measures results in a condition of nervous weakness following
a period of apparent marked improvement. In such a case.

368 RATIONAL HYDROTHERAPY.

the treatment should be at once suspended or modified; but
the same measures should be again employed as soon as the
evidences of therapeutic overwork have passed away. Often
patients feel so much improved, when such a suspension of
treatment takes place, that they imagine that the treatment
has been doing them harm, and that they are better off with-
out it than with it. They should be made to understand that
the improvement experienced after the suspension of treatment
is but the legitimate result of the therapeutic applications
made, and that it is simply a foretaste of the greater improve-
ment and permanent benefit which they will experience later
as the result of the internal vital work which it is the purpose
of the treatment to organize and maintain.

It is, most of all, important to keep always before the
patient the great fact that disease is only normal vital en-
ergy manifested under abnormal conditions. When a sick
person recovers, it is by the operation of forces within him,
the same forces by which the ordinary processes of growth
and repair are carried on. Nature, not the doctor, heals.
The healing agency is within the man, not outside of him.
No new force or principle comes into operation in the struggle
of the body under the abnormal conditions which we call dis-
ease. The disease itself is not the thing to make war upon ;
it is rather the causes of disease which we should combat.
The chief concern of the physician, then, should be to discover
and remove the causes which have made his patient ill, and
to aid, by supplying favorable conditions, the remedial effort
which constitutes the pathological picture we call disease.

GENERAL RULES AND SUGGESTIONS. 369

GENERAL INDICATIONS AND CONTRAINDICATIONS.

As suggestive of the general principles of adaptation of
methods to cases, the following observations may be made: —

Anemic patients require short cold treatment. Special
care should be taken to see that the patient is warm when the
treatment is applied. Long hot baths should not be admin-
istered, however, because of their exhausting effects. A
short exposure of one or two minutes in the electric-light
bath, just long enough to heat the skin thoroughly, is an
excellent preparation for a cold application in the case of a
pale, bloodless patient. The short hot shower and other
heating measures may also be employed.

Feeble neurasthenics, patients who are ex- 786
Disorders hausted by loss of sleep or other causes,

chronic inebriates, and cases of hysteria with
emaciation and general feebleness, require such moderate
measures as the Scotch douche, cold friction, the wet-sheet
rub, the affusion, or the full bath at a moderate temperature.
Affusion constitutes an excellent method in these conditions.

An excellent measure in many cases is a bath at 92^ to
96° F. for 10 minutes, 103^ for 2 to 3 minutes, followed by
affusion at 80^, four to six pails.

Cases of neuralgia, myalgia, painful congestions, chronic 786
rheumatism with painful joints require the Scotch douche or
very short (2 to 3 sees.) cool douches. All douches must be
avoided in cases complicated with neuritis, or tenderness.
Such cases require fomentations, the heating compress, and
half-baths at 85° to 78° F.

What is required is thorough circulatory reaction without
thermic reaction; hence measures involving strong percussion
should be employed. Cold baths should in these cases sel-
dom be employed alone, but must be preceded by heat,
the succeeding cold application being short, or just long
enough to remove from the skin the surplus heat absorbed.
24

370 RATIONAL HYDROTHERAPY.

In the case of very sensitive and timid persons, treatment
shoald be begun with the very short cold douche or the
Scotch douche. An excellent plan of dealing with these
cases is to make the patient stand in a hot foot bath while the
temperature of the water is increased until the heat is almost
unendurable, and the patient can hardly stand still. The
heat impression made by the foot bath thus administered is so
generalized that a short application of cold may then be
simultaneously made without occasioning much inconvenience
or complaint.

787 If cold applications cause unpleasant after-effects in very
sensitive patients, the method should be modified by employ-
ing less force, using non-percutient measures, or employing
a higher temperature, as for example, 70^ to 80° instead
of 60° to yoP F., or a lower temperature. Some authorities
recommend in such cases that the bath be prolonged, instead
of moderated in temperature; but the author's experience has
been that the longer the application in such cases, the more
intense the unpleasant after-effects. Where the douche is not
well tolerated, a wet-sheet rub, cold friction, a sponge bath,
the graduated Scotch douche, or a tepid immersion bath may
be advantageously employed.

788 Neurasthenics and persons suffering from enteroptosis
with extreme irritability of the lumbar ganglia of the abdomi-
nal sympathetic can not endure a cold douche to the abdo-
men. A hot douche without pressure may be employed, and
cold friction with the hand or with a towel, but percutient
measures must be avoided.

789 Hypochondriacs are often very sensitive, and unable to
bear the cold douche. In such cases the neutral bath should
be employed, the patient being gradually trained to water
at a lower temperature until a short cold application can be
tolerated. Cold friction, the tepid affusion, the cool wet-
sheet rub, and finally the Scotch douche may be applied.
The same is true of opium habitues.

In very nervous persons the irritable state of the reflex

GENERAL RULES AND SUGGESTIONS.

371

and automatic centers is indicated by palpitation of the heart,
a sense of weight in the chest, by prickling, numbness, and
other peculiar sensations, wandering pains, headache, and
malaise after cold treatment. In certain persons it is not
infrequently difficult to avoid such effects altogether. It is
advisable in some cases to precede the use of the douche in
its various forms by a period of training by means of cold
friction, the towel rub, the short wet -sheet pack, and the wet*
sheet rub. The temperature should not be low, and the towel
or sheet employed should be wrung as dry as possible, so that
the effect of the cold applications may not be too prolonged
Short affusions, a very short douche applied to the spine
only, or to the spine and legs, with very light pressure and
of moderate temperature (60'^ to 80^ F. ), the Scotch douche, or
the hot bath in some form for 3 or 4 minutes prior to the
cold application, are other measures which may be recom-
mended.

If short cold applications are not well borne, a slightly ^9Q
higher temperature should be used, with stronger percussion.
This method is preferable to that suggested by Beni-Barde and
others; vU*, to attempt to avoid the excitant effects of short,
very cold applications by increasing the duration of the appli-
cation, and thereby producing a slii^ht sedation, or lessened
excitation. While this method seems to be theoretically
rational in practice it fails; for the sensitive patient who can
not tolerate a short cold application because of too great
reaction, generally fails to react well to a longer application,
and thus suffers greater inconvenience than from the short
cold bath* The better plan is to raise the temperature and
increase the pressure. This secures a good circulatory reac-
tion, with a less intense sensory stimulation.

The presence of cardiac disease, either as a 791
complication or otherwise, especially demands
consideration in the adjustment of a course of
treatment. In cases of cardiac hypertrophy with overcom-
pensation, and in cases of functional irritation of the hearty

.Cardiac
Diseased.

372 RATIONAL HYDROTHERAPY.

all extremes of temperature should be avoided. Neutral baths
are indicated. The patient may be trained to endure a douche
at 75° to 85° F. ; but in administering it, care should be taken
to begin at the feet, each day rising a little higher, until the
upper portion of the body is reached. The chest, and
especially the precordia, should always be avoided.

In cases of weak heart the general indication is for baths at
85° to 90^ F. for 5 to 10 minutes, accompanied by friction,
followed by the short Scotch douche at 104° for i or 2 min-
utes, a cold douche at 75° for 10 to 12 seconds, the water
being allowed to fall upon the legs, back, and arms only.
792 In the treatment of cases of organic cardiac disease, it is
important to observe which of the four phases of the dis-
ease the patient presents, and to this end the following
queries should be answered ; viz. : —

1 . Is cardiac irritability present ?

2. Is there incipient dilatation of the heart, as shown by
loss of power in the cardiac muscle ?

3. Have the small arteries lost, or are they beginning
to lose, their contracting power, as indicated by edema of
dependent portions of the body ?

4. Are there evidences of lesions in the viscera, such as
passive congestion or hypertrophy of the liver, congestion of
the stomach, etc. ?

In cases in which excessive compensation exists, exci-
ting measures must of course be avoided ; whereas in the
opposite class of cases, in which the vessels have lost their
power to contract, there is likewise a loss of ability to react ;
hence vigorous cold treatment can not be successfully em-
ployed except in a limited way.

Cold applications, when used, should be applied to small
areas by means of the friction mitt or a towel wrung very dry
from very cold water, and the application should be accom-
panied by vigorous friction. When made in this way, cold
applications may sometimes be employed with advantage in
exciting a weak heart to increased activity.

GENERAL RULES AND SUGGESTIONS,

373

Very hot and very cold applications should be avoided in
cases of cardiac disease with aortic insufficiency, in which
sudden death sometimes occurs, having in a lew instances
been occasioned by a cold douche or exposure to excessive
heat in the Rtissjan bath. In aneurism of the aorta, in ad-
vanced arteriosclerosis, and in apoplexy, the same precau-
tions must be observed. Very hot baths should be avoided
in aortic stenosis. Non-percutient measures are best in these
cases, and moderate temperatures only should be used.

In Bright' s disease and other forms of renal disease, very 793
cold treatment must be avoided ; but short very hot applica-
tions are valuable, especially in acute nephritis-
Very yfi'jf^r /^tj^/tj do not at first react so well as lean
persons, but they bear prolonged treatment much better, in
consequence of their large heat-making resources. Lean
persons react well, but their powers of reaction are quickly
exhausted ; hence they are more likely to suflter from second-
ary chill and untoward results.

Thick-skinned pi rsi^ns of phlegmatic temperament readily
tolerate the very cold douche and a very high pressure; that
IS, tf no contraindicating symptom is present

Cold water as a therapeutic agent is especially 794
HvdrottieniDV adapted to the treatment of actite maiadits
in which fever or pain is present or in which
diminished activity or overactivity of special organs is a
lundamental condition.

It must be remembered that cold applications with per-
cussion should l>e avoided when acute inflammation is pres-
ent, as the strong reaction set up by an application of this
sort will surely give rise to exaggeration of the condition.
Very hot applications followed by tepid compresses are more
I serviceable in cases of this sort*

Hydriatic measures may always be employed with ^reat
advantage in chronic iiiscasc, the tonic eflfects of cold water
being almost universally required in the treatment of these
maladies.

374 RATIONAL HYDROTHERAPY.

795 Surgical cases involving pain^ fever y or danger of inflame
mation, such as compound fractures and wounds of various
sorts; burns, scalds, and many other kinds of accidents and
injuries, afford most excellent opportunity for the thera-
peutic employment of water.

Those who have assigned to hydrotherapy a more limited
sphere of usefulness than that here claimed for it have been
led to this narrowness of view by the failure to recognize to
the fullest extent the great advantages to be obtained by
employing a wide range of temperatures.

Hydrotherapy is especially helpful in the treatment of
fevers from whatever cause, there being no other means by
which a febrile action may be more quickly or permanently
controlled than by the scientific employment of water.

796 The modem science of obstetrics owes much to hydro-
therapy in a variety of ways. The proper use of water dur-
ing the lying-in period greatly assists in conducting both
mother and child through the perils of this critical period,
and in quickly restoring the patient to a normal condition.
The author is hardly prepared to adopt the cold sitz bath
immediately after delivery, as recommended by Pingler; but
during twenty-five years of the practical use of hydrotherapy
in obstetrics, he has found it of invaluable service, especially
in the form of the hot vaginal douche, the hot uterine douche,
the enema, the daily sitz bath as a preparatory measure, the
neutral bath to relieve nervous irritability and insomnia (both
before and after confinement), and cold friction as a gen-
eral tonic.

797 Organic degenerations are of course incurable, but by the
appropriate use of water their progress may often be greatly
delayed, and not a few instances have occurred in which the
degenerations which accompany locomotor ataxia, general
paresis, etc. , have been so entirely arrested as to be held in
abeyance for years. Whatever develops general vital vigor
and resistance must delay the development of degenerative
processes, malignant as well as non-malignant.

GEKEHAL RULES AND SUGGESTIONS*

375

In organic disease of the brain and spinal cord, an arrest
of the disease may often be accomplished, and it is rare
indeed that some benefit is not obtained in cases of this sort.

Brilliant results could scarcely be expected in cases of
hyperplasia or hypertrophy, and yet even in these conditions
marked improvement has not infrequently been effected^
atrophied parts having been stimulated to renewed develop-
ment, so that functions almost entirely lost were restored.

There is no more useful agent than hydrotherapy in 798
dropsy due to chierpsis, anemin, and other etichcxias. When
catised by disease of the heart or kidneys, bydrothcrapeutic
applications are still highly useful, but must be employed
with the greatest circumspection*

Hetfwrrkages from the nose, stomach » lungs, or pelvic
viscera may be successfully combated by suitable applications
pf water, as elsew^here explained.

In gasiric disorders, hydrotherapy affords more assistance 799
than any other remedial agent. The cold douche in hypo-
pc'psia and apepsia, and the hot douche in hyperpepsia meet
the indications of these morbid conditions in a more effective
manner than any other known therapeutic agent, the cold
douche increasing the production of HCI, while the hot
douche diminishes the fonnation of this acid in cases in
which it is already present in excess.

The cold douche applied to the abdomen stimulates intcs-
jtinal peristalsis, and thus combats constipation.

Gemt^nrinarj and rcmil tUsordtrs present many condi- 800
tions which are in the highest degree amenable to hydriatic
treatment. The sit^ bath, rectal irrigation, the vaginal and
uterine douches, the pelvic pack, the fan or jet douche, and
general tonic apphcations are invaluable in this class of dis-
orders. It must be remembered, however, that general
cold applications must be avoided or greatly modified when
acute inflammatory condilions are present in the pelvic organs
or any other of the viscera. Cold friction (1209) is about
the only tonic measure permissible in these cases.

376 RATIONAL HYDROTHERAPY.

801 Pulmonary disorders present a large variety of conditions in
which hydriatic appUcations are capable of rendering invalu-
able service. It is important to remember, however, that
very cold general applications must be carefully avoided in
most cases of this sort. For example, in the application of
the cold douche in a case of chronic bronchitis or where there
is a tendency to pulmonary hemorrhage, the application should
be confined to the feet and legs. A moist pack applied to the
chest is a most valuable measure, which may be supplemented
by cool sponging of the upper parts of the body, followed by
vigorous rubbing.

802 In catarrhal affections of the throat and lungs, the heat-
ing compress may be applied systematically to great advan-
tage, but care must be taken not to cover it too warmly, thus
producing the effect of a poultice, which is highly sedative
and relaxing. A healthy skin is an indication of a healthy
mucous membrane, and disorders of the mucous membrane
may not infrequently be caused to disappear by the employ-
ment of tonic means calculated to bring the skin into a thor-
oughly healthy condition.

803 In affections of the skin, neutral baths arc often of the
highest service. In scaly eruptions, the curative value is en-
hanced by adding alkalies to the bath. The tepid douche may
also be employed with advantage in many cases. Skin
eruptions are usually due to general toxemia. The enema
and hot-water drinking should be freely employed as a means
of tissue cleansing. Cold baths must be avoided.

In chronic eczema, with thickening of the skin, tlie daily
hot douche to the affected parts has proved a most effective
means of restoring the diseased parts to a normal state.

In cases of skin disease in which a considerable portion of
the skin structure is destroyed, as in pemphigus, the prolonged
neutral immersion bath of Hebra may sometimes be em-
ployed with great advantage. In some cases of this sort
patients have remained in the bath for several months.
The diatheses and cachexias especially require the alter-

GENERAL EULES AND SUGGESTIONS.

377

ative and tonic eSects of hydrotherapy, yet the lowered vital
tone existing in these morbid states requires that great
care be exercised.

The three leading diatheses, which are typically repre- 804
sented by chronic rfuumatism, obesity^ and diabeUs, all pre-
sent as their characteristic feature, deficient oxidation. In
the rheumatic diathesis there is a deficient oxidation of the
proteid wastes; in diabetes, a deficient oxidation of sugar;
and in obesity, deficient oxidation of fat.

The cold bath excites oxidation, and hence is especially
indicated in these cases; but there being, at the same time*
diminished vital resistance, lowered nerve tone, and lessened
ability to react in consequence of the prolonged perversion of
nutrition, throuj^h exposure to the influence of depressing
toxic agents and retained excrementittous matters^ tunic
measures must at first be administered with great care, and
the patient must be trained by carefully graduated applica-
tions to react to the contact of cool water

Obese patients require cold baths, followed by prolonged
moderate exercise, to energise the muscles and lower the
body temperature. Rheumatics require hot, sweating baths,
followed by very short cold baths and exercise.

Diabetics, if emaciated, require long neutral baths* Very
hot and very cold applications should be avoided. If the
patient is in good flesh and strong, the Scotch douche, the short
cold douche (4 to 8 sees.), short cold immersion {3 to 3 sees.),
and other cold applications are admissible and advantageous,
especially if immediately followed by moderate exercise.

In the training of feeble patients to the use of cold water,
either one of two methods of training may be adopted In
some cases it is necessary to apply first one and then the
other. The first of these is —

If some form of douche is the mode of appli- 8O5
oJ^Sop!' **' *^^^^^" selected, the water should be employed
at a moderate temperature, as 80^ to 8$^ F.
The application should be 10 to 20 seconds, and followed by

378 RATIONAL HYDROTHERAPY.

energetic friction. From day to day, as the patient's nerve
tone increases, the temperature may be gradually lowered to
65° or even 60^ F. As the temperature is lowered, the
time of the application should be shortened, until at 60^ it
should not be more than 6 to 10 seconds, and at 55°, 3 or
4 seconds.

In obese persons who still have a moderate amount of
energy, a somewhat lower temperature may sometimes be
reached after long training. The same is true in reference
to diabetic patients who are still in good flesh and in whom
there is no marked tendency to emaciation.

In the rheumatic diathesis, and in persons who are
very sensitive to cold, we may begin with the tepid douche
at 85° to 90°.

In cases in which the percussion effects of the douche are
badly tolerated, non-percutient measures may be at first em-
ployed, such as affusion at 80° to 85^, the wet-sheet rub at
the same temperature, the immersion bath for 3 minutes at
85^ to 90^, with friction, the sitting shallow at 80^, the towel
rub, and cold friction.

It should ever be borne in mind that in beginning a course
of treatment it is better to commence with too moderate
than with too severe measures, as otherwise the patient is
likely to become discouraged and lose confidence. Moderate
applications two or three times a day may be made to accom-
plish the same results as a more severe procedure daily.
S0(} A second method of training for the cold bath

Scotch Douche ^^ preliminary heating of the skin followed by
a very short cold application. This succeeds
in some cases better than the method of graduation. Reac-
tion as a rule develops more promptly and regularly after a
short cold or very cold application than after a prolonged
application of higher temperature. For many patients also
an application at 75^ to 80*^ is quite as disagreeable as a
colder one. It is consequently advisable in some cases to
begin with the application of cold or very cold water at the

GENERAL RULES AND SOGGESTIONS,

379

outset, but making the application so short in duration that
untoward effects are obviated. The preliminary heating of
the skin greatly dimjiiishes the unpleasant sensation attend-
ing the cold application, as well as the untoward after-effects
which occasionally occur* The hot application should be at
a high temperature, usually 105'^ to 1 10^; and should be con-
tinued 3 to 6 minutes, or until the patient is so thoroughly
heated that he experiences an intense desire for a deluge of
cold water, which is an evidence that the system has been
prepared to receive the cold application with benefit.

The hot douche, the hot immersion bath, the electric*
light bath, the vapor and hot-air baths, are excellent means
of preparing the patient for a cold application in cases requir-
ing preparation. The electric-light bath is to be preferred to
the other measures mentioned, when it is accessible- Unless
the patient is quite emaciated, the bath may without injury
be carried to the point of slight perspiration ; and in cases of
obesity and rheumatism, when the patient*s general strength
is good, profuse perspiration may be produced without injury,
and in most cases with benefit, but must not be carried to the
point of exhaustion.

The longer the hot application is continued, the longer
the time required for removal of the heat communicated to
the skin by the bath; hence the length of the cold application
must be regulated by that of the hot one, the time of the cold
application, however, being measured in seconds, while the
hot application is measured in minutes. As a rule, the time
of a cold or very cold application will be not more than
2 to 4 seconds after a hot application of as many minutes,
and should not exceed 10 to 15 seconds, after a hot appli-
cation of 6 to 10 minutes*

Cool or tepid applications, which are often required in
diabetic and rheumatic cases and in chronic Bright*s disease
and neuralgia, may be continued i or 2 minutes in many
cases* The required effect must be secured; viz., cooling of
the skin until proper but not excessive reaction is secured.

38o RATIONAL HYDROTHERAPY.

807 The cold application should follow the hot bath immedi-
ately and before there has been the slightest opportunity for
cooling of the skin. To accomplish this, the vertical rain-
douche or shower apparatus may be advantageously placed
in the same compartment in which the vapor or Russian bath
is administered, so that the patient may receive a stream of
cold water upon his body immediately, thus avoiding the pre-
liminary chill, which, if it does not altogether spoil the effect
desired, greatly lessens it.

808 The author has had constructed for this purpose an elec-
tric-light bath and douche apparatus combined, in which the
electric lamps are protected from the action of the water by
an inner lining of plate-glass, so that the patient may
receive a cold douche at the same time that the heat-rays
from the incandescent filaments are falling upon the surface
of the body with full intensity. By means of this apparatus
the applications of heat and cold are really simultaneous,
so that there is no possibility of chilling the surface by
evaporation.

809 In very sensitive persons the full jet should not be applied
to the whole surface. The stream of water should be at first
directed upon the feet and legs from the knees down, the
amount of surface being increased at each succeeding applica-
tion until the whole body is subjected to the influence of cold
water under high pressure. The broken jet should be applied
to the rest of the body, or cold friction may be applied before
the douche. The applications should be made with great
rapidity, however, and should not last more than i or 2
seconds at first, and later, 2 to 5 seconds.

810 In cases of rheumatism with very painful joints, care
should be taken to avoid allowing the stream of cold water
to fall upon those joints which are sensitive, otherwise the
thermic reaction set up may increase the irritation and con-
gestion of the joints, and consequently aggravate the pain and
discourage the patient.

In anemia accompanied by menorrhagia, a condition not

GENERAL RULES AND SUGGESTIONS.

381

Ectctirabic
Maladies.

uncommon, the cold douche should be preceded by a very
short hot shower bath, or a fomentation to the spine, or both-
Care should^ however* be taken in the application of the
douche to avoid the lumbar and abdominal regions.

In anemia with amenorrheaj a general cold douche may 811
be administered, but should be preceded by a hot douche to
the hips, thighs, and feet; or a short hot sit2 and hot foot
bath ; or a hot foot bath, and a warm circle douche to the hips.

Even in disorders which are not curable, much 812
can be done for the patient by the palliation
of the most distressing symptoms, as in cancer
of the stomach accompanied by vomiting; uterine tumor or
cancer giving rise to hemorrhage; advanced locomotor ataxia
accompanied by hghtoing pains; and a variety of other symp-
toms connected with disorders which can not be wholly cured*
Thus the vomiting of cancer may be checked and a very con-
siderable degree of improvement secured; the consump-
tive cough may be controlled, and night sweats, (ever, and
other symptoms of this disease mitigated to a remarkable
extent by suitable hydriatic measures; and if the patient
can at the same time be so situated as to enjoy the advan-
tages of a climatic change at an elevation of about five thou-
sand feet I a cure can be effected in a large number of
otherwise hopeless cases. By the prolonged hot douche or
the revulsive douche, the lightning pains of locomotor ataxia
may often be relieved with a promptness which seems truly
magical ; and out of the scores of cases of locomotor ataxia
which have been under the author's care vrithin the last
twenty years, recovery from nearly all the symptoms present
has occurred in a considerable number of cases, and great
improvement in nearly all.

Thus no case of chronic disease^ no matter how inveterate,
unless it has reached an absolutely hopeless stage, should be
abandoned as incurable without giving hydrotherapy, with
the accompanying regimen of diet and exercise, active or
passive, an intelligent and persevering trial.

382 RATIONAL HYDROTHERAPY.

THE UNTOWARD EFFECTS OF HYDROTHERAPY.

There is no remedy, however valuable, which is not capa-
ble of misapplication or abuse. That untoward effects some-
times result from applications of water is not an objection to
its use, but is rather an argument for its scientific employ-
ment, and suggests the necessity of giving the same attention
to the study of this important therapeutic agent that is given
to the study of the various remedial agents enumerated in the
materia medica.

813 . Perhaps the most common of the unpleasant

Headache. «. i • , .. r n ,. i

effects which sometimes follow remedial ap-
plications of water is headache in some form. The pain is
most commonly located in the forehead, but the top of the
head, the back of the head, or the whole head may be in-
volved. This condition indicates that the application has
been (^i) too extreme in temperature — either too hot or too
cold, {b) too long in duration, {c) that the reaction has been
excessive, or {d) incomplete.

Headache more commonly follows the cold plunge, the
cold douche, or a hot bath of some sort, than any other
form of application. Some patients are so susceptible, in-
deed, that placing the feet in very hot water will induce a
severe pain in the head. In others, strong reaction induced
by any form of cold bath will occasion this difficulty. In
some instances, the headache thus occasioned is extremely
violent, and may last for several hours.

The explanations of headache under these conditions are
various. Some hydriatrists contend that it is always conges-
tive, others that it is always anemic. The author's view is
that the headache following hydriatic applications is some-
times congestive, sometimes anemic, and sometimes purely
reflex or sympathetic in character, due to overstimulation of
the sympathetic centers.

When the headache occurs immediately or soon after a
cold bath, the indication is that the bath was too cold, too

GENERAL RULES AND SUGGESTIONS,

S83

prolonged, administered with too much percussioo, or that
reaction either failed or was too intense, any of these condi-
tions constituting sufficient cause.

The headache which sometimes accompanies or follows a
hot bath is due to neither congestion nor anemia, but rather
to a swelling of the ganglion cells or of the nerve endings in
the brain under the excitation of heat.

Applications which are found to produce headache should
be inodified at once, as definite and serious injury may result
from the prolonged employment of measures which induce an
unpleasant symptom of this sort

Vertigo and sweating may occur either in con- 814
nection with headache or without. Vertigo is
due to the same causes which have been mentioned as pro*
ductive of headache. Sweating of the head indicates too
strong determination of blood to this part,

The three symptoms named indicate the necessity of some
modification of the measures employed; as» for example, a
towel rub or the wet-sheet rub, an aflfuston at 80^, or a short
full bath at 85^ to 90° should be substituted for the horizontal
jet or other percutient measures* Too strong reaction to the
head may also be obviated by wetting the face, neck, and
head just before the application of the bath; by the applica-
tion of a cold compress about the neck and to the head; and
by the hot foot bath just before, during, or after the balh.

Insomnia, nervousness, wandering pains, paU 815
[fisomnlat pit at ion, fidgets, uneasiness, and indefinable

^ ' but unpleasant sensations following a bath, in-

dicate the necessity for the employment of less
Strongly exciting measures. The Scotch douche should be
substituted for the cold douche, or perhaps the douche should
be suspended, the rubbing wet sheet, the towel rub, or the
neutral bath being substituted. The last-named measure is
one of the best of all known remedies (or insomnia. In cases
in which strongly tonic results are desirable, these applications
should not be made in the evening, but in the forenoon, A

384 RATIONAL HYDROTHERAPY.

disposition to insomnia may be combated by a neutral bath
taken just before retiring at night.

Insomnia, or a persistent sensation of fatigue occurring
after three or four weeks' tonic treatment, indicates a neces-
sity for the substitution of dry friction, short electric-hght
baths, the wet-sheet rub, the neutral douche with little pres-
sure, and similar measures in the place of the cold douche
or other strongly excitant treatment, so that the central
nervous system may have an opportunity to recuperate the
energy which has been expended in reaction and reparative
work.

816 In neurasthenia and in many cases of hysteria,
and Hysteria ^" which pain is generally expressed chiefly at

certain points, care should be taken to avoid
exciting or tonic applications to these points. This pre-
caution is sometimes rather difficult to carry out; nevertheless
it is necessary to exercise the greatest care to avoid the so-
called hysterogenous zones, and especially the abdomen in
cases in which the patient complains of decided pain or
tenderness in this region, as the application of cold water
will sometimes precipitate an attack.

Hot and cold applications to the spine will usually give
temporary relief from such an attack, if it docs occur, and
the neutral bath may be employed daily for a few days until
the peculiar susceptibility of the nervous system is somewhat
modified. In such cases, the patient must be carefully
trained to endure cold applications, the first attempts being
made with water at a temperature of 75^ to 80 ' F., and the
temperature systematically lowered from day to day, as the
patient gains power to react.

817 When enlarged or ruptured veins are present, percutient
applications to the affected areas should be carefully avoided.
TakI IT Cold ^^ ^^® beginning of a course of hydropathic

treatment, the patient not infrequently com-
plains of an increase in susceptibility to changes of tempera-
ture. This, however, passes off in a short time, for the

GENERAL RULES AND SUGGESTIONS.

38S

continued use of cold water hardens the skin and increases
its resistance. Great care must be taken to dry the skin
thoroughly after baths of all sorts* by removing not only all
sensible moisture from the surface^ but also that which has
been imbibed by the skin» the subsequent evaporation of
which may produce chill.

Colds» sore throats, and catarrh of the nose and throat
are usually due to neglect completely to dry the skin, thus
exposing the patient to secondary chill and resulting visceral
congestion and acute catarrh, which very readily becomes
chronic. For relief of the cold in cases of this sort, the cold
applications should be preceded by a hot Scotch douche^ an
electric bath, or some other form of sweating bath,

liheumatic pains, which not infrequently foU 818
RheuniAtlc Iq^^ hyd roth era peu tic applications, are not due

Disease, ^^ taking cold, as is often feared, but to in-

complete reaction, or to the setting free of
uric acid, and the consequent effects of an excess of this
irritating substance in the blood. Slow cooling by evapora-
tion after incomplete drying, and the prolonged application
of ''dry cold" by means of rubber bags filled with ice» are
often the cause of rheumatic pains.

Chronic skin disease sometimes presents a serious obstacle
to the employment of hydrotherapy. If suppurating pimples
or furuncles, erythemas, or acute eczemas appear, the indica-
tion is that cold baths should be suspended and that neutral
baths should be employed. Zinc ointment may be advan-
tageously applied to the a Elected surfaces after each bath.
The application of vaseline is also wise* Furuncles following
the stimulating compress are due to infection by the com-
press« It may be prevented by daily boiling the compress
and washing the parts well with yellow soap and hot water,

Priessnitz and the early water-cure doctors 819
made much of so-called ** crises/* but the
modern scientific study of hydrotherapy has
shown that *• crises" are the result of too violent measures,

25

CHseft or Fever
of Reflctton.

386

RATIONAL aVDROTHERAPV

or of strong measures employed for too great a length of time.
The principal symptoms mentioned in connection with crises
are fever, boils, suppurating eruptions, salivation, hemor-
rhoids, diarrhea, and vomiting. The application of too
strong measures to the surface is likely to give rise to erup-
tions and irritation of various sorts, boils, eta ; while excess-
ive water-drinking may cause intestinal disturbances.

There are no salutary effects arising from crises which can
not be obtained by far better means. The practice of produ-
cing crises was based upon the supposition that all disease is
due to impurities, and that these impurities may be gotten
rid of by means of purulent discharges from the skin, arti-
ficially created. No one at all familiar with modem medical
ideas can for a moment entertain faith in this antiquated,
inconvenient, and, happily, now obsolete measure.

820 Slight symptoms of general systemic disturbance, as
malaise accompanied by indigestion, headache, weakness,
and other indications recognized by the water-cure doctors
of the last century as the beginning of a crisis, should not be
regarded as unfavorable, but, on the contrary, as affording
positive evidence that the treatment is sufficiently vigorous in
chamcter to induce pronounced systemic effects. The symp-
toms should not be encouraged, however, but should rather
be checked by some modification of the prescription, such
as has been already suggested, and the patient may be
encouraged that he will soon be able to realize that he is
making rapid strides toward health.

821 In making hydriatic prescriptions, special care must be
taken so to adjust the procedures as to produce just the
amount and kind of reaction desired. In febrile diseases it is
always desirable to repress thermic reaction as far as possible,
and to encourage circulatory reaction. It is Best also that
the reaction should be developed slowly, as thus it will not be
excessive. It is this feature that gives to the cooling pack its
advantage over the Brand bath as an antipyretic. Applica-
tions for the relief of pain should always produce circulatory

GENERAL RULES AND SUGGESTIONS.

3S7

[Inaction* In these cases it is best to develop the reaction as
gickly as possible, so that the procedure shall not be
fatiguing.

In applications tor the reduction of temperature, a cer- 828
tain amount of thermic reaction can scarcely be avoided; but
by employing cold applications accompanied by continuous
friction, both the skin circulation and the temperature are
maintained, and thus the cutaneous nerves are not cooled to a
sufficient degree to set up powerful thermic reflexes, and heat
production is but slightly increased. Cold douches must, of
course, be avoided in cases in which there is elevation of tem-
perature* It is not desirable, however, to altogether suppress
the thermic reaction in fever, as it is important to develop
strongly the resistance of the body, and this can be done only
by such an application as will moderately stimulate metabolism
as well as other functions* The cooling pack accomplishes
this in a most satisfactory manner*

In fevers, circulatory reaction must be encouraged, so as 828
to aid heat elimination while thermic reaction is suppressed.
In chronic disorders requiring tonic measures, quick thermic
and circulatory reaction must be secured; and after all general
procedures, complete reaction must be attained, or the results
sought will not be secured.

The influence upon metabolism must be watched by noting 824
constantly the effect of the treatment upon the weight, the
muscular strength as shown by the dynamometer as well as
by the patient's general feeling, the appetite, and by the urine.
An excess of solids, especially chlorides, signifies excessive
tissue waste. Urea in excess indicates too long or too fre-
quent hot baths, or too much exercise.

The temperature must also be noted. Excessive tempera-
ture elevation after cold baths, or an elevation of temperature 825
followed by perspiration, resembling afebrile movement, indi-
cates excessive stimulation and thermic reaction. The pro-
cedures must be modified or treatment suspended, else an
actual fever, the sO'Called hydropathic crisis, may result.

388 RATIONAL HYDROTHERAPY.

THE HYGIENIC OR PROPHYLACTIC EMPLOYMENT
OF HYDROTHERAPY.

826 Rational medicine, as Dr. Horatio C. Wood, of Philadel-
phia, has so clearly pointed out, consists essentially in the
application of prophylactic measures; that is, the employment
of means which are capable of maintaining a normal individ-
ual in a state of health. It may be suggested as a corollary
from this proposition, that by the employment of those
physiological measures which are most effective in the res-
toration of a sick person to health, the individual may be
maintained in good health.

However applicable this principle may be to other thera-
peutic means, experience has shown most positively that the
cold bath, while one of the most powerful tonics and most
efficient of restoratives, is at the same time one of the most
valuable of all known prophylactic or hygienic measures.
The cold bath acts powerfully upon the sympathetic nervous
system, — that great regulator of nutrition. It likewise affords
a gymnastic means for the vasomotor system of nerves and
centers, and develops by exercise the contractile activity of
the small blood-vessels. Cold water, in common parlance,
hardens the skin; technically, we would say, it increases the
vital resistance of the skin. If habitually employed, the cold
bath protects against taking cold, not by closing the pores,
but by increasing the activity of the cutaneous circulation and
developing the vital resistance of the body in general, and
especially the ability of the body to reheat the skin after it
has been chilled by exposure or cold applications.

Through the influence of the cold bath upon the sympa-
thetic nervous system, all the processes of nutrition and assim-
ilation are quickened. The amount of hydrochloric acid
produced by the glands of the stomach is increased, as the
result of which appetite and digestion are improved; and the
gtpm^Qh, being provided with a better quality of gastric juice,

GENERAL RULES AND SUGGESTIONSp

389

IS better prepared to protect itself against injury from intru-
ding microbes* Modern investigations have show^n that
typhoid fever germs, cholera germs, and, in fact, all varieties
of germs, succumb to the attack of a thoroughly healthy gas-
tric Juice; hence the daily cold bath, by maintaining a sound
digestion, as well as by increasing the general vital resistance
of the body, serves as a most valuable protection against
infectious disorders, even those which are comtnunicated by
virulent living organisms of various sorts.

One of the most interesting effects of the cold bath is the
increased number of blood -corpuscles found in the surface
vessels after the establishment of the reaction which follows
these cold applications. The blood is the means by which
oxygen is conveyed to the tissues, and carbonic acid gas to
the lungs, whence it is discharged from the body. Certain
of the blood cells are also useful in destroying the germs
which may find their way into the blood-vessels, and in
removing dead and useless particles of various sorts.

It is thus apparent that the number of corpuscles con-
tained in the blood is a matter of the greatest importance in
relation to the degree of vital resistance, or the ability of
the body to maintain itself in health under adverse circum-
stances or against the destructive influence of disease-produ-
cing causes.

The total surface area of the blood cells contained in the
body of an average man is 3,100 square yards. It has been
shown by Winternitz and others that by the application of a
cold bath the number of blood cells may be increased thirty
and even fifty per cent. This means an increase of i,000 to
1,500 square yards of surface available for use in conveying
oxygen to the tissues, and removing carbonic acid gas. It
means also an increase of thousands of millions in the number
of active protective cells scattered throughout the circulation.
This effect of cold upon the blood is one of its most valuable
and important uses, and easily accounts for the freshness of

390 RATIONAL HYDROTHERAPY.

color, clearness of complexion, and general buoyancy and
vigor which result from the habitual daily employment of
the cold bath.

In the application of cold water as a hygienic means,
care must be taken, however, to adapt both the temperature
and the mode of application to the age, and also to some
extent to the sex, as well as to the temperament and to indi-
vidual susceptibilities.

827 Children under seven years of age do not well
Cold Bathiag bear the application of very cold water ; there-
Eariy Child- ^^^®' *^^ douche in all forms should be avoided,
hood. cold friction, the rubbing shallow, or the im-
mersion bath with rubbing being used instead,

and never at a very low temperature. A temperature of 70°
to 80^ F. will produce sufficiently strong impressions to de-
velop good reaction in children under seven years of age.
After seven years of age, as the child advances in years,
the temperature may be lowered somewhat, and more vigor-
ous applications may be made, such as the affusion and the
light douche with water at 70^ to 75^ F. in temperature.
After fourteen or fifteen, lower temperatures may be em-
ployed.

The daily cool douche, or affusion, is an excellent means
of relieving urinary incontinence in children, a difficulty indi-
cating weakness of the inhibitory centers, which later may
develop serious nervous disorders.

The daily cold bath is an important aid to general de-
velopment in growing children, and increases not only mus-
cular vigor and energy, but nerve tone. It prevents the
development of neurotic conditions in young persons just
entering upon manhood and womanhood, relieves so-called
growing pains, and promotes vigorous and normal develop-
ment.

828 Adults must adapt the form of the bath to
f \d It their conditions of life, their special predispo-
sitions and individual susceptibilities.

GENEfiAL RULES AND SUGGESTIOKS.

391

The Cold Batfa
for Women.

Sedentary persons especially need the benefit of the cold
bath. Such persons may advantageously employ, before the
cold douche* a hot bath for three or four minutes.

Adults who are predisposed to rheumatism, gout, gravel,
migraine, Bright's disease, neurasthenia, and other maladies
which for the most part are the result of the retention within
the body of the products of nitrogenous wastes, will be
greatly benefited by the employment of a cold bath daily,
but it should be carefully administered. Very cold water
must be avoided, and the cold application (68^^ to So ) should
be preceded by the hot bath for three or four minutes, or until
sweating is produced. In feeble persons, cold friction should
be employed instead of cold applications in which the whole
surface is wet at once.

The daily cold bath is especially useful for
women of civilized nations, because of the de-
teriorating influences of their artificial life.
The hannful customs of civilization, rather than nature, have
made woman *' the weaker vessel/* The cold bath gives
nerve tone, combats nervous weakness of various sorts, is
a most excellent prophylactic against hysteria, and to a
very considerable degree combats the unwholesome tendency
of the indoor and sedentary life to which most women are
subjected*

The coid d€ff/i /av&rs the devchpment af the menstrual
funeiUn in young girls, and if habitually employed, affords
great assistance at the menopause. A woman who has made
regular and |>ersistent use of the cold bath for some years
preceding the •* change of Ufe** is very little subject to the
vasomotor disturbances, the flushings, sweating, etc, which
render the lives of so many women miserable for months,
sometimes years, at this period.

The fohi bath shauld be avoided during' meustruaiian.
Although several authorities recommend that the cold bath be
continued during the menstrual period, the author believes it
to be, on the whole, safest to suspend it at that time, and to

889

830

392 RATIONAL HYDROTHERAPY.

substitute the tepid bath. The cold bath taken at the be-
ginning of the menstrual period may easily result in serious
injury. In one reported case, a fatal hematocele was pro-
duced. In febrile diseases, cold bathing may be continued,
but the intensity should be modified somewhat.

In cases of dysmenorrhea, menorrhagia, and relapsing
inflammation, suitable hydriatic applications may be made at
the menstrual period with great benefit. By the aid of
proper measures of this kind, these disorders may be more
profoundly and favorably influenced than by any other non-
surgical means. Hot fomentations, the revulsive sitz, the
hot vaginal douche, render most valuable assistance at this
period, when appropriately employed.

In pregnancy, the cold douche should be avoided in all
forms. Short cold frictions at a temperature of 60^ to 70^
may be employed with advantage, but the cold douche about
the abdomen and lumbar regions should be avoided.

During lactation, the cold bath may be employed with
good effect, but cold applications about the lumbar and abdomi-
nal regions should be avoided as likely to cause a prema-
ture establishment of the catamenia. It is on this account
better to confine the application chiefly to the upper part of
the body. Cold friction, in strong women even the shallow
bath, is safer than the douche or any measure accompanied
by percussion.
831 Old age involves the liability to the existence

in Old Aee. °^ arteriosclerosis and allied forms of degen-

eration, in either an incipient or an advanced
stage. The skin is inactive, rigid, and comparatively blood-
less, and the heat-making powers of the body are greatly
diminished, so that the thermic as well as the circulatory
reaction is likely to be incomplete, thus giving rise to numerous
untoward and distressing symptoms. On this account, great
extremes in temperature must be avoided. The neutral bath,
douches at a temperature of 75° to 85° F., the wet-sheet rub
at the same temperatures, and the cold friction or towel

GENERAL EULES AND SUGGESTIONS,

393

mb, are the most appropriate measures. Cardiac weakness,
emphysema, and bronchitis are conditions so likely to be
present in aged persons that they must be kept constantly in
mind in the treatment of the old.

The cold bath affords one of the best means for reviving a
person who has been exhausted by heat, and especially by
heat accompanied by profuse sweating.

The hot sponge bath taken in the morning is sometimes
preferable in very hot weather to the cold bath. As the
result of a short hot application, an atonic reaction is pro-
duced« which lessens heat production, and thus enables a
person better to endure exposure to a high temperature.

In the winter season, the habitual employment ot the cold
bath trains the skin to react promptly, and thus lessens the
danger of taking cold or of suffering from pulmonary conges-
tion, as the result of chilling the surface of the body. With
a change of season, however, it is sometimes necessary to
modify the form of the bath.

The importance of the daily cold bath is a matter of far
greater moment than is generally comprehended. In the
opinion of the author, every public school should have con-
nected with it a shower-bath, a swimming-tank, and a gymna-
sium, and all pupils should be required to undergo physical
training not only in the gymnasium but in the swimming and
shower-baths as well, under careful medical supervision. By
this means the physical development of the young may be
greatly encouraged, and evil moral tendencies combated, and
thus the present rapid deterioration of the race may be stayed*
The universal introduction of these measures would certainly
result, within a generation, in the production of a much
more vigorous race of men and women than we now see.

The sweating bath is a hygienic measure of 832
the greatest value for persons of sedentary
habits, constituting to some extent a compen-
sation for lack of exercise. It is a noticeable
fact that the people who inhabit very cold countries, as the

The

Sweating

Process*

394 RATIONAL HYDROTHERAPY.

natives of Northern Russia, etc., are great devotees of the
sweating bath.

The Finns, who for a considerable portion of the year are
confined indoors and have little or no exercise, have been
intuitively led to seek a compensation for the lack of exercise
in the sweating bath, followed by a vigorous cold application.
Every house in Finland has its sweat-room attached, in which
hot steam is produced by pouring water upon heated stones.
After remaining in the sweat-house until sweltering with heat
and dripping with perspiration, the bather rushes out and
rolls in the snow, thus producing a most vigorous reaction.

The sweating bath, followed by a cold application, though
in no means a perfect substitute for exercise, does neverthe-
less to a very considerable degree relieve the system of the
excrementitious wastes which accumulate within the body
when a sufficient amount of exercise is not habitually taken.
This it accomplishes by increasing oxidation and renewing the
body by stimulating tissue changes.

Sweating softens the sebaceous matter which often accu-
mulates in the ducts of the skin, and loosens the dry epithe-
lium by means of which the outlets of the perspiratory ducts
are often greatly obstructed, but its greatest benefit is through
the stimulation of the circulation of the skin, the excitement
of all its functions, and especially in the reflex influences upon
the internal structures which are set in operation, and the
vigorous fluxion of the blood which is created by the intense
hyperemia of the cutaneous envelope produced by prolonged
exposure to heat followed by cold.

The skin is capable of containing one half to two thirds of
all the blood in the body. When its vessels are dilated to
their fullest extent, mechanical displacement of the blood
toward the surface causes a temporary anemia of the internal
viscera, with- contraction of their vessels. By this means,
internal congestions are relieved. The cold application fol-
lowing the sweating bath causes an inrush of blood to the
interior, distending the visceral vessels and stimulating their

GENERAL RULES AND SUCCESTIONS,

395

functions by increased blood pressure and accelerated move-
ment of blood. By the fluxion of blood between the interior
and the exterior of the body; the various vital activities of the
organism are stimulated to the highest degree^ all the nutritive
processes are accelerated, and the most powerful alterative
and tonic effects result.

Sedentary persons should take a sweating bath of some
sort at least once or twice a week, care being taken, however,
to follow the sweating bath by a cold bath of some kind suffi-
ciently prolonged to remove from the skin the heat imparted
to it during the sweating process* and to produce vigorous cir*
c'ulatory and thermic reaction. By this means the skin is
strengthened and protected from the disturbing influence of
atmospheric changes, appetite and digestion are improved,
blood pressure and nerve tone are raised, and the wheels of
life, so to speak, are made to run more smoothly and quickly-
The sweating bath should always be taken at night, and just
before retiring.

The Neutral
Batli,

The bath at 92^ to 95^ is of special value for 838

business men, teachers, orators, physicians,
and all engaged in professions which asso-
ciate comparatively little bodily activity with an undue
degree of mental and nervous strain. The temperature
should be 92 ' to 95- F*, duration 15 to 30 minutes, or even
longer This bath should be taken at bed-time, as it
possesses soporific power to a wonderful degree, inducing
sleep even when hypnotics fail, and by its timely use the
employment of sleep-producing drugs may be avoided* The
individual who finds himself unable to get to sleep on going
to bed, or who awakens after two or three hours unable to
continue his slumbers, will find in the neutral bath a sov-
ereign remedy, which, by the sound sleep thus induced,
and the accompanying vital recuperation, will enable him to
maintain good health under conditions to which he must
otherwise succumb. The loss of sound sleep soon results in
complete nervous break-down, and not infrequently in mental

396 RATIONAL HYDROTHERAPY.

failure as well. The neutral bath at the temperature named
may be taken every night for a prolonged period without
injury, provided that the cold morning bath is habitually
employed. When the rain douche or the horizontal jet is
available, it may well take the place of the neutral bath, as
good effects being obtained from the application of the douche
for five to ten minutes as from a neutral full bath of three
times as great duration.
^^ Precautions. '• When fatigued as the result of the loss of
sleep or severe muscular exercise, a cold appli-
cation should be preceded by a hot douche or immersion bath
for 3 to 7 minutes.

2. If but slightly fatigued, a short cool or tepid douche,
or cold friction may be substituted for the cold bath.

3. A very cold bath should always be short, and should
never be administered when the body surface is cold or chilly.
The hot bath carried to the point of gentle perspiration is an
excellent preparation for a cold application.

4. The temperature of the air of the room in which a
cold bath is taken should always be higher than that of the
bath.

5. Avoid frequent hot baths at all seasons, and especially
in winter, as they are depressing, and lessen vital resistance
to cold and other disturbing influences. The best time for a
hot or warm bath in cold weather is just before retiring.

HYDRIATIC INSTITUTIONS AND THEIR EQUIP-
MENT. AND THE GENERAL MANAGE-
MENT OF CASES.

IN the scientific use of water in the treatment of disease
elaborate apparatus is not essential for effectiveness.
Indeed, it is possible to secure the most valuable of the
therapeutic advantages of water by the aid of sheets, towels^
blankets, a pail a bath-tub, and a thermometer, if coupled
with the consummate skill which comes from long experience*
There can be no doubt, however, that the best results of
hydrotherapy are most readily and quickly attained by the
aid of perfected apparatus especially designed and suited for
bringing to bear upon the body the thermic and mechanical
impressions which may be elicited from water. It may also
be added in this connection, that, while it is true that no
remedy lends itself so readily to all conditions and environ-
ments as does water, and while there are few morbid condi*
tions which may not be greatly benefited by the use of such
simple appliances as are usually found at hand, it is true beyond
question that a very large number of cases, especially those
of a chronic nature, may be much more satisfactorily treated
and far more quickly restored to health by treatment in ao
establishment furnished with all the appliances for the most
efficient use of water. It is not always necessary for the
patient to Hve in such an institution, though he should be
sufficiently near to make daily treatment possible without too
great inconvenience; but in quite a large proportion of chronic
cases it is important that the patient's whole life should be
controlled,^ the diet, exercise, and the entire regimen regu-
lated in harmony with rational living, — in other words, that
the patient should give himself for the time being wholly to
the cultivation of health, in order to secure the desired results.
Hence a lew words may not be out of place in regard to the

39?

900

39^ RATIONAL HYDROTHERAPY.

equipment requisite for an establishment devoted to the use
of hydriatic measures.

901 The most necessary thing is an abundant supply of water.
Soft water is preferable to hard, because of its better effects
upon the skin, but mineral water oilers no real advantage
over the purest soft water. The slight advantages which
may possibly be claimed for certain alkaline mineral waters,
especially those containing carbonic acid gas and chloride of
calcium, in the production of circulatory reaction at neutral
temperatures, may, when desirable, be easily attained by the
addition of the proper chemical substances. Soft water is
much more readily absorbed than hard water or mineral
waters, as has been shown by laboratory experiment. This
gives it greater value when used at neutral temperatures for
sedative effects.

902 A consideration of the greatest importance in relation to
the water supply is the temperature, a low temperature being
a very desirable quality. The summer temperature should
not be higher than 55° F., and five to ten degrees lower is
desirable. At a temperature above 60"^ it is difficult to
obtain some of the most desirable hydriatric effects. It is not
every case in which the powerfully tonic effects of water at
50^ can be utilized, but means should be at hand for the pro-
duction of the profound thermic and circulatory reaction
which may be secured by water at this temperature, admin-
istered with proper pressure, in cases which may require it.
In temperate climates there is no difficulty in obtaining water
at a sufficiently low temperature during the cold months, but
during the summer-time the temperature of water conveyed
for some distance in pipes often rises to 70^ or even 75^. In
such cases artificial means of cooling may be employed. The
accompanying cut (Fig. 28) shows a method of cooling which
the author has found very satisfactory. Water at a tempera-
ture of 70^, after circulating through this apparatus, is deliv-
ered at a temperature of 50^ or less. Water from deep wells
and mountain streams is generally of a sufficiently low tem-
perature for practical purposes.

HYDRIATIC INSTITUTIONS*

399

In the empirical hydropathy of PriessniU and bis fol-
lowers, cold water was the one thing needful; but in modern
. rational hydrotherapy water is employed at all temperatures
' possible without injury to the skin; hence some suitable means
ioi affording an abundant supply of hot water is required.
Water may be conveniently heated by means o£ such a water-
heater as is commonly used in laundries; or when the bathing
estabhshment is heated by steam, it is usually most conve*
nient and economical to heat the water in a boiler through
which the steam is made to circulate by means of brass or
copper pipes. If an engine is used for running a pump,
elevator, or other machinery, the exhaust steam may be
ytilii^ed in heating the water Another method recently
invented is the heating faucet, into which a steam pipe and
a cold' water pipe are connected in such a manner that by the
proper adjustment of the valve the steam and water may be
mixed at the moment of escape, and thus water at any tem-
perature desired instantly obtained* Water may also be
heated by passing a steam pipe directly into the tank of cold
water. This method, however, has the disadvantage of being
extremely noisy. The noise may be sohiewhat lessened by
fastening a suitable head to the open end of tlie pipe, but can
never be entirely overcome.

Live steam is needed for the vapor bath, the Russian
bath, and especially for the vapor douche.

Adequate pressure is a matter of utmost importance for a
complete hydriatic establishment, it being essential for the
different forms of the douche, — the most powerful if not the
most essential of hydriatic procedures. The pressure needed
is at least thirty to fifty pounds, representing a water column
seventy-five to one hundred feet in height A higher pres-
sure is in no way undesirable, though not often required.
When city water pressure can not be utilized, water may be
pumped up into a tank placed at an elevation sufficient to give
the necessary pressure. Each foot of elevation gives a pres-
sure of about .45 of a pound. The pressure required may
be obtained by means of a closed steel tank and an air-pump,

904

400 RATIONAL HYDROTHERAPY.

an arrangement shown in the accompanying cat (Fig. 29).
This device is much used in France, and is very satisfactory.
In the absence of a better appliance, it is possible to administer
the douche, and that in quite effective fashion, by means of
an ordinary green-house spray pump. But in order to secure
all the advantages of this most potent and admirable thera-
peutic agent, a complete and well-constructed apparatus must
be provided. The douche apparatus being naturally the
central feature of a well-equipped scientific establishment for
the employment of hydrotherapy, it should not be clumsy or
incomplete. The cost of a proper outfit, including a percus-
sion douche nozzle with air-pump and tank to operate, need
not be more than $500 to $600 at the most.
905 The apartments devoted to the administration of baths
should be carefully constructed for the purpose, and when pos-
sible, should comprise the following distinct compartments:
An office, a waiting-room (the office and waiting-room may
often be combined), a series of dressing-rooms with cooling-
room adjacent, general treatment-room, a room for douches
of various sorts, a room for the administration of massage,
packs, and fomentat'ions. In addition to these there must be
a water-closet, and provision for the administration of enemas
and vaginal and rectal douches.

Special attention should be given to the ventilation of the
apartments. The amount of air required per hour in living-
rooms is estimated by Parkes at 3,000 cubic feet. In bath-
rooms provision should be made for at least twice this amount
of air, because of the great activity of the lungs and skin of
patients during hydriatic treatment, and also because of the
fact that the rooms are to be occupied by diseased persons,
in consequence of which the air will become contaminated
more rapidly than under ordinary circumstances. The maxi-
mum number of patients likely to occupy the rooms at any
one time should be estimated, and provision made for 5,000
to 6,000 cubic feet of air per hour for each person. The air
should be warmed before it enters the room. It may enter

Fio. j^. COM rRliSS ION TANK DUUCHR,
APPARATUS (p, 400).

HYDRIATIC INBTITDTIONS,

401

at any rate desired, but should not leave the room at a rate
of more than five to seven feet per second. The outlets
should be numerous and located on^ or at, the floor and
beneath the windows, so as to prevent the cold air which
ialls along the outer walls from collecting at the floor, thus
chilling the feet of the bathers. Ventilating shafts should be
located in the inside walls, so that they will always be warm*
If it is impossible to carry the shaft high enough to secure a
strong draft, a suction-fan may be introduced, it being
operated by steam, water, or electricity. Great care should
be taken to avoid drafts, as the rapid evaporation from the
skin produced by moving air readily gives rise to chill and
most unpleasant effects. The temperature of the bath-rooms
should not be higher than 75'-* to jS^ F. A temperature of
65^ to 70^ is preferable for the waiting- and cooling-rooms;
while a temperature five to ten degrees higher may be allowed
for the general treatment-rooms.

The floors of the waiting- and dressing-rooms should be
made of hard wood* and waxed. If necessary, the floor may be
covered with soft rugs, which should be taken out and shaken
and sunned daily. The floors should never be covered with
carpets, as these collect the dust» and often become musty,
and contaminate the air. In apartments in which the floor
is likely to be wet^ as the douche and the general treatment-
rooms, the floor, or at least a portion of it, should be covered
with tile, marble, slate, or concrete. The walls should also
be of impervious material, preferably marble, and no crack
should be left into which the water can enter, or to become
filled with decomposable material.

If gutters are employed for carrying off the water (these
should be depended upon as little as possible), they should be
along the outer wall, and should be deep enough so that they
will nut readily overflow, and should be readily accessible so
that they may be cleaned daily. No pipes of any sort should
pass through the gutters, and there should be sufficient fall so
that they will empty themselves rapidly.

906

402 RATIONAL HYDROTHERAPY.

Partitions should, as far as possible, be made of water-
proof material. No woodwork of any sort should come in
contact with the floor.

For fully equipped bath apartments at least the following
appliances will be required : —
907 Bath-tubs of proper construction for full, sitz, foot, run-
ning foot, shallow, and leg baths. An apparatus for admin-
istering douches of all sorts, including the vapor douche, is
one of the most important necessities, and should be provided
regardless of expense.

For good heat effects an electric-light bath and vapor or
hot-air baths are needed, and for a large establishment it is
well also to add the Russian bath. Electric-light apparatus
should be provided for the administration of local light-baths
to the spine, legs, abdomen, and other parts.

Several large dippers, and pails properly constructed for
the pail douche, should be provided, and there should be an
abundant supply of linen and Turkish towels, linen and
Turkish sheets, large soft woolen blankets, double blankets
for the wet-sheet pack, friction mitts, a shampoo slab, manila
or excelsior for shampooing, fomentation cloths, cheese-cloth
for compresses, hot-water bags, both square and long, hot-
water bags for the throat, and properly constructed sofas and
couches. Several thermometers should be hung about the
bath apartments in various places, by which to regulate the
temperature. The thermophore, when obtainable, may be
employed instead of the hot-water bag.

It may be properly added, however, that the most ele-
gantly equipped establishment for the administration of
hydriatic procedures may be only the means for bungling
and unscientific dabbling with human ailments, unless con-
ducted under skilled medical direction and by the aid of
attendants well trained in the versatile procedures of hy-
driatry. The hydriatrist must know not only that his appara-
tus and appliances are perfect and in perfect condition, but
he must know exactly the condition of the patient to be

HYDRIATIC INSTITUTIONS.

403

treated, and must have a clearly defined rationale for each
application made. Every prescription must have a sound
physiolo^^ical basis. Empiricism is bad anywhere, but espe-
cially so in practical hydrotherapy. A profound knowledge
of physiology and pathology is essential to success.

It may be profitable to note a few of those conditions of
the patient aside from distinct pathological states which
have an important bearing upon the effects of hydriatic pro-
cedures.

The exact condition of the patient as he comes to the bath
should be noted and taken into account, as it may be neces-
sary to modify a procedure which was designated for him the
day before or even the hour before. If he is in a state of
exhaustion, for example* from overexercise or loss of sleep or
other cause, any very cold application will probably be inap-
propriate. If the patient is chilly, he must be wanned* Sim-
ply warming the feet by a hot foot bath may be the only
heating measure needed; but if necessary, fomentations to the
spine, a short hot immersion bath, a hot-blanket pack, or a
hot rain douche just before the cold douche, may be employed
as most convenient or as may seem to be indicated. If the
patient is able, a few minutes' exercise, until gentle perspira-
tion is induced, will, in ordinary cases, be found a more
excellent means of preliminary heating than any form of hot
bath, for the reason that exercise brings into full action the
heat^making processes which the cold bath is designed to
stimulate. If the patient is unaccustomed to cold water, his
feelings should be respected, and the cold applications gradu-
ated in such a way as to avoid so unpleasant a shock as to
distress or discotarage him. If a patient is too feeble to help
himself without more than ordinary assistance* the method of
appiication must be modified to suit bis case; as, for example,
the shallow bath should be used rather than the rubbing wet
sheet. If the patient has little power to react, his reactive
ability must be stimulated by thorough heating before the bath
by means of exercise, perhaps supplemented with a heating
bath of some sort, as a vapor or an electric-light bath.

908

4t>4

RATIONAL HYDROTHERAPY-

909 It is impottant to remember that patients are as likely to
take cold in the treatment-rooms as elsewhere. The patieot
generally attributes his cold to a cold application, because
during such an application he has experienced sensations of
chill or shivering; but in this he is in error It he has taken
cold, it is because of the slow cooling which takes place by
evaporation from an imperfectly dried skin after the bath, or
because of a secondary chill occasioned by improper adminis-
tration of the treatment* He can not take cold from a shorty
vigorous cold application followed by rubbing and a good
reaction. The secondary chill (4^1) must be carefully avoided.
Chill is not infrequently produced by evaporation from the
skin while the patient, who has perhaps had a heating pro-
cedure of some sort, is waiting for the completion of his treat-
ment. The attendant should take care to see that such
dangerous pauses in the treatment do not occur. The cold
treatment must follow instantly upon the completion of the
heating procedure. If from some accident or emergency
a few seconds' delay occurs, the patient must be warmed up
again by the administration of a hot rain or needle douche
(or a minute before the cold douche is given. Chilling of the
feet by walking upon cold floors is doubtless in some cases
the cause of taking cold* This may be obviated by the use
of slippers. The heelless bath slippers, such as are generally
used in the bathing establishments of Italy and Germany
(Fig* 30), are very convenient.

The subject of exercise in connection with baths has been
considered elsewhere (7vi), Suffice it to say here, that, in
general, moderate exercise for 15 to 30 minutes should be
taken both before and after a cold bath by patients able to
exercise, but after a hot bath the patient should rest.

910 The training of patients to endure cold applications is a
matter of the utmost consequence, and it requires considera-
ble intelligence on the part of the attendant as well as the
physician himself to conduct the process skilfully. While as
a rule the temperature should be lowered a little each day,

HVDiUATIC INSTITUTIONS.

405

there will be occasionally a day when the patient's nerve tone
is not quite up to par, when it may be necessary to return
to the higher temperature employed two or three days pre-
viously. The day following, however, with improved nerve
tone, rapid advance may be made toward the goal constantly
aimed at in the average case; namely, the administration
of water at a temperature properly designated as cold or
very cold.

This training is especially necessary in the case of seden- 911
tary persons, such as are represented by the average business
or professional man, teachers, and the wives and daughters
from wealthy homes. Americans are as a class less able to bear
water at a low temperature than are the English, the Germans,
or the French. The reason for this is that Americans gener-
ally maintain their living rooms at a higher temperature in
winter, and load themselves with a mass of unnecessary
clothing at night as well as during waking hours, so that the
skin is generally relaxed, and possessed of little ability to react*
The necessary reactive power may, however, be acquired by
careful training, and the rapidity with which the patient
comes to enjoy the most vigorous cold procedures is frequently
very surprising* The exhikration which comes with the
reaction following the bath is soon recognized as more than
ample compensation fur the slight unpleasantness occasioned
during its application, and indeed it requires only short train-
ing to bring the patient to a point at which the really unpleas-
ant symptoms at first experienced are no longer felt, or are
mitigated to such a degree as to be scarcely noticeable.

It should never be forgotten, however, that very old, very 912
young, and very feeble persons are incapable of enduring the
very cold procedures suitable for ordinary adults, as their heat-
producing powers are much less. Very cold baths must also
be avoided in rheumatism, cardiac weakness, valvular disease
of the heart, organic diseases of the brain and spinal cord,
and degenerations of the kidneys, liver^ heart, lungs, and
other internal organs.

406

RATIONAL HYDROTHERAPY.

913 Very cold or very hot baths should be avoided just before
or just after meals. The shz bath should always be taken
with the stomach empty, and the moist abdominal bandage
should be removed during the meal, except in cases of gastric
irritation in which it may be specially indicated ,

914 From Schiillers experiments* it is evident that the condi-
tioQ of the cerebral vessels should always be taken into con-
sideration in the arrangement of a hydriatric prescription.
Warm baths are contraindicaled in cerebral anemia, for the
reason that they would mechanically cause still further con-
traction of the cerebral vessels; while in pronounced cerebral
congestion the application of very cold baths may be equally
inappropriate in consequence of the intense though tempo-
rary cerebral congestion which they induce.

915 The success of hydriatic procedures depends as much
upon the faithfulness and thoroughness of the attendant as
upon the nature of the procedure itself. Every little detail
must receive conscientious attention. No person can become
qualified to administer hydriatric treatment in a satisfactory
manner unless capable of following a prescription with abso-
lute precision; and no person should be employed to admin-
ister treatment of this sort unless it is known that he
can be fully relied upon to administer it in the manner
indicated,

9 Hi The attendant must never forget that nearly all proce-
dures require a thorough cooling of the head, which demands
bathing of the face and neck with cold water as well as
complete saturation of the hair and wetting of the scalp.
Women generally decline to have the hair wet, protecting it
with a rubber cap so as to avoid the long delay necessar>^ for
drying the hair after the bath. This disadvantage may be
obviated to a considerable degree by a thorough bathing of
the face and neck with water colder than that of the proposed
bath, and the application of a cold compress about the
neck during the treatment
* Arfkiv fUr A7iH, MfJ., 1874,

HYDRIATJC INSTITUTIONS.

407

If the bath is one requiring rubbitig, it must be faithfully 917
dune, but not overdone, and as a rule it must be continuous
from the beginning of the bath to the end of it. Interrup-
tion of the rubbing for half a tninute may be sufficient to
spoil the effect of the procedure altogether. When the pa-
tient is able, he must be constantly encouraged to assist 10
the rubbing, as the physical exercise thus involved is relied
upon as a means of assisting reaction, and is an iniportant
factor in securing the good results expected of the procedure.

In procedures Uke the wet sheet pack and the neutral bath. 918
care should be taken to secure the greatest possible degree of
*|uiet about the patient Bright sunlight should be excluded
by drawing dov^rn the curtains 'a little. Conversation, if al-
lowed at all, should be suppressed. The patient should be
disturbed as Intle as possible, no attention generally being
required further than the changing of the cold compress applied
to the head. If the patient is inclined to sleep during the bathp
he should be allowed to do so. If the purpose of the bath is to
obtain sleep, its duration may be extended beyond the usual
limit, so long as the patient remains quietly sleej)ing, care
being taken that no untoward effects are provoked by the
tccumuiation of heat or other change in the conditions essen-
tial to the proper effects of the bath.

Quiet should always be maintained in the bath-room.
Noisy talking* whistling, singing, and a bustling manner are
entirely out of place there. Patients should not be encour-
aged to converse while taking treatment.

Particular attention must be given to drying and rubbing 919
the patient after the bath. This portion of the procedure is
almost as important as any other, yet it is frequently neglected,
even in the best-equipped and ably managed establishments-
Attendants should see that the bath sheet is thoroughly dry,
but it should not be heated for a tonic application, as
the contact of the heated sheet with the skin is likely to
produce an atonic reaction, thus antagonizing the tonic effects
of the bath.

408

RATIONAL HYDROTHERAPY*

The warm sheet may be apphed after the neutral bath
without harm, and the temperature of the sheet should at
least be such that it will not produce the impression of cold
when brought in contact with the skin. A Turkish sheet is
to be preferred to the ordinary linen or mnslin sheet for dry-
ing after the bath.

Extreme care must be taken to avoid chilling by evapora-
tion after the neutral bath, as by this means the effect of the
bath may be wholly destroyed. To this end the patient must
be closely covered instantly when removed from the bath,
special care being taken to avoid air currents about the neck
and feet. Gentle rubbing over the sheet will facilitate the
absorption of water by the sReet» and the patient may thus
be rapidly dried without producing an undesirable reaction,
either circulatory or thermic.
920 After a cold bath the patient must be thoroughly rubbed
until a good reaction has occurred. Special attention must
be given to the feet and legs^ as these parts, particularly the
feet, are very likely to become cold soon after the bath, through
defective reaction, and may remain in this condition for several
hours unless the patient*s ability to react is good. When
the circulation of the lower extremities is disturbed in this
way^ the cerebral vessels are dilated, and headache is likely
to result. The patient should be first rubbed thoroughly with
a towel or sheet, and afterward vigorously with the bare hand«
the warm fleshy hand of the attendant greatly facilitating
reaction. The patient is by no means dry when the skin ceases
to feel wet. So long as the skin is soft and spongy, it still con-
tains moisture which has been absorbed by the superficial layers
of the epidermis. This absorbed moisture being left to evapo-
rate after the bath, the patient becomes chilly, and contracts
a cold, which he erroneously attributes to the bath, whereas
the difficulty is wholly due to the ignorance or neglect of
the attendant^ or perhaps to the patient*s own failure to
observe the precautions suggested to him by his attendant
or physician.

HYDRIATIC INSTITUTIONS.

409

Rubbing; though thorough, should never be so vigorous as 921
tn produce irritation of the skin or to bruise or exhaust the
patient. Excessive friction depresses the heart.

It is necessary to exercise ^reat care to avoid burning 922
patients when making hot applications. This accident is
liable to occur in the treatment of patients who are in a
state of insensibility from any cause, as from syncope due to
chloroform, the stupor of fever, or sensory paralysis. In
various forms of spinal disease there is a diminished sensibility
and lowered vitality due to the presence of toxins, which
greatly decrease the patient's ability to resist high tempera-
tures, so that severe bums may occur from the application of
a fomentation at a temperature which would produce no un-
pleasant effect when applied to sound tissue. The same is
true of patients under the influence of an anesthetic, and
in some forms of cardiac weakness on account of the slowed
movement of the blood.

EquaJ care must be taken to avoid freezing parts to
which very cold applications are made continuously for a
considerable length of time, especially in the use of the ice
compress, the ice-bag, or the carbonic acid gas compress,
especial care being necessary in the use of the last-named
measure. Parts which may be completely surrounded by the
cold application, as the hand, the foot, the scrotum, the ear.
and parts in which the bones are thinly covered by flesh,
are much more likely to suffer than are other parts of the
body. In some parts, as the face, the cutaneous circulation
is so active that there is very little danger of injury from this
cause. It should be remembered, however, that in patients
who are in a low condition, as in the ataxo-adynamic state of
typhoid fever, the circulation is so sluggish that freezing
occurs much more readily than In normal individuals.

Before putting the patient into a continuous bath, the 92S
skin should be oiled to prevent masceration and resulting
irritation The same precaution must be taken when fomen-
tations are applied daily to a part, as for relief of pain in

4to

RATIONAL HVDROTHERAPV,

sciatica and in chronic joint disease. Oiling of tbe skin is
also essential as a protection against taking cold (or patients
who are under hydriatic treatment, especially during the
cold season of the yean A little refined %*aseline or cacao
butter should be applied daily or every other day^ alter dry-
ing the patient,

934 Great care must be taken to keep the towels, sheets, and
blankets employed about the bath-room in a thoroughly
aseptic condition by frequent laundering. Towels should be
boiled daily. The rashes resulting from the continuous use of
the abdominal girdle on which the empirical hydropaths dote
so much, are in large part due to neglect to properly cleanse
the wet bandage, which, being used day after day, accumulates
fetid matter from the skin, and affords a favorable culture
medium for the various forms of pus-producing microbes which
are always present upon the skin. These rashes are never
desirable, and may generally be prevented entirely by taking
the precaution to apply vaseline to the skin and to boil the
bandage daily. If the bandage is worn both night and day,
it is well to employ a fresh one each night and morning.

925 The hydriatrist should always be sharply on the lookout
for untoward effects from the applications which the patient
is receiving at his hands, and should be ready to apply at
once the necessary remedy, whether in the form of a hydri-
atic antidote or such an adjustment of the prescription as will
obviate these untoward effects, which have been dwelt upon
more fully elsewhere, but may be here again briefly enu-
merated, with a few words of suggestion, as follows : —

936 Less 0f Fksh. — ^If the patient*s weight is normal* as
indicated by the height- weight coefficient (the height-weight
coefficient of the average man is 37; that is, he weighs
37 kilograms (t| o^;.) for each millimeter (one twenty-fifth
of an inch) of height, as the author has elsewhere pointed
out),* a loss of flesh probably indicates o vert real men t 01

* " A New I)yn(ijiiom«ter for Use in Anthropomelry, " read iiefore the Aineric&A
Aisociaddti for Ihe Advance mem of Physical Culture, 1893.

HYORIATIC INSTITUTIONS

4Jt

advance of the disease. There are many cases, however, in
[which metabolism has been so sluggish, allowing an accumu-
lation of imperfectly oxidized waste matters in the body, that
the first effect of active stimulation of the nutritive processes
is disproportionately to increase destructive metabolism.
Under these circumstances there is necessarily a slight de-
crease in the weight. The rubbish must be removed and
I old defective structures broken down before new and more
highly organized tissues can be deposited It is hence appar-
ent that a slight loss of weight need not give rise to any
apprehension: but if this loss is considerable, or continues
for some time, especially if accompanied by a loss of strength
or appetite, it is a matter requiring immediate attention,
and there should be a readjustment of the patient's pre-
scription.

As Bouchard has so clearly pointed out, a great number 927
of chronic invalids are suffering from a slowed or enfeebled
condition of the general nutrition, where there is deficient
metabolism, either constructive or destructive. There are, of
course, morbid conditions in which metabolism is accelerated.
Hydrotherapy affords more effective means than any other
known agent for the control of these tissue changes, as has
been clearly shown in the chapters devoted to the physio-
logical effects of water; but it is of course necessary that they
should be intelligently applied, so that the loss will not be so
rapid as to discourage the patient or reduce his strength
tinduly,

A very common cause of the loss of flesh referred to is the 928

[excessive employment of heating measures. When this is the

lease, these should be at once suspended, and short cold appli-

L cations at 60'' to 65 -\ duration 4 to id seconds, or as cold

as the patient can bear, should be substituted. Long cold

applications should be avoided. In some cases very vigorous

cold procedures can not be tolerated, and only very mild tonic

measures, such as cold friction, should be employed alone or

alternated with neutral baths.

412

RATIONAL HYDROTHERAPY.

929 A gain in flesh is to be effected by means of neutral tenC^
peratures, as by neutral baths, the neutral pack, or the raio
douche, combined with wholesome food and plenty of rest. In
many such cases it is necessary to employ hydriatric measures
in such a way as to produce activity of internal parts, as
m hypopepsia with anorexia and emaciation. The increased
movement of blood and diminished outflow of energy result-
ing from the application of sedative measures, with just suffi-
cient stimulation by cold friction or wet-sheet rubbing to
maintain active nutrition, are effects which may be advan-
tageously employed in cases in which loss of flesh is to be
combated. When pain or irritability exists, higher tempera-
tures are required.

On the other hand, the failure of an overfat patient to
decrease in flesh indicates the need of more vigorous proce-
dures. Obesity may be best combated by the application of
measures which will produce powerful stimulation of the
nerve centers. The wet-sheet pack, vapor bath, or electric-
light bath not too greatly prolonged, followed by the cold
bath, cold shower bath, with affusions to the abdomen, con*
stitute a rational treatment for persons who have been prop-
erty trained to the employment of such powerful measures,

9;10 Li^ss of Appciiic- — The loss of appetite in hydriatric treat-
ment is a matter requiring immediate attention, as the usual
effect of the treatment is to increase the appetite at once.
As a rule, short very cold applications made when the patient
is fasting, powerfully stimulate the appetite. A cold bag
applied over the stomach half an hour before meals is highly
useful for this purpose,

ft!ll L€fss tj^f Strengih, — This, like loss of appetite, is a symp-

tom which is indirectly of great significance, and one which
should receive attention without delay. Tonic hydriatric pro-
cedures energise in a wonderful way both the nerve centers
and the muscular system. Gradual loss of strength indicates
the necessity for more highly tonic applications; or if the
patient is feeble, it may be possible that the applications

MYDRIATIC IKSTITUTIONS.

4T3

are too vigorous, so that the patient*s energies are overtaxed
by the strong reaction induced* The employment of the
author*s universal dynamometer* in connection with hydriatric
treatment famishes a ready means for determining the con-
stitutional effects of the measures employed. A study of the
coefficients which may be obtained by the use of this instru-
ment instantly furnishes a clue to the patient's vital condition^
and affords a means by which any change, whether favorable
or unfavorable, may be at once observed. The height-
weight, strength- weight, streng^th -height, and respiratory-
height and -weight coefficients are especially valuable. The
signihcance of these coefficients and their use in hydriatic
prescriptions has been dwelt upon elsewhere (780).

The blood-count and the percentage of hemoglobin may 933
be watched with great profit* A diminution indicates that
excessive demands are being made upon the system in the
stimulation of eliminative and oxidizing processes. The
appearance of an excessive amount of uric acid or urates in
the urine, while generally accompanied by unpleasant symp-
toms, such as headache, malaise, etc., is not necessarily a
discouraging feature, though it is a symptom the significance
of which the patient will often need to have explained. In
cases in which this symptom appears there has been for a
long time an accumulation or storing-up of uric acid in the
tissues. The increased alkalinity of the blood resulting from
tonic and alterative hydriatic procedures renders possible the
solution and elimination of this toxic element, the product of
the deficient oxidation of nitrogenous wastes, which accounts
lor the sedementary deposits referred to. This symptom
should be welcomed as an indication that the treatment em-
ployed is accomplishing the results expected of it; and no
matter how depressed in mind the patient is, he may be
assured that he is making real progress toward recovery.

The appearance of an exccssii?^ amount of tuea or a iraa 033
of albumin or sugar may be an indication that the procedures

• '•Phjfilcai CcKfficiems/' Modern Medicine Pab, Cu,, Bjttde Creek, Mich.

414

RATIONAL HYDROTHERAPY-

035

employed are too mtense. The temperature should be ele-
vated and the pressure reduced, The possibility of the
appearance of these symptoms should lead to a frequent
examination of the urinary secretions. Such an examination
should be made at least once a week. The author has
arranged a scheme for graphically representing the several
features developed by the clinical examination, together with
the different coefficients which represent mathematically a
number of important relations. A glance at the graphic
(page 415) which maybe prepared by the aid of this schedule
shows instantly what is the effect of the treatment upon the
general metaboHsm, and also reveals any untoward effects
upon the kidneys.

An excessively active destructive metabolism may be at
once suspected from the presence of an excess of chlorides^
while an excess of phosphates indicates great excitation of the
nervous system. In such cases the intensity of the treatment
must be diminished, applications at a more neutral tempera-
ture being employed. Excessive nitrogenous waste usually
results from too prolonged hot baths, leading to abnormal
destruction of the proteid tissue elements. Such a waste is
usually attended by a loss of nervous and muscular energy.

Palpitation of the heart indicates either that the applica-
tion has been at too extreme a temperature, — ^too hot or
too cold,^ — or that it has been managed in such a way as
to produce an improper excitation of the heart When this
symptom is troublesome, more moderate temperatures should
be employed, and with less pressure, and in making the appli-
cation care should be taken to avoid the region of the heart
and chest. In some instances, this unpleasant symptom may
be entirely avoided by the application of a cold compress or
an ice-bag over the heart during the procedure. The appli-
cation of the Scotch douche to the legs at the beginning of a
general cold application, by dilating the blood-vessels of the
lower extremities, aids in lessening the tendency to palpita-
tion of the heart, as does also the application of cold water

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41 6

RATIONAL HYDROTHERAPY.

to the head and chest, especially the precordial region, pre-
viously to the general application of the douche,

936 Dyspnm rarely occurs except in persons suffering from
emphysema, or who are subject to attacks of nervous asthma.
The indication is either that the application made is too in-
tense, or that sufficient care has not been taken to avoid the
region of the chest, especially the front part of it. More
moderate applications or the employment of a somewhat pro-
longed (ro to IS sec.) cold douche (65^* to 70^^), with low
pressure, before the general application, will generally sup-
press this symptom ; or it may be relieved by a neutral com-
press to the chest and a Scotch douche to the legs.

937 Malaise, nervousness, and depression are symptoms com-
monly resulting from overtreatment or excessive employment
of heating procedures* The last-mentioned cause is most
frequent. Depression and malaise may generally be quickly
overcome by vigorous general cold applications or the cold
dorsal percussion douche daily. The Scotch douche to the
back or the prolonged neutral affusion to the spine (93'" to
96"^, 10 min,) relieves nervousness and other symptoms
of excitation.

Vtrtigo and /(?j>/jW^ are symptoms likely to occur in con-
nection with hot applicatians when too greatly prolonged, but
are quickly relieved by cold applications, especially cold affu-
sion to the chest and shoulders. Their recurrence indicates
the necessity for a change in the prescription by lowering the
temperature or by increasing the pressure of the bath,
93S Skephssness may result from excessive stimulation by
intense cold procedures or by the excitement arising from
heating processes. When these procedures are necessary in
persons subject to sleeplessness, they should be administered
in the early part of the day instead of the evening, and if
necessary, the neutral bath may be employed at bed-time to
counteract any excitation which may remain from the treat-
ment in the early part of the day. If the difficulty is not
thus controlled, the exciting measures may be suspended for,

miATlC INSTITUTIONS.

4K

a time, such quieting tneans as the tonic pack, ttie neutral
immersion bath, the neutral douche, or cold friction being
employed instead of the douche or the shallow bath.

Pain may be the result of excessive congestion of some 939
part induced by misapplied or mismanaged procedures, or it
may be simply the awakening of some chronic neuralgic affec*
tion. The cold douche often gives rise to sciatic or intercos-
ta] pains in persons who have been subject to those difl^culties.
I^in is ver>' likely to result from cold applications which have
not been followed by complete and thorough reaction.

Headacht is one of the most common results of misman- 940
aged or too intense hydriatic procedures, **The hydropathic
headache ** is a w^ell- known phrase among the frequenters of
Continental hydropathic institutions. Headache is very likely
to result from excessively cold or excessively hot procedures,
and may be due either to congestion from imperfect regula-
tion of the circulation or to excessive excitation of the
cerebrum.

Deficient reaction, as shown by long-continued pallor and 941
coldness of the skin, with chilliness, cold extremities, and gen-
erally headache, indicates that the duration of the application
has been excessive, or that the patient was not properly pre-
pared for the application. The last-named cause is perhaps
the most frequent. The patient who is chilly or exhausted
when the cold application is made, is likely to suffer in this
way. Deficient reaction not infrequently occurs as the result
of neglect to employ, after the bath, the proper measures
to encourage reaction, the most important of which are rub-
bing and exercise. Exercise is by far the best means of
encouraging reaction, as it sets tn operation roost fully the
forces necessary for perfectly balancing the circulation, increas-
ing heat production, and energi2ing all the vital functions.

Very short and very cold applications are most likely to
be followed by complete and thorough reaction. Reaction
is quite certain to fail, especially in feeble patients, when
a succession of cold applications is made with an interval

4tB

RATIONAL HYDROTHERAPV.

between, as, for examplei a rubbing wet sheet followed by a
prolonged cold sitz bath, or the sitz bath followed by a cold
douche. A patient not possessed of very vigorous reactive
powers would be almost certain to suffer the evil results of
defective reaction following secondary chill, it subjected to
such a formula as the above. The author has known many
similar and worse combinations to be employed, and yet
wonderment was expressed that the results were not such as
had been expected.

043 When the patient fails to react during or after a cold
application, as the wet-sheet pack, the shallow bath, the wet-
sheet rubbing, or the cold douche, a hot application should
be made at once, the temperature of which should be about
lOO"^ F, at the beginning, being rapidly raised until a tem-
perature as high as the patient can endure is reached — io8*^
to I lo . When the patient has become so thoroughly heated
that he longs for some cooling drops to fall upon him (i
to 3 min.), the cold application should be renewed; but
unless he has been accustomed to the use of cold applica-
tions, the temperature should not be lower than 65"^ to 75^,
and the duration should he brief. If a douche apparatus is
not convenient, the patient may be put into a hot immersion
bath at 100°, the temperature being afterward raised to 106^
or 108^^ until he is thoroughly warmed, as indicated by flush-
ing of the face and a full pulse. The cold affusion (70^ to
80'^') may then be employed while the patient sits or stands
in a partially filled tub. The patient should not be allowed
to leave the hands of the attendant until good reaction has
been produced and the circulation has become well balanced,
as shown by a full, steady pulse,

943 Excessiz'e reaciitfu, as shown by overexcitation of the
heart, perspiration, and prolonged sensation of heat, fulness
of the head, perhaps headache, indicates a too intense or too
short application. In the employment of the Scotch douche
the symptoms named are verj^ likely to occur when the cold
application is not employed for a sufficient length of time to

HVORIATIC INSTITUTIONS.

4i9

allay the exciting effects of the heat, and develop the tonic-
sedative iuHuence of coUL Excessive reaction calls (or a
xeappUcation of cold at moderate temperature (65^ to 80^),
[with little pressure.

Eruptions of ihe skin indicate excessive cutaneous excita- 944
' tion, and interdict the use of the sweating pack and sinular
procedures. In some instances the vapor bath or the electric-
light bath must be substituted for more exciting sweating
procedures, ur the prolonged neutral bath, followed by cold
affusion, must be employed instead of more highly tonic
applications, until the irritated condition of the skin is
relieved. Cold friction, the rubbing wet sheet, the hot im-
mersion bath, and similar processes must of course be avoided
in cases of this kind.

Winternitz has made the interesting discovery that hydro- 915
therapy may be employed as a sort of diagnostic •* reagent *'
to determine, in doubtful cases, whether or not syphiUtic
infection exists. In persons in whom this dyscrasia is pres-
ent, the characteristic eruptions occur under hydriatic treat-
ment, especially from the stimulating effect of the sweating
pack and other sweating processes and cold shower baths.

The occurrence of spasm of the voimitary or iuvaluuiary 946
muscles is a symptom that may require special attention.
Cramps in the muscles of the legs sometimes occur in the
prolonged cold. bath administered for antifebrile effects in
continued fevers. This may be obviated by rubbing the parts
with cold water before the bath or by wrapping the legs with
flannels wrung out of very cold water just before the patient
enters the bath. Special attention should be given to rub-
bing the legs in the Brand bath and the shallow bath to pre-
vent the occurrence of this unpleasant symptom in persons
especially subject to muscular cramps, in whom this symptom
is very likely to occur whenever cold water is entered, or even
water at a temperature of 70- to 75'-', thus rendering swim-
ming dangerous. In such cases the limbs must be rubbed vigor-
ously and continuously during cold baths of any sort, special

420

RATIONAL HYDROTHERAPY.

attention being given to the muscles in which the cramp is
most likely to occur.

947 Another symptom of excitation, which not infrequently
occurs when very cold baths are employed, is increase of
seminal losses in cases of spermatorrhea due to irritation of
the spinal genito-urinary center. In these cases cold appli*
cations, if employed at all, should be exceedingly brief^^^ not
more than one-half minute in duration, — and not infrequently
cold applications must be entirely suspended, the neutral
sitz bath for half an hour to two hours bein^ substituted.

94* At the beginning of treatment, patients sometimes com-
plain of a slight or even decided exacerhaiion of morbid
symptoms as the result of the procedures to which they are
subjected. This may indicate either that the treatment is not
yet accurately adjusted to the patient's conditions, or that the
curative processes employed are so powerfully alterative or
perturbing in their effects that there is an intensification of
the effort to restore the patient to a normal condition, the
symptoms from which the patient suffers being simply an
indication that such a remedial process is in operation. In
the latter case an increase of these symptoms need not be
considered in any sense discouraging, the patient being, on
the contrary, thus assured that the measures employed are
aiding nature in her curative work

949 Measures which are radically curative in character by no
means always produce an amelioration of symptoms as soon
as they are applied. Time must be allowed for the healing
processes of nature to proceed to completion. Recover)^
from disease is a thing which requires time, like the growth of
a plant. Good judgment and good sense are necessary fer
interpreting the meaning of an exacerbation of the symptomr^
in a case under hydriatic treatment, whether they are whal
might be termed accidental, or merely functional symptoms,
as, for example, pain, loss of appetite or of energy, or
whether they are of a destructive character, as manifested by
ulceration, suppuration, sloughing, etc. In any case they

HYDRIATIC INSTITUTIONS.

421

can not be regarded as in any way favorable, and demand an
immediate change of the prescription or the application of
measures for their suppression.

On the other hand, the recurrence of biliary obstruiction 950
in the attempt to discharge a collection of gall-stones or a
similar recurrence of rerial colic may indicate an advance in
the curative process. The same may be said with reference
to various remedial processes in which there is an evident
effort to eliminate some foreign substance or to purify the
tissues, as an increased frequency of the recurrence of attacks
of headachCp an effect sometimes observed in cases of chronic
migraine soon after the beginning of a course of hydriatic
treatment.

The hydriatrist, of all physicians, must be thoroughly
acquainted %vith the language of disease^ with all its patho-
logical processes, and must especially be familiar with the
conditions of health as expressed in human physiology. No
hydric application for therapeutic purposes is safe or likely to
prove successful unless made with the full knowledge of the
patient*s condition at the moment, and in harmony with the
physiological and therapeutic principles involved in the par-
ticular case in hand* Routine treatment is always bad
enough, but in hydriatic practice it is absolutely dangerous
and destructive alike to the reputation of the physician and
to the comfort and possibly even the life of the patient.

The application of cold water without friction is one of 951
the best known means of testing a patient's vital state. If
reaction is slow, his vitality is at a low ebb. If a mottled,
cyanotic appearance remains for some time after the cold
application, the indication is proof of cardiac weakness, with
posi^ibility of impending collapse. This test should be fre-
quently applied in cases of typhoid fever or other grave febrile
disorders, and maybe used with much advantage as a test for
determining the advisability of administering an anesthetic in
a case in which there may be some question of the ability of
the patient to receive it with safety.

422 RATIONAL HYDROTHERAPY.

952 It will be helpful to the beginner in the use of

e verage hydriatic measures to find brought together in
of Baths. small space a statement of the average tem-

peratures required for efficient results with the
leading forms of baths. These may be briefly stated as fol-
lows, the extremes being indicated in ordinary type, the
average in bold : —

Douche : cold, 50^ to 70^, 60^; hot, 104^ to 125^
115°; neutral, 92"^ to 97°, 95°.

Affusion : cold, 55° to 65°, 60° ; cool, 70° to 80°, 75°;
hot, 104° to 122°. 113°.

Plunge : cold, 50° to 70°, 60°.

Immersion : cold, 50° to 70°, 60° ; cool, 70° to 80°,
75°; hot. 100° to 106°, 102°; very hot, 104° to 115°,
108°; neutral. 92° to 97"". 95°.

Brayid bath : 70° F.

Shallow : cold, 55° to 65°, 60°; cool, 70° to 80°, 75°.

Cold wet-sheet pack : 60° F.

Hot-blanket pack : 130° F.

Sponge bath: 60° to 75°, 70°.

Wet-hand rubbing : 45° to 75°, 60°.

Cold friction : 32° to 70^^, 50°.

Cold towel rubbing : 40° to 75°. 60°.

Wet-sheet rubbing : 60°.

Hot-air bath : 110° to 180°, 160°.

Local hot-air bath : 200° to 300°, 250°.

Turkish bath : 140° to 250°. 180°.

Russian bath : 110° to 140°, 125°.

Vapor bath : 110° to 140^, 130°.

Foot bath: cold. 45^^ to 65°, 55°; hot, 105° to 120°,
115°

Sitz bath : cold, 55° to 65°, 60° ; hot, 106° to 120°,
115° ; neutral, 92° to 97^, 95°.

Fomentation : 120° to 160°, 140°.

Vnti Tlytm.

THE TECHNIQUE OF HYDROTHERAPY.

THE modes in which water may be applied ta the human
body therapeutically are almost infinite in form and
variety. It is not proposed in this section to under-
take to exhaust the subject, but only to describe those pro*
cedures which are capable of being employed in an exact and
scientific manner, and have been shown by the test of practi-
cal experience to be really essential to enable the hydrothera-
peutist to produce each and all of the various therapeutic
effects which belong to scientific hydrotherapy*

Disregarding temperature, all hydro therapeutic measures
may be divided into two general classes : —

1. ApplicntioHs in tohick iiurmic effects ahne are pro-
(iu€€ii. This class comprises all forms of water baths in
which the application itself is not accompanied by rubbings
or frictions, percussions with the hand, or the mechanical
effects produced by water in motion, the applications being
purely passive in character. Of this class are immersions,
general and partial, when not accompanied by friction ; com-
presses, hot and cold ; packs ; hot air, vapor, and electric-
light baths ; irrigations ; applications of coils or rubber bags
filled with hot or cold water, — in short, all purely passive
applications of heat and cold to the body, either internal or
exteruai

2. Appiicdtions in tvhieh ifnrmic impressions are supp/e-
mented i^y mec/ittnicai effeeis, either {a) by giving more or less
vigorous movement to the mass of water brought in contact
with the skin, or ib) by manual manipulations, such as rub-
bing or friction, and percussion. In this class are included

1000

loor

424 RATIONAL HYDROTHERAPY.

douches of all sorts, also the so-called percutient measures,
wet and dry friction, rubbing sheets, affusions, and immer-
sions accompanied by friction, such as the Brand bath, the
shallow bath, the rubbing sitz.

In most general hydriatic procedures mechanical effects of
some sort are employed to a greater or less extent as a neces-
sary aid to reaction. It is only in comparatively exceptional
cases, in which reaction must be prevented, or is not required,
as in most hot applications, that mechanical effects are abso-
lutely excluded.

In certain cases it is desirable to secure mechanical effects
alone. The thermic effects of water are then suppressed by
the employment of neutral temperatures (92° to 97°), or of
such purely mechanical measures as dry friction and percus-
sion. The last-named procedures belong properly to the
province of massage ; but, as elsewhere remarked, the ef-
fects produced by massage and by thermic applications are
so closely allied, and these procedures so constantly and inti-
mately associated, that it is almost impossible to avoid con-
sidering both under the same head. Indeed, hydrotherapy in
practice is essentially a thermo-mechanico-therapy ; but we
lack a convenient word to express this compound idea, and so
are by the poverty of our nomenclature compelled to describe
and discuss under the general heading •• Hydrotherapy" some
procedures into which water does not enter at all.

In the description of the various hydriatic processes, it is
not possible to follow closely the above classification, although
in the therapeutic application of the resources of hydrother-
apy, it is of the highest importance that it should be held
constantly in mind.

The discussion of the therapeutic application of individual
hydriatic processes is rendered not a little difficult by the
fact that almost every one of the procedures described in this
work, numbering more than two hundred, is possessed of such
versatility and capacity for modification that it constitutes in
itself almost a complete hydriatic armamentarium. In gen-

THE TECHNIQUE OF HYDROTHERAPY*

42s

■onli It may be said that the therapeutic applications which
have heen iDdicatcd for individaal procedures are those to
which the measore in question most conveniently or aptly
lends itself, and tliose the value of which has been proved
by clinical experience. It is true that a physician possessed
of a sufficient amount of knowledge, skill, and experience
will be able to secure nearly all and perhaps the very best
results o( hydrotherapy by the aid of comparatively few and
simple measures. Indeed , there are very few effects which
can not be secured by such extraordinarily simple means as a
sheet p a few towels, a pail, and an ample supply of hot and
cold water, provided the requisite eKperience and skill are
added. But the ability to accomplish large and efficient
results with such small means can be attained only by long
practice and training, while they may be much more readily
reached by the employment of means more exactly adapted
to the purpose required. An expert, with a pocket*knife
alone, can accomplish nearly all that is produced with the
varied tools of the wood-carver and the cabinet-maker, but
certainly not with the same facility or rapidity. An expert
may be able to do more even with a single implement than a
bungler with a hundred tools. But the best results of all will
be attained by the expert who has at command a full comple-
ment of instruments of precision adapted to the work in hand.

It is also a purpose of this work to present in a methodical
form the varied resources of the most versatile and marvel-
ously potent curative agent which a beneficent Creator has
given to man, and not to him only, but to the whole animal
kingdom.

In describing the various hydriatic procedures in the fol-
lowing pages, those which are similar in method of applica-
tion will be grouped together, although their physiological
effects may be quite different, the various therapeutic effects
of water and the methods by which each may be produced
having already been systematically discussed at considerable
length in the preceding section of this work.

426

RATIONAL HYDROTHERAPY.

DOUCHES.

1002 A douche consists of a single or multiple column of water
directed against some portion of the body. In the thera-
peutic euipioymcnt of the douche, three factors are active :
(i) Temptraiure^ (2) Pressure, (3) Mass.

The range of temperatures employed in douches is from
45^ to 125*^ F» The pressure ordinarily employed is from 10
to 60 pounds, represented by a water column of 25 to 150
feet. The mass varies greatly, according to the effect
desired. For the single horizontal jet, a nozzle with an
aperture of one fourth to three eighths of an inch is commonly
employed. In the filiform douche, the column of water is
scarcely larger than a fine hair. Both the pressure and the
mass eSect may be easily regulated by means of the finger
placed in the water column near the mouth of the nozzle,
thus breaking or dispersing the stream. More exact and
certain means of regulating the pressure should be employed,
however^ in regular hydriatic practice.

1003 The douche apparatus should be constructed with pipe
of ample size (at least one and a half inches in diameter), and
should bu directly connected with the sources of both hot and
cold water, the connections being so arranged that the use of
hot and cold water elsewhere in the bath-rooms or in the
establishment shall not cause a variation of the temperature
of the water delivered to the apparatus after it has once been
adjusted for use. This le not always easy to accomplish, but
can always be done if sufficient intelligence and experience
are brought to bear upon the problem.

An accurate pressure gauge and thermometer should be
connected with the apparatus, so that pressure and tempera-
ture may be accurately determined. For facility in the use
of the douche, and for the most efficient work, it is highly
important to have the apparatus so constructed that it may
be quickly adjusted for any form of douche, and for any tern*
perature desired» and in rapid alternation if required.

THE TECHNIQUE OF HV^DRQTBERAPV.

4^?

The author has devised and used for a number of year^
(1899) a very convenient apparatus, the general form of
construction of which may be seen in the accompanying cuts
(Fig^- 3'. 3-)- With this apparatus it is possible to ad-
minister the doache in every required form, at any required
temperature, and to regulate to a nicety both the pressure
and the temperature of the application.

As will be seen by reference to the figure, the apparatus
consists of two ordinary douche apparatuses (A and B) con-
nected by a pipe (X)* Each of these is supplied with a ther-
mometer. A pressure gauge placed between the two valves
indicates the pressure for both. By means of a switch con-
necting the two valves so that they move together, water
from either of these sets of pipes may be directed upon the
patient with the same service hose. By this means the
attendant has complete and instant control of both the tem-
perature and the pressure in the administration of the douche.
The temperature range is from 45^ to 125^. and the pressure
from one-half pound to 45 pounds. In giving the Scotch
douche and the alternate douche, the temperature is carefully
regulated in each of the twin apparatuses to suit the needs of
the case. By adjustment of the proper valves the pressure
may be regulated instantly, and the switch permits the alter-
nations of diBerent temperatures to be made instantaneously.
An extra service hose for each side permits the simultaneous
employment of water at any desired temperature*

With this apparatus for supplying water at any tempera-
ture and pressure desired, there are connected short pieces of
rubber hose with variously shaped nozzles and other appli-
ances for determining the form of the douche, as the jet, fan,
rain, needle, percussion. The rain douche and the multiple
circle or needle douche are each supplied by a pipe from each
one of the twin apparatuses, so that in making successive ap-
plications at different temperatures, as in the use of the Scotch
or alternating douche, there may be no delay on account of
the time required for heating or cooling the service pipe.

KMM

428 RATIONAL HYDROTHERAPY.

A Steam-pipe with service hose and a suitable nozzle
supplies the means for the vapor douche when required.

With an instrument of precision of this sort, water may be
applied to the body with the same accuracy as electricity
is employed by the aid of a galvanometer.

This apparatus has been used by the author and his col-
leagues in the Battle Creek (Mich.) Sanitarium and its
branches in several hundred thousand applications, and has
proved to be eminently satisfactory.

In regulating the temperature of the douche it must be
remembered that considerable cooling takes place in the
column of water while it is passing from the apparatus to the
patient. Descantes* showed that in giving a cold douche at
48^ F. in a room at a temperature of 72^ F. , the temperature
fell 1.8^ in a distance ol 1% meters (ii>^ ft). In giving a
hot douche under the same conditions, the loss of temperature
was 4j4°.
1006 Douches are named according to the form or direction of
the stream, the part to which they are directly applied,
or the organ or set of organs which they are intended to
influence.

Douches are classified according to their form, as the
horizontal jet, vertical jet, fa?i, brokeii jet, vertical rain
or shozver, horizontal rain or spray, jiliform, percussion,
circle, mtdtiple circle or needle bath, Scotch, alternate,
massage douche, irrigation.

Special applications of the douche to particu-
Localized j^^j. parts of the body are described under the

following names : Cephalic, dorsal, lumbar,
thoracic, epigastric, hypogastric, abdominal, plantar, peri-
neal, a7iaL

A number of special applications of the douche

Visceral ^^^ described and designated by the names ol

Douches. , , , . , ,

the organs or mternal parts which they are

specially designed to influence, as follows : Cerebral, cerebro-

♦Descantes, Revue d^ Hydrologie, Paris, 1896, p. 51.

THE TECHNIQUE OF HYDROTHERAPY.

429

Spinal, pulmopmry, cardiac, gastric, cuh'ric, kcpaiit, splenic^
rcnai^ geniio-uriHtiry, ar/ic7i/ar, musmiar.

In some instances the visceral douche is a compound or
complex procedure involving several different successive or
simultaneous applications, as in the case of the renal and
the gastric douche.

The principal appUcations of irrigation are to the nose»
eye, ear. stomach, rectum, colon (coloclyster). bladder, ure-
thra* and vagina,

Physlotog^tcal Effects.— The douche, combining as it does lOOtt
both tlieimal and percussion effects, is essentially an exciting
procedure, and is capable of producing the most powerful
effects which can be elicited by hydrotherapeutic procedures
of any sort.

The precise effects obtained by the application of the
douche depend upon (i) the temperature of the water,
(2) pressure , (3) duration, (4) form of the stream as deter-
mined by the shape of the outlet, {5) whether it is general or
local, and if local (6) the part to which it is applied Accord-
ing to Schiiller's experiments/^ the temperature of the water
employed in the douche, though important, is of less impor-
tance than the mechanical effect. The special adaptation of
the several forms of the douche to individual morbid condi-
tions will be indicated in connection with the description of
the several forms of this procedure.

The douche, like the centripetal stroking of massage, aids 1007
th« movement of blood through the heart, and accelerates the
current of lymph in the lymph channels, in this action co-op-
erating with the peripheral heart and other normal agencies
by which a constant movement of blood through the vessels
is maintained. As Winternitz wrote years ago ( 1 882), * ' The
tns a ifrgo of the blood by the normal rhythmical contractiQn
0/ the vessels sa like peristaltic action, prevents a retrograde
oiovement."' Ludwig has shown that the movement of

•Arth. fUr Xtin. Mtd.^ 1874.

430 RATIONAL HYDROTHERAPY.

lymph is accelerated by the increase of blood pressure in the
capillaries.

The blood pressure of the part upon which the column of
water plays is increased under the influence of the douche,
and Ludwig has shown that increase of pressure in the capil-
laries accelerates the movement of the lymph and increases the
flow of lymph from the blood-vessels out through the lymph
spaces. The douche, like the stroking of massage, acceler-
ates the movement of lymph in the vessels.

The effect of the douche upon cutaneous sensibility differs
chiefly according to its duration. The short douche (either
hot or cold) increases sensibility of all kinds; while if suffi-
ciently prolonged, the douche, either hot or cold, may dimin-
ish all the sensory functions of the skin.

Muscular capacity is increased by the short cold douche,
as shown by the experiments of Vinaj and Maggiori. In
paresis the patient sometimes finds himself perfectly able,
after a short cold douche with strong pressure over the
affected parts, to control voluntary muscles which previously
were almost wholly useless. The hot douche may lessen
muscular capacity to one fifth the normal amount.

The reaction effects produced by the cold douche are not
necessarily more vigorous than those following any other
hydriatic application of the same temperature, but are more
immediate.
1008 The interesting experiments of Couette on the effects of
different forms of the bath upon the body temperature showed
that a short cold douche (5 to 30 sees.) may cause a fall of
temperature amounting to half a degree by the end of 20
minutes, after a brief rise of a few tenths of a degree. A
cold douche of 3 minutes' duration causes an immediate fall
of temperature amounting to nearly i^^ F. within 20 min-
utes after the douche. The temperature still remains below
normal more than an hour after the application of the cold
douche, even when vigorous measures to encourage reheating
are employed.

THE TECHNIQUE OF HYDROTHERAPY,

43i

The warm and the neutral douche have no effect upon

fthe temperature.

The hot douche always elevates the general temperature;

Lthc longer the bath and the higher its temperature, the

[greater the elevation.

The form of the bath seems to have little relation to its

j effect upon the temperature- The controlling factors are the
temperature of the bath» its duration, and the amount of
exercise following it. Pressure apparently has no effect*
Pressure hastens reaction, but has little or no effect upon
metabolic processes. Hence the most important element in
the douche is the temperature. Pressure plays an important
but secondary role.

The general cold douche is one of the most powerful of
all tonics. It creates an appetite for food and a disposition
to, and capacity for, both mental and muscular activity to a
remarkable degree.

The douche encourages both thermic and circulatory

'reaction to a high degree — thermic reaction because of the
rapid cooling of the skin, and circulatory reaction by reason
of the massage effect produced by the intermittent pressure
of the stream of water upon the cutaneous surface.

In the employment of fion-pcrcHtieni hydriatic measures,
lempcrfKurt and duration are the principal factors to be
regulated; but in the employment of the douche, as the
horizontal jet, for example, two other factors of importance
must be taken into consideration; viz,, valumc ^nA pressure.
These factors may be controlled in various ways. Pressure
is regulated primarily by the elevation of the source from
which the water supply comes, or the pressure in the general
system with which the pipes supplying the douche apparatus
are connected. It may likewise be regulated by valves, by
the distance of the patient from the nozzle, and by breaking
and partially dispersing the stream by the finger. The volume

♦Ctmettei " Erude Expetijncntale sur rActfoti Therroique de PEjiu FroMc
en Appiicdtlons Hy^lrotherapeiitiqu^/'

43 2 RATIONAL HYDROTHERAPY.

of the stream in size and form determines to a considerable
degree the effect produced as regards the thermic as well as
the mechanical effects. The greater the volume, the greater
the effect produced, both thermically and mechanically, other
things being equal.

1009 Therapeutic Applications. — The douche is one of the
most universally useful of all hydrotherapeutic measures. In
some Continental hydriatic establishments, especially in
France, the writer found the douche used almost to the
exclusion of every other measure. The cold douche is
perhaps the most powerful of all known tonics. The alter-
nating douche and the Scotch douche are excitant measures
of most extraordinary power. The warm or neutral douche
is decidedly sedative or calmative in its effects. The hot or
very hot douche, with strong pressure, produces exciting effects
similar to those of the cold douche, but being often followed
by atonic reaction, is inferior to the cold for tonic effects.

Used with little pressure, the hot douche is a power-
ful analgesic measure, especially when employed in connection
with cold, as in the Scotch or revulsive douche. The very
hot or revulsive douche is indicated in such painful affections
as sciatica^ painful rheumatic joints, sprains^ neuralgic affec-
tions, visceral disease accompanied by pain, as chronic gas-
tritis, hyperpepsia, gastric ulcer, congestions of the liver zxid
spleen, and in some cases of pelvic congestion, and in so-
called inflammation of the uterus and ovaries.

Contraindications. — The douche is contraindicated in
cases in which it is desirable to suppress reaction as much
as possible, as in acute inflammation, and when acute nervous
irritability or excitability exists. Other contraindications
are referred to elsewhere (803-807, 1023).

THE HORIZONTAL JET.

1010 This is the most useful and generally employed of all
forms of the douche; and in this work, when the word douche
is used without a definite description indicating some particu-

THE TECHNIQUE OF HVDROTHERAPY*

433

lar form of douche, the horizontal jet is the form of procedure
referred to.

The jet douche consists of a single stream, varying ia
diameter from a millimeter or less (the filiform douche) to
an inch or even more. The usual size is about three eighths
to half an inch. The horizontal jet is applied by means of a
nozzle not unlike that of a garden hose, attached to a piece
<if rubber tubing two or three feet in length, so as to permit
free movement (Fig. 33),

Method. — In administering the horizontal jet, water may
be employed at any temperature applicable to therapeutic
purposes. The full force of the stream may be used where
indicated* or the pressure may be broken, either by adjust-
ment of the pressure-regulating valve or by breaking the
force of the stream by placing the end of the linger in the
stream near the mouth of the nozzle so as to scatter the
column of water to the extent desired. The last-named
means of lessening the pressure is always available, and must
be used in all general applications in adapting the force of
the stream to the different regions of the body.

Lemarchand* employed water at a pressure of ten to
fifteen atmospheres, but so great a force is certainly not
required for securing the good effects of the douche, and is
exceedingly liable to abuse. It is a most excellent thing,
however, to have in reserve an ample force for use in any
special case which may demand powerful mechanical effects.

The pressure employed may vary from 5 to 50 pounds.
Still higher pressures may be employed with proper precau-
tions. The degree of pressure should be carefully measured
in each case by the pressure gauge*

To insist, however, that the douche can not be scientific-
ally administered without the pressure gauge is an error; but
if the application of the douche is left to nurses or attend-
ants, the pressure gauge is quite essential. In the author's
opinion, the employment of so vigorous a therapeutic pro-

* Lemjireliiiiid, Annates de in S&fUi/ d^Nydr^Ugie, 18^3.

38

434

RATIONAL HYDROTHERAPY

cedure as the cold douche should always be conducted under
the immediate supervision of an intelligent person who has
been medically trained.

The broken Jet (Fig. 34) is used over the heart and ante-
rior portions of the chest; to the cervical region; and to all
sensitive parts, as over the stomach, liver, bowels, and utems,
in inflammation of these organs; to inflamed or sensitive
points; and over painful nerves. Th^ fuH Jet (Fig* 33), at
appropriate pressure, may be used upon the back, arms, legs,
feet, and over the liver and spleen v^rhen not contraindicated*

The head must be very thoroughly cooled before the
douche, and should be protected by a cold low^el around the
head or neck or both. The jet is usually first applied to
the back for a few seconds, then the legs and arms, then over
the anterior portions of the body and the liver, ending with a
strong dash upon the fec4. The whole body may be gone
over several times in the manner suggested, each particular
region being carefully respected as regards the appropriate
degree of pressure, the patient turning around as directed by
the attendant.

When the cold douche is employed for other than general
tonic effects ; in other words, when this measure is used as a
means of exciting activity in some special organ, the appli-
cation should first be made to the back, arms, and legs, then
over the part in which it is desired to produce the most pro-
nounced effects, as over the stomach in hypopepsia, over
the lumbar region in cases of amenorrhea, etc* At the close
of the application, a few aspersions should be made to the
whole body, and at the last the stream should be directed
upon the feet for 2 to S seconds.

When it is desired to protect a congested organ against
the inrush of blood produced by a general cold application,
the douche should first be applied for 3 to 5 seconds to the
reflex area connected with the part concerned, before the
general application is made. By this means the blood-
vessels of the congested part are strongly contracted before

l^^tG. J 5. Jit AC HA H

DoircHE

XOZJEUC

i tu, j>|. m^L lUK - SJfttktn Htirijtitital Jet ip. 4,14**

I

the general inrush of blood occurs, and thus the part is pro-
tected. This practical fact has led to the appHcation of the
douche over the liver and stomach first after the back, and
before the general application, on account of the almost unt
versa] feebleness of these organs and the need of both pro-
tecting and energising them.

In the general application of the douche, it should be
remembered that the stream should not be allowed to fall
steadily upon one spot, except in case of the loca/i^ed douche,
in which a very pronounced effect is required. By constant
movements of the nozzle* the stream should be directed upon
different portions of the surface in succession, in dashes or
aspersions. In a very short application, two or three asper-
sions will suffice.

When the patient has previously been prepared for the
cold douche by a beating process of some sort, which is gen-
erally the case, great care must be taken that he does not
become chilled by exposure to the cooling effect of evapora-
tion. To avoid this a cold procedure should follow the hot
application instantly ; or if a short interval must intervene, a
few seconds perhaps, the patient must be protected by a
warm woolen blanket. If there is the slightest cooling off
by evaporation, causing cfuUiness, or if an interval of a
minute or two has elapsed by reason of some emergency, the
skin must be thoroughly warmed up again by a hot rain or
needle douche before the cold jet is applied. The condition
of the patient should be such that the cold water will not be
regarded with extreme aversion and dread.

The patient usually stands in taking the douche. If quite

I feeble, he may sit» or better, may be supported.
The duration of the douche is from 3 or 4 seconds (cold)
to as many minutes (hot or neutral). For prolonged appli-
jcations, other means are, with rare exceptions, better suited.
In many cases it is well to combine the different forms of
the douche in an application, beginning perhaps with the
I warm rain douche, applying the cold fan douche over the

43^

RATIONAL HYDROTHERAPY,

liver, abdomen, and chest, and ending with the full jet to
the spine, legs, and feet

The temperature of the ceid douche is from 45^ to 65^ ;
of the €€^^1 douche, from 65^ to 80^ ; of the tepid douche,
from 80^ to 92^ ; of the natirai douche, from 92 "^ to 97^ ;
and of the hot douche, from 104^ to 125^,

The exact temperature as well as the duration must be
indicated in each individual case, unless the application is
to be made by the physician himself, in which case the
immediate effects produced may serve as a useful aid to the
knowledge of the case obtained by previous examination.
The douche must be regarded as a therapeutic agent of too
great power for evil as well as good to permit of careless or
routine employment ; and the German and French physicians
who make use of this potent hydriatic procedure have much
foundation for maintaining that no one but a physician can be
fully competent to apply so powerful a measure.
1011 Physiological Effects,^ This extremely versatile hydriatic
procedure, though constantly used by Priessnitz and the
early empirical hydropaths^ was systematized and developed
by Fleury about the middle of the present century at his
establishment at Belleville, France. Charcot made large use
of the douche in certain forms, especially the dorsal, or
spinal, douche; and to the use of this simple agent he doubt>
less owed, in large measure, the successes which gave him
a world-wide reputation, not only as a pathologist and an
original investigator, but as a medical practitioner. The
cold spinal douche is sometimes known as the Charcot douche,
though not devised by him. In 18S3 and also in 1S89 the
author found the douche in great use in the hospital SalpS-
tri^re, under the supervision of Charcot, and on visiting this
great medical workshop in 1899, he found this and other
hydriatic measures occupying a most prominent place in the
therapeutics of neurasthenia, hysteria, and alt forms of nerv-
ous maladies- The same may be said of the hospital
Charity and other great centers of scientific medicine in Paris.

THE TECHNIQUE OF HYDROTHERAPY,

437

iTie doache is a compound procedure, combining both
thermic and mechanical effects. When used in its most vig-
orous and efficient form, it is capable of producing the must
profound effects, both general and local, which can be
obtained by any hydriatic measure. It may be usefully em-
ployed at all temperatures, and at varying degrees of pres-
sure. It is invaluable both as a general and as a local
procedure.

The effects of cold applied in the form of the douche are
those which have been described in the stiction of this work
devoted to the physiological effects of water at various tem-
peratures, with the addition of such special features as result
from the localisation of the procedure, or such modifications
as may arise from the special forms in which it may be
administered, the combination of thermic and mechanical
effects serving to intensify the influence of both these means
of impressing the nervous system. The thermic effect may
be varied at will by modifying the temperature of the water^
while the mechanical effect may be modified by changes in
the form and size of the column of water used, or the num-
ber of streams employed simultaneously,

Wertheimer* showed that cold applications, as the cold
douche to the cutaneous surface, produce vascular changes in
the kidney and mesenteric vessels. That similar changes
take place in the brain has been demonstrated hy Schiiller
and others.

Carefully conducted experiments made by Storoscheff, of
Moscow, showed conclusively the powerful effects of the cold
douche upon metabolism. The consumption of nitrogen was
found to be considerably increased; the temperature imme-
diately after the application was lowered a few tenths of a
degree and slightly elevated later; respiration during and
after the application was lowered eight breaths per minute;
the pulse was diminished ten to sixteen beats per minute;
the tactile sense was diminished, while the muscular response

•M, WertHdmcr, A^&d/mie di^ Sei^Hces, 1 893, p, 44.

1012

430

RATIONAL HYDROTHERAPY.

1008

lymph is accelerated by the increase of blood pressure in the
capillaries.

The blood pressure of the part upon which the column of
water plays is increased under the influence of the douche,
and Lndvvig has shown that increase of pressure in the capil-
laries accelerates the movement of the lymph and increases the
flow of lymph from the blood-vessels out through the lymph
spaces. The douche, like the stroking of massage, acceler-
ates the movement of lymph in the vessels.

The effect of the douche upon cutaneous sensibility differs
chieJly according to its duration. The short douche (either
hot or cold) increases sensibility of all kinds; while if suffi-
ciently prolonged, the douche^ either hot or cold, may dimin-
ish all the sensory functions of the skin.

Muscular capacity is increased by the short cold douche,
as shown by the experiments of Vinaj and Maggiori. In
paresis the patient sometimes finds himself perfectly able,
after a short cold douche with strong pressure over the
affected parts, to control voluntary muscles which previously
were almost wholly useless. The hot douche may lessen
muscular capacity to one fifth the normal amount.

The reaction effects produced by the cold douche are not
necessarily more vigorous than those following any other
hydriatic application of the same temperature, but are more
immi'diate.

The interesting experiments of Couctte on the effects of
different forms of the bath upon the body temperature showed
that a short cold douche (5 to 30 sees*) may cause a fall of
temperature amounting to half a degree by the end of 20
minutes, after a brief rise of a few tenths of a degree, A
cold douche of 3 minutes' duration causes an immediate fall
of temperature amounting to nearly ij4^ F. within 20 min-
utes after the douche. The temperature still remains below
normal more than an hour after the application of the cold
douche, even when vigorous measures to encourage reheating
are employed.

THE TECHNIQUE OF HVDROTHERAPY.

43!

The warm and the muirai douche have no effect upon
the temperature.

The hot douche always elevates the general temperature;
the longer the bath and the higher its temperature^ the
greater the elevation.

The form of the bath seems to have little relation to its
effect upon the temperature. The controlling factors are the
temperature of the bath, its duration, and the amount of
exercise follounng it. Pressure apparently has no effect.^
Pressure hastens reaction, but has little or no effect upon
metabolic processes. Hence the most important element in
the douche is the temperature. Pressure plays an important
but secondary r61e.

The general cold douche is one of the most powerful of
all tonics. It creates an appetite for food and a disposition
to, and capacity for, both mental and muscular activity to a
remarkable degree.

The douche encourages both thermic and circulatory
reaction to a high degree — thermic reaction because of the
rapid cooling of the skin, and circulatory reaction by reason
of the massage effect produced by the intermittent pressure
of the stream of water upon the cutaneous surface.

In the employment of non-pcrctiiient hydriatic measures,
i em pent i it re and dura Hon are the principal factors to be
regulated; but in the employment of the douche, as th©
horizontal jet, for example, two other factors of importance
must be taken into consideration; vi^., zfoiume ^nd pressure.
These factors may be controlled in various ways. Pressure
is regulated primarily by the elevation of the source from
which the water supply comes, or the pressure in the general
system with which the pipes supplying the douche apparatus
are connected. It may likewise be regulated by valves, by
the distance of the patient from the nozz\e, and by breaking
and partially dispersing the stream by the finger. The volume

*Couette, *' Etude Experiroentak siir 1' Action Thermiquc de PEau Froidc
en AppUcatioiu Hydrotherapeuliqwes/*

440

RATIONAL HVDROTHERAPY,

1016

The douche is unquestionably the most powerful and most
versatile of all hydriatic procedures, and one which may be
most readily and perfectly adapted to all conditions and indi-
cations. The only disadvantage which can be mentioned is
the fact that it can not be administered without apparatus of
sonxe sort. In an emergency, some simple device may be
adopted, such as allowing water to fall from a height. In the
old water-cure at Graefenberg, this was the only form of
douche employed. The stream of the principal douche was
of the size of the arm, and fell from a height of fifteen feet
The temperature of the water employed was often that of ice-
water, or 32^ F, But these crude measures were by no
means capable of accomplishing the results which may be
obtained by the use of the scientific instrument previously
described, and for which the world is chiefly indebted to the
ingenuity and sagacity of that eminent French clinician and
hydrotherapist, Fleury, In the absence of any more con-
venient apparatus, a greenhouse pump may be used, with
good effect.

Ttterapeutic Applications,— The powerful perturbing in-
fluence of the cold douche gives to it the very highest
value as an alterative and restorative procedure. Under
its influence the whole organism is aroused to the highest
degree of activity; the intensity of every function is height-
ened ; the whole body is lifted upon a higher plane of being ;
the vital resistance is increased j digestive activity is aug-
mented, both by increase of motility and by the production
of a greater quantity of hydrochloric acid ; glandular activity
of every sort is quickened ; the processes of assimilation and
disintegration are hastened ; oxidation and elimination are
increased ; all the wheels of life move with a quickened vigor
and regularity. The individual begins to live a more vigorous
and vital life, physically, mentally, and we may even say
morally.

The versatility of the douche permits its adaptation to
every morbid condition. Fleury depended almost wholly

THE TECHNIQUE OF HYDROTHERAPY.

441

Upon this measure in the hydriatic treatment of Invalids of all
classes^ as do the majority of physicians who practice hydri-
atry in France at the present tinie. While not underestimat-
ing the value of the douche, the author does not share in this
extreme partiality to it. Many of the therapeutic purposes
for which it is employed by Duval, Bem*Barde, Bottey. and
many other leading French specialists, may be more conve-
niently obtained by the employment of other simple measures
requiring no apparatus of any kind. It must be said, how-
ever, that the douche is the most powerful and valuable of
all tonic measures. There is no drug^ known to man that is
possessed of such marvelous renovating and permanently
restorative properties.

As a tonic, the cold douche may be advantageously 1017
employed in almost every case of chronic disease. If oot
appropriate at the beginning of a course of treatment, the
constant aim should be to train the patient, by a series of
carefully graduated measures, to a condition which will admit
of the employment of the cold douche* This training may
be accomplished by a variety of means. In general, it will
begin with nonpercutient measures, such as wet*hand rub-
bing, cold friction, the cold -towel rub, the wet-sheet rub, and
the half bath. When the patient*s strength and ability to
develop strong reaction have been increased to a sufficient
degree, the douche may be employed, at first at a moderate
temperature, beginning at 75^, or So'^, or even 90"^ in very
extreme cases, and being gradually lowered from day to day
as the patients strength and resistance increase. The pres-
sure is also gradually increased, beginning with lo or 15
pounds and gradually increasing to 20, 25, or even 40 pounds,
and finally reaching that of the percussion douche*

There is room for discussion as to which ts the better
method of graduating the cold douche,^ whether it is better
to apply it at first with higher temperature, less pressure, and
longer application ; or to employ at once the lowest tempera-
ture Ukely to be used at all, making the application at first

442

RATIONAL HYDROTHERAPY.

1018

very brief, perhaps not more than 2 or 3 seconds, and grad*
ual!y increasing the duration from day to day.

It must be admitted that both methods may be employed,
and perhaps the two arc equally serviceable, provided dis-
crimination is used in their application, and care taken to
apply each plan to the class of cases to which it is especially
adapted. From the observations which the author has made
upon this point, he is^ however, of the opinion that in most
cases it is better that the patient should begin with cool or
cold, but very short, applications, rather than with tepid and
prolonged ones, as the cold application, though shorty is
certain to produce vigorous reaction by the powerful stimula-
tion of the vasomotor centers, while not infrequently a pro-
longed application of higher temperature results in imperfect
reaction and the development of the many disagreeable
symptoms which accompany this condition.

In persons suffering from r/icuma/ism and neuralgia^ how-
ever, it is evident that the very cold douche can not be em-
ployed at the beginning of a course of treatment. This is
likewise true of persons suffering from Brigftfs disease of the
kidneys, gastric ulcer, locmm^ior ataxia^ spinal sclerosis^ and
most organic affections of the brain and spinal cord* In these
rases it is preferable to begin a course of treatment with very
mild non*percutient measures, as the tepid fan douche (90^
to 80^) with little pressure (4 to 8 lbs.).

It is in some cases necessary to employ at the beginning
of treatment a very much lower ppessure (8 to 10 lbs.)
than will be readily tolerated after the patient has had the
benefit of a few weeks' training. Low pressures (i to 4 lbs.)
arc especially indicated in cases in which great hypertstktsia
of the skin exists, and also in relation to special regions which
are the seat of tenderness or pain, as in douches to the joints
in chronic rfteitmaiism^ with much pain or tenderness, to
the chest in inler costal neuralgia, to the abdomen in chronit
hyperesthesia of the solar plexus and the sympathetic gam-
gliUy and to all parts in which much irritability is present.

THE TECHNIQUE OF HYDROTHERAPY,

443

As nonpercotient measures of training^, arranged in the 1019
order in which they may be advantageously introduced into
the prescription for a feeble patient in training for the
douche, the following may be enumerated: Dry rubbings
wet-hand rubbing, cold wet friction, the salt glow, the
towel rub, wet-sheet rubbing, rubbing sitz, the shallow bath.
Each of the above measures is capable of being graduated to
a nicety, and through a wide range of intensity.

In the majority of cases» the cold douche requires a pre- 1020
liminary preparation of the skin by a short application of
heat. When the douche is used for this purpose, a temper-
ature of 104'^ to 120'^ maybe readily employed; 125'-* may
be tolerated for a few seconds, rapidly moving over the sur-
face treated.

It is apparent that the douche may be advantageously
combined with a variety of other hydriatic procedures, espe-
cially such as produce heating effects, as the heating or sweat-
ing pack, the electric-light bath, the vapor, Turkish^ Russian,
and hot-air baths, the immersion bath, the hot immersion
bath, fomentations to the spine and abdomen, the hot enema,
etc. It forms a fitting conclusion for any beating procedure
in which its mechanical effects are not contraindicated*

No other therapeutic agent is of such value as the cold
douche in the treatment of neurasihenia m most of its forms.
In nearly all chronic cases the cold douche sooner or later
becomes the sheet-anchor of treatment- In chlorosis and all
the curable forms of anemia, the cold douche daily wins
successes in scientific hydriatic establishments when iron and
all the other usual remedies have failed.

As a general awakener and regulator of nutntian, the cold
douche has no equal ; and it is also unrivaled as a curative
agent in chr^nie atonic dyspepsia or kypopepsia, and in
most cases of chronic iaxctnia from chronic infections of the
alimentary canal. It may even be employed, after careful
training, and with the exercise of great care, in quite a large
proportion of cases of cardiac insufficiency and renal diseasi,

444

RATIOKAL HYDROTHERAPY.

In chrmiic inebrUty^ and in the treatment of the opium
and other drug^ habits, cold water holds a high place, not
simply as a means of aiding escape from the thraldom. of the
drug, but especially as a means of building up the patient*s
vital resistance, restoring the tone and equilibrium of his
nervous system, and establishing a condition of perfect health
and independence of narcotic or stimulant drugs of any kind,
and so removing the excuse and temptation to relapse.

The cold douche may be used to relieve insomnia due to
cerebral congestion. It acts by producing powerful derivative
effects toward the lower extremities when reaction is estab-
lished, and also through reflex contraction of the cerebral
vessels, from stimuktion of the rich network of vasomotor
nerves distributed in the plantar region of the foot.

1021 In the administration of the cold douche to relieve

cerebral congestion the following method is to be recom-
mended 1 —

A thick, dry woolen sheet is wrapped about the patient,
being drawn tightly about the neck so as to protect the body.
Standing in a foot bath of hot water (104"^ to 1 10'-), he bends
forward while one to two gallons of water at 60^ is poured
upon the vertex of the head and the back of the neck, A towel
wet with water at 50^ is then wrapped about the head, and
the patient stands erect while the cold broken jet or spray
douche is administered to the feet from half a minute to two
minutes. If an apparatus for the administration of the plantar
donche is not at hand, the patient, standing with his face
toward the attendant, turns half around at intervals of 15 to
20 seconds^ and raises first one foot and then the other so as
to receive the force of the stream upon the plantar surface of
each foot for about 10 seconds* The application to the dor-
sum of the feet and to the ankles is then continued as before,
thus repeating for t or 2 minutes.

1088 A short cold douche (ro to 30 sec.) or a very hot
douche (iio'^"l22^) of the same duration maybe advanta-
geously employed in cases of hysterical musihesia. The

THE TECHNJOOE OF HYDROTHERAPY,

445

douche often has the effect to transfer the anesthesia to the
opposite side*

The cold douche is equally useful in kystericai kyperfsthe-
St as, though in such cases the application should be made to
the symmetrical part of the opposite side of the body ; as, for
eatajnple, if the hyperesthesia is in the right leg, the douche
should be applied to the left leg. It is well to apply the hot
douche or fomentation to the affected limb at the same time
that the cold application is being made to the sound part.

The general cold douche administered while an ice-bag is
applied to the throat is a valuable measure in Aj^sfeHca/
apiwnia^ In hysterical paralysis of the lower extremities
the cold douche at 50' may be applied to the dorsal and
lumbar spine with advantage. Strong pressure may be used»
but the stream should be small The parts should be well
rubbed with flannel after the application.

Contraindications,^ Care must be taken to avoid the
employment of the cold douche in all cases in which an
active inflammation exists^ and especially in cases of inflam-
mation of the uicrus, ovaries^ kidneys, sti^mach, liver, blad^
der, or ifmvi is.

In many cases of so-called ekrmfic injlammatian, as intes-
iinai aitarrh, mytiiiis, chrimie gastritis, cystitis, ^nd general
neuritis^ the cold douche tnusi be avoided. The cold douche
IS of high value, however, in cases of passipe eongestion of
the liver, stomachy spleen, and other viseera.

In aeate rheumatism the cold douche is contraindicated,
and may even be dangerous; but in chronic rheumatism^ after
proper training, it may be employed with benefit for consti-
tutional effects. Special care must be taken to avoid the
use of the cold douche in cases of arteriosclerosis, apo-
plexy^*Viilvular disease of the hettri with deficient compensa-
tion, cardiac insufficiency from fatly degeHcration, renal
disease, or from any other cause when marked in degree. In
acute ot chronic nephritis i in painful nervous affections^ as
sciatica, locomotor ataxia, multiple neuritis, in hyperpepsia\

loss

446

RATIONAL HYDROTHERAPY.

and in gastric ulcer; in varicose conditions of the portal or
mesenieric veins, such as sometimes accompany hepatic
sclerosis; and in cases of extreme general nervous irritability^
the cold douche must be avoided. The douche at all tempera*
tares is contraindicated in eruptive disorders of the skin, and
in kyperestkesia and neuralgia of the skin. Heggelin has
pointed out the danger of pulmonary hemorrhage during the
cold douche in persons hable to this accident* on account of
the temporary rise of pressure in the left auricle, and stasis of
blood in the lungs. General cold applications of all sorts
must on this account be avoided in these cases, but such
partial applications as cold friction and the cold-towel rub
may be employed at any desired temperature.

THE HOT DOLJCHE.

1024 The temperature of the water employed may vary from
lOO^ to 130*^. The duration varies from 15 or 30 seconds to 4
or 5 minutes. Very strong pressure is less essential than with
the cold douche, as its effects depend almost wholly upon the
thermic impression. As the hot douche is very largely used
for the relief of pain, little pressure is commonly employed
When water at a very high temperature is used, as 120^ to
125^, care must be taken to keep the nozzle in constant mo-
tion, so that the stream shall not fall constantly upon the
same spot. By this means the accumulation of heat at any
one point is prevented^ and a most powerful sensory impres-
sion is made without injury to the tissues.

In the use of the very hot douche the application should
be begun at a nearly neutral temperature, as 100° to 102^.
the temperature being gradually but rapidly increased, reach*
ing the highest point in from 30 to Oo seconds. Too^much
time must not be tost in the graduation, otherwise the maxi-
mum effect for the time specified will not be obtained. The
patient's sensations are a reliable guide. The temperature
^l:ould be raised as rapidly as possible without producing a

THE TECHNIQUE OF HVDROTHERAFY,

44;

decidedly painful sensation, thus causing excessive nervous
excitation. In order to give the best effects in relieving deep-
seated pain, the temperature must at the end be high enough
to cause a slightly painful sensation.

Physiological Effects,— The general hot douche is a very
exciting procedure. Its physiological effects are very similar to
those of the hot immersion bath» with the addition o( me-
chanical effects. Excitation of the vasomotor centers is pro-
duced by the impact of the water when considerable pressure
is employed. The blood pressure is on this account increased
instead of being lowered, as in the hot immersion bath.
The immediate eflects of a very hot douche are in many
respects similar to those of a cold douche, except that they
are transient, and followed by an atonic reaction. The hot
douche is thus at first excitant » later relaxing, depressant, or
sedative.

The very hot douche is one of the most exciting of all
hydrotherapeutic measures. The nature of the application
permits of the employment of a temperature higher than can
be employed with the immersion or other forms of the bath
in which a thermic impression is made upon the entire surface
at the same instant, so that the nervous impression produced
is greater.

The duration of the hot douche is usually too brief to produce
any very marked effect upon metabolic processes, but it pro-
duces very prompt and decided effects upon the circulatory
and nervous systems. When the temperature is sufficiently
, high to cause slight pairi, a very brief contraction of the small
vessels occurs at the beginning of the application. This effect
is the more pronounced the greater the pressure employed*
This contraction is almost instantly followed by dilatation of
the vessels, causing a very pronounced passive congestion of
the skin, which at once assumes a dusky or cherry-red hue.
If the application is very short, this redness quickly disap-
pears, but if prolonged and at a high temperature, there is
paralysis of the vessels, which persists for a very consider-

1025

448

RATIONAL HYDROTHERAPY.

able length ol time alter the conclusion of the applicalioii.
This is not an active bpt a passive or paralytic dilatation of
the vessels, and is quite different from the active dilatation
produced by a cold douche,

1026 At the beginning of a very hot douche, the heart action is
slowed ; later, it is quickened. This preliminary slowing of
the heart is due to the contraction of the surface vessels, which
is greater in proportion as the pressure of the douche is in-
creased This quickened action results from the powerful
sensory impression made upon the cutaneous nerves, and the
storm of reflex impulses sent in upon the nerve centers in
consequence. The heart shares in the general excitation,
and by its greatly increased activity the blood pressure is
temporarily raised by the rapid filling of the arteries, in spite
of the passive dilatation of the small vessels* There is a
rapid fall of pressure, however, soon after the conclusion of
the application (Exp, 57).

Simultaneously with the passive dilatation of the surface
vessels there is a mechanical contraction of the vessels of the
interior of the body. The withdrawal of one third to one
half of the entire blood of the body into the vessels of the
skin necessarily leaves the vessels of the brain and the viscera
in a depleted condition,

1027 It should be remembered, however, that when very hot
applications are made to the skin, the excitant effects upon
the heart and brain are such as to cause at the first a very
decided cerebral congestion. This was well shown by Max
Schiiller in his experiments upon trephined rabbits in 1874.
In his experiments the very hot immersion bath was em-
ployed. Tlais congestive effect is doubtless due in part to
the preliminary contraction of the cutaneous vessels, but that
it is not wholly due to this cause is evidenced by the fact that
it continues much longer than does the vasoconstriction
referred to, and disappears only when the temperature of the
application has been very considerably lowered. The cere-
bral congestion accompanying a very hot application must

THE TECHNIQUE OF HYDROTHERAPY.

449

be due, then, to the reflex excitation of the brain and heart
and the elevation of blood pressure,

A knowledge of these facts sufficiently emphasizes the
necessity for protecting the head when a very hot douche or
other general application is to be made by a thorough cooling
of the head, face, and neck, and the application of a cold
towel to the head or neck, or both.

The effect of the hot douche upon the central nervous
system is at first excitant, but this state is quickly followed
by a very pronounced sedation and relaxation.

Therapeutic Applications— For simple revulsive efiects
by excitation of the circulation of the skin, the hot douche
from r to 5 minutes at a temperature of lOO° to 125*^ gives
excellent results. Ordinarily, water at a temperature from
104^ to iio"^ should be employed, the duration beiDg 3 to 5
minutes.

The most vigorous efiects of which the hot douche is
capable are produced by raising the temperature until the
limit of endurance is reached. Few persons can bear a tem-
perature much above 120^, but by taking care not to allow
the column of water to fall for more than an instant upon the
same spot, a temperature of 124^ or 125^ may be reached in
most cases, and 130*^^ may sometimes be attained. Applied
in this manner, the hot douche acts vigorously upon both the
blood-vessels and the nerves of the structures subjected to its
action, and produces most powerful revulsive and derivative
effects.

The general hot douche is most frequently used as a prepa-
ration for the cold douche, as in the general Scotch douche
and the alternating douche. It should be employed before
the cold douche whenever the patient feels an instinctive
dread of the contact of cold water, when the skin is cold or
the patient inclined to shiver, and especially when the patient
has had a prolonged cold application, or when a hot applica-
tion has been made and the skin has afterward been cooled
by evaporation, as during an accidental delay.

loss

450

RATIONAL HYDROTHERAPY*

The general hot douche, with very slight pressure, is
exceedingly useful as a means ot relieving general superjieiat
pain, hyperesthesia^ neuralgia^ and paresthesia. It is, in
some cases» valuable in relieving the distressing irritation of
pruriiis, urticaria, d^ntX Jaundice. A very hot general douche
(i lo^ to 122^, rs to 30 sees,, 30 to 40 lbs.) may also be used
with advantage in a relaxed condition of the skin accompanied
by general and copious perspiration occurring without excita-
tion by heat or exercise, as frequently observed in neuras-
thenics.

1029 The hot douche appUed at a very high temperature and of
very short duration, may sometimes be employed with excel-
lent advantage in cases which can not tolerate cold applica-
tions because of unpleasant after effects. For an application
of this sort, a temperature of iio^to 122^ is required, and
the duration should not be more than 5 to 10 seconds (30 to
40 lbs.)* This application is useful in depressed conditions,
snch as occur in advanced cardiac and renal disease. Care
should be taken to avoid the precordial region in cardiac
cases, and the application must not be extended much beyond
the time named*

1030 Lemarchand * maintains that equally as good tonic effects
may be obtained with the very hot douche ( 122^^ F.) as with
the cold douche, and notes that it may be tolerated in a great
number of cases in which cold water can not be employed,
and without the inconvenience of the laborious process of
training the patient to the use of cold water. He finds the
very hot douche always well borne, and declares that it "coo*
cedes nothing to the cold douche*' in its value and efficiency.
For tonic effects tlie highest pressure available should be
employed For the best results, a pressure of 35 to 45 pounds
is required.

The very hot douche is an excellent excitant measure in
CES^ of ^exhaustion from prolonged or violent exertion* For

•^i^niarchind, Ann. S&t. d^ liydr&t. Mfd,, Paris, C^impt. rend. 1893^3,

XXX VI I n 247-375

THE TECHNIQUE OF HVDROTHERAPy.

45'

such a purpose the application must be greatly proIongeJ,
and should be administered with a considerable degree of
pressure (30 to 40 Ibs.» t or 2 sees.).

The general hot douche, as well as the hot-blanket pack,
the hot full batb^ and other general hot applications, is an
imtidoie for an ext-i^ssivi' application of cold which may have
been made through inadvertence or as the result of lack of
acquaintance with the exact physical condition of the patient
or his individual susceptibility. This fact may be borne in
mind with great profit by those who are inexperienced in the
employment of hydriatic procedures.

In connection with the cold douche, the hot douche may
be employed in such a manner as to relieve jmin or conges-
tion^ to excite pHysiohgieal activity, or to control a morbid
process which may be present, according to the methods of
application, which will be explained under the respective
headings, **The Revulsive Douche" (1041) and '*The
Alternating Douche" (lO**)^

THE NEUTRAL DOUCHE.

Temperature, 92 ^ to 97^ ; duration, 2 to 30 minutes ;
pressure, from 2 to 20 pounds, according to the effect de-
sired. The ordinary duration of the general neutral douche is
from 3 to 15 minutes, pressure, s to 20 pounds. Care must
be taken to cover the whole surface as completely as pos-
sible, so as to prevent cooling by evaporation. When used
(or simple quieting or sedative effects, the pressure should
not be more than 5 to 10 pounds ; when employed for deriva*
tive effects, that is, to dilate the surtace vessels, and so
contract the vessels o( the brain by displacement of blood
to the surface, considerable pressure may be employed ; but
the pressure should not be so strong in irritable cases as
to produce an undesirable excitant effect.

For purely sedative effects, the rain or fan douche should
be employed ; for derivative effects, the stronger mechanical
properties of the full jet may be utilized with advantage.

1031

452

RATIONAL HYDROTHERAPY,

1032 Physiological Effects,— The mechanical effect upon the
skin causes widening o( the cutaneous vessels, an effect resem-
bling ordinary circulatory reaction from other hydric applica-
tions, but without thermic effects either tonic or atonic, and
without marked reflex influence, so that the central nervous
system is little influenced. The congested brain is thus
drained of blood, and at the same time not disturbed by a
Sturm of sensory impressions, as in the hot or the cold douche,
The physiological effects of the prolonged neutral douche arc
essentially the same as those of the neutral immersion bath.
This procedure » hke other applications of the same tempera-
ture, decidedly lessens the muscular tone and capacity. It is
on this account well adapted to cases in which there is a
decided tendency to muscular cramp or convulsions.

1033 The effects of the neutral douche differ from those of the
neutral immersion bath chiefly in the fact that the decided
mechanical effect serves to increase the efiftciency of the
application as a means of increasing the volume and move*
ment of blood in the skin, thus relievmg the brain and the
thoracic, abdominal, and pelvic viscera. Another advantage
of the neutral douche over the neutral full bath is the fact
that Its action is considerably more rapid than that of the full
bath, so that the same results may be obtained by a shorter
application. This is a decided advantage in many cases of
insomnia, and especially in the treatment of cases of seminal
weakness and other forms of gen i to- urinary irritation of
spinal origin. This increased rapidity of effect is doubtless
due to its power to decongest the central nervous system.
A neutral douche of 5 minutes* duration is equal in effect
to a full bath of 30 minutes.

The neutral douche offers an advantage over the hot and
the cold douche as a derivative measure in that it is capable
of producing physiological congestion of the skin without
provoking a preliminary congestion of the brain and internal
viscera, and without exciting thermic reaction.

1034 Therapeutic Applications' — The application of the neutral

THE TECHNIQUE OF HYDROTHERAPY.

451

douche (92 to 97^) to the back» along either side of the spinal
column, is one of the most effective means of quieting refle^ic
excitability of the spinal i'rnters. For this purpose, the
application should be somewhat prolonged, usually from 4 to
6 minutes, or even 2 or 3 minutes longer. This effect of the
neutral douche renders it of great service in the treatment of
St. Fitiis^s dance, iaconwtar ataxia, the irritable spine of pteu-
rastkenia, certain genito*urinary disorders due to irritation of
the genito-urinary center, as nacturnat enunsis, seminat
Weakness, vesical irritatiott^ some cases of vaginismtts, and
tratt^mania in both sexes.

The neutral douche is very useful in general nerviius irri^
iabiiity as a means of relieving hypcnsthesia of the skin,
dirmalgia, the itching of pruritis or Jaundice, and general
paresthesias of various sorts. In all cases in which excessive
nervous irritability is present to a marked extent, the applica-
tion should be made with as little pressure as possible.

(See paragraphs 614 and 1130 for further remarks upon
the neutral bath, one of the most useful and interesting of
hydriatic measures,)

THE PERCUSSION DOUCHE,

As the special characteristic of the douche is the percu-
tient effect produced by it, it occurred to the author some years
ago (1883) to undertake to improve this hydriatic measure by
the development of means whereby its one special character-
istic property might be intensified so as to increase the range
of its capabilities, especially in cases in which only a low or
at most a moderately strong pressure can be obtained from
the general water supply. As the result of a dozen years*
CKperimentation, at intervals, an apparatus was perfected
which accomplishes this in an admirable manner. An air
current under pressure is led into a specially constructed
no^^le, near the orifice* This device is shown in the accom-
panying cut (Fig, 3 5 J* The effect of the combination of air

103&

454

RATIONAL HYDROTKERAl'Y.

1036

and water is to break up the single column of water into a
series of short columns, which are projected upon the surface
of the skin with any degree of force desired, each sepa-
rate mass of water receiving from the expanding ma^s of air
behind it an addition to its initial pressure, just as it issues
from the mouth of the nozzle. By regulating the relative
pressures uf the air and the water, any desired form of the
water column may be obtained, from a widely scattered
shower, with large drops, or even the fog douche to a com-
pact stream, which, falling upon the skin, creates the impres-
sion of a fusillade of water bullets, which may be compared
to the stream of lead bullets from a Gatling-gun (Fig* 36)-

The solid stream of the ordinary horizontal jet produces a
more or less constant pressure. If means are adopted to
diminish this sohdarity, as in the so-called broken jet, the
result is greatly to diminish the force with w^hich the water is
projected upon the surface; but in the percussion douche, the
stream is broken, white at the same time its force is aug-
mented to such an extent as to produce, if desired, a decided
stinging sensation as the flying pai tides of water impinge
upon the skin.

The observations which have been made respecting the
modes of application and the physiological effects of the hori-
zontal jet in ordinary form, apply equally to the percussion
douche. The special advantages which it oilers are these:^ —

1. More pow^erful effects can be obtained with the ordinary
form of douche at the pressure available because of the
stronger percutient effects. This remark applies especially
to the circulatory reaction produced. Strong percussion of
the skin alone will produce strong circulatory reaction, as in
slapping the skin wnth the hand. When the percussion
douche is applied with sufficient force, a marked tingling or
smarting sensation is produced, as in dry percussion, and the
skin is very quickly reddened. Thus the blood supply of
the skin is increased, the thermic impression is accordingly

THE TECHNiyUE OF HYDROTHERAPY.

455

intensified as more heat i> abstracted, while the evil effects
M the prolonged retrostasis resulting from *a nonpercutient
general cold appUcation are almost altogether avoided. As
the application progresses from one part of the body to
another, a reddened, congested skin surface Is left behind.

2, The stunning effects of the hydriatic fusilladi^» which,
by means of the percussion douche is made to play upon the
skin, render it possible to employ water at a lower tempera-
ture than can be employed with the ordinary form of the
douche vnth the same water pressure, thus securing better
reaction and more pronoimced tonic effects,

3, The very pronounced percutient action renders it pos-
sible to obtain by this means excellent and decided effects
with water at a higher temperature than is required with the
ordinary jet douche, — a fact of great value in the treatment
of a very large class of neurasthenics, who, not having been
accustomed to cold bathing, are exceedingly rebellious to the
application of very cold water.

4, The force and form of the douche can be instantly
controlled to suit the will of the operator, without modifying
the volume of the water column^ by slight adjustment of the
nozzle itself held in the hand of the operator

Therapeutic Applications. — The percussion douche is use-
ful and is indicated in all cases in which the full jet douche
can be employed. It is the author's practice to employ it
in connection with other forms of the douche in general
applications, administering the percussion douche to the back
and legs.

The percussion douche to the spine at a temperature of
65'^' F. is a most admirable tonic measure for phlegmatic neu-
rasthenics. The percussion douche at 45'^ to 55'^ is one of
the most powerful of all means whereby the central nervous
system may be energiJEed. The tissues of the back are sup-
plied with nerves frotn each of the ganglia of the spinal cord,
so that the entire cord is represented in this small portion
of the body surface. The area of skin covering the hnck

456 RATIONAL HYDROTHERAPY.

being small compared with the entire cutaneous surface,
applications at a much lower temperature and at a much
higher pressure can be made than When the entire skin sur-
face is involved. The general retrostasis which results from
the application of cold to the entire body surface and the
resulting internal congestion are avoided, and reaction is
assisted by the activity of the circulation in the general
cutaneous surface. It is thus possible by means of the cold
percussion douche to the spine not only to influence the
entire spinal cord, but to bring to bear more intense appli-
cations than can be tolerated by the general surface.
This fact gives to the dorsal percussion douche a high value
in the treatment of all forms of disease in which it is impor-
tant to energize the motor or vasomotor centers of the spinal
cord. It is especially useful in neurasthenia and hysteria^
in paralytic forms of writers' cramp, in Raynaud's disease,
in chronic intoxicatioiis, and in hypopepsia, enteroptosis,
and constipation.

The neutral percussion douche is valuable as an applica-
tion to the hips for producing collateral hyperemia to relieve
neuralgia of the pelvic viscera when hot or cold applications
are too exciting.

By the use of water at a neutral temperature (92° to 96^)
powerful circulatory reaction can be produced with no ther-
mic reaction, a point of great value in the treatment of affec-
tions requiring suppression of thermic effects, such as the
lightning pains of locomotor ataxia, spinal neuralgia, and
the hypcrcstJictic states of the sympatJietic ganglia, which
are responsible for a host of obscure reflex pains and par-
esthesias.

The hot percussion douche is less often of service than
the same procedure applied at a temperature of 55^ to 70^;
but it may be very useful in cases in which it is desirable to
produce analgesic and derivative effects with strong circula-
tory reaction, as in applications to the le^^^s in asthma, to the
lumbar spine in lumbago, to the thigh in sciatica, over

THE TECHNigUE OF HYDROTHERAPY. 45/

the liver in the passive hepatic congestion accompanying the
malarial cachexias and so-called bilious dyspepsia, ascites,
rheumatic joints not sensitive to pressure, loss of normal
sensibility in paraplegia, hemiplegia, and spinal sclerosis^
and to relieve the lightning pains of locomotor ataxia.

The hot percussion douche may also serve a most excel-
lent purpose in the treatment of a certain class of neuras-
thenics who have a natural dread of contact with cold water.
It is true that this dread can in most cases be overcome by a
little patient training and systematic lowering of the tem-
perature of the bath from day to day ; but many patients have
neither the patience nor the fortitude to endure this training
process, and are likely to break down in the midst of it, and
suspend their visits before the point has been reached at
which tangible good results may be expected to appear. In
such cases the very hot general percussion douche (iio^ to
125*^) may be employed for tonic effects, and with most satis-
factory results. After a few days or weeks, the graduated
Scotch, and finally the cold douche may be employed.

THE SCOTCH DOUCHE.

The Scotch douche consists in the application of hot 1037
water followed by a short cold application. Any desired
form of douche may be employed. The hot application must
be relatively long (i to 4 min.), and the cold application must
be short (3 to 30 sees.). Employed in this way, the effect of
the cold application is to greatly intensify the derivative or
revulsive effect of the hot water, and to increase its duration.
The application may be general; that is, applied to the whole
surface, or it may localized, according to the effect desired.

The Scotch douche in many cases follows a sweating
application of some sort, especially in dealing with cases of
sciatica, rheumatism, gout, dropsy, and neuralgia, particularly
when accompanied by general toxemia or obesity. The
vapor, Turkish, Russian, or electric-light bath may be used
for the preliminary heating of the skin, or a general hot rain

45 8 RATIONAL HYDROTHERAPY.

douche may be employed. The best of all means is the elec-
tric-light bath so arranged as to permit the employment of
the douche while the patient is exposed to the heat rays
(832). Next to this in efficiency is the Russian bath and
the cold rain douche in combination (831).

In the Scotch douche the stream may assume any form,
as the jet, fan, spray, rain, or percussion douche; usually the
fan or spray douche is employed.

The cold application should follow the hot instantly, with
no interval whatever, as a wet surface is rapidly cooled by
evaporation, so that the heating effect produced by the hot
application may be in large part destroyed in an interval of
exposure lasting only a few seconds.

When employed for general tonic effects, — its most com-
mon application, — the purpose of the Scotch douche is to
serve as a means of training the patient to the application of
the cold douche. The purpose of the hot application is in
many cases to warm the skin so as to prepare it for the suc-
ceeding cold application. It is especially useful in cases of
feeble persons who are not able to take a sufficient amount of
exercise to accumulate the heat necessary to secure prompt
and complete reaction. . The warm or hot rain douche (98^-
to 106"^) is admirably adapted for this purpose. The duration
should be I to 3 minutes, as may be required. The patient's
sensations must generally determine the duration. The tem-
perature and duration should be such that the patient becomes
thoroughly warm, and feels that the contact of the cold water
will be agreeable.

Care should be taken to allow the water to fall upon the
arms and legs, as well as upon the shoulders, so as to thor-
oughly warm the extremities. To avoid overheating the
head, the hair should be thoroughly saturated with cold water,
and the head protected by a thick towel saturated with water
at 60^^. In neurotic patients who have a decided tendency to
cerebral congestion, it is in some cases necessary to place
about the neck a towel wet with cold water (60^).

For the cold application the best efferts are obtained
by the full jet to the arms and legs, the broken or fan jet
over the chest and abdomen, and the percussion douche to
the back. In very sensitive patients, the spray or the fan
douche may be employed instead of the horizontal jet until
the patient has been trained to more vigorous measures.
The temperature of the cold application must be adapted to
the patient's condition. When purely tonic effects are de-
sired, the temperature should be as low as the patient can
endure, — from 6^' to 50^, duration 5 to 20 seconds. In
cases in which very cold applications are contraindicated
(636, 803, lU23h higher temperatures may be employed
(70^ to 85^), and the duration must be extended from 20 to
60 seconds. The higher the temperature, the h>nger should
t>e the duration of the cooling application. It is also impor-
tant, when the temperature is elevated* to increase the pres-
are, ifi order to secure good circulatory reaction.

Although the Scotch douche depends for its
effectiveness upon the transition from heat to
cold, it is not essential that this chajige should
be abrupt; yet the more sudden the change, and the greater
the extremes of temperature employed, the more pronounced
Will be the effecis. In persons who can not endure a sudden
change from heat to cold, the temperature may be gradually
lowered, occupying from half a minute to a minute in the
transition.

In some cases in which there is great susceptibility to
thermic changes, the application should begin at a tempera*
ture near that ol the body (roo ), The heat of the applica-
tion is gradually increased until a temperature of 1 10'-' to 120'^
is reached, held at this point for 2 or 3 minutes, or longer if
necessary, then gradually but rapidly reduced to the minimum
temperature desired.

With very sensitive pitients it is better at first to make
the extremes of temperature not greater than 20-^ to JC^; but
this limit may be gradually extended from day to day until a
difference of 40^ or even 50 is reached

The Crailujiled
Scotch Douche*

46o RATIONAL ^YDROThIrAPY.

The most pronounced effects are produced by managing

in such a manner as to make the applications to the skin at

extremes of temperature as great as possible. The method

of gradual transition is to be employed only in cases in which

this less vigorous measure is positively indicated.

The simultaneous application of hot and cold
The Simulta. , • ^ • j -j j

neous Scotch water possesses, m certain cases, very decided

Douche. advantages, as has been mentioned elsewhere

in the discussion of the hot and cold com-
press (1290, 1356). The principles defined in the para-
graphs referred to apply equally well to the simultaneous
application of the douche. This mode of applying the
douche, which, so far as the writer knows, he was the first
to employ and call attention to, is especially applicable to
cases in which ordinary cold applications are badly borne
or wholly intolerable because of some individual idiosyncrasy.
In certain neurasthenics, the dread and apprehension of
cold water is so great that the patient will not allow an ap-
plication at a sufficiently low temperature to produce any
decided tonic effects, even after a hot application. This
is especially true of neurasthenics in whom paresthesias of
various sorts are particularly common, affecting chiefly the
temperature of the nerves, and manifested by subjective chil-
liness or coldness of the arms and legs, of the skin between
the shoulders, and of other parts. In such cases it is often
possible to administer with benefit a strong percussion dorsal
douche simultaneously with a rain douche at lOO" to 102^.
By a little training the general cold douche may, with
careful management, be administered in these cases. While
receiving the warm rain douche, the patient projects from the
area of the falling streams, different parts of the body in
succession, to receive the cold application, until the whole
body has been gone over. The duration of the application
upon each part should be 2 to 5 seconds, and if desirable,
the intensity of the application may be increased by rapidly
going over the whole surface two or even more times. By

THE TECllNJyUE OF HYDROTHERAPY.

46 J

this method the entire surface of the body, with the excep-
tion of the part to which the cold application is being made,
is under the influence of the wann douche. This renders
impossible general chilliness with retrostasis and the resulting
general vascular and nervous disturbances cunnected there-
with» which follow general cold applications to the surface,
and which in sensitive persons fQllow the application of cold
to a small area even, as the chest, abdomen. back» or a hand
or foot. At the same time the whole surface is acted upon
by the cold douche, and thus each nerve center in the body is
successively excited by reflex influence through the impres-
sions made upon the skin, and so a general tonic and restora-
tive effect may be secured.

This method may be adopted as a means of training sensi-
tive patients to the application of cold water. It resembles
in principle the combined cold shower and Russian bath
;831), and the combined cold douche and electric- light
bath (832).

Special forms of the simultaneous Scotch douche which
may be advantageously employed are the following: —

I . The Dor mi Cold Douche {6^^ to 80^) Combined wiih
the Abdifmimii Hot Douche {106^ to /^j'^).— This measure is
chiefly useful in the treatment of chronic congestive condi-
tions of the stomach, liver, intestines, and spleen, accom-
panied by pain. The duration of the application should be 5
to 20 minutes. The prolonged cold application to the spine
causes contraction of the visceral vessels by reflex stimulation
of the vasomotor centers, while the hot application to the
abdominal wall produces a collateral hyperemia^ whereby the
amount of blood entering the mesenteric vessels and the por-
tal circulation is diminished, thus simultaneously bringing to
bear upon the congested viscera two powerful means of reliev-
ng the morbid condition present. The analgesic effect of the
hot application renders tolerable the cold dorsal douche in
cases in which its use would otherwise be inadmissible. Ap-
plications of this sort should be made with the patient sitting

462

RATIOMAL HYDROTHERAPY,

Upon a stool The pressure should be moderate, 5 to tj
pounds* This application may be usefully employed in cases
of chronic gastric catarrh^ chronic intestinal catarrh, hyper-
esthesia of the lumbar gatigHa of the abdutninal sympa*
thetic, hepatic congestion, splenic congestion, renal congesiii/n,
and enteroptosis, especially if pain is present.

2. The Cold Lumbar and Hot Hypogastric Douche. — The
method of application of this douche is the same as that
described for the preceding, except that it is localized upon
the lumbar and sacral spine and the hypogastrium* This
procedure is especially useful in cases of chrmdc pelvic con-
gest ion, so-called metritis, ovarian congestion^ chronic injlam-
maiion of the inbes, and atonic conditions of the pelvic
viscera accompanied hy passive congestion and pain. It is
contraindicated in cases in which acute inflammation or sup-
purative processes are present.

3* The Combined Spinal Don eke and Hot Doncke to the
Feet. — ^The cold percussion douche is applied to the spine
simultaneously with the hot douche (110' -122-) to the feet
and legs. The fan or spray douche nmy be employed for the
hot douche to the feet* By this procedure, it is possible to
apply a very cold (50^-60'^} percussion douche to the spine,
even continuing it 30 to 60 seconds, in cases of very sensitive
persons who have little power to react and yet who require
the powerful nerve stimulating effect of the cold spinal douche.
This is one of the most effective measures which can be
employed in many cases of neurasthenia, it is especially
applicable to cases in which the general cold douche alone
can not be tolerated. The application should end with two
or three quick applications of cold water over the entire sur-
face uf the body, and the apphcation of the cold spray to the
feet and legs for two or three seconds.

4* 77tc Symmetrical Combined Scotch Donche. — fn certain
hysterical cases, especially in hyperesthesias affecting one side
of the body, a transference of the affection to the opposite
side and a rapid mitigation of the symptoms may be effected

THE TECHNIQUE OF HYDROTHERAPY. 463

by the simultaneous application of the hot douche to the
affected part and of the cold douche to the symmetrical part
of the opposite side of the body. By the daily application
of this measure, the . nutrition of the affected part may be
improved, and with the improvement of the general, health
secured by general tohic measures, the symptom may be
made gradually to disappear.

Physiological Effects. — The physiological effects produced 1088
by the Scotch douche combine those of both the very hot and
the cold douche, though not in their entirety. The hot
application causes passive dilatation of the cutaneous vessels,
with increased heart action and elevation of blood pressure,
with a reflex influence in general tending to atonic reaction.
The cold application slows the heart, augments the blood
pressure, converts the passive dilatation of the surface vessels
into an active dilatation, and by reflex influence produces a
tonic reaction in which every cell and fiber of the whole body
participates, provided the intensity of the cold application is
such that. the tonic effect produced by it more than counter-
balances any atonic effects of the hot application.

It thus appears that very versatile effects may be produced
by the Scotch douche, according as the hot or the cold
impression is dominant. Upon the exact balancing or regula-
tion of the effects of heat and cold this bath depends for
its special physiological and therapeutic properties. If so
managed that the cold application is dominant, the prelimi-
nary heating being just sufficient to warm the skin and pre-
pare it to react to the cold douche, the effects are excitant,
or tonic, and correspond exactly to those of the cold douche.
The brain and viscera are, however, protected to some degree
by the preliminary congestion of the skin, so that the retro-
static congestion of these organs which immediately follows
an ordinary cold application, is less marked and of much shorter
duration, — a fact of great practical importance in dealing
with cases requiring tonic cold applications, while compli-
cated with chronic cerebral, hepatic, articular, and other

464 RATIONAL HYDROTHERAPY.

internal congestions. The physiological effects of cold are
dominant when the concluding cold application is continued
for a sufficient length of time to cause pallor of the skin, chil-
liness, and the thermic reaction of cold. To produce such
effects, the cold application must continue for 30 or 40
seconds, or even longer, unless very cold water is employed.

When the cold application is brief (5 to 10 sees.), produc-
ing neither shivering nor other evidence of refrigeration, no
tonic thermic reaction occurs. The reaction is purely circu-
latory, and hence derivative or sedative rather than tonic
in character. A very brief cold application (i to 3 sees.)
after a hot application of ordinary length may leave the body
under the atonic or depressing influence of the hot applica-
tion. Such an effect as this is rarely desirable, except when
it may be necessary to counteract to a partial extent the
depressing effect of a long hot application employed for anal-
gesic or derivative effects, but in which the excitant effects of
cold are undesirable, as in acute or subacute sciatica, ovarian
neuralgia, enteralgia, or spinal neuralgia.

In many cases it is desirable to balance exactly the hot
and cold effects; the method of accomplishing this will be
explained under the heading, ** Revulsive Douche."
1039 Therapeutic Applications. — The therapeutic uses of the

Scotch douche are even more general than those of the cold
douche. It may be used in all cases to which the cold douche
is applicable, as the hot douche preceding the cold only in-
tensifies the effect of the latter, when rightly managed, and
can be employed in many cases in which the cold douche
could not be utilized, either because the patient will not sub-
mit to the application or because his system is unable to
react to cold without the preparation afforded by the preced-
ing heating procedure.

The merits of the Scotch douche in a variety of morbid
states have been energetically championed in France by
Lemarchand.* The author has found the Scotch douche

* Lemarchand, A fin. cie la Soc. d' Hydro!. Med.^ Paris, 1893.

THE TECHNIQUE OF HYDROTHERAPy.

46s

especially useful in cases in which the skin is very inactive,
or is relaxed, as indicated by profuse and frequent sweatings.
It renders valuable service in the sweating which are charac-
teristic of the climacteric period, and which are frequently
encountered in neurasthenic caises, both men and women.
When employed for this purpose, the hot application should
be at as high a temperature as can be borne (115° to 125^),
duration, i to 2 minutes; and the cold application should be
short (2 to 6 sees.), and of as cold water as is obtainable —
from 55*^ to 65^ if possible. Patients (generally require con-
siderable trainings to enable them to tolerate with benefit the
lowest temperature mentioned.

The Scotch douche is one of the best of all means of
energizing relaxed or paraiystd muscles. Short and very hot
applications are powerfully restorative in cases of muscuiar
fatigue, while cold applications increase muscular irritability
and contractile power. By a combination of these two meas-
ures, we have the most effective means known for the invigor-
aiion of weakened muscular structures.

The Scotch douche is of great value, not only in actual
paresis OT paralysis^ but in the cases of neurasthenics and
dyspeptics who suffer constantly from malaise and a sensation
of muscular fatigue and an actual inability to exercise on
account of the extreme exhaustion following* In such cases
the Scotch douche, consisting of a rain douche at 106^ for i
minute, followed by a general fan or broken jet and full jet
or percussion douche to the spine and legs at 60°, for 20 to
30 seconds, is a most admirable measure, producing, almost
immediately, noticeable good effects.

The localized Scotch douche is of very great service in 1040
cases of lumbago^ crural neuralgia, sciatica, enteralgia, gas-
tralgia, uterine and ovarian neuralgia, pleuritic pains, inter-
costal neuralgia, gastric ulcer, ** spinal irritation," and
ehnmic '' hukaehe/*
30

466 RATIONAL HYDROTHERAPY.

This procedure is often of exceeding value in the treat-
ment of chronic cases requiring general tonic treatment
while suffering from painful local affections of the sort
mentioned, and in connection with the neutral douche in
insomnia and other affections requiring sedative effects. In
cerebral congestio?i, the Scotch douche to the legs is an
invaluable derivative measure, and should precede the general
cold douche in cases of cerebral congestion, hepatic or splenic
congestion, hyperpepsia, and severe visceral congestions of
all sorts. It is also a valuable measure in asthma, especially
the form known as nervous asthma^ in which the Scotch
douche to the legs will often cut short an attack with most
satisfactory promptness.

Bougarel utilized the Scotch revulsive douche to the feet
in nasal catarrh and bronchitis, as well as in asthma.*

Glatz t maintains that there is no better means for com-
bating chronic muscular rheumatism than the Scotch douche,
and that it is invaluable in the treatment of sciatica, — state-
ments which the author has been able to verify in a multitude
of cases.

THE REVULSIVE DOUCHE.

1041 The revulsive douche is simply the Scotch douche em-
ployed in such a manner as entirely to suppress the thermic
reaction which follows the ordinary cold douche. The princi-
ples underlying the application are precisely the same as those
which have been fully explained under the heading **The Re-
vulsive Compress*' (1341). The hot douche is at first admin-
istered at a temperature as high as the patient can bear, the
temperature being gradually increased as tolerance is estab-
lished until it reaches a maximum of 122^ or even 130^, when
the area to which the application is made is small. The dura-
tion of the application should usually be 2 to 4 minutes, or

* Bougarel, Ann. de la Soc. d^ Hydrol Med.^ Paris.

f Glatz, **L'IIydrolherapie Toniqiie et Revulsive," Cong. Period, internal, d.
sc. med. Compt. rend. Geneve, 187S, page 524.

THE TECHNIQUE OF HYDROTHERAPY,

467

until the skin acquires a dusky-red or cherry colon The cold
application is then administered (or 2 to 15 seconds, according
to the temperature of the water employed, and the degree of
irritabihty of the parts. Very irritable conditions require very
brief cold applications. With water at 50 \ 3 or 4 seconds
will Qsually be sufficient; at 60^ to 70'^ » from 5 to 30 seconds
will be required*

As the purpose of the cold application is to remove the
heat which has been absorbed by the akin during the hot
doQche, and thus to convert the paralytic dilatation of the
vessels into an active dilatation by securing the circulatory
reaction of cold without the thermic effect, if the cold appli-
cation is continued too long, thermic reaction will be pro-
duced, and the effect of the application will be spoiled. The
exact length of the cold application may be regulated by
watching the color of the skin.

When the change from passive to active dilatation occurs^
it is indicated by a change in color from dosky-red to scarlet
In most cases no serious harm will result if the cold applica-
tion be carried a little farther than necessary, as the thermic
reaction will be too slight to produce any noticeable eSect ;
but decided chilHng of the surface produces, especially in
those cases in which severe pain is present, a very unpleasant
aggravation of the patient's sufferings. Considerable practice
is required to administer the revulsive douche with skill

For a precise application of this douche it is necessary to
employ a pressure gauge as an indicator of the amount of me-
chanical energy brought to bear in the case. The physician
skilled in hydriatrj'is not, however, necessarily dependent upon
the pressure gauge when the application is administered under
his own eye, which is the almost universal practice in the
scientific hydriatic establishments of Germany and France,

To the well- trained hydriatrist the immediate effect of the
application is the best possible means of regulating the pro-
cedure. As a rule, the pressure ought to be strong enough to
produce prompt reaction. In general, the reaction should

468 RATIONAL HYDROTHERAPY.

begin to appear before the application has ended. The pres-
sure can of course be perfectly regulated when the horizontal
jet is employed, by placing the tip of the iSnger over the end
of the nozzle, thus breaking the force of the stream more
or less.

In the employment of the author's percussion douche the
force of the stream may also be regulated at the nozzle by
the small valve which controls the air current. When em-
ployed for relief of pain, the fan douche should be used.

1042 Physiological Effects. — The revulsive douche is perhaps
the most powerful means of producing vascular revulsion.
The nervous impressions made may be less profound than
those which result from the cold or alternate douche, but the
circulatory effect is intense and lasting. The temporary
congestion produced by the hot douche is rendered much
more permanent or prolonged by the procedure described, as
the circulatory reaction of cold fixes the blood in the skin,
this effect becoming more and more pronounced as the treat-
ment is repeated from day to day. The physiological effects
of the procedure are thus confined almost exclusively to the
circulatory system, and if not wholly mechanical, are certainly
to a large extent due to the storing of blood in the skin and
the drawing of blood from internal parts.

The revulsive douche unquestionably quickens the move-
ment of blood throughout the whole body when employed
either as a general procedure or through associated parts
when the application is confined to reflex cutaneous areas.

The revulsive douche differs radically from the alternate
douche, in that the latter is especially potent as a means of
quickening metabolic and other vital activities; whereas the
revulsive douche, by eliminating thermic reaction, has no
effect upon metabolic processes other than such modifications
as result from circulatory changes.

1043 Therapeutic Applications. — The general effect of the
revulsive douche is precisely the same as that of the Scotch
douche, except that it is less exciting to the general nervous

THE TECHNIQUE OF HYDROTHERAPY. 469

system, and is not to so great an extent productive of meta-
bolic changes, owing to the absence of thermic reaction. The
atonic reaction of heat, as well as the tonic reaction of cold,
are both prevented by the antidotal influence above described.
The effect is practically nothing more than a dilatation of the
surface vessels exercising a derivative effect upon the deeper
structures of the body, but without producing the preliminary
congestion of the internal structures which precedes the reac-
tion when the cold douche alone is employed. This renders
the revulsive Scotch douche an exceedingly valuable measure
for use in cases of cardiac insufficiency y cerebral hyperemia^
chronic gastritis ^ chronic gastro-intestinal catarrh ^ chronic
congestion of the liver and spleen^ acute and subacute ne-
phritiSy hyperemia of the spinal cord, acute congestion and
inflammation of the uterus and its adnexa, and subacute rheu-
matism. By careful observance of the technique described it
is possible to employ the douche with great advantage in the
cases here mentioned, in which the cold douche must neces-
sarily be interdicted, and in many allied conditions.

The revulsive douche is a valuable measure in cases of
both profuse sweating and excessive dryness of the skin. Its
effect is to produce an increase of tone in the tissues of the
skin, and thus to bring about normal cutaneous activity. In
dysmenorrhea with scanty flow it may be applied to the hips,
thighs, and legs. The same measure is useful in congestive
headache and pulmonary congestion, provided care be taken
that the jet does not fall upon any portion of the body above
the umbilicus. The revulsive douche to the legs is also useful
in cases of hyperpepsia, the hot douche being at the same
time applied to the epigastrium and the spine opposite. In
gastric catarrh , gastralgia, or in the acute crises of locomotor
ataxia, it may be employed in the same manner as for
hyperpepsia.

The revulsive douche affords great relief as a local appli-
cation to the painful joints of acute and chronic rheumatism,
also in myalgia, dcrmalgia, intercostal neuralgia, pleuro-

470 RATIONAL HYDROTHERAPY.

dynia, and the lightning pains of locomotor ataxia. In cases
in which the douche (fan) is used for the reUef of pain, the
pressure must be light, not more than 3 to 1 5 pounds.

THE ALTERNATE DOUCHE.

1044 The alternate douche resembles the Scotch douche in
that it employs both hot and cold water; it differs from it
in that the Scotch douche consists of a single application of
water at each temperature, — first hot, then cold, — while in
the alternate douche hot and cold water are repeatedly applied
in alternation. The alternation may be repeated as many
times as is considered desirable in the particular case. The
alternate douche also differs from the Scotch douche in that
the hot application as well as the cold is short. Ordinarily
the applications of heat and of cold are of equal length,
each of about 15 seconds' duration. It is obvious, how-
ever, that there is opportunity for an infinite variety of
modifications in this regard. The longer the hot application
and the shorter the cold application, relatively, the less pro-
nounced and characteristic will be the excitant effects pro-
duced. The temperatures employed must be suited to the
individual case. The greater the extremes of temperature
and the more sudden the transition, the more decided will be
the excitant effects.

1045 Physiological Effects. — The alternate douche is perhaps
the most exciting of all hydric procedures. It combines with
the primary excitant effects of heat the secondary excitant
effects of cold, and through the removal of the heat accumu-
lated by the skin during the hot application by means of the
preceding cold application, the susceptibility of the skin is
renewed, and its reflex activities maintained, and thus the
excitant effect of the hot application is intensified and
extended.

With persons who are very sensitive to thermic applica-
tions, and especially to sudden changes, the alternate douche

THE TECHNIQUE OF HYDROTHERAPY.

471

may be modified in a variety of ways, the most important of
which may be indicated as follows: —

1 . Beginning with a lower temperature for the hot ap-
plication, and a higher temperature for the cold applica*
tion, thus lessening the extremes of temperature employed,
and by progressive graduation, from day to day increasing the
extremes, raising the temperature of the hot application and
lowering the temperature of the cold, the most powerful
effects may after a time be realized.

2. Graduating the procedure during the application, be-
ginning at a temperature near that of the body, raising to
the highest limit, then gradually lowering to the lowest
extreme, repealing this as many times as necessary to produce
the effect desired.

3. Increasing the relative time of the hot application, or
lessening the tinie of the cold application, thus diminishing
the thermic effect.

Therapeutic Applicatians. — The alternate douche is to
be employed in cases in which powerfully excitant effects are
desirable; that is, in cases of old exudations, i-nlargtmcnt 0/
tkc liver, the so-called '' liver of dyspefiiics^''' enlarj^ed spleen,
and siiffcHedJoinis in which active intlaniniatory processes
have ceased. It may also be employed wherever increased
functional activity is desired, as in cases of aiany of (he
ffenii€f-urinary organs^ unaccompanied by irritability, in
paresis or paralysis of a group of muscles, in certain inveter-
ate cases of sciatic neuralgia in which the pain is due to
chronic inffammation of the nerve sheath, and in pleuritic
effusiopis and dropsical accufnulations in other cavities, in the
joints, or in the tissues, as in swellings of the limbs due to
anemia, chronic Bright s disease, erythema nodosum, and the
muscular soreness and rigidity left behind by an attack of
muscular rhcumaiism. The local alternate douche should be
systematically employed two or three times daily as a means

preventing bed-sores in low fevers, to prevent sloughing
"after prolonged exposure to the X-ray, in chilblains, in

1046

472 RATIONAL HYDROTHERAPY.

chronic ulcer of the leg, and in eczema with thickening of the
skin. Indeed, this is a procedure of wide applicability and
utility.

The localized alternating douche is exceedingly valuable
in cases of hypopepsia (the epigastric douche), constipation
(lumbar and abdominal), amenorrhea (lumbar spine, thighs,
and feet), chronic renal insufficiency (the lower third of the
sternum), neurasthenia (dorsal), cold feet and legs. It may
be applied internally to the prostate in chronic enlargement
of this organ, to the rectum in cases in which normal sensi-
bility is lost, and to the stomach by means of the stomach-
tube in cases of dilatation of the stomach with motor insuf-
ficiency.

The general alternate douche is useful for dryness and
inactivity of the skin, a condition commonly present in dia-
betes mellitus and many cases of chronic dyspepsia.

The alternating douche is especially indicated in cases in
which local stimulation is required. The extreme tempera-
tures necessary to secure the best effects render it unsuited to
general application.

THE RAIN DOUCHE OR SHOWER BATH.

1047 In this form of douche (Fig. 37) the water is projected

through a ** rose, "or perforated disc, falling upon the patient
in a number of fine streams. When the disc is placed above
the patient, the procedure is termed the rain or shower
douche ; when held in the hand or fixed beneath a seat, it is
termed a spray. In the rain douche the size of the openings
is usually somewhat larger than in the movable hand spray,
and the disc is also larger and the apertures more numerous.
In administering the rain douche, the same general princi-
ples apply as in the use of the horizontal jet. The procedure
is somewhat more vigorous than the jet, as both the quantity
of water falling upon the patient at each instant and the
amount of surface exposed to contact with the water are

^

THE TBCHNIQUE OF HYDROTHERAPY. 473

greater. The pressure is less, hence the mechanical effect is
less and the reaction more difficult, so that great care must
be observed to prepare the patient for the application by a
preliminary heating, and to take all necessary precautions to
secure reaction afterward.

The shower bath was much used by Priessnitz and in the
numerous water-cures which were established upon essentially
the same plan as that at Graefenberg, in various parts of the
United States and England during the first half of the pres-
ent century. Bell, of Philadelphia, in his admirable work on
" Baths '' (1850) mentioned the shower bath, and it was also
described by Dr. Joel Shew and other early writers on
hydrotherapy in this country.

The author has been familiar with the rain douche or
shower bath for over forty years, having been introduced to
it while a boy in his father's house, where it was a part of the
household furnishing, and its use one of the routine duties of
each member of the family; and during an experience of
more than twenty-five years with this douche in the treat-,
ment of chronic invalids of all classes, he has come to regard
it as an indispensable part of a completely equipped estab-
lishment for the scientific use of water as a curative agent.

The accompanying cut (Fig. 38) represents one of the
large rain douches constructed under the author's direction
for use in the Battle Creek Sanitarium. The apparatus is
also arranged for giving the multiple circle spray, or so-called
needle bath, and the horizontal jet. The apparatus is sup-
plied by two inch pipes, and gives a shower of sixty streams
through as many openings with diameters of one sixteenth
of an inch. The horizontal jet supplies an inch stream
under a pressure of 45 pounds.

On account of the powerful impression made ui)on the
shoulders and the upper part of the trunk, the skin covering
these parts being in intimate reflex relation with the brain
and heart, the disc of the rain douche should be placed not

474 RATIONAL HYDROTHERAPY.

more than two or three feet above the head of the patient.
In general, the perforations should be large enough so that the
water will fall with no great force aside from that given to it
by gravity. As a further precaution, to prevent too great
concentration of the effect upon the organs of the chest, it is
well to begin the application by allowing the water to fall first
upon the feet, first one and then the other being held in proper
position for this purpose for a few seconds each, the water
then being allowed to fall upon the hands, arms, shoulders,
back, and, lastly, upon the chest and abdomen. Or, the
same end may be attained by administering to the feet and
legs a horizontal jet at the same time that the rain douche
falls upon the upper part of the body.

The head should always be covered, in the rain bath, by a
thick towel folded to several thicknesses, or by a rubber cap.
The patient should keep in lively motion during the applica-
tion, flexing the limbs by raising the feet alternately, turning
around first in one direction then in the other, and rubbing
•the chest with the hands. At the beginning of the application
the hands should be applied to the chest to protect it, and
especially the precordial region, from the impact of the water.
This exercise aids reaction, and thus mitigates the effect upon
the heart and lungs.

The combined cold horizontal douche and the vertical rain
douche are certainly the most energetic excitants of all hydro-
therapeutic measures. Cases are not infrequently encountered
in which the effect of this vigorous combination can not be
tolerated, and it is not ordinarily required.
1048 Physiological Effects. — The cold rain douche is one of the
most exciting of all hydriatic procedures. A large amount of
cold water under moderate pressure falls upon the most highly
sensitive and reflexly active portions of the cutaneous surface,
causing a perfect cyclone, so to speak, of nerve impulses to be
sent in upon the cerebrospinal axis; and, naturally, most exten-
sive reflex actions arc set up. At first, the respiratory move-
ments are almost suspended; the breathing is in quick, gasping

THE TECHNIQUE OF HYDROTHERAPY,

475

ts, the heart is powerfully excited, the blood pressure is
raised, and all the phenomeoa resulting from other general
external applications of cold are presented in an intense
degree. General metabolic activity is stimulated ; the brain
and nervous system are intensely aroused, and all the vital
movements are accelerated. According to the observations
of Schiiller, the powerful respiratory movements produced by
the cold rain douche must exercise a salutary effect of the
highest importance in stimulating the lymph currents of the
brain and spinal cord, and in aiding the hepatic and portal
circulations.

The sudden inrush of blood from the surface causes dilata-
tion of the vessels of the brain, but the brain is to some
extent protected by the powerful vasomotor reflexes sent
inward from the face, neck, and upper cervical regions.

In the majority of cases in which the cold rain douche is
employed, a preliminary heating should be applied This
measure is^ on this account, exceedingly convenient, for the
reason that the heating and cooling may be effected by the
same apparatus. When required, the rain douche at roo" to
104^ is applied for 1 to 3 minutes before the cold application.

The €im/ mm douche (/s"^' to 65^) is an excellent tiaining
mea^sure for persons who are so sensitive as to prohibit the
employment of water at a lower temperature, also for grad-
ual cooling after a sweating bath.

The effect of the Aoi rain douche is likewise powerfully
exciting, causing intense cerebral congestion, and first slowing,
then quickening, of the heart, which continues for some time
after the bath. The duration of the hot shower should be
from one-half minute to 2 minutes ; temperature, loo'^' to i r2^\

The neutral rain douche (92'^ to 97 ) causes immediate
contraction of the cerebral vessels (Schuller), and produces a
general calm in the storm of nerve reflexes continually play-
ing between the periphery and the brain and cord. Its
effects are essentially the same as those of the neutral
immersion bath (1I30)» but are much more quickly attained.

1041*

lOaU

4/6

RATIONAL HVDROTHERAPV,

The usual duration of the neutral shower bath is from 3 to S
minutes.

1051 Therapeutic Applications — The rain douche has the dis-
advantage of being far less perfectly controllable than the
horizontal jet or the spray, which may be regulated to a
nicety during administration by one skilled in their use. The
caid shower is practically a fixed procedure, and hence is not
adapted to feeble persons. The ncutrai and graduated rain
douche have a much more general application than the cold
or hot douche in this form. However, the rain douche is an
exce^ingly useful measure at all temperatures.

The cold shower fell into discredit in this country more
than forty years ago, because of its excessive and unwise use
by empirics as a panacea, and by the laity as a daily morning
bath for prophylactic and hygienic purposes. Within the last
twenty years, however, this measure has been steadily return-
ing to favor, and at present every well^fumished private bath-
room is supplied with a fairly good rain douche apparatus.
The accoinpanying cut (Fig. 39) show^ a style of shower bath
such as may be obtained at any large plumbing establishment
of this country or Europe,

1052 The cold shower may be used with advantage as a tonic
measure for anemics who are fairly strong, also in obesity
where the heart is not seriously involved, and with the chlo-
rotic and plethoric. It should be preceded by some appro-
priate heating procedure, as the heating pack, the dry pack,
or a sweating process of short duration*

The short cold rain douche (60'^ to 70^. for 5 to 30 sees.)
is to be employed in cases in which moderate stimulation is
required, with little withdrawal of heat, as in anemia and
chiorosis with emaciation, and in neurasthenia and dyspepsia
when the height- weight coefficient is low. When consider-
able heat elimination is required, the douche is prolonged to
! or 2 minutes. This procedure is especially useful \xv phUg-
malic neurasthenics, sedentary persons in whom the general
metabolic activity is diminished, in obesity, and in all cases

r

THE TECHNIQUE OF HYDROTHERAPY. 477

in which after a long sweating process a gradual and very
thorongh cooling is necessary to prevent continued perspiration.

The cold shower may be combined with the Russian bath
with good effects. By standing in the hot vapor, the patient
tolerates the cold shower much more readily than when
exposed to the chilling effect of evaporation and currents of
cool air. Still better effects may be obtained from the com-
bination of the shower and the electric-light bath, as shown
in Fig. 139 (page 709).

While the cold shower bath perhaps offers some disad-
vantages over the jet or spray douche, the warm or neutral
shower presents distinct advantages. As a hygienic measure,
it offers a most agreeable and rapid method of cleansing the
whole surface of the body, a most important consideration
when large numbers of persons are to be bathed in. a short
time, as in military barracks, charitable institutions, schools,
and public baths. The warm shower bath has long been
extensively used in prisons, reformatories, and other public
institutions as a convenient form of bath for cleanliness.

The author a few years ago (1893) introduced this bath
into a charitable home under his direction located in Chicago,
(the Chicago Medical Mission) especially designed for the
benefit of waifs, tramps, discharged prisoners, and other
classes of homeless men. Of the one hundred thousand and
more men who have made use of the bath in this institution,
a large proportion have testified to the benefit derived from
its use, not only as a means of cleansing the skin, but as a
tonic and invigorating measure. In dealing with this class of
persons, the neutral or warm bath followed by a cold shower
bath has incidentally been found to be a most effective means
of sobering men under the influence of alcoholic liquors.
The cold rain douche of i to 3 minutes' duration is generally
sufficient to restore the mental equilibrium and muscular co-
ordinating power of a man so fully under the influence of
alcohol as to be unable to walk or even stand without support.

478 RATIONAL HYDROTHERAPY.

1063 The neutral rain douche (93° to 96^) is one of the most
effective measures which can be employed for the reUef of
insomnia due to irritability of the cerebrospinal nervous sys-
tem, cerebral congestion, and general nervous excitability.
The application should be made with little force, special
attention being given to the legs and back. The application
of the broken jet, with light aspersions at intervals of a few
seconds to the back of the neck and the occipital region of
the head, during the rain douche, has a remarkably soothing
and soporific effect.

The action of the neutral douche is quicker than that of
the neutral immersion bath, and in some cases its application
may be preferred. A neutral rain douche of 3 to 5 minutes'
duration often produces the same quieting effect obtainable
from a neutral immersion bath of 40 to 60 minutes. The
neutral rain douche may be used in cases in which patients
complain of the necessary length of the full bath. The latter,
however, is preferable for many cases requiring the sedative
effect of a neutral temperature, owing to the recumbent i)osi-
tion, which permits the patient to fall asleep in the bath.
The neutral rain bath may be used to great advantage in
cases of mania with cerebral congestion. Care should be
taken to protect the head by a thick cold compress after a
previous thorough cooling. This method is of course applica-
ble only to cases in which the patient may be readily controlled.

1054 The hot shower serves a useful purpose as a ready and

convenient means of heating the skin in preparation for a cold
jet or spray. The duration may be from one-half minute to
2 minutes when used for this purpose, or long enough to
heat the skin and cause the patient to long for the refreshing;
effect of the cold douche or spray. Care must be taken to
protect the head by a rubber cap or a thick towel well satu-
rated with ice-water, and the hot water must not be allowed
to fall directly upon the head.

THE TECHNIQUE OF HYDROTHERAPY.

479

THB HORIZONTAL RAIN DOUCHE OR SPRAV.

This form of douche (Fig. 40) is identical with the hori- 1055
zontal jet in its mode of application, with the exception that^
instead of a single jet, the water issues from a perforated
head in a considerable number of small streams. The diam*
eter of the head is commonly about three inches^ and the
si^e of the perforations one millimeter (Fig. 41).

Method. — The horijsontal rain douche or spray is ap-
plied in precisely the same manner as the horizontal jet, the
directions and obser\'ations relating to which need not be
repeated here.

PliysiaVogicaB Effects. — ^ The spray douche produces effects 105(1
analogous to those of the horizontal jet, but less intense, for
the reason that the impression made is so generalized, and the
several streams are so small ip size, that the mechanical
effect is very much less than that of the horizontal jet*

The horizontal jet, when broken, may be made to produce
much the same effects as the spray; while the spray, applied
at high pressure, may produce effects essentially the same as
those of the broken horizontal jet or the full jet at lower
pressure.

Therapeutic Applications. — The spray is to be used in 1067
cases in which the mechanical effects of the douche are re-
quired as a means of encouraging circulatory reaction, and yet
the horizontal jet is for some reason regarded as too severe
a measure to be safely employed* ft is indicated in any case
in which the broken jet is applicable. The broken jet is most
conveniently employed in cases in which the full jet may be
received with advantage upon some portions of the body,
while the broken jet alone is admissible upon other parts.
When no portion of the body can safely receive the full
or horizontal jet, the spray douche may be advantageously
employed.

The hot spray is especially indicated in the treatment
of m^uralg^ia with hyperesthesia of the overlying skin, sw&l-

48o RATIONAL HYDROTHERAPY.

leUy painful rheumatic joints , spinal neuralgia^ and spinal
irritation with hyperesthesia: at neutral temperature, with
little pressure, for the relief of the lightning pains of locomo-
tor ataxia; very hot (io6° to 120°) in alternation with very
cold water, for producing powerful revulsive or derivative
effects, as an application to the feet and legs for the relief of
asthma, for the Scotch douche (1037), and in cases in which
the douche is indicated, but the horizontal jet douche is found
too exciting.

The spray has the advantage over the vertical rain douche
in that it is very readily adjustable to all parts of the body. It
does not affect disproportionately the upper part of the body,
and especially the chest, as does the vertical douche. It may
be made a very exciting procedure, although at its maximum
of intensity it is much less exciting than is the full horizontal
jet.

The neutral spray is an excellent measure for insomnia.
For this purpose it should be continued for 4 or 5 minutes
at moderate pressure (10 to 15 lbs.), special attention being
given to the back and legs.

THE ASCENDING DOUCHE.

1068 This ordinarily consists of a jet or spray directed upward
from a nozzle placed near the level of the floor (Fig. 42).
It is chiefly useful for applications to the soles of the feet, the
perineum, and the anal region.

The ascending douche is usually applied at a very low
temperature (60^ to 45*^), with a duration of half a minute to
one minute. It is especially valuable in cases of atony of the
bladder without dilatation, and in cases of weakness of the
genital organs not accompanied by irritation or pain. It is
evident that in cases of chronic dilatation of the bladder the
cold douche will prove of no value, as the muscular walls of
the organ are so relaxed as to be unable to respond to the
stimulus of the douche. The cold ascending douche is also

L

THE TECHNIQUE OF HYDROTHERAPY.

43 1

of great service in cases of kt^morrhoids, cmistifiatian, and
utertHi* and nciai froiapse.

The shori cold ascending douche is very useful in rectal
prolapse and anal insuflicjency, also in Satulence due to con-
stipation.

The we'i^/r^i/ ascending douche is applicable when hyperes-
thesia with excessive irritability of the bladder and genital
organs exists.

The warm ascending douche is very useful as a means of
relieving the pain of anal fissure and irritable rectum.

The hat ascending douche is one of the most efficacious
remedies for the relief of pruritus ani ^nd pruriius tfuiviP,
When employed for this purpose, the temperature should
be as high as can be borne.

The atternaie ascenditifj douche h to be employed in cases
of vesical paresis, ckranic hypertrQphy of \\\^ prostate^ and
exudates resulting from inflammation of the testicles or cord.

The reimisive (1041) ascending douche may be used in
most affections of the gen ito- urinary organs and rectum,
accompanied by pain.

THE CALIPER I>OUCHE.

This apparatus,* which was devised by the author, and is
in daily use at the Battle Creek Sanitarium, consists, as shown
in the accompanying cut (Fig. 43 )» of two semicircular tubu-
lar arms, joined to a support at one end in such a man-
ner that the opposite ends can be separated for the admis-
sion of the patient within the circle. Being portable, the
apparatus may be adjusted to any portion of the body, as the
chest, the neck, the waist, the hips, and one or both legs.

The arms are perforated on the inner side, the openings all
pointing slightly downward and toward the center^ so that
when in use, the water is directed upon a narrow circular area

* Sipc« Ujc above was writlertj the author has learned that a similaT dervicc had
pferiomly been made by a Chicago plumber, but so f ax aa kiitiwn, no practicaJ use
was ever made of it.

1039

482 RATIONAL HYDROTHERAPY.

of the skin. Two forms are in use, one in which the tubes
are perforated with small openings, the other in which a nar-
row slit extends from one end to the other of each circular
tube. The latter form allows the water to issue in a thin,
unbroken sheet, instead of a large number of small streams.

This apparatus is exceedingly convenient for localizing the
douche upon a certain area of the body, in cases in which
prolonged applications of this sort are desirable.

The caliper douche serves the same purpose as the spray
sitz bath so much used in France, when adjusted for applica-
tion just above the hips, with the patient in a sitting position.
The ascending douche may be applied to the anus and the
perineum at the same time, thus influencing at once all the
voluntary and involuntary muscular structures involved in
defecation, and affording one of the most valuable means
of combating constipation.

The caliper douche is especially useful for the application
of the cold douche to relieve constipation, hypopepsia, amen-
orrhea, and flatulence of the stomach and bowels, for which
purposes it is applied to the trunk at the different levels
indicated.

The hot caliper douche is of equal value in cases of hyper-

pepsia, hyperesthesia of the lumbar ganglia of the abdominal

sympathetic, some cases of menorrhagia, chrofiic intestinal

catarrh with diarrhea, chronic gastritis, and infectious

jaundice,

THE CIRCLE DOUCHE.

1060 The device employed in this douche (Fig. 44) consists of
a hollow ring perforated in such a manner that the streams
of water emitted converge on a line passing vertically through
the center of the circle. In use, the ring, connected with the
douche apparatus by a rubber tube, is passed over the head.
By directing movements the water may be made to pass
chiefly over the front and back, or over one shoulder or the
other, passing down over the entire body. The circle douche
may be administered to an arm or leg by passing the limb

THE TECHNIQUE OF HYDROTHERAPY.

483

I

through the center, and moving the ring back and forth.
The circle douche is a very convenient instrument for home
use in a common bath-tub, as the convergence of the streams
renders it possible to employ it %vithoat wetting the walls or
fumitiire of the room. It has the disadvantage, however,
that when utilised for general purposes, it produces too strong
reaction to the headp especially if very strong pressure is
employed.

The circle douche appliance may be used for administer-
ing the circle douche to an arm or a leg, and with excellent
results, when a localized effect in these parts is for any reason
desirable*

TKB FAN DOUCHB.

This consists of a horizontal jet from a nozzle of such 1061
form that the water issues in a broad, thin stream (Fig. 45;.
The friction at the narrow orifice through which the water is
projected greatly diminishes the pressure.

In the absence of a special nozzle the fan douche may be
produced by holding a piece of metal or wood with a smooth
surface against the stream of a jet douche» close to the end of
the nozzle.

PhyslolOiTical Effects-— The weight of the thin blade of imi
water falling upon the skin is very slight, so that the me-
chanical effect of the fan douche is reduced to a minimum.

The physiological effects of the fan douche are essentially
the same as those of other forms of the douche* but less
intense than the full jet, or the rain or spray douche*

Therapeutic Applicattons, — The fan douche is generally 1063
employed in the same class of cases in which the rain dour lie
is indicated It has a wider and more varied application than
almost any other hydriatic procedure.

This form of douche is used in cases in which strong per-
cutient effects are undesirable, as in the application of very
cold water to sensitive surfaces, over painful nerves, hys-
terogenous zones* inflamed structures, and such especially

i

4^4 RATIONAL HYDROTHERAPY.

sensitive portions of the body as the precordial region, the
genitals, and the head and neck.

The cold fan douche may be employed to great advantage
in the following cases: Over the course of the paralyzed nerve
trunk in paralysis; to the dorsal region in neurasthenia
with marked muscular weakness and general feebleness ;
to the dorsal and epigastric regions in hypopepsia; over the
stomach, bowels, and bladder in enteroptosis and atony of the
organs named.

The alternating fan douche is useful in rheumatism with
exudates, but accompanied by little pain.

The revulsive fan douche renders invaluable service in
lumbago, sciatica y painful joint Sy neuritis; to the spine in
spinal irritation; to the feet and legs in asthma; over the
liver in inactivity of this organ; and in chronic icterus.

When pain is not present, the cold douche may be sub-
stituted in applications to the hepatic region.

The hot fan douche is exceedingly valuable in neuralgia
over an affected nerve, and to the dorsal and epigastric
regions in hyperpepsia, and over the affected organ in cases
of visceral pain, whether due to neuralgia, congestion, or
inflammation.

The neutral fan douche renders signal service when
applied to the limbs as a relief for the lightning pains of
locomotor ataxia, and to the spine and back of the neck in
insomnia.

The short cold fan douche to the upper part of the dorsal
region and the neck stimulates the respiration and circulation,
and is often useful in certain cases of asthma.

The fan douche at a temperature of 80^ to 90^ (50 to 60
sees.) is useful in the treatment of irritable neurasthenics
who can not endure the douche in any other form. Em-
ployed in this way, a good circulatory reaction may be pro-
duced without much excitation of the central nervous system,
and a sedative effect may thus be secured without the incon-

THE TECHNIQUE OF HVDROTHERAPY.

485

veniences accompanying the cold douche. The cold jet or
spray, even the percussion douche, may be employed later*
The fan douche has the advantage over other baths
having approximately the same temperature, in that equal
effects are secured by applications of much shorter duration.

THB FILIFORM DOUCHE.

This is a form of horizontal jet in which the water
issues from an exceedingly small opening. it was devised
by de Laur^. In France the filiform jet is produced by a
nozzle terminating in a piece of agate perforated by a capil-
lary opening through which the water is forced with such
great pressure that it becomes a cloud a short distance from
the apparatus. The duration is from i to 10 minutes.

Ptiyslologlcat Effects.— The effects of the filiform douche
are those of strong counter-irritation, suggesting the effect of
mustard, ft is capable of producing most powerful irritation
of the skin, even bleeding through rupture of the small ves-
sels. Exceedingly strong circulatory reaction is produced
with Httle or no thermic activity-
Therapeutic Applications. — Bernard* extols the filiform
douche as a means of producing powerful counter-irritation
for the relief of pain. He describes the effect of this douche
as being very painful for the first two minutes, but after that
period producing very agreeable sensations. This procedure is
usually reserved for rebellious cases, as obstinate sciaticas, and
other forms of neuralgia which do not yield to ordinary meas-
ures. It has been used successfully in kt^nicrania, diphikeriiic
and kysiericai paralysis, chronic rheumatism^ and lumbago.
The first applications must be very brief* Gradually, as toler*
ance is established, they may be extended to 8 or 10 minutes.

1064

*R Beraard, Ann. de t^ Sm/i^d' Hydnti.^ 1894, p. HI*

486 RATIONAL HYDROTHERAPY.

THB FOO DOUCHE.

1065 This douche, known by the French as the douche d'eau
pulverise^ is produced by the same device as that employed
for the percussion douche. A current of air under pressure is
admitted to the nozzle of the douche apparatus at such a
point that the water is made to issue from the orifice of the
nozzle in the form of a fine mist driven with great velocity.
The percussion douche is produced in precisely the same
way, except that a smaller amount of air is admitted. The
refrigerant effect of an application of this sort is very great,
while the percutient or mechanical effect is less than that of
the percussion douche proper (Fig. 46).

Therapeutic Applications. — The fog douche is a most excel-
lent measure to be substituted for the Scotch douche, used in
combination with the vapor douche in cases in which refrig-
eration without mechanical effect is desired, especially in
general hyperesthesia of the skin, spinal irritation^ painful
joints, and sciatica with tenderness of the tissues. The Scotch
douche to the legs, produced by means of the vapor bath
combined with the fog douche, produces most powerful deriva-
tive effects in favor of the brain and other organs of the upper
portion of the body.

THB MASSAGE DOUCHE.

1066 This is a mixed procedure, in which the kneading move-
ments of massage are executed at the same time that a stream
of water is allowed to play upon the surface (Fig. 47). The
kneading movement consists of strong intermittent pressure
with the palms of the hands, as in palmar kneading and
kneading with the thumb and fingers. The movement should
be so applied as to affect the blood-vessels of the muscular
structures as well as those of the subcutaneous tissue.

The parts to which the massage douche is especially appli-
cable are the back, the limbs, and the abdomen. Particular
attention is given to the joints when stiffened by chronic rheu-
matism. Two attendants are required to secure the best

.^y^- . v •^^.-.u'l

"^ A

THE TECHNIQUE OF HYDROTHERAPY. 487

effects, one applying the douche while the other manipulates
the parts.

Physiological Effects — The massage douche, water at a 1067
low temperature being employed, is without doubt the most
powerful of all hydriatic procedures, especially with the use of
the horizontal douche at high pressure, or the percussion
douche.

The massage douche adds to the thermic and mechanical
effects of the ordinary douche the mechanical effects of mas-
sage, thus bringing to bear at the same time and place two
most powerful procedures. The ordinary douche acts directly
upon the skin only, producing effects in the deeper structures
by reflex nervous action and by retrostasis, or mechanical dis-
placement of the blood inward. The douche renders the
skin anemic, while it produces collateral hyperemia of the
muscles. In the reaction which follows, the skin becomes
hyperemic, while the blood supply of the muscles is to an
equal extent diminished. By the combination of massage
with the douche this reaction of the circulation in the muscles
is stimulated, thus at first creating collateral hyperemia and
the stimulation of heat production which results from the
increased supply of blood and heat to the thermogenic tis-
sues located in the muscles.

On the other hand, by hastening the return of blood to
the skin and intensifying the cutaneous hyperemia, the secon-
dary effect of the combination of massage with the douche is
to increase the cooling process, thus offsetting its influence in
stimulating heat production.

The iiitiniatc connection of general metabolism with heat
production renders the massage douche a most powerful
tonic and alterative measure. It is, indeed, but one of the
diversified forms of the ordinary douche the various thera-
peutic effects of which it intensifies; and by acting upon the
deeper structures, it may be said to carry the effect of the
douche inward as far as the internal structures can be influ-
enced by external manipulations.

THE TECHNIQUE OF HYDROTHERAPY.

487

effects, one applying the douche while the other manipulates
the parts.

Physiological Effects. — The massage douche, water at a
low temperature being employed, is without doubt the most
powerful of all hydriatic procedures, especially with the use of
the horizontal douche at high pressure* or the percussion
douche.

The massage douche adds to the thermic and mechanical
effects of the ordinary douche the mechanical effects of mas-
sage, thus bringing to bear at the same time and place two
most powerful procedures* The ordinary douche acts directly
upon the skin only» producing effects in the deeper structures
by reflex nervous action and by retrostasis, or mechanical dis-
placement of the blood inward. The douche renders the
skin anemic, while it produces collateral hyperemia of the
muscles. In the reaction which follows, the skin becomes
hyperemic, while the blood supply of the muscles is to an
equal extent diminished. By the combination of massage
with the douche this reaction of the circulation in the muscles
is stimulated, thus at first creating collateral hyperemia and
the stimulation of heat production which results from the
increased supply of blood and heat to the thermogenic tis-
sues located in the muscles.

On the other hand, by hastening the return of blood to
the skin and intensifying the cutaneous hyperemia, the secon-
dary effect of the combination of massaf;e with the douche is
to increase the cooling process, thus offsetting its influence in
stimulating heat production.

The intimate connection of general metabolism with heat
production renders the massage douche a most powerful
tonic and alterative measure. It is, indeed, but one of the
diversified forms of the ordinary douche the various thera-
peutic effects of which it intensifies; and by acting upon the
deeper structures, it may be said to carry the effect of the
douche inward as far as the internal structures can be influ-
enced by external manipulations*

1067

488 RATIONAL HYDROTHERAPY.

The massage douche may be employed with either very
hot or very cold water, and at all intermediate temperatures.
The most important applications are in connection with the
very cold douche at high pressure, or the percussion douche,
the very hot douche (104^ and upwards) and the neutral
douche (92^ to 98°).

The effects of the hot massage douche are powerfully
revulsive, by adding to the profound circulatory reaction fol-
lowing the ordinary hot douche the active congestion of the
deep muscular and cellular structures. The hot douche con-
gests the skin only ; while the hot massage douche congests
the entire soft parts of the limb to which the application is
made.

The effect of the hot massage douche upon the local tem-
perature is somewhat peculiar. A certain amount of heat is
of course absorbed from the water, and at the same time the
manipulation of the muscles and increased flow of blood
through them stimulates heat production. Both these influ-
ences, however, are antagonized and their effect quickly
annulled by the atonic thermic reaction following the applica-
tion, and the rapid loss of heat from the widely dilated vessels.

Both the hot and the cold massage douche produce a
more intense circulatory reaction in the part to which the
application is made than does the ordinary douche, either
hot or cold. The effect of the cold douche without massage
is to produce anemia of the skin with collateral congestion of
the muscles, but without materially influencing the total
amount of blood supplied to the part; while the hot douche
produces hyperemia of the skin with a corresponding anemia
of the muscles, likewise without great influence upon the
total blood supply. In both cases, however, the combination
of massage with the hydric application, by independently
stimulating the circulation of the blood-vessels of the deeper
structures, has the effect to increase to a marked degree the
total blood supply. It is this fact which gives to the massage
douche its powerful derivative effects. Indeed, it may be
justly said that there is no other known means by which

THE TECHNIQUE OF HYDROTHERAPY. 489

sach powerfol revulsive and fluxion effects may be produced
as by the massage douche.

The massage douche employed at neutral temperatures or
a temperature near the neutral point, produces little or no
thermic effects, but does produce most decided circulatory
reaction, not only upon the surface, but in the deeper struc-
tures as well. Thus its action is almost wholly local. The
douche at a neutral temperature annuls the effect of the
massage as a cutaneous irritant by lessening the sensibility
of the nerves of the skin, thus giving to this form of the
appUcation peculiar properties, and adapting it to meet special
therapeutic indications.

Therapeutic Applications. — The cold massage douche is 1068
the most powerful alterative and tonic of all hydriatic pro-
cedures. It at the same time has the decided advantage of
being ifauch more easily tolerated than the ordinary cold
douche. The shallow bath can be tolerated by persons who
can not endure the cold immersion, for the reason that the
constant friction of the skin maintains the surface circulation,
and prevents chilling of the cutaneous nerves to such a degree
as to produce injurious internal congestion, shivering, and
thermic reaction. The Brand bath is by the same means
rendered tolerable and beneficial in cases in which the im-
mersion bath without friction would produce dangerous and
even fatal effects. During the application of the vigorous
kneading which accompanies the massage douche, the ordi-
nary unpleasant impression produced by a stream of cold
water is lessened to such a degree as to be easily tolerable.
The cold massage douche may thus be employed with persons
who are keenly susceptible to cold impressions, and may
also be of service as a means of training them to the use of
cold water in other ways.

In many cases the tepid douche may be employed with
the best effects, the temperature being lowered from day to
day as tolerance is established. The general cold massage
douche will naturally be employed with persons of good
strength, and particularly in cases in which emaciation is not

490 RATIONAL HYDROTHERAPY.

present, and is especially useful in cases in which spoliative
effects are desirable, as in obesity, fleshy rheumatics, and
diabetics in whom there is no loss of flesh.

The massage douche to the lower extremities furnishes a
useful means of producing derivative effects in favor of the
head and chest. It has the advantage over the ordinary cold
douche that the local anemia and the resulting retrostasis
and increased congestion of the already overfilled vessels of
the head or chest are lessened in duration and in degree by
the stimulating effect of the massage upon the whole circu-
lation of the parts.

The cold massage douche also possesses great value as a
means of stimulating the circulation in joints which have been
the seat at some previous time of inflammatory processes
which have left behind exudation products with rigidity of
the joint structures and limited movement, but in which pain
and other indications of congestion are absent. The power-
ful fluxion effects produced by the massage douche in these
cases is a most efficient means of producing an increased
flow of healthy blood through the parts, thus bringing to bear
upon them the healing influence of the vital fluid, the most
potent of all curative means. In cases of this sort the appli-
cation should not be confined wholly to the joint, but should
extend to the soft structures of the limb, both above and
below the joint. In the case of the knee, for example, the
muscles of both the calf and the thigh should be manipulated
in alternation with the joint itself. The effects of the mas-
sage douche to the joint may be extended by applying the
heating compress, to be changed as often as dried, and to be
worn until the application of the next douche.

The local cold massage douche is equally efficient as a
means of stimulating the removal of old inflammatory exu-
dates in other accessible parts as well as the joints.

The cold massage douche likewise renders great service in
cases of intractable lumbago and sciatica in which the parts
are not sensitive to pressure.

THE TECHNIQUE OF HYDROTHERAPy.

49 1

The kot massage douche may be advantageously applied
to the joints in connection with a cold application of some
sort for the purpose of heightening the effect of the latter or
rendering the joint less sensitive to thermic and mechanical
stimulation. The analgesic effects of the hot massage douche
are likewise effective in cases of sciatica in which cold ap-
plications prove too stimulating.

The neutral massage douche to the legs, with strong
press u re » is an excellent derivative measure for use in cases
of insomnia in which the neutral douche alone applied to the
legs or to the whole surface fails to accomplish the desired
result.

Contraindications. — The contraindications of the cold mas-
sage douche are essentially the same as those mentioned in
relation to the ordinary cold douche (1023)* It may be
mentioned, however, that by making the application partial
in character,^ — that is, confining it to a small area, as a single
limb, until a good reaction has been produced, then extend-
ing to another partp and so on until the whole body has been
gone over, — the untoward effects resulting from a general
cold douche may be obviated without sacrificing any of its
good effects When employed in this way, the cold massage
douche produces effects similar to those of cold friction or
the cold towel rub, but very greatly Intensified, The cold
massage douche should not be applied to joints when inflamed,
congested, or painful to pressure. In certain cases, how-
ever, the application may be made to the soft parts above
the joints, as a means of prodocing powerful derivative
effects.

LOCALIZED DOUCHES,

1069

One of the most valuable uses of the douche (jei, spray,
percussion, fan, fihform) is in applications to certain well-
defined, cutaneous areas with special reference to the internal
organs connected with them. The douche is also sometimes
localized in the treatment of certain superficial parts without

1070

492 RATIONAL HYDROTHERAPY.

reference to internal parts which may be reflexly influenced.
The names by which the principal of these localized douches
are designated are the following : Cephalic^ dorsal, lumbar,
thoracic, shoulder, sternal, epigastric, abdominal, hypogastric,
douche to feet, plantar, anal, perineal.

Physiological Effects. — The effect of localized douches
depends not only upon the duration, temperature, pressure,
and mass of water employed, but upon the particular sur-
face to which the application is made. The fact that every
portion of the cutaneous surface is reflexly related through the
central nervous system with some special internal vascular
area, has elsewhere been sufficiently dwelt upon (353-382) ;
it is only necessary here to call attention to the fact that a
certain number of clearly defined reflex arcs have been worked
out by various investigators, and it is with these that local-
ized douches are chiefly concerned.

Without undertaking to review the general principles
which have been previously explained, it may be said, briefly,
that —

1 . Short applications of cold water with strong pressure
are strongly exciting, producing powerful circulatory reaction
with dilatation of the blood-vessels and increased activity of
the small arteries, veins, capillaries, and lymphatics, both in
the cutaneous surface to which they are applied and in the
internal vascular area reflexly connected with it.

2. ProloJiged cold applications withotit pressure produce
contraction of the small arteries, capillaries, veins, and lym-
phatics of the cutaneous area to which the application is
made, and of the reflexly associated internal vascular areas.

3. Hot applications produce analgesic effects.

4. Neutral applications to these areas produce local and
reflex sedative effects,

5. Alternate applications produce most powerful and valu-
able exciting and fluxion effects.

6. Revulsive applications produce powerful derivative and
analgesic effects by causing collateral hyperemia of the skin.

THE TECHNIQUE OF HYDROTHERAPY.

493

THE CEPHALIC DOUCnE.

The cephalic douche, or the application of a stream of 1071
water to the head, is a procedure whereby the central nerv-
ous system is powerfully influenced (Fig. 48).

Method. — There are two methods of applying the cephalic
douche. In one the patient lies on his face» the head project-
ing over the end of the couch, and depressed sufficiently so
that the stream of water poured upon the back of the neck
runs down over the head. Cold water may he poured from
a dipper or pitcher held at a distance of a few inches to two
or three feet above the patient's head; or if preferred, the
patient may sit in a tub of water at a temperature of 100- to
102^ whiJe water is poured upon the top of the head and
allowed to run down the back of the neck. It is an excellent
plan to pin a towel about the head in such a way as to pro-
tect the eai3 and shoulders, and direct the stream of water
upon the neck and spine. The pressure must always be
slight The fan douche may be used, but not the full jet.

In the general neutral douche for insomnia, the broken
jet may be allowed to play upon the back of the head and the
neck with gentle aspersions for a few seconds at the end of
the application.

Physiological Effects. — A short cold application to the 1078
head causes dilatation of the blood-vessels of the brain.
Prolonged cold applications cause contraction, especially if
the application be continued long enough to produce chilling
(Schiiller).

Therapeutic Appltcatiorts. — The coid cephalic douche is 1073
well-nigh obsolete, being rarely employed except in connection
with typhoid or some other grave fever, in which the cold
bath is used* In these cases, affusion to the head or the
fan douche to the head is a means of highest value to rouse
the activity of the brain, and through it to quicken all the
bodily activities* In these cases the cephalic douche is
administered in connection with the cold immersion friction

494 RATIONAL HYDROTHERAPY.

bath (Brand, 1150), and is repeated at intervals of five min-
utes during the bath. The temperature should be a few
degrees lower than that of the general bath (60^ to 50°).

Great care must always be taken in the application of
douches or affusions to the head. A short cold application
excites the brain, and is useful in melancholia^ in cerebral
anemia, and in sunstroke with pallor. It is especially appli-
cable in cases of melancholia with stupor, in which the
cerebral anemia is usually very marked. The prolonged cold
douche to the head is one of the most powerful of all depress-
ing measures; unless very short, the effect may be too pro-
found; hence the cold affusion is safer.

Long cold applications to the head are exceedingly depress-
ing, but may be used in fever, in cerebral congestion, and in
sunstroke with congestion of the skin.

Affusion, the ice compress, and the evaporating com-
press are usually more convenient for application to the head
than the douche, and safer because less likely to be overdone.

A cold douche to the back of the neck stimulates the
respiratory centers. If too cold or too prolonged, suffocation
or arrest of the heart may result. The hot or cold compress,
alternate compresses, or sponging are milder measures which
produce similar effects, and are in general to be preferred.

A short tepid douche to the head or a tepid affusion will
allay cerebral excitement. It may be usefully employed in
insomnia, maniacal excitemeiit, and cerebral irritation. The
temperature should be from 80^ to 92^, duration from 3 to 5
minutes. Affusion is to be preferred to the douche in most cases.

The neutral fan douche to the occipital region and the back
of the neck, in connection with the general neutral douche,
is a remarkably useful measure in procuring sleep in insomnia.

Hot affusions to the head are useful in syncope and col-
lapse, and in cases of migraine with low arterial tension, but
should be employed with great caution.

In cases of cerebral anemia, alternate applications may
be employed instead of the short cold douche, the hot
douche, or hot or cold compresses.

THE TECHNIQUE OF HYDROTHERAPY-

495

Applications to the head should be managed with great
care» and should at first be employed in a tentative manner^
the effects being carefully noted.

THE DORSAL OR SPINAL DOUCHE (Fig. ^9).

In this procedure either the full or the broken horizontal 1074
jet, the percussion douche, the fan douche^ or the spray
may be employed* The skin of the back is less sensitive
than that of most other portions of the body, and hence
intense applications may be made without unpleasant exci*
tant effects in most cases in which percutient effects are at all
admissible.

The stream of water should not be confined to the median
line, but should be allowed to play rapidly up and down over
a surface extending three or four inches on either side of the
spinal column. As a rule^ the pressure employed should be
as great as the patient can bear The percussion douche
should be employed when available.

Physi0log:ica] Effects — The purpose of the dorsal douche 1075
is to influence the central nervous system, and through its
effects upon the vasomotor nerves to influence the system at
large. That most pronounced effects are obtainable by this
procedure is clearly evidenced by the sense of buoyancy and
increased energy experienced as the result of a vigorous
application, especially of the cold percussion douche, in cases
of either temporary or chronic nervous exhaustion.

Therapeutic AppUcations. — The A*/rV/ douche calms excit-
ability nf spinal origin, as in /ij*s/t'ria and spinal trriiiithm,
hypercstficsm of the itiuibar gang^lia of the abdominal
sympathetic connected with imta/wn of the ^plarnhnies,
trritabiiity of the btadikr of spinal origin, and irniabiliiy
of the ^^tnit^-urinary center; and relieves incouiim'net in
children.

The eald dorsal douche should be employed in spinal ane-
mia, in functional h/eomoior ataxia, in nioti^r insufficienfy of
the bladder resulting in urinary incontinence or retention, in

496 RATIONAL HYDROTHERAPY.

nervous vomiting, in diminished renal activity, and in melan-
cholia, but must be carefully avoided in cases of insanity of
organic origin and all forms of structural disease of the spine.
The cold percussion douche to the spine produces a most
wonderfully beneficial effect in cases of chronic neurasthenia.
By the daily application of this procedure the patient sees
himself steadily lifted up to a higher level, his mental and
nervous tone improving, the trembling, languor, mental con-
fusion, and indecision disappearing ; indeed, the effect of a
single application is so pronounced that the patient himself
at once recognizes the benefit derived from this simple
procedure. Great care must be taken to avoid overdoing the
application. The result will be headache, depression, and
nervousness following a feeling of buoyancy.

The very hot dorsal douche should be applied in gastral-
gia, in connection with the hot douche to the hypogastrium;
and the warm spinal douche (92° to 98^) is of great value in
locomotor ataxia with lightning pains, and in spinal sclerosis.

The Scotch douche to the back may be employed in lum-
bago, in cases of diabetes insipidus, in the irritation of the
renal plexus of the sympathetic so often encountered in mov-
able or floating kidney in connection with enteroptosis, and
in neuralgia of the kidney,

THE LUMBAR DOUCHB (Fig. 50).

1076 Either the full, the broken, the percussion, or the fan
douche may be applied to the lumbar region ; and, except in
cases of painful affections, full pressure may be employed.
Powerful reflex effects are produced by the lumbar douche
upon the organs of the lower abdomen, the pelvic viscera,
and the lower extremities.

The cold lumbar douche is especially useful in cases of
constipation, in motor insufficiency of the bladder resulting in
incontinence or retention, in amenorrhea, in renal insuffi-
ciency, and in infantile uterus, or delayed development of the

^

THE TECHNIQUE OI^ HYDROTHERAPY. 497

pelvic viscera or functions. It should be borne in mind that
a douche to this regipn, to obtain the effect above described,
must be administered with a considerable degree of pressure,
at a low temperature, and very short.

The Scotch lumbar douche is a most excellent remedy in
neuralgia of the uterus and ovaries, in renal congestion, in
urinary retention due to spasm of the neck of the bladder, and
especially in lumbago. It is a sovereign remedy also for the
backache so common in women suffering from pelvic dis-
placements, although of course in these cases its effects are
chiefly palliative. But when employed in connection with
the use of the abdominal supporter, relief is nearly always
prompt and permanent, when no inflammation exists.

In connection with the Scotch fan douche to the lumbar
region for the relief of congestion, revulsive applications
should be made to the feet and legs. Sometimes a better
effect is obtained by applying the revulsive douche to the
shoulders and upper part of the back.

THE SHOULDBR DOUCHE.

Either the full or the broken jet may be applied to the 1077
shoulders, special care being taken to avoid the neck and the
chest surfaces. A very short cold application to the shoul-
ders and arms, followed by a hot application at 1 1 3° to 1 20^,
produces strong derivative effects in favor of the pelvic
viscera. When employed for this purpose, the cold appli-
cation should be made with the percussion douche. The
hot or the Scotch fan douche generally affords prompt relief
in cases of rheumatic pains in the shoulder joints.

THE THORACIC DOUCHE.

In this procedure, the application of the douche is con- 1078
fined to that portion of the trunk above the diaphragm, or
practically the area of the skin covering the ribs, sternum,
and vertebrae. The application should include not only the
throat, sides, and back of the chest, but the tops of the
32

498 RATIONAL HYDROTHERAPY.

shoulders as well. The broken or the fan douche should be
employed. The full jet is Hkely to produce too powerful
an impression.

Physiological Effects. — A short cold application, with
high pressure, made to this region increases the amount of
blood not only in the dermal and muscular coverings of the
chest wall, but within the lungs and pleura.

Prolonged cold applications, with little pressure (65° to
80°, 6 to 10 lbs., I to 3 min.), contract the blood-vessels, and
lessen the amount of blood in the lungs and other organs
contained within the chest cavity.

A short, very cold douche to the breasts stimulates the
circulation in the pelvic viscera, and causes contraction of the
uterine muscle (50^ to 45^, 4 to 10 sees.).

Prolonged cold applications to the breasts with little pres-
sure cause contraction of the blood-vessels of the uterus, and
thus relieve uterine congestion (75^ to 65°, i to 3 min.). The
application of the cold douche to the lower third of the ster-
num causes contraction of the vessels of the kidney, and
increases the flow of the urine. Applied over the heart, the
douche powerfully excites cardiac activity.

Prolonged application, with little pressure, slows and ener-
gizes the heart.

THE EPIGASTRIC DOUCHE.

1079 The broken jet, the fan douche, or the spray should be
employed rather than the full jet in the application of the
epigastric douche.

Therapeutic Applications. — The cold epigastric douche is
of the greatest value in the treatment of hypopcpsia, apcpsia,
gastroptosis, dilatation and atony of the stomach, and in gas-
tric y?^////r//rr. It stimulates both the glandular and the mus-
cular activities of the stomach through its influence upon the
plexuses of Meissner and Auerbach.

The very hot epigastric douche (115^ to 122'^) is equally
valuable in cases of hypcrpcpsia, gastrorrhca, so-called gas-
tric rhetimatisvi^ gastric crises, gastralgia, subacute gas-

THE TECHNIQUE OF HYDROTHERAPY. 499

triiiSf gastro-duodenitiSy or gastric and duodenal catarrh^
infectious jaundice^ and the distressing pain accompanying
chronic ulcer of the stomach.

The tepid thoracic douche (fan) without pressure relieves
nervous asthma when applied to the back and sides of the
chest, and quiets palpitation from irritability of the heart
when applied over the cardiac region. It is rare that very
cold water can be employed at first in these cases; hence it
is better to begin with a temperature of 80^ to 92^, lowering
the temperature at successive applications if the patient is
found able to tolerate colder water.

The Scotch douche may be employed with excellent
success for the relief of intercostal neuralgia^ pleurodynia
from chronic pleuritic adhesions, brachial neuralgia, and r^-
flex irritations arising from hyperesthesia of the solar plexus.

In all painful affections of the stomach the Scotch douche
generally affords marvelous relief. The hot applications
should be at as high a temperature as can be borne (120^
to 125°), and the cold application should be very cold and
very short, 50° to 60^, for 6 to 1 2 seconds. When pain is
produced by slight pressure of the hand upon the epigastrium,
the douche should be applied with the least pressure pos-
sible. Hyperesthesia of the solar plexus, a condition usually
present as a fundamental cause of intercostal neuralgia, pain
between the shoulders, spinal irritation, so-called painful
dyspepsia and nervous asthma, is wonderfully relieved by the
Scotch epigastric douche.

THE HVPOQASTRIC DOUCHE.

This application, in which only the broken jet, the fan, 1080
or the spray douche may be employed, is confined to the
hypogastric region. For its application the patient sits upon
a stool with the knees separated, the head erect, and the
trunk inclined backward.

Physiological Effects. — Through the influence of this pro-
cedure, most powerful reflex effects may be produced upon

500 RATIONAL HYDROTHERAPY.

the organs of the lower abdomen and pelvis. It acts espe-
cially upon the bladder, the uterus, and the ovaries.

Therapeutic Applications.— The cold douche to the hypo-
gastrium, with little pressure, and continued for a half minute
to one minute, causes contraction of the bladder and the
uterus, and of the vessels of all the pelvic viscera; hence this
procedure is of great value in conditions of both active and
passive congestion, and in all chronic morbid conditions of the
pelvic viscera in which congestion is a prominent factor, such
as so-called chronic inflammation of the uterus^ and endo-
metritis. It is likewise very useful in subinvolution^ in dis-
placements due to relaxation of the supporting structures, in
atony of the bladder, and in enteroptosis due to weakness of
the abdominal muscles.

The revulsive Scotch douche to the hypogastrium affords
prompt relief in neuralgia of the uterus, the bladder, or the
ovaries, in uterine pain due to contraction of the cervix,
in vaginismus, vesicle tenesmus, and in hyperesthesia of the
sympathetic ganglia of the pelvis, as shown by pressure upon
the lumbo-aortic plexus and the sympathetic nodes of the
pelvis.

THE ABDOMINAL DOUCHE (Fig. 51).

1081 This local application of the douche is properly confined

to the anterior abdominal surface. It influences the small
intestines, the colon, and the lumbar ganglia of the abdomi-
nal sympathetic. Through these nerve centers important
general effects are produced.

A cold douche applied to the abdomen is highly useful in
constipatiojt, especially when it is due to dilatation of the
colon, and enteroptosis.

The cold abdominal douche is of service in atony of the
bladder, in entci'optosis due to relaxation of the abdominal
muscles, and in pelvic displacements due to atony, when not
accompanied by uterine or ovarian congestions.

THE TECHNIQUE OF HYDROTHERAPY.

SO!

The tvarm or hot douche should be employed when pain
or irrifah/iff exists in the biadder, the itUrus, the ovarus,
or other pelvic viscera.

The Scotch douche is most valuable for the relief of the
pain due to irritatimi of the splattchnic fwrvcs or of the lum-
bar gangii a of the abdominal sympathetic, a condition recog-
nized by pressure upon the ganglia situated about two inches
to the right and the left of the umbilicus^ on the inner surface
of the posterior wall of the abdominal cavity.

The Scotch douche gives excellent resuUs in chronic diar^
rkia^ chronic dysentery, and enteralgia.

DOUCHE Ta THE FEBT.

In this application the broken jet or the spray is com-
monly employed, as the fleshy covering of the foot is so thin
as to make the percussion douche or even the full jet too
painful to be borne in most cases. The stream is directed
upon the feet and ankles, the patient sitting in such a position
that the largest amount of surface may be readily reached.
It is the usual practice to apply the coid douche to the feet
for a few seconds at the end of general applications of the
douche, for the purpose of producing a certain amount of
revulsive effect in this region of the body. In very suscep-
tible persons the douche may be applied to the feet only,
until the patient has been trained to bear a more general
application. This is especially necessary in cases of patients
subject to painful affections of the head or nervous affections
of the chest and heart, as in cerebral hyperemia, ncrvaus
asthma, palpitation of the heart of sympathetic origin, pul-
mc^nary congestion .exophthalmic goiter and chronic migraine.
By taking the precaution to allow the stream of cold water to
fall upon the feet at the beginning or end of the general
cold dotiche, the headache which often follows the douche
(sometimes called the '* hydropathic headache") may gen-
erally be prevented.

1082

502 RATIONAL HYDROTHERAPY.

The cold spray douche prolonged until the skin is red«
dened, produces contraction of the cerebral vessels, and hence
exerts a most useful derivative effect in cerebral hyperemia.

The Scotch douche and the very hot douche may be
applied to the feet with advantage as a means of relieving
cerebral congestion.

THE PLANTAR DOUCHE.

1083 The plantar douche consists in the application of water
under strong pressure to the soles of the feet. Either the
single jet or the spray douche may be employed. The author
has for many years used the apparatus shown in the accom-
panying cut (Fig. 52), which he had especially constructed
for the purpose. It consists of a copper tub with double
bottom, the uppermost one of which is perforated over a sur-
face equal in area to that of the average foot, and with an
outline adapted to the foot. Several openings around the
side permit the ready escape of the water. A perforated
pipe placed around the side of the inner surface of the vessel
at a higher level permits the application of water to the
upper surface of the foot when desired.

The cold plantar douche, continued for one half minute
to 2 minutes, or until strong reaction occurs, produces power-
ful reflex impressions upon the organs of the abdomen and
pelvis. Both the blood-vessels and the muscular walls of
the hollow organs of the pelvis and the abdomen are brought
into strong contraction by this procedure.

Burgonzio has also shown that the vessels of \}c\t, brain
may be caused to contract by this application, rendering it
useful in chronic headache from congestion. The duration
of the applications for this purpose should be one and one-
half to 2 minutes.

The cold plantar douche may likewise render service in
anemia of the brain, in which case the application should
be much shorter (4 to 10 sec). This douche affords one of
the very best means for overcoming habitual coldness of

THE TECHNIQUE OF HYDROTHERAPY. 503

the feet, a condition which is exceedingly common in gastric
neurasthenia^ in hyperesthesia of the lumbar ganglia^ and
especially in enteroptosis. It is chiefly in these cases of vascu-
lar spasm due to reflex irritation, that the plantar douche is
useful as a means of warming cold extremities. It is not
applicable when the coldness is due to general feebleness of the
circulation. In cases of the latter sort, general cold frictions,
the cold precordial compress, the general Scotch douche,
and other measures for stimulating the circulation are required.
The cold plantar douche renders valuable service in hema-
turia^ atony of the bladder^ incontinence of urine in old men,
in spermatorrhea from relaxation of the ejaculatory ducts,
in neurastheniay the result of excessive cerebral activity, in
cases in which the urinary secretion is scanty ^ and in chronic
epistaxis not due to ulceration of the nasal mucous membrane.

THE PERINEAL DOUCHE.

In this douche the application is confined to the cutane- 1084
ous region in front of the anus or the perineum, its purpose
being to affect the organs of the pelvis, especially the rectum,
the prostate, the vesiculse seminales, the deep urethra, the
ejaculatory ducts, the testicles, and the bladder, in men ; and
the rectum, the uterus, the ovaries, the Fallopian tubes, and
the bladder, in women. The perineum has an exceedingly
rich vascular and nervous supply, and strong reflex effects
may be produced by suitable applications to this region. The
application is made with the ascending douche, as much pres-
sure being used as is possible without pain.

Therapeutic Applications — The very cold perineal douche is 1085
useful in constipation, atony of the bladder, chronic urethritis,
prostatorrhea, prostatitis, hypertrophy of the prostate with
induration, spermatorrhea with atony of the ejaculatory ducts,
and especially the diurnal form of the disease, inflammation of
the uterus, subinvolution of the uterus with relaxation of the
supporting structures of the uterus and displacements, as well
as other chronic disorders of the pelvic region characterized

504 RATIONAL HYDROTHERAPY.

by lowered tone. It must be remembered, however, that this
application should never be employed in cases in which pain
is a marked symptom, as the powerful thermic reaction set
up is likely to increase the pain ; spasmodic affections, as
vesical, rectal, or vaginal tenesmus, are also aggravated
by cold applications. The duration of the cold application
should be 2 to 3 minutes.

1086 The very hot perineal douche is useful in most aflFections of
the prostate, the rectum, the uterus, the bladder, and associated
organs. It is especially valuable in cases of spermatorrhea
with great irritability of the deep urethra and hyperesthesia
in the region of the vesiculce seminales and ejaculatory
ducts. The duration of the hot perineal douche should
be I to 3 minutes (115° to 122°). The hot perineal douche
is very useful as a means of relaxing a rigid perineum in
preparation for childbirth when rigidity of the perineum is
known to be present. Little pressure should be employed in
these cases. Vaginal, rectal, and vesical tenesmus are re-
lieved by the hot anal douche with moderate pressure.

It is generally useful to terminate the application with
cold for 2 or 3 seconds.

^ THE ANAL DOUCHE.

1087 This application, administered by means of the rising or
ascending douche, allowed to fall upon the anus, is of great
value in the treatment of hemorrhoids, especially in external
hemorrhoids and in the mixed variety, in which the internal
and external structures are both involved, and joined by ex-
tension of the morbid process across the anal margin.

Galtz produced evacuation of the bladder in dogs having
paraphlegia from division of the spinal cord, by placing a
sponge saturated with cold water against the anus.

The cold anal douche is of special service in the treatment
of constipation, reflexly exciting normal peristaltic move-
ments, and is especially useful in restoring normal sensibility
of the rectum which has become lost by neglect to answer

THE TECHNIQUE OF HYDROTHERAPY. S05

promptly the calls of nature, resulting in an abnormal accumu-
lation of hardened fecal matters in the rectum, and con-
sequent constipation. It is also of great service to persons
who have suffered from the unwise application of surgical
procedures to this portion of the body, resulting in weaken-
ing of the anal muscle to such an extent as to prevent the
proper retention of fluid fecal matters and gas. By the use
of this simple measure such few fibers of the sphincter
as may remain intact may be stimulated to vigorous action.

The cold douche may be advantageously employed in cases
in which internal hemorrhoids have become inflamed, and
are prolapsed.

The very cold anal douche will generally cause a contrac-
tion of the hemorrhoids to such an extent that they may be
easily replaced.

The very hot anal douche is useful in cases of rectal
ulcer and fissure^ vaginismus, and spasm of the sphincter
muscle.

This application is contraindicated in cases of ovarian
neuralgia, enteralgia, vesical irritability, and other painful
affections of the pelvic and abdominal viscera.

VISCERAL DOUCHES.

By the general term "visceral douche" it is intended 1088
to designate a douche administered in such a manner as to
influence an internal organ. It should be understood, how-
ever, that, with one or two exceptions, it is impossible to
make an application directly to the organ itself, but that the
desired effect is obtained through the medium of an applica-
tion to the cutaneous area or areas reflexly associated with
the organ, the condition of which it is desired to influence.

General Physiological Effects.— The visceral douche oper- 1089
ates through the sympathetic or vasomotor centers and nerves
upon internal associated organs. There are good grounds
for believing that in many instances the good effects expe-
rienced are the result pf a collateral anemia or hyperemia

506 RATIONAL HYDROTHERAPY.

produced in the affected parts by retrostasis or the opposite
action, as the case may be. The active fluxion in internal
parts set up by exciting applications of the douche upon the
surface is also a powerful factor in the therapeutic results pro-
duced by these simple but wonderfully potent procedures.

The visceral douche diflFers from the localized douche in
that the latter involves but a single circumscribed area, while
the former often involves a number of areas, which, though
in some instances widely separated anatomically, are inti-
mately associated physiologically through a common relation
with the internal viscus which it is desired to influence.

The principal visceral douches may be designated as fol-
lows : Cerebral^ cerebrospinal^ pulmonary^ cardiac^ gastric^
enteric y hepatic^ splenic, renal, gent to-urinary.

In the description of these several forms of douche it will be
unnecessary to repeat such details of method as have already
been given in connection with the several forms of localized
douches; it is sufficient to indicate the surfaces which are to
be acted upon, with suggestions respecting the therapeutic
indications.

THE CEREBRAL DOUCHE.

1090 The cerebrum is influenced by applications to the head
itself, to the back of the neck, the face, the hands, and the
soles of the feet. Next to the applications to the head
itself, the most powerful impressions may be made by appli-
cations to the soles of the feet, the so-called '* plantar
douche." A prolonged cold application to these surfaces
produces powerful contraction of the blood-vessels of the
brain by reflex action. In applications to the plantar re-
gion the thermic effects of extreme cold are supplemented
by the percussion effects of water at high pressure. Powerful
circulatory reaction is produced in the feet and lower extremi-
ties, especially if the application be extended to the feet and
legs, thus producing a derivative effect in favor of the brain,
in addition to the reflex influence exerted.

THE TECHNIQUE OF HYDROTHERAPY. $0/

Short cold applications to the face, neck» and scalp are
quickly followed by reaction, with dilatation of the cerebral
vessels, and increased activity of all the cerebral functions.
This is also true of general cold applications.

Prolonged cold applications to the reflex surfaces named
produce more permanent contraction of the vessels^ and
secure relief when cerebral congestion is present, especially
if the applications are renewed every few minutes so as to
repeat the reflex effect upon the vessels.

Warm applications to the face, neck, and scalp tend to
congest the brain.

Very hot applications, on the other hand, cause temporary
contraction, and relieve congestion.

Neutral applications (92° to 94^) to the occiput and the
back of the neck relieve cerebral excitability.

Very cold or very hot applications to any portion of the
dermal surface produce an exciting effect upon the cere-
brum.

THB CEREBROSPINAL DOUCHE.

The purpose of this douche is to influence the whole 1091
cerebrospinal system, and through it the body at large.
All the spinal nerves send out branches, which are distributed
to the skin covering the back; so that by applications made
to the dorsal surface of the trunk, in addition to the appli-
cations which have been described under the head of ''the
cerebral douche, " all the cerebrospinal centers may be acted
upon. The method consists essentially in that described for
the cerebral douche, with the addition of an application to
the back. The several steps of the procedure are as
follows: —

1. Affusion, or douche without pressure, to the head, as
described for the cerebral douche.

2. The application of the douche to the feet for 15 or 20
seconds, at a temperature as low as possible, usually at least
as low as 60^ to 50^ F.

508 RATIONAL HYDROTHERAPY.

3. The percussion douche to the spine from 20 to 30 sec-
onds, the stream being rapidly moved up and down and across
the back in every direction.

4. The broken jet to the dorsum and soles of the feet for
30 to 60 seconds.

The cerebrospinal douche is indicated in cases of neuras-
thenia with cerebral congestion. Care should be taken to see
that the patient's skin is warmed before the application of this
douche, so that the internal congestion, including congestion
of the brain, which always occurs when the surface is chilled,
may be avoided. The electric-light bath, the vapor bath, the
hot-air bath, or the warm rain douche (care being taken to
protect the head) are all excellent means of heating the skin
preparatory to the cerebrospinal douche. In patients who
chill easily, the spray douche at 102° to 104^ may be applied
for I minute to the feet and spine, before the cold appli-
cation to these parts.

The tepid or «^«/ra/ cerebrospinal douche is useful in cases
of spinal sclerosis^ general feebleness^ sexual dementia, ex-
haustion from alcoholism and other forms of dissipation, as
well as in an enfeebled condition resulting from loss of sleep
and prolonged mental anxiety.

In certain cases, as in irritable and feeble neurasthenics
with cerebral congestion, the neutral douche to the back of
the neck may be combined with the cold percussion douche
to the spine and feet. In cases of cerebral anemia associated
with chronic nervous exhaustion, the prolonged cold douche
to the spine, legs, and feet may be advantageously associated
with the warm douche or affusion to the head.

THB PULHONARY DOUCHE.

1092 The pulmonary circulation may be influenced by applica-
tions made to any portion of the cutaneous covering of the
chest, but especially to the vertebra prominens. Askatchen-
sky showed that a cold application to the hands is capable of
controlling epistaxis, and the writer has clinically shown that

THE TECHNIQUE OF HYDROTHERAPY.

509

pulmonary henwrrhagc may likewise be favorably influenced
by this procedure. That very cold applications to the hands
and leet, with strong pressure, are also capable of intlucncing
the pulmonary circulation to a marked degrecv has been shown
by the eKperiments of Vasilieff. Winternitif has noted a
similar relation between the thighs and the lungs. The appli-
cation should be considerably prolonged, and with little pres-
sure. The procedure in the pulmonary douche should be as
follows : —

A rapid percussion douche, or horizontal jet with strong
pressure, at 6o^\ to the arms and shoulders; then the broken
jet to the front and sides of the chest; ending with the percus-
sion douche to the back and vertebra prominens; the duration
being from 10 to 1 5 seconds to each part. The mutral douche
to the back of the chest is of value in cases of asthma^ espe-
cially if accompanied by the Scotch douche to the feet and legs.

The pulmonary douche has a somewhat U mi ted sphere of
usefulness, but may be employed in cases which require either
quieting or exciting of the respiratory movements. Thus the
hot pulmonary douche applied to the back may be used with
advantage in asthma; while the caid douche is equally useful
for sedentary neurasthenics who need increased pulmonary
activity to supply an increased amount of oxygen and to
encourage the portal circulation,

THE CARDIAC DDUCKE.

A cold douche, with slight pressure over the heart, first 1093
quickens, then slows, its action, increasing arterial tension.
Prolonged application of cold to the hands has the effect to
slow and energise the heart. Only the broken or the fan
douche should be employed in applications over the heart.
The douche is less useful as a local measure for influencing the
heart than is the ice-bag or the cold compress.

THE GASTRIC DOUCHE.

The viry hot douche (lij^ to 122') applied over the 1094
epigastrium and the spine opposite often gives relief in

SIO RATIONAL HYDROTHERAPY.

painful affections of the stomach. It has the effect to
diminish the secretion of gastric juice; hence is applicable in
chronic gastritis, gastric ulcer, gastralgia, gastrorrhea,
gastroduodenitiSy infectious jajindice, hyperesthesia of the
solar plexus, and especially in hyperpepsia.

A cold douche applied to the same areas increases the pro-
duction of HCl,and increases the muscular tone of the stomach.
It is of especial service in apepsia, hypopepsia, dilatation of
the stomach, and gastric flatulence.

The Scotch douche is in some cases more successful in re-
lieving pain than the hot douche. The hot application should
be prolonged to 3 or 4 minutes. The duration of the con-
cluding cold application should not be more than 15 to 20
seconds. The fan or broken jet should be used, and with
little pressure.

THE ENTERIC DOUCHE.

1095 The blood-vessels of the muscular walls of the small intes-
tines are powerfully influenced by applications to the umbilical
region, the hypogastric region, the lumbar region of the spine,
and the feet. A cold douche to these parts powerfully stimu-

, lates peristalsis, and increases the tone of the muscular
walls. A short application with considerable pressure
increases the secretion and vascular activity, while more
prolonged applications with little pressure lessen congestion
when present.

The Scotch douche relieves painful affections, such as
cnteralgia, colic, and the pain of chronic peritonitis. In
applying this douche for constipation, the cold application
should be made first to the feet, then to the lumbar region,
then to the umbilical and hypogastric regions, and lastly
another short application to the feet, with strong pressure.

THE HEPATIC DOUCHE (Fig. 53).

1096 Administered with proper care, there is no therapeutic
measure which secures better or more definite results than
does the hepatic douche. Lying close to the surface, and

THE TECHNIQUE OF HYDROTHERAPY.

Su

having an exceedingly vascular structure, the liver may be
most profoundly affected by a douche properly administered;
but for this reason, great care must be employed in applica-
tions of this sort. The douche is applied over the region of
the liver; that is, the lower part of the right chest and the
epigastrinm* The fan douche or the broken jet at a low tem-
perature is employed for excitant effects.

To reheve cottgestion, the application should be cold and
with moderate pressure (65^^ to 75^', 15 to 20 lbs, 5 to 10
min.); and the internal reaction should be suppressed by a
general douche to the whole surface immediately fullowing
the hepatic douche^ or by some otlier of the several means
elsewhere described. If considerable pain is present, the gen-
eral douche may be employed first, the local application fol-
luwing immediately. In cases of chronic eniargcmtnt of
the Hver, the alternate douche should be employed, in
acuie congestion of the iivcr accompanied by pain, the tepid
douche should be used. In cases of extreme pain, as in
gail'St^nts, infcciious jauniiice^ and injlammation of the livir^
the Scotch douche is indicated. The hepatic douche is of
especial value in the disorders of the liver encountered in hot
countries, particularly those resulting from malarial infection.

THE SPLENIC DOUCHE (Ftg. 54)-

By means of the fan douche or the broken jet an applica-
tion of cold water of moderate pressure is made over the lower
portion of the left chest, the cutaneous surface overlying the
spleen.

The cold or alternate douche constitutes the most efiective
of all means for combating an enlarged spleen, especially
in cases in which the hypertrophy is due to chronic malarial
infection. Not infrequently, a considerable degree of diminu-
tion in the size of the spleen may be recognized immediately
after an application of this sort. In general, the observations
made in reference to the hepatic douche apply equally well
to the splenic douche.

1097

512 RATIONAL HYDROTHERAPY.

If pain or tenderness is present, the very hot or Scotch
douche should be employed. In the administration of the
splenic douche, short applications should be made to the feet
both before and after the application to the spleen. In cases
in which the general cold douche can be tolerated, it is well
to make such an application in connection with the splenic or
hepatic douche; but in cases of congestion of these organs
care should be taken to malce a short cold local application
first, so as to avoid an increase of the congestion by the inrush
of blood produced by the general application.

THE RBNAL DOUCHE.

1098 The kidneys are influenced by the douche to the lumbar
region, as also to the cutaneous surface covering the lower
third of the sternum. The interesting fact that the sternal
area is reflexly connected with the kidneys, was first pointed
out by Beni-Barde, of Paris. Prolonged cold applications
with little pressure to these areas produce contraction of the
vessels of the kidneys, especially influencing the small vessels
of the parenchyma of the organ, thus increasing the pressure
in the glomerules, and so favoring the outflow of urine.
This interesting explanation of the action of the cold douche
upon the kidney was first offered by Bottey, and makes clear
how the urinary excretion is 'increased by the action of the
cold douche, while at the same time congestion is relieved.
The renal douche is especially serviceable in the treatment of
renal congcstio7i, which is frequently associated with chronic
alcoholism and malarial infection. It also serves a useful
purpose in diabetes and in some cases of Bright' s disease;
but when albumin is present in the urine, the Scotch douche
should be substituted for the cold appHcation.

In painfnl affections of the kidneys^ as in pain due to
7novable or floating kidney^ hydronephrosis ^ neuralgia^ and
renal calculus, the very hot douche or the Scotch douche
applied to the lumbar region is indicated.

THE TECHNIQUE OP HYDHOTHERAFT. 513

THB OENITO-URINARY DOUCHB.

The uterus, the ovaries, and the bladder in women, and 1099
the prostate, the bladder, and the testicles in men, are power-
fully influenced by the application of heat to the lumbo-saoral
and hypogastric regions, and to the inner surfaces of the
thighs in both sexes, and to the breasts in women. There is
also marked evidence of a close relationship between the feet
and the pelvic viscera. In the application of the genito-
urinary douche the stream of water is allovred to fall first upon
the feet, then upon the lumbar region, then upon the inside
of the thighs, and finally upon the breasts and h}rpogastrium.
Strong pressure may be used in applications to the lumbar
region and the feet, but the broken jet or the fan jet only
should be applied to the breasts and the hypogastrium, and
with little pressure.

The short ^ ^A/ genito-urinary douche is applicable in cases
of amenorrhea^ relaxed abdominal muscles and uterine devia^
tions^ subinvolutions^ seminal weakness in men, especially
the form known as diurnal emissions^ enlarged prostate in
men, and atony of the bladder in both sexes. The cold
douche should never be employed in painful or spasmodic
affections of the pelvic viscera. In the last-named disorders,
such as vesical tenesmus, vaginismus, and coccygodynia^ ova^
rian neuralgia, uterine neuralgia, and, in men, neuralgia of
the testicles and spermatic cord, the very hot or the Scotch
douche may be employed with advantage.

THB ARTICULAR DOUCHB.

This douche and the one following differ from others of 1100
this class only in the fact that the internal parts concerned
are outside the abdominal cavity. The fan, the broken jet,
or the spray may be employed with advantage in many affec-
tions of the joint, though in painful affections of this kind
the Scotch douche is preferable. The prolonged cold douche
with little pressure may be used to advantage for antiphlo-
gistic effects in cases in which heat or swelling are present.

33

514 RATIONAL BVDROtHERAPY.

The position of the patient while receiving the application
may be either sitting or standing, whichever will render the
affected part most easily accessible. By producing hyperemia
of the skin by means of the hot douche, collateral anemia of
the joint may be produced in conditions of congestion and in-
flammation. On the other hand, when it is desirable to con-
gest the joint as a therapeutic measure, an anemic condition
may be readily produced by a prolonged cold application to
the knee with little pressure.

Therapeutic Applications.— In chronic affections in which
exudates exist, with limitation of movement, absorption may
be promoted by the alternate douche. Extreme temperatures
and as high pressure as can be conveniently borne must be
employed. The alternate douche is of course contraindicated
by local pain or tenderness. The short, very cold douche
produces powerful alterative effects, and is of value in cases
in which the joint structures are relaxed.

THB nUSCLB DOUCHB.

1101 By means of the douche at different temperatures applied
to the skin overlying a muscle or group of muscles, almost
absolute control may be exercised over the circulation and
functions of the part. This control depends upon the prin-
ciples of fluxion considered elsewhere (698). The douche
may accordingly be utilized with advantage in most affections
of the muscles. When inflavnnatioft exists, the prolonged
cool douche with little pressure may be employed at intervals
of two or three hours, or until the acute stage is past; later,
for the relief of pain, the Scotch douche may be used. For
relieving the pain of muscular rheumatism, the Scotch douche
or the hot douche may be advantageously utilized, also in pain-
ful conditions of the muscles accompanying so-called muscu-
lar strain, and in the condition known as secondary fatigue.
The cold douche applied over a muscle wonderfully in-
creases its working capacity, as shown by the tracings easily
obtainable with Mosso's ergograph (Figs. 55, 56). This effect

THE TECHNIQUE OF HYDROTHERAPY.

S'S

.

is produced, however, only with the short cold douche at
high pressure (50^ to 65^, 3 to 6 sees,, 25 to 40 lbs.). The
prolonged douche at low temperature, without pressure, is
capable of completely annihilating muscular excitability. The
koi douche and the Scotch douche diminish muscular excita-
bility, and render valuable service in the treatment of con-
tractures and muscular spasm, as well as in painful conditions

of the muscle,

THE VAPOR DOUCHE.

This douche (Fig, 57) consists of a jet of steam projected 1103
upon the patient in a manner precisely analogous to that in
which water is employed in the horizontal jet douche. The
apparatus should be so constructed that hot water can never
be ejected from the nozzle, and the controlling valve so
arranged that the maximum amount of steam admitted to the
nozzle shall not be sufficient to carry an injurious amount of
heat to a distance of more than a few inches from the no2jle.
The temperature of the application may be perfectly regulated
by the distance at which the nozzle is held from the surface
of the body.

The advantage of the vapor douche is that it produces
the most powerful thermic effects with practically no percu-
tient effects, which renders it extremely useful as a means of
producing revulsion in cases of neuralgia, as in sciatica, fum-
haga, spinai ucuraig-ia, and also in cases of painful jainis,
musiuiar and articuiar rheumatism, and joints affected by
fibrous ankylosis and local or general hyperesthesia. A most
excellent revulsive measure consists in alternate applications
of the vapor douche in connection with the cold percussion
douche. The vapor douche is one of the most effective
means of heating the skin preparatory to or in connection with
a i:old ratn douche or a horizontal jet.

TtlE AFFUSION, PAIL l>OUCME, OR POURING BATH.

This bath (Fig, 58) resembles the douche in that the 1108
water falls upon the body in a stream* It at the same time

5l6 RATIONAL HYDROTHERAPY.

resembles the immersion bath in that the water is simul-
taneously applied to a large portion of the entire surface,
and with very slight mechanical effect. As a pail is often
used in administering this bath, it is frequently called the
**pail pour." Like the douche, the application may involve
the whole or any portion of the surface.

Method. — ^The requisites are, a tub, which may be an ordi-
nary wash-tub if the patient is able to stand, or if it is prefer-
able to sit, a full-bath tub. If the patient is unable either to
sit or to stand, he may lie upon his face on a cot or stretcher,
over which a large piece of rubber has been spread. The
head of the cot should be so raised that the water will run off
its lower end into a tub properly placed for the purpose.

Several pails of water (three to ten) should be conven-
iently placed for use; a wet towel for the head, a Turkish
towel, and a large linen or Turkish sheet are also required.
The temperature of the water employed may vary from 50^
or 60° to 105^ or 110°, according to the effect desired. The
application may extend to the whole body or to a portion only.
When employed as a general application, the sitting position
in a full-bath tub is usually to be preferred.

Before the bath the patient's head, face, and neck should
be thoroughly cooled with water a few degrees lower than
that to be employed in the affusion. A towel wet in very cold
water is then wrapped about his head ; he seats himself, with
legs extended, in an empty full-bath tub with the plug left out;
the requisite number of pails of water are then quickly poured
over him. The water should not be simply poured upon the
patient, but should be dashed upon him from as great a height
and distance as arrangements will permit. The attendant,
grasping the pail to be emptied upon the patient, gives it a
little swing backward, then tilts it in such a way as to empty
its contents upon the patient as the pail swings forward and
upward (Fig. 58). The patient sits with his hands folded over
his chest in such a manner as to protect the precordial region.
The first pailful of water is thrown upon the folded hands; the

THE TECHNIQUE OF HYDEOTHERAPY.

517

next is daslied upon the upper part of the back. The front
and back of the body are thus treated in alternation until the
required number of pails of water have been employed. After
the last pail is emptied, the attendant vigorously rubs the
trunk and hmbs of the patient for 20 to 30 seconds, then
removes him from the bath, wraps the sheet about him, and
rubs him dry. Special attention should be given by the attend-
ant to the back, legs, and feet, while the patient, if able» is
rubbing the arms and the anterior portions of the trunk.

Local affusions are made to the spine, head, extremities,
and other parts. When it is desired to confine the applica*
tion to the spine, the patient sits on the edge of a bath-tub
while the water is allowed to flow from as great a height as
the pail can be held by the attendant, down the whole length
of the spine.

When the application is to be made to the arm, leg, or
foot, the part is simply held over the bath-tub and the water
poured over it from the desired height. The quantity of
water employed, the temperature, the duration of the applica-
tion, and the size of the stream must be regulated to suit the
patient and the conditions present. Numerous effects may be
obtained by variation of the several factors named (Fig. 59)*

In patients who dread the contact of cold water, and in
whom reaction does not readily occur, the feet may be
immersed in water as hot as can be borne. If too feeble to
stand, the patient may sit in a chair while affusion is applied,
or in case of great feebleness, he may lie in a horizontal posi-
tion upon a cot covered with rubber cloth, so arranged that
the water will run off at the bottom, being caught in a tub or
some other proper vessel.

In the treatment of chronic cases it is best to prepare the
patient for this bath by heating the skin by means of fomenta-
tions or hot bags to the spine and limbs, while his body is
wrapped in warm blankets, or by the vapor bath, the electric-
light bath, the wet sheet, the hot- blanket pack, the hot bath,
and other appropriate means,

5l8 RATIONAL HYDROTHERAPY.

The author has had constructed a pail, shown in the
accompanying cut (Fig. 60), which has been 'found very con-
venient for the administration of this bath. When the water
is poured from one side of this pail, a broad, thin stream is
obtained; when poured from the opposite side, it flows in a
solid column somewhat smaller than the arm.

The affusion may be employed as a substitute for the
douche when the latter is not available. It may also be com-
bined with various other baths, as the Brand bath (712), the
dripping sheet (1216), and as a cooling process after hot baths.

Physiological Effects. — The French divide baths into two
classes, according to whether the water employed is in motion
or quiescent. Affusion is the simplest form of the bath in
which the water employed is in motion, and may be regarded
as a sort of transition from the full or immersion bath to the
douche, the favorite hydriatic procedure of the French hydro-
therapeutists.

Both the thermic and the circulatory reactions are very,
pronounced as the result of an affusion bath at a tempera-
ture of 55^ to 75^, and as a result, the evidences of tissue
change are marked.

The effects upon a healthy person are chiefly the follow-
ing: Cardiac and pulmonary excitation, with an increase of
CO2 excretion; slowing of the pulse 'and increase of arterial
tension; increase in the amount of cutaneous excretion; in-
creased assimilation of albumin; improved oxidation of nitrog-
enous wastes; slight lowering of the temperature. The circu-
latory effects of the cold affusion are essentially the same as
those of the douche, except that they are less pronounced, as
the mechanical effect is less.

The hot affusion is at first powerfully exciting, but is
quickly followed by atonic reaction. The fuutral affusion,
if so managed as to secure as little mechanical effects as
possible, is quieting or sedative. The prolonged local cool
affusion (15 to 60 min.) is a measure of value in combating
subacute inflammation in large joints, through its powerfully

r

THE TECHNIQUE OF HYDROTHERAPY. 519

sedative effects. The temperature should be 70^ to 80^.
This application has the advantage over the cold compress in
that the temperature of the application is constant, so that
reaction is altogether suppressed, and thus the desired seda-
tive effects are more quickly and decidedly developed.

The neutral pour to the spine is a powerful sedative to the
nervous system. It is highly useful in cases of locomotor
ataxia accompanied by lightning pains, or when the disease is
making rapid advancement. The hot local pour is powerfully
revulsive. The local alternate pour is a strongly excitant
measure, and may be employed in such a way as to produce
the most powerful revulsive effects.

Therapeutic Applications. — This is one of the oldest of 1104
hydriatic procedures. It was employed by Hippocrates in
the treatment of syncope, puerperal fever, delirium, and in
swollen joints, as well as in other affections, and at different
temperatures.

Sir John Chardin, the noted English traveler, found it in
use for fevers in Persia in the seventeenth century; and it is
said to be still a custom in Persia to keep pails of cold water
standing upon the street corners during a cholera epidemic.
The natives so thoroughly understand the use of water in
these cases that when a man falls with cholera, the cold
water is immediately poured over him by the bystiinders,
who afterward rub him vigorously until thorough reaction is
produced.

This hydriatric procedure was introduced to the medical
profession of England by Dr. Wright more than one hundred
years ago. Dr. James Currie, of Liverpool, became acquainted ,
with Dr. Wright's practice, and introduced it into the infirmary
of which he had charge, where he made a careful study of its
physiological and therapeutic effects. It may be said, in fact,
that scientific hydrotherapy began with the study of this bath
by Currie, who made careful use of the thermometer for the
purpose both of regulating the temperature of the water
employed and of determining its effect upon the patient.

520 RATIONAL HYDROTHERAPY.

Currie proved that the afiusion bath is a most excellent
means of reducing the temperature in fevers. He also ob-
served, as recorded in his ** Medical Reports/'* that a tepid
affusion is more effective in reducing temperature than a very
cold application. Some modern writers who have called
attention to this same effect seem not to be aware of this
observation by Currie, though all who have had any consider-
able amount of experience in the use of water in fever, must
have noted, as did Currie, that the temperature not infre-
quently rises after a short cold bath to a point higher than
before the bath.

Currie was also the first scientific physician to call atten-
tion to the great value of affusion as a means of combating
the morbid process in infectious fevers. He noted that the
most important effect produced by the application was its
tonic influence, whereby the vital resistance of the patient
may be increased.
1105 General affusion is of very great value, especially in fever
cases in which pulmonary or cerebral congestion or cardiac
weakness is a prominent symptom. Applied to the whole
surface of the body, and especially to the chest and shoulders,
cold affusion furnishes a powerful means of stimulating the
nervous mechanism of the heart, and may well replace the
drugs recommended for this purpose. Similar effects may
be produced by heat and cold to the spine, and by cold wet
rubbing, as elsewhere described; but the effects thus produced
are less vigorous than those of the affusion bath. Affusion
is an essential feature of the Brand bath, water at a lower
temperature than the water of the bath being poured upon
the back of the patient's head at intervals during the bath
(712). Employed in this way, it lessens the delirium, and
greatly improves the heart's action in continuous fevers.

The stimulation of the respiratory movements induced by
the pouring of cold water over the chest is a most powerful

* Currie, "Medical Reports," page 64-

THE TECHNIQUE OF HYDROTHERAPY. $21

means of combating the tendency to hypostatic congestion^
a very grave complication in fevers of severe type. In the
management of low fevers, affusion may be employed in con-
ditions of depression in which the prolonged cold bath would
seem to be contraindicated. In cases of this sort, the patient
should be prepared for the bath by a hot-blanket pack, a
fomentation to the back, or by the application of heat in a
tub of water at ioo° to 102^ for 2 or 3 minutes, until the
skin is warm, when he may be removed from the warm bath,
and cold water poured upon the head and shoulders.

In capillary bronchitis in children, when the air-passages
are clogged with mucus and the respiratory centers so over-
whelmed by the retained COj that there is insufficient power
to expel the accumulation, cold affusion to the chest, by
stimulating the respiratory center, and thus provoking power-
ful breathing movements, renders valuable service.

In the case of young children suffering from capillary bron^
chitis or broncho-pneumonia, the patient may be seated in a
tub partially filled with water at 102^, and cold water poured
over the chest and shoulders. After two or three pailfuls of
water have been thus poured upon the patient, a Turkish
sheet and warm blankets should be quickly wrapped about
him; he should be thoroughly dried, and the surface circula-
tion stimulated by rubbing.

The combined hot full bath and cold affusion may be used
in the various forms of collapse as well as in prolonged
cases oi fever in which the skin is cyanotic. The last-named
measure is of great service in the treatment of cerebrospinal
meningitis. The patient should be placed in a hot full bath
at 100^, and while in the bath very cold water may be poured
over the head, hot water being added to the bath as required
to maintain the temperature.

Cold affusion is one of the most efficient means of combat-
ing the cardiac and general vascular depression present in
alcoholism. Nothing will more quickly arouse the patient
from a drunken stupor than affusion with a half dozen buck-

522 RATIONAL HYDROTHERAPY.

ets of water at 60°. This application should not be made
without a preceding hot application if the skin is cold or the
temperature subnormal, and must be followed by rubbing and
other means' necessary to secure complete reaction.

A very short hot affusion following a cold bath has been
shown to increase its antipyretic effect by atonic reaction,
whereby heat production is diminished.

Affusion, preceded, when possible, by a short hot applica-
tion, is one of the most powerful of all means for rallying the
vital forces in case of collapse, surgical shock, asphyxia, and
even in drowning. It should be noted, however, that the
skin is often quite cold in cases of this sort, and that the cold
application must be at a temperature considerably below that
of the skin, in order that the revulsive effect may be produced.

In cases in which the elevation of the body temperature is
due to some local infection, the tepid' affusion is to be pre-
ferred, as also in other febrile cases in which the patient is
very young or very feeble.

Currie's greatest successes with the use of the cold affusion
were in the treatment of scarlet and typhus fevers ; but this
measure is equally effective in chronic as in acute affections.
In private practice it may take the place of the douche, which
requires a special apparatus and a hydriatic establishment for
its successful administration.
1106 Contraindications. — Cold affusion must be avoided in

cases of cardiac disease with degeneration of the heart mus-
cle, in asthma, in hemorrhagic cases of tuberculosis, and in
cases of typhoid fever complicated with myocarditis, acute
nephritis, intestinal perforation, peritonitis, and in hemor-
rhages from uterine fibroids. It need not be avoided in cases
of typhoid fever in which slow hemorrhage occurs from con-
gestion, but the patient must be managed carefully in such

cases.

THE IMMERSION BATH.

fl07 This bath (see also 712) presents itself in the different

forms of the full bath, the plunge bath, and the swimming or

THE TECHNIQUE OF HYDROTHERAPY. 523

surf bath in fresh or salt water. Bathing in natural sources,
as in the sea and in fresh water lakes and rivers, is a most
healthful exercise and a powerful prophylactic, and may be
employed with advantage by semi-invalids, although this form
of bathing can not be controlled with the accuracy necessary
to secure definite and reliable therapeutic results.

THB COLD PLUNQE.

This bath (Fig. 61) requires a water-tight tank to which 1108
water of a proper temperature is regularly supplied. The
depth is ordinarily about five feet. The temperature is varied
in different establishments from 48^ to 68^.

Method. — The plunge bath should never be entered
when the skiii is cold or a chilly sensation is present. The
body should be well warmed before the bath is entered,
either by a hot bath of some kind, or by the accumulation of
heat in the wet-sheet pack, the dry pack, or by exercise.
The head, face, and neck should be thoroughly bathed with
very cold water before the bath is entered.

It is best to enter the bath suddenly, as the sensation of
cold is thus far less noticeable than when the bath is entered
gradually. The duration of the bath may vary from 2 or 3
seconds to i or 2 minutes.

The patient should rub himself vigorously while in the
bath; or if the space is sufficient, should exercise by swimming
movements. Successive dipping under the water is also
advantageous, the head and shoulders being completely im-
mersed each time.

As soon as the patient emerges from a bath, he should be
wrapped in a Turkish sheet and vigorously rubbed by two
attendants, himself assisting. When dry, he should dress at
once, and exercise moderately for half an hour, or if too fee-
ble to do this, massage or manual Swedish movements should
be administered to insure good reaction.

In taking the cold plunge bath, as in other forms of the
cold immersion bath, the patient should leave the bath during

524 RATIONAL HYDROTHERAPY.

the first reaction, that is, while the surface circulation is good
and the sensation of warmth pervades the skin, and before
chilly sensations have begun to be experienced. If he remains
until the secondary chill occurs and the skin begins to
assume a bluish appearance, thermic reaction is almost cer-
tain to be excessive, often resulting in fainting and subsequent
intense congestion, with headache, visceral pain, and possibly
inflammation of internal parts.

The effects of the plunge bath are most excellent if good
reaction is secured, but highly depressing when reaction does
not occur. Headache, malaise, nervousness, and depression
are indications of defective reaction or an excessive applica-
tion; that is, too long a time spent in the bath.
1109 Physiological Effects. — The plunge bath is a powerfully
exciting and alterative measure; the whole surface of the
body being suddenly brought into contact with water at a
low temperature, a most profound impression is made upon
the central nervous system. The heart and the circulation
are also powerfully influenced. The sudden inrush of blood
from the surface causes an intense congestion of all the
internal viscera, a fact which should never be forgotten,
as it renders this bath inapplicable in quite a large number
of cases.

The effect of the bath is at first a slight elevation of the
internal temperature in consequence of the sudden checking
of heat elimination. After reaction occurs, there is a slight
falling of the temperature, but respiration, heart action, and
all the vital functions are quickened by the profound nervous
impression made. The blood pressure is raised, the circula-
tion of the brain is stimulated, respiratory movements produce
vigorous fluxion of the blood and lymph through the cere-
brum, so that the mind, if previously clouded, becomes clear,
and all the intellectual functions are facilitated. The sudden
contact of cold water with the general surface likewise stimu-
lates the action of the kidneys and the liver, excites peristal-
sis, causes contraction of the hollow viscera, and arouses all

THE TECHNIQUE OF HYDROTHERAPY. 525

the vital functions. Indeed, the cold plunge produces a more
powerful thermic reaction than any other form of bath.

Therspeiitlc Applications. — The cold immersion bath is 1110
especially indicated in cases requiring powerful stimulation of
metabolism, and especially in the class of cases designated by
Bouchard under the general term " slowed nutrition," in dia-
betes without emaciation, in obesity, and for persons in ordi-
nary health, requiring simply vigorous recuperative measures
to repair the damages arising from sedentary employment and .
lack of exercise. The plunge bath is useful in cases in which
the cold douche can not be employed in consequeqce of its
percutient effects. It is a much more vigorous application
than the half bath, producing very powerful refrigerant
effects, with correspondingly strong thermic reactioii and
metabolic changes. It may be properly used after any sweat-
ing procedure, as the sweating pack, the electric-light bath,
the vapor, the Turkish, the Russian, the hot air, the hot
immersion, and other similar procedures. In the Turkish
bath establishments of Constantinople and Cairo, visited by
the writer, t\iere are tanks of hot water in which the patients
immerse themselves, or sit upon the edge with the legs im-
mersed, laving the water upon their bodies. Some European
establishments provide a hot plunge in addition to the cold,
but it is very little used. The cold plunge bath, being a most
vigorous procedure, should not be prescribed without a full
knowledge of the patient's condition.

Contraindications. — The routine use of the plunge bath so 1111
common in connection with Turkish bath establishments is
highly dangerous. Many persons can not take the plunge
bath without running the risk of serious injury. The short
cold plunge should be avoided in all cases in which there is an
elevation of temperature, as the bath has a decided tendency
to produce temperature elevation, the body temperature being
sometimes found one or two degrees above normal several
hours after the bath, owing to the great increase of heat pro-
duction resulting from the thermic reaction.

526 RATIONAL HYDROTHERAPY.

This bath is contraindicated in pernicious anemia, anterior
sclerosis, cardiac weakness, great exhaustion from either phys-
ical or mental labor, loss of sleep, great emaciation, Bright's
disease with albumin in the urine, and in diabetes with rapid
loss of flesh. It is also dangerous for persons having a tend-
ency to pulmonary hemorrhage, or hemorrhage of the stom-
ach, as in gastric ulcer and hepatic sclerosis.

THE FULL OR IMMERSION BATH.

1112 This bath (Fig. 62) was first scientifically studied by Currie,
who recommended the cold immersion bath as a means of
prolonging the effects obtained by cold affusion, and espe-
cially as a measure to be applied in intermittent fevers as
soon as the second or hot stage is developed, asserting that
**the judicious and resolute application of cold might super-
cede all other remedies in fevers of this class. ** *

Method. — The full bath is administered in an ordinary
bath-tub, which may be made of wood, copper, zinc, porce-
lain, or enameled iron; or a bath-tub may be improvised in a
number of ways. Portable tubs convenient for dwellings not
provided with plumbing may be easily constructed. The
first requisite is a frame of wood resembling in shape the top
of an ordinary bafh-tub. To this support, rubber sheeting is
attached in such a way that when the ends of the frame are
placed on chairs or other supports, the sagging sheeting just
touches the floor (Fig. 63). Water may be conducted into
the tub by means of a rubber hose attached to the water fau-
cet. Well-oiled or painted ducking may be used in place of
the rubber sheeting.

Perhaps, on the whole, the cheapest way, when it is nec-
essary to improvise a tub, is to make one of ordinary lumber
— whitewood, basswood, or pine boards, an inch and a half
thick, and planed smooth on both sides. The tub should be
about six feet in length, two feet in width» and a foot and
a half in depth. The cracks may be caulked with oakum.

♦Currie's '* Medical Reports."

V

THE tBCHNlQUB 6^ dYDftOtHBRAPV. $^7

iSoch a tab can be made by a good carpenter in a few hours,
and if kept well painted inside, may be used ibr a long time.
When necessary for use for a fever case, the tub may be
placed near the bed and filled with water. The temperature
of the water may be regulated by adding either hot or cold
water as need.ed The prolonged cold bath will require the
addition of ice or very cold water. The temperature of the
hot bath, that is, a bath above the temperature of the body,
may be readily maintained by the addition, from time to
time, of jugs or bottles filled with boiling water, which does
away with the necessity of so much dipping out and in of
water. The patient's head while in the bath should be sup-
ported by an air pillow, or other suitable means.

For an alkaline full bath, add a half ounce of salsoda for
each gallon of water.

Full baths may be conveniently classified according to their 11 IS
temperature as coU, neutral^ hot^ graduated^ and alternate.

THE COOL OR COLD FULL BATH.

The temperature of this bath may be from 50^ to 75®; III4
duration, 4 seconds to 20 minutes. Before entering the bath
the patient's head, neck, and chest should be well wet with
water at a temperature ten or twelve degrees below that of
the bath, the head while in the bath being protected by a
towel wet in very cold water. The bath should be entered
as suddenly as possible, so as to generalize the impression
made. Vigorous rubbing by the patient himself or by one or
more attendants should be applied during the entire duration
of the bath.

As in the case of the plunge bath, the patient should leave
the bath during the first reaction, and should never remain
until the second rigor occurs.

Currie's method of administering the cold bath was quite
unique. The temperatures employed ranged from 54^ to 59^.
The patient was placed on a sheet, with which, by the aid of
several attendants, he was lowered into the bath and allowed

528 RATIONAL HYDROTHERAPY.

to remain for five seconds, then lifted out until reaction
began, as shown by slight reddening of the skin, then dipped
again, the operation being repeated from three to five times.
After the last dip he was rubbed vigorously. Currie found
this method especially successful in the treatment of infectious
fevers, for which purpose he considered it a specific more than
a century ago (1797). It is evident, however, that the benefi-
cial effects he obtained from this bath could not to any con-
siderable degree be attributed to the temperature reduction, but
must have been derived from the stimulating influence of the
application upon the general vital processes, whereby the
vital resistance of the patient was increased.

It is interesting to note that Currie was familiar with the
fact that the cold bath gives rise to an elevation of the tem-
perature,* when of short duration (i to 5 min.). This eleva-
tion of temperature is especially marked when the friction,
which should always be applied during the bath, has been
omitted.

When the bath is prolonged beyond a mere dip in cold
water, it is a good plan for the patient to sit up in the tub,
rubbing his chest, legs, sides, and arms, dipping his hands con-
stantly in the water, and every three to five seconds lean-
ing backward until the body is immersed to the neck.
1116 Physiological Effects. — The effects of this form of im-
mersion upon a healthy person are essentially the same as
those of the cold plunge bath, but a little less intense. The
thermic reaction after the cold full bath is greater than after
any other bath. The temperature curve shows first a depres-
sion amounting to one or two degrees, continuing for two or
three hours after the bath, but finally followed by a return to
normal, or even an elevation of a degree or more. The
temperature rise may be followed by sweating, as after a
malarial chill and fever. By a frequent repetition of the cold
bath a veritable hydropathic fever may be induced.

♦Currie, "Medical Reports," page 154.

THE TECHNIQUE OF HYDROTHERAPY. 529

According to Maggiori and Vinaj * the cold immersion
bath nearly doubled the muscular capacity of the middle fin-
ger of the left hand, while the neutral bath produced no effect
at ally and the warm bath at 104^ for 6 minutes decreased
the work from 5,000 to 900 kilogrammeters (Exp. 58).

The perturbing and alterative effects of the cold immersion
bath are greater than those of the douche and half-bath, for
the reason that the system is left almost wholly to its own
resources to produce reaction; hence this bath is unsuited for
very feeble patients, or those whose reactive powers are not
vigorous. The immersion bath is less valuable as a tonic
than baths in which the application is accompanied by
mechanical movements, as friction or percussion; but that it
powerfully stimulates metabolism is shown by the observation
of Lepine,t who found that the immersion of a fasting dog for
15 minutes in water at 40^ more than doubled the amount of
urea.

Therapeutic Applications. — The immersion bath may be 1116
used in cases in which the plunge bath is not readily accessi-
ble. It is also admissible in cases in which the plunge bath
can not be safely employed on account of its excessively
exciting effects, as with certain neurasthenics, or when the
patient is too feeble to take the plunge bath because of
inability to assist himself to the extent necessary. The pro-
longed cold full bath not accompanied by friction is one of
the most depressing of all hydriatic procedures, and is seldom
indicated. When a general cold application is required, the
wet-sheet pack, the shallow bath, the douche, or some other
form of bath in which the mechanical effects of friction or
percussion are added to the powerful thermic effects of the
cold as an aid to reaction, will, with but very rare exceptions,
be found preferable.

The cold bath was once used as an antipyretic measure,

* Blatter fur Klin. Med.

\V Union Midicale^ 29, 1880, p. 722.

34

^36 ftAtlONAL ttVDROtHERAPY.

but has long since been abandoned in favor of the so-called
** Brand bath," to be described later, which is generally
meant whenever the term *• cold bath ** is employed in cur-
rent medical literature as used in connection with the treat-
ment of febrile disorders. That the cold bath may render
valuable service in the treatment of fevers has been abun-
dantly proved by clinical (experience; and it is not necessary to
appeal to modern statistics to find proof of the marvelous
efficiency of the cold bath in the treatment of febrile mala-
dies. Currie describes an epidemic of typhus which occurred
at the military prison located at Stapleton, England,* where
a large number of French prisoners were confined. There
were, in all, 815 cases. All were treated by the cold affusion,
with a result of only forty-one deaths, a little less than five
per cent. , which for typhus fever is certainly an unusually for-
tunate record. The mortality was almost wholly confined to
persons who were debilitated by age, dissipation, or exposure.
We find no equally favorable statistics in the record of modern
military practice. The usual enormously high mortality, in
the light of present knowledge, would certainly seem to indi-
cate an unnecessary waste of human life.

The cold full bath is indicated, and may be most appro-
priately employed, in cases of obesity without marked cardiac
degeneration, and in cases of slowed nutrition when the gen-
eral strength is fair. It creates an appetite and improves the
digestion in appropriate cases, but is so much inferior to other
hydric procedures equally useful for the same purpose that it
is seldom used.

Employed as a means of cooling after a vigorous heating
procedure, it may render excellent service.

The cold full bath is a useful measure as a means of toning
the skin after a prolonged hot bath, and may be advantageously
employed in some cases in alternation with the hot immersion
bath as a means of exciting the sympathetic centers and
encouraging the production of hydrochloric acid in cases of
hypopcpsia. For persons enjoying fairly good health, a dip

♦Currie, *• Medical Repwrts," 4lh edition, p. 388.

THE TECHNIQUE OF HYDROTHERAPY. 53 1

into a tub full of cold water is an excellent morning bath.
It creates an appetite, accelerates the circulation, arouses the
nervous system, and produces decidedly exhilarating effects
in those who have become accustomed to its use. When
employed for this purpose, the duration of the immersion
should not be more than 3 to 1 5 seconds. The patient should
rub himself vigorously while in the bath, and should dry him-
self quickly and thoroughly afterward. He should then take
moderately active exercise for 1 5 to 20 minutes, such as walk-
ing, or general exercises in the gymnasium. The daily use
of the cold immersion bath in the manner suggested is one
of the most effective means of fortifying the system against
disease, both acute and chronic.

Contraindications — These are essentially the same as 1117
for the plunge bath, though the cold full bath may often be
tolerated when the cold plunge would be inadmissible. It is
contraindicated for young children and very aged persons.
The cold full bath should be avoided during gestation and in
febrile conditions due to acute inflammation of some internal
organ, as in acute peritonitis or gastritis, enteritis, inflamma-
tory conditions of the uterus or ovaries, and other visceral
inflammations.

Another morbid condition which should have mention as
a contraindication to the cold bath, is hematuria. This con-
dition, when present, indicates disease of either the bladder
or one or both kidneys, a condition likely to be enormously
increased, perhaps to a dangerous stage, by the retrostasis
necessarily resulting from the cold bath. The short hot bath,
followed by cold friction, wet-sheet rubbing, and the cold
compress, exchanged at intervals of. an hour or two for fomen-
tations to the loins, are suitable measures for cases of this sort.

The cold full bath may bie advantageously em- 1118
Tlie Cold Full ployed as a measure of hygienic routine by
^enic Measure PG^"sons of fairly robust constitution. The
author does not recommend plunging into
rivers and lakes in the winter-time through a hole in the
ice, a practice highly lauded by certain writers, and under-

532 RATIONAL HYDROTHERAPY.

taken by many to their sorrow, a quarter of a century ago.
Such a measure is dangerous and quite unnecessarily heroic,
as all the gcod efifects obtainable from the cold bath may be
secured by its use in a more rational and convenient way.

A good method of employing the cold bath as a morning
tonic is this : Fill the tub sufficiently full of water to allow
complete and instantaneous submergence of the entire body
except the head. Immerse as quickly as possible after cool-
ing the head. The duration of the bath must be very brief,
not more than 5 to lo seconds. Rub vigorously while in the
bath, and after emerging rub with coarse towels until the body
is warm and dry. Exercise till reaction is complete. The
best time for the bath is immediately after rising from bed,
and while warm and feeling a relish for the contact of cold
water. Used thus, this bath is a powerful means of promoting
vital resistance and maintaining the integrity of the body.

A remarkable testimony to the hygienic value of the daily
cold bath is noted by Currie in his ** Medical Reports'* (4th
edition, p. 378). Quoting Dr. Wright, he says: **I agree
with Dr. Falconer, of Bath, in thinking that the cold affusion
will secure persons from taking the plague itself, though
exposed to its contagion."

Surgeon Mc Gregor, formerly superintendent surgeon of
the English army in Egypt, confirms this view by a very
interesting observation. While he was in charge of the
** Blues," a famous old regiment then located at Canter-
bury, an epidemic of typhus fever, generally complicated with
pneumonia, broke out. The disease developed so rapidly that
in a short time one fifth of his regiment were on the sick-Hst,
and there were thirty-three cases of fever, with daily acces-
sions to the number. At this juncture it occurred to Mc-
Gregor, a disciple of Currie, who was familiar with the use of
the bath in the treatment of cases of fever, that the cold bath
might be used for prophylactic as well as curative purposes.
Accordingly, to use his own words, *' About the 12th, at my
earnest recommendation, all the regiment out of the hospital

THE TECHNIQUE OF HYDROTHERAPY. 533

were marched three times a day to the riverside, and every man
was made to bathe. The good efifects of this were speedily
manifest; the number of new fever cases decreased daily, and
those that did appear wore a milder aspect. Many, indeed,
yielded to the common treatment ; in some cases an emetic,
and in others the cold bath, at once cut short the disease.
We lost no case in October. Indeed, it was evident to all
that after the general bathing of the regiment, the contagion
stopped; the few cases that occurred after this were stripped
of all the alarming and dangerous symptoms with which the
disease broke out. In all, there were sixty cases of fever
occurring from July to the 21st of October, on which day the
last case appeared. We lost six of this number." *

The immunity evidently conferred by the tri-daily bath
was certainly more than a coincidence. It would seem emi-
nently reasonable to suppose that if the cold bath aids recov-
ery by stimulating the vital forces and increasing the vital
resistance, and to such a degree that the patient already thor-
oughly infected with the disease is brought to a safe recovery,
the application of the same measures before the contraction
of the disease ought so to fortify the system as to enable it to
successfully withstand the influence of the infectious element
to which the malady owes its origin. The principle involved
in this suggestion is one well worthy of the most thoughtful
consideration. If the principle holds in relation to a single
malady, it is equally sound in relation to all others which
depend upon either infection or any other external cause, of
course excepting accidents.

It is a well-known fact that intoxicated sailors 1111)
The Cold Bath are often suddenly sobered up by falling into
an Antidote the sea. The excitant effect of the contact of

for Alcoholic the cold sea water with the temperature
Intoxication. nerves of the skin reacts upon the brain and
spinal cord with such intensity as to arouse to
activity the alcohol-narcotized centers. The author has long

* Curric's '* Mcdicnl Kcp>rts," p. 394, j Curiosities of Common Water, 1793.

534 RATIONAL HYDROTHERAPY.

been familiar with this fact, and has made very frequent use
of it in overcoming the acute effects of alcohol poisoning. He
has frequently seen a man so profoundly under, the . influence
of liquor as to be unable to stand alone, who could not speak
distinctly or coherently, completely sobered within four or
five minutes by the employment of the hot and cold shower
bath.

Dr. Robertson, of Baitadoes, reported in the early part
of the present century an interesting case which illustrates
very forcibly the powerful influence of cold water in antago-
nizing the acute effects of alcoholic poisoning. The tempera-
ture of the water employed, as determined by Dr. Robertson,
was ^(P to 80°. We quote as follows from page 201 of Dr.
Currie's ** Medical Reports,** to which we are indebted for the
account of this interesting case: —

** A gentleman of this island, whose name was Weeks, a
great votary of Bacchus, was in the practice, from fifteen to
twenty years, of plunging into cold water when he rose from
his bottle, and of actually going to sleep in a trough full of
water, with his head supported on a kind of wooden pillow
made for the purpose, above the surface. When he dined
abroad, and had not the convenience of his own trough, he
used to strip off coat, waistcoat, and shirt, and sit exposed in
the open. air, and in that situation go to sleep, whether it
rained or not. And sometimes he went and bathed in the
nearest adjoining pond, to which he generally required assist-
ance to be conveyed. The effect of this practice was, that
instead of experiencing debility, lassitude, headache, and
nausea on awakening, he fc^ind himself cheerful and refreshed,
and free from all the effects of intoxication. In the year
1789, dining one evening abroad, he got alternately drunk
and sober three several times before midnight, each time
recovering his sobriety by immersing himself and sleeping in
cold water; and on awakening, returning to the company.
The last time, after supper, he was so immoderately intoxi-
cated that he insisted on his companions undressing him and

THE TECHNIQUE OF HYDROTHERAPY. 535

carrying him to the pond. They carried him accordingly in
a chair, and set him up to the chin in water, whete he con-
tinued upwards of an hour, a person supporting him. I have
this last circumstance from a gentleman of the party, whose
veracity may be entirely depended upon.

"At home, however, he used, as I have already men-
tioned, a trough made for the purpose, with a bench in it as a
pillow, having been nearly drowned when sleeping in his pond,
from the negro who was appointed to watch him having him-
self fallen asleep. In this watery bed he would sleep, one,
two, three, or even more hours, experiencing always the
greatest refreshment. His wife and family, when they
wished him to change his quarters, used to draw out the plug
and let the water run off, when he would awake, and humor-
ously complain of the loss of his bed-clothes. At length this
expedient began to lose its effect in arousing him, and one
time he continued to sleep in his empty trough. In conse-
quence of this he was seized with extreme rigors and chills,
followed by a severe attack of rheumatism, which affected
him a long time, and made him desist from this practice in
future. But to the end of his life he was in the habit of
sitting with his clothes open, and sometimes quite naked,
exposed to the wind and rain."

THE GRADUATED BATH.

This bath, the advantages of which have been urged by 1120
Ziemssen, Bouchard, and others, is a form of the full bath
especially adapted to the treatment of fevers. The method
consists essentially in a full bath the temperature of which is
gradually lowered.

Method. — The patient enters the bath at a temperature
from nine to ten degrees below that of the body, and the
temperature of the bath is lowered at the rate of two degrees
a minute to ^^^, continuing at this point until shivering and
chattering of the teeth occur (Ziemssen).

The principle of graduation thus suggested by Ziemssen is

536 RATIONAL HYDROTHERAPY.

a valuable one, but the temperature of the bath is so rapidly
lowered that the discomfort to the patient is almost as great
as in the method of Brand. Bouchard aims to avoid the
nervous shock and suffering of the patient by the following
method, as described in his work.* The initial temperature
of the bath is three or four degrees below the temperature of
the patient. For example, if the patient's temperature is
(per rectum) 104^, the bath will begin at 100^ F. At this
temperature the patient is comfortable, and experiences no
shock. The water is cooled at the rate of two degrees Fah-
renheit, or 1° C. (1.8^ F.), every five minutes until the
temperature of the bath is reduced to 86°, never lower. The
patient should be continuously rubbed after the tempera-
ture of the water has been lowered sufficiently to produce
chilly sensations. This prevents chilling and shivering, and
the consequent increase of heat production.

The advantages of the graduated bath of Bouchard are
that it does not produce vascular ^spasm, arterial pressure
is not raised, and the lowering of temperature is greater than
in the cold bath. In fevers, the bath is administered every
three hours; so that when a patient's temperature rises to
104° or above, it may be necessary for him to spend half of
his time in the bath. The temperature is usually reduced
about one degree, though sometimes it falls as much as three
or four degrees.

A formidable objection to the cold bath is the nervous
shock which it produces, the dread the patient experiences,
the discomfort, the cyanosis, which latter symptom often
gives a case a very grave appearance, although the danger
may not be so great as it appears. It must also be remem-
bered that in persons whose hearts are organically diseased,
and especially when the arteries are weakened by arterioscle-
rosis, the very cold bath can not be employed without great
danger. The graduated bath is free from these objections,
and is hence a most valuable hydrotherapeutic measure.

♦** Lemons sur les Auto-Intoxications,'* Paris, 1887, p. 230.

THE TECHNIQUE OF HYDROTHERAPY. 537

Physiological Effects. — The special physiological effect of 1121
the graduated bath is to reduce the body temperature, which
it accomplishes in a most efficient manner, though perhaps
less rapidly than by the cold bath with friction. The gradu-
ated bath for 30 minutes is equivalent, as an antipyretic
measure, to a cold bath at 70° for 10 minutes, and its
effects are more permanent.

A marked advantage of the graduated bath is that it pro-
motes thermic reaction to a much less degree than does the
cold bath, hence has not so great a tendency to increase heat
production, while it is equally efficient as a means of increas-
ing heat elimination.

The graduated bath may be managed in such a way that no
shock* whatever is produced; so that it is much more agreeable
to sensitive patients and those who dread cold applications.

The intensity of the bath depends upon the length of time
it is continued and the degree of temperature to which the
water is lowered. As the temperature of the bath is gradu-
ally lowered, opportunity is afforded for observing the effect
upon the patient, so that the bath can be stopped at the
point at which the most favorable results are noted; that is,
the cooling may cease at any temperature desired, the bath
being then continued at a fixed temperature, which may be
tepid, cool, or cold, as is most desirable.

Therapeutic Applications. — The graduated bath is, in the 1122
author's opinion, the most efficient method of reducing
temperature in fevers. By its aid all the effects can be
secured which are obtainable from any other form of the
bath. It can be easily managed in such a way as to produce
the temperature-reducing effects of the tepid, cool, or cold
bath, by ceasing to add cold water at the proper point, and
may be graduated to a nicety to suit the varying conditions
of individual cases.

The principle of the graduated bath is an exceedingly
important one, and may be applied to other procedures as
well as the full bath. It may be remarked also that in the

538 RATIONAL HYDROTHERAPY.

employment of the cold bath and cold friction, the bath may
be graduated by giving the first bath at a temperature eight
or ten degrees below that of the body, and lowering each
successive bath.

If in a fever case mdications are present which point to
the necessity for cold applications for general tonic effects, to
increase vital resistance, or to energize the heart, these may
be met by the cold friction, the cold towel rub, the rubbing wet
sheet (in bed), the ice-bag over the heart, and a variety of
measures which may be much more conveniently, safely, and
comfortably employed than the Brand bath.

THE TEPID IMMERSION BATH.

1123 The method of administering the tepid bath is essentially
the same as has been described for the cold immersion bath
(1112). The temperature is from 8o^ to 90^. The tepid
bath is generally administered at a temperature ten to twelve
degrees below that of the body. Care should be taken to see
that the water covers the shoulders, in order to prevent pul-
monary congestion. The usual time of the tepid bath is
about 30 minutes, but by employing general friction it may be
continued for many hours (at 88*^ to 90°).

1124 Physiological Effects. — The tepid bath slows the pulse,
lowers the temperature of the body by the abstraction of
heat, but produces little or no thermic reaction, and hence
does not give rise to increased heat production. The circula-
tory reaction takes place slowly, the preliminary contraction
being slowly developed and the subsequent dilatation equally
slow. The effect of the bath in reducing temperature will
depend upon the relative temperature of the patient, the
duration of the bath, and the degree to which the bath
approaches the lower limit of the range of tepid temperature,
or near 80°.

J J 25 Therapeutic Applications. — The tepid bath was much
used by Hippocrates in the treatment of iever, and has
been in modern times extolled by Dujardin-Beaumetz and
Bouchard.

r

THB TBCHNIQUB OF HYDROTHERAPY. 539

Riess treated several hundred cases of t3rphoid fever with
the continaoas tepid bath at 88^. The patients were kept in
the bath from eight to fifteen hours, or until the temperature
fell to the normal, or nearly so. The temperature usually
b^an to rise again soon after the patient was removed from the
bath. As soon as it reached loi^, the application was
repeated. In some instances the patient was obliged to spend
almost his entire time in the bath in order to keep the tem-
perature near the normal point. For a continuous bath of
this sort it is necessary that the patient be made comfortable
by suspension in a sheet, the ends of which are secured to the
sides of the bath-tub. The statistics furnished by Riess
showed that the duration of the disease was very perceptibly
diminished by the continuous tepid bath.

The tepid bath given for half an hour or an hour is to be
preferred to the very cold bath in pneumonia^ also in low
stages of typhoid fever in which the patient has not had the
advantages of cold water treatment in the early period of
the malady. Care should be taken to protect the head with
cold water in the tepid bath as well as in the cold bath, and
friction should be applied when there is the slightest tendency
to chill. Friction must be more energetic in the tepid than in
the cold bath, for the reason that the thermic impression is
feeble, so that the circulatory reaction depends almost wholly
upon mechanical effects.

The tepid bath may sometimes be used as a training for
cold applications. It is also a very useful measure in connec-
tion with electricity in the electro-thermal bath.

THE HOT IMMERSION BATH.

This is an ordinary full bath administered at a tempera- 1126
ture of 98° to 104°. At temperatures above 104^ the bath is
properly termed ** very hot," but the effects of the full bath at
temperatures ranging between 100° and 113^ differ in degree
only, not in kind. It is the purpose to consider under this
heading the effect of the immersion bath at any temperature
above that of the body.

54^ RATIONAL HYDROTHERAPY.

Methods. — The time of the hot bath varies from 2 or 3
minutes to 15 minutes, according to the temperature and
the case. It must never be very greatly prolonged, for the
reason that baths at any temperature above that of the body
cause a rapid accumulation of heat and rise of temperature.
In the administration of the bath at a temperature consider-
ably above that of the body, the beginning temperature should
be 100^, it being gradually raised by the addition of hot water
to the maximum temperature desired. By this means the
skin becomes gradually accustomed to the heat, and a much
higher temperature will be tolerated than if the patient enters
the bath at the maximum temperature. The cerebral excita-
tion is also less.
1127 Physiological Effects. — The hot or very hot immersion
bath is a powerfully exciting measure. During the applica-
tion the general nervous system, the heart, and the blood-
vessels, as well as the system generally, are strongly excited
by the powerful thermic impressions transmitted inward and
by the profound vascular impression made through the dilata-
tion of the surface vessels. Heat production, the oxidation
of nitrogen, or the production of urea and metabolism in gen-
eral, are quickened under the influence of the elevated tem-
perature. The skin is intensely congested by the paralytic
effect of the heat upon the vasoconstrictors. A very short
primary contraction of the vessels occurs when the tempera-
ture of the application is very high (iis"^ or above), but the
characteristic effect upon the cutaneous circulation of hot
general applications is to paralyze the small vessels. The
cutaneous glands are excited to activity, the skin is reddened
and bathed in perspiration.

The study of the effects of the hot immersion bath upon
the circulation by means of the instruments of precision
devised by Oliver, of England, for determining arterial
pressure and measuring the caliber of the arteries, affords
interesting results. The author has found the use of these
instruments somewhat difficult, requiring considerable prac-

THE TECHNIQUE OF HYDROTHERAPY. 54 1

tice in order to secure uniform results. They are the best yet
made for the purpose, however, and afford reliable data when
carefully used. The general result of many experiments, as
reported by Oliver, is that a hot application — that is, a bath
at 100^ to 105^ — causes contraction of the radial artery, by
reason of the extreme dilatation of the small vessels; it is
also indicated by the marked enlargement of the submerged
parts, which may amount to more than six per cent. When
the temperature of the bath was slightly below that of the
body, the radial artery was at first enlarged, but later con-
tracted with the dilatation of the surface vessels. The cold
bath caused strong contraction of the radial artery, its diame-
ter being reduced by a bath of 40^ from 2.2 mm. to 1.3 mm.,
with a corresponding increase of tension. This effect lasts, of
course, only until reaction begins.

These experiments are of great practical interest in show-
ing that the effects of applications to the surface are not upon
the small cutaneous vessels only, but involve the large arterial
trunks lying deep in the tissues, at least when large areas of
the skin are acted upon.

Much useiful information respecting the effects of the hot
immersion bath has been gathered from a study of this bath
in the public baths of Japan (Fig. 64). Professor Baltz has
had an excellent opportunity, during many years' residence in
Japan, for a thorough study of the effects of these baths,
since in that country it is the general custom to take a hot
bath almost daily. In Tokio alone there are given about
400,000 hot baths daily, the price being so low as to be
within the means of the very poorest, — one-half to one cent.
Baltz himself has for many years taken a hot bath at least
twice a week, and in summer, after great exertions in moun-
tain-climbing, often twice a day.

The Japanese usually take the bath at 115^, sometimes
hotter; while Europeans living in Japan take it at 104^ to
109.4° F. Before going into the bath, the head is rubbed
with hot water, whereby the blood-vessels of the head are at

542 RATIONAL HYDROTHERAPY.

once relaxed, and anemia of the brain is prevented. The
duration of the bath is 5 to 20 minutes, according to the tem-
perature. When the sensation of heat is very great or
strong palpitation of the heart is experienced, the bather
leaves the bath at once.

The first effect upon going into the hot bath is a goose-
flesh contraction and blanching of the skin for a few seconds,
followed by a gradual relaxation of the cutaneous vessels with
reddening. The pulse is at first slow, then gradually quick-
ens. The respiration is only slightly influenced at the b^in-
ning; later it is manifestly changed, especially in the case of
men, to the thoracic type. The body temperature, measured
under the tongue, shows a gradual rise to 104^ F., and even
above. This rise is produced not only by the retention of
heat, but also through its direct absorption. The^ rise
appears very quickly, often within six minutes. After leav-
ing the bath, the temperature rise generally continues to the
amount of .6° to 1° more; and does not return to the normal
until from one to two hours have passed. The arteries relax,
and the temporal artery becomes tortuous, as in arteriosclero-
sis. The pulse is full, and the pulse-curve high. Remaining
in the bath after the proper temperature is reached causes diz-
ziness and nausea. The albumin metabolism is, according to
this observer, not increased in the hot bath, as previously sup-
posed. Before leaving the bath, the bather generally pours
cold water over himself to prevent continued sweating.

It is generally supposed that after a hot bath one takes
cold very easily. Dr. Baltz claims, on the contrary, the very
opposite, namely, that it is impossible to take cold; that
taking cold occurs only after a tepid or warm bath whose
temperature is the same or lower than that of the body,
The very hot bath produces paralysis of the skin vessels,
which continues for some time, and prevents the vessels*
reacting to cold. The opinion that the very hot bath pro-
duces diminished resistance is disproved by daily experience
in Japan.

THE TECHNIQUE OF HYDROTHERAPY. 543

The author has obtained interesting information concern-
ing the Japanese baths from a friend, Dr. Swartz, who was
for many years a medical missionary in Japan, and through
long residence in the country and frequent attendance at the
baths, became able to enjoy them at as high a temperature
as the Japanese. Dr. Swartz testifies that the effect of the
bath is decidedly stimulating, and that no depressing effects
whatever follow its use. Some persons cool off the skin by
means of the cold bath after coming from the hot bathing
tanks, but natives may frequently be seen running through
the streets quite nude, even in very cold weather, without
any cooling appHcation; and yet it is asserted that they do
not take cold.

The effects of the bath at this very high temperature are
in many respects identical with those of the cold bath. This
is true, however, only during the application. After the hot
bath, certain atonic effects are apparent. Perspiration,
quickening of the pulse, and reddening of the skin continue
for a varying period; but sooner or later contraction of the
cutaneous vessels occurs, accompanied by dilatation of the
internal vessels. The heat production, which was tempo-
rarily increased, is now lessened, and the phenomena of
atonic reaction appear.

That the Japanese native does not take cold after this
extremely hot bathing, is probably due to the fact that the
temperature of both the skin and the blood is at so high a
point that ordinary and even extraordinary exposure does not
suffice to produce a chill either by lowering fhe temperature
or by cooling the peripheral nerve filaments. The cutaneous
vessels remain dilated for a long time after these extremely
hot baths, as the result of paralysis of the vasoconstrictors.
The cooling occasioned by evaporation takes place very
slowly; consequently the contraction of the peripheral vessels
and the resulting intense visceral congestion which introduces
the train of phenomena accompanying the condition known
as a **cold, " does not take place.

544 RATIONAL HYDROTHERAPY.

1188 Tbenpeutic Applicstioiu.^ — The hot immerrioii bath is
perhaps most useful as an eliminative or spoliative procedure.
The bath at 104^ to 1 10^ for 10 minutes, followed by a dry
pack, is a most efficient sweating procedure. This bath may
be advantageously employed in dropsy^ when excessive loss
of tone of the heart and blood-vessels, as indicated by gen-
eral cyanosis, is not present. It must be remembered, how-
ever, that in dropsy, when due to cardiac disease, the heart
is not able to bear the sudden shock of cold water, and con-
sequently the greatest care must be taken in cooling off the
patient after the hot bath. He should be wn^iped in a
Turkish sheet, covered with a blanket, and allowed to cool
off gradually in a room at a temperature of 65^ to 70^, or he
may be rubbed with the moist hand, or even tepid sponging
may be practiced when the skin is very hot and the tendency
to perspiration strong. To avoid chilling by evaporation,
only a small portion of the body should be uncovered at a
time during the sponging or rubbing. In treating patients
who chill very easily it may be necessary to do the rubbing
beneath the blanket. Very high temperatures should be
avoided in the hot immersion bath, because of the tendency
to excitation of the brain and heart. A temperature of 120^
is dangerous to life, and a bath at iio^ should not be con-
tinued more than 10 or 15 minutes.

The hot bath is also a powerful derivative. Baltz consid-
ered it a specific in the capillary bronchitis and bronchial
pneumonia of children, but found it of no benefit in croupous
pneumonia. It operates in these cases as a derivative meas-
ure, relieving the overfilled vessels of the lungs by congesting
the vessels of the skin and the muscles. Its effect is
manifested very quickly. The breathing at once becomes
easier, and the cough ceases. The temperature of the bath
in such cases should be 104° to 106^; its duration from 5 to
1 5 minutes. As soon as strong reddening of the skin appears,
the patient is removed from the bath. Such a bath may be
applied to children two to four times in the twenty-four hours,

TBS Tscimtoufi Of HYDRorimRApy. 545

as seems to be indicated. In cases in which the temperature
is very high, the child may be placed in the bath up to the
epigastrium while cold water is poured over the upper part of
the body.

The hot immersion bath has proved itself a very valuable
measure of treatment in cerebrospinal meningitis. The
temperature should be 103^ or 104^; duration from 10 to 15
minutes, the application to be repeated every three or four
hours. The head should be protected by a compress satu-
rated with ice-water, which should be frequently renewed,
or by cold irrigation or a cold coil.

In amenorrhea or in suppressed menstruation this bath
should be administered at loi^ to 105^; duration h^lf an
hour or more, at the time menstruation is due. It may be
repeated twice a day for two or three days in succession.
There is no more effective measure for dysmenorrhea with
scanty flow, a temperature of 102^ to 112^ being employed
for 15 minutes. The hot bath may also be administered in
painful menstruation when the flow is profuse; but when
employed in such a case, it should be of short duration, not
more than 3 or 4 minutes, at a temperature of 105° to 1 10^,
and should be immediately followed by the hot vaginal
douche at 104^.

In chronic bronchitis, a very hot bath, 5 to 7 minutes
in duration, accompanied by rubbing with the friction mitt,
relieves congestion of the mucous membrane; and when the
disease is complicated with asthma, generally affords prompt
relief from the distressing paroxysms. The patient should
be carefully cooled after the bath, and oil should be rubbed
upon the skin.

The hot bath at 102° to 106° may be very profitably
employed in chronic rheumattsm and obesity, being used
daily, or every other day, for 10 to 15 minutes. Rubbing
during the bath increases the beneficial effect in rheumatism,
by aiding circulatory reaction. Massage of the joints may
be practiced with great advantage during the hot bath.
35

546 RATIONAL HYDROTHERAPY.

Las^que* in his work upon •* Hot Baths'* recommends
the bath at a temperature of 113^ in rheumatism.

The hot bath should always be followed by a cold appU-
cation, which in cases of obesity should be very vigorous
and prolonged, as cold immersion or a cold shallow; but in
rheumatism the prolonged tepid or Scotch douche or cold
friction should be employed instead.

In the acute nephritis of scarlet fever the Scotch douche
affords the best means of relief from the renal congestion.
The temperature should be from 106° to iio^; duration, 10
minutes. It may be repeated two or three times in twenty-
four hours when the symptoms are urgent.

The daily hot bath affords relief from the intolerable itch-
ing of jaundice, and aids the skin as well as the kidneys in
ridding the system of the bile pigment with which the tissues
are poisoned. Gastric and intestinal colic are quite promptly
relieved by the bath at iio^ for 10 to 15 minutes, but in
cholera the cold friction bath succeeds better.

The relaxing effect of the hot bath is highly valuable as a
palliative measure in cases of gallstones and renal colic.
The effects of the bath may be increased by gentle massage
employed at the seat of pain in such a way as to aid the
movement of the calculi through the proper channel.

The intolerably depressing pain of cystitis yields promptly
to the very hot bath, but is greatly aggravated by cold; so
that gradual cooling at a neutral temperature is required.
Other measures must of course be employed to remove the
causes of the pain.

In musciilar rheumatism, the hot bath relieves pain by
encouraging the elimination of the toxins to which the pain
is due, as well as by direct revulsive or derivative effects.

The hot bath is an excellent means of preparing the skin
and the system at large for a cold bath in cases in which such
a preparation is necessary. The hot bath may be equally
well employed in cases in which an overdose of cold water

♦ Las^ue, Arch. Gen. de Med., 1874, p. 132.

f

THE TECHNIQUE OF HYDROTHERAPY. 547

has been inadvertently applied. It is well to remember that
heat is a perfect antidote (or cold, while cold is an equally
perfect antidote for excessive applications of heat, provided
no structural change has taken place.

In delirium tremens a short hot bath followed by cold
friction or a cold shower bath renders valuable service.

In the beginning of measles^ scarlet fever^ and other erup-
tive disorders, the hot bath often renders great service by
encouraging the development of the eruption.

In typhaid fever ^ when the patient is in a low state, and
in cases in which the circulation is sluggish, as indicated by
cyanosis, and when the nerve centers are depressed by the
profound toxemia present, the hot bath at 102^ to 106^ may
be advantageously employed for 3 to 5 minutes.* It should
be followed by cold afifusion, two or three gallons of water
being poured over the back and chest, with the patient sitting
up in the tub, or by general cold friction with the friction
mitt. The same measure is equally valuable under similar
conditions when occurring in measles, smallpox^ diphtheria^
and other febrile disorders.

Galen recommended the warm bath followed by rubbing
with cold water as a means of lowering the temperature in
fever.

In infantile convulsions the hot bath for 3 to 5 minutes,
followed by affusion consisting of a quart or two of water
poured over the patient's head and spine, is a powerful life*
saving means. Immediately after the affusion the child should
be wrapp)ed in warm blankets, so as to produce quick
reaction.

The very hot bath may also be used with very great
advantage in asphyxia of the newborn. The child should be
dipped in hot water for 15 to 20 seconds, then cold water
dashed over it, while artificial respiration is practiced.

Tarnier recommends the hot bath (100° to 104°) for 40
minutes as a successful means of combating the profuse
vaginal discharge which so often occurs in nursing mothers

548 RATIONAL HYDROTHERAPY.

of feeble constitution. The continued and obstinate bloody
discharge which often occurs under the same conditions like-
wise yields to this measure. A brief application of cold
friction should follow the bath.

1129 Contraindications — The hot bath must be avoided in
cases of organic disease of the 'brain or spinal cord, as tabes^
sclerosis^ and viyelitis; in cases of cardiac weakness and
cardiac hypertrophy ; in arteriosclerosis ; and in threatened
or existing cerebral apoplexy. If employed at all in cases of
chronic nephritis, it should be with the greatest care and
precaution to prevent subsequent chilling, and resulting vis-
ceral congestion with an increase of renal inflammation.

It should be remembered, also, that in the employment
of the hot tath the body temperature is rapidly increased.
Hot baths are naturally contraindicated in febrile disorders,
except in certain adynamic states; and even then the hot
immersion bath will rarely be called for, other procedures
being preferable and safer. If for any reason it seems neces-
sary to employ the hot bath in a febrile case, the application
must necessarily be very brief (3 to 4 minutes), to avoid
undue elevation of temperature.

THE NEUTRAL BATH.

1130 This is simply a full bath at the temperature of 92^ to
97^, administered in the usual manner. For a discussion of
the general properties of the neutral bath, see paragraph 717.

Method. — Friction should not be administered, unless it
be very gentle rubbing when the patient first enters the bath,
if he feels a slight inclination to chill. Chill will not occur,
however, if the temperature of the bath is properly adjusted
to the patient's conditions. The average temperature of the
bath should be 94^ or 95^. When the patient is feverish and
the skin hot and flushed, even though there be no rise of
temperature, the temperature of the bath may be 92^ or 93°.
If the patient is thin and bloodless, with small heat-making
capacity, the temperature of the bath should be 96^ or 97'^.

.THE TECHNIQUE OP HYDROTHERAPY. 549

All mechanical effects should be avoided after as well as
during this bath» as its purpose is to secure calmative or seda-
tive effects. The duration of the bath when applied for relief
of insomnia, should be from 1 5 minutes to one hour. When
used for the reduction of temperature, however, it may be
continued for a much longer time, as three to four hours; and
in certain cases of acute mania^ obstinate insomnia, ox fever ^
it may be continued for several hours consecutively, at a
temperature of 92^ or 93^. In certain traumatic cases, it
may even be continued for weeks or months, the patient
being removed only for urination and defecation (1136).

Physiological Effects — Kuhn, of Niederbronn,* first scien- 1181
tifically described the interesting characteristics of the neutral
bath. He considered a bath as neutral when of such a tem-
perature that it abstracts from the part immersed exactly the
same quantity of heat that the part naturally receives from
the blood. The neutral point, according to this authority, is
the physiological zero. Below this point water is absorbed;
above, it is exhaled. Both the -absorption and the exhalation
increase in proportion as the temperature of the body varies
from the neutral point. This is usually 93^ to 94°. This
point marks, then, the limit where absorption ceases and exha-
lation begins. He also noted that fresh water, in determin-
ing the more or less rapid imbibition of water by the skin,
promotes the cutaneous reaction which plays so important
a r61e in hydriatic treatment. The reaction in fhis case is
increased according to the coldness and purity of the water.
Cold or cool baths, by introducing cool water into the blood
mass, render the blood more aqueous, diminishing its density,
and thus acting as a sedative. The purer the water, the more
calming are the effects of the bath on account of the greater
amount of water absorbed. The neutral point is not fixed.
It is solely and entirely regulated by the individual sensation.
There is a certain equilibrium between the heat subtracted
and the heat produced in normal conditions. It varies a little

'Monograph, Paris, 1854.

5 so RATIONAL HYDROTHERAPY.

according to the constitution of individuals, and the disease,
and especially with the refrigerating power of the surrounding
medium; that is, it is always more elevated when the water
is charged with salts than with pure water. In other words,
salt-water baths can be taken at a lower temperature than
fresh-water baths, since the former stimulate heat production
more than do the latter at the same temperature.

The neutral bath diminishes the pulse-rate, but does not
modify the respiration. Exhalation by the skin is suspended,
so that water accumulates in the tissues. It is in this way
the cutaneous nerves become supersaturated with water, rather
than by absorption of water from the bath. At the neutral
point, there is then practically no movement of fluids either
inward or outward. The urine is greatly increased in quantity;
while its acidity is decreased; it may even become alkaline.

The temperature and mode of administration of the neutral
bath are such that neither thermic nor circulatory reaction is
produced. The bath may consequently be prolonged for an
almost indefinite period without producing exhaustion or any
other untoward effects. When the bath is prolonged for a
considerable period, the patient should be suspended in a sort
of hammock consisting of a sheet let down into the tub and
secured to the edges, and should be made comfortable by
means of an air pillow. The temperature of the neutral bath
may be maintained uniform by placing covers over the tub,
and addiiJg jugs or bottles filled with hot water as often as
may be necessary; or a portion of the water may be removed
from time to time, and replaced with water at a higher tem-
perature. When the temperature of the surrounding atmos-
phere is such as to prevent cooling, so that the bath is warmed
by the heat of the body, it may be necessary to add cooler
water occasionally to prevent elevation of temperature,
whereby the bath would cease to be neutral in its effects.
This bath depends for its good effects entirely upon the
careful adjustment of the temperature within the limits
named, 92*^ to 97° F.

THE TECHNIQUE OF HYDROTHERAPY. 55 1

The physiological effects of this bath are to lessen nerve
sensibility, and Kolliker, Hyman, and Krebs have shown
that the absorption of water by the nerve filaments accom-
plishes this. That an anemic or bloodless skin is more
sensitive than a congested skin has long been a matter of
observation, but it is only recently that the actual demonstra-
tion has been afforded by the experiments of the investigators
named. The protection afforded the central nervous system
against reflex irritation of all sorts by a perfectly neutral medium
contributes to the sedative effects of the neutral bath.

The neutral bath is the most purely sedative procedure
afforded by the whole range of hydriatic measures. The
neutral douche produces very similar results. Its influence is
strongly derivative through the circulatory reaction induced
by the mechanical effects. The neutral bath excites activity
of both the skin and the kidneys to a marked degree.

The neutral full bath, as well as other baths near or above
the body temperature, is followed by a decided lowering of the
surface temperature. The internal temperature remaining
normal, it is evident that there must be a decided reduction
in the rate of heat production. The surface temperature
sometimes falls as much as six degrees, which would indi-
cate a lessened heat loss amounting to nearly 25 per cent,
and a corresponding decrease of heat production. In the case
of the neutral bath, this effect is not due to atonic thermic
reaction, as when an application above the temperature of
the body is made to the skin, but must result simply from
the cutting off of those reflex influences due to contact
with the skin of air at a temperature below that of the
body, thus annulling one of the important factors in main-
taining the activity of the thermogenetic processes in
the muscles. This effect of the neutral bath necessitates
special care to avoid chilling of the patient by exposure to
cold air. The patient should generally recline for an hour
after the bath, covered sufficiently to prevent chill, but with-
out overheating.

552 RATIONAL HYDROTHERAPY.

1132 Therapeutic Applications — At the quaint and interesting
old bathing resort at Leukerbad, Switzerland, which the
author visited in 1883, he foond still in use the S3rsteni of
immersion in water at a neutral temperature which has there
been employed during several generations in the treatment
of a large class of chronic disorders, including skin affections
of various kinds. The patients enter the bath about 6 or 7
o'clock in the morning, without breakfast, and remain
immersed up to the chin until about i p. m. The accom-
panying cut (Fig. 65) represents scenes such as may be daily
observed.

Riess applied the neutral bath in a large number of cases
of organic disease of the brain and cord, including fiarap/e^ia,
locomotor ataxia, chronic inflammation of both brain and
cord, especially in meningitis, in rheumatism deformans, and
in various other chronic affections. His success was so great
as to give good reason for the belief that this procedure pre-
sents valuable therapeutic value in cases of this sort The
author's experience with the continued neutral bath has been
sufficient to convince him of its great value.

It is interesting to note that Currie'"' had a thorough
appreciation of the value of the neutral bath, which he
employed at 90^ to 95^. He recommended it **when the
Jtrength is wasted by fatigue and perspiration." He re-
marked, *'In the degrees in which it does not quicken the
circulation, the warm bath is soothing and sedative, especially
when the immersion is prolonged; and it is the temperature
from 90^ to 95- that is so singularly restorative for fatigue."

The neutral bath, continued for thirty to sixty minutes, or
even longer, renders great service in general dropsy, whether
due to cardiac or renal disease, especially in cases in which
more vigorous measures can not well be employed. It also
renders valuable service in chronic sciatica accompanied by
severe pain, as a means of continuing the good effects ob-
tained in the use of other measures, such as the Scotch

*Curric's ''Medical Reports," pp. 194-196.

THE TECHNIQUE OF HYDROTHERAPY. 553

douche, the prolonged fomentation, the revulsive compress,
massage, electricity, and other well-known means.

In insomnia there is practically no single measure of treat- 1133
ment so valuable as the neutral bath. For this class of
patients the bath should be administered at bedtime. The
patient often becomes drowsy in the bath, and may fall
asleep. He may be allowed to sleep in the bath for several
hours if it is found that removal counteracts its hypnotic
effect, which is not infrequently the case. The sleeping
patient must be carefully watched, however, to see that the
head is not submerged.

On removal from the bath, in cases of insomnia, great
care should be taken to avoid chilling of the surface by
evaporation. The patient should be instantly wrapped in a ,
Turkish sheet and woolen blankets, and should be dried by
gentle patting of the sheet or blanket, and without rubbing
either with the sheet or with the dry hand, being afterward
placed in bed as quickly as possible, and his surroundings
made in every way conducive to sleep, so that the good effects
of the bath may not be lost by excitation of the nervous sys-
tem by unfavorable conditions.

It will be interesting to recall the fact that Hippocrates
well appreciated the neutral bath as a means of inducing
sleep.

In multiple neuritis, apoplexy, and in the treatment of
the alcohol, opium, cocaine, and chloral habits, the sedative
effects of the neutral bath arc of immense service. In cases
of this sort it is generally necessary to employ a temperature
of 95^ to 97^. The influence of a difference of two or three
degrees, or even of a single degree, is quite surprising to a
person who is not thoroughly acquainted with the singular
potency of hydriatic measures, when employed with exactness.

Vigoroux * recommends the neutral bath for one to three
hours for neurasthenics and rheumatics. This author strongly
condemns the cold douche in these cases, as he finds the

♦Vigoroux, *' Neuraslhcnie ct Arlhritisine," p. 308.

554 RATIONAL HYDROTHERAPY.

urine of neurasthenics, as of rheumatics, acid, which denotes
deficient oxidation, notwithstanding the total amount of the
products of excrementitious waste is deficient.

When there is a tendency to heart failure in the use of
the warm bath, in cases of cardiac insufficiency, or after the
withdrawal of opium or other drugs, this inconvenience may
be wholly overcome by the use of the ice-bag over the heart
during the bath. An application to the head and neck is also
necessary in cases of this sort when a temperature approxi-
mating that of the body is employed. The value of the
neutral bath in the affections mentioned is largely due to its
action upon the kidneys, the activity of which it encourages
to a high degree, while at the same time it quiets the irritated
•brain and cord. This purification of the blood through
increased renal and cutaneous activity improves general vital
action, and gives this bath decided restorative as well as
sedative effects.

The neutral bath is of great value in chronic diarrhea,
peritonitis, and other chronic affections of the abdomen, and
especially those in which the patient is in a condition to inter-
dict the employment of very hot or very cold baths. In such
cases it may be employed daily for i 5 to 30 minutes. It is
also of value in cases of toxemia, which is so commonly pres-
ent in chronic dyspepsia, and in pruritus without eruption,
either with or without jaundice, also in the several forms of
urticaria.

The neutral bath is often employed in connection with
electricity. The author has for more than twenty years
made extensive use of this bath as a means of making gen-
eral applications of the galvanic, faradic, and sinusoidal cur-
rents. This subject will be treated more fully under the
head of Electro-Hydric Baths (1457).
1134 The neutral bath may be employed as an antipyretic and

antifebrile measure in contijiucd fevers, and is especially
serviceable for infants, old persons, and others with a feeble
constitution, or in cases which have been neglected in the

THE TECHNIQUE OF HYDROTHERAPY,

555

early stages until the patient has reached so low a state that
the cold bath is interdicted because the nerve centers have
not enough vitaUty left to react to so heroic a measure.
When employed for this purpose, the temperature of the
bath at the beginning should be gS'^p and should be rapidly
lowered to 92*^ or even 90°, when it should be prolonged for
half an hour to two hours. The length of the bath should
be not more than 10 minutes for very aged persons, and 5 to
ID minutes for infants, but should be repeated every two
hours, or whenever the temperature reaches 100^ to 102^^,

The neutral bath is especially indicated in disorders of the
nervous system and of the heart and blood-vessels. Arterio-
sclerosis gives rise to deterioration in the central nervous
system as well as elsewhere. From deficient flushing of the
parts with healthy blood, tissue deterioration begins; and the
disorder is then rapidly intensified by the accumulation of
tissue poisons in the part, and degeneration of the blood-
vessels takes place with great rapidity* Long-continued con-
traction of the blood-vessels gives rise to a disturbance in the
nutrition of their walls, which finally results in relaxation and
paralysis, and the local disorder becomes fixed.

Either very cold or very hot applications must be avoided
in cases of chronic disease of the central nervous system,
because of the diseased condition of the vessels, which are
overworked, and liable to rupture under the strain of the
sudden inrush of blood in the general retrostasis accompany-
ing applications to the whole surface, and in the collateral
hyperemia resulting from very cold applications to the back.
As a rule, a temperature below 70 - or above i lO"^ is not use-
ful in the treatment of organic nervous disorders. Partial
cold friction may be employed in these cases, but general
applications should be at temperatures not far removed from
the body temperature, or 85^ to I04'^,

Contraindications.— About the only contraindication for
the neutral bath is the presence of some morbid condition to
which the application of water may be inappropriate or inju-

113S

556 RATIONAL HYDROTHERAPY.

rious. In certain cases of eczema and some other forms of
skin disease, water aggravates the symptoms. Also in great
cardiac weakness, and in certain cases of neurasthenia^ the
neutral bath is depressing, and must be avoided, or at least
employed with exceeding care and caution, and accompanied
by supplementary procedures, such as cold friction, the wet-
sheet rub, and the cold precordial compress over the heart.

THE CONTINUOUS BATH.

1136 The continuous bath (Fig. 66) is simply a neutral bath
prolonged for many hours, days, weeks, or months, as the
case may require.

Method. — A suitable bath-tub must be provided, and
should be placed in a well-ventilated and convenient apart-
ment with suitable arrangements for changing the water as
may be required for cleanliness and regulation of the tem-
perature. The ordinary bath-tub, without accessories, will
not answer the purpose, for the reason that the patient soon
becomes weary with the effort to support himself, or is incon-
venienced by the pressure of his tissues against the hard
metal or porcelain surfaces of the tub. The arrangement
should be such that the patient may be as fully as possible
at ease. This requires that he should be suspended by some
arrangement resembling a hammock. A closely woven ham-
mock, covered with a blanket, may be used for the purpose,
or a strong linen sheet may be employed. The hammock
may be suspended from hooks attached to the walls of the
room, being allowed to sag into the bath-tub sufficiently to
submerge the patient. The sheet may be supported in
proper position by means of a frame with pegs or holes
properly adjusted to the top of the tub. By means of strong
tapes attached to the sheet, it may be fastened to the frame
in such a way as to maintain the patient's body in the most
comfortable and restful position.

In emergency, and while better arrangements are being
perfected, the patient may be made comparatively comfort-

:m-

'#

THE TECHNIQUE OF HYDROTHERAPY. 55/

able by means of one or more blankets folded and placed in
the bottom of an ordinary bath-tub, or better still, by means
of air pillows filled with water of the same temperature as
the bath, or several large water-bags placed in the bottom
of the tub so as to support the hips, shoulders, and heels.
Pillow-cases filled with excelsior, such as is used for mat-
tresses, or curled hair, may be employed in the same way.
The head should be properly supported, and care should be
taken that the shoulders are constantly covered with water
to prevent chilling by evaporation and the consequent pul-
monary congestion which is almost certain to result from
prolonged cooling of these important reflex areas.

The temperature of the water should be 94° to 95°, the
average neutral temperature. On first entering the bath, the
patient may be very gently rubbed for one or two minutes, to
prevent the preliminary contraction of the cutaneous vessels
which sometimes occasions at first a slight disturbance oi the
general circulation. The temperature of the bath may be
maintained by dipping out a portion of the water from time
to time, and adding either hot or cold water, as may be
required to bring the temperature to the neutral point. By
covering the bath, cooling by evaporation may be prevented,
and the necessary reduction in temperature may be readily
effected by putting into the bath bottles or jugs filled with
ice-water. A jug containing three quarts of ice-water will
lower the temperature of a forty-gallon bath one degree.

The duration of the bath will differ according to the char-
acter of the case. When employed for temperature reduc-
tion or to control delirium, pain, peripheral hyperesthesia,
nervous excitability, or mania, a few hours (at most ten or
twelve hours) will usually suffice to accomplish the result
desired. In continued fevers, and in organic affections of the
brain and spinal cord, for which the bath may be employed,
it is sufficient in most cases to keep the patient in the bath
during the greater part of the day, allowing him to rest in
bed at night. But in cases of extensive burns, bed-sores,

558 RATIONAL HYDROTHERAPY.

and certain forms of skin disease, it is often necessary to
make the bath absolutely continuous, removing the patient
only long enough at proper intervals to allow opportunity for
evacuation of the bowels and bladder. In a few instances,
the bath has been continued for an entire year, and even
longer. There is no reason why life might not be prolonged
indefinitely in this bath so far as the normal performance of
all the vital functions of the body is concerned, as the bath
interferes with no vital process. The water of the bath
should be entirely changed every twenty-four hours.

1137 Physiological Effects. — Riess, who made a careful study
of this bath in the city hospital of Berlin, in the years 1874
to 1876, maintained that the physiological effects of the bath
are negative, affecting neither pulse, temperature, nor respira-
tion. More recent observations have, however, shown that
the pulse is slowed by the bath, and that other bodily func-
tions are affected, if not profoundly, at least to a noticeable
and important extent. As in the neutral bath, the cutaneous
nerves imbibe moisture, not through the absorption of water
from the bath, but by retention of water through the suspen-
sion of perspiration. The urine is noticeably increased in
quantity, and becomes less acid or even alkaline. The higher
the temperature of the bath, the greater the alkalinity, as
shown by Jardet. At the neutral temperature there is prac-
tically no absorption of water nor of substances contained in
the water. There is only suspended perspiration.

1138 Tlierapeutic Applications. — Hebra was one of the first
among scientifically trained physicians to make use of the con-
tinuous bath.* When studying skin diseases in Vienna with
Hebra, Jr., and Professor Kaposi, Hebra's successor in 1883,
the author found the continuous bath in systematic use. One
patient then in the hospital had been in the bath more than a
year. Hebra reported five hundred cases, — of variola, pem^
phigus, burns, 2SiA gangrene of the skin, — and showed that
most excellent results were obtainable by this therapeutic
procedure.

♦Hebra, Wien, Med. Woch,, 1877, also 1865, pp. 893, 920, 940.

THE TECHNIQUE OF HYDROTHERAPY. 559

Passavanty of Frankfort, reports most gratifying success
in the treatment of extensive burns with the continuous bath.
According to his experience, pain is almost instantly relieved
by immersion in the neutral bath, the patient remaining com-
fortable so long as submerged.

Riess,* of Berlin, made a special study of the influence
of the continuous bath upon internal maladies of various
sorts, as well as in the treatment of typhoid and other fevers.
In the treatment of over eight hundred cases of typhoid
fever he secured a death-rate of 8. 5, a much better record
than that shown by the statistics of any other hospital in the
city. He employed a temperature of 88^ in fever cases, and
administered the bath whenever the temperature rose to
102°, keeping the patient in the bath continuously until the
temperature was brought down to 100^, and returning him
to the bath as soon as the original temperature was reached.
The continuous tepid bath presents the following advantages
over the cold bath, as shown by Riess, together with some
possible disadvantages : —

1. It is less disagreeable to the patient; indeed, it occa-
sions him no inconvenience, and is generally welcomed, while
the cold bath is received only under vigorous protest.

2. It involves no risk of injury to the heart in cardiac
weakness, nor to the brain in arteriosclerosis, and can be
used in many cases in which the cold bath must be interdicted.

3. It affords more prompt relief to cerebral and nervous
symptoms, these features, when present, disappearing almost
altogether with the first bath.

4. Cyanosis and other evidences of disturbance of the
circulation do not occur.

5. The temperature is reduced slowly, hence temperature
reduction is more permanent, there being no increased heat
production by thermic reaction.

6. The duration of the disease is decidedly shortened, the

^ Riess, Arch, fur Klin. Med., 1889, 1890.

560 RATIOKAL HYDROTHERAW.

average stay in the hospital, with Riess's eight hundred cases,
being less than eighteen days.

7. All the symptoms of the disease are mitigated to a
marked degree.

8. The labor of caring for the patient is greatly lessened,
which is a boon to the patient as well as to the attendant.

It is true that the continued bath does not afford that
degree of cardiac stimulation or excitation of vital resistance
which is developed by the cold bath; but this is largely com-
pensated for by the increased activity of the kidneys and skin
which is secured by the continuous bath, a fact of primary
importance, since the symptoms of cardiac weakness which
are often so pronounced in continued fevers, are to be properly
attributed not so much to actual exhaustion of the heart as to
the profoundly depressing effects of the toxins characteristic
of the special malady present and the retention of tissue
wastes resulting from diminished oxidation. When desired,
however, any required degree of cardiac or general vital stim-
ulation may be secured by the occasional application of the
Brand bath, when not contraindicated, or by the cold fric-
tion, the cold-towel rub, or the cold wet rubbing sheet in bed.

The large clinical experience of Riess showed that the
continuous bath possesses powerful curative virtues in all
affections of the brain and the spinal cord which are at all
curable, as in cases of exudate from inflammations, as in
mcnifigitis, and mitigates the symptoms to a wonderful degree
even in the most intractable and incurable cases. The meas-
ure proved decidedly beneficial in cases of spinal sclerosis,
locomotor ataxia, paraplegia, hemiplegia, apoplexy, and
chorea. It was found equally helpful in the treatment of
intractable sciatica and cutaneous hyperesthesias, affecting
a cure in cases which had resisted all other measures. In
delirium and mania, it exercised a phenomenal sedative
effect, was highly beneficial in dropsy and in chronic diar-
rhea, and afforded excellent results in chronic rheumatism.
No remedy has been found more useful in bed-sores. Its

THE TECHNIQUE OF HYDROTHERAPY. 56I

results in other functional nervous disorders suggest its pos-
sible value in epilepsy.

Dauche2* reports complete relief from hysteria with
extremely grave gastric symptoms. The patient was immedi-
ately relieved by the tepid bath in four to eight hours, and in
three weeks was well.

The principal patrons of Leukerbad, Switzerland, where
the neutral bath is administered to many scores of persons in
great tanks for several hours a day, are irritable neurasthen-
ics, rheumatics, and persons suffering from psoriasis and
eczema. That many are cured is evident from the. fact that
these famous old baths still retain their popularity, notwith-
standing their comparative inaccessibility, and the powerful
competition of the more fashionable resorts in Germany and
Bohemia. When the author visited these baths, some seven-
teen years ago, although the season had yet scarcely opened,
multitudes were already flocking there, to avail themselves
of what they supposed to be the specific virtues of the min-
eral ingredients of the bath, by which, however, they were
not at all likely to be benefited, since at the temperature at
which the baths are ^iven (95^ to 98^) the movement of fluids
is toward the surface of the body, so that absorption can not
take place to any appreciable degree.

The partial continuous bath, which renders such signal
service in certain surgical cases, will receive attention else-
where in this work (1303).

Hebra employed the continuous neutral bath for many
days, and even months, in hundreds of cases of skin disease s,
especially in pemphigus and extensive burns. When the
continuous neutral bath is to be employed, the precaution
should be taken to rub the skin with vaseline at least once
a day, to avoid unpleasant effects from the prolonged macera-
tion of the skin in water.

In employinp^ the continuous bath, care should be taken

* Hull. Gen. de Therap.y 1884, p. 153.
36

562 RATIONAL HYDROTHBRAPy.

to apply oil or vaseline to the surbce of the body to avcud
excessive maceration of the skin.

The continuons bath is certainly a hydriatic procedure of
great value, and one worthy of more attention than it has
received from the profession in this country.

THB BPPBRVBSCBNT BATH.

1189 This consists of a full bath the water of which contains
chloride of calcium, carbonate of soda, and carbonic acid gas.
The effervescent bath is administered at the famous resort
of Nauheim, Germany, by the aid of natural mineral water,
which is heavily charged with carbonic acid gas, and contains
in solution a large amount of chloride of calcium. The
author was, through the courtly of Dr. Schott, afforded an
excellent opportunity of studying this bath and its effects at
the principal bathing houses at Nauheim; and having for a
number of years made use of the artificial Nauheim bath in
a similar manner at the Battle Creek Sanitarium, he feels
confident that just as good effects are obtainable from the
artificially prepared bath as from the natural mineral water
of Nauheim.

1140 An artificial effervescent or Nauheim bath may be pre-
pared by adding to ordinary water, carbonate of soda, chlo-
ride of calcium, chloride of sodium, and hydrocholoric acid, in
proper proportions. The effects obtained from a bath thus
prepared are practically identical with those obtained from
the use of the natural Nauheim water.

Method. — The bath is given in three grades, the intensity
and stimulating effect of which are progressively increased
with the increasing proportion of the chemical substances
which they contain. The composition of these several grades
is as follows for a bath of forty gallons: —

I. Chloride of sodium, 4 lbs.; chloride of calcium, 8 lbs.;
sodium bicarbonate, jf^ lb.; to which is added commercial
hydrochloric acid (25 per cent), ^ lb.

THE TECHNIQUE OF HYDROTHERAPY. 563

2. Chloride of sodium, 8 lbs.; chloride of calcium, I3
lbs.; sodium bicarbonate, i lb.; commercial hydrochloric
acid, i}i lbs.

3. Chloride of sodium, 12 lbs.; chloride of calcium, 30
lbs.; sodium bicarbonate, 2 lbs.; commercial hydrochloric
acid, 3 lbs.

When a copper tub is employed, the amount of bicarbon-
ate of soda must be increased about one fourth, to protect
the copper from the action of the hydrochloric acid.

In the preparation of the bath, the chloride of sodium,
chloride of calcium, and bicarbonate of soda are first dis-
solved in the water, and the hydrochloric acid, the quantity
of which should be fifty per cent, greater than the bicarbon-
ate of soda, is then added. The effervescence may be pro-
duced rapidly or slowly, as desired.

For slow effervescence, place the bottle containing the
acid, with stopper removed, at the bottom of the bath, lay-
ing it down upon the bottom, and moving it around from
time to time. The bath will be ready in two or three hours.
For rapid effervescence, invert the bottle without removing
the stopper, place the mouth of the bottle just below the sur-
face of the water, withdraw the stopper, and move the bot-
tle about over the surface of the bath, so as to distribute
a uniform layer of acid. By this means, the bath may be
prepared in five minutes. Its temperature should be 92*^ F.

Hydrochloric acid may be dispensed with by employing 1141
the substances indicated in the formula given on the next
page, the intensity of the application being regulated by the
number of powders used, one, two, or three powders being
employed, according to the effect desired. The powders are
graduated in such a way as to give three degrees of cutaneous
stimulation, according to the strength of the solution formed
by dissolving them in the water of an ordinary full bath.
No harm is done to tin-lined copper tubs.

564 RATIONAL HYDROTHERAPY.

FORMULA FOR ONE POWDER.

9

Sodinm carb. (sal-soda) zX lbs.

Sodium bicarb >l( lb.

Cakiiun chloride 3 lbs.

Sodium chloride. a lbs.

Sodium bisulphate i lb.

Mix and dissolve the first four ingredients ; then add
slowly the sodium bisulphate, which should be kept by itself.
It is not desirable to produce very marked effervescence, but
rather to secure the saturation of the water of the bath
with CO,.

The carbonic add gas is produced by this formula very
slowly, so that it is nearly all absorbed by the water, thus
making the method an economical one. It should be remem-
bered that it is the CO, dissolved in the water, and not that
which escapes by effervescence, that produces the desired
effect upon the skin.

Generally the bath should be taken two or three days in
succession each week, then one day's respite be allowed. With
persons in good strength, four or five successive baths may
be given.
1142 Physiological Effects.— In the effervescent bath the thermic
and circulatory reactions produced by an ordinary water bath
at the same temperature is supplemented by powerful reflex
vasomotor effects resulting from the irritation or stimulation
of the skin by the carbonic acid gas, the chloride of calcium,
and the chloride of sodium in solution in the water. Chlo-
ride of calcium and CO, are by far the most active of
the several chemical substances present. These substances
stimulate the cutaneous circulation to a high degree without
provoking thermic reaction, and in this way a powerful de-
rivative or revulsive effect is produced. The viscera are
relieved of congestion; the activity of the peripheral vessels
greatly lessens the labor of the heart, and secures a better
distribution and more active movement of the blood through-

THE TECHNIQUE OF HYDROTHERAPY.

out the body; the skin is stimulated to increas4
thus lessening the labor of the kidneys.

Therapeutic Applications.— The increased activity
surface circulation, through dilatation of the cutanec
vessels, produces a powerful derivative and revulsi
upon the viscera. In this respect the effervescent
neutral temperature accomplishes the same result as
very hot bath or the Scotch douche, and has the :
that the extreme temperature is avoided, a matter of
portance in cases of airtiiac weakness with diiaiatian
chronic nephriiis^ since in both these cases very hot t
cold baths must be avoided. In ti^mkness of ihe hea
baths are contraindicated because of the harmful exci'
first produced and the secondary depressing effect,
baths are equally damaging because of the increased
brought upon the heart by the contraction of the cuta;
vessels before reaction appears. In cases of renal A
the diseased organs are likely to suffer serious injury fro
temporary congestion resulting from the contraction
surface vessels.

An ordinary water bath at a neutral temperature is
pable of calling into activity the reflexes essential for decided
revulsive or derivative effects. By the warming of the skin
through the strong circulatory reaction produced, a lower tem-
perature is tolerated without shivering, and thus a decided
tonic effect upon the heart and vessels is realized from the
neutral bath, a fact of much importance in the treatment of
cases of cardiac insufficiency with dilatation. The author has
for more than a quarter of a century been decidedly opposed
to the use of mineral waters of all descriptions, as wholly
unscientific in principle; but from his personal experience at
Nauheim, he feels compelled to admit that, in this one inst^uice
at least, the presence of mineral salts in the water effects cer-
tain advantageous results worthy of recognition; and the
effervescent bath has given, in his hands, most excellent
results, even in some very extreme cases of cardiac disease

566 RATIONAL HYDROTHERAPY.

with dilatation. Dropsy soon disappears, the heart lessens
its volume, sometimes to the extent of one fourth its sice
daring a single bath, and all the symptoms improve, many
times to the extent of complete disappearance. Equally good
results are obtained in renal affections. Not infrequently
albumin disappears entirely from the urine, and dropsical and
other symptoms also disappear, so that the patient is brought
to a condition of comparative health. Graduated manual
Swedish movements and a special dietary must be employed
in connection with the baths.

Schott,* who has made a study of the Nauheim baths for
more than twenty years, claims them to be very efficient in
the cure of cardiac and renal cases. He has even seen old
valvular murmurs, disappear entirely under treatment by these
baths.

In illustration of the power of the effervescent bath to
influence the dilated heart in a favorable way, several illus-
trations are presented herewith, showing the diminution in
size which may be secured by this means, and that often in a
remarkably short space of time (Figs. 67, 68, 69). The
author has seen the area of cardiac dulness diminish nearly
an inch in diameter after an effervescent bath in a case of
marked cardiac dilatation and loss of compensation.
1 144 Precautions. — In the employment of the effervescent bath,
care should be taken to avoid exhausting the patient, espe-
cially in cases of cardiac disease. The breathing of the patient
should be quiet when the bath is entered. If considerable
dyspnea is present from walking to the bath, the breathing
should be allowed to become tranquil before the bath is
administered. The chest should be wet before entering the
bath, and the limbs should be well rubbed during the process.
With very feeble patients, this bath should be administered
only every other day. To those a little stronger it may be
given two or three days in succession, but even the strongest

•Bldtter Klin, WocK^ iSSo, 17, 35, 7-9, 372, 4. Medical Record, March II
1899. p. 345.

Viz

67. Outline of Dilatci Heart, (a) before Treatment;
(A') after Treatment (p. 566).

7itH

Fig. 6S. Outline of Dilated Heart (A) before and (A') af
Kffervescerit Hath (p. 566).

l-ig. 69. Outline of Dilated Heart (A) before and (B) after
Effervescent Bath (p. 566).

<

THE TECHNIQUE OF HYDROTHERAPV-

567

patient should oot take more than three baths in succession
without a day*s interval.

At the beginning and before the patient's sasceptibility is
known, it is best to start with the mildest bath, increasing
the quantity of the chemical ingredients as he becomes accus-
tomed to the measure. In the case of very sensitive persons^
the temperature may be made a little higher (94^ or 9S^).
It is important that the patient should not become chilled
during the bath,

THE SURGE BATH.

This bath is given in a rocking tub (Fig. 70). The tem-
perature of the water employed should be from 60^ to 75^.
The effects are intermediate between those of the ordinary
full bath at the temperature named and the sea bath. Reac-
tion occurs more quickly than in the ordinary full bath,
allowing the use of a temperature from five to eight degrees
lower

Therapeutic Applications. — The surge bath at 60^ for 15
or 20 seconds is a powerfully tonic measure, well adapted to
robust patients. The bath should be used following a heat-
ing bath of some sort, as the wet-sheet pack, an electric-light
bath, a hot shower, or some similar procedure,

g^A BATHS.

The sea bath is a measure of great value from both a
hygienic and a therapeutic standpoint. Under this head we
may consider the swimming b^th, and baths taken in natural
bodies of water, whether in lakes, rivers, or the sea*

Method — ^The sea bath may be a simple immersion, or a
swimming bath in which the effects of the bath are combined
with exercise. The length of the bath must depend upon
the temperature of the water, and upon the individual's sus-
ceptibility, or whether he has been accustomed to the baths.
Ordinarily, the duration of the bath at first should not be
more than 3 to 5 minutes. Later, it may be increased to 20

1145

1146

1147

568 RATIONAL HYDROTHERAPY.

or 30 minutes, but should seldom be longer than this. The
effects of the sea bath are essentially those of the full bath
at a slightly higher temperature. The saline constituents of
sea water encourage circulatory reaction, as does also the
exercise which is commonly taken with the bath.
1148 Therapeutic Applications. — This bath is especially useful
as a tonic or restorative measure, for which purpose it is
employed by many thousands of people who visit seaside
resorts during the summer season. Many persons are injured
by the sea bath through neglect of the common rules which
should always be observed with reference to cold bathing.
The following precautions are especially important: —

1. The bath should not be taken within an hour before or
after eating a meal.

2. The bath should not be taken when a person is ex-
hausted from either mental or muscular effort, or through loss
of sleep, or if he is nervously weak from any other cause.

3. On first entering the water, a slight chill occurs, which,
however, quickly disappears as reaction sets in. The bather
should not remain in the water until the second chill appears,
as the reaction from the second chill will be imperfect, and
the result will be languor, lassitude, stiffness in the muscles
and joints, and depression with possibly various nervous symp-
toms. Gentle rubbing must be continuous to prevent chill.

4. When the bather emerges from the water, he should
receive a spray or shower douche at a temperature ten or
hftcen degrees below the temperature of the sea, and should
afterward be thoroughly dried and vigorously rubbed. The
cold douche following the bath should be of short duration,
not more than 3 or 4 seconds.

5. The bather should dry quickly, and afterward exercise
with moderate vigor for i 5 or 20 minutes, or until the circu-
lation is thoroughly established.

If the bath is succeeded by cold feet or hands, headache,
chilliness, lassitude, sleepiness, or other unpleasant symptoms,
it is probable that it was too long continued, or that some of
the foregoing rules have been violated.

THE TECHNIQUE OF HYDROTHERAPY. 569

MUD BATHS.

In this bath, the patient Hes in a tub surrounded with 1149
mud of about the consistency of thick gruel or mush. The
muds used for this purpose usually contain saline and alkaline
substances, which act upon the skin, stimulating the per-
ipheral circulation. The effects of course vary somewhat
according to the ingredients of the particular mud employed.
The mineral substances are not absorbed from the mud, as is
geqjerally supposed, but simply act upon the skin. The effect
is consequently in some cases similar to that of the effer-
vescent bath.

Therapeutic Applications. — The mud bath is most often
employed in cases of rheumatism and gout. Many persons
are doubtless helped by its use, but the benefit received is not
greater than might be obtained from the scientific use of
water without the mud.

THE BRAND BATH.

This bath (Fig. 71), which is generally meant when a cold 1150
bath is spoken of in the treatment of typhoid fever, differs
from the ordinary cold bath in several particulars. The rou-
tine procedure as employed by Brand and his disciples in the
treatment of continued fever cases is as follows : —

Method. — The bath-tub, containing water at a .tempera-
ture of 65^ to 70^, is placed near the bed. The patient is
lifted from the bed into the tub as quickly as possible, the face
and head having been previously cooled by the application of
water at 50^. Care should be taken to immerse the patient to
the neck. Exposure of the shoulders is likely to give rise to
pulmonary complications. The head should be protected by a
towel wet in ice-water and wrapped about the head in such a
way as to form a sort of trough leading down the back of the
head. On entering the tub the patient is rubbed vigorously for
two or three minutes, then sits up for a few seconds while two
or three gallons of water at so'^ are poured upon his head and
allowed to run down the back of his neck. He then lies

S70 RATIONAL HYDROTHBRAPY.

down again, and the rubbing is repeated. At the end of five
minutes the affusion to the head is repeated, and the robbing
continued.

If there is weakness of the heart, the cold water should
also be poured upon the front of the chest. The rubbing
of the patient should be continued during the whole bath.
When the patient first enters the bath, he often experiences
extremely unpleasant sensations. Respiration is gasping and
difficult. This inconvenience is at once relieved when the
cold water is poured over the head. The bath is continued
from I o to 20 minutes. If employed for infants or old per-
sons, the bath should be very short. If the skin becomes
cyanotic, or if marked shivering or chattering of the teeth
occurs, the patient should be quickly removed from the bath,
snugly wrapped in a sheet, and covered with a blanket A
hot bottle should be placed at his feet if cold, and the limbs
should be nibbed. Reaction soon takes plac^, and the skin
is reddened by the increased movement of blood through
it. The patient's temperature falls from half a degree to
two or three degrees. The bath is usually repeated at the
end of three hours or sooner — whenever the rectal tempera-
ture reaches 102^. The author prefers not to allow the
temperature to rise above 101.5° before administering an
antipyretic bath of some sort. This rule may be easily
adhered to during the whole course of the fever, except,
possibly, during the developmental stage of the disease,
when the temperature is rising.

Although this bath is a most effective and valuable thera-
peutic procedure, and one which is much used, its rationale
is comparatively little understood ; it will therefore be worth
while here to devote space to a special consideration of its
physiological and therapeutic effects, that there may be a
thorough appreciation of their bearing upon the management
of febrile disorders.

It is certainly a mistake to govern the employment of
hydric procedures altogether by the temperature in febrile

THE TECHNIQUE OF HYDROTHERAPY. 57 1

cases. In tsrphoid fever, it might not be wise to use the cold
bath when the temperature is below 102°, but hydric proce-
dures of some sort may be applied; hence the author does
not think of confining himself to the use of the Brand bath
alone in the treatment of this disease, notwithstanding his
high opinion of its value. The most important purpose
gained by the use of this application is not the reduction of
temperature, but the increase of vital resistance and the
elimination of toxins, as Winternitz long ago pointed out.

In rare instances of typhoid fever, the temperature
scarcely rises above normal during the whole course of the
malady, and yet a fatal issue has sometimes occurred in
these cases. This fact alone is sufficient indication of the
necessity for the employment of other means than the
thermometer as a guide in the direction of therapeutic agents.
In cases in which the temperature remains comparatively low
because of some peculiarity of the patient's constitution or
some unknown factor, there may be as great need as in any
possible case for the general vitalizing and tonic effect of cold,
which, however, may be obtained by the employment of
measures far less vigorous than the Brand bath. It is cer-
tainly a patent error to say that if a patient's temperature
does not reach 102^ or more, there is no call for a bath.
The bath is needed for cleanliness, for tonic effects, and to
energize and sustain the heart. Cold friction, the cold-
towel rub, the tonic wet-sheet pack, and even the half-bath
at a moderate temperature, are all measures which may
render invaluable service in so-called mild cases of typhoid
and other fevers, and should have their place in the thera-
peutics of febrile disorders.

Physiological Effects — Applied in the manner indicated, 115]
the effects of the Brand bath are as follows : —

1. General vital resistance is increased.

2. The nerve centers are energized.

3. Muscle tone or excitability is mcreased.

4. Activity of the kidneys, liver, and skin is increased.

f
57a RATIONAL HYDROTHERAPY.

5. The amoont of oxygen received and CO, exhaled daring
the bath is nearly three times the normal amount, showing
great increase of oxidation.

6. There is marked increase in the blood pressure*

7. The pulse is slowed.

8. The heart is eneigixed.

9. The number of blood-corpuscles in the circulation is
increased, especially white corpuscles.

10. The circulation is improved in a number of ways;
viz.: —

(a) By the primary contraction of the cutaneous vessels
and subsequent dilatation, vigorous fluxion is produced in the
internal viscera and vessels, which are first made to contract,
then to dilate; and then, as dilatation of the skin vessels
increases, contraction again takes place, thus wonderfully
stimulating the movement of the blood through the body,
and correcting any condition of stagnation or hyperemia which
may exist in the lungs, liver, spleen, brain, or elsewhere.

{6) The excited respiratory movements act in a powerful
manner in increasing the movement of blood and lymph in
the central nervous system and the abdominal viscera, the
diaphragm acting as a blood-pump as well as aiding the proc-
esses of respiration.

The friction applied aids the reaction by dilating the
vessels of the skin, prevents shivering, and assists heat elim-
ination. The rubbing must not be too violent, as vigorous
rubbing will have a tendency to excite heat production. It
must be applied with just enough vigor to warm and redden
the skin. Strong shivering gives rise to marked increase
in heat production. When shivering is prevented by friction,
the refrigerant effects of the bath are greatly increased
at the same time that the internal congestion is prevented,
and the patient is able to endure the bath very much longer,
and a more pronounced antipyretic effect is produced.

Cold affusion practiced at intervals during the bath causes
contraction of the cerebral vessels, accelerates the movement

THE TECHNIQUE OF HYDROTHERAPY. 573

of the lymph and blood throughout the brain and cord, and
thus energizes the nerve centers to a remarkable degree. By
the application of cold water to the chest, the respiratory and
cardiac centers are also powerfully stimulated.

Therapeutic Applications — How these effects may be 1152
usefully employed in typhoid and all continued fevers will be
readily appreciated after considering the conditions and indi-
cations present in these disorders. The indications in typhoid
fever and most other continued fevers may be briefly stated
as follows : —

1. To sustain the vital forces, and increase vital resistance.

2. To destroy and eliminate bacterial toxins and tissue
poisons.

3. To increase respiratory activity.

4. To increase oxidation.

5. To augment the activity of the liver.

6. To facilitate the work of the kidneys.

7. To encourage the functions of the skin.

8. To energize the heart.

9. To raise the tone of the peripheral vessels; that is,
to energize the peripheral heart.

10. To regulate and increase the movement of the blood
through the vessels, preventing visceral congestion and func-
tional failure.

11. To encourage blood formation, and to improve the
quality of the blood. ^

12. To lower the temperature of the body.

13. To ameliorate the sufferings of the patient.

14. To prevent complications.

Let us consider each of these indications somewhat at
length.

I. It is not by the high temperature, nor by the patho- 1153
genie organisms which invade the body, but by the poisons
produced by these organisms and by the toxins generated
within the body itself, that life is destroyed. These poisons
kill by their effect upon the nervous system, — a pernicious

574 RATIONAL HYDROTHERAPY.

influence which is manifested by headache, delirium, insom-
nia, weakness, stupor, coma, ataxia, and various other symp-
toms which point directly toward the great centers of life, the
ganglia of the brain and cord. Space does not here permit
the detailing at length of the various ways by which the
organism defends itself against these toxins, which have been
so admirably pointed out by Charrin in his work, **Le
Defenses Naturelles de TOrganisme." But a modem study
of febrile disorders has shown clearly that the most impor-
tant thing to be accomplished in dealing with this class of
cases is to aid the body in its battle against death by toxe-
mia, through support of the organism in every possible way;
hence, any measure which increases vital resistance, which
replenishes the life forces, which antagonizes the depressing
and other toxic influences of the poisons present, must be of
paramount importance. The fever patient has no appetite
because digestive ability is lacking; little or no hydrochloric
acid is found in the gastric juice; the secretion of the sali-
vary glands, the pancreas, liver, and other digestive glands is
likewise lessened or impaired in quality, and all the nutritive
processes are nearly paralyzed. The assimilative activity of
the tissues is also weakened as much as is the digestive power
of the alimentary canal and accessory organs.

The cold bath rouses to activity the nearly paralyzed
nerve centers by the powerful sensory impressions sent inward
from the skin; it relieves the congested brain of surplus blood
by the powerful fluxion induced, cleansing it from the accumu-
lated poisons by increased movement of fluid in the lym-
phatics of the brain, and secures conditions favorable to
sleep, thus giving the nerve centers a chance for rest and
recuperation. And it does more: it increases the activity of
the gastric glands, thus encouraging the production of hy-
drochloric acid, thereby securing both an appetite and the
ability to digest the food taken. With improved nutrition, the
resisting power of all the cells of the body is increased. This
is shown by the clean tongue, the absence of sordes, and the

f

THE TECHNIQUE OF HYDROTHERAPY. $7$

disappearance of fetor in the breath. The bodily forces, thus
encouiaged, are enabled to maintain the battle against the
invading parasites until their life period has run out, or the
body, by physiolc^ical changes, is rendered an unfavorable
habitat for them.

2. In typhoid fever the body is exposed to the noxious 1154
influence not only of typhotoxin, a product of the specific
germs which characterize this disease, but also other toxins ^
produced by the colon bacillus, and various microbes which
thrive in the alimentary canal. Roque and Wile have ^own
that the quantity of toxins found in the urine of typhoid fever
patients is double the normal. The application of the cold
bath decreases the toxicity fivefold until convalescence is
established. The advantage to the system of thus getting

rid of this enormous amount of toxic material can not be
overestimated.

The cold bath, by increasing the movement of the blood,
and thus stimulating the activity of the entire organism,
encourages not only the destruction of germ poisons by those
glands which are charged with this special duty, but also
their elimination through the various channels which furnish
outlets for both physiological and pathological poisons.

3. The increase of respiratory activity reflexly produced 1155
by the bath secures a vigorous movement of blood in the
pulmonary vessels, thus combating stagnation and prevent-
ing hypostatic congestion with its resulting evils. Accumu-
lated mucus is expelled from the small tubes, and the volume

of air passed into the lungs is increased to two or three
times the ordinary amount.

4. One of the best-known effects of cold applications to 1156
the surface is the thermic reaction (4-60), by means of which
there is an increase in all the metabolic processes, and espe-
cially in the oxidation processes. This is very important,

as in the grave forms of fever there is generally a marked
decrease of oxidation. The leucomains, or accumulated
typhotoxins, are imperfectly oxidized; and not being reduced

$7«

toOe pafecdjr sofadile font

Thei

bfi
of csdiadmsi
' ocnLy or over tliree
of fever

Aan fifty pi
II9' die cold Inth
farflifarrs tiiek Himimrinn, wlifle fke
; of Mood Iw iiigs thfin ih oontad with tlie
capable of fmtlier dttngins or reoioiiiie them. That the
iDcreased aimwint of uijgeii luliuduoed bjr the deeper icspiijk-
tioo vtsuHtiaghom the cold both is w^HynMJ is shovnfay the
fad that die icapiialmy qootient remains the same; thai is»
while the amoimt of osj|;en absorbed k three times the asaal
qoanti^, the amoont of CO, diminatcd is propcftiaoate to
the oxygen absorbed.
11S7 5. The liver plays an fiii rwlingly important role in fever
cases. It is the oigan upon which, more than upon any other,
perhaps, depends the life of the fever patient. The liver is a
sentinel standicg at the door of the circaiation. The toxins
which enter the portal vein from the alimentary canal, as
well as those which are in circulation in the blood, when
broogfat to the liver, are held back and destroyed by it to snch
an extent that by comparison of the blood of the portal vein
and that of the hepatic vein, its toxicity is found to have been
diminished one half by passing through the liver, as has been
proved by Rogers and others. In fever, its functions as a
regulator of nutrition, as an excretory* organ, as a blood organ,
and as a destroyer of toxins, are all in large measure held in
abeyance, as is readily shown by the glucose test for hqntic
insufficiency. The system is so flooded with poisons as to
overwhelm the liver : it becomes congested, its vessels are
distended with stagnated blood, its tissues filled with paialya-
ing poisons, and local pathological processes not infr»inently
result, as shown by the enlargement so frequent in febrile

THE TECHNIQUE OF HYDROTHERAPY. 57/

cases, and the degeneration which is so prominent a feature
in the post-mortem changes observed after death from typhoid
and other fevers. These degenerative processes, once sup-
posed to be due to the elevated temperature of the blood, are
now known to be due to the influence of the toxins with which
the blood is filled.

The cold bath, by the strong fluxion of blood which it sets
up, empties the vessels of the stagnated and half-paralyzed
liver, energizes to renewed activity the poison-benumbed
ganglia which control it, arouses to its work the hepatic cell,
thus renewing all the functions and maintaining the. integrity
of this most important viscus, which has been aptly described
as a ** shut door," preventing the entrance of poisons into the
general circulation so long as it retains the full use of its
powers.

6. One of the most marked effects of the cold bath is its 1158
influence upon the kidneys. The volume of the urine is
sometimes increased two or three times. The kidney, as

well as the liver, suffers from the constant contact of the
toxins with which it has to deal, as shown by the renal
degeneration often found after death from febrile diseases.
So long as the kidneys and liver can be kept doing their duty
as blood purifiers, the organism has a good chance to hold
its own in the battle for life. The cold bath assists the func-
tions of these organs as no other measure does.

7. The dingy, dry, inactive skin of the fever patient, under
the influence of the cold bath soon becomes white, moist,
and active. The improvement of the cutaneous circulation
may be noted from day to day. Nothing could be more
marked than the contrast between a fever patient who has
been subjected to daily bathing and one who has not
enjoyed the advantage of this wonderful regulator of the
vital processes. The skin of the latter is dry, leathery,
tawny, inactive as parchment, while that of the bathed
patient is clear, supple, moist, elastic, lively, and responsive
to the thermal and mechanical agents applied for the purpose

37

578 RATIONAL HYDROTHERAPY.

of aiding heat elimination, arousing the nerve centers, and
awakening vital resistance. The skin has been shown by
Bouchard and others to be an important outlet for highly
toxic substances, which are generated in the body under mor-
bid conditions as well as in the physiological state. The
marked stimulation of the skin by the contact with cold water,
and the friction to which it is subjected, adds a powerful factor
to the defenses of the body against the toxins which are poison-
ing the nerve centers, in addition to the service rendered
through the internal reflex actions set up by the impressions
made upon the cutaneous nerves, whereby the liver, the
suprarenal capsules, and other poison-destroying glands are
brought to a high degree of activity.

1169 Brunner has shown* that the active skin is capable of
eliminating germs in vast numbers ; while Herz has shown
that the dry skin transmits very little heat outward; and
Leyden, that one of the most important indications in typhoid
fever is to encourage the elimination of water, which, as he
.has demonstrated, accumulates to an abnormal extent in the
tissues in this disease. Weyrich has shown that friction of
the skin may increase the elimination of water fifty per cent.
The moist friction of the cold bath and the increase of skin
activity created by it thus meet at one and the same time
three important indications presented in typhoid and other
infectious fevers; viz.: (i) Increased elimination of moisture
through improved blood supply; (2) increased elimination of
heat through conduction and evaporation of the moisture of
the skin, not only immediately after the bath, but subse-
quently, as the result of the increased blood supply; (3) in-
creased cutaneous activity and elimination of germs.

1160 8. The cold bath aids the heart to a degree which is
unapproached by alcohol, digitalis, strychnia, or any other
known agent. It renders a still more valuable service in its
influence upon the blood-vessels. The low tension often

* Brunner, Berliner Klinische Wochenschrifl^ 1 89 1, page 505.

^

THE TECHNIQUE OF HYDROTHERAPY.

present in grave febrile conditions is not due alone
depressing influence of the toxins upon the cardiac o
and the interference with the nutrition of the muscular s
tares of the body, but is largely, perhaps chiefly, di
shown by Romberg/* to the loss of tone in the j
vessels and the weakening of the vasomotor cente
medulla. This is indicated by the cyanotic appearance o
face, the blue lips and nails, and the general turgid ap]
ance of the skin.

The condition of the blood stream under these con
may be compared to that of a stream of water lectving
. hose of a fire-engine from which the nozzle has been remo
The machinery itself may be in no way interfered wit!
owing to the removal of the resistance against which it .
been working, and which acts as a means of regulating
action, the pump ''runs away/' as the engineer says. 1
wear and tear to the engine is tremendous, but its cyli
do not fill with water, and the lessened quantity of w^
pumped is raised only a few feet, and runs away with
force to low levels where there is no resistance,

The same thinp: happens with the heart when general
vasomotor relaxation occurs. An important element in heart
regulation is lost. The steadying influence of well-filled
vessels and a solid column of blood to work against being no
longer in operation, the heart flies away in rapid, ineffective
movements, and the blood stream flows off in the shortest
circuits instead of filling the whole system. The natural
result is congestion of the great vascular internal viscera, the
liver, lungs, and kidneys, as well as the brain and spinal cord.

Under these circumstances the heart may be compared, as
Hare has suggested, to a locomotive which has steam up, and
is in a condition to do a tremendous amount of work, but
because of the slipperiness of the track makes no headway in
pulling the train, its wheels only flying around like a spinning

* Berliner Klin. PVccA.,i^$.

580 RATIONAL HYDROTHERAPY.

top, doing no effective work. A little sand on the track,
however, changes the whole situation by affording the resist-
ance necessary to regulate the action of the engine. The
wheels move slowly and steadily, the steam cylinders have
time to fill, and the energy in the steam is utilized.

These illustrations are not wholly exact, since in the case
of the pump and the locomotive the machine may remain
wholly intact, while in the case of the heart this is not true.
The heart depends for its energy upon the constant filling and
flushing of its vessels. When the blood pressure is low, its
nutrition suffers in consequence. Blood accumulates in the
dilated vessels, so that the volume passing through the heart
is diminished; the whole blood stream is slowed; it becomes
filled with waste products, and may be compared to a stag-
nant or sluggish stream of water in which filth accumulates.
In consequence of this slow movement, the action of the liver,
kidneys, skin, lungs, and other poison-destroying organs is
interfered with, and the heart is worn out by its constant
ineffective work. Its period of rest may be diminished per-
haps one third or more. Under these defective conditions for
nutrition and rest, its energy rapidly fails, so that a vicious
circle is formed. The low pressure weakens the heart, and
the weakened heart still further decreases the pressure. In
this condition, without relief of some sort, the patient must
rapidly sink into collapse, followed by complete syncope
and death from so-called heart failure. The cause of the
failure is not, however, primarily with the heart, but in the
vessels, as suggested by Romberg, and further demonstrated
by Paessler.* The importance of the researches of Romberg
and Paessler can scarcely be overestimated, for they show us
at once the folly of seeking to correct the morbid condition
known as cardiac weakness or failure, when present in acute
febrile disorders, by the administration of drugs to excite or
stimulate the heart. To do this is like putting on more steam

**< Kongress far innere Medicin," Weisbaden, 1896, pp. 256, 266.

THE TBCHNigUE OF HYDROTHERAPT-

S8l

pressure when the pump is running away or the locomotive
wheels slipping on the track. Nature has provided us with
a most admirable remedy in an external agent; viz., cold,
which strikes at the root of the evil, and is attended by no ill
effects. It is only necessary that these facts should become
known to the medical profession to secure for cold water the
universal recognition which intelligent men are always ready
to accord a great truth that has for its basis a fundamental
law of nature,

9. Cold applications to the skin cause contraction of the 1161
small arteries throughout the bod}', and this instantly raises

the blood pressure. Cold excites the activity of the heart
also, so that at first it beats not only with more vigor but
with greater frequency. As a result, the blood-vessels are
rapidly filled, blood pressure is raised^ and the liver, kidneys,
and other excretory organs are flushed with blood and encour-
aged to do their normal work, thus rapidly diminishing the
amount of poison taken into the blood. The nutrition of the
heart is also improved; and with the higher tension its move-
ments are slowed, so that its periods of rest are increased;
while at the same time the small vessels, constituting the
peripheral heart, by their increased activity, accelerate the
movement of blood, thus lessening the work of the heart*
While by this combination of factors the heart's work is
decreased, the energy of its action is increased, as is also its
power to work, by iltc improved condiiions under tvhith it
labors; so that, instead of a vicious circle, there is soon organ-
ized a group of influences which steadily improve the condition
not only of the heart but of all the tissues, thus enormously
increasing the power of the body to resist the disease and
expel the invading organisms and their toxic products.

10. The increased movement of blood throughout the 1I6S
body, and especially the fluxion of the visceral vessels, occa*
sioned by the several vascular movements set up, — first brief
contraction, then a longer dilatation from retrostasis of the
blood from the skin, and lastly a considerably prolonged con-

$82 RATIONAL HYDROTHBKAPY.

traction due to the filling of the surface vessels when reaction
occurs, — antagonize in the most powerful way the tendency
to visceral congestion with stagnation of blood, failure oi
local nutrition and function, and the multiple mischiefs flow^
ing out of the disturbance of the activity of the organs essen-
tial to the maintenance of organic life.
1168 II. The effect of the cold bath upon the blood must cer-
tainly exert a potent favorable influence in febrile disease. As
has been shown by Winternitz and various other observers,
the number of corpuscles in circulation in the blood may be
at once increased by the cold bath to the extent of twenty-
five per cent., or even more; and Thayer* has shown that
this effect follows the administration of cold baths in typhoid
fever as well as in health.

In fever the number of corpuscles is greatly diminished,
consequently the oxygen-carrying power of the blood is pro-
portionately diminished. The area of the corpuscles drcu*
lating in the blood of a healthy person is about 3, lOO square
yards. With the reduced blood count of fever, this oxygen-
absorbing area may be reduced to 2,000 square yards or less.
If this area can be increased two thirds, or brought up to
nearly the normal amount, the oxygen-absorbing power, and
consequently the oxidizing power of the blood, may be pro-
portionately increased. It is interesting in this connection
to recall the fact that the white corpuscles are increased in
number to a greater extent than are the red corpuscles by
cold applications. The leucocytes play an important role as
defenders of the body, in destroying microbes, while the serum
destroys bacterial toxins. From these facts it is readily
apparent that the action of the cold bath in increasing the
number of corpuscles in circulation serves a most important
purpose in sustaining the body in its conflict. What other
agent known to man is capable of rendering such service as
this.^ Antipyrinc and aritipyretics of all sorts diminish the

^ Johns Hopkins Hospital Bulletin, Bait., 1893, IV, 37-40.

THE TECHNIQUE OF IIVDROTHERAPY.

583

i

blood <mmi instead of imrvasing it, and thus i^rcaily Ivsst'u
ike oxidizing potvcr of the blmni.

12. Liebermeister * has shown that heat prudaction is
increased in (ever, while Winternitx has demonstrated that
heat ehmination is decreased, at least iu many cases> It is
apparent that the greatest degree of elevation of tempera-
tore would be produced by the co-existence of increased heat
production with diminished heat elimination. The cold bath
renders an important service in reducing the temperature,
although this is not by any means the most valuable of its
effects- The elevation of the temperature in fever is without
doubt a conservative or protective action by the vital forces,
it having been clearly shown that the elevation of tempera-
ture accompanying infectious disordcm serves a most useful
purpose in estabUshing imniunity, by rendering the body an
unfavorable habitat for the invading parasites.

However, the importance of lowering the temperature in
fever, even one or two degrees, or a fraction of a degree, is
shown by the investigations of Maiirel, t according to which
the white blood-corpuscles are destroyed at a temperature of
109^ to II i^ within an hour, and are able to survive at a
temperature of 107.6^ to 109,4^ for only three hours. When
it is remembered that the internal temperature of the body
is two or three degrees higher than the axillary temperature^
it is evident that whenever the patieut*s axillary temperature
reaches 105'' to 106^, his life is in imminent danger* The low-
ering of the body temperature one or t%vo degrees in such a
case may be the immediate means of saving life.

Another consideration of importance is the fact that eleva-
tion of body temperature gives rise to increased oxidation of
nitrogen, causing rapid wasting of the muscular, nervous, and
glandular structures of the body. This weakening of vital
structures is one of the chief sources of danger in febrile dis-
eases. Here is a frequent cause of cardiac faihire, and of

1161

584 RATIONAL HYDROTHERAPY.

many other grave conditions which accompany ataxic and
adynamic febrile states.

The cold bath lowers the temperature of the body not
simply by abstracting heat or by dilating the surface vessels,
but by aiding in the removal of the conditions which give rise
to the elevation of temperature; in other words, it strikes at
the causes of the condition, and is hence not merely a symp-
tomatic remedy. The cold bath is thus not only a powerful
antithermic agent, but is antifebrile as well, which is more
than can be said of any of the medicinal antipyretics ; for,
while they do lower the temperature, they do not shorten the
duration of the malady y nor lessen its fatality. While lower-
ing the temperature, they at the same time lessen the vital
resistance, stupefy the nerve centers, and weaken the defenses
of the body. The cold bath, on the other hand, arouses the
dormant nerve centers, energizes all the vital functions, and
improves oxygenation and metabolism at the same time that
it abstracts superfluous and harmful caloric.
1165 13- Another most important service which the cold bath

renders the fever patient is the amelioration of his discom-
forts. Medical men who have been subjected to this method
of treatment while suffering from typhoid and other fevers,
have unanimously testified to the comfort which it secures.
The application itself is by no means a pleasant procedure;
but the relief which it affords, the sense of well-being which
it creates, with the decidedly favorable modification of all the
morbid conditions characteristic of febrile maladies, speaks so
strongly in its favor that intelligent patients readily submit to
it, and after the first few baths welcome the arrival of the
hour for the treatment.

It is true that nervous, excitable, and illy controlled indi-
viduals sometimes resist the treatment, while ignorant friends
urge vigorous protests against what seems to tlicm unneces-
sarily severe and cruel treatment. Their prejudices must be
overcome by gentle management and a little tact, which sel-
dom fails to secure their co-operation. The brown, thickly

THE TECHNIQUE OF HYDROTHERAPY. 585

coated, swollen, and parched tongue, the sordes-covered lips
and teeth, the catarrh of the stomach and bowels, the tym-
panitis, flatulence, exhausting diarrhea, headache, mental
stupor, nervousness, apprehension, the cadaverous, ocher-col-
ored appearance of the patient are almost never seen when «
the cold bath has been administered from the very beginning.
Indeed, the picture of the disease is so completely changed
that one would scarcely recognize it from the typical descrip-
tion in the text-books. If all patients could be taken in hand
with thorough hydriatric management within two or three
days after the beginning of the attack, or at least before the
fifth day, in typhoid fever, the disease would rarely appear
in other than its mild form.

14. Lastly, it may be said in behalf of the cold bath as a 1166
remedy in typhoid fever, that its thorough use early in the
disease rarely fails to prevent grave complications of any
sort, such as pneumonia, myocarditis, nephritis, perforation,
intestinal hemorrhage, and the various paralyses and other
distressing sequelae so notoriously frequent in typhoid fever
when managed in the usual way. The same is true as regards
all the infectious fevers. The prejudice sometimes encoun-
tered against the use of cold water, based on the supposition
that it increases the liability to pneumonia or other complica-
tions, is wholly without foundation. The very opposite, in
fact, is true.

In regard to the results of the cold bath in typhoid fever 1167
and other infectious febrile disorders in relation to the saving
of lives, a long chapter might be written. A very few statis-
tical facts must here suffice: The ordinary mortality in typhoid
fever, as shown by the statistics of our large cities, is 25 to
30 per cent., and a still larger percentage of mortality is not
infrequently reported. Brand has collected a series of 1,223
cases in which the cold bath was intelligently employed
from the beginning, the treatment having been instituted
within the first week. Of these only twelve died, or less than
I per cent. The mortality in a series of 5,000 cases.

$86 RATIONAL HYDROTHERAPY.

including many in which treatment was not thoroughly applied,
was less than 4 per cent Osier,* of the Johns Hopkins
Hospital, reports a very great reduction in mortality from
typhoid fever by the adoption of the cold bath treatment In
the experience of the author and his colleagues, which in-
cludes several hundred cases of this disease treated by the
cold bath and analogous procedures, the mortality has been
less than 3 per cent. In pneumonia, the mortality has been
reduced more than one half. Schill reports no cases of
scarlet fever, with no deaths. Remier treated 3,000 cases of
scarlet fever with cold baths followed by rubbing, and ¥dth
a very low mortality rate, t Equally satisfactory results have
been obtained in the treatment of smallpox and other infec-
tious fevers.

In Germany and France it is the almost uni-
]J*^22S!!f^" versal custom to administer alcohol to the
with the Cold P^^tient just before putting him in the cold
Bath. bath. Some practitioners, as Wintemit^,

administer but a very small amount, as a single
mouthful of wine; while others give brandy in considerable
quantities. A few American practitioners also employ brandy
freely with the cold bath. The unwisdom of this practice
will be apparent on due consideration of the following facts: —
1168 I* One purpose in administering the cold bath is to secure
a true stimulant or tonic effect by arousing the vital energies,
especially through excitation of the nerve centers of the vaso-
motor, sympathetic, and cerebrospinal systems. Alcohol was
once supposed to be capable of effecting this, and was used
for this purpose in typhoid fever and various other morbid
conditions accompanied by depression of the vital forces. At
the present time, however, it is well known, and with prac-
tical unanimity admitted, that alcohol is neither a tonic nor
a stimulant, but a narcotic; that it depresses and does not
excite; that it lessens, and does not increase, the activity of

*** Johns Hopkins Hospital Reports," p. 321.

•\ T\iomv^y Journal 0/ tk€ American Medical Association^ 1S96, p. 1332.

THE TECHNIQUE OP HYDROTHERAPY.

587

the nerve centers; and that this is true of small as well as
large doses, as has been shown by the researches of careful
investigators* In evidence of the foregoing may be cited the
following statements from medical men recogniised as authori-
ties throughout the civilised world; ^

Harnack says: * ' It shpuld also never be forgotten, that, even
in small doses, tht paralysing action of akokol is exercised
mosf tapidlf and energeiically upon the tonus of the blood-
%*t$$£h— the importance of which tonus for the regularity of
the circulation and the cardiac energy is %veli hnmvn/*

Victor Horsleyt an eminent English surgeon, speaks thus
respecting the influence of alcohol upon the heart: **SLirgeons
of former days used alcohol extensively to combat shuck, but
the old theories of shod' have been proved erroneous, and ako-
hoi has consequently become unnecessary. It will be less and
less used in the future, and the discredit into tij>hich it has
fallen is jusiijicd.''

Hermann Frye, by the use of Mosso*s ergograph, showed
that *'in the nnfatigued mnsrle, alcohol lessens the extent
of its maximum contraction, owing to a lessening of the
peripheral irritability of the nervous system/*

The heart is a muscle, and consequently alcohol can not
be expected to increase its working power; and when labor-
ing under the influence of toxic agents, as in a febrile state,
it is clearly evident that the effect of this agent must be dis-
tinctly and altogether pernicious.

Chantemesse* calls attention to the diminished toxicity
of the urine in many cases of typhoid fever, the toxins being
retained in the body during the fever, resulting in an enor-
mous increase of the toxicity of the urine during convalescence.
This fact is of great importance in connection with the use
of antipyrine and alcohol, which lessens the activity of the
kidneys, and so causes still further retention of toxins.

The use of hot coffee, tea^ or other medicaments in con-

•Bouchftrd'f "Traits dc M^decine.'*

588 RATIONAL HYDROTHERAPY.

nection with hydriatic procedures is also to be in every way
deprecated, as a sort of mixed and antagonistic therapeutics,
for which no good scientific reason can be assigned. Coflee,
like alcohol, is a narcotic. It lessens the susceptibility of the
nerve centers to stimulation by the thermic impressions made
upon the skin, and thus lessens the .effect of the applications
made, as shown in relation to alcohol. When it is desirable
that these impressions should be mitigated, this may be
accomplished much more effectively and consistently by rais-
ing the temperature of the application, or by preparing the
skin for the application of cold water by a preceding hot
application, either local or general.

In a series of physiological experiments conducted by the
author in 1893, and reported at the meeting of the American
Medical Temperance Association held at Milwaukee in May,
1893, it was clearly shown that nervous, muscular, and
glandular activities are all diminished to a noticeable degree
by the ordinary medicinal doses of brandy and other stimu-
lants.*

It is clear, then, that those who administer alcohol before
the cold bath, by so doing antagonize the therapeutic activity
of the measure, since so far as the alcohol has any effect what-
ever, it is to depreciate or neutralize the very effect which
it is designed to secure by the cold application.
1169 2. The effect of alcohol is to cause dilatation of the periph-

eral vessels. This it does by paralyzing the vasoconstrictors.

As already stated, paralysis of the peripheral vessels and
of the vasomotor centers of the medulla, as shown by Romberg
and Paessler, are the real causes of heart failure; hence
alcohol, in its effect upon the vasomotor centers and nerves,
can only aggravate the very condition for the relief of which
it is administered. Alcohol at the same time exercises a like
effect upon the accelerator nerves of the heart, which are
both anatomically and physiologically associated with the vaso-

* See Medical Temperance Quarterly^ July* 1893.

THE TECHNIQUE OF HYDROTHERAPY. 589

constrictors, as Waller has so clearly pointed out. By this
means, while the heart's action seems to be freer, the move-
ment of the blood through the systemic circulation is slowed,
as is shown by the stasis in the peripheral vessels, which is
cleariy indicated by the dusky hue of the skin in a man under
the influence of alcohol. The influence of alcohol is in this
respect somewhat akin to that of the warm bath. The effect
of a cold application, however, is the very opposite; viz.,
the stimulation of the vasoconstrictors. At first this effect is
so pronounced that the blood-vessels are almost completely
emptied of their contents, and the skin becomes blanched in
appearance.

As reaction sets in, the caliber of the blood-vessels is
increased, but stimulation of the vasoconstrictors continues in
that wonderful rhythmic activity of the small vessels, the
peripheral heart, whereby the blood is steadily pumped from
the arterial into the venous system, resulting in a bright red
flushing of the skin, which indicates an increased flow of the
blood through the periphery and an increased rate of move-
ment throughout the whole circulatory system.

3. It is not maintained that no preparation for the cold 1170
bath is needed, but rather that there is a far better method
than by the use of alcohol. The ideal preparation is to be
found in the application of heat. If alcohol in any way aids
reaction, it is not by augmenting the activity of the nerve
centers, but by encouraging the relaxation of the surface
vessels. But this can be accomplished far better by either a
general or a local application of heat, as a foot bath, fomen-
tations to the spine, or when convenient, a general applica-
tion of heat, such as a hot full bath for one or two minutes, a
hot-blanket pack, a hot shower, or even hot water drinking or
a hot enema, or wrapping the patient in warm woolen blan-
kets for a half hour or so, with hot bags about him. All
these are measures whereby the preparation for the cold bath
may be accomplished far more efficiently than by any form of
medication.

590 RATIONAL HYDROTHERAPY.

Heat is a natural preparation for cold. The application
of heat to the surface vessels is a physiological stimulus
whereby the centers are aroused to activity, and the thermic
nerves rendered in the highest degree capable of responding
to the reflex stimulus which the cold applications communi-
cate to the skin, and through it to the nerve centers.
1171 4. While it is true that the patient seems to bear the cold
bath better when alcohol is administered, this fact is the
strongest kind of argument against the use of alcohol in this
connection; for the only way in which alcohol can diminish
the shock or lessen the discomfort of the patient in the appli-
cation of cold water, is by lessening nervous sensibility through
its narcotic effect; and just so far as this is accomplished,
the effect of the bath is neutralized and its efficacy lessened,
for the reason that the whole effect of the cold application
depends upon the thermic impression made upon the skin.
Thus, so far as this impression is diminished^ the effect of
the bath itself is diminished; the combination of such
antagonistic measures as alcohol and cold water can not be
regarded otherwise than in the highest degree nnphilosoph-
iealy and from the standpoint of rational therapeutics^ absurd.
The practice is one which appeals strongly not only to the
prejudices of the laity, but to the predilections of quite too
large a proportion of physicians; but not one scientific fact or
even plausible apology can be brought forward in support of
this practice.

After twenty-five years of extended experience in the use
of baths of all temperatures, the author feels justified in
taking a most uncompromising stand against the use of alco-
hol in any form in connection with hydriatic procedures. If
there are any two agencies in the world which are absolutely
irreconcilable, they are alcohol and water. Their application
in conjunction gives, not the sum of two co-operating or
complementing agents, but the difference between two neutral-
izing and antagonistic measures. In any case in which alco-
hol may seem to be indicated as a means of preparing the

THE TECHNIQUE OF HYDROTHERAPY.

591

patient for the application of a cold bath, heat may be
employed to far better advantage, with the certainty of better
results, and with absolute physiological consistency.

It is important that a further word be said regarding the
employment of the cold bath* The idea that no very de-
cided effects can be obtained from the use of water without
resorting to a very low temperature, is certainly an error.
The utility of the cold and the very cold bath has certainly
been very greatly overrated. In France, Beni-Barde and
others have long been contending for the employment of less
heroic measures in hydrotherapy, and the more general
recognition of the utility of wider ranges of temperatures for
hydriatric applications,

A long experience in the practical use of hydrotherapy in
the treatment of all classes of ailments, acute and chronic, has
convinced the author that very cold general applications,
especially if prolonged, are rarely needed, and that far better
effects can be obtained by the use of temperatures which do
not occasion the patient so much discomfort nor give rise to
such apprehension as to constitute a nervous shock either to
him or to his friends. The author has never found it neces-
sary to exclude the patient's friends from witnessing any treat-
ment applied because of the alarming or distressing symptoms
occasioned by it, and considers that it is entirely unnecessary
that any such treatment be employed. Indeed, a measure so
violent in character that constant vigilance must be employed
to prevent collapse or heart failure can not be regarded as
safe to be commended for general use. Putting a patient
into a very cold bath and keeping him there until his teeth
chatter and there is painful shivering with perhaps cyanotic
skin, is a measure which would belter be relinquished for
other safer and quite as potent procedures, which the science
of hydrotherapy is abundantly able to supply.

It is true that by constant rubbing of the patient during
the bath and by the strictest attention to the pulse, the color
of the surface, and the condition in general, any serious

S92^ A fiATIOHAL HYDROTHBIUFfr

epects from cold applications of waJb&c may geii6ra|l]r.^l>e
avoided; but it most be conddered th^t if the desired, l^i^ta
can be obtained by the employment of less violent measojce^
t)|^ 4sure certainly to be preferred. , ,.

1 1 72 ^ In this connection it should be mentioned that jfacqm^ of
France* reported, in 1839, 513 typhoid fever cases, iwith onljf
four deaths, treated by means of the 4x>ld enema, cold wat^
drinking, and the cold abdominal compress changed every jo
to 30 minutes, while 349 cases treated at the same period
})y ordinary methods gave a mortality of 91 deaths,* 9, $tati$-
tiod showing which is scarcely outdone by the most favorite
l^ult^ reported for the Brand treatment.

Scientific therapeutics gives no countenance to routine
ipethodsjn the treatment of a^y malady, whether by the tise
of ivater or medicinal agents, and the author feels certain that
a better acquaintance with the versatile resources of hydros
therapy will lead many practitioners who have rqs^^ded cold
baths as almost the sole method to be employed in the tr^t-
ment of infectious fevers, to adopt a much more comprehen-
sive hydriatic armamentarium.

1173 The following excellent suggestions concerning the hydri-
atic treatment of fevers are from Winternitz, the highest
living authority on all subjects pertaining to hydrotherapy: —

1. Give the first bath at a temperature of 75^ to 85°,
diminishing the temperature of each bath one degree until
65^ is reached.

2. During the bath pour over the head and spine water at
a temperature two to five degrees lower than the water of the
bath. The effect of this will be not only to cool the head but
also the bath, and thus secure better reaction.

3. The duration of the first bath should be 3 or 4 minutes.
The time may be extended with succeeding baths until the
duration is from 10 to 12 minutes. If the first bath is given
at as high a temperature as 88°, the duration should be
longer, as longer time is required for temperature reduction.

* Bernard, ** Lemons siir la Chaleur Animale/* Paris, 1876.

THE TECflNlQUE OF HYDROTHERAPY.

593

4. The number of baths should be three or four daily.

5. The abdominal compress should be worn during the
night. It should not be too cold nor too frequently changed,
to avoid excessive excitation of the nervous system. The
temperature should be ordinarily about eo*^, and the com-
press should be changed about once in 40 to 60 minutes,

6. When tlie maximum daily temperature begins to
decline, the temperature of the bath should be raised to
84-^ to 88^.

J, Avoid too severe friction on account of excessive stim-
ulating effects.

8. The patient should be left in the bath until the axillary
temperature, as felt by the hand, is the same as that of the
rest of the body. This is a good indicator of the effects of
the bath in lowering temperature,

9, The patient should be immediately removed from the
bath at the first symptom of secondary* chilL If he is threat-
ened with collapse, a very short bath should be administered
every hour until the collapse is no longer threatened.

It is almost needless to add that the application of the
cold bath or an equivalent hydric measure should begin at
the earliest possible period in the disease, or as soon as
decided febrile symptoms make their appearance, both in
typhoid and other more infectious maladies, when not con-
traindicated.

The author employs the bath whenever the temperature
reaches lOKS^ F,, repeating it as often as once in three
hours if necessary. Natural and refreshing sleep should not
be interrupted for the bath unless the temperature is high
and rising rapidly; but the comatose sleep indicating pru-
found intoxication may be interrupted with advantage by ihe
administration of the bath, which will often be followed by
normal refreshing sleep for an hour or more.

Contraindications — Collapse, sub-normal temperature,
inability to react, threatened pulmonary or intestinal hemor*
rhage^ hematuria, shivering, sweating, old age, infancy.
38

594

HATIONAL HVDROTHERAPY*

The Brand bath is likewise contraindicated in the eruptive
fevers, as smallpox and measles. In the author's opinion its
use is unvirise in pmumoniir, and in other disorders in which
intense inflammation is present in an important iotemal
organ, as in acute hcpaiitis, saipingiiis^ ovariiis, mtuin-
giiis, acute ^astriiis, enieniis^ and especially in the various
forms of nepkritis, either acute or chronic.

THE SHALLOW BATH.

1174 In this procedure (Fig, 72) the patient is rubbed while
sitting in a tub partially filled with water. The requisites
are, a tub with tour or six inches of water of the proper
temperature, a sheet, two or three towels^ and a large dipper.

Method,-' The patient, having been properly prepared, —
the feet warm, the general circulation well established by
exercise or previous warming in bed or by a warm bath,
the head protected by a towel wet with water at 60-,— seats
himself in the tub with the legs extended, and immediately
begins vigorous rubbing of his arms^ chest, and abdomen,
while the attendant rubs the back and sides with both hands
for 20 seconds, then dips water from the tub and dashes it
upon the back for 10 seconds, then rubs 20 seconds, then the
patient lies down in the bath while the attendant rubs his legs
for 10 seconds. This occupies Just one minute* For a two-
minute bath, the above is repeated; for a bath of three min-
utes, the procedure is repeated a third time.

At intervals of one minute the patient should lie dDwn in
the bath, so that the whole body except the head is sub-
merged for 5 to TO seconds, the attendant rubbing the legs
vigorously in the meantime.

When employed for tonic effects, the temperature of the
water should be 75*^ to 65^, and the length of the bath
I to 3 minutes, For the reduction of temperature in febrile
cases, the temperature should be 85° to jo"\ and the dura*
tion 6 to 15 minutes.

Care must be taken to adjust the temperature of the bath

THE TECHNIQUE OF HYDROTHERAPY.

S95

exactly right, for when the temperature is too high, the skin
is left in an anemic, pale, and relaxed condition. It too low
a temperature is used, excessive congestion of the internal
viscera may be induced through weakness of the walls of the
blood-vessels, which, being unable to contract with sufficient
vigor to throw the blood back to the skin, reaction may
fail, and the effects of the bath be spoiled, by exhaustion
of the vasomotor centers through a too prolunged appli-
cation.

The depth of the water in the shallow batli is ordinarily
not more than six inches; if deeper, it interferes with the
rubbing. When the depth of the water is sufficient to reach
the umbilicus, the bath is termed a ha!f-bath. The points in
which the shallow bath differs from the half -bath are chiefly,
{a) the longer continuance of the latter; (^) the rubbing may
be dispensed with unless the temperature is low; (^r) the tem-
perature is usually cool, neutral, or hot.

The effects of the shallow bath are intensified and some-
what improved if two attendants are employed, one rubbing
the legs while the other rubs the back and sides,

A useful mode of applying this bath is in combination with
the immersion bath — the shallow bath at 70"^, the immer-
sion at 60*^, the water having been previously prepared in
two tubs at the temperatures indicated, and the patient
warmed by the hot-blanket pack, the vapor bath, or the
electric-light bath. The patient is first immersed for three
to five seconds in the full bath, then placed in the shallow
bath, which, having a temperature ten degrees higher, pro-
duces a warm and comfortable sensation. The patient feels
no dispositioQ to chill, and by the aid of rubbing he is ren-
dered so comfortable tliat the bath may be continued for
a considerably longer period than when administered without
the preparation suggested,

A fairly vigorous patient can administer the shallow bath
to himself, sitting in a tub containing a few inches of cold
water, and applymg the water to various parts by means

THE TECHNIQUE OF HVDROTHERAPV,

S97

coodition of the patient and its power to increase vital resist-
ance is clearly indicated by its effect in increasing muscular
capacity* as has been repeatedly and clearly shown (Exp, 59).

Employed at a temperature of 80- to 85^, the shallow or
haif-bath is a quieting or sedative measure. The higher the
temperature, the more vigorous the rubbing necessary to
produce good circulatory reaction, as the intensity of the ther-
mic impression is lessened.

Therapeutic AppJications,— The shallow bath is one of the
most generally useful of all hydriatric procedures. It may be
used as a substitute for the douche when the latter is not
available, and when a procedure less powerful than the
douche is desirable, though essentially the same results may
be obtained by increasing the length of the application and
the frequency of its repetition.

The impact of cold water upon the skin, the thermic
impression, together with the strong friction applied by the
attendants, and the exertion made by the patient in rubbing
himselfi together constitute a powerful combination of potent
factors for dilating the surface vessels, and thus antagonizing
the antmiti of the skin present in the vast majority of chronic
diseases and in most infectious fevers as a result of the toxic
inflaence of the retained excretions and the specific poisons
of bacterial origin.

The temperature of the shallow bath» when administered
for anemia, should ordinarily be about 75^ to 60'-'. The
application should be short (i to 2 min.). For very feeble
and irritable patients, the duration of the bath at first appli-
cation should be not more than from 15 to 30 seconds, a
simple dip in the cold water.

The bath may be usefully employed in anemia^ in arrant c
affections of the spine, as c/irauic tnyelitis, mcningiHs with
exudate^ and ataxia with faralj^sis but without marked pain.
The temperature of the application in such cases should be
70® to 80° and the duration 6 to to minutes.

The shallovv bath may be used not only as a principal pro-

1170

598 RATIONAL HYDROTHERAPY.

cedure, but also as a tonic measure following a sweating appli-
cation. It is much better tolerated than the douche by
persons suffering from cardiac troubles and asthmatic affec-
tions. It may also be employed in place of the Brand bath
as a means of lowering temperature in patients whose tem-
perature is hot very high and who are not very weak. When
the antipyretic effect is desired, it is wise to introduce the
principle of graduation, by beginning the bath with a tem-
perature of 92^ to 95^ and lowering it by pouring water upon
the patient and lowering the temperature of each pailful until
^QP to 75^ is reached. The patient must be rubbed vigor-
ously enough to prevent chilling. If severe chill occurs, he
should be removed from the bath at once, rubbed dry, and
put to bed, wrapped in warm blankets.

The shallow bath is an excellent means of antidoting the
depressing effects of heat after a prolonged spoliative applica-
tion, as the electric-light bath or the vapor bath employed in
cases of obesity, the sweating pack, or any other prolonged
heating process which leaves the patient in a depressed con-
dition. For this purpose it answers very satisfactorily as a
substitute for the douche, and is of great service in cases in
which the latter is contraindicated, or when a douche appar-
atus is not accessible.

The shallow bath is an excellent bath for use in neuras-
thenia, especially gastric neurasthenia, also in hypopepsia^
chrofiic constipation, diabetes, uric acid diathesis, and a large
class of disorders due to uric acid accumulation, when neu-
ralgia and local inflammatory processes are not present to
any marked extent.

Rohrig has shown that a considerable increase of perspira-
tion causes constipation, a result frequently noted in hydriatic
establishments in patients who are taking a course of sweat-
ing baths for the reduction of flesh, or other spoliative or
eliminative purposes. The shallow bath is of special service
in these cases as a means of counteracting the constipating
effect of the sweating processes, as well as in ordinary cases

THE TECHNIQUE OF HYDROTHERAPY.

599

rot constipation in which the disorder is the result of deficient
fintestinal secretion. This effect must of course be encour-
aged by the copious drinking of cool or cold water at the
proper hours (1375).

When employed for the relief of constipation or conges-
tion of the liver or spleen, the water should be dashed upon
the umbilical region or upon the surface overlying the liver
or the spleen as may be indicated*

In Germany the shallow bath is much used as a method uf
preventing threatened chill in infcrmittrnt maiarial fetter.
The author can testify to its merits as a means of aborting
the malarial paroxysm* but he prefers to precede the applica-
tion by a preliminary heating by means of a hot immersion, a
hot-blanket pack, an electric-light bath, a vapor bath, or a
vapor douche. When given for preventing the malarial chill,
the bath should be very short and very vigorous, duration not
more than 30 to 60 seconds* The patient should be imme-
diately afterward wrapped in warm woolen blankets and sur-
rounded W4th bags or bottles filled with hot water or other
means of heating, aJid kept in bed until two hours after the
time of the expected chill has passed.

The //*>/ half-b;rth produces powerful revulsive and anal-
gesic effects in relieving pain. The shallow bath is seldom
employed except for cold applications, but the hot shalluw
bath tnay be used in place of the hot silr for the relief
uf pelvic pain, also for the relief of sciatit and crural Ht'u-
ralj^ia, and in some cases of rheumaiic pains affecting the
joints of the legs. It allows a better position of the limbs
than the sitz bath, the circulation through them being less
interfered with than when they are Hexed, as in the sits bath,
and pressure upon j^aeat nerve trunks is avoided.

Contraindications,-- The shallow bath is contraindicated
in cases of chronic congestion of the heart, brain, or spinal
cord. With great care it may be used tn pntumouia and
fiifuHs^, but it is not needed in these disorders, and may better
be avoided. Its use is contraindicated in fever cases compli-

1117

1178

600 RATIONAL HYDROTHERAPY.

cated with myocarditis^ in perforation^ collapse^ peritonitis^
and hemorrhage from injury to the vessels, also in acute
pelvic inflammation or congestion, in all suppurating processes
in the pelvis, in cases of ovarian neuralgia and neuralgia of
the sciatic nerve. Neither should it be used in cases of
menorrhagia or profuse menstruation or metrorrhagia from
bleeding fibroids or cancer. It must be sedulously avoided
in all forms of acute inflammation when deeply seated, as in
cystitis^ enteritis^ gastritis^ nephritis^ myelitis^ or menin-
gitiSt prostatitis^ ovaritis, and salpingitis.

THE WBT-SHBBT PACK.

1179 This extremely useful and widely applicable hydriatic
procedure, generally accredited to Priessnits, was invented
and first used by Lucas, in 1750. It consists in enveloping
the body with a wet sheet, and preventing evaporation by
careful protection with dry wrappings.

Requisites. — One large double blanket, one single blanket,
two large sheets, one of which should be linen, a large linen
towel, two or three gallons of water at a temperature of 60^
to 70^. Water at a higher or lower temperature may be used
when indicated, but is seldom required.

Method. — The pack may be applied in various ways, but
the following method, which is employed by Winternitz, and
was kindly demonstrated to the author by Dr. Strasser,
assistant to Professor Winternitz, and lecturer at the Poly-
clinic in Vienna, is the most satisfactory : —

1. A sheet is folded once lengthwise, and laid across a
couch near its head. The upper edge of the sheet should
cover the lower third of a thin cotton or hair pillow placed
at the head of the couch (Fig. 74).

2. Next, the double blanket is spread out, and placed
across the couch so that one end hangs over the side oppo-
site the attendant about two feet, the upper edge falling
about two inches below the upper edge of the dry sheet
(Fig. 75).

THE TECHNIQUE OF HYDROTHERAPY. 60I

3. The linen sheet should now be wrung out by two per-
sons* grasping the sheet at each end and twisting it in oppo-
site directions until it is as dry as possible. The sheet is then
spread out upon the blanket, the lower end falling an inch or
two below the upper edge of the blanket (Fig. 76).

4. The patient lies down upon the sheet in such a way
that the upper edge of the wet sheet projects three inches
above the shoulders.

5. The patient raises both arms above his head while the
attendants draw one side of the sheet across the body, turn-
ing it well up under the arms and tucking it in closely all
along the side of the body. From the hips down, the edge of
the sheet is tucked snugly around the leg of the correspond-
ing side, leaving the other leg uncovered (Fig. T7\ The
patient lowers his arms and holds them close by his side
while the other side of the sheet is passed over and tucked
in. A fold is made in the sheet over each shoulder so as to
make it fit the neck closely, care being taken not to con-
strict the vessels. The body is thus completely and closely
enveloped by the sheet (Fig. 78).

6. The farther edge of the blanket is now drawn across
the patient and tucked under the shoulder, the side, and
around the legs, with great care. A fold is made over the
farther shoulder, so as to make the blanket fit closely about
the neck (Fig. 79).

7. The attendant now seizes the long end of the blanket,
and pulls upon it in such a way as to bring the coverings in
close contact with the body everywhere. The loose end is
then thrown over and tucked around the patient, being wound
about him two or more times like a winding-sheet. He is
thus enveloped like a mummy (Fig. 80).

8. The blanket is next doubled under at the foot, and the
dry. sheet at the head is brought around with a neat fold over
each shoulder, and tucked under the shoulders so as to protect
the skin of the face and neck from contact with the blanket,
and completely to exclude the air (Fig. 81).

602 RATIONAL HYDROTHERAPY

g* For additional warmth, a woolen blanket is folded
once, laid lengthwise upon the patient, and tucked under the
shoulders and sides and about the legs. Two or more blan-
kets may be applied at first, if necessary, one or more to be
removed later.

When the pack is administered in this way, the patient
will rarely complain of long delay in "warming up/' Chill
in the pack is usually due to the fact that at some points the
wet sheet is not in perfect contact with the surface, and as a
result, evaporation takes place with coohng, instead of accu-
mulation of heat and vigorous reaction. The cooling effect
thus started in small areas extends to the whole surface, and
the patient is made exceedingly uncomfortable. But when
the cold sheet is brought everywhere in close contact with the
skin, reaction occurs immediately^ and the disagreeable effects
resulting from prolonged chilling are avoided*

In cases of very feeble or very nervous persons, one or both
arms may be left out of the wet sheet j but should be included
in the blanket, to avoid chilling.

Care sliould be taken to see that the patient's feet and the
whole surface of the body are warm when the pack is applied.
If the feet do not warm up readily in the pack, they may be
left out at the first application, and until reaction is improved.

Kussmaul recommends the wet-sheet pack in acute nephri-
tis. When used for this purpose, it should be applied imme-
diately after a vigorous heating of the skin by means of the
hot-blanket pack or short hot immersion bath, that reaction
may take place immediately. The sheet should be wrung very
dry, and the patient should be well and very carefully envel-
oped, and allowed to sweat freely.

Rendu prefers the wet-sheet pack to the Brand bath as a
therapeutic measure in acute febrile disorders, not only because
it aids the elimination of the toxins present in the disease^ but
because of its quieting effects upon the central nervous
system,' while it at the same time develops vital resistance. *

• Revue d* Hygiene Therapeutique, June, 1893, p. 164.

■>

THE TECHNIQUE OF HYDROTHERAPY*

603

Rendu* also especially praises the pack as a measure for
the treatment of pneumonia^ because of its value as a means
of preventing cardiac failure and collapse.

It is less disturbing to the patient, much more convenient
to use, does not require a bath*tub, which is not always ready
at hand; hence can be used anywhere, and may be graduated
to any degree of intensity required.

The cold wet-sheet pack employed in the manner directed
has another advantage over the cold bath in that its effects
are more durable, being somewhat slowly developed.

Winterii!t2 has clearly shown that the cooling pack is
much more effective as a means of reducing temperature than
the Brand bath, the gradual lowering of temperature being
more decided and more durable than after the cold bath.

In the use of the wet-sheet pack as an antipyretic, it will
be observed that the sheet is warmed up more slowly with
each successive application; consequently, the duration may
he increased from three to five minutes at each successive
renewal. The sheet need be changed only when it is showr,
by actual examination to have acquired nearly the tempera-
ture of the body. So long as the temperature of the sheet is
lower than that of the body, a good cooling action is taking
place.

In the dripping sheet, shallow bath, and many other
hydri^^ic procedures, reaction is increased by friction ; but in
the wet-sheet pack, friction can not be employed ; as a sub-
stitute, in cases in which reaction does not readily set in,
warm bottles may be placed at the feet and sides of the
patient Tliis is undesirable, however, as a routine method ;
the bottles should be used only when actually necessary. A
better plan is to press and rub the limbs outside the coverings-

Thc head should be thoroughly cooled by wetting the
scalp, face, and neck with cold water before the patient goes
into the pack, and a toweU or better, a cheese-cloth napkin,
saturated with cold water should be placed upon the face and

604 ftAtlOHAL HYDROTH^RA^V.

wrapped around the head, or the neck, if the patient will not
permit the wetting of the hair. The towel should be
changed at intervals of lo to 15 minutes during the pack.
The duration of the pack will depend upon the effect desired.
For tonic effects the usual length of the application should
be 20 minutes, or until the patient feels a general glow
induced by the return of the blood to the skin and a sensation
of comfort and well-being, which marks the beginning of
reaction. If exciting or heating effects are desired, the
patient should remain in the pack until perspiration begins.
If the effect desired is elimination^ then the pack may be
continued for one to two hours or even longer, or so long as
sweating continues, if the strength of the patient will permit.
If a sufficient supply of blankets is not at hand, the accumu-
lation of heat may be assisted by enveloping the patient in a
rubber sheet outside the other wrappings. When this plan
is adopted, the rubber sheet must be spread upon the bed or
couch between the folded dry sheet and the blanket.
1180 Physiological Effects. — When the wet sheet first comes in
contact with the surface of the body, a decidedly chilly sensa-
tion is produced, which lasts for 5 to 20 minutes, when a
febrile process is not present; when the skin is hot and the
temperature high, no disagreeable sensation is produced. As
reaction sets in, the chilliness disappears, and gives place to
a sensation of comfort and well-being. Nervousness, when
present before the application, is somewhat aggravated during
the first few minutes after the patient enters the pack, but
soon disappears, and a sensation of delicious calm pervades
the system, and in many cases the patient falls asleep.

Schiiller, in his experiments upon rabbits, noticed that the
vessels of the brain, which were dilated at first, as soon as
the general reaction set in, began to contract, the brain sub-
stance steadily shrinking, while the dura bulged more and
more through the accumulation of lymph. This condition is
one most favorable for the production of sleep and repair
of the brain structure. It is the condition present during

THE TECHNigUE OF HVDROTOERAPY.

605

physiological sleep. Later, as the beat thrown off by the
skin, which is greatly increased in amount by the dilatation
of the surface vessels, wartns up the wet sheet, the heat
accumulates in the covering about the patient, and the tem-
perature of the blood is raised sufficiently to induce general
perspiration, the beginning of which is indicated by the
moistening of the brow.

If the pack is continued for several hours, perspiration
will continue^ growing more and more profuse for one or two
hours, and possibly longer in some cases, but sooner or later
the activity of the sweat-glands will cease, their energy seem-
ing to be exhausted. Sweating may be increased and pro-
longed by making the patient drink freely.

From the foregoing it will be recognized that the effects
produced by the wet-sheet pack are exceedingly varied,
a series of distinct groups of effects presenting themselves
in regular succession. The actual effects produced wilt
depend, then, upon the length of the application, or at least
upon the degree of development reached. In some persons
the march of the phenomena is more rapid than in others.

The time occupied in the development of the various phases
of the procedure may be divided into four periods, which are
characterised as follows: (1) Cooling or antipyretic, (2) neu-
tral, (3) superheating, (4) sweating. These several ]5eriods
are the natural result of the progressive accumulation of heat,
for which provision is made by the close wrapping of the
patient, and which necessitates the exercise of very great
, care in so adjusting the wrappings about the neck and the feet
as to prevent the escape of the warm air and vapor devel-
oped by the heat of the body. The amount of heat gener-
ated by a person of average sise in the course of an hour is
very considerable, amounting to 450 heat units, or sufficient
to raise 45 pounds of water ten degrees in temperature^ or to
I elevate the temperature of the entire body of a patient weigh-
ing 150 pounds* three degrees, if this heat should be all
retained, The greater part of this thermic energy is ex-

6o6 RATIONAL HYDROTHERAPY.

pended in warming up the wet sheet and its coverings and in
evaporating the moisture of the sheet. As soon as the cover-
ings are raised to the temperature of the body, the heat
begins to accumulate ; and as soon as it has accumulated sufiB-
ciently to elevate the temperature of the blood .7^, perspira-
tion begins (Bouchard).
1181 During the first or cooling stage, heat is rapidly ab-
stracted from the body, and powerful thermic reaction is
induced. Circulatory reaction is slow, for the reason that
there are ho mechanical aids to dilatation of thp surface ves-
sels, such as the friction of the rubbing sheet and the shallow
bath, and the percussion effects of the douche. The pack in
this respect differs from nearly all other general hydriatic pro-
cedures. The body is left wholly to its own resources, hence
the importance of the proper preparation of the patient before
the bath, so that his powers of calorification and circulatory
reaction may be equal to the demand made upon them. This
is the reason why heating processes of some sort — exercise, vig-
orous rubbing, or the hot bath — are almost indispensable as
a preparation for the cold wet-sheet pack, unless the patient
is in a febrile state. Priessnitz, who, though without scien-
tific education, was certainly blessed with remarkably acute
intuition, usually administered the wet-sheet pack before the
patient arose in the morning, while the skin was warm with
the heat accumulated during the night.

The effects produced during the cooling or refrigerative
stage of the pack are intensely alterative in character. All
the organic processes are excited in connection with the
intense thermic reaction induced, and an exceedingly power-
ful appeal is made to every nerve center in the body. The
whole system rallies to resist the invasion of the depressing
agent, cold; and if the pack is arrested during or at the end
of this stage, or when reaction begins, the general effect
produced will be tonic, and will be essentially the same as
that of a cold bath of the same temperature, provided, of
course, that reaction is fully developed by exercise, rubbing,

THE TECHNIQUE OF HYDROTHERAPY.

607

or other means, after the conclusion of the process. If the
process is arrested as soon as the reaction begins, that is»
at the end of 8 to 12 minutes, a freshly cooled sheet
being applied, the effect is powerfully antithermic and anti-
febrile.

The second, or mittrai, stage of the pack begins when the 1188
temperature of the wrappings and the warm moist air sur-
rounding the patient reaches a point approximating that of the
body, or 92^* The effect during this period is essentially the
same as that of the neutral bath. It is quieting, calmative,
and productive of a disposition to sleep. Renal activity is
excited. When the pack is ended with this period, no other
effects are produced.

When prolonged to the third period, that of superheaHng^ 1183
the body temperature is slightly elevated as heat elimination
is more and more interfered with, and the excitant effects of
a temperature above 98'^ make their appearance, the face
becoming flushed, and the brain intensely congested, unless
the head is cooled by a cold compress to the head and face,
frequently renewed. When the pack is prolonged, and per-
spiration does not promptly make its appearance, the patient
experiences the same weakness and languor which result from
a prolonged bath at lOO'-" to f02^.

As excitation resulting from the accumulation of heat
increases still further, the skin becomes more and more
active, until the perspiratory glands are so excited that visible
perspiration appears upon the brow, marking the beginning of
the fotirth stage, that of cxcitatioti^ or the sivcating stage.
During this stage a prodigious amount of vital work is per-
formed, not only by the skin, but by the nerve centers and
internal viscera associated with it. Every cell in the body is
stimulated to increased activity by the elevation of tempera-
ture and the powerful thermic impressions made upon the
whole cutaneous surface. Under the influence of the elevated
temperature, the elimination and destruction of tissue toxins
take place with augmented rapidity; the heart beat is accel-

6o8 RATIONAL HYDROTHERAPY.

erated, the activity of the peripheral heart is likewise
increased, and the movement of blood in the vessels is aug-
mented, resulting in increased activity of all the eliminative
processes; there is increased oxidation of albumin, and in-
creased elimination as well as more perfect oxidation of
nitrogenous wastes. Thus the sweating pack is a powerful
spoliative or reducing measure.

It should be noted that the pack may not only be arrested
at the end of the several stages, but that any stage may be
prolonged for almost any desired length of time. For exam-
ple, the first stage may be prolonged either by removing a
portion of the covers so as to permit evaporation as the sheet
is warmed, or by renewing the sheet, as has been described.

Instead of the long woolen blanket applied like a wind-
ing-sheet, the author prefers for the cooling pack two single
blankets, which are laid across the couch in such a way that
the patient lies in the center. In wrapping the patient, the
two angles are each brought across and disposed in like man-
ner. An extra folded blanket may be added for warmth.
This plan facilitates renewal of the sheet.

The second, or neutral, stage may be prolonged by with-
drawing most of the covering as soon as reaction has well set
in, so that the loss of heat by evaporation will not be inter-
fered with sufficiently to cause the temperature to rise above
that of the body. Care must be taken constantly, however,
to see that the body is uniformly protected; the sheet must
not be loosened so as to allow local air currents to be estab-
lished, as this would produce local chilling and effects which
might in some cases be really serious.

The third stage may be prolonged by withdrawing a small
portion of the covers, as by taking off the outside blanket,
and by bathing the head and face almost continually with
cold water so as to produce a slight refrigerant effect, by cool-
ing the brain. A cold towel may also be wrapped about the
neck. Thus the extreme excitant effects of the pack may be
checked and sweating delayed.

THE TECHNigOE OF HVDROTHERAPV.

The fourth, or sweat in|:^, stage may be prolonged almost
indefinitely by making the patient drink every half hour a
glassfal of water, either hot or cold, or some suitable beverage
prepared with water and fnjit-juice* The head should not be
cooled excessively, and extra blankets may be applied, if nec-
essary to increase accumulation of heat. In cases in which
the skin is very inactive, so that perspiration is long delayed,
several hot-water bottles may be placed about the patient
inside the dry blankets, and he may be made to drink
copiously of hot water or hot lemonade.

Therapeutic Applications. — From the foregoing it will be 1184
readily seen that the wet-sheet pack is an exceedingly useful
hydriatic procedure, and that it is capable of ready adaptation
to a great variety of conditions. If a i^^nic effect is desired,
the pack may be interrupted soon after the beginning of the
second stage, or when reaction is well established. Employed
in this way, the pack may be made useful in a great variety
of conditions; but it is far less valuable for securing tonic
effects than the douche, the half- bath, the wet-sheet rub, and
other procedures of briefer duration, and in which the thermic
irritation is supplemented by the mechanical stimulus of
friction, and the percussion effect of the douche.

The tcmic pack is indicated in all forms of wasting diseasCp
as in anemia, tubcrcuhsis, convalescence from fever, and
chronic toxemia connected with dyspepsia, as well as in
ehronie di sonic rs of the liver ^ and especially in the toxemia
of chronic nmtarinl infection. Its value in the treatment of
infectious fevers is largely due to its tonic effects.

The pack may be employed in many cases in which the
shock of the cold bath could not be well borne by the patient.
Employed for tonic effects, the wet-sheet pack, continued
well into the second stage, is of great value in anemia, c/t/o*
rosis, diabetes, nervous dyspepsia, ncnrasihenia, seuriy,
chronic gastritis, hypopepsia, eonstipation, and general
paresis. The tonic pack also renders most valuable service
in the intervals of intermittent and relapsing fever,
39

6lO RATIONAL HYDROTHERAPY.

1186 The neutral pack, that is, the wet-sheet pack, continued
until the end of the second stage, is of much value in a great
variety of cases, being especially useful in insontfiia^ acute
mania, melancholia, neurasthenia with nervousness and
depression, and in cases of cerebral irritation of whatever
origin. The neutral pack is an excellent measure of treat-
ment in the class of cases mentioned, since it is not only
tranquilizing but tonic in its effects. The excitation resulting
from the tonic effects of the first stage is calmed by the tran-
quilizing influence of the second period, which is terminated
before the development of depressant effects, thus adapting
this measure to the class of patients with whom purely tonic
measures, such as the cold rubbing wet sheet and the douche,
produce unpleasant effects by exaggerating symptoms due to
irritability of the nerve centers.

Schtiller's experiments showed the wet-sheet pack to be
one of the most effective of all means for quieting the general
nervous system, which it accomplishes by lessening the blood
supply of the brain, slowing the respiration and heart beat,
lessening the reflex irritability and activity of the cerebral gan-
glia, increasing the quantity of lymph in the brain, and thus
supplying a condition essential for sleep.

The wet-sheet pack is of special service in the insomnia
and delirium of typhoid and typJi us fevers, and m. pneumonia.
The author has more than once seen a delirious fever patient
who had not slept for several days, while in a pack fall into
a tranquil sluniber from which he awoke refreshed and quiet.

The neutral pack is of almost equal service in the treat-
ment of epilepsy, eJiorea, and tetany.
1186 The heatin^^ pack, that is, the cold wet-sheet pack contin-

ued until the end of the third stage, is perhaps most useful as
a preparation for tonic applications, such as the shallow bath,
the cold douche, the pail douche, the wet-sheet rub, and the
cold immersion in cases in which powerful derivative meas-
ures are required. If interrupted before the exciting effects
are pronounced, it may be usefully employed in eerebral

cangcsiimi, hepatic and splenic congestions from chronic
malarial infection, constipafiuu accompaJjied by hcmorrkoitis^
ahdominai dn^ps}', and as a means of developing tiie erup-
tion in eruptive fevers. For the last-named purpose this
procedure is unexcelled, producing powerful cutaneous stimU'
iation.

The pack is also of especial service in the early stage of
erupt itfe fevers, when the skin is hot, dry, and congested,
and before the eruption has fully appeared. It not only relieves
the patient *s discomfort by lessening the cutaneous conges-
tion, but evidently aids, as above pointed out, in de%^eIoping
the eruption* Hence its value in measles, scarlet fever, and
smallpox,

Tlie sweating pack^ or fourth stage of the process, is a
highly spoliative and eliminative measure.

The efficiency of the wet-sheet pack as a means of stimu-
lating the elimination of poisons is well shown in persons
addicted to the tobacco habit. In such cases the sheet often
smells strongly of nicotine alter having been wrapped about
the patient for an hour, even a week or two after he has
discontinued the use of the weed.

Indeed, the wet-sheet pack is one of the most useful of
hydrotherapeutic procedures, as it combines at once very
powerful effects, great convenience and universality of appli-
cation, and remarkable flexibility for modification to suit dif-
ferent pathological condLtions. It is a powerful means of
influencing the general nutrition through its effects upon the
sympathetic nervous system, and through it upon all the proc-
esses of secretion, circulation, assimilation, and excretion.
While less perturbing than the douche^ it is still capable
of producing in a more gradual, gentle, but none the less
effective manner, most profound impressions upon the whole
vital economy.

In the absence of more ready means of healing the skin,
the wet-sheet pack, continued until the skin becomes well
warmed, or until very gentle perspiration shows upon the

1187

6l2 RATIONAL HYDROTHERAPY.

face, is an excellent preparation for the cold douche or
other cold application. The electric-light bath, the vapor
bath, fomentations to the spine, the hot-air bath, and other
heating measures are, however, generally more convenient than
the wet-sheet pack as a means of accumulating heat in the
skin; and there is danger, especially in the case of feeble
patients, that the prolonged character of the application may
excessively fatigue the patient or exhaust the nerve centers.

One of the characteristic physiological effects of the wet-
sheet pack is increased activity of the mucous membrane.
This effect is produced only when the application is carried
to the stage of reaction. Thus used, the pack is invaluable
in cases of chronic constipation and hypopepsia. It is equally
valuable in many cases of chronic bronchitis, with dry cough,
and in chronic pneiunonia and pleurisy.

By its derivative effect the wet-sheet pack removes vis-
ceral irritation and congestion, and its beneficent influence is
indicated by the fact that the patient from day to day gains
in power to warm the sheet, thus showing that his power
to react is increasing, and that the blood is being strongly
diverted toward the skin. When the visceral congestion and
irritation are removed, as indicated by the disappearance of
symptoms directly due to these conditions, the wet-sheet
pack may be exchanged for a more highly tonic measure, as
the shallow bath, or the cold or Scotch douche. As a deriv-
ative measure it is of great service in intestinal catarrh,
congestions of the spleen and liver, and in cerebral Jiyperemia,

The leathery, dry, hide-bound skin of the chronic dyspep-
tic becomes clear, supple, and active under the influence of
the wet-sheet pack employed tri-wcekly, followed by oil
rubbing. For the most rapid effects, the pack should, in
these cases, be carried just to the point of beginning reaction;
but perspiration should not be induced unless the patient has
a considerable amount of flesh; and then great care must be
taken to avoid too long continuance of the pack, as when
thus used, it is a very exciting measure, and the majority of

THE TECHHlQliE OP HYDROTHERAPY,

patients suRering from chronic indigestion have but little
recuperative power and small capacity for tissue production.

la Jiiundke the wet -sheet pack affords an excellent
method for relieving the extreme itching and irritation which
usually accompany this condition, at the same time aiding in
the elimination of morbid elements from the blood. In these
cases the pack may be carried to the point of slight perspira-
tion, if irritation is not thereby induced. In cases in which
the itching is very pronounced, care should be taken to avoid
perspiration; the pack must terminate at the end of the neu*
tral stage, which may be prolonged if desirable (page 6oS)>

Contraindicatiotts and Precautions — The cold wet-sheet
pack can nut be employed for patients whose vital resources
arc so small that they are unable to react without the aid of
friction or other mechanical means. It must also be avoided
in eruptive disorders of the skin, and in the exanthemata after
the eruption occurSp being too strongly exciting to the skin.

It is possible to use the pack in many cases in which it
would otherwise be contraindicated, by previously subjecting
the patient to some mild heating procedure, as a short hot
immersion bath {% to 5 min., at 104- to iro"^ F.), the elcc-
trie-light bathp fomentation to the spine, hot water drinking,
a short hot sitz bath, or a hot blanket pack.

By the aid of special precautions the pack may be em-
ployed without difficulty in cases in which untoward effects
might otherwise \m produced. Parts that are sensitive to
cold may be covered with a dry cloth. Parts requiring special
protection are: the spine in spinal irritation; the chest in
asthma; the heart when very excitable; sensitive surfaces in
neuralgia; and in certain cases, the genitals.

For example, in cases of so-called spinal irritation or
spinal neuralgia, in which the contact of cold water with the
skin produces severe pain, the spine may be protected by a
strip of flannel six or eight inches in width and of the proper
length. This should be laid in the proper position on the
sheet just before the patient lies down to be enveloped*

nm

RATIOMAL HYDROTHESAPV-

In asthmatics, in whom cold applications to the cheSt pro-
duce paroxysms of dyspnea, the chest should be protected by
a piece of flannel of proper size and one thickness.

In cases accompanied by hyperesthesia of the skin cover-
ing the abdomen, similar precautions may be employed, the
dry fiannel being placed over the abdomen. If the feet do
not react well, they may be left out of the sheet, and warmed
by means of rubber bags or bottles filled with hot water, or
other similar means, or by rubbing before the pack. It is not
necessary that the feet be included in the pack in order to
secure the general results desired.

When applying a cold pack in cases in which a nervous
state of the heart or iungs exists, place a dry towel over the
chest before wrapping the patient in the wet sheet*

In the case of very feeble patients, a training for the pack
may be practiced, by beginning with a narrow trunk pack,
daily extending it in both directions until the whole body
is involved. Or, with very feeble patients, the treatment
may be begun by placing a single towel wrung quite dry out
of cold water over the front of the body, enveloping the
whole body with blankets. The next day a wet towel to the
back may be added, then one • to each of the lower extremi-
ties, and later to the upper extremities, until finally the
entire body may be enveloped in the sheet.

In the use of the wet-sheet pack, headache, nervousness,
fainting, vertigo, indicate that the pack has been continued
for too long a time, and the circulation has been unduly
excited.

A curious phenomenon which sometimes accompanies the
application of the wet-sheet pack, is the appearance of a rose
color, accompanied by a fetid odor, and sometimes a muci-
laginous secretion. The cause of this phenomenon is not
fully explained, but may be due to bacterial action.

The majority of patients who are benefited by the pack
fall asleep within a few moments after reaction begins. The
patient may be allowed to sleep during the pack; but the

THE TECHNIQUE OF HYDROTHERAPY,

I

application should be terminated when the proper effects
have been produced. Sometimes in cases of acute mania
with insomnia, or even in ordinary cases of insomnia which
do not yield to other measures, the patient may with advan-
tage be allowed to remain in the pack for several hours if he
continues to sleep* but care must be taken to remove a suffi-
cient amount o£ the coverings so that he shall not be over-
heated^ and also on the other hand equal care must be
observed against chilK It is generally necessary to cover tlie
legs and tlie feet somewhat more warmly than the trunk.
The tendency to overheating may also be combated by cold
applications to the head. If applications to the face and
forehead are not sufficient, the scalp may be moistened. It
is not generally necessary to use the ice-cap or ice-water*
The head compress should be omitted when it causes
chilliness.

A graphic proof of the tonic eflFect of the wet-sheet pack
concluded at the first stage of the procedure is afforded by
the ergograph of Mosso, which shows a decided increase in
muscular capacity as the result of the tonic application of
the pack (Exp. 60).

THE COOLINQ PACK.

If it is desired to employ the pack as an aniipyretic, it
should be applied in the ordinary way (page 608) p but must
be interrupted before the end of the first stage; that is,
before the refrigerant effects are obliterated by the accumu-
lation of heat. The procedure must be repeated as soon as
the sheet is warmed by applying a sheet freshly wrung from
water of the proper temperature. Any degree of antithermic
effect desired being secured by repeating the renewal To
secure the most pronounced antithermic effects, water at 60^
to 70^' should be employed. There is no advantage in tising
water at a lower temperature. Colder water stimulates heat
production to such an extent as to antagonize the effect
desired. The sheet should be left very wet; and if the tern-

1180

6l6 RATIONAL HYDROTHERAPY.

perature is high and the skin very hot, two sheets instead
of one may be used, so as to prolong the refrigerant effect.

The patient should be covered with only two thicknesses
of blanket, so as to allow slight cooling through a moderate
amount of evaporation ; but care should be taken to prevent
the entrance of air about the neck so as to avoid undue chill-
ing of this part, whereby congestion of the lungs and possibly
acute bronchitis or even pneumonia may be produced. Fig.
82 shows a method of protecting the shoulders.

Rub the limbs vigorously for a few seconds after the
application of each new sheet before wrapping the woolen
blankets about the patient. This will ensure reaction and
encourage heat elimination. When the patient's tempera-
ture is high and the skin very hot, it may be necessary to
renew the wet sheet at the end of five or six minutes. The
duration of each successive application is from five to eight
minutes longer than the preceding. The first sheet may be
applied at 60° to 65^, and each successive sheet 2° or 3'^
higher. The renewal of the wet sheet may be avoided by
opening the wraps and rubbing the sheet with ice, continuing
until the sheet is sufficiently cooled.

If there is prolonged chilling, or if the patient's teeth
chatter, the woolen blanket should be opened, and the
patient vigorously rubbed between the sheet and the blanket.
As soon as the shivering ceases, he may be wrapped up again
until he becomes warm. The cold wet-sheet pack managed
in this way is an excellent substitute for the cold bath.

Therapeutic Applications. — The cooling pack is indicated
in all cases of febrile disease, and especially in typhoid fever,
typhus y erysipelas, febricula, dengue, malarial fevers, yelloiv
fever^ the plague, acute bronchitis, and ifijiuetiza.

THE COLD SHOWER PACK.

1190 When antipyretic effects are desired, instead of removine;
the sheet from the patient for rewctting, the same results
may be accomplished, though not quite so rapidly, by open-

_ sheet and sprinkling the body as well as the sheet

with cold water (Fig. 83). The patient should be made
to turn first on one side and then on the other, so that the
whole body may be exposed to the cold application, A better
method still is to place the patient upon a cot covered with
robber cloth so arranged in relation to a tub placed at the foot
of the cot that any surplus water may be caught as it runs off
(Fig. S4). Water niay be turned over the patient from a
sprinkler or any convenient vessel By this means the cool-
ing effect of the sheet may be continued, and may be made
almost as intense as the cold bath. The temperature em-
ployed should be from 60'^ to 65'^ F. If the patient does not
well tolerate very cold water, a temperature of 70^ to So% or
even 85^^ will be found efficient if the application is prolonged*

Nearly twenty-five years ago the author made use of this
form of pack as an anlithermic means in the 'treatment of
some fifty cases of typhoid fever in an epidemic of this dis-
ease. Every case recovered, although the type of the disease
was in several cases very grave.

Therapeutic Applications. — The practical applications of
the shower pack are the same as those of the cooling pack
(1189)- It need only be added that the shower pack, being
a measure which may be made almost as powerfully anti-
pyretic as the Brand bath, is especially suited to cases in
which the temperature is persistently high, and does not yield
to more moderate measures.

Contraindications — ^ These are the same as those pointed
cut for the Brand bath*

THE SWEATINQ PACK.

When it is desired to produce powerful eliminative effects \19\
by means of the wet-sheet pack, the application may be made
in the manner already described (1179 K with the exception
that more covers are employed, to encourai^e reaction, and it
is generally wise to place hot bags at the patient's feet and
sides. He should take a glassful of liot water before the

6l8 RATIONAL HYDROTHERAPT.

pack, and two or three glasses while in the pack. In
in which perspiration is not easily induced, the pack may %e
preceded by a hot bath for 3 or 4 minutes. The temperiitafe
of the bath should be from los^ to 1 10^. The patient*« ddn
shoold be so well heated that he will anticipate the oOMMt
of the cold sheet with pleasure. There should not be She
slightest delay between the hot bath and the cold aheeL
The hot-blanket paek may be used in case of the hot biith
when the latter is not convenient.

When it is desirable to prolong the perspiration, die
patient may be removed from the wet-sheet pack after tlie
activity of the skin is well established, to be at once wrapped
in dry blankets surrounded by bottles or rubber bags filled
with hot water. He should be induced to drink at intervals
of 10 to 15 minutes a half glass of hot water or weak hot
lemonade. iRubbing the limbs and trunk outside the wrap-
pings will stimulate perspiration. The patient may increase
heat production by contracting and relaxing the muscles with-
out changing the position of the limbs.

Therapeutic Applications. — This procedure is one of the
most powerful of spoliative and eliminative measures. It is
invaluable in jaundice^ dropsy, syphilis, and most other mala-
dies in which eliminative effects are indicated. It may be
employed with very great advantage in cases of obesity^
rheumatism, gout, dyspepsia, chronic toxemia, neurasthenia
with inactive skin, chronic nephritis, enfeebled chronic inva-
lids whose habits have been sedentary, alcoholics, victims of
the tea and coffee habit, and tobacco users, especially smokers,
and in malarial fever, catarrhal jaundice, septicemia, ascites,
amyloid liver. Belts palsy, acute and chronic myelitis, lepto-
meningitis, epilepsy, neuralgia, migraine, tetany, and Ray-
naud's disease.

Any degree of depletion or eliminative effect desired may
be produced by prolonging the sweating process.

A cold application should always follow the sweating pack.
In rheumatism, neuralgia, Bright*s disease, and feeble heart.

6l2 RATIONAL HYDROTHERAPY.

face, is an excellent preparation for the cold douche or
other cold application. The electric-light bath, the vapor
bath, fomentations to the spine, the hot-air bath, and other
heating measures are, however, generally more convenient than
the wet-sheet pack as a means of accumulating heat in the
skin; and there is danger, especially in the case of feeble
patients, that the prolonged character of the application may
excessively fatigue the patient or exhaust the nerve centers.

One of the characteristic physiological effects of the wet-
sheet pack is increased activity of the mucous membrane.
This effect is produced only when the application is carried
to the stage of reaction. Thus used, the pack is invaluable
in cases of chronic constipation and hypopepsia. It is equally
valuable in many cases of chronic bronchitis, with dry cough,
and in chronic pneumonia and pleurisy.

By its derivative effect the wet-sheet pack removes vis-
ceral irritation and congestion, and its beneficent influence is
indicated by the fact that the patient from day to day gains
in power to warm the sheet, thus showing that his power
to react is increasing, and that the blood is being strongly
diverted toward the skin. When the visceral congestion and
irritation are removed, as indicated by the disappearance of
symptoms directly due to these conditions, the wet-sheet
pack may be exchanged for a more highly tonic measure, as
the shallow bath, or the cold or Scotch douche. As a deriv-
ative measure it is of great service in intestinal catarrh,
congestions of the spleen diuA liver, and xn cerebral hyperemia.

The leathery, dry, hide-bound skin of the chronic dyspep-
tic becomes clear, supple, and active under the influence of
the wet-sheet pack employed tri-weekly, followed by oil
rubbing. For the most rapid effects, the pack should, in
these cases, be carried just to the point of beginning reaction;
but perspiration should not be induced unless the patient has
a considerable amount of flesh; and then great care must be
taken to avoid too long continuance of the pack, as when
thus used, it is a very exciting measure, and the majority of

THE TECHNtQljE OF HVDROTHERAPY.

613

patients suffering from chronic indigestion have but little
recuperative power and snnall capacity for tissue production.

In jaundice the wet^sheet pack affords an excellent
method for relieving the extreme itching and irritation which
usually accompany this condition, at the same time aiding in
the ehminatton of morbid elements from the blood. In these
cases the pack may be carried to the point of slight perspira-
tion, if irritation is not thereby induced. In cases in which
the itching is very pronounced, care should be taken to avoid
perspiration; the pack must terminate at the end of the neu-
tral stage» which may be prolonged if desirable (page 608).

C0ntraindicatl0ns and Precau 11005,-^ The cold wet-sheet
pack can not be employed for patients whose vital resources
are so small that they are unable to react without the aid of
friction or other mechanical means. It must also be avoided
in eruptive disorders of the skin, and in the eKanthemata after
the eruption occurSp being too strongly exciting to the skin.

It is possible to use the pack in many cases in which it
would otherwise be contraindicated, by previously subjecting
the patient to some mild heating procedure, as a short hot
immersion bath (% to 5 min., at 104"' to 1 10^ F,), the elec-
trie-light bath, fomentation to the spine, hot water drinking,
a short hot sitz bath, or a hot blanket pack.

By the aid of special precautions the pack may be em-
ployed without difficulty in cases in which untoward effects
might otherwise be produced. Parts that are sensitive to
cold may be covered with a dry cloth. Parts requiring special
protection are: the spine in spinal irritation; the chest in
asthma; the heart when very excitable; sensitive surfaces in
neuralgia; and in certain cases, the genitals*

For example, in cases of so-called spinal irritation or
spinal neuralgia, in which the contact of cold water with the
skin produces severe pain, the spine may be protected by a
strip of flannel six or eight inches in width and of the proper
length* This should be laid in the proper position on the
sheet just before the patient lies down to be enveloped.

1188

620 RATIONAL HYDROTHERAPY,

The dry pack may be applied to a portion of the body
only, as the trunk, the lower half of the body, one or both
legs, the knee, ankle, or elbow joint, or a paralyzed limb.

If used as a means of preparing the skin for a cold appli-
cation, by storing up in it a quantity of bodily heat, the result
sought may be facilitated by vigorous rubbing of the limbs
outside the coverings.

In certain countries a dry p^ck is administered by envel-
oping the patient in dry hot sand. The effect is the same as
though blankets were wrapped about the patient. Rusch-
pier introduced the methodical use of the sand bath in 1831.
It is still employed in Germany. The temperature of the
sand is from ti8-to 122'^ F.

1193 Physiological Effects,^ The efifect of the dry pack is first
to secure an accumulation of heat by lessening the heat
elimination, and in extreme cases to auf:;Tnent the heat of the
body by the application of artificial heat through the aid of
hot-water bottles, hot bags, the drinking of hot water, etc.

The natural result of this accumulation of heat is to
increase the temperature of the blood. The body tempera-
ture often rises two to four degrees. The elevation of tem-
perature is doubtless due not only to the accumulation of
heat, but to an increase of heat production, the natural result
of the continuous exposure of the body to a high temperature.

With the elevation of body temperature, perspiration is
induced. Before perspiration begins, the face is often flushed,
the patient experiences an uncomfortable sensation of fulness
in the head, and the pulse rate is decidedly increased. With
the beginning of perspiration the patient becomes more com-
fortable ; but the dry pack, as a sweating process, is by no
means the most agreeable of thermic applications.

1194 Therapeutic Applications. — The dry pack is especially
indicated in shock, collapse after hem.orrhage, anesthesia, or
a severe surgical operation. It is also of great value in the
treatment of the cold stage of intermittent fever. It is useful
in all cases in which there is a subnormal temperature.

In cases of /fara/jsis, applications of the dry pack» some-
times general* but more fie(|iiently local, as in paraplegia
and hemiplej^ia, may be ii.^tsd to great a*lvantage.

Id the absence of better means, the dry pack may be
used as a preparation for the cold douche and other cold pro-
cedures. Care uitist be taken, however, to make ihe cold
application instantly on the removal of the patient from the
pack; otherwise a slight chill will be prodoceil, and the
effect will be spoiled* The dry pack may also be used with
advantage for ** breaking up a cold," for which purpose it is
often very successful when applied wilhin a U\v hours after
the exposure. In cases of coiiapst\ arietitis, or phiebiiis m
irpfund, in stpiici'mia, maiariai and typko-malarial fever,
nminrial ncttraigia and in odtsih% the dry pack is useful.

In ehronic rheumatism, when the patient is not able to
secure the advantages of the hot-air^ vapor, Turkish, electric*
light, or hot inmiersion baths, the dry pack may be employed
with advantage. It may also be used in chronic rheimiatism
for continuing the effect of the hot bath, the patient being
immediately afttT the bath wrapped in dry warm woolen
blankets, and left to continue perspiring for an hour or two.

The dry pack is frequently employed as a means of pro*
mating reaction after a cold bath in feeble patients.

Contraindloitions and Precautions. — i. In the application

the dry pack, the fact that heat elimination is diminished
sliould he borne in mind. If the application is continued too
long, or if too great an amount of heat is applied, the body
temperature may rise to an injurious degree. This is espe-
cially true in its use to abort a malarial chill.

2. When employed for the reUef of chronic rheumatism, or
for sciatica and other neuralgias involving large nerve trunks,
the dry pack can not be followed by extremely cold applica-
tions without running the risk of producing severe pain and
other inconveniences. In cases of this sort^ the wrappings
may be removed gradually, so that the patient may be cooled
off by degrees* or partial cold friction may be employed*

1196

622 RATIONAL HYDROTHERAPY.

3. When employed in cases of paralysis, the application
should not be continued so long as to induce profuse per-
spiration. When the normal heat of the skin is restored, a
portion at least of the wrappings should be removed.

4. When employed to produce perspiration, the dry pack
should not be used more frequently than once or twice a week,
except in cases of obesity.

5. The dry pack is contraindicated in cases of chronic
cerebral congestion^ irritable hearty eruptive disorders of the
skin, and in cases in which patients are extremely nervous or
excitable. It can seldom be employed to advantage with
children as a means of inducing perspiration, and except
when used to combat collapse or abort a malarial paroxysm^
is not very frequently called into use, as the hot-blanket pack
and other heating procedures are more convenient

THE HALF-PACK.

1196 This procedure (Fig. 85) is precisely the same as the wet-
sheet pack (1179), with the exception that it is confined to
the trunk of the body and the hips, the arms and legs being
• excluded from the application. It may be confined to the
trunk only, and is then called the trunk pack.

The same materials are needed for the application, the
only difference being in their disposition ; the same tempera-
tures are employed, and the remarks made with reference to
physiological effects and therapeutic indications are equally
applicable. It may be added simply that the half-pack is
attended by less inconvenience to the patient, while its thera-
peutic efficiency is almost as great as that of the full pack.

The half-pack is of special value in insomnia and the
nervous affections growing out of indigestion with resulting
irritation of the abdominal sympathetic. When employed
for insomnia, the pack should be applied at bedtime, and
may be kept in place during the greater part of the night
if necessary to enable the patient to sleep.

The contraindications are the same as for the pack (1188).

THE TECHNIQUE OF HYDROTHERAPY,

623

THE HaT-BLANKET PACK.

The hot-blanket pack (Fig. 86) consists m the envelop- 1197
ment of the body in a woolen blanket wrung out of water as
hot as can be endured by the patient without pain or injury.

Recjui sites. ^ — A couch or bed with a good mattress^ a small
hair or cotton pillow, four or five woolen blankets, a rubber
blanket^ two or three bottles or rubber bags filled with hot
water.

Method. — The pillow is laid upon the couch, the rubber
blanket is first spread out, the upper edge oyerlappiog the
pillow, and all but one of the woolen blankets are spread out
smoothly, one after the other, in such a manner as just to
cover the pillow. Another blanket, having been placed in
water at a temperature of about 160^^, is then wrung out.
The most convenient manner of wriufjing out blankets is
showTi in Fig. Sy. The blanket should be rapidly wrung as
dry as possible. After wringing, it is spread out upon the
dry blanket as quickly as possible, and the patient, having
previously disrobed, lies down at once in the center of the
blanket and is quickly enveloped as directed for the wet -sheet
pack (1179). Hot water bottles or bags are placed at the
feet for additional heat.

Physiological Effects— The hot-blanket pack is an excit- 1108
ing and heating measure of great power. It communicates
heat to the body, diminishes heat elimination, and increases
heat production. Its application excites the circulation,
increases the pulse- rate, raises the temperature two to three
degrees, and when sufficiently prolonged, induces profuse per-
spiration. It differs from the sweating wet-sheet pack in that ^
its action as an exciting procedure is direct, whereas the
wet-sheet pack is primarily sedative^ the exciting effects being
secondary, as the result of the reaction.

The hot-blanket pack is followed by an atonic reaction
through which the circulation is slowed, nerve tension low-
ered, and the activity of the vital processes diminished. Its

624 RATIONAL HYDROTHERAPY.

frequent repetition produces depression of nerve tone, lowers
vital resistance, and enfeebles the circulation.

The effects of the hot-blanket pack differ from those of
the dry pack in that the application of the dry pack is not
followed by atonic reaction, the heating being gradual.

The hot-blanket pack, after the first moment, is essen-
tially a vapor bath. The loose meshes of the wrappings are
filled with warm vapor, which is retained by the rubber sheet.
The effects are essentially the same as those of a vapor bath.
1199 Therapeutic Applications. — The hot-blanket pack is es-
pecialljr useful in cases in which the temperature is subnormal,
as in cases of collapse, surgical shock, etc. It is useful in
all cases for which the dry pack is indicated, and is generally
to be preferred to the dry pack except in the cold stage of
intermittent fever, when the dry pack is preferable, because
of the danger of provoking chill through the evaporation
which takes place from the moistened skin when a hot-
blanket pack is administered.

The hot-blanket pack is a valuable procedure in cases of
acute BrigJit' s disease, in the albuminuria of pregnancy, in
eclampsia, in convulsions of children with pallor, to induce
perspiration in subacute r lieu mat ism, in eJironic toxemia, in
infectious jaundice, in nepliritis complicating typhoid, scarla-
tina, yelUnv fever, measles, and other infectious fevers, in
influenza, malarial and uremic coma, malarial hematuria,
septiceinia, muscular rheumatism, doigue, collapse of cholera
and cholera morbus, peritonitis, renal calculus, acute myeli-
tis, and as a derivative in lobar pneumonia.

The hot-blanket pack is also useful as a preparation for
cold applications, especially in adynamic febrile types, when
the skin is cold, to insure good reaction, and thus aid heat
elimination. It is almost equally useful in cases in which
heat production is much increased as a means of lessening
thermogenesis by atonic thermic reaction. In the first class
of cases, the duration of the application should be just long
enough to warm the skin; in the second class, the applica-
tion should not continue more than from 2 to 4 minutes.- In

/I

THE TECHNIQUE OF HYDROTHERAPY. 625

all cases the temperature should be as high as the patient
can bear without burning.

Contraindications and Precautions. — Most of the sugges-
tions made in relation to the dry pack are applicable here.

1. Extreme care must be taken to prevent increase of
body temperature, especially when employed as a means of
increasing heat elimination in fevers. The body tempera-
ture must be taken in the mouth, before, during, and after
the application.

2. Care must be taken not to burn the patient by wring-
ing the blanket out of water at too high a temperature. This
is especially likely to occur in cases of paralysis in which there
is found not only diminished sensibility of the skin, but low-
ered vitality of the tissues, and hence a double risk of injury
from the application of too high a temperature. This danger
is also very great in cases in which the circulation is greatly
slowed in consequence of the administration of an anesthetic
for surgical purposes and in cases of collapse in cyanosis and
anasarca.

3. It must not be forgotten that the hot-blanket pack,
like other general hot applications, although primarily stimu-
lating, is ultimately exhausting and depressing; hence it must
be carefully employed, especially in the case of chronic affec-
tions. It affords so much comfort jn many cases that patients
often call for its too frequent repetition.

Recent observations afford ground for the belief that
disease germs are eliminated in great numbers by the skin,
especially during very vigorous perspiration. This fact renders
this procedure useful in all the acute infections.

THE EVAPORATINQ SHEET.

The evaporating sheet (Fig. 88) is one of the simplest of 1200
cooling procedures. It consists in wrapping the patient in a
sheet wrung out of hot or cold water, as the indications may
require, and allowing cooling by evaporation. The sheet
should be wrung moderately dry, and should be applied next
40

626 RATIONAL HYDROTHERAPY.

the skin. The cooling is the result of the absorption of heat
due to the evaporation of the water contained in the sheet.

Physiolos^ical Effects. — The evaporation of one pound of
water will absorb about one thousand heat units, which for
a patient weighing i6o pounds, would amount to a lowering
of the body temperature six degrees. Such an effect is never
produced, however, for the reason that heat production is
constantly going on, and is replacing the heat loss at the
rate of 7.2 units per minute or more. With a febrile tem-
perature of 103°, spontaneous evaporation takes place at a
very rapid rate from the surface of the sheets wrapped about
the body; and when the evaporation is aided by means of
vigorous fanning, as with a current of air from an electric fan
(Fig. 89), most powerful refrigerative effects are produced.
The patient should be gently rubbed continuously.

Therapeutic Applications. — The evaporating sheet is a
useful measure in certain cases of fever. Either the cold or
the hot evaporating sheet may be used, according to the indi-
cations present. The hot evaporating sheet is, however, most
commonly employed. It is especially useful in adynamic
cases, or where the patient is very nervous, depressed, appre-
hensive, and distressed at the thought of contact with the
cold water. The hot evaporating sheet should be wrung very
dry out of very hot water; the attendant should wrap the
sheet about the patient very quickly, so that a strong impres-
sion of heat may be made upon the skin. As the evapora-
tion takes place, the sheet will be rapidly cooled, and heat
should thus be removed from the body.

The first impression of the hot sheet lessens heat pro-
duction by reflex influence and dilates the surface vessels.
While the vessels remain dilated, heat elimination takes place
at ten times the ordinary rate (Conrad Klar). At the end of
3 to 5 minutes, the vessels become contracted so as greatly to
lessen the rate of heat elimination, and hence the application
should be renewed at short intervals (i to 3 min.).

Evaporation is on the whole not a desirable or valuable
mode of refrigeration except in cases in which there is very

THE TECHNIQUE OF HYDROTHERAPV.

627

excessive activity of the surface circulation^ with abnormal
heat and no tendency to chill. Slow cooling of the skio
by evaporation causes a contraction of the surface vessels
which is not followed by reaction, and which is accordin^jly
not only accompanied but followed by congestion of internal
parts. Therefore this method of cooling is rarely indicated.
The cold sheet should be resorted to only in cases in which
the surface congestion is so excessive that the contraction
occasioned by cooling will be only sufficient to establish a
normal condition of the vessels, and without inducing retro-
stasis of blood and congestion of the viscera. Active cuta-
neous circulation should be maintained by rubbing*

WET-HAND RUBBlhtQ.

This procedure ( Fig, 90) consists simply in rubbing the
cutaneous surface with the wet hand,

flethod — Water at 40'' to 75^, with plenty of Turkish
towels, a Turkish sheets and a woolen blankctp are the only
requiBites for this bath. In beginning the application the
attendant stands with his side to the couch, facing the patient,
dips both hands into the water, then applies them^ one to
each side of the patient's face, covering as large an area as
possible. Friction i^ made from the median Hue outward,
the tips of the fingers sweeping over the brow and describing
a sort of semiciicle along the cheeks to the under side of the
jaw. Repeat the movement three to six times. In men, wet
the hair by shampooing with wet fingers or a w^et towel.

Before wetting the face, a dry Turkish towel should be
folded about the head in such a way as to protect the ears,
and if the patient is a lady, the hair also, a precaution which
will be much appreciated by nervous patients (Fig, 9().

Next the application is made to the chest, both hands
being employed, first the upper part, then the sides of the
chest being rubbed vigorously, then the abdominal surface.
After the entire chest has been gone over three or four times
with quick, short movements and considerable pressure, the

1201

628 RATIONAL HYDROTHERAPY.

towel is thrown over the chest and the surface dried qviddy;
the rubbing being continued until- the surface is reddened*
The face and head are not to be dried until the end, as it is
desirable that these parts be cooled by evaporation.

The prolonged application to the head is to protect from
congestion ; the application to the chest before proceeding to;
other portions of the body is to stimulate the heart and langs
to increased activity, thereby promoting reaction.

The arms, first one^ then the other, next receive attentioo..
The attendant grasps the patient's hand with his left hand*
while with the right he vigorously rubs the arm with kmg
rapid strokes reaching from the shoulders to the wrist, his
hand being kept cold and moistened by dipping in the basia
after every four to six strokes. If the patient is fairly vigor-
ous, he may hold his arm perpendicular while the attendant
rubs with both hands.

On finishing the arm, the attendant rubs\he hand between
both his own, and ends with one or two smart blows upon the
palm with the flat of his hand. The arm is quickly enveloped
with a Turkish towel (Fig. 92), the patient holding one end,
and is rubbed until the reddening of the skin indicates the
establishment of reaction. The blanket is then drawn over
it, and the other arm is treated in like manner.

Next give attention to the abdomen. Apply the fric-
tion first transversely, the rubbing being done alternately
with the two hands, then in a circular manner, following the
course of the colon. The thighs are next treated, but one
being uncovered at a time. Then follows the treatment of
the legs and feet, each of which should be rubbed until the
circulation is well established.

The patient should now turn upon his face, and fold his
arms beneath his forehead, thus drawing the shoulder-blades
upward and outward, so as to flatten the dorsal surface as
much as possible. The attendant then dips his hands and
applies them first to the back and sides of the neck, ex-
tending the fingers around so as to reach the front of the

THE TECHNIQUE OF HYDROTHERAPY. 629

neck. The upper part of the back, the shoulders, and the
outer portion of the upper arm should next receive attention,
then the middle and lower parts, and the sides of the trunk.
Lastly, apply to the whole length of the spine a few vigorous
strokes. As fast sis any part is dried, it should be covered.

The treatment concludes with an application to the feet of
water at the same temperature as that applied to the head.
The ankles and dorsum of the feet should be vigorously
nibbed, and the sole percussed with energy, but not rubbed^
on account of the unpleasant tickling sensation induced.

Not more than 5 to 15 seconds should be occupied in rub-
bing any part with the wet hand before the application of the
towel. If the rubbing is insufficient to produce reddening
of the surface, light spatting or percussion should be applied
after drying. Good reaction should be secured in each area
treated before proceeding to another portion of the surface.

The skin must be warm at the time of the application.
An excellent hour is before rising in the morning.

The temperature employed and the duration of the treat-
ment must depend upon the individual case. The tempera*
ture most frequently employed is from 65° to 75°, or the
ordinary living-room temperature. Generally the hands of
the attendant are simply dipped into water so as to moisten
their surfaces, no more water being applied than is naturally
carried by the moist hand. In certain cases, however, as
when this procedure is employed as a general antipyretic or
antifebrile measure, a larger quantity of water should be
employed. The bed of the patient in such cases should
be protected by a rubber blanket and the patient should be
wrapped in a Turkish sheet. Instead of simply dipping his
hand into the water, the attendant cups his hand in such a
manner as to dip up all the water possible. This is quickly
thrown upon the portion of the surface under treatment at the
moment, which is at once vigorously rubbed. This alternate
deluging and rubbing of the skin may be repeated from one
to half a dozen times. In certain cases hot instead of cold
water is employed.

630 RATIONAL HYDROTHERAPY.

1202 Physiological Effects — Wet-hand rubbing is an efficient

means of producing strong circulatory reaction with moderate
thermic reaction by the combined influence of cold and friction.
The reaction Is still further encouraged by rubbing with the
dry towel, and afterward applying friction and percussion
with the hand.

The physiological effects of wet-hand rubbing are mixed
in character, owing to the mixed nature of the application,
the friction giving rise to mechanical effects, while the hydric
effects proper are purely thermic. Employed at a tempera-
ture considerably below that of the skin, the application
energizes both the cardiac and the respiratory functions, and
thus a mild general tonic effect is produced. The friction as
well as the cold impression increases blood pressure. The
activity of the peripheral heart is increased, while the central
heart is energized, often to a remarkable extent. By the
employment of ice-water, the tonic effects may be consider-
ably intensified, while on the other hand, by the employment
of very hot water or even that at a neutral temperature,
quieting effects are produced, with relief of pain when this
symptom is present.

It is interesting to note that while hot applications gen-
erally produce lowerijig of blood pressure, luhen the applica-
tion is accompanied by moderate friction, there may be a
moderate increase of tension,

1203 Therapeutic Applications. — The cold wet-hand rub com-
bines tonic, restorative, and derivative effects. The intensity
of the effects produced depends upon the temperature of
the water and the vigor of the friction. The colder the
water, and the more vigorous and prolonged the friction, the
more intense the effects. The feeble neurasthenic patient
experiences, after an application of cold wet-hand rubbing,
a delightful sensation of increased vigor, and relief from
malaise and mental and nervous weakness.

Wet-hand rubbing may be made a most useful means
of reducing the temperature and increasing vital resistance

THE TECHKIQUE OF HYDROTHERAPY,

6ij

in febrile cases where the patient is too feeble to endure the
application of the cold bath or the cooUng pack^ or under
circumstances prohibiting these antipyretic measures. The
lower the temperature of the water used, the more freely it is
applied to the parts which are being rubbed, the longer the
application, and the more frequent its repetition, the greater
will be the antithermic or antifebrile effect produced (40^
65^), This means of reducing temperature is very appropri-
ate for children and aged persons, and in cases of typhoid
and other continued fevers in which the cold immersion bath
can not for any reason be employed^ as in cases of f^iies-
iinai pcrfotatiQFi, mj^ocaniiiis, nepkritis, collapse, and other
complications.

Wet-hand rubbing with water at a temperature of Sj^ to
95^ is a quieting measure of value in /evcns/irn^ss due to nerv-
ous excitabihty rather than to actual elevation of tempera-
ture. When employed for this purpose, the rubbing should
be very gentle, and the passes should be in the form of strok-
ing, the direction being, so far as possible, from the center
toward the periphery. The surface may be left moist or may
be dried by simply covering with a towel and gently passing
the hand over the surface. The effort should be to avoid
both thermic and circulatory reaction or stimulatioD of the
heart

Wet-hand rubbing is a measure of less power than the
rubbing wet sheet, cold friction, and most other tonic appli-
cations, and hence its use is naturally limited to cases in
which other more vigorous and more efficient measures can
not be employed. It is well adapted to vc'rj^ feeble neuras-
thenics who dread water and have but little power to react.
The warmth of the hand of the attendant, the rubbing, and
the small amount of water employed when used for tonic
effects, all tend to promote reaction, so that it may be said
that there is no patient too feeble to admit of the application
of this measure. Even very weak patients allow the appli-
cation of ice-water when applied to the surface by the medium

632 RATIONAL HYDROTHERAPY.

of the hand, though water at a much higher temperature
would not be tolerated if applied by means of a sponge, towel,
wet sheet, or any other vehicle. In very feeble, nervous, and
excitable patients, the upplication should be made at first at
a temperature of 70^^ or even 80^, and lowered one or two
degrees each day until water at a temperature of 50° or even
lower can be tolerated.

By this means the patient may be gradually trained to
receive at first tepid, then cool, and finally cold water; then
other procedures, as the cold friction, the towel rub, the
rubbing wet sheet; and later the half-bath, the cold shower,
and the horizontal douche, may be employed.

Wet-hand rubbing is especially indicated in the cases of
very feeble invalids who, being entirely unaccustomed to cold
water, have a dread of its application, which might almost be
termed a species of hydrophobia.

Wet-hand rubbing is useful in fever cases in which the cir-
culation of the skin is deficient, as shown by pallor, coldness,
and cyanosis, as a preparation for more vigorous antipyretic
measures. Each part must be rubbed until red. It may be
appropriately employed whenever it is desirable to encourage
cutaneous reaction, either alone or following a hot bath of
some sort. This measure is especially useful in cJiilblains
(40^ to 50°).

For very feeble patients wet-hand rubbing may be applied
to the back only. Very cold water applied to the back in
this way is an excellent tonic. Cold wet-hand rubbing is also
useful in aiding the circulation in the lower extremities in dys-
peptics and neurasthenics troubled with cold feet and legs.
In these cases the circulatory disturbance is not due to weak-
ness of the heart, but to vasomotor spasm in the cold parts.
Rub first with ice-water, then with warm flannels until red
and warm.

There is no procedure of more general value than this
simple measure. It is applicable to almost every form of
acute and chronic disease. It is of special service in all

THE TECHNIQUE OF HYDROTHERAPY. 633

forms of chronic disease accompanied by anemia or low nerve
tone and feeble vital resistance^ the number of which is too
great to mention. It may be so graduated as to constitute
the most mild and gentle measure possible, or a most vigor-
ous and thoroughgoing hydriatic procedure.

Vigorous rubbing of the surface with the hand while cold
water is poured upon the patient from the height of a few
feet, is the most efficient means of combating sunstroke.
This method was first used by Paulus of £gina, A. D. 660
(Wintemitz). It has been advocated in recent years by a
number of writers on hydrotherapeutics.

Wet-hand rubbing is constantly employed in combination
with many other baths. For instance, in the application of .
heating compresses, if the patient does not react promptly,
the surface should be first rubbed with the hand dipped in
cold water. Rubbing the chest with cold water is a valuable
means of accelerating the heart's action before a general cold
application, and thus increasing the patient's ability to react.
Rubbing the face, head, and neck with cold water is the
usual preparation for cold baths of all kinds.

Wet-hand rubbing is employed in connection with the
shallow bath and the shallow foot bath, and rubbing with the
hands is practiced in connection with nearly all cold baths
excepting packs, compresses, and the different forms of the
douche. In general, cold friction applied locally is an excel-
lent means of protecting an internal part against congestion
from the cold douche. The water employed should be very
cold, and the application should be made to the cutaneous
area in reflex relation with the internal part which it is desired
to protect; as, for example, if it is desired to protect the liver,
the application should be made over the region of the liver
just before the douche. The stomach, bowels, chest, and
heart may be protected in like manner.

Contraindications. — Wet-hand rubbing should not be
employed for the reduction of temperature in smallpox^ scar-
let fever, or other exanthemata. It is also contraindicated

634 RATIONAL HYDROTHERAPY.

in eczema and other non-inflammatory t3^pes of eruptive dis
eases of the skin.

THB SPONQB, ilBLUTlON, OR TOWBL BATH.

1804 This (Fig. 93) is a general hydriatic measure consisting
of an application of water to the surface by means of a wet
sponge or towel.

Requisites. — A basin of water at the proper tempera-
ture; a large bath-sponge or coarse towel; Turkish towels; a
foot tub if the patient is able to stand erect.

ilethod- — The foot-bath tub should contain water at a
temperature of 104° to 1 10°. With the patient standing in
the foot bath bending forward, his head, face, and neck are
thoroughly and repeatedly drenched with cold water (50^)
by means of a satuiiated sponge or towel. The attendant
then applies the saturated sponge (60° to 70°; average 65^)
first across the chest and abdomen, then the back, the arms,
and the legs. The sponge should be applied with moderate
pressure, and should be rewet as often as emptied of water.
The whole surface of the body should be gone over very
rapidly.

The sponging being completed, a dry sheet is thrown
about the patient, who steps out of the foot bath, and holds
his feet in alternation over the foot bath each two or three
seconds, while cold water is poured over them. The patient
is quickly rubbed dry, assisting himself as much as possible
in the rubbing so as to encourage reaction by exercise. After
the bath the patient should take moderate exercise, or if
unable to do so, dry friction should be applied (1221).

The patient whose strength is at least moderately good
may administer this bath to himself by means of a towel,
following as nearly as possible the order just indicated as
regards the application. The application to the back may be
easily made by grasping the towel by its ends, throwing it over
a shoulder, and making a seesaw movement.

To a patient who is unable to stand, this bath may be

THE TECHNIQUE OF HYDROTHERAPY.

■

.

administered in bed (Fig, 94). Care should be taken that
the feet are not cold* and that the whole surface of the body
is warm. The application ts made when the patient is
reclining in essentially the same mauuer as when in the stand-
ing position. A rubber blanket must be placed beneath him
on the bed, and so arranged that the surplus water may run
away into some proper receptacle, to prevent wetting of the
bedclothing. The rubber sheet should be covered by a Turk-
ish sheet, which for simple spon^jing with a well-wrung
sponge may be sufiScient, The patient having been un
dressed and covered 10 the bed, the attendant begins the
application by first sponging the face and neck, then the fol-
lowing parts in succession : One arm, the other arm. the
chest and abdomen, the front side of the legs, the back, the
back side of the legs. No portion of the body should be
exposed to the air except the portion under treatment, and
this should be covered as quickly as possible after drying.
Not more than 3 to 5 seconds should be employed in the
sponging of each part, the same length of time in rubbing the
parts with the hands, and J to 10 seconds in the drying and
rubbing of each part.

The temperature of the bath and its duration depend upon
the effect sought. If the desired effect is the reduction of
temperature and the stimulation of vital resistance^ water
at a temperature of 60^ to 70^ should be employed, and a
basin of water should be placed near the bedside so that as
much water as possible may be lifted in the towel or sponge
and applied to the patient. Each part should be sponged
and rubbed thoroughly so as to induce good reaction; and
after the whole surface has been gone over, the application
may be repeated as many times as is necessary to secure
the effect desired. When employed for tonic effects, the
amount of water should be small, the temperature low (so'^
to iS% ^^^ ^he rubbing and spatting vigorous.

The whole body should be kept warmly covered, except
the part being rubbed, in all cases other than those in which

636 RATIONAL HYDROTHERAPY.

rednction of temperatare is the object sought, and even in
these cases so much exposure should not be allowed as to
prevent reaction by the disturbing effects of evaporation.

The patient, if feeble and with defective circulation,
should be prepared for the bath by an accumulation of heat
in the skin in any convenient manner, as by the dry pack,
that is, wrapping with warm blankets with a hot bag to the
spine and feet; by a hot-water bath; by hot-water drinking;
or by a fomentation over the abdomen.

1205 PiiysiologlGal Effects. — The physiological effects of the
sponge or towel bath, or ablution, as the application is some-
times termed, are essentially the same as those of wet^hand
rubbing, and depend upon the same conditions. The difference
is simply that this application is more vigorous; a larger quan-
tity of water is employed, more heat is abstracted from the
body, the general thermic and circulatory reactions are more
intense, and the application is in every way a more vigorous
one than the simple rubbing of the surface with the wet hand.
The procedure is also somewhat more strongly refrigerant, and
hence better adapted for use in febrile conditions. Very hot
and very cold applications contract the vessels of the limited
area to which the application is being made, but this is so
small compared with the whole cutaneous surface that no
perceptible retrostasis toward the viscera occurs, as in the
cold immersion, the cold douche, and many other forms of
cold application; while by successive applications to different
parts of the surface, the whole body is gradually brought into
a state of vigorous reaction. This is one of the chief charac-
teristics of the bath, and constitutes its leading distinguishing
feature.

1206 Therapeutic Applications. — The therapeutic effects of the
sponge bath are likewise essentially the same as those of
wet-hand rubbing. It is simply a somewhat more vigorous
application, which may be employed for the production of
tonic, antipyretic, analgesic, calmative, and other therapeutic
effects, both general and local. It is one of the most use-

THE TECHNIQUE OF HYDROTHERAPY,

63;

ful of hydric applications because readily available under
alinost any circumstances demanding the employment of
water as a therapeutic means.

The cold ablution or sponge bath is highly advantageous
io all cases in which the skin is anemic, as in chlorosis^ myxe-
dema^ anemia^ cases of cardiac and rcnai dn^psy, and in all
cases to which cold friction and cold towel rubbing are appli-
cable. Skilfully applied I it is a good refrigerant measure,
but when used to reduce fever, it must often be employed
almost continuously for several hours in succession, or until
the desired effect has been obtained. The work should be
done so briskly and energetically that good cutaneous circu-
lation is maintained, and shivering prevented The begin-
ning of pronounced shivering is an evidence that the full effect ,
of the bath as an antipyretic has been obtained* The cool
sponging should be conlinueJ in fever cases until shivering or
other evidences of secondary chill appear, notwithstanding
the most active efforts to postpone the same by rapidly going
over the whole surface, first with the very wet sponge, then
rubbing with the hands and drying with the towel, and finally
rubbing with the warm hand, then repeating the process.

The cold sponge bath is useful in adynamic febrile states^
as in typhoid fever, when the extremities are cold. The
water employed should be quite cold (50^ to 60^), The
sponge should be wrung quite dry, and should be rubbed
quickly over the limbs, which should then be rubbed vigor-
ously with the warm hands until reaction occurs. The suc-
cess of this measure depends upon using very cold water and
making the application very short and vigorous.

Currie called attention to the value of the sponge bath in
mild cases of fever in children and in very feeble patients, and
also pointed out that this measure may be advantageously
employed in cases of general fever due to some internal
inflammatory process in which the cold bath can not be safely
used on account of the condition of the blood-vessels of the
affected part.

638 RATIONAL HYDROTHERAPY.

This bath is an excellent one for self-application when
the patient is able to administer the treatment to himself at
home. It may be employed every morning, on rising, with
advantage. As the patient becomes accustomed to the appli-
cation of cold water, more vigorous measures, such as a
sponge or towel bath, a cold friction bath, or cold immersion,
may be employed.

Hot sponging is sometimes advantageous in fever as a
means of reflexly lessening the tendency to heat production;
the water employed should be very hot (130° to 140°), and
the application should be very rapidly made.

Local ablutions are valuable in many conditions, as in hot

sponging of the spine for the relief of so-called spinal irrita'-

4fion^ headache, intercostal neuralgia, sleeplessness, and the

general nervousness so often encountered in neurasthenia.

The general hot sponge bath is of value in relieving the
night sweats of consumption.' The water should be applied
as hot as can be borne, especially over the chest and abdomen.

The hot alkaline sponge bath is of service in urticaria.
In this the application should likewise be made as hot as the
patient's skin will bear; that is, 130^ to 140^. The water
employed should be rendered alkaline by the addition of a
teaspoonful of soda for each pint of water. Very hot spong-
ing is highly useful as a means of relieving itching of the skin
when not accompanied by eruption.

When warm or hot water is employed, vigorous rub-
bing after the bath is not required. If a towel is used to
dry the parts, it should be simply laid upon the surface and
gently rubbed or patted with the hand outside. Wrapping
the patient in a Turkish sheet is the best method of drying.

The very hot sponge bath is much employed for hemo-
static effects. The application may be made directly to the
bleeding surface, as in capillary oozing, for which it has ren-
dered most efficient service in abdominal surgery, or through
the remote effect of the stimulus of heat upon the vasomotor
nerves, as in the stoppage of noseblecding by sponging the

THE TECHNIQUE OF HYDROTHERAPY,

639

face with very hot water. When used tqr hemostatic effects,
very high temperatures must be employed, — from 140^
upwai*ds. When directly applied, the sponge must be only
half wrung^ and must be held with firm pressure in close
contact with the bleeding surface, but great care must be
takan to avoid injury to the parts.

Recent results show that local septic processes may often
be checked by the application of water at a temperature of
180^ to 212'-', by means of a saturated sponge held for a few
seconds m contact with the suppurating surface. Care must
be taken to avoid injuring the healthy tissues adjacent. The
object sought is not simply destruction of the pyogenic
microbes, but a slight cooking of the devitaHzed and degen-
erated tissues upon the pyogenic surface, and a powerful
stimulation of the circulation and the nerves of the part.

The tt'pid sponge bath is a very grateful application in
feverish conditions, especially in cases in which the tempera-
ture is not sufliciently high to admit of more vigorous meas-
ures. If the skin is kept moist by frequent sponging,
evaporation is promoted and the patient is thus cooled with-
out producing the thermic reaction and consequent elevation
of temperature hkely to result from cold sponging. The
purpose of tepid sponging is simply to restore the natural
cooling process which has been interrupted by suspension of
perspiration.

The ncuirai sponge bath at a temperature of go- to 98"^
is a quietingj sedative measure of great service in nervous
states accompanied by feverishness without elevation of tem-
perature. It is also useful in mild febricuia, and in fevers in
which the temperature is only slightly above normal, and
in which the skin is flushed and dry,

Alicrmitf sponging of the spine is a powerful excitant
of the cardiac and respiratory centers, and may be employed
with wonderful advantage in cases of apium pmsoni^g^
asphyxia from coal gas, and in cases of t&xemia, in which
the heart *s action is greatly weakened. This application

640

RATIONAL RYDftOTS

1207

is also valuable for ^ its remarkable tonic effects upon thei
central nervous system; for the relief of hmdache and thfij
pains at the back of the head and neck of which neura
thenics often complain, there is no better palliative than hot
and cold sponging to the cervical and dorsal spine. Wlien
used for such excitant and revulsive e£Fects, two sponges are
employed, with one of which hot water is applied, with the
other cold, the two being used in alternation. Ice is some-
times used in place of the cold sponge.

Sponging the parts with either hot or cotd water is an
exceedingly valuable measure for sprains and bruises. The
water employed should be either very hot or very cold, 01
revulsive hot and cold applications may be made 1^130^, %^
min. ; 60°, 20 sees.) If the sprain is recent, having occurred
within a few hours, the ankle and foot should be sponged,
with water as hot as can be borne, the temperature bemgr
raised as the skin becomes tolerant. In cases of neglected
sprain, in which the parts have become swollen and acutely
inflamed, sponging with ice-cold water, gently passing the
sponge over the part and squeezing the water upon it, may
be employed for an hour or two at a time several times a
day until the acute stage of the inflammation is passed, or
during twenty-four or forty-eight hours. In the interval be-
tween the applications, the cooling compress should be
applied.

Alternate hot and cold applications may be applied to
joints in which exudates have occurred as the result of rheu-
matism^ sprain, or traumatic arthritis. Alternate applica-
tions are not useful in cases in which the parts are very
painful. Neither cold nor alternate applications of this sort
should be made to joints which are the seat of a tubercular
process.

Contraindications. — The cold sponge bath should be
avoided in cases of fever accompanied by cyanosis with cold-
ness of the surface. In such cases, cold friction following a
hot application is indicated. The surface must be warm and

THE TECHNIQUE OF HYDROTHERAPY. 64 1

the movement of blood active in the skin to secure good
reaction to a cold application. It must also be avoided
in feeble cases when the patient is perspiring. This pre-
caution does not apply when perspiration is the result of
exercise without exhaustion or after a sweating process.

Sponging, as well as other procedures accompanied by
friction, is generally inapplicable to cases in which the skin
is irritable, as in cases of cutaneous disease and the eruptive
fevers.

THE SALT QLOW.

In this procedure (Fig. 95), salt of medium fineness and 1208
slightly moistened is applied to the surface of the body with
friction movements, the amount of pressure being adjusted to
the patient's sensation. With very thin-skinned persons,
abrasion and irritation of the skin may be very easily pro-
duced. Persons of dark complexion, whose skins are usually
thick, bear more vigorous applications than blondes.

The patient prepares for the treatment by lying down upon
a slab or bed covered with a sheet, having previously been
divested of his clothing. The sheet is drawn over the patient
to prevent chilling. One part after another is then exposed
and rubbed with the moistened salt, two or three pounds of
which should be conveniently at hand in a basin. When this
treatment is given in an institution, the patient may sit upon
a stool, lie upon a slab, or stand upon a low stool, while
receiving the application, in a room especially arranged for
the purpose, and at a temperature sufficiently high to pre-
vent chilling.

After the application, the salt which adheres to the surface
is removed by the cold affusion, shower, or spray. The
patient is quickly dried and rubbed in the usual manner. It
will be noticed that the skin is hard and almost as smooth as
marble after this application. In cases of feeble patients, a
dash of hot water or a warm shower should be given just
before the final cold application.
41

642 RATIONAL HYDROTH£RAPY.

PiiysiolQSical Effects. — The salt glow is an admirable
means of producing circulatory reaction, without thermic reac-
tion if the temperature employed is not very much below that
of the surface of the body. The salt acts as a chemical irri-
tant to the skin, in addition to the mechanical stimulus pro-
duced by the rubbing of the sharp crystals in contact with the
surface of the body.

The salt glow produces to an intense degree the circulatory
stimulation of the brine bath, the sea-water bath, the effer-
vescing bath, and the saline sponge, and with little thermic
effect, provided the temperature of the salt when employed
is not much below that of the body. By moistening the salt
with ice-cold water, it is possible, however, when desirable,
to produce most powerful thermic effects in addition to the
circulatory reaction produced by the chemical effect of the
salt and the friction.

Therapeutic Applications. — The salt glow is atonic meas-
ure of high value, and also produces valuable derivative
effects; it is especially valuable in feeble patients whose
heat-making powers are small, and in whom thermic reaction
does not readily occur, or if it does, the cold bath still has the
effect to exhaust the patient and produce loss of heat. The
salt glow is valuable in cases in which the skin is very inac-
tive, a condition commonly found present in chronic indi-
gestion. It may be usefully employed in cases of Bright* s
disease, and in diabetics, conditions demanding increase of
skin activity, but contraindicating the cold bath.

The salt glow must be avoided in eczema and most other
forms of skin disease, and must not in any case be used so
frequently as to produce cutaneous irritation. This measure
is rarely of use in any form of acute disease.

COLD FRICTION.

1209 By the term **cold friction** (Fig. 96) is designated a
procedure which consists in the application to the surface
of the body of a series of partial wet rubbings, one part after

THE TECHNIQUE OF HYDROTHERAPY.

<543

another being taken in systenjatic order until the whole cuta-
neoiLS surface has been broiiglit into vigorous reaction-
Requisites — A vessel containing a few quarts of cool,
cold, or very cold water; ice-water may be employed in many
cases. A mitt (Fig, g?) consisting of rough material of
some sort, — ordinary rough Hnen or Turkish toweling is not
desirable. Coarse mohair answers fairly well for the purpose;
but the best fabric is a closely woven woolen cloth resem-
bling hair-cloth, but slightly rougher to the touch, which is
manufactured in Egypt and Turkey, where the author became
acquainted with it in the Turkish baths of Cairo and Con-
stantinople, It is there used for a sort of preliminary sham-
pooing applied after the sweating process is completed and
before the application cf soap. This material possesses just
the right degree of roughness, stimulating the skin without
irritating it, and is so closely woven that it may be made
to hold just the right amount of water for the purpose for
which it is designed A Turkish sheet and one or two towels
are also required.

riethod. — The patient is undressed, and lies upon a bed or
a massage couch wrapped in a Turkish sheet. First of all,
the head, face, and neck should be wet with cold water. If
the hair is not wet (ladies often object to this), a napkin
wet with cold water should be placed over the face. The ves-
sel containing the cold water is placed at one side, near the
head of the couch; the attendant places the mitt upon the
right hand, and then uncovers a small portion of the patient's
body, preferably the front of the trunk. He then dips the
mitt into the cold water, and proceeds to rub the surface until
reddened, redipping the mitt one or more times, covering
the whole surface rapidly. Care should be taken to secure
reaction in each part before proceeding to the next- Then
with his left hand the attendant extends the arm and treats it
in like manner, drying rapidly and covering. The other arm
is then treated, and then in succession, the legs, and back,

644 RATIONAL HYDROTHERAPY.

the hips, and back of the legs, and lastly the feet. The soles
of the feet should be spatted, not rubbed (Fig. 98).

This application is graduated by the temperature and the
degree of saturation of the mitt, — ** moist mitt," ** wet mitt,"
and •* filled mitt.** The mitt is first saturated with water,
then well wrung, and slipped on the hand. For the (a)
** moist mitt*' the palmar surface is merely touched to the
surface of the water; for the (b) **wet mitt,*' the hand cov-
ered by the mitt is quickly dipped in the water two thirds its
length, then shaken to remove surplus water; for the (c)
'•filled mitt" the whole mitt is immersed and filled with
water, and quickly carried to the part to be treated; the
water flows out while the surface is being rubbed, and the
effect is thus almost as vigorous as that of the half- bath, only
that it is partial in its application, and hence may be em-
ployed in cases in which the shock of a cold application to the
whole surface simultaneously would be injurious.

By this means it is easy to bathe a fever patient with ice-
water or water at a temperature of 35° to 45° without the
production of shock or other undesirable effects, while secur-
ing the tonic effect upon the heart and the increase of general
vital resistance, which arc the most desirable effects.

In cases in which cold is positively contraindicated, hyper-
emia of the skin may be induced by hot mitten friction, using
water at as high a temperature as possible.

This method, which the author has systematized and
introduced within the last year (1899), he has found among
the most useful of all cold applications, both as a tonic and as
an antipyretic. One of the great advantages of the method
is that it lends itself so readily to all the various conditions
arising in the treatment of pathological states.
1210 Physiological Effects.— The act of rubbing the surface
produces mechanical effects similar to those from the impact
of water under pressure, as in the douche, although the effect
is certainly much less pronounced than that of water at
the same temperature in the form of the douche; however.

THE TECHNIQUE OF HVDROTIIERAFY*

<54S

"a much lower temperature may be employed with cold
friction than with the cold douche (32'^ F/), and hence the
reaction induced may be even more powerlul* and indeed,
according to the author's observation, is more quickly secured,
than with the cold douche. Indeed, there is no form of
douche, except the author's percussion douche, which pro-
duces so vigorous and prompt reaction as does the cold fric-
tion applied with a mitt of proper texture. Reaction occurs
with great rapidity in this procedure for the reason that the
delay which commonly follows the thermic impression of cold
before reaction begins, is prevented by the application of
vigorous friction sittiultaneonsly with the thermic impression.
Circulatory reaction is also stimulated to a high degree, and a
large amount of blood is rapidly brought to the skin.

The stimulation of the peripheral nerves induced by
cold friction produces most profound reflex effects upon the
nervous system, the heart, the glandular structures, and
indeed the whole organism. It is a most powerful tonic;
hence a regulator of nutrition and a potent vital stimulant.

The friction mitt may be advantageously employed in the
rubbing sitj:, the rubbing shallow, or the Brand bath, and all
other forms of cold baths in which rubbing is desirable* In
mixed applications of this sort it may be advantageous to
employ a mitt for each hand. In general, however, the bare
hand is better in these cases, as its warmth helps to secure
the circulatory reaction which is one of the essential objects
of the application. The use of the mitt somewhat intensifies
the thermic effect of the bath.

Therapeutic Applications. — Cold friction may be locally 1311
applied over any part desired. When applied to the lower
extremities, for example, the effect is revulsive or derivative.
Cold water applied to the precordial region with friction
influences the heart in a powerful manner Cold friction
applied to the back and scalp powerfully stimulates the
cerebral functions.

Cold friction is indicated in all cases requiring tonic appli-

646 RATIONAL HTDROTHBRAP7.

cations; hence it is invaluable in neurastkemat and especially
with very feeble neurasthenics who are either too weak to
receive the douche or too exhausted to react to this poweif ol
tonic procedure. Cold friction affords the best of all means
for training patients to endure the contact of cold water
with the surface. It has no equal as a measure for graduated
hydriatic training.

This procedure may be advantageously employed in cases
of anemia, chlorosis, in all forms of wasting disease^ as
tuberculosis^ and in convalescence after fevers; in cardiac
dropsy^ as a means of stimulating the peripheral circulation;
in anasarca from renal disease; in chronic toxemia accom-
panied by spasm of the peripheral vessels; in all cases of
cardiac insufficiency; in febrile conditions^ to reduce tempera-
ture, whenever cold in any form is indicated. It is a hydric
measure of remarkable versatility, and may be employed in a
vast variety of cases. There is no measure of greater value
than cold friction in the treatment of tuberculosis pulmonaris.
The application may be made twice daily with advantage, a
temperature of 75° being used at first, and steadily lowered
day by day until 35? can be readily endured. The *' moist
mitt" should be used. As it is the tonic effect which is
especially desired, care should be observed that each surface
treated is made to glow with vigorous reaction before pro-
ceeding to another part. This prevents pulmonary congestion.

Cold friction affords an excellent means of testing the
ability of a patient to react. In fevers, it presents an excel-
lent test for the state of the heart, and even affords a valu-
able means of prognosis. Great slowness to react, the parts
remaining cold and pale, indicates excessive irritability of the
vasomotor centers or nerves. This condition, which is com-
monly present in anemia, especially in grave cases, is often a
cause of great difficulty in securing reaction. When present
in acute fevers, vascular spasm is a positive indication of
diminished heat elimination, and suggests at once the necessity
of employing some means to increase the peripheral circulation,

THE TECHNIQUE OF HYDROTHERAPY.

647

such as the short, hot-blanket pack» hot immersion for 3 to

4 minutes, fomentations to the spine, or some other heating
process, to be followed by cold friction, and is a contraindica-
tion for prolon^'cd cold baths. When the skin is vcrj^ slowly
reheated after an application of cold water, a mottled blue
appearance remaining, the indication is great feebleness of
the thermogenetic functions of the body, or diminished power
of calorification. In fevers, this condition indicates impend-
ing collapse.

Cold friction must be mentioned also as a measure more or
less indispensable in typhoid fever in txged pers&ns, children^
and diabetics, and in this disease when complicated by ataxic
and adymnnit amditions ; in dicrotic puisc, siup&r, snifHor-
mai temperature, pregnancy, puerperal fever, also in chronic
dysentery, ma lariai fever, eotna from any cause, tvhmfiing'
cmigh, yellmv fever^ plague, dengue^ influen^^a, lithemia,
leprosy, emaciation^ scurvy^ rickets^ purpura^ anorexia^
hypapepsia, intestinal catarrh^ chrmiic nephritis, hysteria^
neurasthenia^ Belts palsy, migraine, clwrea major, paralysis
agitans, and morphia and other drug habits. A cyanotic
skin is always an indication for cold friction preceded or fol-
lowed by heat, if the patient is very feeble.

When frequently repeated or prolonged hot applications
are required, cold friction should be employed every two or
three hours, or at least two or three times a day, to maintain
cardiac tone and general vital resistance.

Contraindicatloits,— There is scarcely any condition in 1818
which the cold friction mitt may not be employed. There
are almost no contraindications except cutaneous lesions, in
which the wet-towel friction should be substituted.

THE COLD TOWEL RUB.

This procedure consists in friction movements made upon I8I3
a cold wet towel spread out upon the surface^

Requisites, — A towel for the head, several Itnen towels
for the application; a sheet and a towel for drying; a pail of

648 RATIONAL HYDROTHBRAFT.

water at the temperature desired for the Mpplkaiflifin^.mft^ ^
basiii of water at a temperature ten d^reea |ower»; ;^,

Method. — The patient should lie in a recnmbeirt: pfwit|fwi
with all his clothing removed, and wrapped in a T^fij^fix
sheet and a woolen blanket, a portion of the coveriDgr ImwCT
laid aside so as to expose the portion to which the ^ppSaMfm
is to be made. The head, face, and neck are first hatked
with the colder water, in which one of the towels is ailaQ.Wft,
and wrapped about the head. A linen towel is then wropg
very dry out of the water prepared for the puipcMfr jn the
paU. After being quickly shaken out, it is app J it: iT smoothly
to the part to be treated; and with the hands applied in
such a manner as to cover as laige a portion of the towel
as possible, they are rapidly moved from point to point with
firm pressure, so as to bring each part of the to%vel succes*
sively in close contact with the skin. The rubbing should be
continued until the towel is warm, when it may be removed;
the dry towel is then placed upon or wrapped about the part,
and it is rubbed until the skin is dry and well reddened h^
reaction. The corresponding part of the opposite side is then
treated in like manner. If the patient is decidedly neuras-
thenic, special attention should be given to the back; while
if the case is one of cardiac insufficiency, special attention
should be given to the chest, arms, and legs.

The hands are rubbed upon the towel, but the towel is
not rubbed upon the skin. Particular attention should be
paid to this. The effect desired is not produced by mechan-
ical irritation of the skin, but by the assistance rendered the
circulation by the intermittent pressure upon the tissues. The
hands are applied with long, rapid, alternating strokes, fall-
ing upon the surface with sufficient force to give a decided
percussion effect. The friction movements may be alternated
every few seconds with gentle percussion (1227). The
whole surface of the towel should be gone over constantly, so
as to avoid chilling by evaporation.

In order that the desired therapeutic effect may be obtained,

THE TECHNIQUE OF HYDROTHERAPY.

649

the temperature of the water must be maintained at the initial
temperature. This may be accomplished by employing a
number of towels, so that no towel is used twice in the
same application. A plan which the author prelers as more
practicalp however, is the following: Two pails or bowls of
water are prepared, one of which is ten degrees lower than
the temperature at which the application is to be made, The
usual temperatures will be 60^^ and 50°, The face, neck,
and head are cooled with the cooler w^aten After a towel
has been applied to a surface and rubbed until warm, it is
dropped into the cooler water, where it remains while the
part is being dried and rubbed. In preparing the towel for
a new application, it is gathered and squeezed, then dipped
into the other pail (60'^) and wrung out.

An excellent plan for institution work, where abundant
facilities are supplied, is the following : Have ready several
good-sized, rather heavy linen towels. Fold each one to half
the length, wet in the cold water, twist, and leave in the
water ready to wring out quickly when wanted. With the
patient lying on his back, covered by a Turkish sheet, and
the head cooled by one of the towels, uncover the chest,
apply a well-wrung towel, rub well, then dry. Then uncover
one arm, let the patient hold it up, and quickly wrapping a
wet towel around it, let him catch the upper end with the
hand of the arm under treatment (Fig, 99), holding the other
end at the shoulder by his other hand while the attendant
rubs vigorously, or the patient may hold the towel at the
shoulder only, the arm lying by his side (Fig. 100). Then
treat the other arm, and each leg. The patient holds one
end of the towel for the leg, and both ends for the trunk
(Figs. 101, 102)* He then turns upon his face, and pass-
ing one hand over his shoulder and the other around back
of the hip, he holds the towel spread out upon his back
(Fig. 103); or the towel may be held at the upper end only
(Fig. 104),

If the patient is too feeble to assist, the towel may be

650 RATIONAL HYDROTHERAPY

kept in place by making the friction movements with Ae :tipo
hands simultaneously and from the center toward thee^dt^^or
sides. It is far better, however, that at least one end'iiCrEliw
towel should be held by the patient, so that the aMaadaat
may make long strokes with strong pressnre, thos incraacHpg
the mechanical effect, which is an essential part of this 'pio*
cedure, especiidly when employed for the eacellent tonic
effects to be secured by it.

A towel is applied to the back of each leg, and lastly one
to the feet, as follows : While the patient lies upon his face,
the feet a few inches apart and the soles turned ap» a towel
is prepared and spread out under the feet, extending up above
^ the ankles. The feet are separated, and the ends. of the
towel turned over and wrapped around each foot (Fjg. 105).
The soles are then percussed, and the ankles, instep, and toes
rubbed until the towel is warm. Special care mnst be taJoen
in drying the feet, to rub them until warm. The solcB of the
feet are important vasomotor areas, and have extendedlceAex
relations; hence the importance of keeping the feet wamkr*

In drying, the dry towel should be applied and held in
place in the manner described for the wet towel, or a corner
of the Turkish sheet may be drawn over the part in such a
way that long strokes may be made without displacing it (Fig.
106), or the patient may assist by holding one side (Fig. 107).

The amount of water in the towel may be regulated to
suit each case. When refrigeration or antipyretic effects are
required, the towel must be very wet, and its application
renewed upon the same part several times in quick succession.

If the case is one of cardiac insufficiency, the treatment
should begin with a limb, and end with the application of the
towel over the chest. By this means, the small vessels are
first dilated and stimulated to activity, thus lessening the
work of the heart before the more powerful stimulating effect
of the application to the chest is brought to bear upon it.

For very feeble patients, the temperature of the water
employed at first may be as high as 70*^ to 75^, but it should

Ik

i

;1

THE TECHNIQUE OF HYDKOTHERAPy*

651

be lowered with each application until water at 55'^ or 60^
may be used. Still better effects may be obtained at JO^.

The hot towel rub may be used when cold is positively
contraindicated* As high a temperature as possible shouJd
be used (140^ to 160°), Otherwise the method is the same.

Physiological Effectj.^The physiological effects of the
cold towel rub are precisely the same as those of the rubbing
wet sheet, except that they are somewhat less pronounced,
The nervous shock produced by the wet towel of a given
tennperature is very much less than that produced by the
contact of the whole sheet with the surface of the body.
At the same time, the reaction produced may be made just
as complete as when the sheet is employed, and without pro-
ducing any considerable degree of congestion of internal parts
through retrostasis. As each part is successively treated, the
cold application causes contraction of the vessels of the asso-
ciated internal parts. As reaction occurs, the visceral ves*
sels are dilated, and excited to increased activity. Thus
vigorous fluxion is produced in one part after another until
every internal organ has been awakened to new life and
action, and all the bodily functions are quickened.

The fact that the inrush of blood and the succeeding reac-
tion do not occur in all parts of the body at the same moment
constitutes a most important distinction between the general
rubbing sheet and the cold towel rub, the significance of
which is great in the therapeutic applications of this pro-
cedure, since it renders the use of this measure possible smd
exceedingly useful in many cases in which the cold wet sheet
as well as all other general cold applications must be inter-
dicted, as in extreme cardiac weakness, acute renal conges-
tion or in flam mat ion, pulmonary or intestinal hefnorrliage.

The intensity of the effect produced depends upon sev-
eral factors, especially the following: -

I. The temperature of the water employed. Little effect
is produced by water at a temperature above 60^^, but a tem-
perature of 70^ to 75° may be used at the beginning in very

1214

6$ 2 RATIONAL HYDROTHERAPY.

feeble patients with little power to react. The higher the
temperature, the greater the amount of rubbing required to
produce proper reaction.

2. The amount of water left in the towel when wrong
out. The more water, the greater the thermic effect,
because the greater the amount of heat abstracted from the
skin. A very dry and very cold towel is very exciting, and
if the rubbing is not excessive, may be even sedative and
thermic.

3. The number of times the towel is applied in immediate
succession.

1816 Therapeutic Applications. — Cold towel rubbing, being
simply a diminished or partial wet sheet rubbing, may be
employed in precisely the same cases in which cold sheet rub-
bing is employed, where patients can not endure the whole
sheet,

The cold towel rub is of value in fevers not only as a
means of improving the skin circulation, but by moistening
the skin and thus encouraging evaporation of water, it pro-
motes heat elimination, which is one of the most positive of
all indications in fever. Weyrich has demonstrated that
friction alone may increase evaporation over 50 per cent.
The cold towel rub, then, is not only a direct antipyretic
means in febrile conditions, but promotes in a high degree
heat elimination through evaporation from the skin, amount-
ing to more than 100 heat units per hour. The cold towel
rubbing, as well as cold friction, affords a valuable means of
preparing the patient in adynamic febrile cases to receive the
cold bath, or the cooling pack.

The cold wet towel may often be used advantageousl}'
after a fomentation to the spine either as a local or as a gen-
eral application; also after fomentations to the abdomen and
other parts as a means of preventing too pronounced sedative
or depressing effects from the hot application. When thus
used, the towel should be wrung very dry out of very cold
water. If applied after a fomentation, the first application

THE TECHNIQUE OF HYDROTHERAPY.

653

should be made directly to the heated part. Cold wet-towel
rubbing or cold friction at intervals of two or three hours is
necessary to prevent depression of the heart and the central
nervous system when prolonged hot applications are neces-
sary, as in cases of acute nephritis.

This measure is of great service in the systematic treat-
ment of chronic invalids, as a step in a progressive series of
treatments increasing in vigor from wet-hand rubbing or cold
friction to the shallow bath or the douchcp and especially in
the treatment of anemia^ chrmiic indigestion^ ncurasihcnia^
and a long list of maladies requiring tonic measures, including
(ubcrctdosis of the lungs, glands {scrofula), skin {lupns\ or
bmi€$^ chronic rheumatism and lithemia, dialu-les, rickets,
purpura, Aemophilia^ obesii^^ efnaciaiian^ dyspepsia, gastric
ulcer, and especially in cases of cardiac wcaA^ficss cither with
or without organic or valvular lesion* In all these cases,
great care must be taken to graduate the application, begin-
ning with a very dry towel and lowering the temperature one
degree each day till 40^ is reached,

Coniraindicationd* — In cases of asthma and cardiac affec-
tions attended by pronounced weakness of the heart or excess-
ive compensation, the wTt tuwel should not be applied to the
chest. The chest should be rubbed with the moistened hand
until good reaction is produced* Other contraindications are
rare.

THE WET-SHEET RUB AND THE DRIPPINQ SHEET.

This procedure, perfected by Priessnitz, consists in a
thorough rubbing of the body while enveloped in a wet sheet*

Requisites.^ A linen sheet, a Turkish sheet, two towels,
a tub containing hot water for the feet, a pail of water at
60^ to 70^, Water at a higher or lower temperature may be
employed when indicated.

Method -The patient, being prepared, the head cooled in

the usual way and protected with a cold wet towel, stands in
the tub of hot water with the dry sheet wrapped about him.

1316

6$4 "*^ PATIONAL HVDROTHERAPY.

^Ttefe attendants prepare the wet sheet (Fig, 108), which should
ife wrong dry enough so it will not drip rapidly (Fig. 109).

When the sheet is ready, one assistant, holding one end
of Ae linen sheet properly gathered in the right hand, and
seizing the upper left-hand corner with his left hand, steps in
front of the patient, while the other attendant withdraws the
diy sheet and steps behind to assist The patient holds up
bptH arnifi, while the attendant in frotit places the upper left-
band corner of the sheet under his right arm (Fig. i to); the
patient then lowers the right arm, holding the sheet in place,
while the attendant passes the sheet quickly across the front
of the body beneath the left arm. which is then also low^ered.
The sheet is then carried around the body by the assistance
of the attendant who stands behind the patient, and pulls the
Sottom around. As the sheet is brought across the back ol
tiie patient, the attendant in front reaches over and seizes
tEe upper t^df^e of the sheet just above the point of the right
shoulder, and pulls it first upward, then down upon the
patient's chest (Fig. iii), while with his other hand he car-
ries the sheet across the chest, covering the fold, and over the
left shoulder, deftly tucking the corner under the edge of the
sheet behind.

The attendant behind tucks the sheet between the pa-
tient's legs, which are then brought tightly together. The
sheet is thus brought everywhere in close contact with the
skin. As soon as the patient is thus enveloped, — an opera-
tion which should be completed in 5 to 8 ^seconds, — both
attendants begin to rub vigorously, covering the whole sur-
face as quickly as possible, one the legs and hips, the o^er the
trunk and arms (Fig. 112). The rubbing should be co^q-
ued for i to 3 minutes, or until the sheet is everywhere tfior-
oughly warmed. The attendant should bear in mind that
the patient is not to be rubbed with the sheets but ofH^'^ke
sheets with downward percussion strokes. The ba^ 'does
not depend for its effects upon irritation of the skin by the
friction of the sheet, but upon the thermic stimulation aad

>.

i

li

I

i

THE TECHNtQUE OF HyDROTHERAPY.

65s

the assistance to the cataneous circulation afforded by inter
mittent pressure upon the surface vessels- The rubbing
movements are made with a sort of glancing percussion stroke
from above downward. Percussion may be applied over the
tleshy parts. Gentle patting rnay be applied to parts that
are sensitive to rubbing. Care should be taken that the
whole surface of the body is gone over many times and in
rapid succession.

The rubbing must continue with vigor during the entire
application. Very strong attendants are required^ as a vigor-
ous bath-man will usually find himself quite out of breath
at the end of the procedure, if he has done his duty. When
the sheet is well warmed, it is dropped, the Turkish sheet
thrown about the patient, and the bath completed by vigorous
rubbing over the Turkish sheet, followed by dry friction with
the hand» with or withuut oil rubbing. Sometimes a Scotch
douche follows the wet sheet before the drying.

The intensity of the bath may be readily varied in a num-
ber of different ways: (i) By the temperature of the water
employed; (2) by the amount of water left in the sheet; (j)
by using a thinner or thicker sheet; (4) by employing two or
more wet sheets in succession, changing as soon as warm;
(5) by the vigor of the friction movements applied; and (6)
by the duration* This fact renders the rubbing wet sheet a
most convenient measure for use outside of a regular hydri-
atic establishment, or where convenient appliances of various
sorts are not at hand.

The longer the duration of the bath, the greater will be
the thermic effect produced. Hence, when excitement of the
^nerve centers and tissue change is undesirable, the sheet
should be wrong dry, the temperature of the bath should
not bo too low, the duration should be short, and the rubbing
should be vigorous.

For very feeble patients the rubbing wet sheet may be
applied in bed* Care should be taken to apply hot bags or
Wt fomentations to the feet during the application. For bed-

6S6 RATIONAL HYDROTHERAPY.

ridden patients the sheet may be applied in much the same
way as when the patient stands. The sheet being spread
upon the bed over a blanket, the patient is placed upon it,
and raises his arms above his head while one side of the
sheet is passed across the body, the edge being tucked under
the trunk and between the legs. The arms are then lowered,
and the other half of the sheet is drawn across the body in
such a way as to include both arms and to cover the shoulders,
the free corner being tucked well under the shoulder, and
care being taken to exclude the air. The patient is then
vigorously rubbed from head to foot, the whole surface being
gone over as rapidly as possible. If there is a tendency at
the first to chill from too rapid evaporation, a warm blanket
should be drawn across over the wet sheet, and the friction
applied beneath it. The rubbing should continue until the
whole surface of the body is well reddened and the sheet
warmed, usually i to 3 minutes. The sheet should then be
removed and the patient at once covered with a linen or
Turkish sheet and a blanket, and dried beneath the blanket.

When it is necessary to avoid retrostasis in the use of the
rubbing wet sheet, as in cases of cerebral hyperemia and
marked visceral congestion, the patient should stand in very
hot water (104° to 1 10°) during the application.

The rubbing wet sheet may be applied several times daily
when necessary to procure the desired effect. When a satu-
rated sheet is employed, it is sometimes necessary to apply
vigorous percussion in addition to friction in order to secure
proper circulatory reaction. In applying the cold rubbing
sheet, care must be taken to see that the patient's skin is
in a condition to receive a cold application with benefit. If
the surface is cold, it must be warmed by a hot shower or
some other heating bath. The wet-sheet rub should never
be given when the skin is cold, or the patient chilly or appre-
hensive of a chill.
1217 The Dripping Sheet. — In giving the dripping sheet, which

is a much more vigorous thermic application than the rub-

THE TECHNIQUE OF HYDROTHERAPY.

657

bing wet sheet, two or three pailfuls of water at different
temperatures should be in readiness. The sheet is applied
thoroughly saturated with water, and dripping. The patient
is not rubbed, but vigorously spatted for 20 to 30 seconds.
Then a half pailful of water at a little lower temperature
than that in which the sheet was originally wet may be
poured over each shoulder, and the spatting or percussion
resumed. When evidences of reaction appear in returning
warmth, another pailful of water at a still lower temperature
may be poured over the patient if desired; but so vigorous an
application is seldom indicated. The usual temperatures
employed are 70^ for the sheet, 65*^ for the first pail, 60^' for
the second pail When higher temperatures are employed,
it is difficult to get good reaction, since the exciting effect
of coM is necessary to arouse the nerve centers to the
requisite degree to produce the thermic and circulatory reac-
tion which this procedure is intended to provoke.

By energetic percussion outside the sheet, the cutaneous
circulation is maintained, and so the bath may be prolonged
until the desired effect has been attained. Care must, how-
ever, be taken to terminate the application at once when the
slightest symptoms of secondary chill appear; that is, when
the patient begins to lose the sensation of glow and warmth
which follow the first chill from the contact of the cold
sheet, and is threatened with shivering, with goose-flesh and
blueness of the skin. The full development of these symp*
toms should not be allowed to occur.

In cases in which it is unwise to allow the patient to stand
erect, the application may be made thus: Place upon a bed
a rubber sheet for protection. Spread upon this a linen sheet
wet in water at 75*^, and slightly wrung. Place the patient
on the sheet, envelop him quickly as for a wet-sheet pack
(1179); then let two attendants proceed to encourage circu-
latory reaction by moderate percussion and gentle rubbing of
the whole surface, giving special attention to the extremities.
As the sheet is warmed, cool by splashing over it water at
43

6s8

RATIONAL HYDROTHERAPY,

60^ to 70*^, continuing the spatting, and cooling by rewetting,
until the patient begins to shiver. Then remove the wet
sheet, wrap in a dry linen or Turkish sheet, cover with
a woolen blanket, and after fifteen minutes take the rectal
temperature* Renew when the temperature reaches 102^ F.

In fever cases with extremely feeble heart, the hot reclin-
ing dripping sheet is sometimes useful as a preparation for
the cold towel rub or cold friction. The sheet should be
very hot, and should be applied quickly*
1818 Physiological Effecta,— This procedure slows the pulse
and energizes the heart, at the same time that respiration is
increased, contrary to the usual physiological law. Plen-
inger noted a slowing of twenty beats a minute, while res-
. piration increased five breaths per minute. Thermic reaction
is usually less marked than in the immersion bath, circula-
tory reaction predominating; but thermic effects are obtain-
able at will in any degree of intensity. As the result of an
ordinary application the rectal temperature falls two tenths
to five tenths of a degree, while the axillary temperature
is elevated. The very pronounced and lasting circulatory
reaction produced, secures a vigorous cutaneous circulation
and an increased rate of blood movement in the whole body.
The effects of this procedure are intermediate between the
douche and the wet-sheet pack; it is a sort of wet -sheet
pack in the first stage, with mechanical effects added.

At the first moment, the application causes deep, gasping
respiration* and sometimes slight shivering; but these sensa-
tions quickly give place to more prolonged and deeper respir-
atory movements, with slowed heart action and general
feeling of warmth and glowing of the skin, as reaction begins.
This procedure, combining, as it does* the mechanical effect
of friction with the thermic effect of cold, produces at first
a general contraction of the small vessels of the skin, very
quickly followed by active dilatation.

During the first period of contraction there is dilatation of
the vessels of the brain, lungs, and abdominal viscera, quickly

THE TECHNtOUE OF HYOROTHERAPY.

6S9

followed by contraction when the blood returns to the skin
with the reaction. Blood pressure is increased, as is also
muscular capacity; there is improved assimilation of nitrogen,
with increase of appetite and temporary lowering of tempera-
tare.

The most pronounced antipyretic effects, shown by low*
ering of temperature, are obtained by the use of a very wet
sheet, a double sheet, repeated wetting of the sheet, by pro-
longed application, and by the use of the dripping sheet. By
means of these several variations any degree of antipyretic
effect may be produced. The most pronounced excitant
effects are produced by a sheet wrung dry out of very cold
water. The temperature ordinarily employed is 60^, but a
lower temperature may be employed in robust patients, and a
higher temperature (65^ to 70*^) with persons who are not
accustomed to the use of cold water*

Therapeutic Applications. — A most important use for the 1219
cold dripping sheet is the lowering of temperature in cases in
which the cold bath can not be readily employed. It maybe
used in such a manner as to secure all the good effects of the
Brand bath without any of the inconveniences of that pro-
cedure. The author has employed this measure, with modi,
ficatiooSf for more than twenty-five years in the treatment of
continuous fevers^ with excellent results.

Wet-sheet rubbing is a most excellent tonic procedure
following the heating pack, the wet-sheet pack, the electric-
light bath, and sweating procedures of all sorts. It has the
advantage that it may be employed almost anywhere, as 00
apparatus is required; hence it is an especially valuable meas^
ure for use in the home. When tonic effects are desired,
the sheet should be wrung very dry out of cold water (6o'^),

The fact that this procedure is capable of producing both
thermic and mechanical effects of the most powerful char*
acter, and the readiness with which the intensity of the appli*
cation may be modified, enables the physician to produce
by this simple means alone nearly all the effects obtainable

RATIONAL HVDRQTHERAPY,

by hydric applications; hence the rubbinf^ wet sheet may be
properly designated as a pre-eminently useful hydriatic pro-
cedure. II the occasion requires strong^ derivative effects,
with the minimum amount of metabolic change, as in the case
of feeble, bloodless patients, with small heat-making capacity,
very thin sheets wrung very dry out of water of low tempera-
tures (50^ to 60^) may be employed. The rubbing will be' very
vigorous, and the duration short (t to 2 min,).

If, again, it is desired to produce decidedly alterative effects,
through the production of strong tonic thermic reaction, a
thicker or double sheet, wrung less dry, and renewed if quickly
warmed, the application prolonged to 3 or 4 minutes, affords
a means for securing any degree of effect which may be
desired. The continued friction of the surface maintains the
movement of blood in the skin, and thus prevents the
shivering and other unpleasant symptoms arising from the
internal congestion, which would otherwise require a speedy
termination of the application before sufficient reduction of
the temperature had been secured to call forth the requisite
degree of heat production and accompanying tissue change.

Further, if it is desired to produce antiphlogistic effects,
the dripping sheet prolonged to 10 or 15 minutes, or the rub-
bing wet sheet, if sufficiently long continued, is capable of
producing any degree of refrigerant effect desirable. There
are few other therapeutic measures, and certainly no medicinal
agent known to man, capable of producing such versatile and
desirable therapeutic effects.

The rubbing wet sheet is an excellent tonic measure for
those unable to endure the douche. It is especially valuable
as a derivative measure in cases of cerebral congestion and
in disorders of the liver, spleen^ lungs, and digestive v s-
cera, in which congestion is a prominent symptom, as in
chronic gastritis^ chronic bronchitis, the chronically disor-
dered liver of dyspeptics. It may also be used in some cases
of chronic congestion of the pelvic viscera in which pain is
not a prominent symptom.

THE TECHNIQUE OF HYDROTHERAPY.

661

The inactive skin of dyspepsia, rk£umatism, gout, and
diabetes may be excited to activity by this procedure. In
cases of anemia, chlorosis, and neurasthenia, aged persons
and feeble women, the wet-sheet rub affords an excellent
tonic measure^ which may be employed anywhere, and with-
out apparatus. It is particularly valuable in relieving the
passive hyperemia of so-called chronic gastritis or gastric ca-
tarrh and allied affections of the small and large intestines,
known under the varions names of chronic enteritis, intes-
tinal catarrh^ pseudo-membranous colitis, etc* It is appli-
cable likewise to the chronic splenic and hepatic congestions
which follow and accompany malarial in/fcfions. In ctfnges-
tian of the spinal card, in hjpopepsia, apepsia, constipation,
dilatation of the colon mid stomach, and most other functional
disorders of the digestive organs, the powerful derivative
effects of the rubbing w^et sheet are indicated The dripping
sheet may be employed in all cases in which it is desirable to
increase metabolic activity, as in cases of slowed nutrition
(Bouchard)* It is hence valuable in obesitj*, chronic rheu-
matism, gout, and diabetes. Under its inOuence, the dry»
dingy, inactive, hidebound skin of the chronic dyspeptic and
the arthritic becomes clear, transparent, supple, moist, and
elastic after a daily application for a few^ weeks, especially
when accompanied by the use of some suitable sweating
procedure once or twice a week, as the electric-light or vapor
bath, or the wet -sheet pack.

The wet^sheet rub affords an excellent remedy in insom-
nia due to cerebral congestion without special irritability of
the cerebral cells. The effect of the application in stimn-
lating circulatory reaction may be increased without thermic
reaction by the addition of common salt to the water in the
proportion of two pounds to the gallon (60'-', i or 2 min.).

The rubbing wet sheet is especially indicated in insomnia
when the skin of the sleepless patient is hot and dry. A tem-
perature of 75*^ to 85^ should be employed rather than a
lower temperature, so that thermic reaction may be avoided.

RATIONAL HYDROTHERAPY

t

e skin surface is cool, the rubbing wet sheet produces
.blc effects in insomnia, increasing the wakefulness by
g reflexes from the skin,

cases of cardiac insufficiency due to valvular disease of

rtj the rubbing wet sheet renders valuable service as a

\ of stimulating the peripheral heart and fixing a consid-

»e amount of blood in the skin. The dilated central

is thus relieved, its action is slowed and energised, the

circulation is improved, and the author has seen not a

ses permanently helped by this means when other meas*

1 failed to afford more than temporary relief,
may be appUed twice daily in cases of cardiac dropsy
patient has a fair degree of vigor Generally it should
eceded by a short heating of the skin by means of the
ic-Ught bath for 3 to 5 minutes, the vapor bath for 4
-xtes, or a very short hot immersion bath (104^ to 106^,
I.). Great care must be taken to avoid weakening the
i by overheating the patient* If necessary, an ice-bag
n be employed over the heart during the heating process,
Cxilles de la Tourette * has successfully employed the rub-
bing wet sheet to combat the febrile symptoms which occur
m exophthalmic goiter.

This procedure furnishes also an excellent substitute for
the spray or shower douche as a means of fixing the blood in
the skin after a sweating pack, a vapor or an electric-light
-bath, or other heating processes, when a douche apparatus is
not available. It may be advantageously used in cases of
myxedema^ and especially during the febrile exacerbations
which frequently occur in this disease.

In the adaptation of the temperature of baths to different
cases, it should be borne in mind that a low temperature is
necessary for good effects with wet-sheet rubbing, on account
of the quick reaction required. The body is exposed during
the application to the cooling effects of evaporation, which to

i

*Progris Midical^ 1890, p. loi.

THE TECHNIQUE OF HYDROTHERAPV*

665

n etmsiderabk def^ree interferes with reaction; hence the pow-
erful influence of a low temperature, as welt as the mechanical
effects of friction and percussion, is necessary to secure the
prompt return of blood to the surface after the primary con-
traction of the periphera] vessels occasioned by the first
contact of the cold sheet with the skin. The best effects are
obtained by temperatures between 50° and 60^,

Cotitraindications. — The principal contraindications for 1820
the nibbing wet sheet and dripping sheet are fnianeims erup-
tions, extreme hypetestkesia of the skin, acute visceral infiam-
matimt, general neuritis^ severe neuralgic affections involving
large nerve trunks, and such extreme feebleness of the circn-
lation that proper reaction can not be secured. Persons who
can not endure temperatures below 80^ should not receive
this bath, as reaction will be deficient. Other measures
should be applied until reaction is improved, such as the cold
I wet'hand rub, cold mitten friction, and the cold towel rub.

DRY FRICTION,*

Massage is the natural accompaniment ol hydrotherapy.
The following procedures, — fulling, tapping, hacking, knead-
ing, together with friction and joint movements, — encourage
and assist in the development of the processes of accelerated
tissue change and restorative metamorphosis which are set up
by tonic hydriatic processes* Massage may be employed in
such a way as to produce sedative as well as tonic and altera-
tive effects of both a remote and a local nature, the same as
hydriatic procedures*

Friction (Fig. 113) is simply one of the several valuable
procedures of massage which may be advantageously em-
ployed in connection with hydriatic measures. It consists
in systematic rubbing of the surface with the bare hand.

1221

• For a fiill fJtjsctipUoa of the f^Jrms and id ct hods ol massage, sec die author'a
work, **llic Art of Message." M*idcrn MtjtliciQe rubiisbicig Compiiiiy, JlMttJe
Creek, Mich.

664 RATIONAL HYDROTHERAPY.

Method. — In the ordinary employment of friction, as in
drying a patient after a bath, the rubbing should be applied
in both directions, as the effect desired is not only mechan-
ically to assist the blood movement toward the heart, but to
stimulate the cutaneous circulation.

In the systematic application of friction, the movements
should, as a rule, follow the blood-vessels. This is espe-
cially true in friction of the extremities. We quote the fol-
lowing brief description of friction from the author's work on
massage: —

* * In this procedure the whole or a part of the hand is moved
over the surface with a considerable degree of pressure, the
pressure varying in different parts — heavy over thick, fleshy
masses, light over bony surfaces and thin tissues. The pres-
sure, however, should never be so great that the hand will
not readily slip over the surface, nor sufficient to interfere
with the movement of the blood in the arteries.

**The principal effect of friction is upon the superficial
veins, the large venous trunks, and the lymph spaces and
vessels. In the application of friction, the thumb only, or
the whole or a greater part of the palmar surface of the hand,
is brought in contact with the part operated upon. Five
different forms of friction may be described, as follows: —

'' Centripetal friction (Fig. 114), in which the movement
is in the direction of the blood current in the veins, chiefly
applicable to the extremities, the movement being from below
upward, and from the hands and feet toward the body, the
thumb or palmar surface of the hand being employed.

'' Centrifugal friction^ in which the movement is opposite
to that of the blood current.

•* Circular friction (Fig. 115), appHcable to the extremi-
ties. The limb is grasped by both hands, which make an
alternate wringing or twisting movement, beginning at the
hand or foot and extending upward.

** Spiral friction (Fig. 1 16), a sort of combination of the
preceding, executed with one hand, which progresses from

Ilk :

ill-!

lift i

r

THE TECHNIQUE OF HYDROTHERAPY*

665

the lower, or distal, to the upper, or proximal, end of the
part with a son of spiral movement

'* Rotary friction (Fig. J17). in which the hands are made
to move over a broad surface in an elliptical, circular, or
semicircular direction; especially applicable to such fleshy
areas as the hip and that portion of the back lying above the
spines of the scapulse- In applying rotary friction 1 it is often
necessary for one hand to support the tissues while the other
hand is executing the movements,

'*Rate of Moi'ement. — The rate of the movement will
necessarily vary according to the length of the strokes, and
hence differs in different parts of the body* The rate may be
from thrity to one hundred and eighty strokes per minult\

'* Direction of Movement, -^^The. direction of the move-
ment in friction must necessarily vary more or less, accord-
ing to the part operated upon. The general rule is to follow
the large veins. Special care should be taken, in the treat-
ment of the extremities, to follow the large venous trunks,
making firm pressure directly over the large veins with tiie
thumbs, passing from below upward.

'*In the treatment of the forearm, the masseur will give
special attention to the radial vein, which runs along the
outer and anterior portion of the forearm; the anterior and
posterior ulnar^ which course along the anterior and posterior
aspect of the inner border of the arm; and the median^ which
lies along the middle of the anterior surface of the forearm
(Figs, \\% and 119).

'* In the upper arm, special attention will be given to the
cepkalic along the outer side, and the basilie along the inner
side, of the arm {Fig< 120),

*• In applying friction to the leg, the thumb should at first
be passed with firm pressure over the long saphenous, the
course of which is from the instep along the anterior inner por*
tion of the leg to the groin and the short saphenrnts^ the course
of which is from below the outer malleolus along the outer and
posterior portion of the leg to the bend of the knee (Fig. 12 1).

p

RATIONAL HYDROTHERAPY,

^ntripetal friction is applied to the following parts ia
direction designated : — -
'■lead, from before backward, and above downward-

fJt, downward.
aackf above shonlder- blades, circular; from shoulder-
S to sacrum, down; in the region of the loins, from the
:oward the spine.
^ipSj circular.

C/iest, from the sternum toward the axilla,
A&dormn, upper part, from above downward and out-
owerpart, from the median line downward and outward,
nis and iegs^ from below upward,
' firt^mtfU absarpiwn, rub toward the heart (centripetal

n-

" For sedatit^e and derivative effects upon the viscera and
centers, rub downward (centrifugal friction}.

** Rubbing upward, or in the direction of the venous blood
current, increases ike aetiviiy of the circulation* ^^fl

'* Rubbing downward decreases vascular activity. ^^H

'* In the application of friction, pressure should always be
uniform for the part operated upon, and should be carefully
graduated to meet each particular case.

**As a rule, some lubricant should be used, — fine vase-
line, cocoanut oil, cacao-butter, or talcum powder.

** Friction is applicable to all parts of the body, but is
especially useful to the limbs, head, and neck. II should
always be used at the beginning of the application of mas-
sage, if the surface is cold.

** In the application of friction to large parts, both hands
should be used either together or in alternation. In the
treatment of a part which is small, it may be steadied by one
hand while being treated by the other.

'^Mode of Applying Friction to Different Parts, — A
systematic order and method is essential in the application of
friction to different parts of the body, which may be described
for the chief divisions of the body as follows ; —

THE TECHNIQUE OF HVDROTHERAPY-

667

*' The Hand. — The patient's extended hand being allowed
to rest in one hand of the operator, with the dorsal surface
up, the masseur, holding the fingers of his other hand firmly
extended, applies the tips of his fingers to the patient*s hand
in such a way that they will fall into the grooves between the
adjacent fingers and metacarpal bones. The fingers are then
pushed along in these grooves from the roots of the nails to
the wrists. After repeating the movement several times on
the back of the hand, the patient's hand is turned so that the
palmar surface will be up, and the same movement repeated
as before, with the modification that the fingers are carried
a little farther up the wrist until the heel of the operator*s
hand rests in the hollow of the patient's hand, when slight
rotary movement and firm pressure should be made, for the
purpose of compressing firmly and emptying the numerous
veins of the fleshy portion of the palm.

* * The movements upon the back of the hand should be at
the rate of sixty a minute; on the palmar surface a smaller
number of movements will be executed per minute on account
of the pause fur one or two seconds in making rotary fric-
tion in the palm after each centripetal stroke. .

** The Forratm.— Wiih the arm of the patient half flexed,
the masseur, facing the patient and operating with both hands^
should make strokes from wrist to elbow, first with one hand
upon one side, and then with the other hand upon the other
side of the arm, in such a manner that each hand will include
one half the circulation of the forearm, both thumbs resting
upon the front of the arm. The operator may, if he prefers,
stand with his back to the patient, making the strokes alter-
nately with the two hands, as before.

**The masseur should keep constantly in mind the fact
that firm pressure is to be made only with the ascending
friction stroke* The hand is allowed to glide lightly over the
surface in the descending or stroking movement, as a sooth-
ing measure, and not for the purpose of applying friction.

**In the treatment of very feeble persons, the patient may

668 RATIONAL HYDROTHBRAPY.

be too much fatigued if the operator works with both hands
at once, thus leaving him to support his own arm. In such
base the patient's arm should be supported by the masseur,
who will grasp the patient's hand with his own right hand,
or the left hand with his left, applying spiral friction
with the other hand upon the front side of the arm, then
changing hands to operate upon the back surface of the
arm.

•* The Arm. — Work the arm in a manner similar to tltat
described for the forearm.

^^The Shoulder. — In applying friction to the shoolder,
Ae masseur faces the side of the patient, operating witb the
two hands in alternation, following the surface of the joiisli,
and always taking care to work centripetally; that is, toiH^od
the heart or toward the center of the body, and* taking pains
to follow the irregularities of the surface. The under as wdl
as the upper side of the shoulder should receive attention.

«• The Foot. — Begin with the hand, by friction with the
ends of the fingers upon the dorsum of the foot, the operator
standing in such a position as to face the sole of the foot.
After finishing the dorsal surface, change the position so as
to face the side of the foot, and make alternate transverse
movements with the two hands on both sole and dorsum,
working vigorously from toes to heel and instep. Lastly,
extend the friction movements to the ankle, working with
both hands, and following the grooves on each side of the
tendon Achilles.

** The Leg, — With the leg half flexed upon the thigh,
standing facing the patient, the masseur applies friction to the
calf of the leg from ankle to knee, making eight or ten strokes,
then turns his back to the patient, and operates upon the
front of the leg by means of the thumbs working in alter-
nation.

^^ The Thigh, — Standing with his back to the patient,
the masseur grasps the leg in such a manner that the fingers
fall behind and the thumbs in front, and makes very firm but

THE TECHKIQUS

lOTHERAPY,

669

rather slow strokes from knee to groin, not torgetting to give
the knee due attention.

'' T/it' C//iJ^.— The patient's arms should be separated
a little from the sides, so as to straighten the outer portion
of the pectoral muscles. The masseur, standing at one side,
and facing the patient's feet, makes strokes from the insertion
of the pectoral muscles at the humerus toward the median line,
beginntng at the upper border, just below the clavicle. The
two sides may be operated upon simultaneously, or in succes-
sion, both hands being employed upon one side, one hand
following the other in the movements. In progressing down-
ward, the movements should be reversed below the pectorals,
and the hands should be carried as far around the sides as
convenientj care being taken to work toward the axilla above,
and to follow the direction of the ribs and cartilages, until the
whole surface has been covered, from the clavicle to the
lower border of the last ribs

'* T/itr AdtUmi-n.— Fdicing the patient, the masseur first
makes long strokes from the upper to the lower portion of the
abdomen, one hand following the other over the recti muscles,
the two hands operating simultaneously over the lateral por*
tions. After covering the whole surface six or eight times in
this manner, strokes should be made more exactly in the
direction of the veins, as follows: At the upper part of the
abdomen, make strokes downward and outward, following
the direction of the lower cartilages; for the middle portion,
make strokes from the median line outward, reaching around
as far as possible; for the lower portion, make the strokes
downward and outward, in the direction of the hip joints*

'* The Ntxk, — Facing the patient, place the hands one on
each side of the head in such a manner that the little fingers
Will rest in the groove behind the lower jaw, the other fingers
resting upon the mastoid processes and the inner border of
the heels of the hands touching. Move the hands downward,
and at the same time rotate them inward, so as to bring as
large a portion of the palmar surface as possible in contact

I

I

RATIONAL HYDROTHERAPY,

with the neck At the lower border of the neck, move the
hands outward toward the shoulders. After a few strokes,
carry the hands a little farther back around the neck, so that
as they move downward^ the thumbs will rest one on each
side of the larynx, thus compressing al! the veins of the neck,
both the superficial and the jugular, which lie deep. Finish
with a few strokes applied to the back of the neck^ starting
at the occiput, and carrying the strokes downward and out-
ward to the point of the shoulder

*' Tk€ Z'atv,— Standing facing the patient, the operator
places the palmar surfaces of his hands in contact, then ap-
plies them to the patient's face in such a manner that the
little fingers touch the forehead at the median line. Separat-
ing the hands at the ulnar border, they are gradually spread
out J as in opening a book, until the little fingers rest upon the
temples, and the tips of the thumbs fall at the middle of the
forehead,

*' Fixing the thumbs at this point, the outer borders of
the hands are moved downward by lateral flexion at the wrist
until the forefingers fall at a level with the eyes. The whole
hand is then moved downward in such a way that the nose is
grasped and compressed between the thumbs while the palms
of the hands and the fingers cover the cheeks. The move-
ment is continued downward and finished by bringing the
hands together below the chin. The object kept in view
should be to bring as much of the hand as possible in
contact with the face, and to touch every portion of its
surface.

** The Head. — With the patient sitting or half reclining,
and the masseur standing behind, the ends of the fingers and
thumbs, with the fingers slightly flexed, are placed firmly in
contact with the scalp, and a movement executed similar to
that employed by a barber in shampooing. The mistake
must not be made of applying the friction to the hair instead
of the scalp. The movement begins at the vertex, gradually
extending to the borders of the hairy scalp.

m

THE TECHNIQUE OF HYDROTHERAPY. 67 1

•• The Hip, — In friction of the hip a very considerable
amount of pressure is admissible, as the muscles and fleshy
masses are very thick and firm. In applying friction to the
hips, the masseur may face either the head or the feet of the
patient.

*' I. Make rotary friction upon the two sides simnltane-
ously or in succession. In very fleshy persons it will be found
necessary to support the tissues with one hand while operat-
ing with the other, on account of the great mobility of the
muscular mass and the roughness of the skin, so frequently
encountered in this region of the body.

**2. Apply centripetal friction, working from the great
trochanter toward the crest of the ilium, and along the crest
of the ilium from behind forward.

*• The Back, — The patient lies upon his face, the masseur
facing his head.

'* I. A few light strokes are first applied from the occiput
to the sacrum, along the center of the back, one hand fol-
lowing the other. The lateral surfaces are then covered by
the two hands working simultaneously from above downward,
and rotary friction is administered with greater pressure to the
fleshy mass lying above the shoulder-blade. The two sides
may be treated simultaneously or in succession, one hand
being used to support the tissues. The latter method is usu-
ally necessary in very fleshy persons.

* * 2. From the shoulder-blades to the hips, lateral strokes
are made, the masseur standing with his left side to the pa-
tient, facing his feet, the hands being placed as far around the
sides as convenient, and simultaneously drawn toward the
spine, the movement ending with the hands in contact. Great
care should be taken to follow the ribs in the region of the
thorax, which will give the movements a semicircular direction.

•• 3. Separating the index and middle fingers of the right
hand, place one on either side of the spinous processes, and
making firm pressure, move the hand downward from the
occiput to the sacrum. The object should be to crowd the

RATIONAL HYDROTHERAPY.

ends of the fitifjers as deeply into the tissues as possible on
either side of the spinotas processes, so as to influence the dor-
sal spinal veins. If necessary, the left hand may be used to
increase the pressure,

'*4. Finish the back by a few Hght strokes from above
downward, using both hands simultaneously, covering as much
surface as possible with the fingers in contact."

In the employment of friction in connection with hydro-
therapy, the deliberate and elaborate methods above described
are not ahvays necessary or advisable. In cases in which the
purpose fs simply to encourage circulatory reaction and warm
the skin, the whole surface should be gone over in a very vig-
orous manner, employing the larger movements as above indi-
cated, while omitting the finer details, so that too much time
shall not be lost, thus giving opportunity for chilling by evap-
oration. In many cases, however, it is advantageous to
apply thorough and systematic friction after the patient has
been well dried, not only as an aid to complete reaction, but
as a means of supplementing the effects of the hydrJatic
application. In such cases, the methods described for differ-
ent parts of the body may be followed out in detail.

When dry friction is quite disagreeable or produces marked
irritation of the skin, the surface may be lubricated with tal-
cum powder, fine vaseline, or cacao-butter.

If it is desirable to increase the stimulating effect of the
friction to some degree, vinegar, or mustard water (a table-
spoonful of ground mustard infused for ten minutes in a
pint of hot water) may be employed, but these chemical
stimulants are rarely needed.
1222 Physiological Effects,— The physiological effects of fric-
tion have been dwelt upon at length in an earlier chapter
(591). Briefly summarized, these effects, as determined by
Naumann* and Rohrig, t are as follows: —

I. Very light friction causes contraction of the surface

♦Naumann, Prager, Viert, 1867.
f ROhrig, Deutsche Klinik, p. 254.

THE TECHNIQUE OF HYDROTHERAPY.

<^^7J

esselSt rise of blood pressure, and slight elevation of tem-
perature,

2, Moderate friction causes, first, contraction of the blood
essels, with rise of blood pressure, then dilatation of the

putaneous vessels, with increase of blood movement and fall
I temperature.

3. Very vigorous friction produces, almost from the very
ginning, extreme dilatation of the small vessels, the stage

i contraction being so brief as to be scarcely distinguishable;
the pulse is slowed to a marked degree, also the respiratory
movements. Heat elimination is so increased that the tem-
perature is lowered to a very marked extent, one observer
reporting a lowering amounting to 1.8^ F. The amount of
xygen consumed as well as CO^ is increased by friction, also
he quantity of urea. When extremely violent friction is
applied, albumin has been known to appear temporarily in
the urine; in experiments upon animals the general tempera-
ture falls very decidedly, while both heart and respiration faiL
I In hydrotherapy the effect usually sought is that of
biodemte friction; namely, preliminary contraction of the
blood-vesselsj followed by dilatation. By this means, the
reaction which follows the cold application will be encour-
kged* The vigor of the application should be just sufficient
|o slightly encourage heat production without at the same
time increasing heat elimination to such a degree as to cause
an excessive loss of heat. In this regard, friction seems to
operate in precisely the same manner as exercise. Too vio-
lent exercise after a cold bath, for example, causes an excess-
ive loss of heat, and consequently, exhaustion. The same
may be true of friction, whether the patient rubs himself or
is rubbed by an attendant, if the application is too vigorous
nd long continued.

All the cutaneous functions are excited by friction. The
skin becomes oily through stimulation of the sebaceous
glands; and, according to Weyrich and Wintcrnitz, perspira-

•tion may be increased more than 50 per cent The tempera-
43

6/4 RATIONAL HYDROTHERAPY.

ture of the skin is elevated from two degrees upwards.
Winternitz has shown that heat elimination may be increased
more than 95 per cent. The powerful influence of friction
in promoting heat elimination is readily shown by a simple
observation based upon a method of determining the amount
of heat elimination elsewhere pointed out (page 316). In-
crease by friction of the skin temperature of a patient with
a warm skin, amounting to two degrees (95° to 97°), in-
creased his heat elimination to the extent of 7 per cent.;
while in the case of a patient with a cold skin warmed to the
extent of ten degrees by friction (85° to 95^), the increase in
heat elimination amounted to 66.6 per cent.

The mechanical effects of friction depend upon the direc-
tion in which it is applied.

1223 Centripetal friction, that is, dry friction movements
made in the direction of the blood current in the veins,
accelerates the movement of the blood toward the heart,
and thus increases the vital activity in the part to which it is
applied, the movements constituting a sort of pumping
process by means of which the arterial as well as the venous
circulation is accelerated. The lymph spaces and channels,
as well as the blood-vessels, are emptied, and the lymph
circulation is thus encouraged. The activity of the vital
exchanges is increased, the tissues are rapidly freed from
the waste matters produced in them, an increased amount of
oxygen and of nutritive materials is brought to the part, and
thus all the metabolic processes are encouraged.

1224 Centrifugal friction, in which the movements are made
in a direction opposite to that of the venous blood current,
retards the circulation, lessens vital activity, and hence pro-
duces a sedative effect.

In hydrotherapy the friction is for the most part applied
either centripetally or in both directions.
1226 Therapeutic Applications. — Either moist or dry friction is
employed in connection with nearly all hydrotherapeutic pro-
cedures. Dry friction naturally follows nearly every appli-

THE TECHNIQUE OF HYDEOTHERAPY.

675

cation of water After cold baths, friction must always be
employed £or 3 to 5 minutes or longer. It may be moderate
in intensity, so that the loss of heat shall not be so great as
to induce secondary chill or vital exhaustion.

After a hot bath, vigorous frictiun movements are some-
tkiies needed to encourage the effect of the bath by increas-
ing cutaneous circulation and inducing perspiration. Care
must be taken to protect the patient by warm covers. If the
purpose of the hot bath is simply to produce a derivative
effect, general perspiration being undesirable, care must be
taken to avoid violent friction.

Light friction is applicable to cases in which the skin is
congested and contraction of the blood-vessels desirablef such
a condition as exists, for example, in the * * feverishness "
experienced in connection with a severe cold This fact
seems to have been discovered by the native masseurs of
China, to whom the world is very largely indebted for the art
of massage. A traveler in China informed the author that
when at one time suffering from a severe cold, he employed
a blind Chinese masseur, who inmiediately proceeded to
administer very gentle centrifugal friction, and refused to
employ centripetal movements, notwithstanding the request
of the gentleman that he should do so, the latter supposing
that the operator through ignorance was giving to his move-
ments a wrong direction. Evidently the experience of the
native manipulator had taught him that a hot, flushed skin
should be stroked in a centrifugal rather than a centripetal
direction. In the application of friction ^ either moist or dry,
this principle must be kept in mind. If the tissues have been
overexcited by excessive manipulation, if pain has been
induced, or if excessive reaction has been occasioned by a
Scotch douche, or the skin overexcited by a vapor, Russian,
electric-light, hot immersion, or other heating process, an*
excellent antidote is offered in centrifugal friction applied in
the form of gentle stroking.

A hot, flushed skin resulting from vasomotor disturbance

676 RATIONAL HYDROTHERAPY.

rather than a rise of temperature, is a condition not infre*
quently met in neurasthenics, and is often a distressing symp-
tom in connection with the menopause. Centrifugal friction
is indicated.

Friction is especially indicated in cases of inactive^ hide-
bound skin, when the skin is dingy, jaundiced, pale, cold, or
insufficiently lubricated, the result of deficient activity of the
oil glands.

Dry friction is' excellent in Bright' s disease and diabetes,
either with, or independently of, appropriate water applica-
tions. It is also of great value in cases of very weak and feeble
patients, in fever convalescents, in consumptives when in a
nonfebrile state, in asthmatic persons suffering from chronic
bronchitis, who often have a very strong antipathy to cold
water, and are very sensitive to weather changes; also in
emaciation and dyspepsia.

Dry friction may be advantageously employed as a means
of lowering temperature in cases of fever in which the surface
6f the body is cold. The skin should be rubbed, preferably
in a centripetal direction; that is, in the direction in which
the venous blood flows; and the rubbing should be continued
until the surface is warmed. The elevation of the surface
temperature to the amount of ten or twelve degrees by rub-
bing may increase the rale of heat elimination 60 or 75 per
cent. Lubrication of the surface with oil in connection with
the rubbing enhances its effect, not only by facilitating the
friction, but by increasiui^ the loss of heat by radiation (1232).

In rubbing the patient, bjth in the bath and afterward, it
is well to keep in mind tlie fact that rubbing is of special
value at certain points. These points are as follows : First,
the extremities; second, the back; third, the chest; fourth,
the parts which are in immediate relation with external pain
*or internal coni^estion. For example, in cases of cerebral
hy[>eremia, special attention must be i^iven to rubbing the
legs and arms. A^ain. in case of /•:.*:;/ pain, the lower part
of the luck should be rubbed vii^orously; for ovarian pain,

THE TECHNIQUE OF HYDROTHERAPY.

^77

the outer sorface of the hips; for gastric pain, the dorsal
region of the back; lot splenic pain, under the left shoulder-
blade^ for hepniic pain, under the right shoulder-blade; in
neurasthi'ma, the back of the neck, a common seat of pain,
should receive especial attention; in cerebral anemia and in
MieriHc disorders, the top of the head; in const ipat ion, the
abdominal surface; in kypopcpsia, the epigastric region; and
in eye strain, the supra-orbital and temporal regions; in cer-
tain ovarian disorders and some forms of ne h r as/ /tenia ^ the
hands and feet, especially the heels, wrists, and finger joints.
These areas are shown in Figs, 122, 123, copied from Dana.*

A most valuable application of friction is in the treatment
of sprains. At first, centrifugal friction — gentle downward
stroking ^ — should be applied. After the first forty-eight
hours, centripetal friction may be used to increase the move*
nient of blood through the part. The application should be
made, not to the joint at first, but to the surfaces above the
joint or between it and the heart, thus causing dilatation of
both the arteries and the veins connected with the part. The
blood channels being enlarged by this means, the movement
of blood is accelerated and the healing process facilitated.

Contraindications and Precautions,-- In some persons the
skin is so sensitive that friction proves too exciting, giving
rise to insomnia, nervous irritahiiit}^ and general discomfort.
Such persons are generally good subjects for the neutral bath
and very gentle tonic measures.

Very light friction of the general surface hinders reaction
by causing contraction of the blood-vessels. The effects on
both the surface vessels and the heart are essentially the same
as the first effect of a short, cold application. Hence, very
light friction should be carefully avoided after a cold appli-
cation, but may be employed with possible advantage after
a hot application. On the other hand, energetic, but not
violent J friction encourages the tonic reaction of cold, acting

1226

•»A Climcd Study of Neuralgias.'^'

678

RATIONAL HYDROTHERAPY.

10 harmony with the vital movements of normal reaction,
and hence naturally follows the cold bath.

Excessively severe or violent friction after a cold bath
occasions depression of both heart action and respiration, and
also gives'rise to excessive loss of heat and too great activity
of tissue change, producing various untoward effects, such
BSf (i) a secondary chill or succession of chills; (2) sweat-
ing and consequent depression, thus converting an applica-
tion intended to secure a tonic effect into a reducing or
sedative application; (3) nervous exhaustion and fatigue from
excessive demands upon the reflex centers of the spine.

Care must be taken after cold applications of any sort, to
a^void such vigorous friction as to induce perspiration.

It is especially necessary to avoid too vigorous rubbing
after cold baths during the hot season, when the heated
atmosphere encourages excessive reaction and perspiration.
Gentle centrifugal friction may be properly and profitably
employed as a means of combating excessive reaction, when
this has been produced by a too cold bath, by too warm
wrappings after a bath, by excessive exercise, or even by too
prolonged or violent frictipn following the cold bath. If
after tonic applications, perspiration appears, the effect of
the bath has been spoiled, and the patient will be weakened
instead of strengthened by it; hence it is easy to convert
a tonic application into one of a very different character, thus
producing most undesirable results, by neglecting properly to
supervise the drying and rubbing of the patient after the bath.

On the other hand, care must be taken to avoid the oppo-
site error. Very light, inefficient friction after a cold bath
results in contraction of the blood-vessels, whereby reaction
is hindered instead of encouraged; and the more prolonged
an inefficient application of this sort, the more pronounced
will be the ill effect produced.

It should be remembered that the effects of friction upon
the heart closely resemble those resulting from irritation of

THE TECHNIQUE OF HYDROTHERAPY.

679

the pneumogastric. Slight irritation increases the heart's
action, whereas violent irritation slows or depresses it.

Light rubbing or stroking should be employed only for
the purpose of diminishing a tendency to excessive reaction.
The stroking should then be centrifugal in direction, or from
the center of the body outward.

If there is a tendency to excessive reaction, with a dispo-
sition to perspire, energetic rubbing should be avoided, and
the patient should be dried by gentle patting over a towel,
and the surface should be exposed now and then for a few
seconds; or if considerably overheated, it may be cooled hy
a current of air set in motion by a fan or a towel. If the
patient has a very sensitive skin which is irritated by rubbing
with the dry hand, the hand may be moistened, or friction
may be practiced with a wet napkin or a sponge, or talcum
powder may be applied to the skin.

In rubbing the skin when slightly moist^ it is ver}' easy to
produce abrasion by using too much force^ as the hand often
adheres quite tenaciously to the surface of the patient s body.
This difficulty may best be remedied either by sprinkling a
Httle talcum powder over the surface operated upon, after
dryings or by using a little vaseline or cacao*butter.

During the friction, the attendant should take care that
his own hand is thoroughly dry* If there is a tendency to
perspiration of the pahn of the hand» it should be dried with
a towel, then well covered with talcum powder.

Friction can not be applied to an area of dry skin not
lubricated more than six or eight minutes without producing
irritation. It should be remembered that irritation of the
skin may mean much more than simply a slight inconvenience
— it may result in profound nervous disturbance, and may
seriously interrupt a course of treatment which is very essen-
tial to the patient's welfare. In fever cases an abrasion may
be the beginning of a bed-sore* Recent observations suggest
the necessity of the same precaution in cases which have
been subjected to examination by the X-ray,

RATIONAL HVDKOTHERAPY.

Theie ate cases in which light friction may be employed
to vay great advantage as an alternative with hydriatic pr
cedmA/viheti the patient's vital forces arc too much reduc
to aII<Wr rf the daily employment of cold douches or simih
spf^ids^tkmB. The author has not infrequently found it'advan^
tageons to suspend hydrotherapeutic measures for a shor
time almost altogether, substituting dry friction with
•hahd, a soft brush, or a linen, flannel, or Turkish cloth mitt,]

In very sensitive patients, as certain neurasthenics, genti
fOttiiig over the sheet must take the place of friction as
meims of drying the skin.

When patients are suffering from rhtumatic jainis^ iht\
parts should not be rubbed vigorously, but strong frictioi]
-Sfabilld be applied to each limb at a point just above the
'ttSebted joint and in a centripetal direction. In cases cl]
acute inflammation of any sort, the friction must be at
ceiltriftigal, and on the distal side of the affected part*

Vigorous friction after the Brand bath is usually avoided^
although a slight increase in temperature lowering might be
effected thereby. There is a real gain in the omi^i^ion, how-
ever, in the greater permanence of the temperature redocti^tfi.

Friction must be avoided altogether in cases of empHve
disorders of the skin, in eruptive fevers, also in cascb of
erythema, dermalgia, and cutafteous hyperesthesias. Whin
the skin is hot, flushed, and dry, gentle friction may s^Eiie*
times be employed, but as a rule, friction is to be aipcrided;
also when perspiration is profuse. Gentle friction or sisc^ng
must be avoided when it is desirable to promote reftetion;
vigorous friction should be avoided when strong reaction is
undesirable.

After a neutral bath, in which it is desirable to suppress
both thermic and circulatory reaction, care should be tak^i to
avoid friction as far as possible. The patient should be dried
with gentle pressure with the hand outside the sheet, so as to
bring it in close contact with the skin, the sheet being contina*
ally readjusted so as to bring new portions into contact with

h.

THE TECHNIQUE OF HYDROTHERAPY.

68 I

the moist surfaces. The same measures should be adopted
after hot baths in which it is undesirable to further stimulate
the cutaneous circulation, and after a short cold bath when
there is a tendency to excessive reaction.

PERCUSSION.

Massage is the natural adjunct of hydrotherapy. It pro-
duces both mechanical and reflex effects which result in the
development of powerful circulatory reaction. The circula-
tory reaction produced by massage is very prompt, no delay
being occasioned by contraction of the blood-vessels due to
chilling of the patient, as when cold water is applied* Of the
various procedures of massage, nearly all are efficient pro-
motors of circulatory reaction; but aside from friction, the
effects of which have already been described, percussion is
the only form of manual manipulation which is systematically
associated with ordinary hydric applications. In the massage
douche, deep kneading in its various forms is also advanta-
geously utilized, as elsewhere mentioned (lOOO).

Method. — **This procedure consists of blows administered
by the hand in various ways and with varying degrees of
force, the two hands being used in alternation [Fig. 124].
The movement is always from the wrist joint, which gives
to the blow the quality of elasticity. The inexperienced opera-
tor holds the wrist rigid, and pummels the patient^ much as
a pugilist would do, thus producing disagreeable and painful
effects; while a dexterous and experienced operator maintains
a flexibility of the wrists which adds greatly to the good
effects of the treatment.

** A stiff blow bruises the surface tissues without produc-
ing any beneficial effect upon the deeper structures, the force
of the blow being expended upon the surface. An elastic
blow, executed in the manner described, penetrates deeply
without injuring the superficial structures. A skilled masseur
gives springy blows, the movement being chiefly at the wrist

122;

682 RATIONAL HYDROTHERAPY.

joint. As a rule, the hand should strike the body tiaiis-
versely with relation to the muscles." *

Of the various forms of percussion, spatting and clapfiing
are the only ones which are especially valuable in connection
with hydrotherapy.

Spatting consists of percussion with the palmar surface of
the extended fingers held rigid. This is the form in which
percussion is most frequently employed. It is applicable to
most parts of the body.

In clapping, the whole hand is employed, the palmar sur-
face being so shaped as to entrap the air as it comes in con-
tact with the skin, producing a sort of explosive effect and a
loud sound. Clapping is used on fleshy parts where strong
surface stimulation is desired.

1228 Physiological Effects The physiological effects of per-
cussion are practically identical with the mechanical and
reflex effects produced by friction (591). This procedure is a
powerful excitant, acting not only upon the skin, but npon
the tissues beneath. A short, light application produces
spasm of the superficial vessels. It may be said that light
percussion produces much the same effect as light friction:
moderate percussion, the effect of moderate friction; and very
vigorous and prolonged percussion, the effects of vigorous and
prolonged friction (1222). Friction differs from percussion
chiefly in the fact that by the movements made in friction. •
the blood is forced along the venous channels, thus mechan-
ically aiding the circulation ; while in percussion the mechan-
ical effect is less, but the sensory impression is much stronger,
and hence the reflex effects are more marked. Percussion
and friction may be combined, as in the percussion friction
stroke employed in the cold wet-towel rub and the wet-
sheet rub.

1229 Therapeutic Applications. — Percussion, both spatting and
clapping, may be usefully employed to intensify the effects of

» "The An of Massage," Modern Medicine rub. Co., BatUe Creek, Mich.

^-3-

- THE TECHNIQUE OF HYDROTHERAPY. 683

friction in cases in which reaction does not promptly occur,
or where the brief application of a more powerful stimulus
than that induced by moderate friction is desirable, as in
the wet rubbing sheet and the dripping sheet, and after a
general cold application.

The suggestions made with reference to the therapeutic
use of friction are also applicable to this procedure. It may
be mentioned, in addition, that in chronic sciatica and lunt"
bago, special attention should be given to these regions. In
cases of cirrhotic liver or spleen^ vigorous percussion is
applied to the surface overlying these organs.

In chronic constipation, the effect of the cold douche to
the abdomen may be intensified by vigorous percussion of this
region. Percussion over the sacrum is an effective means of
stimulating the genito-urinary organs in atony of these parts.
In cases of pleuritic adhesions, chronic pneumonia, and
dropsy of the chest, make percussion ovef the affected part.

Contraindications. — The contraindications are essentially 1280
the same as for friction. Special care must be taken to
avoid severe percussion in cases of arteriosclerosis, and when
febrile conditions exist, with a hot, flushed skin.

DRY SHAMPOOING.

This consists of friction of the surface with the flesh-brush 1231
(Fig. 125), the friction mitt (Fig. 97), or the hair glove (Fig.
126). The effects are identical with those described under
the head of friction. The dry shampoo especially encourages
circulatory reaction. The friction is applied with short and
rapid to-and-fro strokes and little pressure ; hence the effects
are largely reflex.

Tlierapeutic Applications. — Dry shampooing is sometimes
useful in the treatment of patients who manifest great intol-
erance to hydric applications. It is especially adapted to
persons with thick, tough, inactive skins. It may often be

684 RATIONAL HYDROTHERAPY.

applied with advantage in alternation with hydric applica-
tions. It produces good circulatory reaction almost without
thermic effect; hence is well adapted to persons who have
little heat-making capacity, and who have habitually a cold
skin. The author has made great use of this measure as an
introductory application in the day's program, administered
to the patient while still in bed bdfore rising in the morning.
Rough treatment of the skin should always be avoided.
Such an amount of friction, with the brush, the hair glove,
or the hand, as gives rise to abrasion, eruption, or persistent
redness of the skin, is harmful instead of helpful.

OIL RUBBINQ.

1282 This is one of the most ancient procedures used in con-
nection with hydrotherapy. The old Romans always had
themselves rubbed with oil after their baths. Oil rubbing is
much practiced by the natives of savage countries, especially
in tropical Africa.

Method. — The oil or unguent is applied by simple friction
movements, generally centripetal in character, such as have
already been described (1223).

The best effects are obtained when the application is made
after a warm or tepid bath, as the epidermis then more readily
absorbs the oil. The application of oil to the dry skin is
generally disagreeable. Care should be taken to avoid the
application of too much oil, and the surplus should be
removed by gently wiping the surface with a soft towel at the
end of the application. Care must be taken to avoid such
vigorous friction as to induce perspiration.

Vegetable oils or fine vaseline should be employed, rather
than animal oils of any sort. Cacao-butter is especially serv-
iceable. Care should be taken that the oil used is not in
the slightest degree rancid, and the patient should receive a
thorough soap shampoo at least twice a week.

Physiological Effects. — The efiFects of oil rubbing are
essentially the same as those of moderate friction, except

lYDROTHERAPY.

68s

that it is a milder measure. The lubrication of the surface
lessens the degree uf reflex stimulation* The mechanical
effects are the same as in ordinary friction. Oil rubbing may
accordingly be practiced in cases where dry friction would be
too exciting.

An important physiological effect %vhich must be remem-
bered in connection with oil rubbing is that the application
of oil to the surface of the body to a marked degree lessens
heat elimination by conduction while increasing radiation
(Exp. 61). The natives of Samoa and other South Sea
islands, who are great swimmers, and spend much of their
time in the water, habitually smear themselves with oil before
entering the waten On the other hand, heat radiation by
the skin is very considerably increased by the application of
oil Peclet has shown (Schumann) that an oil surf ace radiates
heat 50 per cent, more rapidly than a water surface* The
amount of heat lost by radiation when the body is exposed is
about twice that lost by conduction. The increase of heat
loss by radiation thus overbalances the diminution of heat
elimination by decreased cood activity.

The natives of Africa, when exposing their nude bodies to
the direct rays of the tropical sun, habitually protect them-
selves by smearing the skin with melted fat of some sort.
Smearing the skin with oil in cold weather affords protec-
tion only through the fact that the body is covered with
clothing.

The popular supposition that the body may be nourished
by the application of oil to the skin is an error. Probably
very little, if any, of the oil applied to the skin enters the
circulation; nevertheless^ great care should be taken that
the unguent used is not in the slightest degree rancid, for
the poisonous fatty acids are apparently quite readily absorbed
by the skin.

Therapeutic Apptlcattons* — Lubrication of the surface
with oil facilitates the applicatiun of dry friction» and prevents
the irritation likely to result from repeated and long-contin-

686 RATIONAL HYDROTHERAPY.

ued rubbing of a circumscribed area, as is often necessary in
the treatment of joints for the removal of chronic exudates.
Oil should also be applied to the surface as a protection for
the skin against excessive masceration in cases in which the
general or partial continuous bath is employed. Prolonged
and vigorous friction of the feet and limbs with oil may be
used with Qxcellent effects for the relief of cold feet^ a con-
dition exceedingly common in gastric neurasthenia^ and as a
preparation of the feet for a cold pack if they are inclined to
be cold.

Oil rubbing may be eriiployed advantageously in most
cases to which dry friction is applicable. It is a good plan to
apply a little oil to the surface at least two or three times a
week in most cases in which daily baths are* administered,
especially in cold weather. Oil or an unguent of some sort
should always be applied after a shampoo in which soap has
been used, as the removal of the natural oily covering of the
skin increases heat elimination by conduction and the liability
to take cold.

Patients who react poorly, and who are very susceptible to
cold, should be rubbed with oil after each bath. Oil rubbing
is especially needed in cases in which the skin is dry, through
deficient activity of the oil glands of the skin. Great care,
however, should be taken to avoid too vigorous rubbing in the
application of the oil, as sweating from too strong reaction is
very easily produced, to the disadvantage of the patient. In
the treatment of infants and children, a marked and most
favorable effect upon nutrition is produced by oil rubbing.
Application of oil after cold baths encourages reaction. In
most cases of chronic dyspepsia when accompanied by
emaciation, in diabetes, and in most cases in which malnutri-
tion with dryness of the skin is a prominent feature, oil
rubbing is a valuable therapeutic resource.

Oil rubbing has been used in scarlet fever and other infec-
tious fevers as a means of lowering the temperature, with
some success.

■

consists in exposure of the entire body, with 1233
the exception of the head (Fig. 127), to a superheated atmos-
phere.

Method. — The patient, undressed, is placed upon a stool
in a suitably constructed cabinet inclosing the entire body
with the exception of the head. The air of the cabinet is
gradually heated to the desired degree by means of a steam
coil, or a kerosene or gas stove; or the heating may be
accomplished by means of alcohol or strong whisky burned in
a cup or saucer placed in a basin of water. Burning alcohol
or whisky does not, however, give an ideal hot-air bath,
because of the large amount of watery vapor produced by the
combustion of ^ these substances. When an open flame of
any kind is employed, great care should be taken to avoid
burning the patient or setting fire to the cabinet.

The temperature employed is from 120^ to 200'^; a tem-
perature of from 140^ to iSo^ is usually sufficient to produce
profuse perspiration.

Perspiration should be encouraged by making the patient
drink a glass of water just before going into the bath, and U
possible, one or two more during the bath.

The hot-air bath should nearly always be followed by a
cold bath of some sort. This may be a wet -sheet rub, the
shower or horizontal spray, the affusion, the full bath, or a
sponge bath. In cases in which the bath has been employed
for eliminative purposes, and has been continued for a half
hour or more for the purpose of prolonging the sweating proc-
ess, care must be taken not to make the cold application too
abruptly. The cooling must be gradual, the initial tempera-
ture being a little below that of the body (about 98"^), and
somewhat rapidly but gradually lowered to 75° or 80^, at
which point it may be continued for 30 to 60 seconds, or
until the pulse becomes tranquil, the skin smooth and free
from moisture, and the vascular excitement of the skin quieted.

The hot-air bath is not infrequently employed as a means

68 S RATICWAL HYDROTHERAPY,

of heating the skin prehminary to a cold application of s
sort. It may in this way precede a cold douche^ a cold
sheet pack, a cold immersion, a cold sponge, or a wet-s
rub. When used for this purpose, the bath should be con-
tinued just long enough to induce gentle perspiration,
continued longer, a sedative efiect may be produced whict
will antagonize the tonic effect desired from the cold applica-
tion which follows. As a means of inducing perspiration, thej
hot-air bath is inferior to no other measure except the elec*
trie-light bath.

Before the patient enters the cabinet, the hair of the
scalp should be thoroughly wet and the face and neck wel
bathed with cold water. If there is a great tendency tc
cerebral congestion during the bath, a towel saturated witl
cold water or an ice collar may be placed about the neck.

If a regularly constructed cabinet is not available for m\
bath, an efficient hot-air bath may be administered by veryl
simple means which can be improvised ahnost anywhere; for]
example, the patient may be placed in an ordinary cane-
seated chair, the seat of which is covered with a moist nap-^
kin. Underneath the chair may be placed a kerosene o9
stove or even an ordinary kerosene lamp, or alcohol or brandy
may be burned in an open dish. Below the seat of the
chair should be placed a sheet of metal, so that the patient
will not be burned by the ascending current of superheated
air. The hot air is retained about the patient by surroiuidiiig
both the patient and the chair by a rubber blanket ; or in the
absence of this, several ordinary blankets, with newspap^s
placed between, may be substituted.

It is even possible to administer a hot-air bath in bed tjy
building over the patient a sort of canopy by means pf
blankets spread upon hoops, as shown in the accompan]^||e^
cut (Fig. 128). The hot air is conducted into the space abOfOt
the patient by means of a metal pipe four or five inches. In
diameter, and connected with a kerosene stove or a lane
kerosene lamp. Care should be taken to protect the 1^

THE TECHNIOOE OP HYDROTHERAPY.

689

clothing from the hot pipe, by means of asbestos or other
fire-proof material.

Care must be taken in administering the hot-air bath to
avoid such sudden and excessive applications of heat to the
skin as to cause dilatation of the surface blood-vessels before
there has been time for the adjustment of the circulation of
the viscera. Neglect of this precaution sometimes ^ves rise
to vertigo and fainting. This danger may be obviated by the
application of the cooling compress to the head, face, and
neck of the patient Excessive cold applications to the head
and neck may. however, antagonize the effect of the bath by
opposing the sweating process. The hot-air bath must not be
employed too often, as it is a depleting or sedative measure,
and if too frequently resorted to, may give rise to nervous
exhaustion and debility.

The purpose of the cold application following the hot
bath is to increase the tonus of the blood-vessels, to energize
the nerve centers, and to change the condition of passive con-
gestion of the skin to one of active vascular excitability.

In very susceptible persons, fainting sometimes occurs on
the application of very cold water in the form of a shower,
spray, or affusion, on emerging from a hot-air or other hot
bath. The cause of this is the strong contraction of the
blood-vessels of the brain the instant the cold water comes
in contact with the skin. In persons liable to this incon*
venience, the graduated shower or some other form of the
graduated bath should be employed for cooling off-

In cases in which the hot-air bath is employed to induce

sweating, the patient, after remaining for 15 or 20 minutes in

the bath, may be removed and wrapped in warm blankets

for half an hour or longer to continue the sweating. The

sweating process may be encouraged by making the patient

drink freely in the pack as well as in the hot-air bath. A

quarter or half glass of water should be swallowed every five

minutes.

44

RATIONAL IiyDROTHERApy

olo^ical Effects — The first effect of the hot-air bath

^t the skin and the body. The heat is communicatcd|

skin by the dry, hot air, the temperature of the succes-

:rs of the skin being elevated until finally the blood-

3 are reached and the temperature of the blood is raised

sufficient degree to cause perspiration- The skin be-

s red through the dilatation of the surface vessels, which

a state of passive congestion. The temperature of the

s generally elevated from two to five degrees according

3 duration of the bath. Whan the bath is continued

me length of time, or for a short time at high tempera*

respiration l>ecomes very short, difficult, and thoracic.

'e is headache, and intense thirst, with nausea and vertigo,

kening of the pulse and respiration nearly always occur

le hot-air bath. These symptoms usually disappear with

tion of the surface vessels and the beginning of perspira-

They may be largely prevented by vigorous friction

u .lie skin before the bath, and by raising the heat slowly

until perspiration begins.

The temperature of the bath should usually be from about
130° to 160° F. ; duration, 20 to 30 minutes. Local applica-
tions may continue for an hour or more at moderate tem-
peratures.

The hot-air bath causes an elevation of the body tempera-
ture, and hence is not adapted for use in cases in which
febrile action is present. This fact, however, gives it special
value in the treatment of rheumatism, through the increased
oxidation of proteid wastes (567).
1236 Therapeutic Applications — The hot-air bath is seldom
employed except in connection with other baths, though its
effects may be either primarily or secondarily the object
desired. The hot-air bath is one of the most convenient
means of inducing perspiration. It is on this account quite
liable to abuse. Perspiration is far less useful as an elimina-
tive measure than is generally supposed, the perspiration
usually containing but a small amount of toxic substances.

THE TECHNIQUE OF HYDROTHERAPY.

691

The chief value of the hot-air bath is perhaps as an
exciting^ measure for the purpose of stimulating the skin
during an application, and for some time after, if desired

This bath is much employed in rhtumalism. It is of
service in the ioxe$Hia of chronic dyspepsia, biliousness, etc*
It may be used in obestij^, and with caution in certain cases
of Brights iiiseast\ It is useful in cardiac dropsy^ but
must be employed with great care and moderation to avoid
depressing the heart High temperatures must never be
employed in cardiac cases, and the temperature must be
very gradually raised. It must be wholly interdicted in cases
of extreme cardiac dHaiatian*

The hot-air bath may be used to excellent advantage for
revulsive effects in sciatica, Imnbaga, and other painful nerv-
ous affections involving large nerve trunks. In these cases
the bath should be continued only long enough to heat the
skin sufficiently to induce gentle perspiration, and should then
be immediately followed by a very short cold general applica-
tion with special attention to the part affected* For e?(ampl€,
in sciatica a cold spray or douche would be employed over
the course of the ner\'e in the affected Itnib, or a towel wrung
out of cold water might be applied over the part, and the
part vigorously rubbed for 30 to 60 seconds.

In making a cold application after a hot bath in rheuma-
tism, an excessively low temperature must be avoided. Very
cold applications in such cases have the effect to cause an
immediate return of the pain and stiffness, which the hot
bath usually relieves. A prolonged tepid spray may be safely
employed in these cases, at a temperature of about 80^ to
85^, the time, from i to 3 minutes, and followed by a gentle
spray, shower, or a graduated immersion. Beginning at 95^,
the teniperature may be lowered to 80^ within 2 minutes^
with rubbing.

In extreme cases of rheumaiism and Bright s disease in
which cold applications can not be tolerated at all, the
patient, on leaving the hot bath, should recline upon a cot,

692 RATIONAL HYDROTHERAPY.

wrapped in a linen sheet, which should be partially opened
now and then to admit of evaporation. After the first min-
ute or two, a warm blanket may be thrown over him, which
should be removed every five minutes for a few seconds, the
covering being lessened as the patient gradually cools off. In
the course of half an hour or an hour, when the pulse has
become normal and the skin cool and smooth, the patient
may be allowed to dress, but not before. Tepid sponging,
fanning, etc., may also assist in the cooling.

Severe cold applications must likewise be avoided alter a
hot-air bath in Bright*s disease, also in cases of weak heart.
The sudden afflux of blood to the internal viscera may pro-
duce so intense a congestion of the kidneys as to damage
these organs, and may so distend the right side of the heart
as seriously to cripple its action.

1236 Contraindications. — The hot-air bath should be avoided
in eruptive skin disorders^ in cases of extreme cardiac zveak-
nesSyin ihe febrile conditiotty in diabetes with emaciation, in
exophthalmic goiter, in arteriosclerosis, and in advanced
cases of nephritis.

In the employment of sweating processes of every kind, it
must be constantly borne in mind that the natural effect of
these applications is to produce inactivity of the bowels, as
pointed out by Rohrig. The intestinal inactivity is of course
caused by diminished secretion of moisture from the intes-
tinal mucous membrane. The constipating tendency of the
sweating processes may be largely overcome by copious water-
drinking. Cold water is preferable to hot as a means of
stimulating peristaltic activity. Cold water may be taken
freely at proper hours (14'23).

THE LOCAL HOT-AIR BATH.

1237 This measure consists in the application of superheated
air to circumscribed portions of the body, as an arm, a limb,
a knee-joint, etc. By means of a properly arranged chamber
connected with a kerosene or gas lamp or other source of
heat (Fig. 129), it is easily possible to bring to bear upon a

drcamscribed portion of the body a temperature of 300^^ to
400^*

The Japanese admiaister the local hot-air bath in a very
simple manner A properly constructed box is placed over
a quantity of live coals until it is thoroughly heated. The
limb to which the application is to be made is then placed in
the box, and properly covered so as to retain the heat. The
effect of this appltcatton is very profuse local sweating and
powerful revulsion. It can not be maintained that the spe*
cific effect produced differs essentially from that which may
be obtained from applications of rubber bags filled with hot
water, fomentations, and other measures whereby as high
a degree of heat as the skin can resist without injury may be
readily applied. Of course the temperature of the skin itself
never even approaches that of the surrounding air.

Therapeutic Applications.— Remarkably excellent effects 1238
are certainly obtainable by the daily or frequent application of
the localised hot-air bath, especially in cases of rhcmnaiic
joints, chr&nic inflammaii&n of the joints with exudates, and
allied affections. The duration of the application may be a
few minutes to several hours, according to the intensity of the
application* the sensations of the patient, and the nature of
the case under treatment. In very chronic affections, pro-
longed applications are usually necessary. In more acute
cases, short applications are preferable and sufficient.

When the limb is removed from the hot-air cylinder, it
may be wrapped in a large mass of cotton or wool, covered
with oil or rubber cloth, then with flannel, to continue the
effect of the bath. Before the dry pack is applied, a towel
wrung very dry out of cold water may be wrapped about the
part and vigorously rubbed for 10 or 15 seconds to secure a
strong circulatory reaction whereby the blood will be fixed in
the skin and the revulsive effect rendered more permanent.
The localized hot-air bath is contraindicated in cases of acute
infiammation, in general fever, and in cases in which the skin
of the parts is diseased.

694

RATIONAL HYDROTIlERAPYp

THB TURKISH BATH.
1889 This is a very old procedure, dating back to the time of
• like Romans. The author, with thousands of others, has
explored in Rome and Naples the ruins ol baths which were
i&*active operation in the time of Nero ; and while once wan-
dering about the ancient places of Jerusalem, he one day
accidentally stumbled upon an old Turkish bath which was
built and used in the time of Herod, and after the lapse of
neldrly nineteen centuries is still in active operation. In this
bath the air is heated by means of a huge brick furnace, the
body of iNdiich is eiq>06ed in the room, the door for intro*
ducing fuel being outside the wall of the house. In a little
grotto dug out of the limestone rock at one side, a man lay
Upon the floor perspiring, while an attendant, reclining by
his side, supported himself upon his right elbow while lei-
^^ ^ surely kneading and shampooing the bather with his left
hand.

The modern Turkii^ bath requires an establishment espe-
cially fitted up for its appltcation, the essential features of
which are : dressing-rooms, a warm room, or tepidarium
(temperature iio° to 130°), a calidarium, or hot room (tem-
perature 150° to 170°), a shampoo-room, a douche appara-
tus, a plunge bath, and a cooling-room.

The air of the rooms may be heated by steam coils, or
so-called direct radiation, or by currents of hot air, or indi-
rect radiation. The latter means is the most desirable, and
is essential to good ventilation. Usually, Turkish bath
rooms are provided only with steam -coils or pipes; and no
provision being made for change of air, the atmosphere soon
becomes so impure by emanations from the body that the
good effects which otherwise might be secured by the bath
are largely spoiled by the poisons inhaled.

ilethod. — The Turkish bath is similar to the hot-air bath,
but differs in that it includes the whole body, and that it is
accompanied by friction, kneading of the muscles, and sham-
pooing. As practiced by the Turks at Constantinople and

THE TECHNIQUE OF HYDROTHERAPy.

the Arabs at Cairo, the bath also includes joint movements of
various sorts, ' — stretching, twisting, flexion, etc.

Before entering the bath, the patient should drink freely
of either hot or cold water, as he prefers, A few minutes
after entering the bath, another glass of water should be
taken. Three or four glasses of water should be taken al
intervals during the bath. During the first lo or 15 min-
utes, the patient is frequently rubbed by the altendaiit for
one or two minutes, to encourage dilatation of the surface
vessels, and to induce perspiration. If perspiration is long
delayed, apply a hot foot bath or a hot fomentation to the
spine. If there is a disposition to cerebral congestion, the
hair and the scalp may be moistened, and a cold towel may
be placed about the head and neck. When the patient
begins to perspire, he should enter the second apartment, the
intense heat of which will give less discomfort after perspira-
tion is well established than if entered at the beginning.

From the hot room the patient goes to the shampno*room,
^ where, lying upon a slab, he h first gone over from head to
foot by the attendant with the hands dipped in water, the
manipulations being calculated to remove as thoroughly as
possible the layer of cuticle which has been loosened by the
free perspiration. The first two manipulations are for the
purpose of loosening the dead cuticle, the last removes it
These rubbings and strokings are continued until the skin is
smooth and polished like marble. (Fig. 130/)

These movements are not easily described. They consist
substantially of three sorts of manipulations : —

K Simple firm pressure with the hand spread out and
held firmly in contact with the skin with much pressure and
with slight lateral movement.

2. Rapid to- and- fro movements, systematically applied
to small areas in succession, as an arm, half the chest, the
abdomen, etc.

3. Long stroking movements, applied after laving the part
with water*

THE TECHNIQUE OF HYDROTHERAPY. 697

This interesting fact respecting the influence of the Turkish
bath upon the circulation was well studied by E. Large.*

At a temperature of 150^ to 180°, the respiration is purely
thoracic, and more than doubled in frequency. The Turkish
|)ath powerfully excites the sudoriparous glands. In his
experience with this bath during the last twenty-five years,
the author has often seen patients lose two pounds or more
in a single bath of an hour's duration.

The amount of fluid which may escape through the skin
under favorable conditions is very great, sometimes amount-
ing, as in the case of a workman in hot weather, to as much
as one fifth the body weight in twenty-four hours. Excessive
activity of the skin is of course attended by an unusual move-
ment of fluids toward the surface of the body. The amount
of fluid poured into the alimentary canal is considerably
reduced , and the result is constipation, the urine being also ren-
dered scanty at the same time. It is thus evident that vigor-
ous sweating must promote absorption from the alimentary
canal. It is due to this fact that the sweating bath is such
a powerful means of stimulating nutrition.

A lowering of blood pressure also occurs as the result of
the diminished volume of blood. The rapid loss of fluid dur-
ing profuse perspiration, amounting to three or four pounds
per hour, emphasizes sufficiently the necessity for copious
drinking in connection with sweating baths of every sort.
The usual absence of perspiration during fever, also the ab-
sence of the normal odor of the perspiration during the febrile
state, as observed by Bouchard, are interesting phenomena
which indicate the importance of the skin as a heat-regulating
organ, and as an avenue for the escape of toxic matters from
the blood. The Turkish bath usually fails to excite perspira-
tion in fever.

Therapeutic Applications. — The Turkish bath may be use- 1241
fully employed in the majority of chronic disorders. It is

* ** Reclicrchcs Physiologiqucs sur les Bains de Vapeur Sdche " (Hamman
Rains, Turcs).

698

RATIONAL HYDROTHERAPY.

an error, howeverp to suppose that the profuse sweating which
may be induced by this bath is at all essential to good results
in all classes of cases.

The therapeutic indicatioDS are essentially the same as
those mentioned for the hot-air bath* The same suggestions
and precautions are also applicable. It is especially impor-
tant to investigate, by careful physical examination, the
condition of every patient before submitting him to so vigor-
ous a process as the Turkish bath. Like the hot-air bath.
the Turkish bath may be used either as a sweating process
or as a meaus of preparing the skin for cold applications of
any sort (1235).
1242 Contralndications^^The Turkish hath should not be em-
ployed ill cases of skin disease accompanied by eruptions,
on account of the excessive congestion of the skin induced,
whereby the eruptions are aggravated. The vapor and
Russian baths are better in these cases. The Turkish bath
must also be avoided in most cases of arganic disease of
the /wari, in Bright s disease of the kidneys, in most pui-
monary affections^ in cases of arteriosclerosis in which the
disease has reached an advanced stage, in cases in which a
previous attack of apoplexy has recently occurred, in diabetes
with emaciation, and m febrile affections.

Care must be taken to avoid* the overuse of the Turkish
bath. It is on the whole a very agreeable procedure, and
may easily be employed to excess. Frequent long-continued
exposure to the sedative influence of heat is debilitating.
This effect of the bath is overcome, however, provided the
application is not too prolonged or too frequent, by means of
the cold shower or plunge with which the bath is completed.

I

THE RUSSIAN BATH.

1243 In this bath the patient lies upon a slab in a small room
filled with steam, being rubbed at intervals by an attendant
so as to promote the early appearance of perspiration. The
temperature of the room is usually from 115^ to 120°; 140^

k^^tefl

THE TECHNIQUE OF HYDROTHERAPY.

699

is barely endurable, but can not be continued for any great
length of time without danger. The length of the bath may
be from 10 to 20 minutes, A cold shower bath is sometimes
arranged in the apartment, so that the patient can, if he
desires, expose himself to the alternate action of heat and
cold by stepping under the shower bath for a few moments.

In Finland a Russian bath is produced by pouring water
upon heated stones in a room provided for the purpose. This
method is essentially the same as that used from the earliest
times by the North American Indians.

The Russian bath, like the Turkish, is followed by a sham-
poo and a cold shower or plunge bath (1239). Tho same
precautions should be observed at the conclusion of the bath
respecting the cooling of the patient, as elsewhere indicated
(1233).

Physialogical Effects.— The effects of the Russian bath
are essentially the same as those of the hot-air bath (1233);
but to the ordinary effects o I other hot baths the Russian bath
adds one disagreeable feature, — the interference with the
respiratory process, because of the saturated condition of
ths atmosphere of the bath.

The elimination of CO^ is diminished in the Russian bath»
and perspiration is less active than in the Turkish or the hot*
air bath at a temperature equally endurable.

One advantage possessed by the Russian bath over the
Turkish or hot-air bath is that it is better tolerated by persons
suffering from eruptions or cutaneous irritation of any sort.

Perhaps the most important characteristic of the Russian
bath is the rapid and considerable rise of body temperature,
due to the interference with heat elimination through the skin
and lungs, as well as by the heat communicated. The body
temperature rises higher and more rapidly in the Russian
than in the hot-air or the Turkish bath. As a result, the
oxidation of proteid elements is greatly increased, the con-
dition being allied to that of fever. This increased oxidation
of nitrogen gives to the Russian as well as the vapor bath

lUi

700 RATIONAL HYDROTHERAPY.

and the sweating pack a special value in the treatment of
chronic rheumatism and all forms of uric-acid poisoning and
chronic toxemias, in which one of the chief indications is for
increased oxidation and destruction of nitrogen-containing
wastes and toxins. There is no bath which excels the Rus-
sian in this particular, except the electric-light bath, which
rapidly heats the body, not by retention of body heat, but by
the penetration of the rays of radiant energy into the depths
of the tissues and powerfully excites metabolism.

1846 Therapeutic Applications These are essentially the

same as those already mentioned in relation to the hot-air bath
and the Turkish bath. The Russian bath is for some persons
more agreeable than the Turkish or hot-air bath, because of
the effect of the moist air upon the skin. Persons suffering
from acute bronchial catarrh often experience very great tem-
porary relief in the Russian bath. Its effect is likely to be
transient, however; and unless extraordinary precautions are
taken, the exposure ordinarily necessary after the bath is
likely to result in an aggravation of the cold. The Russian
bath whitens the skin by improving its circulation, relieves
rheuviaiic pain, and may be advantageously employed in
diabetes when there is no cardiac complication, in the chronic
toxemia of dyspepsia, and in some skin disorders in which
Turkish and water baths prove too irritating ; it relieves pain
in sciatica, and is generally useful in the rheumatic diathesis.

The Russian bath is not so well adapted to the treatment
of cases of obesity as is the hot-air or the electric-light bath
or the sweating pack. The reason for this is the tendency in
obesity to overheating and systemic weakening in conse-
quence of the exhaustion of the nerve centers.

Contraindications. — Extraordinary care must be exercised
to avoid overheating the patient in this bath, as heat elimina-
tion is almost altogether suspended; and hence the bath must
be avoided va febrile cases. The bath must also be interdicted
in cases of cardiac weakness, in most cases of advanced Br ighf s
disease, pulmonary tuberculosis, and in arteriosclerosis.

THE TECHNIQUE OF HYDROTHERAPV.

701

THE VAPOR BATH.

The vapor bath (Fig. 131) resembles the hot-air bath
in the mode of administration. The same sort of cabinet
may be uscd» and the emergency arrangements suggested for
the hot-air bath are equally useful for the vapor bath (Figs,
127, 128). When the vapor bath is given in bed, however,
an oil cloth must be placed under the patient to avoid wet-
ting the mattress.

Among the different methods of giving a vapor bath may
be mentioned the following i —

1. Water may be boiled in a flat-bottomed basin over an
alcohol lamp or a small gas or kerosene stove. The basin
should be wide, and the quantity of water small, so that it
may boil quickly and vigorously.

2. A pail of boiling water may be placed in the cabinet
beneath the chair on which the patient sits, and into this may
be lo%vered one by one well*heated flat-irons, bricks^ stones,
or other mineral or metallic masses, a wire being attached to
each so that the entrance into the water may be easily con-
trolled. The mass should be gradually let down into the
water, so that the steam may not be generated too rapidly.

3. A rubber tube attached to the spout of a teakettle
witi a tight-fitting cover is a useful method of conveying
steam to the cabinet

4. In the absence of a better arrangement, a vapor bath
may be taken in an ordinary bath-tub supplied with hot and
cold water, by the aid of the following simple arrangement
devised by Winterujtz : A board of a si^e sufficient to support
the patient, and perforated with inch holes, is laid in the tub,
and raised by proper supports three or four Inches from the
bottom. By means of a piece of ordinary garden hose three
or four feet long, connected with the hot-water faucet, the
hot water may be carried to the upper end of the tub beneath
this board. By leaving out the plug, the hot water is thus
allowed to run in and out of the tub; and as it passes the

124f

702 RATIONAL HYDROTHERAPY.

whole length of the tub before escaping, it gives off a huge
quantity of steam, which, passing up throngli the openiqgs
in the board, surrounds the patient with warm vapor. The
vapor is retained about the body of the patient by f^nV^^
placed over the top of the tub, and tacked axonnd theneck
in such a way as to protect the head from the warm vi^idr.
The intensity of the heat may be regulated by controBiiiK the
flow of water. The inventor of this ingenious kiiui of /vapor
bath informed the author, when on a visit to his
ment at Kaltenleutgeben, near Vienna, that he had
able to administer a good vapor bath with two gallpoft pf
hot water. . Y*

Nothing could be simpler or cheaper unless . i^ lw^.4^
method adopted by the New Zealanders, who, as pB^.bfilte
been informed by Mr. Maui Pomare, administer a *
by the following unique but effective means: Several.!
are laid upon a small heap of wood properly arraBigod;.tlie
wood being lighted, the stones are soon heated very faoL
They are then covered with a thick bed of green . leaww^
upon which the patient lies down. The patient is covered
with a blanket, which retains the moist vapor from the steam-
ing leaves, and is thus made to perspire profusely. After
the bath he is cooled by plunging into the sea.

An old French author describes a method of administer-
ing a vapor bath by placing an empty wine barrel from which
one head has been removed, over a fire until well heated,
then reversing it and putting the patient inside, enveloping
both the patient and the barrel in thick coverings to retain
the heat and moisture.

The accompanying cut (Fig. 132) shows an extremely con-
venient portable cabinet which may be employed for either
the vapor or the hot-air bath.

In certain cases it is desirable to administer a vapor hath
with the patient reclining. This may be accomplished in sev-
eral ways. A convenient arrangement devised by the author
is shown in Fig. 131 (b).

>1

THE TECHNIQUE OF HYDROTHERAPY.

703

PhysioTogical Effects— The pulse is greatly quickened,
rising rapidly to 140 or 150 beats per miaute. The heart is
quickly tired out by the excitation of the hot bath, with the
low vascular tension to which it gives rise, because its periods
of rest are diminished. Beating at its ordinary rate, the
heart has about forty seconds to rest out of each minute;
but if its rate of beating is increased 25 to 50 percent., its
periods of rest are diminished proportionately.

The pulse is much more profoundly affected in the vapor
than in the hot-air bath. Sweating begins much sooner in
the vapor than in the hot-air or Turkish bath, and less quickly
than in the electric-hght bath. Ft should be noted that the
appearance of moisture upon the surface of the body is not
necessarily an evidence of perspiration, as it may be the
result of condensation of vapor upon the skin. Frey, in his
interesting study of the hot-air and vapor baths,* calls atten-
tion to the interesting fact that while the respiration is quick-
ened, the respiratory movements do not increase either in the
hot-air or the vapor bath in proportion to the pulse. In the
vapor bath, however, respiration is excited to a much greater
degree than in the hot-air bath.

The absorption of oxygen is interfered with in the vapor
bath for the reason that the respiration is not quickened in
proportion to the increase in the pulse-rate. Oxidation is
thus interfered with to some extent. When perspiration is
induced by exercise, the breathing is quickened in proportion
to the heart action, a larger amount of oxygen is taken into
the system^ and hence sweating resulting from exercise is
less exhausting than that produced by the vapor bath or
other sweating processes.

The effect of the vapor bath upon the body temperature
is very profound, the rectal temperature rising in the course
of 20 or 30 minutes sometimes to the extent of three or four
degrees* The temperature of both the rectum and the axilla

* " Experimentdb Sliidien uber die Wirkun)^ Her hcissen Lttfl und pAcapf^

bMcr," Arihiv f^ir Fiyrhmtritt Berlin, iSSu, XI, 2<S6"S7o.

1247

more quickly m the vapor bath than in
ish or dry hot-air bath (Exp. 62). The axillary temperature
rises more rapidly and to a higher point than the rectal
temperature. This is doubtless due (i) to the fact that vapor
is a much better conductor of heat ; and (2) to the further
fact that cooling of the body by evaporation is suspended in
the vapor bath as in the Russian bath, the hot immersion
bath, and the wet-sheet pack.

In consequence of the elevation of temperature produced
by the vapor bath, this procedure becomes a powerful factor
in the oxidation of proteids, in common with all other hydri-
atic procedures which are accompanied by elevation of body
temperature*
1848 Therapeutic Applications — The vapor bath is indicated in
the same class of cases as those for which the hot-air, Turk-
ish, and Russian baths are recommended. It is especially
useful as a means of heating the skin previously to a cold
application of some sort (120^^ for 3 to 5 min.). For this
purpose^ however^ it is inferior to the electric-light bath. Its
only specific application is as a heating process in cases in
which the skin is so irritable that the hot-air bath, the elec-
tric-light bath, and other similar processes are contraindi-
cated. The contact of the moist vapor with the skin produces
a soothing effect in these cases, provided an excessively high
temperature is not employed. The vapor as well as the Rus-
sian bath has a further advantage in that it softens the epi-
dermis, and facilitates the discharge of sebaceous matters and
inspissated products from the perspiratory ducts, thus reliev-
ing a condition which one writer graphically describes as
** constipation of the skin."

The physiological effects produced by the vapor bath,
particularly its influence upon blood circulation and tissue
activity, indicate it to be a powerful therapeutic procedure.
The influence of the bath upon proteid oxidation especially
adapts it to the treatment of those cases of retarded nutrition
in which it is desirable to stimulate the oxidation of proteid

THE TECHNIQUE OF HYDROTHERAPV*

70s

wastes, as in r/wumaiism or £tmt, and that very large class
of chronic cases» including a large proportion of neur asthen-
ics, in which the uric acid diathesis is the fundamental dy&
crasia which forms the general background for the varied
pathological pictures presented.

The vapor bath is a powerful elimtnative measure. When
employed for this purpose, its duration should be from 15
to 30 minutes. The prolonged vapor bath is indicated in
chronic rheumatism. Jaundice^ tertiary svphiUs, and when-
ever general spoliative effects are required, as in obesity with
rheumatism.

The vapor bath is useful in all forms of chronic toxemia.
It is especially well adapted to this class of cases, being
exceeded in value by 00 procedure excepting the electric-
light bath, which by its greater power to heat the tissues,
stimulates still more actively the oxidation of tlie proteid sub-
stances of an excrementitious or toxic character, the presence
of which gives rise to the exceedingly varied conditions so ad-
mirably described by Bouchard in his ** Autointoxications."

Neuralgias, especially facial and spinal neuralgias, sciatica^
hemicrania, peripheral paralyses, especially when due to
syphilis, paralyses resulting from the exudates of gout or
rheumatism, functional disorders of the spinal tord, hys-
teria, hypochondria, are all favorably influenced, often with
remarkable rapidity, by the vapor bath- Exudates and effu*
sious, whether of inflammatory origin or due to mechanical
disturbance of the circulation, are absorbed under the power-
ful alterative and spoliative influence of the vapor bath;
although for this purpose it 15 perhaps less efiective than the
hot-air or the electric-light bath. Paralysis resulting from
exudative meningitis of the spine not infrequently yields
rapidly to the influence of the vapor bath. This measure
may also be appropriately applied in the treatment of chronic
nephritis during an acute exacerbation, in infectious jaundice,
in acute alcoholic poisoning in connection with the cold bath,

in tetany, in migraine and malarial neuralgia (between at^

45

7<^ RATIONAL HYDROTHERAPY.

tacks), and as a heating procedure m connection with gen-
eral cold applications, such as the douche, the half bath, and
the wet-sheet rub. As a heating procedure (2 to 5 rain.), it
is very convenient, and is widely used in continental hydri-
atic establishments, although the electric-light bath is rapidly
superseding it.

In the application of the vapor bath, it is important to
remember that it is a very powerful measure. It is far more
energetic than the hot-air bath, for moist air is a better
medium of communicating heat to the body than is dry air.

Contraindications.— The contraindications for the vapor
bath are the same as those for the hot-air and the electric-
light bath as regards general conditions. The vapor bath
is a more vigorous procedure than the hot-air bath, and hence
better adapted to the strong and young than to old and feeble
persons. Great caution must be employed in its use in ad-
vanced cases of cardiac or renal disease, in which it must be,
as a rule* strictly prohibited. Exceptions to this rule are
noted in the discussion of the hydriatic treatment of these

affections,

THE LOCAL VAPOR BATH.

1249 While the chief use of the vapor bath is in general 1

cations, it may be made to render valuable service in iiatKSi»
partial applications as well. By suitable arrangemeiita|# the
application may be confined to an arm, a leg, or any ctfmfli<-
scribed portion of the body. When thus used, a jpaoh
higher temperature may be employed than when the jf||ple
cutaneous surface is exposed.

Therapeutic Applications. — The powerful heating effect of
the vapor bath renders it highly valuable as a means of rdifir-
ing pain. It may be applied in nearly all conditions to wtlich
the fomentation is applicable. The fomentation itself is iniact
little more than a crude form of vapor bath. As compared wiUi
the fomentation, the partial vapor bath has the advantage that
it avoids mechanical contact with the affected part, and hence
is better suited to cases in which there is extreme sensitiveness

5,

THE TECHNIQUE OF HYDROTHERAPy.

707

of the skin, as in superficial inflammations and cutaneous hy-
peresthesias. Nearly twenty- five years ago the author learned
from a patient who had long been a great sufferer from pain-
ful hemorrhoids and rectal nicer, an application of the local
vapor bath which is worth mentioning. This patient had
made the discovery that by pouring into a pail a gallon or two
of boiling water and sitting over it while evacuating the
bowels and for a short time afterward, he was able to escape
the terrible pain which he otherwise suffered.

By means of the vapor doHcfie(tiQ2), circumscribed vapor
baths may be administered to any portion of the body, and
at a temperature much higher than water in any other form
can be applied.

THE ELECTRIC'LIQHT BATH.

In 1 89 1 the author's attention was called by a colleague,
Dr. Kate Lindsay, to the convenience of the ordinary incan-
descent electric lamp wrapped in flannel as a means of apply-
ing heat in cases of pain. He had, some years previously,
made extensive use of sunlight in the treatment of chronic
invalids by a variety of means, especially the sun bath, mod*
ified by glass of various colors, and by means of large lenses
which concentrated the rays of light upon painful points for
the relief of hyperesthesia, particularly in the treatment of
so-called spinal irritation. The observation above referred
to, showing the electric light to be a convenient means
of applying heat for local pain, led him to renew the study
of the properties of light, and to begin experiments with
various kinds of apparatus designed to make therapeatic
applications of the electric light, which resulted in the devel-
opment of the incandescent electric*light cabinet and various
other devices for the general and local application of heat by
means of the electric light. The first form of cabinet
devised consisted of a compartment about eight feet in height
(Fig. 133), upon the inside of which were placed between
fifty and sixty incandescent lights, the spaces between the

1250

708 ^ RATIONAL HYDROTHERAPY.

rows of lights being filled with glass or metal minors to mul-
tiply the number of lights by reflection. The cabinet is so
arranged that the whole body of the patient, sitting uprightp
can be exposed to the influence of the light, or the head
may be excluded, as in the ordinary vapor bath. By means
of switches and a proper grouping of the lamps in wiring,
the number of lights in use can be instantly and perfectly con-
trolled. As the heat effects of the bath are derived
directly from the incandescent films by radiation, and do not
at all depend upon the heating of confined air, the follest
provision is made for ventilation. It is not at all necessary
that the air should be confined.

In another form of cabinet (Fig. 134), provided mthm^tg
to ninety lamps, the patient lies in a horizontal position, the
lights being placed on three sides. A suitable couch, provided
with rollers, is pushed entirely within the cabinet, or only so
far as to expose such portions of the body as it is desired
to bring under the influence of radiant light and heat By
this plan, the influence of the light may be confined to the
feet and legs, or any other portion of the body up to the neck.
If preferable to do so, the attendant may protect by a sheet
and a piece of mackintosh any portion of the body which
it may be desirable to exclude from the action of the bath.

By means of other constructions, the effects of the incan-
descent light are localized for the spine (Fig. 135), the trunk,
(Fig. 136), the legs (Fig. 137), and the joints (Fig. 138).
These appliances are so quickly and easily managed that they
constitute by far the most convenient and effective means of
applying heat to the cutaneous surface. By the touch of
a button the whole heating power of the stpparatus may
be brought to bear at once, or may be as quickly terminated.
The intensity of the application may be regulated by a
rheostat, or by the number and candle-power of the lamps
employed.

riethod. — There are two general forms of the electric-
light bath; viz., the incandescent-light bath and the arc-light

^^He^i

^

Pic. TJ5* ELECTiric*Liciif Hat it fob

Fig. i^a. ELECTRtc-Lt^HT Bath *q% JoisfT

FiLI.

il6. Flllimic LiiiJiT Kuii fog

lit;

t.Ljtcii4lc LlJ>Ui Hat II jrpK Fjt£i

THE TECHNIQUE OF HYDROTHERAPY.

709

bath. Unless otherwise indicated, the term ' * electric-light
bath ** as used in this work refers to the incandescent electric-
light bath, the several forms of which are shown in accom-
panying cuts. The author has also arranged cabinets in
which the arc light and the incandescent light are combined.

The trunk electric-light bath has been found especially
valuable in cases of disorders of the liver, kidneys, stomach,
and bowels.

Employed in any of its localised forms, the application is
usually followed by a cold trunk pack, cold friction, or a cold
spray or douche to the surface which has been exposed to
the heat

The incandescent electric-light bath and the calorific
or heating bath administered by means of the electric-arc
bath may be regarded chiefly as heating procedures, and
should be followed by cooling applications in precisely the same
manner as the hot-air, Turkish, vapor bath, etc* The incan-
descent electric-ltf^ht bath is superior to every other form ol
heating procedure in the quickness with which the skin may
be heated when the object sought is simply a preparation
for the cold bath. The time required may be not more than
3 to S minutes* When strongly derivative or eliminative
effects are required^ the application may be continued for l$
to 20 minutes. A longer application is likely to produce
exhausting effects through overstimulation of the nervous
system and excessive elevation of temperature.

For general revulsive effects, the author has devised a new
form of bath, which combines the shower and douche with
the electric-light bath. The cabinet is made in such form
that the patient stands in an upright position (Fig, 139).
After the skin has become thoroughly warmed by the heat
from the lamps, a cold shower or horizontal jet douche of the
desired temperature is applied, the lamps being protected
from the cold water by an internal lining of plate glass* The
revulsion thus produced is of the most powerful character^
and may be repeated as many times as required. By repeat-

7IO RATIONAL HYDROTHBRAPY.

ing the cold application for lo seconds at intervals of half
a minute, this bath may be made very highly exciting 4Uid
also tonic.

The sweating electric-light bath is usually followed by a
shampoo and a cold douche, the finishing treatment beiqg
essentially the same as that for the Turkish and the Rus-
sian baths.

In cases in which the purpose is simply to excite the dren-
lation of the skin, the daily shampoo is not reqoired, as the
heating process will be terminated when active perspiration
b^;ins. Feeble patients and persons not accustomed to cold
water may be cooled by means of the wet-hand or wet4owel
rub, by the cool friction mitt, or by affusion.

In the radiant-heat, or incandescent electric-light, bath
the body may be subjected to the most intense heat desired
without confining the patient, and without overheating the
atmosphere surrounding him. * This is due to the well-known
fact that rays of heat pass through such transparent media
as the air without heating them. This accounts for the intense
cold experienced by balloonists and those who ascend high
mountains, even in the tropics. As the woodchopper in the
logging-camp roasts his back before a big log fire on a cold
winter's evening, while the frost is taking sharp nips at his
nose on the other side, so the patient in the incandescent
electric-light bath, while perspiring freely, may be surrounded
by air at the ordinary temperature, temperature.

If it is desired to heat the air of the bath, this may be
accomplished by simply closing the cabinet, excluding the
head. The glass globes of the lamps soon become heated,
and in turn heat the air. The heating power of the globes
depends upon the degree of vacuum. Wintemitz has shown
that the more air the bulb contains, the more the glass is
heated. It thus appears that the incandescent electric-light
bath may be so managed as to combine with the remarkable
effects of radiant heat, all the effects of the ordinary hot-air
bath, the value of which in promoting evaporation from the

i

.1

THE TECHNIQUE OF HYDROTHERAPY,

711

skin and thus encoaraging perspiration, is certainly tncon*
testible.

Local applications of the incandescent-light bath may be
continued for half an hour or more, if desirable, as in the
treatment of chronic inflammation of the knee*}oint for resol-
vent effects, and in obstinate cases of sciatic neuralgia

Local applications to the spine are a most efficient means
of exciting the spinal centers, and at the same time producing
a powerful derivative effect- This is a most excellent meas-
ure in spinal neuralgia, in lumbago, and in reflex spinal pains
arising from irritation o( the sympathetic ganglia.

Applications of the electric light to the joints is a more
efficient method in old affections of these parts than any other
known, and when combined with the heating compress and
massage, accomplishes wonders in a class of cases most of
which are generally looked upon as incurable. The heat and
actinic rays penetrate the depths of the tissues, vitalising and
energizing the diseased and sluggish parts, and quickening the
healing process.

A convenient appliance for a local application of the
electric light may be easily improvised iioin an ordinary
incandescent lamp by simply adding a conical tin shade of
sufficient size to prevent contact of the lamp with the skin,
If the heat is too intense, the skin may be protected by one
or more thicknesses of white flannel cloth.

The Arc-Light Bath — Experiments have shown that in
the incandescent light bath only five per cent, of the electrical
energy employed is thrown off as luminous rays; hence the
great heating power of this bath.

In the arc light bath (Fig, 140), as stated elsewhere (599)
in this work, we have other important factoid. The electric
arc light has been shown to contain actinic rays in even larger
proportion than does the sunlight. In the arc-light cabinet
which the author has had constructed, devices are introduced
whereby the calorific, the actinic, or the combined rays of the
electric arc may be brought to bear upon the patient This

12S1

712 RATIONAL HYDROTHBRAFY.

cabinet consists of a quadrangular construction which permits
the exclusion of the head of the patient. In each comer of the
cabinet is placed a powerful arc light, so arranged that it may
be moved up and down at will, thus bringing its rays to bear
at any level. At each side of the opening through which the
rays of each lamp are admitted, hangs a hinged door^ one of
red glass, the other of blue glass, so arranged that either
screen may at will be brought before the lamp, thus excluding
from the cabinet all rays except those which are desired.
By means of a strong air current circulating through each
lamp compartment, the accumulation of heat is prevented
when desirable. The air of the cabinet is also constantly
changed so that the patient may be subjected exclusively to
the action of the radiant heat of the electric arc.

The * author's experience with this form of bath is less
extensive than with the incandescent form, but it has been
sufficiently long to establish a reasonably fixed method for its
employment. The calorific effects of the bath are secured
by filtering the rays through red glass as described elsewhere
(596), this being used when heating effects alone are desired.
On the whole, the author's experience has shown the arc light
to be less serviceable for this purpose than the incandescent
light, as the light is less evenly distributed, and the method
of obtaining heat much less economical. By means of the
blue-glass screen the actinic rays are employed, with the
exclusion of a large share of the luminous and calorific rays.
The heating effects obtained with blue glass are very slight,
but marked nervous and other vital phenomena may be elic-
ited by a sufficiently long exposure, the experimental proof
of which has been given elsewhere in this work (599).

The electric arc-light bath is only to a moderate extent
a heating procedure, but the heat is sufficient to warm the
skin thoroughly, so that tonic applications such as the cold
douche may be employed directly after this bath.
1252 Physiological Effects. — In experiments conducted by the

author, assisted by his colleagues, Drs. Paulson and Rand,

THE TECHNIQUE OF HVDKGTHERAPV.

713

and Professor Gomberg of the University of Michigan, who
superintended the chemical work, several very useful and
interesting facts respecting the physiological effects of the elec-
tric-light bath have been demonstrated. It was ascertained,
for example, that this bath is without doubt the most efficient
and satisfactory of all modes of producing perspiration » as it
stimulates the perspiratory glands and other structures of the
skin in the most powerful manner. It causes the perspiration
to appear in a remarkably short space of time, thus avoiding
the exposure of the body to the exhausting effect of prolonged
heati as profuse perspiration generally appears in the electric-
hght bath in 3 to 5 minutes, even when the temperature
of the air surrounding the patient is not above 85'^ F*» while
the dry pack not infrequently fails to produce vigorous activity
of the sldn within less than an hour and a half or two hours,
a still longer time being sometimes required,

A fact which must be kept in mind in the employment
of this powerful means of calorification, however, is that the
body temperature, as indicated in the rectum, may rise to 103^
or even higher in a prolonged electric-light bath.

It has also been ascertained that the lungs throw off, while
exposed to the incandescent light, a decidedly larger propor-
tion of carbonic acid gas than usual, showing increased oxi-
dation. Hence the bath must not be excessively prolonged,*

The peculiar value of the electric-light bath is due to its
ufTiciency as a source of radiant energy. In the Turkish balb,
heat is communicated to the body chiefly by convection from
heated ain Air, being a poor conductor, communicates
heat to the body very slowly. Absorption of heat is further
hindered by the skin, which is an excellent non-conductor, and
by the rapid evaporation of moistur« upon the skin, whereby
it is cooled so rapidly that it is possible for a person to enter
and remain for a considerable time in an atmosphere far above
the boiling point. The heat of the electric light is in the form

•See pai><^r, **The Incandescent Electric* Light ar Radiant-llent Bathj*' rc»d
liciotc the EleclTo-Thcrapcutk Associfttion at lis fourth jini>ual mecrliig, New
Vofk, Sept. 25-37; i%4^

714 RATIONAL HYDROTHERAPY.

of radiant energy. The electrical current of the incandesoeot
electric-light bath develops light rays to the' extent. of only
5 to 8 per cent;, while heat rays are developed to the extent
of 92 per cent.*

This energy is not communicated to the body by convec-
tion. The skin, as well as the air, is to a large extent trans-
parent to radiant heat, and the same is true of all the living
tissues. This is evidenced by the^gastrophone of Einhom
and other transilluminators. Through a speculum placed in
the vagina with a suitably arranged electric light placed close
to the abdomen, the author has seen the interior of the
trunk illuminated and made to glow with a bright red light,
the red color being due to reflection from the red corpus-
cles of the blood. Even the bones are translucent to light
when in the living state. This is clearly shown by placing
the hand between an electric light and the eye, with the fin-
gers in close contact; if the hand is placed near enough to the
light, the whole fingers will be seen illuminated, the bones as
well as the soft parts. It may thus be said that heat from
the electric light penetrates the body just as it would penetrate
any other transparent or semi-transparent medium ; while the
heat of the Turkish, vapor, or Russian bath is communicated
to the body by convection, and slowly works its way into the
body by heating the successive layers of living tissue which,
although, like glass, transparent to radiant energy, also pos-
sess to a greater or less degree the nonconducting quality
of glass and allied substances.

Dr. Wintemitz, professor of nervous diseases in the Royal
University at Vienna, after having carefully reviewed the
author's observations concerning the electric-light bath, and
having himself made an extended study of the bath, states his
conclusions in a recent workt as follows : —

•* The electric-light bath presents an advantage over every
other means of applying heat in the readiness with which the

* Kuhner, Int. Klin. Rundschau^ Wein, 1894.
f Winternitz, " Fortschritle dcr Hydrotherapie."

THE TECHNIQUE OF HVDROTHEiiAPY.

71s

dosag^e may be regulated as regards time and intensity. The
instant the switch controlling the circuit is closed the whole
force of the bath or that portion of it in use is brought to bear
at once upon the body. The instant the circuit is opened the
heat is wholly and absolutely withdrawn. By means of prop-
erly adjusted switches whereby the number of lamps in use
may be controlled » the amount of heat applied may be exactly
regulated.

''Another advantage of the electric-light bath is that it
does not interfere with heat elimination. It in fact encour-
ages heat elimination by encouraging free perspiration. Many
other forms of hot applications^ particularly hot water baths
and sweating packs, cause retention of bodily heat In the
electric-light bath, the heat elimination and the excretion of
efiete matters which accompany vip^orous perspiration pro-
ceed wjth increased activity at the same time the rays of
radiant heat are penetrating the tissues, elevating the tem-
perature of the blood, and quickening all the vital processes/*

•*The importance of this property of the electric-light
bath is clearly shown by the interesting experiments of Con-
rad Klan* This investigator showed by calori metric experi^
ment that with the body exposed in an atmosphere somewhat
below the body temperature, heat elimination was during the
first five minutes ten limes the nonnal amount; while during
the second five minutes the amount of heat eliminated was
half as great. The diminished loss during the second five
minutes was doubtless due to contraction of the blood-vessels
o( the skin. In the electric-light bath the cutaneous vessels
are thoroughly relaxed, and this condition is maintained by
the action of the rays of light falling upon the skin while the
air about the patient is but little above the ordinary atmos-
pheric temperature, a condition which in the highest degree
favors heat elimination/'

Professor Winternitz continues : —

*'The electric-light bath is a new invention by Kellogg,

»KI«r, f^'iifjf, Kim. IV^ek., 1S95, p, tSo.

7l6 RATIONAL HYDROTHBRAFY.

Battle Creek, Mich., U. S. A. It is undoubtedly true that
radiant heat penetrates the tissues much better than con-
ducted heat, and it is very probable also that the inner life
of the cell is influenced by the radiant heat, either qualita-
tively or quantitatively, and to a higher d^;ree. All the
effects of the vapor bath can be produced by the electric-light
bath. The loss of carbonic acid gas is considerably greater
in the electric-light bath than in the vapor bath, and what .
is especially remarkable, perspiration occurs very quickly and
at a very low temperature, and is very profuse. [Indications
of perspiration are sometimes noticed at 28^ R. (95^ F.).
The author has observed perspiration at 85^ F., and Pro-
fessor Wintemitz stated to him personally (1899) that he had
seen moisture appear upon the skin in a single instance at
65^ F. The patient was a somewhat excitable neurasthenic^
and very susceptible to the stimulus of radiant energy.]

* * Ordinarily a much higher temperature is necessary before
symptoms of sweating occur in the vapor bath. The time
required to produce sweating in the electric-light bath is com-
monly 3 J minutes, whereas about 5 minutes are required in
the vapor bath. Finally the quantity of perspiration is con-
siderably greater in the electric-light bath. That the radiant
heat is the main cause of this, and not the heated air, was
evident from the observations made by us that the external
part of the leg upon which the rays of light directly fell per-
spired very much more quickly and profusely than the internal
part of the leg, which received only reflected rays. After
ID to 30 minutes the body temperature increased to 40^ C.
(104° F.), the pulse to 160, respiration to 42, — symptoms
of the condition resembling fever. We have used the elec-
tric-light bath in ways analogous to the use of the vapor bath
in a number of cases of sclerosis, rheumatism, and gout, and
have been much gratified with the results. We have as
yet made no further experiments. Kellogg reports very good
results in sclerosis, arthritis, and many disorders of nutrition.
Lehmann has been very successful in psoriasis. Since we

THE TECHNIQUE OF HYDROTHERAPY.

7^7

have m the electric-light bath a thermal method by which the
degree of heat applied can be physiologically and exactly
measured, and knowing the powerful influence of light upon
the life of the cell and of the whole organism, we believe
that this method will hold a prominent place among the forms
of thermal applications, and that we shall be enabled by
its use to influence a series of maladies more quickly, more
effectively, and more satisfactorily than heretofore/'

For a fuller discussion of the physiological effects of sun-
light and of the electric light, see pages i68 to i8o.

Therapeutic Applications* — The electric-light bath has
proved, in the author's hands, of far greater value in the
[treatment of a large variety of maladies than any other means
^ of applying heat except water, and admits of much more
general employment than the ordinary Turkish, Russian, vapor,
or hot-air baths. One reason of this is the convenience and
rapidity with which the degree of heat may be graduated by
turning on or off one or more groups of lamps, the amount
of heat being thus rendered absolutely and instantly control-
iRble, since the source of heat relied upon is the incandescent
filaments of the lamps rather than a heated atmosphere. The
instant the lamp is turned off, the heat which had previously
been emitted is withdrawn from operation. If additional heat
is required, the desired number of lamps may be turned on,
and become instantly operative.

Another reason for the more universal utility of the incan-
descent-light bath is the fact that when properly applied, its
effects are highly tonic in character, A short application of
the bath at full force for a time just sufficient to induce pow-
erful stimulation of the skin without provoking perspiration
is a most effective means of cutaneous stimulation. The
tonic effects of such an appHcation may be still further inten-
sified by instantly following the bath with a cold spray or
other cold application^ thus producing a revulsive effect of the
most agreeable and effective characten The excessive beat-
ing of the skin prepares the way for the cold application,

13&3

71 8 RATIONAL HYDROTHBRAPir.

without at the same time so overheating and relaxing the
blood-vessels as to render recovery of the tone of the ciita-
neous tissues so tardy as to involve the risk of exhausting the
patient too greatly or exposing him to the liability of taking
cold. In the experiments referred to, the amount of perspita-
tion produced in the electric-light bath was found to be
double that produced in the Turkish bath. The body tem-
perature is also raised much more rapidly in the electric-light
bath than in any other form of bath, because the rays of
radiant energy pass through the skin and reach the interior
of the body at once.

The electric-light bath is especially valuable in cardiac
disease and in diabetes^ in which prolonged sweating measures
can not usually be employed without more or less risk. The
penetrating nature of the heat of the electric-light bath stimu-
lates oxidation of the residual tissues, and thus hastens the
disappearance of redundant fat in obesity. In dropsy^ associ-
ated with either cardiac or Bright's disease, in the toxemia of
chronic dyspepsia^ and in all conditions for which general
and local applications of heat are applicable, the electric-
light bath stands pre-eminent.

Chronic malarial cachexia, syphilis, diabetes^ obesity^
neuritis, neuralgia, acute nephritis, migraine, neurasthenia,
tetany, habit chorea, and hysteria yield good results to the
thermic impressions of the electric ray.

In rheumatic and anemic patients, and in all cases when
the heat-making capacity is small, the electric-light bath
serves an exceedingly useful purpose in preparing the skin for
cold applications by storing up in it supplies of heat. And it
serves a useful purpose in this way, not only in preparing the
patient for tonic applications of water, but as a means of
producing most excellent revulsive effects. For pure revulsive
effects, only the circulatory reaction is desired, it being, in
fact, necessary to suppress thermic reaction altogether.
Hence the duration of cold applications which follow hot
applications should be such as exactly to neutralize the heat

THli TECHNIQUE OF HYDROTHERAPY,

719

wliich has been absorbed by the skin in the previous hot
apphcation. The electric-light bath havhag the power to
store up quickly a large amount of heat in the skin, it is
consequently of special service in applications of this kind,
[which are the most effective means of relieving internal con-
Igestion, as well as the most powerful of all external agents
for the relief of pain.

The electric-light bath is superior to all others in the
[treatment of chronic rkeumaiism and all maladies dependent
I upon the uric acid diathesis, owing to its ability to elevate
body temperature while at the same time producing vigorous
cutaneous activity. The elevated temperature stimulates the
oxidation of proteid wastes, and augments vital combustion,
f while the increased skin activity carries off the waste prod-
ucts prepared for elimination.

Recent physiological experiments have shown that the
' elevated temperature in febrile conditions is one of the
methods by which nature combats the causes of disease, or
neutralizes some of the morbid conditions resulting from
disease. The physiological effects of the electric-light bath
may exercise in many cases a strongly curative influence
by the elevation of the body temperature, thereby enabling
it to produce antitoxins, or to render effective the curative
efforts instituted by the vis medicatrix nainra of the body*
As a prophylactic, this bath also possesses a high value,
especially for persons who live a sedentary life, as teachers,
doctors, lawyers, preachers, Judges, and professional men
generally, and to a still greater degree for the majority of
women, as it is the best substitute for muscular activity in
the open air

The hygienic value of tlie sweating bath is certainly
scarcely yet appreciated by the majority of civilised men and
women. This can not be said of the Finns, however; for in
Finland every house has connected with it a bath-house with
conveniences for producing vigorous perspiration. Indeed,
the author, while on a recent visit to Copenhagen, was told

720 t?ATIONAL HYDROTHEBAPV.

by an intelligent Finnish gentleman that it is the custom in
his country for a young man anticipating matrimony to
build as a foundation for his future home, first of all, a
sweat'house. A vast multitude of city dwellers in civilized
countries are suffering tortures from disease in various forms,
and dying prematurely, because of the neglect of that impor-
tant hygienic provision In the injunction of the Almighty to
Adam, *' By the sweat of thy brow shalt thou eat thy bread/'
Indeed, the neglect to sweat is one of the most prolific
causes of disease in the conditions of civilized life* A mod-
ern writer has very sagaciously suggested that the chief differ-
ence between the savage and the civilized man is in the way
he sweats. The savage sweats his brow in earning his bread,
and taxes his brain but little; the civilized man earns bis
bread by the sweat of his brain » but seldom sweats his brow.

The electric-light bath, while not a complete substitute
for the sweating produced by exercise, certainly comes nearer
to being so than any other heating process; and when followed
by some vigorous cold application, as the cold bathj_
a hygienic value which can not be overestimated.!

A local application of the electric light for 1 5 or 20 min-
utes, followed by an application of an ice compress or ice
friction for 5 to 8 seconds, is almost a panacea for the pain
of sciatica and for similar painful affections in which there
is no inflammatory action.

The electric-light bath has been found superior to all
other means for applying heat to circumscribed areas of the
surface; and by the use of a number of simple appliances it is
far more convenient in its application than the fomentation,
hot bags, or any similar appliance (Figs. 135-138).

M. Below, who has for some time employed the electric-
light bath constructed after the author's plan, reported in a
paper read before the medical society of Berlin in 1898, a
considerable number of cases in which the bath had been
successfully used in the treatment of rheumatism, syphilis,
and various other morbid conditions.

■•\'< -f

;••♦ i
•'i

n i.

THE TECHNIQUE OF HYDROTHERAPY. 72 1

That the electric arc light acts powerfully upon the nerv-
ous system has been clearly proved by the experiments of
Maklakow, Arloing, Paul Bert, and others. As yet, it is
true, we are not fully acquainted with the exact measure of
this influence; neither do we know precisely to what extent
it may be utilized therapeutically; but knowing the fact, and
having at hand the appliances necessary for exact observation,
we are on the road to therapeutic discoveries which may prove
to be not only interesting but of immense advantage to the
human race.

That it is a true nerve tonic can not be doubted. It is
daily in use in the treatment-rooms of the Battle Creek Sani-
tarium, and in the great hydriatic institution of Dr. Winter*
nitz, at Kaltenleutgeben, near Vienna, and produces most
excellent results, especially in the treatment of neurasthenics
suffering from chronic toxemia.

Finsen, of Copenhagen, has shown that the actinic ray of
the electric arc is capable of destroying the bacillus of tuber-
culosis in the skin under suitable conditions, and has utilized
it in the successful treatment of hundreds of cases of lupus.
On the occasion of a visit to the ** Light Institute** at
Copenhagen, an institution under the supervision of Professor
F'insen, the author saw demonstrated most clearly the power-
ful therapeutic value of the actinic ray of the electric arc in
the treatment of this disease (Figs. 141, 142, 143). There
were numerous cases nearly cured, photographs of which,
taken when they entered the institution, showed that the
disease had already attained an advanced stage, while the
history showed that these cases had proved wholly intractable
to other methods of treatment. This is well shown by the
accompanying illustrations (Figs. 144, 145). At the time of
the author's visit, there were one hundred and twenty-five
persons under treatment in the institute. A large number of
these were personally seen, and the progress which had been
made under the treatment was remarkable. The author

is awaiting the opportunity to make a trial of this same

46

in the treatment of leprosy, believing that it may bg
of value in dealing with this most obstinate malady,
St in the tubercular form of the disease.

THE SUN BATH, OR INSOLATION (Fig. 146).

nlight is one of the most powerful of all hygienic and
tive agents. As a hygienic measure it is of inestimable
in the destruction of dangerous microbes, the most of
ii are unable to resist the a^Hon of the direct rays of the
or more than a few minutes. Sunlight is thus the most
tant of all disinfecting and sterilizing agencies. The
of sunlight in the maintenaice of health is well shown
dwarfed development or ipid deterioration of plants
ived of its stimulating influence. In caves, mines, and
sr places from which the light is excluded, plants, with
p exception of the fungi, do not grow, or if they do, very
ckly die, never attaining maturity. Animals also are
irfed and sickly under these conditions.
It was long ago noticed that in hospitals a larger percent-
age of recoveries occurred on the sunny side than on the
shady side of the ward. At least a part of the well-known
good effects obtainable from an outdoor life or from sys-
tematic exercise out of doors must be attributed directly to
the influence of the sun's rays.

In taking a sun bath, either the whole or a part of the,
body may be exposed to the direct influence of the solar rsLys,
or some protection may be afforded by a covering of white
cheese-cloth. The bath may be best taken in a room prop-
erly constructed for the purpose. The room should face the
south (in the Northern hemisphere), and the windows should
be sloping. The patient should lie on a cot placed before a
window, the head being protected from the direct rays of
the sun. The length of the exposure will depend upon the
intensity of the sun's rays and the effects sought. If the
light is very intense, or the patient very feeble, the duration
of the bath should not be more than five minutes, if the

THE TECHNIQUE OF HYDROTHERAPY. 723

whole body is exposed; while in less sensitive patients, or •

those accustomed to the sun bath, it may be continued from
twenty minutes to half or three quarters of an hour.

Physiological Effects. — The sun*s rays not only influence
the skin, but pass through the skin into the body, exciting and
stimulating every cell and tissue. The surface circulation
is greatly accelerated, free perspiration occurs, the heart's
action is increased, and the activity of all the vital functions
is promoted. In many cases the patient experiences very
pronounced sensations of languor or drowsiness during the
bath, and not infrequently falls asleep. The effects of the
sun bath are practically identical with those of the electric-
light bath, which has been previously described.

The investigations of Finsen, of Copenhagen, Bert, and
Maklakow, referred to elsewhere (597 to 599), have greatly
broadened our knowledge regarding the physiological effects
and therapeutic properties of light. Sunlight may be prop-
erly regarded as not only a source of radiant energy in the
form of heat, but as a powerful tonic through its actinic rays.
Its calorific, or heating, rays may be isolated by placing a red-
glass screen between the sun and the patient, so that the
actinic rays are filtered out. For tonic effects, the calorific
rays may be separated by employing a blue-glass screen in
like manner. *

Therapeutic Applications — The sun bath is useful in all 1255
cases of mal-nutrition^ anemia, inactivity of the skin^
chronic dyspepsia, most cases of neurasthenia, indigestion,
chlorosis, rheumatism, diabetes, and obesity. The only class
of cases in which the bath is positively contraindicated is that
in which the patient has recently suffered from heat stroke,
and is especially susceptible to the action of the direct rays of
the sun.

The ancients made great use of the sun bath in the treat-
ment of the sick. According to Plutarch, Diogenes, the
renowned Athenian cynic, was in his old age accustomed to
lie in the sunshine for the purpose of recruiting his energies,

724 RATIONAL HYDROTHERAPY.

a Gostotn which, according to Pliny, was common among old
men in Greece, It is stated that Diogenes valued his sun
bath so highly that when called upon by Alexander, who
offered to render him any service in his power, he replied,
'*Only stand a little out of my sunshine./'

According to Pliny, the sun bath was also in very common
use among the Romans. Both the older and the younger
Pliny were accustomed to spend an hour in exposure to the
sun daily after dinner. Hippocrates prescribed the sun
bath (or chills. A noted French physician once said to some
people who had brought their children to him for treatment;
** Take these children to the country; feed them as well as
you can; but above all, roast them — roast them in the sun/'

5u£:s:«stions and Precautions,^ It must be remembered
that some people are so susceptible to the sun's rays that
untoward effects resembling, or identical with, heat stroke,
are very readily produced. On this account it is well tp keep
the patient under careful supervision during the bath, espe-
cially the first applications. If the sun's rays are very
intense, a sheet should be thrown over the patient at the first
application, to avoid the possibility of extreme effects. In
all cases, the exposure of the head must be avoided. The
actinic rays powerfully influence the brain. The author
observed, as a common custom in Egypt, the protection of
the head by a huge red shawl wound about it.

LOCAL OR PARTIAL MYDRIATIC MEASURES.

1256 A very great variety of local or partial hydriatic applica-
tions are in use, each experienced practitioner of hydrother-
apy employing some measures which he has especially devised
or modified to meet his own views or convenience, or in the
adaptation of his resources to his needs. Thus, in the de-
scription of local or localized measures, the author will not
attempt even to mention all possible applications, but only
the leading and typical forms and their principal modifica-
tions. Several new measures, the outgrowth of the authors*

t i

THE TECHNIQUE OF HYDROTHERAPY. 725

personal experience, are presented, but only such as have
borne the test of actual use and have proved their efficiency.

In a strict sense, all hydriatic applications are local or
partial in character, since the most general measures, as a
rain douche, an immersion or a vapor bath, act directly only
upon the skin, thus immediately influencing only a small por-
tion of the blood-vessels and nerves of the body. As fully
shown elsewhere, however, an application to the entire cuta-
neous surface, though partial in an anatomical sense, becomes
general through reflex action and reaction.

These general applications are often of service for secur-
ing purely local effects, as in the use of the hot bath in acute
nephritis, which relieves the renal congestion by congesting
the skin; the neutral bath to quiet the central nervous sys-
tem; the wet-sheet rub to relieve cerebral congestion.

On the other hand, local or partial applications, while g:en-
erally employed for purely local or localized effects, either at
the seat of application or at some remote part by revulsive or
derivative influence, likewise produce in many instances more
or less decided general effects, as may be noted in the tonic
influence of the running cold foot bath, the general sedative
effects of prolonged cold applications to the head, the restor-
ative and energizing effects of a cold douche to the spine, the
excitant effects of very hot or very cold applications to almost
any portion of the surface, even though the area be very
limited.

The localized effects of partial applications depend upon
a few well-established principles. These have been elsewhere
briefly stated, but may be here recapitulated and extended : —

1. Reflex Relations — Every portion of the cutaneous sur- 1257
face is in special reflex relation with some internal organ or
vascular area. The most important of these reflex relation-
ships are the following (Figs. 147, 148): —

(i) The skin of the scalp, face, and back of the neck
is in reflex relation with the brain. The circulation of the
scalp is also immediately connected with the brain through

i

um of the skull, the vessels of which anastomose
:liose of the scalp and those of the brain.

The skin of the back is reflexly related to the centers
le spinal cord. This is also tme of the entire skin sur*
of the trunk and limbs,

(3) The skin covering the neck is reflexly, through the
d cord, related to the pharynx and the larynx,

(4) The upper dorsal region, the skin of the chest in
and behind, and the inner surface of the thighs, have

'-lal vasomotor reflex relation with the lungs.
^S) That portion of the chest wall overlying the heart
precordia) is especially associated with the heart, — - a
often of priceless service,
flt (6) The skin covering the lower portion of the right chest
reflexly related to the liver.

(7} The skin surface of the lower left chest is associated
th the spleen.

(8) The skin covering the lumbar region is reflexly
associated with the uterus, ovaries, bladder, rectum, kidneys,
and intestines.

(9) The skin covering the lower part of the sternum is
especially associated with the kidneys.

(10) The dorsal spine is associated with the stomach, a
fact which may often be made of great service in the suppres-
sion of nervous vomiting.

(11) The skin of the epigastrium has special relations with
the stomach.

(12) The whole surface of the abdomen, and especially
the umbilical region, is reflexly related to the intestines.

(13) The lower abdomen is associated with the uterus,
bladder, colon, and rectum.

(14) The feet, and to a considerable extent the whole
lower extremities, are associated with the brain, lungs, blad-
der, uterus, ovaries, and bowels.

(15) The skin covering the shoulders and upper portion of
the back and the arms and hands is an area which is
closely associated with both the cerebral and the pulmo-

THE TECHNIQUE OF HYDROTHERAPY. 727

nary circulations, and may be employed in producing most
useful therapeutic effects both by the reflex influence of cold
applications and by the derivative effects induced by hot
applications.

2. Internal Reaction. — The changes induced in internal 1268
parts by applications to the surface, especially by cold appli*
cations, may be not improperly termed internal reaction.
(For full discussion of the phenomena of reaction, see para-
graphs 429-481.) These changes it is desirable sometimes
to suppress or diminish, in other cases to encourage.

In general, it may be said that the more intense the exter-
nal application, the more pronounced will be the internal
reaction. The reaction of cold differs diametrically from the
reaction following a hot application. The reaction following
cold increases all kinds of vital work — heart and vessel work,
brain and nerve work, gland work, respiratory work, tissue
building, oxidation, poison destruction, poison elimination,
heat production. Heat is followed by decrease of vital work.

It is often desirable to lessen the internal reaction to cold.
This may be done in several ways, as follows: —

(i) By applying water of a higher temperature, thus less-
ening the external reaction.

(2) By means of the Scotch douche or other analogous
measures. The greater the extremes of heat and cold, the
greater the internal reaction. By raising the temperature of
the cold application and lowering that of the hot application,
thus lessening the difference between the two extremes, the
intensity of the internal reaction may be diminished.

In the use of the alternate douche (1044), the greater the
number of alternations, the greater the excitation induced.

Internal reaction may be diminished when alternate appli-
cations are employed, hy graduation of the alternations, — in-
creasing the difference between the extremes of heat and cold
with each successive alternation, either by increasing the
temperature of the hot application or lowering that of the cold
application, or by changing both simultaneously.

728 RATIONAL HYDROTHERAPY.

(3) The graduated Ifaih, either immersion or douche,
lessens internal reaction and especially thermic reaction by the
avoidance of an abrupt change of temperature. The zero of
the temperature sense is gradually lowered by beginning the
bath at a temperature near that of the body (98^ to 100^ F,),
and gradually cooling to 90^ during a period of from 30 to
60 seconds. The sensory impression made is thus greatly
attenuated,

(4) By applying tefi>r£ the local application a general cold
bath of some sort^ the external and internal reactions may
be generalized, and thus the local effect will be attenuated.
The general application may be either a general douche or
some form of nonpercutient application, as a wet-sheet pack
(1179), a wet-sheet rub (1216), an affusion (1103), or gen-
eral friction J either moist or dry,

(5) We may precede the local application by the general
Scotch douche, the intensity of which may be graduated in any
one of the several ways elsewhere pointed out (pp. 457, 459-
461),

(6) We may f^liaw the local application with a general
douche or other cold application whereby general external
and internal reaction may be produced.

1269 3. Reflex Action. — A cold application to the surface
causes at first a brief contraction of the vessels in the
internally related viscus as well as in the skin. This con-
traction is normally followed by reaction in both the skin
and the internal parts. For the production of reflex effects
the douche is the most powerful measure (1070 to 1103), but
various other means may be employed, as the following : —
(i) Local cold affusion.

(2) Hot and cold affusion.

(3) Cold foot bath for 10 to 20 seconds, the water very
cold and not more than one fourth of an inch deep.

(4) Alternate foot bath.

(5) Cold sponging.

(6) Cold compress.

THE TECHNIQUE OF HYDROTHERAPY. 729

(7) Ice rubbing.

(8) Fomentation followed by ice rubbing.

(9) Fomentation followed by an ice compress for a few
seconds.

(10) Hot sponge bath followed by ice- water sponging.

(11) Vapor douche followed by cold affusion, ice rub, or
ice compress.

The reflex effects resulting from localized hydriatic appli-
cations differ in both intensity and quality, according to
the duration and temperature of the application.

4. Fluxion. — By the term fluxion is meant the movement 1260
of blood. There are four modifications of blood movement
to be considered : —

(i) Increasing the rate of movement of blood through an
organ.

(2) Diminishing the rate of movement of blood through a
part.

(3) Increasing the volume of blood in a part containing too
little blood (anemia).

(4) Diminishing the volume of blood in a part containing
too much blood (congestion, or hyperemia).

In the preceding paragraphs the rationale of increased-
rate of blood movement resulting from reflex hydriatic appli-
cations (1257) has been explained, as has also the produc-
tion of passive congestion for derivative effects (1261) It
remains to consider more fully the rationale of the production
of changes in the volume of blood by hydriatic means not
acting reflexly.

When a cold application is made to the whole surface of
the body, all the internal organs are thereby congested —
after the first momentary contraction of their vessels has
passed away — by the mechanical displacement of blood from
the skin inward, or retrostasis. During the first instant after
the general cold application, while the internal vessels are con-
tracted, the surplus blood, chased out of the systemic circu-
lation, finds temporary refuge, so to speak, in the veins and

73^ RATIONAL HYDROTHERAPY.

the portal reservoir, from which, in the later moments, it is
distributed among the internal org^ans. When the cold appli-
cation is partial, however, this general retrostasis of blood
does not occur except to a very limited extent, a very different
readjustment of the blood distribution taking place. For
example, if cold is applied to the lower part of the body,
the blood-vessels, both external and internal, contract, and
the blood is driven out of the lower extremities, pelvis, and
lower abdomen. At the same time, the vessels of the head,
chest, and arms are dilated, and the volume of blood in these
parts is increased. The reverse is equally true. The
umbiUcus is the dividing line in this compensatory action. If
cold is applied to one foot' or hand, the effect is not, hov^'ever^
as might be supposed, to increase the volume of blood in the
other hand or foot, but to decrease it, as shown by Brown-
Sequard, through reflex action, A cold compress or a per*
cussion douche over the spine does not produce general inter-
nal congestion to any marked degree, but causes contraction
of the spinal vessels, which by reaction is followed by active
congestion if the application is short and intense, and so pro-
duces a powerful tonic effect through exciting the spinal
centers.

By means of hot applications, effects the opposite to those
following cold are produced. The dilatation of the vessels of
the legs following hot applications to these parts produces
congestion of the vessels of the lower part of the body and
anemia of the upper parts.

By the application of this principle, it is possible to com-
bat either anemia or congestion of the brain, lungs, uterus, or
other important vital parts. It should be said, however, that
the principle is more often and more conveniently applicable
to congestions and anemias of the upper parts of the body
than to similar conditions of the lower parts, for the reason
that intense congestion or anemia of the brain and lungs can
not be induced with the same degree of safety with which we
may congest the legs or lessen the blood supply of these parts.

1

i

THE TECHNIQUE OF HYDROTHERAPY. 73 1

Collateral Anemia and Hyperemia. — Where all the parts 1281
concerned are supplied by a common arterial trunk, recip-
rocal changes in the volume of blood occur between the
superficial and the deeper parts. This relation exists between
any muscle, joint, or bone and the overlying cutaneous area.
It also exists between the overlying skin and the following
organs : The brain, the spinal cord, the eyes, the ears, the
serous lining of the pleural and peritoneal cavities, the lungs,
the kidneys, the uterus and ovaries in woman, the testicles
and prostate in man. This relation between the skin and the
uterus, ovaries, kidneys, bladder, and lungs is less intimate
than between the muscles and joints; but clinical results as
well as anatomical considerations indicate that such a rela-
tion really does exist, though more remote, and it is even
possible to trace a very distinct and direct anatomical connec-
tion between the blood-vessels of the liver, stomach, intes-
tines, spleen, and pancreas, and the contiguous superficial
parts (1270 to 1276).

If, in illustration of this principle, we apply a cold com-
press over a fleshy part, as the front of the thigh, the result
will be the production of pronounced anemia of the skin
and a corresponding hyperemia gf the underlying quadriceps
extensor femoris muscle. If, on the other hand, a hot com-
press or fomentation be applied instead, the result will be the
diversion of blood to the skin and the production of anemia
of the muscle (Figs. 149, 150, 151).

It is by the application of this principle that we are able
to combat inflammation, congestion, and pain in muscles
and other deep parts which are directly connected with the
skin through a common blood supply. By diverting blood
into the skin by means of a fomentation or other hot applica-
tion, the congested or inflamed muscle, nerve, 'or joint may
be relieved.

In not a few instances, the collaterally related parts are
not contiguous. The relation of the blood-vessels rather
than the simple contiguity of the parts should be considered.

732 RATIONAL HVDROTHERAPY,

Many examples' of this might be given. The cutaneous^
vessels of the arms are collaterally related with the brain
circulation through the vertebral branches of the subclavian;
with the lungs through the superior intercostals; the legs and
hips with the head by diverting blood into the abdominal
aorta and its branches; the legs with the pelvic viscera by
diverting blood into the external branch of the iliac.

The most powerful effects possible arc obtained by
measures which combine the principle of induced hyperemia
of collaterally related parts with that of reflex stimulation of
the controlling vasomotor centers. Fortunately, the cutane-
ous areas which may be utilized (or these respective purposes
are often distinct, so that there is no anatomical obstacle in
the way of their simultaneous employment These relations
are indicated in Figs, 152-155. Examples; The fomentation
to the back of the chest with the cold compress tu the JroTit;
a hot foot bath combined with a cold hypogastric compress.

Venous or passive hyperemia may likewise be induced as a
means of draining collateral vascular areas. The means to
be employed are the fomentation at a moderately high tem-
perature (104^ to 120°), and the protected heating compress
applied without change until the desired effect has been
obtained. Venous congestion is produced in connection with
the arterial hyperemia resulting from a hot application. It
may also be induced simultaneously with arterial hyperemia,
by operating upon distinct areas (1291).

The portal system constitutes a most important arrange-
ment for modifying the volume of blood in the systemic sys-
tem. It is capable of holding all the blood in the body, and
having no valves, there is easy fluxion in and out through the
four gateways by which it communicates with the systemic
veins (1277).

By means of induced collateral arterial hyperemia the
arteries of a part are drained, the blood supply is lessened,
and tension lowered. By induced venous hyperemia the
veins of the part interested are drained, and the movement of

■%

If

.:;.:?•

I.
i

It'

THE TECHNIQUE OF HYDROTHERAPY. 733

blood through the part is accelerated by lessening resistance.
An inflamed part does not need less blood, but less tension,
and especially the rapid removal of toxins, CO 2, and disabled
leucocytes, and an abundant and constant supply of fresh and
pure serum, oxygen, and active leucocytes.

In active visceral congestion, as in the flrst stage of an
inflammation, collateral arterial hyperemia is especially indi-
cated. In passive congestion, collateral venous hyperemia is
especially useful, but the best effects will be obtained by the
simultaneous application of these two procedures 1291).

Induced venous hyperemia may render most valuable
service in many cases by association with cold compresses
applied to another cutaneous area which is reflexly associated
with the actively congested internal organ under consideration.

Cutaneous Areas which may be Utilized lor Derivative 1882
Effects. — The anatomical arrangements whereby derivative
effects in favor of various internal parts may be produced by
hydriatic measures are scarcely less elaborate and interesting
than those by which reflex effects upon both blood and nerve
supply are secured. The following are only a few of the
more important and clearly established collateral relation-
ships whereby useful derivative effects in favor of important
vital organs may be induced through the application of heat
(1286) or combined heat and cold (1290), the skin surfaces
named indicating the areas to which the application is to be
made, and the blood-vessels the channels through which the
fluxion takes place (heat produces hyperemia of the skin, and
collateral anemia of the deep structures which are vascularly
related thereto, while cold applications to the same surfaces
induce anemia of the skin and hyperemia of the deep-lying
parts) (Figs. 150, 151): —

The Brain. — The scalp, through the direct vascular con-
nection between the cutaneous vessels and the vessels of the
dura mater; the skin of the face, by diverting the blood into
the cutaneous branches of the external carotid. This method
is rarely practical, however, as the bones of the skull and

734 RATIONAL HYDROTflERAPY.

face are so good conductors that the brain is quickly heated
by a hot application, and thas the desired derivative effect
is lost The most practical method of lessening the blood
supply of the brain is by means of alternate compresses or the
reflex influence of cold applications. Hot applications must
be brief.

Short hot applications to the back of the neck may divert
blood from the cerebral branches of the vertebral arteries into
the cervical, influencing especially the cerebellum.

Hot applications to the hands and arms may diminish
cerebral congestion by diverting blood from the vertebral
arteries, which are branches of the subclavian. If made very
hot, favorable reflex effects will also be produced during the
first moments of the application.

Warm applications about the neck, even warm wrappings,
congest the brain by inducing dilatation of the carotid and
vertebral arteries (cold produces the opposite effect [307].
Prolonged warm applications to the back of the neck congest
the brain^ as the vertebral arteries give off few cutaneous
branches, so that their dilatation by prolonged warmth results
in an increased supply of blood to the brain.

The direct connections between the venous sinuses of the
brain and the cutaneous veins of the scalp afford opportunity
for the relief of passive congestion of the brain by dilating
the cutaneous veins, and thus enlarging the channels leading
to the heart. The anatomical arrangements whereby the
blood entering the cranium may be conveyed back to the
heart through the cutaneous veins of the head are numerous
and highly interesting. According to Woolsey,* the following
relations exist : -

** {a) The longitudinal sinus communicates with the tem-
poral veins through 'one or both parietal foramina when pres-
ent, and, in the child, with the veins of the nose through the
foramen cecum.

♦"Text-book of Anatomy by American Authors." Gerrish.

THE TECHNIQUE OF HYDROTHERAPY. 735

* {b) The lateral sinus is connected with the occipital (or
posterior auricular) vein through the mastoid foramen (the
largest and most constant emissary), and sometimes with the
vertebral vein through the posterior condylar foramen.

••(r)The cavernous sinus communicates with the ptery-
goid plexus through the foramen of Vesalius and the foramen
ovale, as well as through the inferior ophthalmic vein; 'with
the pharyngeal plexus through the foramen lacerum medium;
and with the internal jugular vein by the carotid plexus
through the carotid canal.

**(rf) The occipital sinus communicates with the verte-
bral and extraspinal veins through the anterior condylar
foramen.

'' {e) A small vein occasionally passes to the torcular
through a foramen in the occipital bone near the external
occipital protuberance."

By hot or alternate hot and cold applications to the areas
above indicated, any one of the principal sinuses of the brain
may be drained into the veins of the adjacent skin. For
example : —

1. To influence the longitudijial sinus, applications
should be made to the parietal region, that is, the sides of
the head.

2. The lateral sinus may be drained by applications to
the back part of the head, especially the areas just behind
the ears.

3. The cavernous sinus may be drained by applications
over the ear, face, and side of the neck.

4. Blood may be diverted from the occipital sinus by
applications to the back of the neck.

Applications made to the back of the neck influence espe-
cially the cerebellum, dilating the vertebral and the posterior
jugular veins.

Applications to the side of the head and neck drain the
brain through the internal jugular.
• The Spine. — The skin of the back may be used to drain 1263

736 RATIONAL HYDROTHBRAFY.

the spinal cord, through the dorsal branches of the aortic
intercostals, which nourish the cord.

The dorsi-spinal veins, the superficial veins of the back,
form a plexus which connects with the vertebral veins of the
neck, with the intercostal in the dorsal r^on, the lumbar and
sacral veins lower down. The dense plexuses formed by
these veins in the skin and especially about the spinous proc-
esses, form a capacious reservoir into which the blood may be
diverted from the venous plexuses which occupy the spinal
canal (meningo-rachidian) with which they are connected by
anastomosing branches passing through the intervertebral
foramina and joining the vertebral, intercostal, lumbar, and
sacral veins.

The veins of the spinal cord itself join the vertebral veins
at the base of the skull. Applications intended to influence
the blood supply of the vertebrae or structures connected with
them should be applied the whole length of the spinal col-
umn. Applications directed toward the envelopes of the
spinal cord should extend from the base of the brain to about
the middle of the lumbar region. Applications intended to
influence the spinal cord itself may cover the entire spinal
area, but care must be taken to give particular attention to
the extreme upper portion, including the lower and back part
of the scalp.

1264 T/ie Eyeball, — The skin of the eyelids and forehead
drain the eyeball, by dilating the supra-orbital branch of the
ophthalmic, a branch of the internal carotid.

1265 The Middle Ear, — The whole side of the head and face,
diverting blood from the internal carotid and internal max-
illary. If the hot compress extends below the jaw, the com-
mon carotid will be dilated. An ice-bag below the jaw with
the fomentation increases its effect by contracting the carotid.

1266 The Internal Ear. — Receiving its blood supply from the
vertebral artery, a branch of the subclavian, the internal ear
is not influenced by heat over the ear, but may be relieved
when congested by warm applications to the arms and cold

THE TECHNIQUE OF HYDROTHERAPY. 737

applications to the head and the back of the neck» thus
diverting the blood into the arms from the vertebral arteries
while at the same time contracting the vertebral arteries by a
proximal cold compress or an ice-bag to the back of the neck.

The Nasal Cavity, — The face and sides of the head, 1247
diverting the blood from the internal carotid and the internal
maxillary.

The Pharynx, — The whole face, diverting blood from the 1268
internal maxillary and the ascending pharyngeal.

The Larynx, — The skin of the neck overlying the larynx, 1269
and the arms, diverting the blood from the internal branches
of the carotid and the subclavian into their external branches
(the superior and inferior thyroids). The arms and back,
and the sides of the upper chest may also be utilized. Chill-
ing of the arms and shoulders should be avoided.

The Lungs, — The aim is to influence the bronchial arter- 1270
ies, the nutrient vessels of the lungs. The collaterally related
cutaneous surfaces are: —

1 . The anterior chest wall from the clavicle to the umbili-
cus, influencing especially the pleura (also the pericardium)
through the cutaneous branches of the internal mammary.

2. The pleura of the posterior chest wall, through the
cutaneous branches of the aortic intercostals.

3. The arms, through the diversion of blood from the
superior intercostal, a branch of the subclavian, influencing
especially the pleura of the upper part of the chest. Induced
hyperemia of the arms also relieves congestion of the pleura
of the anterior wall of the chest by diverting blood from the
internal mammary, a branch of the subclavian.

4. A direct relation exists between the bronchial arteries
and the skin of the right chest, through the fact that the right
bronchial arteries arise from the aortic intercostals. The
relation between the left bronchial arteries and the skin cir-
culation» is less direct; hence the importance of making
applications to the whole chest in the hydriatic treatment of
pneumonia, though one lung only may be affected. It is

47

738 RATIONAL HYDROTHERAPY.

especially important that the application should be made to
the back of the chest.

It is interesting to recall the fact of the connection of the
bronchial arteries with the pulmonary capillary plexus and
veins, whereby arterial blood passing through the lungs may
return at once to the left heart without entering the systemic
venous system, and without visiting the right side of the heart,
forming thus a sort of second pulmonary circuit, very small,
but possibly very useful in many conditions for carrying on
oxygenation of the blood independently of the pulmonary
circulation proper.

5. Through the free anastomosis of the tracheal branches
of the inferior thyroid and the bronchial arteries, the nutrient
vessels of the lungs may be influenced by applications made
to the front part of the neck. Cold applications made to this
region will tend strongly to concentrate the blood in the lungs.
By warm or alternate warm and cold applications the blood
may be diverted from the lungs by facilitating the movement
of blood through the collateral circulations, and passive con-
gestion may be relieved.

6. The veins which return the blood from the nutritive
arteries (bronchial) of the lungs empty on the right side
into the azygos vein; on the left side either into the superior
intercostal or the azygos vein. The intercostal veins are thus
on both sides so connected with the bronchial veins that
when dilated by hot or alternate applications the blood stream
through the lungs may be accelerated, thus relieving passive
congestion, a condition which constantly exists in pneumonia
after the first stage, and in cardiac disease accompanied by
dyspnea due to deficient compensation. Applications to be
efficacious for this purpose must cover the whole thoracic cage,
and especially the back and sides, as the intercostal vessels
with which the bronchial arteries are associated are chiefly
distributed to these portions of the chest. An appreciation
of these anatomical relations is sufficient to impress the neces-
sity for maintaining active circulation of the skin in pneu-

THE TECHNIQUE OF HYDROTHERAPY. 739

monia, and allowing opportunity for complete reaction to
take place at short intervals when cold applications are
made. If continuous cold applications are made to the front
of the chest, care must be taken to maintain warmth, and to
prevent collateral pulmonary congestion by applying heat
behind.

The Kidneys, — The loins, through the renal branches of 1271
the lumbar arteries.

The Bladder, the Uterus and Adnexa^ and the Prostate, 1272
— The sacrum, buttocks, perineum, external genitals, inner
surface of thighs, groins, suprapubic region, through the
sacral, gluteal, obturator, sciatic, inferior hemorrhoidal, super-
ficial perineal, deep circumflex iliac, and deep epigastric
arteries, derived from the internal iliac.

The Rectum, — The anal region and the perineum, through 1278
the inferior hemorrhoidal, superficial perineal, and other
branches of the internal pudic.

The Stomach, — The arterial circulation of the stomach 1274
may be influenced through the free anastomosis of the gastric
artery with the esophageal arteries, which in turn anastomose
with the inferior thyroid, a branch of the subclavian. An
arterial connection also exists between the vessels of the
stomach and of the internal mammary, through the phrenic
artery. The venous circulation of the stomach is connected
with the skin through anastomosis of the gastric with the
esophageal veins, which empty into the right azygos vein.
The last-named vein also receives the intercostal veins, espe-
cially those draining the skin covering the sides and back of
the chest. Applications intended to influence the arterial cir-
culation of the stomach should be of such size as to cover the
lower third of the sternum, the cartilages of the lower ribs,
and the space between these structures and the umbilicus.
When it is desired to influence the venous circulation, as in
chronic gastritis, cardiac insufficiency, and hepatic cirrhosis,
the applications are made to the back and sides of the chest.

The Liver and Spleen, — The arterial circulation of the 1275

740 RATIONAL HYDROTHESAFT.

liver and spleen may be influenced by the same meBamtk
described in relation to the stomach. The vessels of these
organs are connected with the cntaneoos circalation thcoiv^
the anastomosis of the phrenic arteries (right and left) wiUi
the internal mammary and the intercostals. Passive cooiges-
tion of these organs is seldom of serious importance except
when arising from disturbance^ of the portal ciicalatum.
Applications to relieve general portal congestion (1377) will
relieve hepatic and splenic congestion, since such causes as
tend to concentrate the blood in the portal drculaticm will
influence in like manner the liver and spleen, together with
the other abdominal viscera.

1876 TAe Intestines. — The intestines, especially the doodenom
and the colon, have no vascular connection with the surface
except through the renal circulation. Hot applications to the
lumbar region by lowering the pressure in the lumbar veins
may divert a portion of the blood from the left renal vein with
which the veins from the duodenum and the transverse colon
communicate. Similar applications over the front and lower
portions of the chest exercise a like influence through the con-
nection of the phrenic veins with the left renal vein on the
one hand and the internal mammary on the other. Alternate
applications may relieve the venous circulation of the duode-
num and the colon through diversion of blood from the renal
vein into the veins which accompany the branches of the
renal artery distributed to the suprarenal capsule, the capsule
of the kidney, and the overlying muscles.

1277 T/te Portal Circulation. — The portal veins contain no

valves. This makes it possible for this appendage of the
venous system to render the most valuable service as a blood
reservoir, the capacity of which may be very easily and
quickly varied, thus constituting a regulating or balancing
mechanism whereby the delicate structures of the body are
saved from injuries which they might otherwise suffer from
sudden or excessive increase or diminution of the blood pres-
sure. There is maintained a constant balance between the

THE TECHNIQUE OF HYDROTHERAPY. 74 1

intra-abdominal pressure and the general blood pressure.
Even the volume of gases in the intestines and the tension
of the abdominal muscles influence the blood pressure. The
great splanchnic nerve is, through its control of the portal
circulation, one of the most important factors in the blood-
pressure-controlling mechanism of the body; it especially
influences the cerebral circulation.

The study of the relations of the portal system to the 1278
general venous system and to the blood distribution of the
skin, is exceedingly interesting, and of high practical value.
The blood gathered up by the portal vein from the stomach,
intestines, spleen, pancreas, and gall-bladder, in the main finds
its way back into the general venous system only after it has
passed through a second capillary network in the liver, from
which it is gathered up, and conveyed to the ascending vena
cava by the hepatic veins. There are, however, other chan-
nels well known to anatomists, of great practical value to the
hydriatic practitioner. These are, as pointed out by Todd and
Bowman * many years ago, as follows : —

1. The hemorrhoidal plexus ^ which communicates with
the mesenteric veins on the one hand and the internal iliac
on the other, thus furnishing an outlet for the blood of the
portal circulation at its most dependent part, — an important
safeguard against the development of diseased conditions of
the hemorrhoidal veins.

2. The esophageal veins, which connect the gastric veins
and the vena azygos minor.

3. A direct connection between the left renal vein and the
veins of the duodenum and the colon.

4. A direct connection between the phrenic vein and the
portal system at the surface of the liver (Kiernan).

According to Treves, the eminent English anatomist, the
visceral vessels which anastomose with the parietal or cuta-
neous and muscular vessels are derived from the hepatic, renal,
and suprarenal arteries, and also the vessels supplying the
pancreas, caecum, ascending and descending colon, and the
duodenum. The connecting superficial vessels are derived

♦••Physiological Anatomy," 1850.

RATIONAL HYDROTHERAPV,

from the fArenic, lumbar, Uio-lumbar, lower intercostal,
epigastricp a&d circumflex iliac trunks, Schiff also has]
demonstrated an anastomosis between the portal veins and]
the epigastric veins at the umbilicus.

In a case detailed by Professor Chiene (Journ, Anat.
Phys.p voL 3) the coeliac axis and mesenteric vessels werej
{Miggedy but blood in sufficient amount to supply the visceral

( hUl reached the branches of these arteries through their
fMUdetalcomoiun [cations. The anastomosis gives an anatom-
imli demonstration of the value of local blood-lettings and

' of^ eoimter-irritants in inflammatory afiections of certain of
tiie iviacerai and also a scienti&c basis to the ancient prac-

. tbe of poulticing the loin and the iliac region in nephritis and
iHfiaflamipatson about the cxcum/' (Surgical Applied Anat-
omf, Page 371.)

Theae ioteresting anatomical relations, when understood
^ the hydrtatic physician, place at his disposal most power-
fid means of inBuencing the portal circulation. By warm
or hot applications to the rectum the veins composing thei
hemorrhoidal plexus may be dilated, thus relieving any
abnormal pressure in the portal circulation. By hot applica*
tions (5 to 15 min.) to the anal region, a hot pelvic pack or
a hot sitz bath, followed by a short cold application (30 to 60
sees.), strong fluxion of the portal circulation may be pro-
duced, and passive congestion may be thus relieved.

Chronic portal congestion is best combated by the pro-
longed cool sitz (1508) and the wet girdle (1347). The
temperature o£ the sitz should be 80^ to 70°, the duration 1 5 to
30 minutes. The girdle should be protected by flannel only,
and should be renewed every four hours, or just before it be-
comes dry, so that a tonic effect may be constantly maintained.
These prolonged cold applications cause contraction of the ex-
ternal and internal branches of the iliac arteries, thus lessening
the supply of blood to the iliac veins, and so lowering the jM'es.
sure on the systemic siUe of the hemorrhoidal plexus, and
increasing the outflow of blood from the portal veins. It is

THE TECHNIQUE OF HYDROTHERAPY. 743

thus that the cool sitz a£fords relief in hemorrhoids, in catarrh
of the rectum and colon, and in dysentery and diarrhea.

Cold applications either to the rectum itself or to the skin
will temporarily produce the opposite effect; namely, interfer-
ence with the movement of blood from the portal circulation
into the systemic veins through the hemorrhoidal plexus.
But if the application is short in duration, the reaction fol-
lowing may produce a result similar to that fweduced by waan
or hot applications.

The effect of a prolonged hot application to the abdomi-
nal surface is quite different from that of a short application.
The tone of the mesenteric vessels is constantly governed and
modified by the reflexes sent in from the skin covering the
abdomen. Cold causes contraction of the muscles of the
intestinal walls as well as of the arteries, veins, and lym-
phatics, and even of the abdominal muscles; while heat pro-
duces the opposite effect. It is for this reason that we apply
heat in colic and cold in tympanitis, acute inflammation, and
hyperpepsia or hyperchlorhydria. A short hot application
momentarily dilates the mesenteric vessels, but when it is
removed, the subsequent cooling of the skin restores the
normal tone. Thus passive portal congestion is relieved by
short hot applications (5 to 10 min.), followed by cold (i or
2 min.), through the energetic fluxion induced. For marked
therapeutic effects the application must be renewed at inter-
vals of two or three hours. The compresses may be alter-
nated several times in succession at each application. When
the application is prolonged, the mesenteric vessels lose their
tone, and fill up with blood from the systemic circulation. It
is thus that the prolonged (20 to 60 min.) warm sitz or the
continuous heating abdominal compress or the wet girdle
produces not only hyperemia of the skin, but also filling of the
portal vessels. When this effect is desired, the compress or
girdle must be protected by an impervious covering so as to
secure the maximum amount of heating effect. When flan-
nel alone is employed, the wet compress gradually dries by

744 RATIONAL HYDROTHERAPY.

evaporation, through which means a cooling e£fect is produced
just sufficient to maintain the tone of the mesenteric vessels,
thus producing intense hyperemia of the skin with accelerated
movement of blood, but without overfilling the portal veins.
The means by which the portal circulation may be infla-
enced through the communicating vessels, have already been
described. The hot trunk pack (15 to 20 min.), the sweat-
ing pack, the hot abdominal compress, the wet girdle cov-
ered with flannel only, the short hot sitz, and the Scotch
douche to the spine and abdomen are the most effective
means of draining the portal circulation through the cuta-
neous veins. A short cold application should always follow
the hot application, to restore the tone of the visceral vessels.

1280 The Upper Half of the Body, — Induced hyperemia of the
legs diverts blood from the brain, chest, and pelvis, and by
induced hyperemia of the arms, shoulders, and chest, conges-
tion of the pelvic viscera may be lessened.

The Rationale of Localized Measures. — In the following
paragraphs (1260 to 1291) the practical application of the
foregoing principles is illustrated by means of the compress.

1281 (i) Internal reaction, with dilatation of visceral vessels,
occurs almost instantly after a short cold application, for the
reason that the cause of the reflex vascular spasm (the cold
application) being removed, the heat of the surrounding tis-
sues (100' to 106 ) quickly relaxes the parts. The rhyth-
mical activity of the vessels of the part and the amplitude of
their contractions are increased through the stimulation of
the controlling ganglia. As a result, the supply of blood is
increased, and with this arrive fresh and enlarged supplies of
oxygen, leucocytes, and nutrient material. There is also a
more thorough removal of CO^ and other waste products,
and hence an increase in the normal vital activities of the
part, a higher grade of life, better tissue formation, and in
time a restorative reconstruction in case the tissues of the
organ concerned are in a morbid or diseased condition.

1282 (2) The effect of a prolonged cold application is to cause

THE TECHNIQUE OF HYDROTHERAPY. 745

oontinuous contraction of the vessels of the internally related
part so long as cutaneous sensibility is maintained; but when
the application is so intense or prolonged as to destroy the
sensibility of the skin, the reflex action ceases^, and stimula-
tion of the vasomotor centers no longer exists ; hence, the
vessels of the related internal vascular area relax. Thus
a cold application, if too prolonged or too intense, may defeat
its own purpose, producing an effect the very opposite to that
intended. This interesting fact seems to be little known, or
at least little regarded, if one may judge from the loose way
in which instructions are given for the use of cold applications
to the skin for relief of internal congestions and inflammations.

The reflex stimulation of cold may be maintained by
removing the application for 3 to 5 minutes every 20 to 30
minutes, the parts being well rubbed with warm, dry flannel
in the interim, or heat may be applied for 2 or 3 minutes.

The effect of a prolonged cold application, made in the
manner suggested, is to. lessen the blood supply of an internal
viscus. This may sometimes be desirable, but is certainly far
less often needed than is generally supposed. Injury does
not result so much from the excess of blood in a part as from
stagnation of blood. The blood is the chief healing agency
in the body. It can not be too often reiterated — it is the
blood that heals. Hence the aim should be to increase the
supply of fresh blood to a part by encouraging the movement
of blood through it, rather than to lessen the volume or the
activity of the blood current.

While a cold application causes contraction of the vessels
of the related viscus, the contraction of the cutaneous vessels
may tend to fill the vessels of the part, if there exists collat-
eral relation of the cutaneous and visceral vessels involved.
The actual effect produced will depend upon the relative
activity of the two forces. Care must be taken to arrange
the compress in such a way as to avoid antagonistic effects of
this sort. For example : In making cold applications to
relieve cerebral congestion, the cold application should include

746 RATIONAL HYDROTHERAPY.

the neck, so as to cause contraction of the main supplying
trunks, thus preventinfj the collateral hyperemia of the brain,
which may be induced by cold applications to the face
alone.

In certain cases the effect of cold applications may be to
increase internal congestion to such a degree as to make this
the dominant effect, thus constituting a contraindication. A
^ood illustration of this is seen in the case ot the eye. A cold
compress contracts the supraorbital artery, thus increasing
the blood supply of the eyeball to which a collateral branch
is distributed. For this reason the fomentation rather than
the cold compress is indicated in inflammation of the eyebalL
But the application must not be so prolonged as to heat the
eyeball itself, thus dilating its vessels. In most cases inflam-
mation of the lids is better relieved by short, very hot applk-^M
cations than by prolonged cold compresses. If cold corD*^H
presses are used, they should be very small, not larger "than
the eye socket, and care should be taken that they do not
extend above the brow,

1383 (3) Th^ proximal cold compress controls local bl

supply by contracting the supplying arterial trunk. This
procedure is of special value in the treatment of congestion
of the head, a cold compress, an ice-collar, or an ice-bag
being applied to the neck. An ice-bag to the back of the
neck contracts the vertebral arteries; cold applied to the sides
or front contracts the carotids. The proximal compress is
of greatest value when associated with heat applied deriva-
tively, as in the treatment of cerebral congestion or inflam-
mation, or inflammation of the pharynx, nasal cavity, or
middle or internal ear (1327).

1284 (4) If the cold application is permitted to accumulate heat
sufficiently to allow partial reaction to occur, being renewed
only at intervals of 10 to 40 minutes, or when it has become
warm, a still different effect is produced. At the first appli-
cation of the cold, the blood-vessels are made to contract,
thus forcing out of the diseased organ the accumulated and

loodVf

THE TECHNIQUE OF HYDROTHERAPY. 747

poison-laden blood. The lymph vessels share in the con-
traction, and likewise the muscular elements of the capsule
and other structures. Thus the organ is well squeezed, so to
speak, as one might compress a wet sponge in the hand.
The germ-laden leucocytes are sent on their way to the spleen
or other parts for repair or destruction, while a new supply of
these most valiant and important body defenders is later
brought into the part. As the compress warms up, internal
as well as external reaction takes place, the vessels dilate,
their rhythmical pumping is stimulated, and thus the introduc-
tion of a fresh and vital supply of blood is effected. By this
means, leucocytosis is encouraged, and the supply of fresh
leucocytes is constantly renewed, just as a wise general con-
tinually brings against the enemy fresh relays of soldiers,
retiring those who are worn out by the combat, in order to
maintain a vigorous fight.

From the foregoing it will be seen that the frequently re-
newed heating compress has characteristic properties which
commend it for use in specific inflammations of deeply seated
parts, as in pneumonia, typhoid fever, hepatitis, gastritis, pel-
vic and other internal inflammations.

It may be further remarked in relation to this form of par-
tial application, that by permitting sufficient reaction to main--
tain an active ciitajicous circulation^ an excellent derivative
effect is produced, the value of which is often overlooked.

(5) By alternate hot and cold applications to a limited 1285
cutaneous area, a most active fluxion of blood through an
associated internal part may be produced ; and this effect
may be many times repeated, by reason of the constant
renewal of the sensibility of the skin surface by hot appli-
cations, thus maintaining a high degree of reflex activity.
The frequent change from heat to cold (every 15 sees.) power-
fully excites the nerve centers in charge of the parts, and thus
the nerve supply; hence, this form of application is contrain-
dicated by pain or acute inflammation.

Each application of cold causes instant contraction of

748 RATIONAL HYDROTHERAPY.

the associated visceral vessels; each application of heat in-
stantly restores the normal temperature of the skin, and
terminates the reflex effect of the cold. Thus the organ is
alternately emptied and filled, much as a sponge may be
squeezed and filled, and this may be accomplished almost as
rapidly as the compresses can be applied, and may be con-
tinued indefinitely, — a veritable pumping process by which
blood may be passed through any internal organ, a genuine
vasomotor gymnastics, applicable to a multitude of acute and
chronic conditions.

On the other hand, an application so capable of exciting
both vascular and nervous activity is especially adapted to
cases of passive congestion, chronic exudates, and atonic and
indolent states, such as malarial enlargement of the liver and
spleen, rheumatic joints, serous and fibrinous exudates in the
chest, muscles, or joints.

1286 (^) ^^U /'^^ applications produce internal vascular effects
somewhat similar to those of cold applications; but the con-
traction is briefer in duration, and occurs only when the
application is sufTiciently hot to cause pain, and to induce
contraction of the cutaneous vessels. The contraction of
the cutaneous vessels quickly gives way to dilatation, espe-
cially of the veins, because of the direct influence of the heat
upon the sympathetic ganglia of the small vessels; but the
stimulation of the vasomotor centers continues as long as the
temperature of the application is sufficiently high to excite
pain, and thus the influence upon the reflcxly related parts
may be much more prolonged. It must be remembered,
moreover, that the application of heat to large surfaces, or
over the heart, has the effect to excite the action of the
heart, which is usually undesirable. The arterial trunks are
also dilated, an effect often desirable and indicated, but which
must sometimes be avoided. Hot applications for purely
local effects should be not larger than necessary, and the
duration must be carefully regulated.

1287 (7) A ican)L or ;/i7//;7// compress is soothing in its effects.

THE TECHNIQUE OF HYDROTHERAPY. 749

This fact is due to the shutting off from the internal related
viscus of all external stimuli. It is by these stimuli, chiefly
thermic in character, that the vascular tone and functional
activity of internal parts is maintained. These vital conditions
are, at least in very great measure, dependent upon the fusil-
lade of sensory impressions constantly playing upon the spinal
and cerebral centers. When these impressions become too
intense, or the nerve centers abnormally sensitive, the phe-
nomena of irritation appear — pain, spasm, hyperesthesia, etc.
Neutral applications protect the skin against external irritants.
This explains the soothing effect of the poultice. It mdst be
remembered, however, that a warm compress, when applied
across an arterial trunk, has the effect to dilate the vessel,
and thus to increase the volume of blood flowing into the
parts supplied by it. Hence the fulness in the head and the
discomfort resulting from too warm clothing of the neck.

(8) Moderately hot applications generally produce con- 1288
gestion of the associated vascular areas. It is in this way

that a warm hip or foot bath encourages the menstrual flow,
and the heating abdominal compress fills the portal circula-
tion with blood, and thus relieves the brain. The fomenta-
tion (1328) and the heating compress (1344) are the most
important partial measures for accumulating or concentrating
blood in parts in which such an effect is desirable either to
combat a local anemia or to produce a derivative effect in
favor of some remote or associated part, though many other
procedures are of great service in special cases.

(9) By means of the prolonged heating compress it is pos- 1289
sible permanently to increase the volume of blood in a part,

thus lessening the volume of blood in some collaterally related
area. For example, the prolonged heating abdominal com-
press not only distends the cutaneous vessels, but also the
portal circulation, thus drawing away from the brain or lungs
a considerable amount of blood, and relieving an existing
congestion, either active or passive. (a) When the effect
desired is increased volume of blood in a given part, for the

7 so RATIONAL HYDROTHERAPV.

purpose of producing anemia in some proximate or remote
part, the wet towel should be protected not only by Bannel,
but also by rubber cloth or other impervious material. The
purpose is to retain as much heat as possible, so as to secure
the fullest dilatation of the cutaneous vessels, {d) When it
is desired to increase the movement of blood in a reflexly
related part, while at the same time combating stagnation or
passive congestion, a compress covered only with flannel
should be employed, so that by the limited but constant
evaporation taking place, there may be maintained an aciive
congestion of the skin and related parts, with derivative
effect, and at the same time a vigorous Huxion in the reflexly
related viscus, and a stimulation or energizing of the nerve
supply of the part, and of all those vital activities whereby
disease processes are opposed and the integrity of the body
conserved,
1390 (lo) The hot and cold compress (13S6) produces remark*
able eSects by combining derivative and reflex efiects. For
example, {a) a fomentation to the upper back diverts blood
from the bronchial vessels, while cold simultaneously applied J
to the front of the chest contracts the same vessels by reflex
influence, thus intensifying the effect (1270); {b) Cold over
the sternum with a fomentation over the lumbar r^on
relieves congestion of the kidneys in the same way, by divert-
ing blood into the cutaneous branches of the lumbar arteries
while contracting the renal vessels (1271); {c) The pelvic
circulation is controlled by a cold bag over the hypogastrium
in conjunction with a hot pelvic pack (1272); (rf) To relieve
congestion of the liver, stomach, spleen, or pancreas, the
application may be reversed, the heat being applied to the
anterior surface and the cold application behind; or if pain is
not present, the compress may be applied to the whole
trunk, thus acting derivatively upon the whole portal system,
while an ice-bag is placed over the stomach to contract the
gastric vessels, and thus combat congestion, which is likely to
be the cause of the pain; or for distension of the stomach

THE TECHNIQUE OF HYDROTHERAPY. 75 1

with gas, a frequent accompaniment of hyperpepsia or hyper-
chlorbydria, which depends upon the escape of gas from the
blood rather than upon fermentation (1275); (e) The intes-
tines are most strongly influenced by the cold compress to
the umbilical region combined with the fomentation over the
lumbar region.

(i i) The /lot and cold pack (1365) consists in a hot bag or 1291
coil combined with a heating compress or partial pack. The
action differs from that of the hot and cold compress in that
the principal action is a remarkable derivative effect through
drainage of the arteries of the affected part by the passive
hyperemia induced by the heating compress, while at thf
same time blood is diverted from the veins by the dilatation,
of the collaterally related vessels by means of the hot bag.

The hot and cold pack very strongly influences both the
arteries and the veins. It is, perhaps, our most powerful
derivative procedure, its effects being almost wholly deriva-
tive in character, while the hot and cold compress concerns
chiefly the arteries, which it influences both reflexly and
derivatively.

Special Indications and Precautions Respectins: Localized 1292
Applications. — Great care must always be employed in the
application of douches or affusions to the head, (i) A short
cold application excites the brain, and may be used in melan-
cholia and cerebral anemia, and in sunstroke with pallor.
The prolonged cold douche to the head is one of the most
powerful of all depressing agencies. Unless very short, the
depression may be too great; hence the cold affusion is better.

(2) Hot and warm as well as cold applications to the head
must be managed with great care, and should be at first
employed in a tentative manner, carefully noting effects.

(3) A cold or very hot douche to the back of the neck
stimulates the respiratory centers. If too cold or too pro-
longed, suffocation or arrest of the heart may result. The
very hot or very cold compress, alternate compresses, or

752 RATIONAL HYDROTHERAPY.

sponging are milder measures which produce similar effects,
and are in general to be preferred.

(4) A short tepid douche to the head or a tepid affusion
will allay excitement. It may be usefully employed in insom-
nia, maniacal excitement, and cerebral irritation. The tem-
perature should be from 80^ to 92° for 3 to 5 minutes; a
slightly higher temperature causes congestion. Affusion is to
be preferred to the douche. In the application of water to
the head, percussion should always be avoided.

(5) Hot affusions to the head are useful in syncope and
collapse, and in cases of migraine with low arterial tension,
but should be employed with great precaution. In cases of
cerebral anemia, alternate .applications may be employed
instead of the short cold douche, or hot or cold compresses
may be applied. In syncope, especially when the condition
is prolonged, hot or alternate hot and cold compresses or
affusions should be applied to the head and face.

(6) Long cold applications to the head are usually exceed-
ingly depressing, but may be used in fever, in cerebral con-
gestion, and in sunstroke with congestion of the skin.

(7) The affusion, the ice-compress, and the evaporating
compress are usually more convenient for application to the
head than the douche, and safer, because less likely to be
overdone.

(8) Hot applications must not be indefinitely continued.
By degrees the beneficial effect often disappears. The ves-
sels of the deeper-lyinf^ parts fill up from the anastomosing
vessels and from heating of the deeper parts of the vessels,
and consequent dilatation of the vessels, so that the advan-
tage at first gained is after a time lost, and thus the deriv-
ative or revulsive influence of the heat in dilating the
surface vessels is effaced. To renew the effect, however,
it is only necessary to make a short cold application, with-
drawing the heat for the purpose. The cold application
must be very intense (40'' to 60 ~^), and the duration must
be brief (10 to 60 sees.), just long enough to contract the sur-

THE TECHNIQUE OF HYDROTHERAPY. 753

face vessels, sending the blood on into the veins, and thus
making room for another diversion of blood from the deep
parts through the application of heat. The cold application
also serves a most useful purpose in causing reflex contrac-
tion of the vessels of the deeper parts, thus aiding in the
production of the desired anemia, which is increased and
maintained by the succeeding hot application.

(9) As a corollary from the above principles, it appears
that, in general, partial cold applications should rarely be abso-
lutely continuous, but should either be allowed to accumu-
late heat sufficiently to permit slight reaction, or should be
interrupted by a short hot application at intervals, or by brisk
rubbing of the skin. Continuous cold is indicated only in
cases of superficial inflammation at the very onset of the
morbid process, and then must not be so intense as to sus-
pend tissue activity, which condition is indicated by numbness
of the parts when induced by cold.

(loj Hot applications likewise, when long applied, must
be interrupted at intervals of 1 5 to 30 minutes by a very short
cold application.

THE COLD FOOT BATH (Fig. i56).

The cold foot bath (45° to 55^, i to 5 min.) though less 1293
useful than the hot foot bath, is of gieat service in producing
retiex, revulsive, and other effects. The sole of the foot is
one of the most important vasomotor areas in the body, hav-
ing very direct connection with the nerve centers which control
the circulation of the pelvic and abdominal viscera.

The brain circulation may also be influenced by stimulation
of the rich vasomotor nerve supply of the plantar region, a
fact of practical interest in cases of cerebral congestion.

Method. — The water at proper temperature should be placed

in a small tub adapted to the purpose, to a depth of three

or four inches. The feet, previously warmed, are immersed

in the tub for i to 5 minutes. Friction should be applied to

48

754 RATIONAL HYDROTHERAPY,

the feet continuously during the bath, either by the hands of
the attendant or by the patient's rubbing one foot against the
other in alternation.

Physiological Effects. — Among the most interesting effects
of the cold foot bath are the vasomotor and other reflex
effects set up in the pelvic viscera, causing contraction of the
vessels and muscles of the uterus (in women) and the organs
connected with it. The blood-vessels of the brain, the stomach,
the liver, the bladder, and the intestines, are made to con-
tract at the same time. Intestinal peristalsis and contraction
of the bladder are also excited. To obtain the most pro-
nounced effects, the temperature must be very low (45° to 50°).
The duration will vary with the effect desired.
1294 Therapeutic Applications. — The revulsive effects of the
cold foot bath are very decided, and continue for a long time
— much longer than those obtained from a hot foot bath or
similar applications. As a derivative and revulsive application,
the short cold foot bath is useful in cerebral congestion and
uterhie hemorrhage. For these purposes, however, the
application must be very short (20 to 60 sees.), as it is the
primary effect alone that is desirable. In cases in which
the feet are constantly cold, and in persistent sweating of the
feet, the rubbing cold foot bath is a most useful measure,
making the feet glow with circulatory reaction (50^ to 60^,
I to 3 min.). It must be repeated daily.

The prolonged cool foot bath (60^ to 70'^) may sometimes
be employed as an antiphlogistic measure in cases of injury
to the feet, such as sprains, strains^ inflamed bunions^ and
similar conditions. The feet must be well warmed before the
application is made, by walking, running, rubbing, or by heat.

Contraindications. — The cold foot bath must generally be
avoided in cases of cystitis, pelvic cellulitis, salpingitis, and
in all forms of pelvic and abdominal congestion and inflam-
mation, as peritonitis, prostatitis, proctitis, and in hepatic^
uterine, renal, and intestinal congestions. In these cases
the very hot foot or leg bath should be employed (i 15^ to 125^).

1

THE TECHNIQUE OF HYDROTHERAPY. 755

THE SHALLOW FOOT BATH.

The shallow foot bath is a variety of the cold foot bath 1296
in which the amount of water employed is small, barely suffi-
cient to cover the toes. After being held in the bath for
one-half minute, one foot is taken out and rubbed for half a
minute and returned, then the other is treated in Uke manner,
this being continued until the whole surface is well reddened
with strong circulatory reaction. Lastly the feet are wiped
dry and thoroughly rubbed with the dry hand. The soles are
vigorously percussed. The water should be very cold, or at
a temperature of 45° to 55°. The shallow foot bath gives
rise to powerful reflex effects upon the pelvic viscera, causing
contraction of the vessels, and thus relieving uterine conges-
tion. The intestines and even the brain are also influenced.

Therapeutic Applications. — The shallow foot bath pro-
duces powerful reaction effects to the feet, and is thus of
great service in chronic cases of cold and sweating feet. Its
applications are the same as those of the ordinary cold foot
bath, only differing in being somewhat more intense.

THE RUNNING OR FLOWING FOOT BATH.

This bath is a modification of the shallow foot bath, in 1296
which, through the constant change of water by means of
suitable arrangements, the initial temperature is mafntained.
Water from a natural source, at as low a temperature as can
be obtained, is commonly employed. The outlet should be
so placed that the water can not accumulate to a depth
greater than one-half inch. Circulatory reaction is pro-
moted by the movement of the water in contact with the feet,
and constant alternate rubbing of the feet one upon the
other. The purpose of the flow of water is to maintain a
uniform and low temperature, while at the same time reac-
tion is promoted by the incomplete submergence of the feet
and constant friction. The sole of one foot is rubbed against
the dorsum of the other for 10 to 15 seconds, then the feet

756

RATIONAL IIYnROTIIERAPV.

are reversed; and thus each foot is treiited. The bath is pro-
longed until the toes are reddened by reaction.

Therapeutic Applications. — This bath is indicated in all
cases in which the ordinary cold foot bath may be used
(1294), and is more effective. It is a powerful derivative
measure, and a highly valuable remedy in cases of An^/V-
ually cold ft^et from vasomotor spasm of the extremities. The
remedial effect in these cases is obtained not alone !>y
means of the very decided hyperemia induced in the vessels
of the feet and legs, but by reflex influence upon the sympa-
thetic centers, especially the lumbar i^anglia* Incidentally,
cerebral congestion is relieved both by reflex spasm of the
meningeal vessels during the bath, and by the diversion of
blood to the lower extremities through the reaction following.

This bath is of special value in the management of ne-uras-
tlienics suffering from cold extremities and cerebral conges*
lion, producing an excellent general tonic effect.

In cases of insomma due to cold feet, it is well to precede
the application by a hot foot bath (i lO^ to 1 1 5^, 2 to 5 min. ).

When the hands as well as the feet are cold^ a rubbing
cold hand bath may be taken at the same time with the foot
bath, rubbing the hands together in very cold water.

The flowing foot bath, preceded by the hot foot bath or
the hot leg pack, may be advantageously used half an hour
after eating in cases of hyperpcpsia with cold extremities

Contraindications. — The flowing foot bath should be
avoided in catarrh of the bladder, irritable rectum and blad-
der ^ and other forms of pelvic inflammation. It is also con-
traindicated in ovarian neuralgia^ neuralgia of the bladder^
sciatica^ and rhetimatic affections of the toes and ankles.

THE HOT FOOT BATH.

1297 The requisites are a suitable receptacle for the feet, and
a supply of very hot water, with cold water for tempering.

Method. — The temperature required for positive effects
is 104° to 122°. The bath should begin at a temperature

''•^- •--^**^

THE TECHNIQUE OF HYDROTHERAPY. 757

of 102° to 104^, and should be gradually increased until by
the end of two or three minutes a maximum temperature of
1 1 5^ to 1 22° is reached. The duration may be from 5 minutes
to half an hour. The feet should be completely immersed in
the water; the effect may be intensified by increasing the
depth of the water.

After the very hot foot bath, the feet should receive a dash
of cold water, — affusion, jet, or spray, — to produce the true
revulsive effect by suddenly cooling the skin and encouraging
tonic circulatory reaction.

Physiological Effects. — Bergesio has shown that the hot
foot bath produces in a diminutive way precisely the same
effects as the general hot bath. At first the pulse is slowed
and the brain congested, but after three or four minutes the
pulse rate is increased, and the brain becomes anemic, this
condition persisting for some time after the bath is terminated.
Shokovsky showed that the foot bath at 108° to 115^ for 20
minutes caused elevation of the temperature in the external
auditory canal amounting to one degree Fahrenheit. The
rectal temperature at the same i'lmQ fell to the same extent.
Arterial tension was increased 8 mm.*

Therapeutic Applications- — This bath is more commonly
used, perhaps, than any other, as a derivative measure. At
a temperature of 103^ to 1 10^ the hot foot bath is an exceed-
ingly useful means of balancing the circulation, by the dilata-
tion of the blood-vessels of the legs relieving congestion
of the brain and other organs in the upper half of the body.

Very hot (115' to 125°) as well as cold applications to
the feet stimulate the involuntary muscles of the uterus, in-
testines, bladder, and other pelvic and abdominal viscera.
i^eat may be used at first in cases in which cold is not well
tolerated. The dilatation of the blood-vessels produced in
the feet by this application extends to the upper parts of the
limbs, and even to the vessels of the pelvic viscera. This is
shown by the vigorous pulsation of the femoral artery after

*\Vratsch, Lyon MiUiical, 18S3, page 541.

75B

RATIONAL HYDROTHERAPY.

a hot foot bath. By vaginal examination it may be readily
noted tliat the pulsation of the pelvic vessels is greatly in-
creased in vigor, indicating ^a heightened vascular activity.
By this means the uterus and ovaries receive an increased
supply of blood, which renders the foot bath a useful measure
for restoring the function of menstruation when suspended.

The very hot foot bath is exceedingly useful in cases of
sprain of the ankle joint. Anesthesia of the plantar region
and ueuralg-ia of the foot and gout are relieved by the very
hot foot bath. The application should be made two or three
times a day, and continued for 20 to 30 minutes each time.

The hot foot bath is also of very great service as a means
of relieving or preventing a cold resulting from accidental
chill mg ol the feet, if applied soon after exposure.

The prolonged warm or hot foot bath (98 ^ to io6'^) dilates
the vessels of the feet^ and produces collateral anemia of the
pel vid viscera. A short, very hot foot bath (iio"^ to 120^,
5 min.) produces the same effect. The hot foot bath (104^
to uo^) accompanies the cold sitz,

THE ALTERNATE FOOT BATH.

1298 In the employment of the alternate foot bath, the feet are
placed in hot water for 2 or 3 minutes, then in cold water for
20 seconds to i minute. They are then returned to the hot
water for 2 minutes, then replaced in the cold water, this
operation being repeated a number of times. The alternate
foot bath is a more highly excitant measure than the cold
foot bath. It is especially useful in chilblains, in local as-
phyxia, in habitual coldness of the feet, and for sweating
feet.

THE LEO BATH.

1299 This bath (Fig. 157) is essentially the same as the foot
bath, with the exception that a deeper tub is used, with a
larger amount of water. Any desired temperature may be
employed.

THE TECHNigUE OF HYDROTHERAPY. 7S9

The leg bath is a powerful derivative measure, and may
be used in cases which do not readily yield to the employ-
ment of the foot bath. It is especially serviceable in the
treatment of insomnia^ pulmonary congestion^ dysmenorrhea^
suppression of menstruation, hyperpepsia, ovarian congestion^
and pelvic pain from other causes. In all the above-men-
tioned conditions the warm or very hot leg bath is employed.
Low temperatures are rarely called for with this procedure.

The contraindications for the cold leg bath are the same
as for the cold foot bath.

THE ARM BATH.

Immersion of the arm in water (Fig. 158) is frequently 1800
a useful measure, especially in suigical cases. In cases of
felons, sprains, and various other injuries to hands and arms,
antiphlogistic effects may be obtained in this way. Chronic
ulcers and some forms of chronic skin disease, and especially
btirns of the arms, may be successfully treated by prolonged
immersion. The temperature in cases in which deeply
seated inflammatory conditions are present should be 92^ to
97^, or neutral. A cold bath under such conditions will be
followed by reaction with increase of congestion and pain.
A long hot bath will cause local elevation of temperature and
increased fulness of vessels, and will likewise increase the
local pain and intensify the morbid process. A neutral
temperature, preferably as near 92° as possible, especially if
prolonged for several hours, lessens pain, lowers local tem-
perature, diminishes congestion, and thus favors resolution.
A short hot arm bath relieves pain by producing hyperemia of
the skin and collateral anemia of deep inflamed parts.
Superficial pains or inflammations require neutral applications.

The Elbow Bath (Fig. 1 59) is a modification of the arm 1801
bath which is best suited to the treatment of inflamma-
tory affections of the hand. Immersion of the elbow in cold
water lowers the temperature of the hand more efficiently
than does cold immersion of the hand itself. This interest-

760 RATIONAL HYDROTHERAPY.

ing fact, first discovered by Priessnit2, is dependent npon the
principle that an application of cold across the trunk of an
artery contracts the artery and all its distal branches (Exp.
63). The same results may be obtained by a cold compress
about the arm.

THB HAND BATH.

1802 Immersion of the hands in very cold water exercises a
powerful influence — much greater than might be expected —
upon the cerebral and pulmonary vessels. Vasilieff showed
(1885) that immersion of the hands in cold water for a suffi-
cient length of time is capable of slowing the pulse and the
respiration, lowering the temperature in the external anditofy
canal, lessening the pressure in the cerebral arteries, and nar-
xowing the veins of the retina. The hot hand bath produces
opposite phenomena. These observations explain the efitect
of the cold hand bath in controlling epistaxis. Holding a
block of ice in the hand is an excellent means of checking
nosebleed, and in the author's hands has proved of service in
pulmonary hemorrhage, checking the bleeding very quickly
even when other measures seemed to be unsuccessful.

Brown-Sequard and others demonstrated long ago the
powerful reflex influence of immersion of the hands in hot or
cold water, observing that the immersion of one hand in cold
water caused a lowering of temperature in the other hand,
while placing one hand in hot water produced an elevation of
temperature in the other hand.*

THE PARTIAL CONTINUOUS BATH.

1303 This bath, flrst introduced by Langenbeck,t consists in
the continuous immersion of a limb in water at a neutral
temperature. Laiigenbeck resorted to its use as a method
of treating surgical wounds, and reported many hundreds
of cases dressed by this method. The results claimed

• Archives tie PhysiologU, v. 3, pp. 497-50*-
\ Deutsche Klinik, 1855. No. 39, pp. 409-4"9-

THE TECHNigUE OF HYDEOTHERAPY,

761

by him were as follows; (i) Lessening of pain from the
wound; (2) lessening of fever; (3) lessened secretion or sup-
puration; (4) accelerated healing process. Many leading
German and French surgeons adopted this method of deal-
ing with surgical wounds; and had it not been fur the wonder-
ful discovery of Lister, the partial immersion bath might have
remained for a long time the moat successful method of
dressing surgical wounds. Figures 160 and 161 show the
ingenious devices of Langenbeck for the practical and con-
venient employment of this bath. Duplicates of these were
used by Dr, Frank Hamilton in his practice in Bellevue
Hospital. Dr. Hamilton certainly deserves credit for his
earnest advocacy of the immersion treatment of wounds
at a time when amputation was the almost inevitable result
in cases of badly contused injuries of the limbs. While the
author was a student under Dr. Hamilton in Bellevue Hos-
pital in 1874, numerous grave cases were successfully treated
by this method in the hospital wards.

The author had the pleasure of listening tu a heated dis-
cussion upon the utility of the method, which occurred at the
Academy of Medicine 10 the winter of 1874-75, D^- Hamilton
defending the immersion treatment, while Dr. James Wood
and others as vigorously denounced what they chose to
denominate the ''maceration method,*' The antiseptic
treatment of wounds and injuries has since rendered this
method of comparatively little value, but circuinstances still
occasionally arise in which it may be utilized to advantage, as
in the treatment of senile gangrene, severe burns, painful or
lacerated wounds, and in the absence of antiseptic dressings.

THE SITZ BATH.

The sitz bath (Fig* 162) is one of the oldest and most 1304
serviceable of hydriatic procedures.

Method — ^The tub may be of metal, porcelain, or wood*
It is usually of such form and size that the patient may be
comfortably seated in it by leaving the feet outside and

762 RATIONAL HYDROTHERAPY.

flexing the limbs, the feet being placed in a separate and
smaller tub during the application. The flexion of the limbs
in a sitz bath is, however, to some degree objectionable, as
it interferes somewhat with the circulation; and on this
account the author is much inclined to exchange the sitz bath
for the half-bath (1174) in dealing with a large class of
cases. The temperature of the sitz bath may be cold, cool,
neutral, tepid, hot, or very hot. There are also the mbbing
sitz, the flowing sitz, and the revulsive sitz.

The sitz bath may be made to serve the purpose of a gen-
eral bath by rubbing the body during the bath with the hands
or with a towel wet in water of the same temperature.
THE COLD SITZ BATH.
1305 In this procedure, either still or running water may be
employed, according to the effect desired.

The temperature of the cold sitz bath is 55^ to 65°. A
lower temperature is seldom required. The time should be
I to 1 5 minutes. The duration of the cool or the tepid sitz
may be considerably longer (70° to 80°, 10 to 15 min., with
rubbing; 88 ■ to 92°, one-half hour to several hours).

In a cold sitz bath the patient should always be rubbed
sufficiently to prevent chilling, and care should be taken that
the feet are kept warm, either by the hot foot bath or by hot
bags, or flannels wrung out of hot water and placed about the
feet and legs. The limbs should be so adjusted that there
will be no pressure upon the popliteal space, as this will inter-
rupt the circulation in the feet, and interfere with the results
of the bath. If necessary, the foot bath may be elevated a
little, or the edge of the sitz bath may be covered with a
thickly folded flannel to prevent compression of the vessels.

In the flowing sit:: bath, cold water is admitted to the
tub at such a rate that the temperature may be maintained
at the initial point, the surplus water being allowed to flow
out through an opening properly placed.

The bath may be administered two or three times a day
with advantage in some cases, but the practice of using the

I

1

I?

''T

l'

.i.

t\

f

THE TECHNIQUE OF HYDROTHERAPY. 763

bath five or six times a day, which prevails at some hydro-
pathic establishments, is not to be recommended.

Physiological Effects. — In the sitz bath an impression is 1306
made upon the cutaneous areas which are reflexly connected
with the viscera of the pelvis and also those of the lower part
of the abdomen; namely, the lumbar region, the hypogas-
tric region, the outer and inner surfaces of the thighs, the per-
ineum, and the external genitals. The physiological effects
depend, as in other baths, upon the temperature, the dura-
tion, and sometimes the mechanical effects combined with
the thermic impressions.

The cold sitz bath produces a profound effect upon all the
bodily functions. The general effects are those which per-
tain to the application of cold water, such as lessened activity
of the skin, goose-flesh, contraction of the cutaneous vessels,
slowing of the pulse, increased arterial tension, lowering of
the temperature of the parts immersed, and if the bath is
short, a powerful reaction in the parts brought in contact
with the water and reflexly related parts.

A short cold sitz (30 sees, to 2 min.) produces active
dilatation of the vessels of the lower abdomen, increasing the
movement of blood through these parts. The thermic reac-
tion produced, heightens the nutritive processes in the parts
concerned, and excites contraction of the muscular structures
of the viscera, thus influencing the bladder, pelvic organs, and
the structures involved in the acts of defecation and urina-
tion, together with the various musculo-ligamentous structures
which support the abdominal and pelvic viscera. During
the first moments of the bath, the cold sitz produces in-
creased activity of the heart and a temporary rise of the blood
pressure.

Therapeutic Applications. — Short applications (70*^ to 1307
50 , 5 to 8 min.) produce tonic effects. Prolonged applica-
tions may be sedative. The bath is most frequently employed
for fluxion effects upon the pelvic viscera. The cool sitz bath
is derivative when continued for 15 to 20 minutes, or long

764 RATIONAL HYDROTHERAPY.

enough to cause very decided dilatation of the snrf ace
sels. The special advantage of the bath depends opon the
persistence of this dilatation, which fixes a large quantity of
blood in the skin. Contraction of the internal vessds pro-
duced at the same time by the irritation of cold, aids in estab-
lishing a condition of relative anemia in the internal parts.

The cold sitz may be advantageously applied in cases of
iaundice after the hot enema or in alternation with the sweat*
ing process. It stimulates the outflow of bile by strongly
increasing the tension of the portal circulation.

The cold sitz bath Is an excellent derivative measure for
patients who are moderately vigorous, and who suffer from
congestion of the brain^ or from hepatic or splenic conges-
tions or chronic enlargement from malarial poisonings or
other chronic conditions of like character. This measure is
especially useful in atonic and paretic conditions of the genito-
urinary organs, and in the nocturnal urinary incontinence
of young children. In chronic uterine affections accom-
panied by a relaxed condition of the vessels, ligaments, and
muscles, this measure is invaluable (70° to 80°, 10 to 15
min.). It is equally valuable in chronic congestion of the
prostate, gleet, in the atonic forms of seminal weakness,
and in constipation and atony of the bladder in both sexes.

Contraindications. — The cold sitz must not be prescribed
in cases of acute inflammation of the pelvic or abdominal
viscera, in painful affections of the bladder or genital organs,
in sciatica, nor in cases of acute pulmonary congestion.

THE PROLONGED COLD SITZ BATH.

1308 The sitz bath at 60° to 70° for 15 to 40 minutes causes
prolonged contraction of the vessels of the pelvic and abdom-
inal viscera, thus making it a most effectual measure in com-
bating chronic congestions or so-called chronic inflammations.
A hot foot bath must be giVen simultaneously.

In many cases a temperature of 75° to 80° (usually about
75^) is preferable to a lower temperature, especially for

THE TECHNIQUE OF HYDROTHERAPY. 765

patients who have not been accustomed to cold water, and in
whom a lower temperature produces pain or other unfavor-
able excitation, due to the intense internal reaction. The
bath may be continued in cases of passive pelvic congestion
for 30 to 40 minutes with excellent effects. In some cases it
is desirable to begin the bath at a temperature of 85° to 90°,
lowering it, after the first few minutes, to 75^. The duration
of the bath should ordinarily be 15 to 20 minutes. For
chronic congestion, a bath at 65^ to 75*^ affords most satis-
factory results. The cold must always be accompanied by
the hot foot bath (104^ to 110°).

Physiological Effects. — The prolonged cold sitz causes
very pronounced effects upon the pelvic circulation. The
contraction of the cutaneous branches of the internal iliac
tends to produce hyperemia of the pelvic viscera, while the
reflex effect is to contract the pelvic vessels. If the parts are
rubbed so as to maintain strong surface circulation, the bal-
ance of effect will be to decongest the pelvic viscera. With-
out friction, the internal parts will be congested. This may
be obviated by the simultaneous hot foot bath, which drains
the iliac vessels through the femoral artery, while the reflex
from the skin contracts the visceral vessels, affording a most
beautiful example of the advantage of simultaneous hot and
cold applications. The temperature of the foot bath should
not exceed 1 10^. A higher temperature may dilate the pelvic
vessels.

Therapeutic Applications. — The prolonged cool sitz affords
excellent results in chronic menorrhagia when not due to
vegetations of the endometrium. It should be used in con-
nection with other measures of treatment. A Russian ob-
server finds the prolonged cold sitz following the hot vaginal
douche the most effective means of relieving pelvic congestion.
Winternitz recommends the prolonged cold sitz after the wet-
sheet rub as the most effective of all measures for the relief
of chronic diarrhea. Both these observations the author is
able to confirm by many clinical examples.

766 RATIONAL HYDROTHBKAPT.

The cold sitz bath is also indicated in kem&rrhagte 0/ ike
bladder^ intestines^ uterus^ urethra^ and rectum^ in kemar^
rkoids^ ckronic inflammation of tke prostate^ ckranit metritis^
circum-uterine inflammation^ and in most chronic inflamma-
tions of the pelvic viscera when pain is not a prominent
symptom. The hot foot bath should be administered simul-
taneously. The pelvic vesseb are thus drained of Uood while
they are at the same time reflexly contracted.

* The revulsive sitz is a very short cold sitx, simply a dip
into cold water for a few seconds, following a very hot vku
(115^ to 120^), of 3 to 8 minutes' duraticm. It is a most
powerful sedative measure in painful affections of the pelvic
viscera. It may be very advantageously emplciyed in cases
of ovarian or uterine neuralgia^ enteralgiay and in pednfid
affections of the bladder^ rectum^ and prostate.

The cold sitz, accompanied by rubbing of the whole sor-
face with cold water, is a powerful means of stininlating
cerebral activity. Wintemitz has shown by plethysmognqihic
observations that the cold sitz increases the volume of the
arm. This is accomplished through the contraction of the
mesenteric vessels, which, with the spleen, constitute a sort
of flexible reservoir into which the blood may escape from
other portions of the body, and from which, by various means,
it may be driven back again into the general circulation.
The cold enema and the cold abdominal douche are the only
other measures capable of acting in so direct a manner as
the cold sitz upon this great reservoir of the blood. An
eminent London preacher, Mr. Joseph Parker, has a small
bath-room fitted up in the rear of his pulpit, in which he
habitually takes a cold sitz just before appearing before his
audience. He testifies that the effect of this application upon
his cerebral activities is most remarkable, and asserts that if
he can have his cold sitz bath, he feels able to command
any audience that can be gathered before him.

Contraindications. — On account of the considerable in-
crease of blood pressure at the beginning of the bath, the cold

THE TECHNIQUE OF HYDROTHERAPY.

767

sitz is always contraindicated in cases in which suddenly
increased arterial pressure is likely to prove detrimentaL On
this account it must be avoided in most affections of the
heart* It is also contraindicated in all acute inflammations
involving the viscera of the abdomen or pelvis, as in cystiiis^
prostatitis, metritis^ Qvaritis^ entcriiis, colitis, appendicitis,
pcrit&nitis, salpingitis, and so-called r^//ii/iWi; in affections
of the bladder^ uterus, and intestines attended by muscular
spasm; in vaginismus ; in enteralgia^ lumb^-abdaminal neu-
ralgia, neuralgia of the ovaries, bladder, testicles; in eac
cygod^nia and sciatica; and in most pain/til affections of
the gcni to-urinary organs. The cold bath in any form must
be avoided in spi^rmatorrhea accompanied by hyperesthesia
of the prostatic urethra, or frequent losses; the cold sitz is
especially harmfuL In many cases in which the cold bath
is contraindicated, a sitz bath at 8 5*^ ^ , gradually cooled to
75^, may, however, be employed with benefit The length
of. the bith when employed in this manner should be 15
to 20 minutes.

THE COLD RUBBINQ SITZ BATH (Rg* 163).

The patient's head having been properly cooled and pro-
tected by a wet towel, he steps into the hot foot bath, and
then seats himself in the sit^ bath. The attendant at once
begins a vigorous rubbing of the hips, back, and thighs*
The rubbing should continue during the entire bath, the
patient rubbing the abdomen and thighs while the attendant
rubs his back and sides (duration 3 to 4 min.p temperature
65" to 55"). Friction mitts maybe employed to facilitate
reaction in persons very susceptible to cold and who do not
react well. At the end of the bath it is well to administer
the Scotch douche to the hips and legs. When this is not
available, a douche at a temperature ten degrees below that
of the bath may be applied over the hips and feet (20 sees.).

Physiological Effects.— The effect of this bath is to pro-
dace decided thermic and mechanical impressions upon the

1309

768 RATIONAL HYDROTHERAPY.

reflex areas associated with the viscera of the pelvis and
lower abdomen. A most powerful and lasting circalatoiy
reaction is produced in the surface vessels, which defrfetes
the circulation of the associated internal areas by collateral
influence, producing a strong revulsive effect.

Therapeutic Appiicatloiis. — ^The cold rubbing sitjs is a pow-
erfully tonic measure, influencing especially the genito-orinary
oiffans, and is applicable to all atonic conditions. It is one
of the best of all measures for the relief of constipation^
and of atony of the bladder accompanied by incontinence or
retention of the urine, when pain and active inflammation are
not present. It is an excellent procedure in cases of subin-
volution of the uterus and adnexa in women, and enttroptosis
in both sexes, especially when the abdominal muscles are
greatly relaxed; in nocturnal enuresis of children ; in impotence
in men, sterility in. women; and in cases of uterine and
ovarian displacement^ in conjuction with other appropriate
measures of treatment.

This measure may be used with advantage in certain
cases of insomnia, being repeated two or three times during
the night if necessary. Usually two or three hours of good
sleep will be obtained after each application. It is also valu-
able in constipation with apepsia or hypopepsia, and in dila-
tation of the stomach and colon. It may be employed in
delayed labor, cold water being poured upon the spine while
the patient is in the bath.

In certain cases in which the rubbing sitz is indicated, so
great intolerance to cold water exists that the patient must be
very carefully trained for some time before a vigorous appli-
cation can be made; in such cases the bath may be given at
80^ to 85^, being lowered one or two degrees daily until a
really effective cold bath may be administered. When the
higher temperatures are employed, the duration of the bath
may be prolonged with advantage to 6 or 8 minutes.
1310 Contraindications. — This bath is not admissible in cases
of acute inflammation and congestion, and in painful or spas-

THE TECHNIQUE OF HYDROTHERAPY,

769

modie affections of the pelvic and abdominal viscera^ as neu-
ralgia of the ovaries or tesHcles, tenesmus of the bladder or
rectum, and tfaginismus^ It may be added, however^ that
the cold rubbing sit^ is of high value in cases of ovarian neu-
ralgia and other painful non-inflammatory affections of the
pelvis, if made of short duration (one-half minute to a min-
ute), and preceded by a hot pelvic pack or a hot sitz bath for
10 or 15 minutes. When employed in this way, it serves to
fix in the skin, so to speak, the blood which has been brought
to it by the preceding hot application, and thus intensifies
and prolongs the analgesic effect.

THE VERY MOT SITZ BATH,

Temperature, 106*^ to 120^; duration, 3 to 10 minutes. 1311

It is well to begin with a temperature of loo'^ rapidly add-
ing hot water until the maximum temperature is reached,
A hot foot bath is taken with it (do^- to 120'').

Physiological Effects — The general effects are essen-
tially the same as those of the hot immersion bath (1126).
The cutaneous branches of the external iliac are widely
dilated, diverting blood from the internal viscera. The hot
foot bathj by dilatmg the branches of the external iliac, still
further drains the portal circulation. At tempemtures above
110°, especially if the bath is continued beyond three or four
minutes, the effect is to excite the pelvic circulation, and to
concentrate the blood in this portion of the body.

Therapeutic Applications — The hot sitz is of great service
in restoring the menstrual function when suspended as the
result of general chill or other cause. The shallow, very hot
sitz is an excellent measure in relieving the pain of intlamed
hemorr holds. It is likewise of great value in vaginismus^
spasm of the neck of the bladder, anal tenesmus, in uterine
colic ^ in nepkritic colic, in sciatica, lumbo-abdominal neural'
gia, neuralgia of the ovaries, iesticles^ and bladder, and in all
painful affections of a non-inflammatory character, involving
the viscera of the pelvis and lower abdomen. The hot sitz

49

RATIONAL HYDROTilERAPV.

s a most powerful analgesic measure. For the best

it should be followed by a short cold application.

cases in which this bath is employed for the relief of

visceral congestion, great care must be exercised to

le surface of the body gradual iy, so as to restore the

the vessels without producing a general and sudden

ction of the surface vessels, whereby the good eEfccts

□ bath may be immediately destroyed (aflusion or spray,

5 min. ; or 40°, 5 to lO sees.). The slightest chilly sen-

n following the batl
'in pleasant symptoms '
::ation.
1311 }v ri. most useful form of

termed the n-vuisive siiz.
temperature being rapidly 1
patient remains in the bath
carefully protected by a cold ^d
the neck. As the patient
of cold water is dashed upon
a tonic reaction, and fix in the

accompanied by a return of
L have been removed by the

\ bath is what the author has
bath begins at 100^^ F., the
id to 115^ or i2o\ The
} 8 minutes, the head being
press upon the head or about
s from the bath, a pailful
the hips, so as to produce
skin the blood with which it
has been well filled by the hot bath. There is no better
analgesic measure than this for the various neuralgias and
hyperesthesias of the genito-urinary organs to which women,
and occasionally also men, suffer most persistently, and often
without any substantial relief.

THE NEUTRAL SIT2 BATH.

1313 The character of this bath is essentially the same as that'
of the neutral full bath. It is simply a circumscribed neutral
bath. The temperature is 92° to 97°; the duration maybe
from' 1 5 minutes to an hour or two.

Physiological Effects. — The effects are those of a limited
neutral bath. No decided thermic or circulatory reaction is
produced by it, and as a consequence it exercises a pro-
nounced calmative effect upon the viscera of the pelvis and
lower abdomen.

4

■

THE TECHNIQUE OF HYDROTHERAPY.

771

Therapeutic Applications.— The neutral sitz balh is an
exceedingly usefal means of relieving nertious irritabiliiy and
congesiicn of the/r/i'iV viscera. It is of great service in the
treatment of painful and inflammatory affections of the
geni to- urinary organs in both men and women, in pruritis of
the vulva and anus, in stranguiatcd hcmorrfmds^ friqueni
urination from irritability of the bladder, spermatorrhea
arising from excessive irritabiUty of the gen tto- urinary center,
" — frequent losses, — neuralgia of the spermatic cord and
testicles^ and in cases of enter&ptasis accompanied by extreme
hyperesthesia of the lumbar ganglia of the abdominal sympa-
thetic, also in chronic backache from rectal and uterine dis-
orders or enteroptosisy and coccygadynia.

The neutral sitz bath is highly antiphlogistic in character,
and may be employed in subacute and even acute inflam
matory conditions, such as acute catarrh of the bladder and
urethra, and in subacute inflammations of the uterus, Qvaries^
and tubes. This bath is especially useful as a means of relief
in neuralgia of the Fallopian tubes or of the testicles, in vagin-
tsmuSt pruritis of the anus and vulva, vesical and rectal
tenesmus, hyperesthesia of the tumbo-aoriic plexus, and in
hyperesthesias of the genito-urinary organs. It is indicated
as a sedative means in erotomania in both sexes, m priapism^
and in cases of spermatorrhea accompanied by a marked
hyperesthesia of the urethra and ejaculatory ducts, and in
all cases of pelvic disease in which cold applications are inad-
missible on account of pain or the inflammatory condititms
which may be present.

THE COMPRESS.

This is simply the application of water at any temperature
by means of a cloth, a sponge, spongiopyline, or other siitta-
bte medium. More than a century ago Benjamin Rush used
a compress of clay with excellent results. The ordinary old-
fashioned poultice is a compress, but inconvenient and
uncleanly. For ordinary purposes, a linen cloth of two to

1313

772

RATIOKAL HYDROTHERAPY,

I

1314

r

four thicknesses and of proper size, or cheese-cloth doubled
four to eight thicknesses^ renders the best service. If the
compress is to be greatly prolonged, a rubber bag filled
with water at the proper temperature, or a rubber coil
through which water at a suitable temperature ts continu-
ally passed, may be applied over the compress so as to main-
tain the desired temperature. In addition to the compress,
there may be needed a piece of flannel for covering, also
in some cases, oilcloth, mackintosh, or rubber cloth, and a
Turkish sheet and towel for drying the parts at the con-
elusion of the treatment.

Compresses may be classified according to their tempera-
ture, as: (r) verj co/d {^S^ or less); (2) coo i or Cffa/ing- (60 to
70°); (3) 7varm or neutral (92*^ to 98°); (4) fwi (102^ to
1 10'^); (5) very hot (iio^ to i6o^); (6) alternate (very hot
and very cold in alternation); (7) revulsive (short cold foUow-
ing prolonged very hot); (8) hot and cald (simultaneous); (9)
kat and cold pack ; (10) heating or stimulating (applied cold,
more or less protected, and prolonged until warmed by the
body heat); (11) tY\e proximal compress ; (12) the irrigating
compress.

These several forms of the compress produce effects so
characteristic as to demand particular consideration of each
as a special procedure,

THE VERY COLD COMPRESS.

This application may consist of folded cloths saturated
with ice-water, and changed every 4 or 5 minutes, or the low
temperature may be maintained by bits of ice placed between
the folds of the compress. Other methods consist in the usf,
of the ice cap (Fig, 164), the rubber or aluminum adl
(Fig. 165)^ or a specially constructed rubber sac (Fig. 166)*
through which a stream of water at a low temperature is
made to flow continuously, a rubber bag filled with broken
ice (Fig. 167), or a rubber sack containing a cooling mi^+tn-^

When ice or very cold water can not be obtatat
many tropical countries, a very satisfactory substit f

■•i

[ ::

- k

n

rf

THE TECHNIQUE OF HYDROTHERAPY.

773

be found in ammonium nitrate. This chemical substance has
the property of absorbing an enormous amount of heat In
passing from the solid to the liquid state. By adding to a
quart of water eight ounces of nitrate of ammonium, a tem-
perature of 41^' was secured, the initial temperature of the
water being 70^^ and the temperature of the room in which
the experiment was made being 70^ F.

A very intense degree of cold may be obtained by means
of carbonic acid gas condensed in the form of snow, known
as the **COa compress/* For this purpose a flannel bag is
used^ filled with absorbent cotton, A short pipe leading from
the reservoir containing the liquid carbonic acid gas is passed
into the middle of the bag, and the liquid gas is then allowed
to escape. The rapid evaporation quickly fills the bag with
a white snowy mass which has a temperature of — So''' F.
When the bag is filled, it may be slipped inside a sack
made of thin mackintosh*

The cold of the carbonic acid gas compress is exceedingly
intense and penetrating, In certain cases the author believes
this compress has advantages which are not possessed by any
other application or any other mode of utiliiing cold* In
application, the skin should be protected by flannel placed
between it and the bag. This precaution is also necessary
in most cases in the use of the ice-bag.

Schult^e has shown* by numerous experiments that the
deep tissues may be cooled by applications of ice to the
cutaneous surface, contrary to the conclusions drawn by some
other observers. According to his observations, the tempera*
ture of the tissues half a centimeter (one fifth of an inch)
below the surface was found to have fallen i8'^ F. ; at a
depth of two centimeters {four fifths of an inch), the lowering
of temperature was 3.6^ F. j and at a depth of seven centi-
meters, nearly three inches^ there was still a lowering of
temperature amounting to nearly one-half degree. A ther-

• JoEroy, «»TKesc d' Aggregation," Pwis, 1878, p. 176.

r

RATIONAL HVDEOTHERAPy

ter applied to the internal surface of the chest in a case
>racentesis showed a diminution of temperature of

iy 7^ F. A clinical thermometer placed against the
surface of the cheek while ice was pressed against the

M. surface showed a diminution of more tlian fourteen
ucgxees in temperature. A thermometer placed in the vagina
indicated a fall of nearly one and one-half degrees, as the

lit of an application to the hypogastrium of a large

ider filled with ice ''^-n. 64, 65, 66, 67).

Physiological Effects — se depend upon the length of

application and the pari which it is applied. A shorty
coid compress has the :t to produce a primary con-
traction, followed by dilatation of the surface vessels and of
the visceral vascular area in reflex relation therewith. By
means of such an application, it is possible to influence the
circulation in an internal viscus^ to awaken vital activity, to
relieve passive congestion, to encourage leucocytosis, and tu
increase vital resistance, as in pneumonia. The ice^watcr
compress produces more powerful cooling effects than ice or
the ice-bag, as the skin is more easily wet.

Prolonged very cold applications cause spasm of the sur-
face vessels, together with contraction of the vessels of the
reflexly related internal part, and hyperemia of collaterally
related vessels.

Continuous very cold applications lower vital action, and
may even suspend all vital activity in the parts cooled. The
surface becomes blue from excessive absorption of oxygen from
the slowed blood stream in the veins. The nerve ends are
benumbed, and reflex activity between the surface and the
corresponding internal area is interrupted. This effect is
sometimes very useful, and may be employed to abolish
reflex activity when indicated; but more frequently this effect
is undesirable and contraindicated, and must be prevented by
frequent removal of the cold compress, and restoration of the
parts by warm rubbing or allowing an interval for reaction.

THE TECHNIQUE OF HYDROTHERAPY.

775

Continuous cold causes contraction of the arteries of the
cooled parts; hence the value of the continuous ice-bag or
poultice in the proximal compress, as in the ice-coHar.

Prolonged cold applications (an ice-bag for 15 to 30 min.)
over the heart slow the pulse and raise blood pressure. Con-
tinuous cold applications depress the activity of the heart*

Very cold applications made to such extremely vascular
Imparts as the head may lower the temperature of the entire
body, when carried to the extent of producing shivering.

Intense cold to the head becomes decidedly painful when
prolonged. Continuous cold to the head operates somewhat
differently than applications to any other portion of the body.
The vascularity of the scalp is so great that the circulation is
not suspended even when ice is employed. The bones of
the skull are thin; and being, like other bones, good con-
ductors, the continuous cold application to the head is
capable of lowering the temperature of the brain, and by
depression of the cerebral thermic centers heat production is
.diminishedp and thus general vital activity is lessened.

A short cold application to the head (i to 5 min.)
excites cerebral activity through the reaction which follows.
But by re wetting the cold application every three or four min-
utes, a renewed contraction of the vessels is induced at each
contact of the cold water, and thus the vessels are made to
contiact more vigorously, and Ihe effect of the application is
more intense than if continuous, as by an ice-bag or ice-
corn press»

Intense cold applications, especially when made to the
head, become very painful when prolonged* Si^ch a degree
of cold is unnecessary to secure the therapeutic effect desired.

Therapeutic Applications.— The v erf cold compress ren-
ders valuable service in many cases, but its usefulness is
small compared with that of the cool or cooling compress,
which will be mentioned later. It may be usefully employed
in the suppression of Uca/ inflammation in Joinls, inflamed
wounds^ and other conditions in which powerful sedative

1316

I

RATIONAL HYDROTHERAPY,

effects are required. Applied to the head, it lowers the tem-
perature in fever, relieves deiirium in febrile conditions, may
control excitement in acute mania, and renders in val cable
service in meningitis, used in connection with the warm bath. ■

The ice-bag over the stomach for a half hour before meals
is exceedingly useful in anorexia. Ice-cold applications ai^
also of service in certain cases of neuraigia. Ice compress^
may be applied for the relief of inflamed kemorrkoids. An
ice-bag laid across the trunk of an artery is more effective in k
reducing the blood supply of the part in which the artery is W
distributed than an application made directly to the part
itself; and an application made to the axilla, the bend of the fl
elbow, the groin, or the bend of the knee, will control infiam- "
mation in the distal portion of the limb more effectively than
a cold application to a hand or foot The ice collar or very
cold compress about the neck is a powerful means of reUev-
ing cerebral congestion. An ice compress over the heart
lowers the general temperature by cooling the blood, while
it energises the heart. It must be removed for five minutes ^
at intervals of 20 to 30 minutes, so as to allow reaction, thus
maintaining the sensibility of the skin upon which its ener-
gizing effect upon the heart depends; or the skin may be
rubbed or heat applied for one minute every 15 or 20
minutes.

A cold compress to the face and the upper spine causes
contraction of the vessels of the nasal mucous membrane,
and will thus control nosebleed. This measure is also useful
in cases of acute and subacute nasal catarrh. Prolonged cold
applications to the back of the neck and the face constrict
the vessels of the brain, and so relieve cerebral congestion.

Cold compresses to the inner portion of the thighs, the
perineum, the vagina, and the lumbar region cause contrac-
tion of the vessels of the uterus, and are useful in uterine
hemorrhage, intestinal and vesical hemorrhage, bleeding
hemorrhoids^ etc. Ice-bags to the spine aid in lowering the
general temperature in fever.

THE TECHNIQUE OF HYDROTHERAPY.

177

A cold compress to the thighs, perineum, and hypogas-
trium in conjunction with a very hot fomentation (lO mitiO
over the lumbar region, is a valuable means of arresting hem-
orrhage from the kidney when the bleeding is from small
vessels and not due to malignant disease. The cold compress
contracts the renal vessels, while the fomentation to the loins
diverts blood from the renal circulation into the collateral
vessels.

The cephalic, spinal, and cardiac compresses act in special
ways in lowering temperature. The head compress lowers
the temperature of the blood in the brain, and lessens the
activity of the cerebral centers. The cardiac compress low*
ers the temperature of the blood as it passes through the
heart and lungs. The spinal compress causes dilatation of
the vessels of the lower extremities, and thus exercises a
refrigerative effect, extending over a much larger surface than
that to which it is directly applied,

Dieulafoy recommends the application of ice-bags to the
whole length of the vertebral column in ataxic cases of typhoid
fever. The author has made use of this measure in many
cases of typhoid fever, with excellent results. In some in-
stances, however, the alternate hot and cold spray is more
effective. This measure combats the tendency to, menin-
gitis and other lesions of the cord. Care must be taken
to avoid injuring the vitality of the skin.

The ice compress may be applied directly to a wound as
a means of checking Heeding^ but the compress must be large;
instead of covering the wound only, it must extend over the
whole part, or the greater portion of it. The circulation of
a wounded part must not, however, be restricted to such a
degree as to interfere with its nutrition. Hence the cold
must be withdrawn as soon as possible. Pure blood is the
great healing power in the body, the source of life and ener^,
in health and disease alike. In case of wounds of the hand
or foot, the cold proximal compress may render inestimable
service.

77^

RATIONAL HYDROTHERAPY-

N&sebietd may be checked by the appUcation of cloths
wrung out of ice-water to the face or to the uppier part of the
spine.

An ice-bag applied aver the stomach or to the spine oppo-
site Will often check vomiting, and will relieve the excnjciattng
pain of cancer of the siomack or chronic ulcer.

An ice-bag or ice compress renders great service in cas^
of inflamed and prolapsed hemorrhoids^ and affords marked
relief to the pain which accompanies ulcer and cancer of the
rectum. The pain of orchitis is relieved by the cold com-
press, the parts being supported meanwhile. It must be
remembered, however^ that in such cases the parts may be
easily damaged by a too intense or prolonged application, the
tissues being sometimes so chilled that sloughing occurs. It
is only necessary to employ ordinary care and discretion,
however, to prevent this. The cold applications should be
continued until the parts are no longer sensitive to pressure*

The pain of toothache from alveolar inflammaiiam is often
more readily relieved by a cold application to the side of the
neck just below the jaw, than from a hot application to the
cheek. The two applications may be used simultaneously .

Dr. Chapman pointed out many years ago that the ice-bag
or intense prolonged cold applications made to the back
produce a sedative influence upon the spinal cord, and also
upon the vasomotor sympathetic nerve centers. Dr, Chap-
man's idea was that this effect is to be attributed to tlie
benumbing effect of cold resulting in lessened activity of the
centers brought under its influence. According to fiim, an
ice-bag applied to the lower portion of the spine, will dflatc
the vessels of the lower extremities, and increase the blood
supply of the pelvic viscera. While not prepared to sup-
port all of Dr Chapman's claims, the author has noted a
number of cases in which the application of the ice-bag to the
lower portion of the spine has produced a very marked effect
upon the circulation of the lower extremities, A young lady,
a bed-ridden invalid, who had for years suSered ffoin cold

^1^

I

THE TECHNIQUE OF HYDROTHERAPY.

779

feet and legs, noted that her limbs became warm and filled
wilh blood within ten or fifteen minutes after the applica-
tion of the ice-bag to the lower spine. The patient was first
to call attention to this effect of the ice-bag as a curious and
interesting circumstance. Many similar cases might be cited.
When used for this purpose, the cold application should be
continuous and prolonged.

Applications of ice across the neck, just above the ster-
num, influence the pneumogastric nerve, and will often relieve
spasm of the bronchioles in asthma within a few minutes.
Care must be used to avoid contact of cold water or ice with
the chest, and heat may be used to the back of the chest*

The ice coUar is a valuable measure in the treatment of
diphtheria, the application being exchanged at intervals of
15 to 2Q minutes for a very hot short fomentation. The effect
of this procedure is to diminish the blood supply to the
inflamed parts by its influence upon the carotid^ the periph-
eral branches of which are made to contract by the apptt-
cation of cold over their trunks. A beneficial influence is
also exerted by the reflex effect of the cold application upon
the vessels of the affected region; and thus in two ways
the blood supply of the part is diminished, and the inflamma-
tory process controlled to a corresponding extent. In cases
in which the inflammatory action js extremely intense, and
after the first onset of the disease, the cooling or even the
heating compress should be employed instead of the cold
compress.

Applications of ice to the mucous membrane of the nose
and lips have been shown by Drs, Beer and Forges, of Vienna,
to be efficient in restoring respiration in cases of asp/i/xta
from opium, chloroform, or other narcotics. The cold appli-
cation excites the respiratory cent en

By a mixture of two parts of finely pounded ice with one
part of common salt, a very intense degree of cold may be
produced, sufficient to quickly freeze the parts to which the
mixture is applied when necessary for surgical pvirposes.

780 RATIONAL HYDROTHERAPY,

1317 Contraindications and Precautions.-^If ice is used, one thick-
ness of flannel should be placed between the ice and the skin.

In cases in which ice must be used for a long time, it is
wise to withdraw the application for a few minntes at inter-
vals of half an hour, and to make an application of very hot
water from I to 3 minutes, as a precaution against too great
depression of the vitality of the parts, or the parts may be
rubbed until warm and red.

The very cold and the cold or cooling compress must be
avoided in all cases in which the collateral hyperemia pro-
duced by it may do injury. This collateral effect must always
be burne in mind. Examples ; Inflammation of muscles and
jmnts; deeply seated abscesses vascularly connected with the
cutaneous surface; parietal pieitrisy or peritonitis; inflamma-
tion of the structures of the evchaii.

It must also be remembered that the same reflex impulse
which excites the vasoconstrictor nerves, causing vascular
spasm in a deeply seated part, likewise excites all the other
nerves of the part, and so may intensify pain when present
Hence the cold compress is contraindicated in most cases in
which pain is a prominent symptom. The revulsive compress
(1341) or the fomentation followed by the neutral or heating
compress, is to be preferred in these cases.

Sometimes, however, the cold compress may be employed
by combining with it a hot application, thus realizing its good
effects while antidoting by means of heat its untoward effects.
Examples: A hot foot bath with an ice-bag over an inflamed
ovary or tube; an ice-bag to the epigastrium in gastritis,
with a fomentation to the back; a fomentation to the ear and
cheek in otitis media, with an ice* bag over the carotid.

THE COLD OR COOLINO COMPRESS-
IS 18 Hippocrates was familiar with the cooling compress,
employing it in the treatment of fevers by having linen cloths
dipped in cold water and applied to the hottest parts, while
the patient was at the same time given cold water to drink.

THE TECHKiQUE OF HYDROTHERAPY.

7S1

The temperature to be employed is 55^ to 70°- For
I sedative effects, the compress may be changed every J or 10
minutes. The higher temperature may be employed when
thin compresses are used, as the evaporation taking place
from the surface will keep the temperature down so that
reaction and dilatation of the vessels will not quickly occurs
but renewal must be more frequent. The lower temperature
named is greatly preferable, because of the decided effects
upon the arterial trunks* After the first onset, the cold com-
press, changed every 20 to 30 minutes, is most useful For
the principles which govern the mode of application of the
cold compress, see paragraphs 1256 to 1292.

The compress should always cover an area larger than the
part to be influenced. The recommendation of a leading
physician, published in a well-known medical journal, that
thin cloths four inches square be laid over the region of the
appendix as a means of combating appendicitis, is a veritable
[travesty of hydrotherapy. The smallest viscera of the trunk
}uires a compress at least one foot square.
Physiological Effects.- — The cooling compress has been
very carefully studied by Winternitz and Baginsky** It is a
powerfully revulsive measure, and one of the most valuable
' of all means of controlling, through the cutaneous circulation^
the circulation of the viscera. When the cold compress is
applied to the skin, causing contraction of the surface vessels,
with dilatation of the deeper-lying vessels which are supplied
by the same artery, the blood-vessels of the reflexly asso^
ciated viscera are, through reflex influence, maintained in
a state of contraction so long as the application is so managed
as to avoid reaction, or so great lowering of the skin tempera-
ture as to destroy sensation, and thus abolish reflex action.
When the skin becomes numb under the influence of a cold
compress, the vessels of the associated vascular area dilate

I31»

* Bagin^ky, ** Lehrbuch der KitideT Krankhetteti,** 1896, p. 392.

782

RATIONAL HYDROTHERAPY.

through loss of the influence of the skin reflexes, while the
blood is diverted from the collateral syrface vessels into the
deep vessels. This is a most undesirable effect, against which
the nurse or physician who makes use of cold applications must
be constantly on his ^uard. Neglect of this precaution is
responsible for failure to obtain good effects in multitudes of
cases.

Sometimes the cold compress produces a tendency to
general chilliness. This njust be prevented by a siinultaneous
hot application to some surface where hyperemia of the skin
w*ill be advantageous, as to the feet or the back. If the feet
are cold, the hot foot bath or hot leg pack is always indicated
as an adjunct of the cold compress to the head, abdomen, or
pelvis-

A prolonged cold proximal compress, that is, a cold appli-
cation, as an ice-bag; placed over an arterial trunk, causes
contraction of the artery and all its distal branches, A waim
or hot application produces the opposite effect. This princi-
ple is especially important in relation to compresses applied
to the neck, axilla, bend of elbow% groins, or popliteal space.

The effectiveness of the cool or cooling compress depends
upon the continued maintenance of a moderately cool tem-
perature, with frequent renewals, whereby coottnuous stimu-
lation of the vasoconstrictors is maintained.

It must not be forgotten that the action of the cool com-
press invojves more than its direct influence upon the nerve
centers* It sets up and maintains a regular play of reflex
nervous impulses between the skin and the related internal
parts, through the medium of the nerve centers. When the
area involved is general, the whole nervous system is excited
to a most pronounced degree. This play of nervous activity
is a dominant factor in the revulsive effect produced by the
cold application. Tlirough it there is produced an increase
of vital work in the parts interested, — local metabolism,
secretion, excretion, heat production^ etc,

The most important effect of the cool compress in many

THE TECHNIQUE OF HYDROTHERAPY.

7S3

cases is the fluxion produced by it in deep parts. Fluxion
is without doubt one of the most powerful hydriatic resources
which we possess. The correct managjment of this thera-
peutic force is the most severe test to which an individual's
knowledge of hydriatic principles and procedures can be
brought (1260^ 1291)-

Cool compresses may be employed in such a manner as
to influence the circulation and the functions of the liver,
spleen, stomach, kidneys, intestines, lungs, brain, pelvic vis-
cera— in fact, all the internal structures of the body.

When used as an antithermic or antipyretic measure, the
compress should cover at least one fourth of the skin area
(page 316), The size of the compress may be estimated
from the weight of the patient by a simple calculation based
upon the proportion 180 : IV : :jo j^, in which IV represents
the weight of the patient, and x the skin area of a person
weighing 180 pounds. The required size of a coolitrg com-
press for use in reducing temperature will be: for a person
weighing 180 lbs., 5 sq* ft; 120 lbs., 4 sq. ft; 60 lbs., 3 sq,
ft.; for a child weighing 30 lbs*, i J sq. ft,, or 12 x 16 inches.

In Dr. Thainpsun*s experiments upon dogs, published in
1892, it was found impossible to lower the rectal tempera-
ture by applications to the sacrum or abdomen. In these
experiments an incision was made in the abdominal wall, the
bulb of a thermometer was introduced, and an ice-cold appli-
cation made to the surface. The thermometer indicated no
change of the temperature of the inner surface of the ab-
dominal wall so long as the anirnal remained alive, though
cold applications to the head produced a very decidedly cool-
ing effect upon the brain.

The experiments of Schultze give somewhat different
results, showing actual reduction of temperature from cold
applications to the abdomen (ISl^)* Nevertheless, it is
doubtless true that the chief effects of the cold abdominal
compress in cases of visceral inflammation, unless large
enough to cover one fourth of the body surlace, are obtained

1320

784

RATIOl^AL !iVDROTHERAPY.

1321

4«^

through its influeoce upon the circulation and innervation of
the diseased structures by reflex action through the vaso*
motor centers.

The temperature of a deeply seated part is dependent
upon its functional activity, and the rate of blood movement
through it The slower the movement of blood, the higbef
will be the temperature. Hence passive con^restion favors
local elevation of temperature. The active fluxion of blood
through a viscus, which may be induced by the cold or
cooling compress, may thus lower the temperature of the
most deeply seated organs, and exercise a decided antiphlo-
gistic influence without actually lowering the temperature of
the intervening parts.

It is by this reflex influence that we are able to control
inflammations in the lungs, spinal cord, stomach, liver, intes-
tines, uterus, ovaries, and other deeply seated organs.

Therapeutic Applications.^- The cool compress may be
employed in such a manner as to render invaluable service in
all forms of localized iujlammatory processes, whether super-
ficial or deep. In superficial inflammations the compress pro-
duces vasoconstriction, and thus sedative effects are brought
about as soon as the application is made. In case of visceral
inflammation, the beneficial results obtained are through reflex
action, the application being made to the surface which is in
reflex relation with the inflamed part (Figs, i6S, 169)*

The compress is exceedingly useful in typlwid fever. It
should be covered with flannel only, not with oilcloth, so
that there may be little retention of heat, and so as to
encourage fluxion in the mesenteric vessels and leucocytosis
rather than retention of blood in the portal vessels. The
object of the abdominal compress in typhoid is to encourage
leucocytosis and vital resistance in the diseased structures,
rather than to reduce the temperature.

Care must be taken that the application never be made
in such a way as to cause numbness or even lowered sensi-
bility of the skin, as it depends for its effects upon the main-

I

:.-^^

C* Diagr^iti sh^nwini; im-ul €iHM\«ott%i:an^^mimn, »^ in a boil.

/\ I)i^4;rii<n thowinj; tetiei ,>f Uicni conge«tian> Uy 4 tnmi:i<i|j|tion wliji li ilil.>in the tyrfafiarltng vc^^btl*,
nous (p. 7H.J

THE TECHNIQUE OF HYDROTHERAPY.

7«5

tenance of reflex activity between the skin and the viscera.

The cold compress is of greatest service in pneumonia.
It must be applied to the whole (rout chest and the affected
side, and changed as soon as well warmed (128^).

The cool compress is highly useful as an application in
cases of mrdiiu insufficiency^ either in fevers or as the result
of disease of the heart. It is applicable in nearly all cases
except those in w^hich there is degeneration of the cardiac
muscle; in myocarditis it is valuable, notwithstanding the
affection of the muscle, for the reason that it controls, to such
a remarkable degree, inflammatory processes. In cases of
erysipelas, except when affecting the face or scalp, a cool or
cold application is more serviceable than the ice compress as
an antiphlogistic application.

In dirmatiiis, the cool compress is exceedingly valuable.
In ittflammation of the externai portions of the eye^ the cool-
ing compress is mure effective than ice-cold applications, but
it is effective only when the inflammatioQ is confined to the
eyelid itself. When the eyeball is the seat of the inflamma-
tory process, the fomentation or the revulsive compress ap-
plied over and above the eye, is the proper measure. The
application should be made to the eyelid and cheek only, not
extending above the eyebrow |12ti2>

Cold applications for superficial inflammations should be
made as long as the parts have a bright red appearance, but a
mottled blue appearance of the skin is always an indication for
the application of heat, as it shows excessive contraction of
the small arteries and slowed movement of blood. Such a
case requires the hot compress every two hours (lo min.) with
the heating compress between applications.

When renewed every 5 to 8 minutes, the effect of the
cooling compress is to maintain contraction of the cutaneous
vessels and simultaneous contraction of the vessels of the
reflexly associated visceral vascular area. When the compress
is left in place long enough tor reaction to be established (15
to 30 min*), the effect is somewhat different. The reflexly

786 RATIONAL HYDROTHERAPY.

associated visceral vessels are dilated, as well as those of the
skin. When the application is renewed, the freshly cooled
compress causes contraction of the cutaneous vessels and
renewed contraction of the visceral vessels. This effect,
frequently repeated, serves to maintain a vigorous circulation
through the affected org^an, and thus combats in the roost
decided manner the tendency to stagnation or passive hyper-
emia which is always present in visceral inflammation* This
measure is consequently a most efficient means of combatiDg
kyfitrsiatic congestion of the lungs in surgical cases and pro-
longed helplessness from any cause, in resisting the action of
specific bacteria in typhoid /c'vi*r, and also renders most
valuable service in the early stages of pncmnonia. When the
febrile activity is very great, the compress may be renewed
as often as every J to to minutes. Later, when the activity
of the inffammatory process is somewhat lessened, as shown
by the slower heating of the compress, it may be left in place
for an hour. The skin must be well rubbed at each renewal
In all deep-seated visceral inflammations, the same principles
hold good.

The abdominal compress, frequently renewed, maintains
active contraction of the mesenteric vessels. The cooling
may be made continuous by ice-bags, but a more moderate
temperature is, on the whole, better. This compress should
be employed as a routine measure in typhoid fever, and may
sometimes become the chief reliance, as in cases of intesti-
nal hemorrhage and other conditions contraindicating the
general cold bath. The cold abdominal compress was used
successfully in fevers by Le Drau, of France, in 1 73 1.

Often the patient's feelings are a good guide as to whether
heat or cold should be applied. The organic intuitions of
the body are marvelously correct guides in the application
of rational and physiological measures. It is a common thing
to hear a patient say, when a correct hydriatric prescription
is made, **That will do me good, I am sure.'* And it does.
Nature is a wise teacher and a watchful nurse.

THE TECHNIQUE OF HYOROTHfiRAPV.

787

Mays, of Philadelphia, has for several years advocated 1322
{the ice-bag to the chest in pneumonia^ and the results
f he reports * are certainly much superior to those obtained
by other methods in common use. For more than twenty
jyears tlie author has employed the cold compress or ice
I compress in the early stages of pneumonia, exchanging it
I every three hours for a fomentation, during the early stages
[of the disease, and applying the cooling compress as soon as
[the crisis was passed and the period of resolution begun.

The prolonged application of the cold compress to the
[ cutaneous surface produces contraction, not only of the blood-
[iressels of the skin, but also those of the deeper tissues under-
[lying the area to which the application is made. This effect
lis reached, however, only after long application. The first
[effect of an application over a muscle, for example, is to
[cause collateral hyperemia of the muscle simultaneously with
{the cutaneous anemia produced.

The cold compress or ice-bag over the heart for half an
[hour twice a day is of great value in cases of palpitation
land cardiac insufficiency. The continuous application of the
iice*bag is equally serviceable in cases of cardiac irritability
[(ltJ83). Winternitz very strongly urges the value of this pro-
cedure as a substitute for digitalis, to which it is infinitely
superior. Its use is indicated by the appearance of dicrotism
in typhoid fever or in depression of the heart from shock.

Contraindicatiaits* — The precautions and contraindications
relating to the cooling compress are the same as have else-
where been indicated for the very cold or ice compress (1317).
It needs only to be added that the compress at a temperature
rof 60^ to 70- is generally useful, while a lower temperature is
[often injurious.

THE COOHNO COIL.

A refrigerating method much employed in Germany is the 1323
ii^^ating cat I (Fig. 170). consisting of a flat coil of rubber

• Transactions of the PhUaddphin County Medical Society, 1S95* P* V^-

788 RATIONAL HYDROTHERAPY.

tubing through which cold water is passed. The coil is
placed over a thin wet compress. The author has devised
a rubber sack (1336) so constructed that its walls can not
become too widely separated, and provided with an inlet
and outlet on opposite sides. The sack is put in place, and
connected by two pieces of rubber tubing with a fountain
placed at a proper level and a receiving vessel placed on
the floor. By regulating the temperature of the water in
the fountain and the rate of the flow, any desired heating or
cooling effect may be obtained. When ice-water is used, the
same water may be employed continuously, it being only nec-
essary to dip the water back from the lower into the higher
vessel as the latter is emptied and the former filled.

Therapeutic Applications. — The cooling coil is especially
useful only in those exceptional cases in which continuous
cold is desirable, as in meningeal inflammation^ as a precor-
dial application in fever with very high temperature and
bounding pulse, and as a proximal application (1327) in
cases of wounds of the extremities.

THE EVAPORATINQ COHPRBSS (Rg, 171).
132-1: This consists of a thin compress or other absorbent mate-
rial kept moistened with water and cooled by evaporation. In
the evaporation of a pound of water about i,ooo heat units
are rendered latent; that is, the evaporation of a pound of
water absorbs as much heat as would be required to raise 1,000
pounds of water i ^ in temperature. The rate at which the
water evaporates from a compress of this sort depends opon
the heat of the part, the temperature of the surrounding
air. and the amount of air brought in contact with it. A
compress twelve inches square, covering an area of 144 square
inches, may remove from the body under favorable circum-
stances 1 50 heat units in an hour; but in order that the
evaporating compress may accomplish its work, it most be
in direct contact with the skin, must be kept constantly
moist, and must not be protected. The moistened hair

THE TECHNIQUE OF HYDROTHERAPY,

789

serves very well the purpose of an evaporating compress to
the head, but the hair must be kept wet, A moist compress
laid upon the surface of the dry hair is practically without ,
effect in cooling the head.

Therapeutic Appllcatloiis. — The evaporating compress is 132d
of great value in fevers as a means of cooling the head, Ben-
jamin Rush employed clay poultices as a cooling measure in
the latter part of the last century. The evaporating compress
is a most excellent means of maintaining a moderate degree
of cold in cases of erythema, and in various conditions of irri^
$aii&n of the skin in which an intense inflammatory process
is not present, so that more vigorous cooling measures are
not indicated. The wet head-cap is a very useful measure in
cases of acute cerebral congestion^ and not infrequently proves
a sovereign remedy for the instfmnia which so often accom-
panies this condition. The evaporating head compress is con-
traindicated in rheumatics because of the tendency to cause
rheumatic pains of the scalp.

THE IRRlOATtNO COMPRESS.

In this procedure a compress consisting of several thick-
nesses of cheese-cloth or soft muslin, or a mass of abfsorbent
cotton, having first been saturated with cold water (60'^^), is
laid upon the part to be treated. It is kept moist by an
arrangement whereby cool or cold water is made to trickle
slowly upon the compress, thus keeping it saturated, and con-
stantly changing the water which it contains, so that as fast
as the water in contact with the skin becomes warm, it is dis-
placed by that of a lower temperature. The parts treated
should be so disposed as to be inclined somewhat, that the
water which enters the compress at the upper end may run
away at the lower end. By means of a surgical cushion or
oilcloth the water may be collected as it runs away in a vessel
at the side of the bed or couch. A convenient arrangement
for conducting the cold water from the container to the limb
is a simple siphon, as shown in Fig. ijz. The tube should

1326

HATtONAL HYDROTHERAPY*

to constricted by tyin^ a string about it or by other means

■ the water will flow at jnst the proper rate to inaintaiii

temperature desired. If a fountain with a stopccM!:k is fl

iployed, the flow of water may be regulated by the cock.

The physiological effects and the therapeutic appHciiii^m

a bis procedure are the same as with the ordinary cold com- ■

ss, the only difference being that by the method of iiriga-

'I tik/n the temperature of the application may be maintained at

, a certain point as long as ^'^sirable, and thus reaction may

be easily suppressed, ]rri| ton is especially applicable in

cases of wounds, burns^ bruises^ and other injuries in which

the dressing can not be readily removed without irritatiiig

the injured surface.

Suggestions and Precautions^ — It should be remembered
that when a very low temperature is employed, the parts
may be so devitalized by the long-continued application of
cold as to be injured. Consequently a fomentation should
be employed for 5 to lo minutes once in two or three hours,
to maintain proper activity of the circulation*

•i

I

THE PROXIMAL COMPRESS (Fig. 173).

•1327 This procedure differs from other compresses in that the
application is made, not to the part which it is desired to
influence, but at a point near the part and between it and the
heart. It is not always convenient to apply a wet cloth to
the part to be cooled. This is especially true in the case of
wounds, which must be antiseptically treated, it being quite
impossible to maintain asepsis with the use of the water
dressing jn the case of an open wound. This treatment of
open wounds won great success half a century ago, before
antiseptic treatment was understood, but the present method
of dry antisepsis is so much superior, that this method is not
to be considered in comparison with it. In many cases, how-
ever, great advantage may be gained in the relief of pain and
the control of inflammation by the antiphlogistic effects of
the cooling compress applied in the manner suggested. The

I

THE TECHNIQUE OF HYDROTHERAPY.

791

principle on which this compress rests has a sound experi-
mental basis. Th^ apphcation o{ cold to the trunk of an
artery has been shown to cause contraction of the artery and
of its distal branches (Winternitz). The clinical advantage
of the application of cold in this way was well understood
before the physiological explanation was experimentally dis-
covered, Priessnit^ employed the cold elbow bath for the
control of inflammatory processes uf the hand, and recognized
the same principle in the treatment of wounds and inflamma-
tions in other parts of the body. The proximal compress may
be usefully applied either by means of a cooling compress, fre-
quently changed, at a temperature of 60^ to 70^, or by means
of the cooling coil or sack, or a bag filled with ice or ice- water,
and protected by one or two thicknesses of flannel (Exp. 6S).

The following are the most useful applications of the cold
proximal compress : —

To the knee and the calf of the leg as an antiphlogistic
measure for the foot.

To the whole thigh or an ice-ba^ to the popliteal space
to influence the portion of the leg below the knee.

An ice-bag in the groin to influence the whole leg.

The cold compress around the elbow joint as an antiphlo-
gistic measure to the hand.

An application to the whole upper arm as a measure to
influence the forearm.

An ice-bag to the axilla as an antiphlogistic measure for
the whole arm.

An ice-bag at the bend of the elbow as a means of lower-
ing the temperature of the hand.

An ice collar about the neck to control congestion of the
brain. This is also a most effective measure in laryngeal
inflammation, and may be used in meningitis.

THE FOMEPCTATION (Fig, 174),

This is an application of a hot compress, usually a thick
folded flannel cloth, applied a number of times in succes-

1S2S

792 RATIONAL FIYDROTHBRAFY.

sion at a high temperature. It is essentially a local vapor
bath. There is no such thing as a ''cold fomentation."

Requisites. — The material for a fomentation may be a
piece of an ordinary woolen bed blanket, spongiopiline, a
large flat sponge, or a thick woolen cloth of any sort, or,
in the absence of anything better, a thick mass of cotton
cloth, as cheese-cloth, towels, etc.

The flannel cloth should be large enough so that when
folded to four thicknesses, it will well cover the part to which
the application is to be made. Fomentations are generally
made to cover too small an area. If the affected part involves
an area the size of the hand, the fomentation should cover a
territory three or four times as large, as the good effect de-
pends much upon the size of the surface to which the applica-
tion is made. A pain confined to a point not laiger than a
finger-tip, if acute and persistent, may require for its relief
an application covering one or two square feet.

In addition to the flannel used for the fomentation, a much
larger dry flannel or blanket and a piece of mackintosh should
be at hand to cover the moist cloth, so as to retain the heat.
Two or three large towels are also needed. A supply of
water at boiling heat should be ready for use. If the fomen-
tation must be given at some distance from the source of
supply, a pailful of hot water may be made to retain its heat
for some little time by covering and wrapping it well with
a woolen blanket or a piece of carpeting.

riethod. — The proper application of a fomentation con-
sists of the following steps: (i) Preparation of the patient;
(2) wringing the flannel out of hot water; (3) renewal of the
application one or more times; (4) finishing treatment. These
several steps are executed as follows : —

I. The patient should lie on a bed or couch, with the part
to be treated thoroughly exposed. A little vaseline or cacao
butter should be first rubbed over the surface to be treated,
especially when the treatment is to be given daily. The
patient's clothing, and the bed-clothing should be so arranged

{ i

if

iit

I

that it %viU not be wet, as otherwise he may take cold after
the treatment. Care must be taken that the extremities
are warm ; and If there is cerebral congestion, a cold cephalic
compress (1371) should first be applied.

2. Unless too large, the fomentation cloth is placed in a
strong towel, the towel being folded around it so as to leave
the ends free ; the attendant then grasps the towel by the
ends, dips the whole in the hot water until completely sat-
urated and heated to the temperature of the water, then
wrings it over the pail by twisting the ends of the towel and
stretching lengthwise (Fig, 175), A convenient method is
partially to unfold the cloth, dip one end into the water, and
fold together again in such a way that the dry portion will be
on the outside. Then, by wringing, the dry part will become
saturated by the absorption of water from the wet portion*
By using an extra large fomentation cloth, the central portion
only may be wet, leaving the ends dry to be grasped by the
hands for twisting and WTinging (Fig. 176).

The intensity of the application and the length of time
the fomentation will retain its heat will depend upon the
amount of water left in the cloth, as well as the temperature
of the water. When very hot water is used, the cloths must
be wrung very dry, otherwise there will be danger of blis-
tering the patient. Another precaution which it is well to
observe is to place a dry flannel next the skin, so that the heat
of the fomentation may reach the skin gradually. More water
may bo left in the fomentation and a higher temperature may
be employed when the skin is thus protected. When so intense
a heat is not needed, but rather a poultice effect is desired.
very soft flannel may be used and a considerable amount of
water should be left in the cloth> but for this effect the tem-
perature should not be so high as to make the application
painful at first contact,

3. Ordinarily, when a mass of flannel of considerable
thickness is used, the fomentation will require renewal at
the end of about five minutes. When very intense heat

HATiONAL HYDEOTHBRAPY

required^ or a thin compress is used, the renewal must be
de at more frequent intervals. lo other cases, a sufScietil
ount of warmth may be retained to last for eight to ten
mtes. If desirable or convenient, a rubber bag, a bottle
id with hot water, or some other heated object, may be
ilied between the moist cloth and the dry covering to
intain the heat.

When the fomentation cloth is removed for renewal, the
wrappings should be quickly replaced and the cloth wrung i
of hot water and repl ed as quickly as possible, so
It the surface will not become chilled by evaporation, and
the effect of the fomentation be thus neutralized. An excellent j
plan, when continuous heat is required, is to have a second |
cloth wrung out and ready for instant application when |
renewal is necessary. |

4. The duration of the fomentation must depend upon |
various conditions, most of all upon the patient's own sensa-
tions, especially when it is applied for the relief of pain. |

The beneficial effects of the fomentation should be still
apparent several hours after the application. If the symp-
toms return after having been relieved, the application may be
^ ' renewed. Occasionally, continuous application for several

hours is necessary, especially in cases in which acute pain is
present. So long as the pain or other urgent symptom is
relieved by the application, and returns when it is removed,
the application may be continued. Every half hour, how-
ever, the hot compress should be replaced by a well-wrung
cold wet towel for i or 2 minutes.

In concluding the treatment, a cold application should
always be made. This usually consists of a towel wrung very
dry out of cold water — the colder the water, the better.
This should be applied quickly over the whole surface which
has been reddened by the fomentation, and should be
retained in place for 30 to 60 seconds. It should then be
removed and the part rubbed slightly, and immediately
covered with dry flannel. In cases in which pain is not pres-

THE TECHNIQUE OF HYDROTHERAPV.

795

ent. no harm could result from a more thorough coohng of
the part, but it is only necessary to remove from the skin the
heat which has been introduced by the fomentation. By
this plan, circulatory reaction is produced and a thorou^^h
revulsive effect is secured, without producing thermic reaction,
which is undesirable when either pain or acute inflammation
is present. In the last class of cases it is often desirable
to follow the fomentation by a cooling (1318) or heating
(1344) compress, as in pneumonia, pleurisy, and erysipelas^
and sometimes in acute arthritis*

Fomentations may be improvised in a great variety of
ways, as the author has often had occasion to learn by per-
sonal experience. When stopping at a Western hotel some
years ago, he was suddenly aroused in the middle of the
night by a loud outcry, and being called to the bedside of the
patient, found a young woman suffering from a distressing
pain in the liead. She was almost beside herself with pain,
and writhed in agony as every fresh paroxysm came on. No
hot water being obtainable witliout considerable delay, the
following plan was adopted: A towel was folded and wet,
then laid upon the bottom of a large dipper placed bottom
upward. The inverted dipper was then held over a kerosene
lamp, as close as possible to the top of the chimney without
producing smoke. In two or three minutes the compress was
steaming hot, and by the time the first one was cooled,
another was ready for instant application* The patient
experienced almost immediate relief, and in ten or fifteen
minutes she was sleeping comfortably, and in the morning
seemed in usual health.

In an emergency a flannel cloth or a cloth of any sort may
L>e wrung out of cold water and wrapped around a stove-
pipe or laid upon the top of a stove, or held against its side
for a few seconds until heated. To prevent soiling by con-
tact with the stove, the cloth may be placed between the
folds of a newspaper; the newspaper^ being moistened, will
not bum.

RATIOHAL HYDROTHERAPY

13211 Physiological Effects*^ The fomentation is a power!
excitant measure, stimulating tissue activity, increasing meta
olism or tissue changep quickening the circulation and general
nutritive processes, and encouraging absorption and repair. Aa
the result of the excitant effects upon the sensory, vasomotor,
and sympathetic nerves, highly valuable therapeutic effects am
produced. The fomentation is, in fact, one of the most exten-
sively useful of all hydriatic measures. It is often of great
service in the palliation of symptoms the radical relief of
which depends upon other more general procedures whereby
restorative constitutional effects may be produced.

Fomentations, like other forms of hot applications, have
not only a primary or direct excitant effect, but also a seo
ondary sedative effect. There is an action and a reaction in
connection with hot appHcations, the same as with cold ap-
plications^ as has been previously pointed out {578 J. Whea
employed for therapeutic purposes, sometimes the action
effect of the fomentation is desired, sometimes the reactioa
effect.

When applied at a sufficiently high temperature, the fomen
tation produces a temporary blanching of the parts from the
contraction of the small vessels, which is quickly followed by
relaxation or paralysis of the constrictors. When long con-
tinued at a high temperature, the vasomotor paralysis produced
and the turgidity of the cutaneous structures is very pro-
nounced, and continues for a considerable time, as shown
by the dusky redness. The dilatation of the surface vessels
produced by the hot application is passive in character, while
cold produces active dilatation. The relaxing effect of the
hot application seems to influence the veins somewhat more
than the arteries, which accounts for the dusky color pro-
duced, indicating venous congestion.

Very hot applications lessen the sensibility of the cuta-
neous nerves.

The parts brought under the influence of the high tem-
perature are, for the time being, excited to increased action.

I

'\

THE TECHNlyUE OF HYDROTHERAPY.

as shown by the intense pigmentation of the skin which often
results from the daily application of the fomentation for a
few weeks. After the application is withdrawn, however, an
atonic thermic reaction occurs, as the result of which all
kinds of vital activity are lowered. The examiaation of the
blood of the part to which the fomentation has been applied
for a short time shows a notable diminution in the proportion
of the hemoglobin and red cells and an increase in the pro-
portion of white cells. Hot applications encourage migration
of the white cells by increasing their activity, and their accu-
mulation in the vessels.

When the blood-vessels of the skin over a deeply seated
part are widely dilated and filled with blood as the result of
a hot application, a collateral anemia exists in the vascularly
associated areas; that is, deep parts supplied by the same
arterial trunk.

The effect upon the deep structures underlying the sur-
face to which the fomentation is applied, and supplied by the
same artery, is exactly the opposite of that resulting- from a
cold application. The dilatation of the cutaneous vessels
causes contraction of the vessels in the deeper structures. It
is in this way that fomentations relieve pain when applied
to the skin overlying a deep part which is the seat of an
inflammatory process. This explanation also sipplies to
applications to the abdominal surface for the relief of visceral

b inflammations, since there is a connection between the venous
p circulation of the abdomen and that of the cutaneous cov*
ering of the abdomen. This fact becomes very apparent in
cases of hepatic cirrhosis, by the enormous enlargement of
certain cutaneous veins (1277-1279).

Through this means, heat becomes a valuable antiphlo*
gistic measure, notwithstanding the fact that inflammatory
processes are attended by an increase of heat It is more
than probable that the increase of heat accompanying inflam*
matory action is not simply an incidental result from the
morbid process present » but is one of the methods adopted

r

798

1330

RATIONAL HYUROTHERAPy.

I

<

by nature for the cure of inflammatory processes or the miti-
gation of their evil effects. This may explain the wooder-
ful benefit derived from the use of heat in a large number
of local inflammatory processes. Recent experinnents go to
support the idea that elevation of the temperature of an
inflamed part may sometimes serve as a valuable aid to the
natural processes of defense, stimulating vital activity, and
encouraging the development or the efficiency of those subtle
elements by w^hich nature renders the tissues inhospitable to
the microscopic parasites upon which inflammation almost ^
always depends. ^M

The fomentation is one of the most efficient means of pro- ^\
ducing dilatation of the surface vessels of a circumscribed
part, and thus producing local hyperemia and collateral
anemia. Derivative effects are also produced by dilatation
of the veins of the part to which the application is made, thus
diverting the blood from the veins of some associated part
It is in this way that the portal circulation is relieved, when
it is the seat of passive congestion, by large abdominal fomen-
tations or a hot trunk pack.

Therapeutic Applications. — Local revulsive, derivative,
analgesic, and excitant effects follow the use of the fomen-
tation. The fomentation is always indicated when it is nec-
essary to reduce a swelling; stimulate the absorption of an
effusion or an exudate, excite tissue change, increase local
blood supply, promote phagocytosis, and awaken functional
activity. In these cases it is best used in alternation with
the heating compress. Remote antiphlogistic and hemostatic
effects are induced by the constriction of the blood-vessels
through excitation of the sympathetic and vasomotor nerves.
This remote effect is exceedingly valuable in cases of visceral
congestion and inflammation; hence the efficiency of the
fomentation in relieving both the pain and the congestion in
inflammation of the liver, acute and chronic gastritis, sfi^***r
congestion and enlargement, acute and chronic intestinal
catarrh, peritonitis, ovaritis, metritis, and inflammatory

THE TECHNIQUE OF HYDROXriERAPV.

790

affections of the muscles and nerves, in all of which cases
the application is made directly over the aflfected part.

The most valuable therapeutic action of the fomentation,
to which its remarkable pain-relieving properties are due,
is based upon its power to produce prompt and most
pronounced revulsion* There is no means by which such cer-
tain, immediate, and such intense and efficients revulsive
effects may be produced, as through the dilatation of the cuta-
neous vessels under the influence of moist heat.

The methods by which hot applications may be best
employed for the relief of congestion and inflammation of the
brain, the Kings, the liver, and other internal organs, have
I been pointed out in preceding paragraphs (1260-1292).

In case of acuU injlammatwn involving the surface
structures, the fomentation may be usefully employed for
a short period (5 or lO min.) at intervals of two or three
hours, cool applications being employed in the interim. By
this means the analgesic and sedative effects of the hot appli-
cations are obtained.

Hot applications are perhaps most frequently employed
for their analgesic, or pain-relieving, effects, for which they
certainty afford a most efficient resource. The analgesic
effects of heat are obtained chiefly through its revulsive
effects, which have been previously explained (667-678)*
For the best results, the applicaption must be made at a very
high temperature, the compress being hot enough to cause
slight pain when first brought in contact with the skin. Its
actual temperature should be from 140° to 160^^. There will
be tittle or no danger of burning the patient, provided the
compress has been wrung as dry as possible, and the skin
has been carefully covered with vaseline, and protected by
single thickness of flanneL When these precautions are
observed, the hot water does not come in actual contact with
the skin, but only the highly heated air or vapor, the fomen-
tation thus becoming really a local vapor bath.

As an analgesic, the fomentation generally gives ofiagtc

1331

1332

RATIONAL HYDROTHERAPY.

relief. The fomentation may be applied in nearly all condi-
tions in which pain is present, whether of functional or organic
origin. Its powerful derivative effects often afford tempo-
rary relief even in maladies which are incurable. There is
no more effective means than the fomentation for the relief
of pain from strain or sprain of joints and muscles, and other
injuries in which the skin is unbroken. It may also render
very valuable service in the relief of pain and relaxation of
tense tissues in cases of iiisioaition and fracture of bones,
thereby greatly facilitating the adjustment of the displaced
parts. The author has made it a practice for more than
twenty years to administer a fomentation just before applying
the dressing in a fresh fracture, unless the patient presented
himself immediately after the injury. The effect is greatly to
mitigate the patient's suffering, as well as to prevent subse*
quent swelling, and thus facilitate healing. The fomentation
should be applied after the bones have been restored to posi-
tion; or if the parts are so swollen and ^sensitive as to make
it difficult to manipulate them, fomentations may be applied
for 20 to 3C minutes before any attempt is made to readjust
the bones to their normal position. Heat relaxes, or rather
causes expansion of, the white fibrous tissue of the joint liga-
ments. By the use of the fomentation in this manner, the
administration of an anesthetic may often be avoided-

For the relief of c/irouic pains, the pain from gaii-stanis^
renal cahuii, hepatic pain, infectious jaundice, and for neu*
raigias and other painful affections of the joints, the fomen-
tation is of immense service, if applied thoroughly. In the
painful conditions often present in hyperpepsia, a fomentation
applied half an hour after meals, or when the pain begins,
affords great relief. The applications should be very hot* but
not very long continued, as continuous heat over the abdomen
alter meals is an exciting measure.

A very short fomentation over the heart is useful in r^-
iapse under anesthesia^ m opium poisotiing, and in cases ot
heart failure due to other causes. The application should be

THE TECHmQUE OF HYDROTHERAPY.

Sat

followed by a cold compress or aa ice-bag, which should be
left in place for half an hour, when the hot application may
be renewed for a few minutes if necessary.

For diseases of the eye tail, very hot applications to the
eye, avoiding the cheek, but extending over the brow, afiord
great relief, and greatly facilitate recovery (I264)»

The fomentation may be applied to the whole head for the
relief of headache due to anemia of the brain, a condition
^ generally found present in neurasthenia, and indicated by a
^■sense of weight or pressure, while the face is pale and the pulse
feeble.

The pain of iaothache^ migraine^ and earache is greatly
mitigated, if not wholly relieved, by fomentations. Care
must be taken to confine the application to the face. If the
hot compress extends to the neck below the jaw, the conges-
tion will be increased by dilating the common carotid. It
is for this reason that cold applications often relieve a painful
affection of the jaw more readily than heat, by causing refiex
contraction of the deeper vessels. In such a case still better
effects will be obtained by applying the ice-bag or cold com-
press lower down or below the jaw, so as to contract the large
vessels of the neck simuUaneously with the fomentation to
the face or the side of the head. The very best effects
are obtainable by revulsive applications (673, 104 U 1341).

In cases of hyperesihesia of the solar plexus and the
umbilical ganglia of the abdominal sympathetic, the fomenta-
tion not only relieves the local distress^ but also a great
number of reflex symptoms which have their origin in sym-
pathetic nerve disorders, such as cold hands and feet, gid-
diness^ pain in the loins, between the shouider-fdades^ in the
iack^ of the neck^ and various other reflex neuralgias, pares-
ihesias, and vasomat&r disiurimnces,

Farquharson recommends fomentations to the anal region
in inconiiiunce of urine when of spinal origin, and especially
when due to a sort of chorea of the lumbar cord.

RATIONAL HVDROTHERAPY

Fomentations to the throat are of great value in inflam-
matory affectitms of the /arynx, fauces, and ionsiis, through
the strong revulsion which they produce, diverting the blood
away from the internal parts to the skin. The application
should be continued for i 5 to 2o minutes; then the cooling
compress (1318) should be applied for an hour or two, when
the fomentation should be renewed. Hot compresses are
applicable in croup, both true and false, but especially in false
croup, in which they always afford rehef. In iruc croup, it
aids, to some degree at least, in the loosening of the obstruct-
ing membrane; and in faisc croup, the fomentation causes
relaxation of the contracted air passages by relieving the irri-
tation which gives rise to the disease. After the foment atioo,
the heating compress should be applied.

The fomentation is exceedingly useful in combination with
cool or cold compresses in many cases, as for example, to the
throat in diphtheria and tonsiiliiis, and to the chest in pneu-
monia and pieurisy. The application should be applied for
5 to 10 minutes at a temperature as high as can be bome*

In uiccrations and injiammations of the cornea^ in pannus,
iritis, and in affections of the deeper parts of the eyeball, hot
applications render great service. The application should not
be continued for more than 15 to 20 minutes at a time, how-
ever, and should be followed by very short cold applications
lasting for 10 to -15 seconds, after which the parts should be
covered with warm cotton or Bannel to prevent cooling by
evaporation, or a neutral compress (96'^ to 98^') may be applied.
The neutral compress must be changed every to to 15 minutes
to prevent elevation of temperature through accumulation of
heat, whereby the stimulating effects of the poultice will be
produced; it should also be covered with dry flannel or oil-
cloth to prevent cooling by evaporation. The compresses
should be applied over the eye and the forehead just abovCi
rather than to the cheek.

Fomentations to the spine may be applied m tever as a
means of stimulating the spinal centers, especially the sweat

r\

^.*^

THE TECHNIQUE OF HYDROTHERAPY.

803

enters, and warming the surface, thus increasing heat
llimination.

Fomentations over the abdomen relieve the painful iym-
' paniiis of typhoid fever; and in peritonitis and inflammatory
processes of the pelvis they not only relieve the pain, but
lessen the inflammatory process by bringing: the blood to the
surface^ and contracting the distended veseels of the affected
internal part. The atonic reaction which follows hot applica-
tions also aids in combating the inflammation.

^P In the case of pelvic and atdotninal inflammaiii>ns^ a hot
hip pack or hot trunk pack is, however, generally much more
serviceable than the simple application of a fomentation^ since
a larger surface is rendered hyperemic, thus diverting more
blood from the abdominal or pelvic viscera*

In all forms of gastric pain the fomentation is an itivalu-
able remedy* It must cover the area from the fourth rib to

' the umbilicus, and between the two axillary lines.

^^ The cold compress to the epigastrium in combination with

^^the dorsal fomentation produces most happy effects, acting
reflexly to contract the gastric vessels while the fomentation
drains them by dilating the intercostal veins (1362).

In the early stages of erysipelas, and also of meningitis
of the brain and cord, the fomentation is of great service.
It relieves pain in both classes of cases. In meningitis it
likewise acts as a derivative and an antiphlogistic through the
atonic reaction induced. The application of heat should not

I be continued more than 3 to 5 minutes, and should be followed

Kf a continuous cold application.
Very hot applications (135^ to !6o^) are exceedingly sen*^
eable in cases of swollen internal hemorrhaids or prolapsed
;ctum, with large external hemorrhoids. The water should
be applied as hot as can possibly be borne, by means of a soft
cheese-cloth or sponge. The application should be continued
for 15 or 20 minutes, when the hemorrhoids, if internal, should
be gently pressed up into the bowel, to avoid strangulation by
contraction of the sphincter muscle, and a cold compress

1333

«!t

iM

RATIONAL HVDROTHERAPV

should be applied If the bowel, or hemorrhoids^ can not be
reduced, the hot applications should be renewed tor lO to JJ
minutes every hour, the cold compress being coDtinued diir-
ing the intervals*

The fomentation should be employed on the same plan in
orckiiis, acute inflammation or €ong€Sti&n of the &vari€$,
uttrus^ and kidneys^ and in prostatitis, proctitis, and vagini*
lis when accompanied by much pain. In inflammnti^ft ot
the biiiddcr the cold compress must be omitted, the parts
being simply kept warm.

Tiie hot fomentation to the perineum is indicated
inflammation of the prosttite.

Hot applications over the hypogastrium, thighs, and the
vulva and perineum are likewise indicated in inflammnU^^m
and other paiufut affections of the utirus and ovaries*

hitertostai ncuraigia, pleurodynia^ lumbago, sciatic&t
and other pains of similar character may generally be made
to vanish as if by magic under the potent influence of the
&]mentation vigorously applied, Htmictanta, being aa acute
toxemia, in most cases, at least, is more obstinate, but is
often greatly relieved.

In nvuraigia and acute artirular rheumatism, in which
the application of cold as a linisKing measure may cause a
return of the pain, the parts may be allowed to cool gradually,
by leaving the last fomentation cloth in place for i 5 or 20
minutes, or until it has become nearly of the temperature of
the skin. It should then be removed^ the part dried and
geotly rubbed, then covered with a warm dry soft ilaunel
folded to several thicknesses.

The accompanying cuts (Figs> 149, 150) show at a glance
the areas over which hpt applications should be made for
relief of the most common localized painful affections and for
combating congestions in the internal viscera by means of
derivative measures. Further details respecting the methods
of controlling the visceral circulations have been giveu else^
where (1260-1291).

ts

I

:^

THE TECHNIQUE OF HYDROTHERAPY.

805

In pneumonia, pleurisy^ and acute bronchitis, the fomen-
tation is an invaluable remedy. In the acute stage of the
disease^ fomentations should be employed only for short
periods, the cool compress or the ice-bag being applied in
the interval, changing every 20 minutes for the fomentation.

In pneumonia, cold or cool compresses should be applied
immediately after the removal of the fomentation, which
should be renewed at intervals of one» two* or three hours.

In pulmonary congestion from any cause, fomeatations to
the chest often render important service, relieving pain and
diverting the blood from internal to external parts, thus
lessening the congestion of the diseased long. In making the
application, the region of the heart should be avoided if
possible. The application should be made to the whole chest
or to the back and sides especially (1270).

A fomentation to the back of the chest accompanied by a
cold compress to the front (the hot and cold comprciss
(1356), is perhaps the best of all means of combating
passive pulmonary congestion. By means of the foment a*
tion the bronchial vessels are drained into the skin, while the
cold compress stimulates contraction of these vessels by reflex
action.

In cases of hemorrhage of the iungs a very hot fomenta-
tion may be applied to the upper part of the spine and back
of the neck in connection with the cold chest compress.
The application should be very short (3 to 5 min.), and should
be repeated every 15 minutes.

In the application of heat for derivative effects upon a
lung, an ovary, or other vise us, the temperature should be
high enough to cause a painful sensation of excessive heat, or
as high as possible without actually injuring the skin. Thus
the reflex effect of sharp irritation of the cutaneous nerves
will be obtained, with contraction of the vessels of the part
which it is designed to influence, and the collateral anenna
which it is desirable to establish by diversion of blood to the
skin, will be aided by excitation of the vasomotor centers.

RATIOKAL HYDROTMBRAPY.

Very hot fomentations should be applied in the early stage
o( boils, not only for the reHef of pain, but to stimulate the
vital activities whereby the disease may be aborted. Fomeo-
tations promote suppuration in fully developed boils, or
** bring them to a head/' as the laity say, but it is exceed-
ingly questionable whether under any circumstances the sup-
purating process should be encouraged* If pus is present.
It should be reached as quickly as possible by means of tha
surgeon's knife, and antiseptic treatment should be applied
at once. Fomentations are, however, exceedingly valuable
in these cases, notwithstanding the wrong theory of their use;
for if applied early enough, suppuration may be averted
by the stimulation of the vital activities of the tissues^ and
the increased fluxion of healthy blood through the infected
parts. Daring the painful stage, when pus is forming, very
short hot applications afford relief by producing strong revul-
sion, distributing the blood to surrounding parts. The com-
mon practice of applying hot poultices to boils is uncleanly
and inconvenient, and has no advantages over moist heat
derived from fomentations with soft and easily moistened
fabrics^ as the hot cotton poultice.

The moist heat of a fomentation, properly managed, affords
more relief than any other measure in cases of rkeumaiic pains
in either muscles or joints. The fomentation should be
applied all about the joint, and should also cover the limb for
several inches above and below the joint, if possible. These
applications may all be made several times daily. During
the day it is best to follow the fomentations with dry cov-
erings tQ protect the joints, and at evening the application,
made just before the patient retires for the night, may be foU
lowed advantageously by the heating compress. The latter
should be made of soft, very thin material,— four to six thick-
nesses of cheese-cloth, — and covered with oiled muslin or
some other water-proof material, then with a thick layer of wool
or cotton, and several layers of woolen bandage outside of all*

Very hot applications made to the upper part of the neck

I
I

THE TECHNIQUE OF HYDROTHERAPY.

807

or back of the head, also the top of the head and the face,
constitute one of the most efficient means of relieving cerebral
cangtstian. This measure is especially useful in thkt form of
congestion or hyperemia of the brain due to overwork. Tht
^icmperatun' s/untld be /jj^ ta i^o'^\ or high enough i& induce
flight pain at the beginning a/ the afipiication, A hwer
temperature than this has the effect ta produce slight con-
gestion in a norma! brain^ or to increase the conges f ion
I when the blood-vessels are ovcrdis tended. The compresses
phould be light, and should be renewed every two or three
minutes. Two compresses are required for appHcations of
this sort, so that when one is removed, a freshly heated one
may be applied instantly, allowing no time between for cool-
ing of the surface by evaporation. The sensation of weight
and pressure at the back of the head, of which anemic neuras-
thenics often complain, and which commonly results from
excessive mental work, loss of sleep, and other exhausting
influences, generally yields promptly to these appHcations.
Light, very hot fomentations are exceedingly useful in

t nearly all forms of nervous headache, whether occipital or
frontal The compresses should not be large or heavy, and
should be frequently changed.
In cases of low-pressure headache {anemia of the brain)
relief is best obtained by the heating compress to the bead

P^nd by moderately warm applications around the neck,
whereby the blood supply of the brain is increased.

In cases of great loss 0/ blood; fatal syncope may be pre-
vented by making moderately hot applications to the head,
and so encouraging the circulation of blood in the brain* The

i application should be made especially to the neck and the
top of the head Hot applications made to the face alone.
Of to the sides of the head or the occiput, might temporarily
decrease the volume of blood in the brain. Very hot appli-
cations may also momentarily increase the anemia.
For indigestion, colic, suppression qf urine, constipation
accompanied by abdominal pain and tenderness, torpid liver,

RATIONAL HYDROTHERAPY.

and dysmenorrhea, the very hot fomentation is a remedy of
great value, and may be used with brilliant results. The
efficiency hi this measure in relieving sick-headncke is unri-
valed, the applications being made to the 5pine» head, neck*
or stomach.

When employed to relieve suppression of the urine from
congi^stion of the kidneys or in acute nephriiis, the fomenta-
tion should cover the whole central and lower part of the
back, extending well around to the sides. The application
should be as hot as the patient can bear, for lo minutes, and
should then be followed by cold friction for i minute, the
parts being afterward well protected by dry flannel. The
procedure may be repeated every 30 minutes. If the patient
has good power to react, the heating compress may be
applied instead of cold friction, and may be left in place
until the following application of heat.

In hysteria, very hot fomentations may with great advan-
tage be applied over the hyst erogenous zones when pain is
present.

Dr. Noir, a French physician, a few years ago pointed out
the fact that very hot applications are of great value in the
treatment of herpes eircitiatus, the applications being made
daily, at a temperature of I23"\ When the disease affects the
scatp, bichloride of mercury should be added to the water
employed for the fomentation, in the proportion of one part
to two thousand. It is well in some cases of this kind to
make the bichloride application continuous by means of layers
of gauze saturated with the solution and covered with oiled
muslin.

Very hot water (140° F.) is wonderfully successful in the
treatment of acne of the face. For many years the author
has made use of hot applications to the face in the fonn of
the hot spray or small hot fomentations, or hot water applied
by means of a soft sponge, in cases of this sort. The tem-
perature required is about 140^^, The greatest inconvenience
in the use of this remedy for acne is the fact that the effect

'^

THE TECHNIQUE OF HYDROTHERAPY

809

of the hot water can not be coafined to the diseased parts.
In order to avoid this objection, the author has had made
a simple device for applying moist heat to acne, which he
finds very convenient. It consists simply of a conical, hollow
copper cone (Fi^- ^77)' furnished with a handle* The
cylinder is closed with a small cork, and the point covered
with a small mass of moist cotton. Being filled with boiling
water, and the cork placed so as to prevent spilling, it is ready
for use* The cotton -covered tip is moistened, then applied
to each pimple or blotch, and held there for one or two sec-
onds, or as long as the heat can be endured* By this simple
device, the applications can be made in rapid succession^ and
to the diseased structures alone. The application should be
renewed at least twice a day, each pimple being touched
from four to six times at each sitting.

Fomentations have been successfully used (or the relief of
irreducible hernia.

The fomentation to the spine or abdomen may be used as
a heating measure preparatory to a general cold procedure*
Used in connection with cold wet friction, it aids in lower*
ing the temperature in febrile conditions accompanied by
diminished heat elimination.

It is impossible to enumerate all the morbid conditions in
which the fomentation is found useful. We might mention,
further, the following : Hysteria, hysterical anorexia, UptQ*
meningitis, spinal irritation, acute thorca, chorea major,
general tic, paralysis agitans, tetany, occupation neuroses^
angiomnrotic edema, scleroderma, mn scalar contraction,
aieoholism, delirium tremens, morphinism, cocainism^ lead
poisoning, heat stroke, dermalgia; over the liver and spleen
in malarial fever; as a means of relieving abdominal pain
occurring during gestation; as an application to the abdominal
surface in parturition; as a spinal, cardiac, or cephalic
application in collapse or shock; in retinitis, keratitis,
chronic granular conjunctivitis, typhus, typhoid fever, the
plague, smallpox, scarlet fever, infiucnsa, chronic dysentery^

8to

RATIONAL HYDROTHERAPY.

•"»• :■

miliary fever, ftbricula^ locomotor ataxia, diabttes^ chr&nU
gastritis, tuberculosis of the lymph glands^ IVtits disease^
Hihemia, increased peristalsis, gastric ulcer, cholera m^rius^
cholera in/anium^ Asiaiic cholera, appendicitis^ torticollis^
ascendiftg paralysis. Bells palsy, Meniere's disease, paraly-
sis of the circumflex nerve, myelitis^ anterior poli&myelitis.
The thorough application of the fomentation two or thiec
times a day for a week or two preceding an abdominal opera-
tion, in cases in which chronic or subacute peritonitis is pres-
ent, aids much in preparing the patient for safe transit
through the perils of the operation. The operation should
not be delayed, however, when urgently indicated.

The hot compress has many uses in connection with other
procedures, particularly the cold compress in producing anal'
gesic, revulsive, and derivative effects.
1334 Contraindications and Precautions.^ — i. The fomentation
has been greatly abused. When this procedure gives rise
to profuse and weakening general perspiration, it should be dis-
continued, and hot sponging substituted. The temperature
of the water in hot sponging may be some degrees higher
than that used for the fomentation, for the reason that a
smaller area of the skin is involved in the treatment at a
given moment.

2. it is generally wise to follow the fomentation by a very
brief application (4 to 30 sec.) of cold by means of a com-
press wrung very dry out of cold water.

3. Great care must be exercised in the use of the fomen-
tation to avoid damage to the skin in cases of paralysis or
diminished sensibility.

4. When used for the relief of neuralgic pain, as sciatica*
toothache, and nervous headache, and also when employed
for the purpose of producing remote vasomotor effects, as for
the relief of congestion of the liver, in hyperesthesia of the
lumbar ganglia of the abdominal sympathetic, in cases of
chronic gastritis, pelvic inflammation, and in similar condi-
tions, the heat of the fomentation should be as great as can

THE TECHNIQUE OF HYDROTHERAPY.

8ll

be borne without injury to the skin, and sufficient to produce
slight pain when the application is first made.

5. As the fomentation usually produces more or less per-
spiration, care should be taken to protect the patient after the
removal of the fomentation, and in most cases a tepid or cool
shower, towel, or sponge bath is advisable. When (or any
reason a cold application can not be made, the patient should
be wiped dry with a soft towel, and covered sufficiently to
prevent chiHing; but the covering should not be so warm as

I to induce continued perspiration*

6. In cases in which the fomentation is applied for the
relief of an acute inflammatory condition in which the part
affected is so situated that the application comes in immediate

\ contact with it, it must be very brief (not more than j to lO
minutes) repeated at intervals of two or three hours, cold
compresses being applied during the interval In case the
f inflammatory affection is situated in an internal viscus, the
[application may be continued for half an hour, or even for
la longer period, provided there is not at the same time a con-
Isiderable genera! elevation of temperature. The rea&on for
this will be apparent when it is considered that heat is
directly stimulating; and while heat may be briefly applied
directly to the inflamed parts, as a means of relieving pain,
\ a long-continued application might result in stimulating the
inflammatory process* When the inflamed part is more
deep-seated, however, the heat of the fomentation does not
I reach the diseased part, but its blood-vessels are made to con-
tract through the influence of the heat upon the vasomotor
I nerves, and through the induced collateral hyperemia.

7. In some painful aff actions, especially when the skin is
>ln a state of hyperesthesia, the application of intense heat
I aggravates the pain as well as other symptoms. In such
[cases more moderate heat — neutral or even cold or heating
j compresses- — should be employed

8. It should be remembered that if a fomentation is left in
I contact With the part long enough to allow the temperature

8l2 RATIONAL HYDROTHERAPY.

to fall very considerably, an effect the very opposite from
that desired may be induced.

9. Vaseline should be freely applied to the skin before the
fomentation, when the latter is employed daily.

THE HOT-WATER BAG (Rg. 178).

1335 Heat, either with or without accompanying moisture, may
be applied by a variety of other methods, as by means of a
rubber bag filled with hot water. The exact effect of the
fomentation may be secured by wrapping a hot bag with a
moist flannel cloth. Hot bricks, bottles filled with hot water,
and other heated objects may be used in a similar manner.
Appliances of this sort are most commonly used when it is
desirable to employ heat for a considerable time, or when the
chief purpose is to communicate artificial heat to the body» as
in shock or collapse, asphyxia, and feeble circulation.

Dr. Chapman recommended the use of a hot bag to the
spine, the effect being, he claimed, to stimulate the sympa-
thetic nerve centers, and thus diminish the size of the small
vessels throughout the body. He insisted that the tempera-
ture of the application to the spine should not be higher than
120"^. I have for twenty years made use of the spinal hot
bag, and had constructed for the purpose a rubber bag some-
what broader and longer than that of Chapman. The applica-
tion is made not to the spine, but to the back, and hence should
cover a sufficiently broad area to bring under the influ-
ence of heat a considerable portion of the cutaneous branches
of the posterior spinal nerves. The special effects noted by
Dr. Chapman and others are due, not to the immediate
action of the heat upon the nerve centers, but to the reflex
influence effected through the impressions made upon the
nerves of the skin, and the influence upon the collaterally
related blood-vessels.

THE SYPHON HOT-WATER BAG.

1336 The syphon bag (Fig. 179) devised by the author some
twenty-two years ago, is a convenient method for applying

THE TECHNIQUE OF HYDROTHERAPY. 813

either heat or cold continuously. It is used in precisely the
same manner as the cooling or beating coil (1323). The
device consists of a bag, the sides of which are connected to
prevent excessive bulging, and with an opening at either end.
A tube connected with one end of the bag communicates with
a fountain, either in the ordinary manner or on the syphon
principle. Another tube connects the opposite end of the
bag with a receptacle at the bedside. The flow of water
IS easily regulated by means of a proper stopcock, or simply
by tying a string about the outlet tube. By means of a
series of bags properly constructed for fitting different parts
of the body, either heat or cold may be continuously applied
in a most effective manner, and the temperature may be per-
fectly regulated. The author has had prepared bags of differ-
ent shapes, which are adapted to use for different parts of
the body. He prefers the bag to the coil for the reason that
the amount of non-conducting material between the water
and the patient is less. The bag also fits the surface more
smoothly anU completely than does the coil, and is more
uniformly heated.

THE THERMOPHORE.

This is a rubber bag containing a quantity of a chemical 1837
compound which acquires the property, after being heated for
a definite time, of giving off heat at quite a uniform rate for
several hours, — from two or three to ten hours, according to
the conditions. Wrapped with a moist flannel, the thermo-
phore makes an excellent continuous fomentation. Without
the moist covering, it constitutes a most convenient and
serviceable means of applying dry heat for any desired thera-
peutic purpose. In preparation for use the bag is immersed
in boiling water for some minutes, until the contents are
liquefied.

The thermophore is especially indicated in cases in which
continuous and long-continued heat is necessary.

1339

11

RATIOKAL HYDROTHERAPY.

THE nuSTARtJ FOMENTATION.

This measure consists of an ordinary fomentation in which
mustard is added to the water employed in the proportion of
a tablespoonful of ground mustard to the quart of water. It
is not necessary to prepare a large quantity of water. One
quart of boiling water into which a tablespoonful of mustard
has been thoroughly stirred, and steeped for a few minutes,
should be poured upon the fomentation cloths placed in a
basin or paiL

The effect is that of the fomentation intensified by the
addition of the chemical irritation of the mustard.

The mustard fomentation is especially applicable to cases
in which a very quick and strong revulsive effect is desired, as
for the relief of severe pain, or to secure strong derivative
effects. Care must, however, be taken to avoid excessive
irritation or blistering of the skin.

THE NEUTRAL COHPRESS.

This is a compress at 92'^ to 97^, its temperature being so
nearly that of the skin that neither thermic nor circulator}*
reaction is produced. Its effects arc simply those of a poul-
tice. The sensibility of the cutaneous nerves is lessened by
the imbibition of mnisture, as in the neutral bath. The surface
covered by the compress is protected from external irritants
of all sorts. A quieting effect is thus exerted upon that por-
tion of the interior of the body which is in reflex relation with
the cutaneous surface treated.

Therapeutic Applications* — The neutral compress is by no
means so useful as the cool or the cold compress, but neverthe-
less renders extremely valuable service in special cases. It is
useful as an application to the spine in hc&motor ataxia, es-
pecially as a means of relieving lightning pains. When applied
to the spine for this purpose, it should cover the whole lower
half of the back. It may be usefully applied over the abdo-
men in cases of hyperesikesia of the skin due to an irritable
condition of the abdominal sympathetic centers. It may

THE TECHNIQUE OF HVdROTHEHAPV.

8.5

replace the pmiltice in all cases in which this old-fashioned
measure might be profitably employed. It should be re-
marked, however^ that the use of a poultice or any substitute
for it as a means of encouraging suppuration is not in harmony
with the principles of modern rational medicine. The reten-
tion of the body heat encourages the growth of the patho-
genic microbes, causing the diseases together with the toxins.

The neutral compress may be usefully employed as a
soothing application for painfu! ivoumiSy and in dermatitis,
when the acute stage of the inflammatory process is past.
The addition of an antiseptic of some sort in very small
proportions is often useful in preventing the development of
micro-organisms, which is favored by the compress*

The heating compress applied after a fomentation is useful
in relieving the excrutiating articular pain of acute rheuma-
tism. As the compress is rather lightly coveredp and with
Hannel only, the neutral rather than the stimulating eSect is
obtained. The same measure renders valuable service in
cases of sprain^ joint injury from dishcatit^n^ chronic infiam-
mation of the joints, and even in cases of tuberculosis of
the joint

The neutral compress sometimes proves more serviceable
in relieving the pain of neuralgia in certain cases than either
hot or cold applications. The temperature should be about
95^, or as near that of the body as possible. It operates
simply by excluding irritation, preventing contact with the air,
and filling the tissues with water, whereby the nervous sen-
sibility is diminished. It is especially indicated in cases of
neuralgia affecting nerves very near the surface, as in der-
malgia and the neuralgia following herpes rosier. It some-
times proves successful also in most obstinate cases of hyper*
esthesia of the skin in which other measures have failed.

The heating chest pack and the moist abdominal girdle,
also the general pack, owe certain of their effects to the
properties which are characteristic of them in common with
the neutral pack. It is largely tlirough its nerve-quieting

RATIONAL HYDROTHERAPY,

influence as a general neutral compress that the wet-she
pack renders such signal aid in combating insomnia. The
author could easily cite many scores of cases of insomnia
which have been promptly relieved by this simple means.
The neutral abdominal compress acts with equal efficiency in
reheving hyperesthesia of the "abdominal brain/' the solar
plexus, and the lumbar gangha of the sympathetic.

THB ALTERNATE COMPRESS,

J

i

i

1340 This measure consists in the application of very hot and
very cold compresses in alternation. M

flethod-— The procedure is simply a succession of com-
presses renewed every half minute« — every other compress
consisting of a fomentation, and the alternate a compress
wrung quite dry out of cold or very cold water. The duratioaj
of each application respectively may be timed so as to mee^
any special condition. For example, the hot compress may
be given a duration twice that of the cold compress^ or the
reverse. As a rule, the duration of the hot application should
be equal to or greater than that of the cold. The procedure
must always begin with a hot application and end with a
cold one.

Physiological Effects. — The effects of alternate or sucx^es-
sive applications of heat and cold to some extent combine the
eflfects of both the cold and the hot compress. The sedative
effects of both applications are, however, absent, as only the
first effects are developed. The general effect of the applica-
tion is exciting or stimulating. The hot application, with
which the procedure begins, widely dilates the cutaneous ves-
sels, and especially the veins. The cold application causes,
first, contraction, then with the reaction which immediately
follows, active dilatation of all the vessels of the skin, with
an increased movement of the blood. When the hot and
cold applications are of equal length, or when the cold
application exceeds the hot in intensity, a decided thermic
reaction occurs, with marked stimulation of the metabolic

processes. The application is thus both revulsive and exciting
to a high degree.

The internal vascular spasm occasioned in reflexly related
internal organs by the cold application is quickly terminated
by the hot application which follows in alternation at regular
intervals during this procedure. After the ordinary cold com-
press the internal vascular contraction gradually disappears
as the skin returns to its natural temperature; but when the
skin is suddenly heated by the fomentation, the irritating ef-
fects of the cold application are abolished at once, and the
blood-vessels of the part are dilated, thus encouraging the
general movement of blood-

There is probably no other procedure which is capable of
so intensely and rapidly exciting the movement of the blood
in superficial parts and in deeper parts associated with them,
either in sharing the blood supply, as in the case of an under-
lying muscle, or through reflex nerve connections (1259)^
as when applied to a cutaneous area having vasomotor rela-
tions with the liver or some other viscus,

TKerapeutic Applications. — The alternate compress may
be advantageously employed to combat the tendency to sup-
puration in cases of /i?eaii::^d suppuration when beginning
blueness of the parts shows stasis of the blood and the estab-
lishment of a condition of the circulation favorable to the
suppurative process. By these alternate applications better
effects may be obtained than from the application of either
heat or cold alone. Continuous cold lowers the vitality of a
part, and thus lessens the ability of the tissues to combat the
microbes present, and lessens the supply of oxygen, by slow-
ing the movement of the blood. Hot applications excite the
the tissues to increased activity which is increased by the
thermic reaction following the short cold application. Heat
applied to the skin widens the surface vessels, and narrows
the vessels of the deeper structures; while cold produces the
very opposite effect* Thus by the alternate application of
heat and cold the vessels of the deeper parts, in which sup-

5*

RATIONAL HYDROTHERAPY,

puration is threatened, may be kept in such constant move-
ment, contracting and dilating, that the cell-paralysing pto-
mains will be washed out, the stagnant blood will be moved
on, and a new supply of fresh, active leucocytes will be
brought into the part. This effect of the alternate procedure
in some cases renders it superior as an analgesic measure to
either the cold or the hot compress alone, through the relief
of venous stasis^

The alternate compress is superior to most other measures
(or combating the tendency to bed-sores, which are so likely
to appear in typhoid fever, tuberculosis, and other wasting
disorders. The alternate compress may be usefully employed
as an application Xo paraiy::t'd Umbs, and to parts affected by
c/ttiifliiiHs, also as a means of stimulating absorption in drof^ty
o( the abdomen, dropsy of the chest, and in chronic pleurisy
and fneumimia, in which the parts damaged by the acute
inflammatory process have not been wholly restored. Alter-
nate hot and cold applications made to the spine powerfully
impress the whole central nervous system, and form a most
effective means of arousing a patient from the lethargy of
0pium poisonings profound akohol inioxicaiion, or poisoniag
by any other narcotic drug. The author recalls very vividly
a case of opium poisoning to which he was called in consulta-
tion some twenty-five years ago, in which a patient's pulse
was reduced to less than twenty, and respiration to four per
minute. Thoroughgoing hot and cold applications to the
spine quickly brought the pulse to a nearly normal count, the
respiration became twelve per minute within five minutes, and
the change in the entire aspect of the case was so marvelous
as to seem little short of a miracle to the by-standers, who
had never before witnessed the powerful stimulating effects
of thermic applications properly managed.

THE REVULSIVE COMPRESS.

1341 The revulsive compress differs from the alternating com-
press in its mode of application only in the different timing of

r\

THE TECHNIQUE OF HVDROTliERAPY.

Stg

the heat and cold. In the alternating compress the applica-
tions are of equal time, or at least the hot application does
not exceed the cold. In the revulsive compress the hot appli-
cation is applied for several minutes, while the time of the
cold application is only a few seconds. Usually the hot appli-
cation, or fomentation, remains in place for 4 or 5 minutes,
or at least until its maximum heating effect is reached. It is
then withdrawn, and a cold compress is instantly applied and
allowed to remain in place for 20 to 40 seconds, or just a suffi-
cient length of time to absorb from the skin the heat commu-
nicated to it by the fomentation.

Physiological Effects.— The purpose of this mode of pro-
cedure is to secure a strong circulatory reaction without ther-
mic reaction. The vascular dilatation resulting from heat is
transient in character. Within a short time after the heat is
withdrawn and the skin exposed to the air, the blood-vessels
sfre made to contract by the cooling resulting from the evapo-
ration and contact with the air at the ordinary atmospheric
temperature. The circulatory reaction following a cold appli-
cation is, however, much more lasting in character, and is also
more thoroughgoing, since it is an active rather than simply a
passive or paralytic dilatation of the blood-vessels, and influ-
ences the arteries to fully as great an extent as the veins. By
a short cold application following a hot application, the atonic
reaction is converted into the tonic reaction of cold, the state
of the blood-vessels being thus very materially changed, and
active fluxion of the blood in the skin is thereby main-
tained for a considerable length of time (667).

The alternate compress produces both circulatory and
thermic reaction. In the revulsive compress the procedure
is so managed that the thermic reaction is wholly sup-
pressed. This gives to it superior power as an analgesic
measure, in which respect it is, in fact, superior to all other
hydriatic processes. This end is attained by superheating the
skin before the cold application, then making a cold application
of just sufficient intensity and duration to absorb the surplus

I i

' 4

'J

820 RATIONAL HYDROTHBRAFT.

heat without reducing the skin temperature below the normal
point. Under these conditions, thermic reaction can not pos-
sibly occur; hence metabolic activity is not increased, nettho'
do systemic or local disturbances occur, and a purely revulsive,
non-excitant, and analgesic effect is obtained.

Therapeutic Applications. — The revulsive compress is
especially applicable to all forms of neuralgia and painful
affections of every description. In some cases relief may
best be obtained by very hot applications, in others by cold
applications, and in still others by alternate applications ; but
in quite a large proportion of cases in which pain is present,
..^ applications of a character which produce thermic reaction

'i^ increase the pain by exciting the affected nerves. Tliis is

especially true of cases in which inflammation is present
For this class of cases the revulsive compress is indispensable.
This compress is also a powerful decongestant and deriva-
tive. It is of value in cases of visceral congestion^ especially
in such painful conditions as gastric congestion^ gastritis^
enteralgia, acute sciatica, neuritis, painful affections of the
eyCy and spinal irritation. It often affords immediate relief
from the excruciating pain of toothache. It is applicable also
in cases of gastric crises, and other painful conditions accom-
panying locomotor ataxia,

ALTERNATE APPLICATIONS TO THE SPINE.

1842 The importance of this special procedure will amply justify
its separate consideration as a special measure for securing
other than purely local results. In addition to hot, cold, and
neutral applications, there may be made to the spine a num-
ber of alternate applications in the form of either the Scotch
douche, the alternate douche, or the revulsive douche, all of
which are useful under special circumstances. There are
other non-percutient applications capable of producing similar
effects, which may also be employed.

Alternate applications so managed as to produce the
effects of the Scotch, the revulsive, or the alternate douche.

THE TECHNIQUE OF HYDROTHERAPY-

82f

minus the percutient or mechanical effects, may be conven-
iently made by the use of two bags, one filled with very hot
water, the other with cold water ; by the fomentation and
the cold or ice compress in alternation ; by alternate hot and
cold sponging ; and by the hot and cold pour. The method
of applying these several measures to the spine is not different
from that pursued with other regions of the body, but may
be briefly described by way of general illustration. The hot
and cold water bags, hot and cold compresses, hot and cold
sponging, are all best applied with the patient lying down
upon the face, or upon the side and inclined toward the face.
The hot and cold pour must be applied with the patient sitting
upon a stool, leaning slightly forward, with the arms folded
in front The hot and cold water bags are the most conve*
nient means for prolonged applications. The hot and cold
compress, or the fomentation followed by the cold compress,
or rubbing the spine with a piece of ice covered with two or
three thicknesses of cheese-cloth, are more vigorous meas-
ures which may be employed when it is desired to secure
results by a short intense application.

Alternate sponging is a less vigorous application than the
alternate compress, and is most frequently employed when
calmative effects are desired, through the tonic influence of
this application upon the spinal centers. The alternate pour
may be used in cases in which the alternate douche is not
readily available.

In the use of the hot and cold water bags, the hot bag
may remain in position for lo to 15 minutes, the cold bag
30 seconds to 2 minutes. In the employment of the alter*
nate compress, the fomentation is first applied for jo or
IS minutes, then a very cold compress for half a minute.
A thin compress wrung very dry out of ice- water is best
for the purpose when the object sought is the relief of the
pain which accompanies so-called spinal irritation. If excit-
ing effects are desired, the hot and cold applications should
be of about equal length; viz.* 1 5 to 20 seconds each.

I
I

RATIONAL HVDEOTHERAPy,

Alternate sponging is a measure which may be con*
tinned for as long a time as is found agreeable to the patient,
and may be repeated as often as indicated The hot spong-
ing is best done with a very soft sponge attached to a handle
(Fig. 1 80). The sponge should be of good size, and great
care should be taken to press out the hot water sufSciently
to avoid risk of blistering the spine. A sponge wet in cold
water may be used in alternation with the hot sponge, or
a piece of ice wrapped in thin muslin, or a couple of thick-
nesses of cheese-cloth wet in cold water may be quickly
rubbed np and down the spine for 3 to 10 seconds after the
hot sponging has been continued for a few seconds.

In the employment of the hot and cold pour, care most
be taken to adapt the application carefully to each itidividual ■
case. A somewhat prolonged (5 to S min.) hot pour to the'
spine, followed by a cold pour for 15 to 20 seconds, is a most
excellent means of relieving congestion of the cord. TheH
pour may be very conveniently administered with the patient
sitting over the edge of a full bath-tub, or upon a fow stool _
in a bath' tub, the feet being placed in hot water for deriva- ^
tive effects, and to protect them from contact with the cold
water. When exciting effects are desirable, the duration of
the heat and the cold should be about 15 seconds each*
Powerful exciting effects may be produced by this means.

Therapeutic Applicatians,— The alternate process is oj
great value in neurasthenia; especially in very feeble cases,
a remarkable reviving effect is at once experienced by the
patient during the application, and for some time afterward*

Alternate compresses or sponging to the spine afford
one of the most eflicient means of arousing the patient from
Qfiium or uk&hol narcosis, ft is equally indicated in Prussia
acid poisoning, and in cases in which there is a depressed
condition of the spinal centers, as in syncope, asphyxia from
coal-gas or carbonic acid gas poisoning, or drtjivning. The
application should be continued not only until the patient
shows evidences of returning consciousness, but for some time

THE TECHNIQUE OF HYDROTHERAPY. 823

after, to maintain the necessary degree of nervous and vital
activity. The author has more than once employed this
measure with success in threatened collapse under chlorofortn^
and to combat grave symptoms arising from the injection of
cocaine, years ago, when the anesthetic properties of this drug
were first known and its toxic properties not so well under-
stood as now. Alternate applications to the spine may be
systematically employed in general paresis^ acute ascending
paralysis^ pachymeningitis^ and muscular atrophy. It is fre-
quently serviceable in chronic anemia, toxemia from gastro-
intestinal disorders, and general systemic depression in vari-
ous acute and chronic affections.

ALTERNATE APPLICATIONS TO THE HEAD.

In some cases of violent headache, especially the con- 1343
gestive form, most excellent results are obtained by alter-
nating hot and cold compresses, or hot and cold sponging
of the upper portion of the spine. The application should
begin at the occiput, and extend to a point midway between
the shoulders.

Very hot sponging (160^), followed by the application of
an ice-bag, is one of the most efficient means of relieving
cerebral congestion. In severe cases an ice compress may
be applied over the top of the head and the face, the hair
being well moistened, at the same time that the hot sponging
is being applied at the back of the neck.

Another alternate measure which the author has found
serviceable in relieving cerebral congestion and headache is
the application of steam to the face by means of a metal
mask constructed for the purpose, alternating with a cold
blast. The face is exposed to the action of steam for 2 or
3 minutes, then for about half a minute to a strong blast
of cold air from a fan. Thus the face is cooled not only by
contact with the cold air, but by the rapid evaporation taking
place from the moist surface (Fig. 237).

824 RATIONAL HYDROTHERAPY.

THE HEATING COnPRESS OR LOCAL PACK (Pig. 181).

1344 This most valuable hydriatic procedure consists in a thick
moist linen compress well covered with flannel, with or with-
out an outer covering of impervious material.

The heating compress may be applied to any part of the
body. Its most useful applications are to the trunk, the
chest, the neck, the spine, and the joints.

riethod. — The principle upon which the effects of the heat-
ing compress depend is the production of reaction by a pri-
mary cold application, and the accumulation of heat by pro*
tccting the cold compress in such a manner as to prevent,
wholly or in part, the escape of heat by means of radiation
or evaporation.

The degree of protection may be regulated by the number
of thicknesses of flannel applied as a covering, or if complete
protection is desired, by the application of an oilcloth, rubber
cloth, or some other impervious material. Oiled paper may
be used in an emergency, in the absence of anything better.
In all cases it is necessary to cover closely the edges of the
coinpress so as to prevent the formation of air currents at
any part, as such currents produce cooling by evaporation.
Even though the area thus cooled may be very small, the
refrigerant effect produced may be sufficient to greatly dis-
turb or even wholly destroy the legitimate effect of the com-
press.

The degree of protection will be regulated by a number
of conditions; as, -

I. If the patient's temperature is elevated and the skin
hot, one or two thicknesses of flannel sheeting or one thick-
ness of flannel blanket will suffice, as the purpose is simply
to limit evaporation so as to prevent too rapid cooling. When
the surface is cool or cold, even though the temperature may
be elevated, several thicknesses of flannel (three or four)
may be employed. The covering should be sufficient to
insure slight warming of the compress, but not enough to pre-
vent drying by evaporation.

I

RATIONAL HYDROTHERAPY,

or varied. At the beginning and for some minutes after the I
cold wet cloth is brought in contact with the skin, there^
exists strong contraction of the vessels, and by reflex action the
same condition is prodTjced in the related intemai ar^^.
When reaction takes place, however^ heat begins to aocomu-
late, and dilatation of the vessels occurs, which increases with
the accumulation of heat, — a characteristic which gives to I
the procedure its name. This dilatation is at first an active
or tonic dilatation, in which there is an increased movement
of blood to the skin; but later, when the temperature has
risen above the normal temperature of the skin, the vessels
lose their tone and become relaxed. This is especially true
when an impervious covering is employed, so that the highest
degree of heating effect is produced. The degree of this
paralytic dilatation of the blood-vessels and the congestioii
will, of course, depend upon the exact mode in which the
bandage is applied^ and the degree of the protection* A
series of experiments made by Winternitz and Strasser, which
the author has repeatedly verified, shows that heating takes
place at quite a different rate, the maximum temperature
being reached at very different periods, according to the
mode of applying the bandage and the degree of protection
afforded (Exp. 69. 70).

When lightly covered, the heating compress slowly cools
by evaporation, producing an active fluxion in the associated
viscera; and by the improved circulation and nutrition, the
normal conditions arc restored, and the passive congestion is
overcome. With each reapplication there is contraction of
the arterial walls, which empties the blood-vessels, and dis-
lodges the leucocytes which may be adhering to the vessel
walls, thus antagonizing inflammation and chronic congestion.
As the compress warms up, the vessels gradually dilate again,
and the blood moves with increased velocity.

The degree of reaction also depends very much upon the
condition of the patient. Bloodless, very feeble patients
sometimes react very slowly, and in a particular case the effect

THE TECHNIQUE OF HYDROTHERAPY.

827

>f a well^protected compress may not be greater than that
[of a partially protected compress with another person* This
Ijact must be constantly considered in giving directions respect-
ping the application of the heating compress.

In persons in whom reaction takes place very slowly after
the application of the compress, so that uncomfortable chilU-
sess and other disagreeable symptoms are experienced, the
surface with which the bandage is to come in contact should
>e vigorously rubbed with the dry hand until red, or with the
land or a friction mitt dipped in water at a temperature ten or
if teen degrees below the temperature of the bandage.

The colder the water, the drier should be the compress.
The smaller the compress, the sooner will reaction occur.
>uring the warming-up period, before superheating begins,
lie effect of the heating compress is highly tonic, exciting
dl the functions of the skin and the internal parts connected
iifith the area treated. During the period of superheating, or
that in which the temperature rises above the normal tem-
perature of the skin» the peculiar excitation characteristic of
fheat is produced, including analgesic effects upon the skin and
associated parts, and also developing atonic thermic rese-
ction, and producing powerful derivative or revulsive effects.
If it is desired to emphasize the tonic effect of the appli-
ition, it is only necessary to lower the temperature and
make the covering relatively less, so that excessive heating
^may not occur.

If the effects of heat are desired, with the strongest pos-
sible revulsive effects, the moist bandage should be very
ifarmly covereil with blanket flannel^ and the impervious
jrotection carefully applied. It may be well to remark that
|when the greatest heat accumulation is secured by the imper-
ious covering, the skin is most strongly stimulated, and the
[most powerful derivative effects are induced ; but when
the impervious covering is omitted, vascular activity and tone
iing maintained in the skin, a strong tonic effect is exerted
Upon the viscera, and most powerful fiuxion effects occur

828 RATIONAL HYDROTHERAPY.

These facts should be borne carefully in mind in the therapeu-
tic application of the heating compress, especially in its use
in the form of the abdominal compress or the wet girdle.
1346 Therapeutic Applications. — This measure is indicated in

ifisomnia, t7idtgestion, constipation, bronchial catarrh^ iatyU'-
gitis, articular rheumatism^ and a great variety of other con-
ditions. Whenever there is need for increased movement
of blood, absorption of exudates or effusions^ quickened func-
tional activity, or to relieve swelling from venous stasis, the
heating compress may be advantageously used. The pro-
tected heating compress proper should be used in cases of
old joint trouble, in which the leading object sought is to pro-
mote absorption of exudates; in cases of chronic bronchial
catarrh; to relieve cough in tuberculosis and spasm of the
bronchioles in tf^///;;/^; for the abdominal compress and the
leg compress when strongly derivative effects in favor of the
cerebral circulation are desired; to the head for the relief of
acute corysa, headache, vertigo, or iiisomnia due to anemia;
to the spine for spinal irritation (1355).

Impervious protection should also be used for the gastric
or abdominal heating compress in cases oi hypopcpsia. in
hyperesthesia of the abdominal sympathetic, and in cases
in which patients chill easily, and whose circulation and heat-
making powers are so sluggish that the compress does not
become sufficiently heated to accomplish the result desired
unless evaporation is wholly prevented.

One of the most practical and effective applications of this
compress is in the treatment of chronic rheumatism for the
relief of pain and to restore lost joint motion. Hot fomen-
tations applied night and morning, followed by the heating
compress to be worn during the succeeding twelve hours,
constitutes a good method in the treatment of rheumatic
joints.

A very important use for this procedure is in the treatment
of pneumonia. The compress should be large enough to cover
the whole chest, and should be renewed as soon as well

/^

THE TECHNIQUE OF HYDEOTHERAPY.

S29

warined, so as to encourage energetic fluxion in the lungs,
the importance of which has been pointed out elsewhere.

The heating compress hkewisa finds useful employment as
an application to the trunk in acute and chronic peritonitis
(frequently renewed, in the acute form), amyloid infiltrati&n
of the liver ^ amyloid kidney^ mute ascending paralysis^ con-
gesiioH of the spleen^ ascites, infectious Jaundice, icterus ne^-
tmtornm, appendicitis, enteralgiay intestinal catarrh, gastric
ulcer ^ hyperorexia, Addison s disease, ckranie migraine; to
the spine in tacomatar ataxia and occupation neuroses, spinal
neuralgia, hyperpepsia^ and as a local measure in muscular
rheumatism, chronic appendicitis, chronic ovaritis and sal-
pingitis; to the scalp in anemic insomnia; and as a deriva-
tive measure in acute coryza.

Precautions* — Few measures o( treatment are capable of
producing more disastrous results than the beating compress
when improperly used, and especially when so applied that
prompt reaction does not occur. The slow but prolonged
chilling produced by the evaporation resulting from the loosely
applied or imperfectly protected heating compress, when not
indicated as a therapeutic measure, is certain to result in
visceral congestion and aggravation of the condition for which
it is appked, with rheumatic pains and numerous other incon-
veniences, both general and local. The effects, in fact» are
precisely the opposite of those desired. There is no other
hydriatic measure the success of which depends more wholly
upon exact technique; and few which yield more gratifying
results when properly applied,

THE WET OIRDLB (Rg. iSa)*

This application is practically the same as the half -pack,
except that it covers a more limited area. The region to
which it is applied is bounded by the nipple line above and
the hip joints below. The application is addressed especially
to that portion of the skin having most immediate reflex rela-
tion with the abdominal viscera.

1347

Sjo

RATIONAL HYDROTHERAPY

sagec

This measure has been exceedingly popular in Germanjr
for at least a hundred years, and possibly a much lor
time, under the name of *' Neptune's girdle."

Requisites A linen bandage usually eight or nine incfc

wide and about three yards in length, or sufficiently long to^
pass three times around the body; a flannel bandage three
or four inches wider; and a water-proof covering of oiled silk
or other impervious materiaL ^

Method.— The application is to be made in accordance with"
the principles already pointed out in relation to the heating
compress (1344). The girdle may be wide enough to reach
from the axillst to the hips, when it is termed the frunk
pad'. In some cases also it is better to reduce the size ot
the bandage at the starts covering only the abdominal sur^fl
face instead of passing the bandage around the whole
trunk. The impervious covering may be applied or omitted^
as indicated. ^

181S Physiological Effects, — The wet girdle certainly produces
a powerful effect upon the vasomotor centers, and through
them upon the abdominal viscera. It is without question one
of the most effective and well-known means for combating
visceral irritation and congestion. The slight chilliness which
is at first produced disappears more quickly than when a larger
surface of the body is involved, as in the wet -sheet pack* The
patient soon experiences a pleasant, cool sensation, and a
sense of well-being, with relief of any sensation of heaviness
of the epigastrium or of the head, vertigo, and other unpleasant
symptoms which may have previously existed. Later, perspira*
tion may appear. General perspiration is less likely to occur
than when the wet-sheet pack is employed, ff the covering
15 properly adjusted, the pack may be continued for several
hours without inducing perspiration or other than a simple
prolonged tonic reaction with powerful derivative and calma-
tive effects upon the internal viscera. The wet girdle acts
powerfully upon the sympathetic, the moist warmth which
follows the first chill soothing and relieving the visceral irri-
tation. That there is a most intimate relation between

TMe tECHNiQdE 61^ HYDROTHERAPY.

S31

the viscera and the structures of the abdominal wall is
clearly shown by the strong contraction of the abdominal
muscles frequently occurriog in connection with visceral irri-
tatioti. In these cases, extreme hyperesthesia is often present
in both the right and the left ganglia, and in the sub-umbilical
sympathetic ganglia, or the so-called lumbar ganglia of the
sympathetic and the lumbo-aortic plexus. The application of
cool water to the abdominal walls stimulates contraction
of the bladder, uterus, and bowels, — another evidence of the
intimate nervous relation between the skin and the muscles
of the abdomen and the viscera contained within its cavity.
The wet girdle may be so managed as to be practically a
prolonged neutral bath; or it may be made a powerfully
derivative procedure, according to the degree of protection
provided.

Elsewhere full explanation has been made of the influ-
ence of induced cutaneous hyperemia upon the portal circula-
tion, and both the arterial and the venous circulation of the
stomach, liver, lungs, and other viscera (1271 to 1277).

Therapeutic Applications, — ^The moist abdominal bandage
is one of the most valuable of what might be termed the
minor hydr ot her apeu tic measures. Its use is applicable to all
cases in which there is evidence of visceral irritation or hyper-
esthesia pt the abdominal sympathetic ganglia, a condition
which is almost universally present in chronic dyspepsia, c&n^
slipitfifrft, gasiric and iniesiinal catarrh, hepatic cangcsti^m
and other disorders of the Uver which result from chronic gas-
tric disorders, and in many cAramic pdvic disorders. It is
almost a panacea in cases of chronic backache, also in heavi-
ness across the abdomen, when the seat of the discomfort is

^not located in the pelvis.

The therapeutic effect of the wet girdle differs somewhat,

[according to the exact point at which it is applied. Over the
lower portion of the abdomen the chief effect is concentrated
upon the bowels, allaying irritation, increasing secret ion« and
thus tending to promote normal activity and to relieve ckrcnu

laie

^ fHffii, Appfied huumJ Ae itpper pottioft of the A4&-

mm m bandage m osefsl as a means of promtitmg b^tli-

actmty of the slomach and ttrer. Its efiect k power-

niUy revulsive. It stimolales the vasonKitor centers^ and

ace relieves €4jm^^itian of the liver^ kidn^s^ and other

4ninal viscera. It is also of much service in ordtnair

r/r/xm with diiatatwn and ^r&lafse of the si&m^ifJk, fl

There is no mote serviceable measure m the treatment Of
chronic indigestion in all its forms. lo kyf^rfitfsm^ it should
be applied vary cold, wmn^ very diy, covered just sufltdentjy
to secure good reaction, saperheating being avoided hy omit-
ting the impervious <!ovenng. This is also true in each of
the conditions above mentioDed.

lo kyp&pepsia^ the l^ndage should be wrung out of water
at a temperature of 60^ to 70^, very diy, and should be well
covered with flannel, the impervious covering being also
applied when necessary* to secure good reaction, as it is desir-
able to secure the most powerful revulsive effects possible, and
also the atonic thermic effect of heat.

For flatuleme of the stomach or intestines, a cold, well-
wrung bandage with a moderate amount of flannel cover-
ing should be employed. Dilatation of the colon, enteroptosis^
lack of normal sensibility in the lower bowel, are best treated
by the bandage wrung very dry out of very cold water, and
lightly covered with flannel. The bandage should be renewed
just before it becomes dry, or every three to four hours.

A well-protected heating compress may be advantageously
employed in cases of hyperesthesia of the lumbar ganglia^
general sensitiveness of the abdominal sympathetic^ enter'-
algia, chronic peritonitis, painful conditions resulting from
peritonitis, recurring appendicitis, or inflammation of the
cecum when the case is for any reason not suitable for opera-
tion.

The moist abdominal bandage, either with or without the
impervious covering, is a most excellent means for combating
insomnia. The reaction should be strongly pronounced, so

THE TECHNIQUE OF HYDROTHERAPY. 833

as to divert the largest possible amount of blood into the skin
of the trunk as well as into* the portal circulation, which is
alone capable of holding all the blood in the body. As this
system is associated with the venous vessels of the abdominal
wall, it is possible by means of the heating compress ta divert
a large portion of the blood into this portion of the circu-
latory system, thus causing contraction of the cerebral ves-
sels and an accumulation of lymph beneath the dura mater,
whereby conditions favorable for sleep are secured (Schiiller).

For the relief of insomnia the wet bandage or girdle
should be applied at bedtime, and may be renewed to advan-
tage at least once during the night, as the bandage must be
kept moist in order to be effective. The patient is apt to
be nervously irritated when the bandage becomes perfectly
dry. It is also highly important that reaction should take
place promptly, as otherwise prolonged chilliness may result,
and the patient become so nervous and disturbed that the
hypnotic effect of the application is wholly lost.

The wet girdle, when properly managed, is a more valu-
able hypnotic in combating insomnia than any or all medici-
nal drugs.

The wet girdle may be advantageously employed in nearly
all forms of visceral irritation. Care should be taken, how-
ever, to avoid impervious covering. In hyperpepsia espe-
cially, this is necessary, and the bandage should be changed
every three or four hours. In hypopepsia the impervious
covering should be applied, especially in cases in which there
is marked evidence of congestion, as in chronic gastritis^ and
in congestion of the mucous membrane arising from cardiac
insufficiency or cirrhosis of the liver. The wet girdle is of
value in disorders of the menopause, serving to lessen mor-
bid sympathetic reflexes and vasomotor disturbances. In the
preparation of patients for abdominal operation the wet girdle
without impervious covering is of service. The bandage
should be covered with flannel only, and should be changed
every four to six hours, the purpose being to increase the
53

834

RATIONAL HYDROTKERApV.

\^A

movement of blood through the viscera, and thus prepare
them for the ordeal which the patient must undergo. This
measure is also of great advantage in gestation. It may be
used with benefit during the entire period, and especially dur-
ing the later months.
1350 Precautions and Contraindications* — t. It should be
remembered that the wet girdle is serviceable only when
moist* When it becomes dry, it should be removed, and a
dry flannel put in its place, after nibbing the parts with the
hand dipped in cold water; or it should be renewed,

2. With the majority of persons it is sufficient to wear the
girdle at night only- In cases of enteroptosis in which patients
suffer from backache and abdominal pain when on their feet,
the moist girdle may, however, often be advantageously worn
during the day, and should be supplemented by an ahdominal
supporter

3, When worn night and day, the wet girdle frequently
gives rise to an eczematous, or, in some cases, herpetic
eruption of the skinj sometimes boils make their appearance
in the region covered by the bandage. These morbid proc-
esses are in no way desirable, and care should betaken to pre-
vent them. The old notion that efiete matters are eliminated
through purulent discharges was long ago exploded. Neither
is any special benefit to be derived from the irritation pro-
duced by an eruption or any other morbid process. The
resources of hydrotherapy enable us to stimulate the skin
to the highest degree, and a healthy skin is more ready to
respond to physiological stimuli than is a diseased skin.

The eruption occurs as the result of wearing the moist
abdominal bandage only when it is not kept scrupulously
clean. It should be boiled daily, or rinsed in a ten-per-cent.
solution of chloride of lime, or a ten-per-cent. solution of sul-
phate of 2inc, or a one-to-one-thousand bichloride of mer-
cury solution. If cleansed daily by any of these methods,
the troublesome eruption which sometimes follows the pro-
longed use of the bandage may be readily prevented. There

4

/^

THE TECHNIQUE OF HYDROTHERAPY. 835

is no advantage whatever in this eruption, but on the con-
trary, a positive disadvantage. There are always present
upon the skin pus-producing germs, the development of which
is encouraged by the continuous warmth and moisture secured
by the bandage. The accumulation of perspiration in the
bandage furnishes a culture medium for the development of
these germs, and thus encourages the infection to which the
eruption is due. The surface treated should be daily washed
with hot water and yellow soap, and a little vaseline should
be applied.

4. Chronic invahds sometimes become addicted to the
wet girdle. They rely upon it to such an extent that they
may be said to be quite dependent upon it. This is quite
undesirable. As a means of preventing irritation and other
inconveniences arising from the constant. employment of the
girdle, it is wise to omit the application either during the day
or night, as may be most advantageous and convenient; or
if for any reason it must be worn continuously night and day,
it should be left off for a day at least once a week, a dry flan-
nel bandage being worn in its place.

5. As the protected heating compress, when applied to the
trunk, accumulates blood in the portal system, it is obviously
unwise to make use of this measure in conditions involving
chronic disease of the liver or spleen, and in inflammatory
affections of the stomach and bowels, in ulcer of the stomachy
in varicose conditions of the gastric veifis^ in hemorrhoids^
intestinal catarrh, bleeding fibroid oi the uterus, and in acute
pelvic inflammations or congestions. In these cases the wet
girdle covered with flannel only may be used with great
advantage.

THE ABDOMINAL HEATING COMPRESS.

This is a procedure similar to the wet girdle, but more 1351
limited in extent, being applied only to the anterior portion of
the trunk, from the pubis to a point an inch or two above the
epigastrium, and extending to the loins on either side.

836 RATIONAL HYDROTHERAPY.

Method The same materials are needed as for the wet

girdle. A compress of proper size, consisting of six or eight
thicknesses of soft cheese-cloth, fits the skin better than one
consisting of coarse toweling. The compress wrung out of
cold water is applied to the front of the trunk between the
sternum and the pubis, and a dry bandage placed over it in
such a manner as to hold it in place. The woolen and
water-proof coverings are then added.

Physiological Effects. — The effects of the abdominal heat-
ing compress are essentially the same as those of the wet
girdle (IS^tT), but somewhat less pronounced. This applica-
tion acts especially upon the sympathetic centers and the
viscera.

Therapeutic Applications. — This procedure is extremely
useful in minor cases of visceral irritation or congestion^
indicated by sensitiveness in the region of the liver, spleen,
or bowels, hyperesthesia of the lumbar ga?iglia of the abdomi-
nal sympathetic, constipation, flatulence^ gastric and intes^
tinal catarrh, insomnia, and other nervous affections arising
from irritation of the abdominal sympathetic. The abdomi-
nal heating compress may be used as a milder or introductory
procedure in all cases in which the wet girdle is indicated.
1353 Precautions and Contraindications. — In the use of the wet

girdle or the abdominal compress for the relief of insomnia,
it must be remembered that the brain is relieved at the
expense of congesting the portal circulation. The portal sys-
tern is a reservoir capable of containing all the blood in the
body. When the heatinj^ compress is applied in such a way
as to accumulate the largest possible amount of heat, as
when covered very thick with flannel or protected by oil-
cloth, mackintosh, or other impervious material, both the
cutaneous and the visceral vasoconstrictors are relaxed, thus
diverting into these parts an enormous amount of blood,
and relieving the cerebral vessels by a sort of internal blood-
letting.

If kept moist, and not too warmly cover ed, the walking

THE TECHNIQUE OF HYDROTHERAPY. 837

powers are improved; but when excessively covered, it be-
comes exciting and weakening, and when worn at night, may
cause dreams, fidgets, and insomnia, by reflexly producing
cerebral congestion. This is a point worthy of the most
careful consideration in the use of the procedure.

This intense portal congestion is wholly harmless in con-
ditions of health, for it is evidently a part of the function
of the portal system and the distensible and elastic viscera
connected with it, especially the spleen, to serve the body
in this fashion as a sort of overflow reservoir, whereby the
regulation of the circulation may be effected under conditions
which without this aid would baffle the efforts of the other
regulators of the blood supply. But what is true in normal
conditions by no means always holds good in conditions of
disease. When the portal system is the seat of pathological
states involving changes in the vessel walls, as in the vari-
cose condition of the veins of the stomach and intestines
which often accompanies hepatic sclerosis; in the acute con-
gestions of the spleen and liver which are present in chronic
m.alarial infection, typhoid and other continued fevers; in
acute congestions of the liver due to infection from the
alimentary canal, as in catarrhal or infectious jaundice ; in
chronic gastritis and gastro-intestinal catarrh ; in abdominal
dropsy; and in constipation due to atony and dilatation
of the colon, — in these and kindred states, any procedure
whereby the portal congestion already present is increased
can not be otherwise than damaging in a high degree; and
hence in these conditions the portal reservoir can not safely
be utilized as a means of diverting blood from the cerebral
circulation. In such cases the desired end may be accom-
plished by other means almost, if not quite, as effective.
The cutaneous envelope of the body, while a less capacious
reservoir than the portal system, is, nevertheless, capable
of holding fully one half of all the blood of the body, and,
fortunately, can not be easily filled to a really dangerous de-
gree. By means of the heating pack (1186), the wet-sheet rub,
cold friction, or even the shallow bath and the Scotch douche.

838

RATIONAL HYDROTHERAPY.

m

1353

the skin may be readily congested to such a degree as to ren-
der the cerebral vessels anemic while the lymph spaces are
filled, thus securing the conditions necessary for sleep and
repair of the cerebral energies.

A varicQse condition of the abdominal veins should always
be taken as an indication that the protected abdominal girdle
should not be employed. This condition is easily discovered,
when present, by making the patient stand up. The varicose
vessels will then be seen just above the pubes running out-
ward, nearly parallel with the groin. Other veins naay be
seen near the epigastrium.

It should be remarked that in these cases the abdoniioal
girdle is not altogether interdicted, but only when imper-
viously covered so as to cause superheating of the skin and
consequent paralysis of the vasoconstrictors; the flannel-cov-
ered compress may often be advantageously used, as in dropsy
of the abdomen.

The abdominal compress has a decidedly laxative effect.
The cold abdominal compress, renewed every hour or two, is
a most efficacious remedy in diarrhea and intestinal flatulence.

When necessary to employ the abdominal compress io
cases of menorrhagia, the bandage should be confined to the
region of the umbilicus, to avoid congesting the pelvic viscera.

To obtain the best tonic effects, the compress should be
renewed every two or three hours-

In feeble persons, the measure may begin with a small
folded napkin applied over the epigastrium,

THE DRY ABOOMriSAL BANDAGE.

This measure consists in a broad flannel bandage of suffi-
cient length to extend two or three times around the body*
In cold weather, it should be applied whenever the moist
abdominal bandage is omitted. If the moist bandage is worn
during the nighty the dry bandage should be applied in the
morning, and worn during the day, after cool sponging and
rubbing of the parts on removal of the moist bandage.

.:^^

THE TECHNIQUE OF HYDROTHERAPY. 839

The dry abdominal bandage is valuable, first, as a means
of supporting the viscera when enteroptosis exists, although
for this purpose it is not very effective as an abdominal sup-
porter, as it constricts the trunk to some degree, and does
not elevate the viscera to the extent desirable in most cases.

The warmth afforded by the abdominal bandage is exceed-
ingly helpful in many cases in which the digestive functions
are feeble and the sympathetic ganglia irritable. Indigestion
and other disorders may be greatly mitigated by a dry flannel
bandage applied about the abdomen.

THE HEAD PACK.

A cheese-cloth compress wet in very cold water is applied 1354
to the head after the hair and scalp have been thoroughly wet
with cold water. A rubber cap like a lady's bathing cap is
then placed over all, and the retention of heat soon warms
the compress and develops the usual effects of such an appli-
cation. Where there is a heavy growth of hair, simply wet-
ting and covering it with the rubber cap is sufficient to develop
the full effects of the stimulating compress.

On rising in the morning, the scalp should be well drenched
with cold water, then rubbed dry, and protected by a cap
during the day to prevent taking cold. This is an excellent
measure for promptly relieving an acute **cold in the head."

The use of the stimulating head cap is indicated in chronic
headache, when due to anemia; in chronic neuralgia and
rheumatic affections of the head; in chronic nasal catarrh
with diminished secretion, and in acute coryza. The stimu-
lating compress may be preceded by a very short hot applica-
tion for the relief of headache — to the face when due to
nasal catarrh, to the top of the head when due to anemia.
It is also useful in baldness due to failing nutrition of the

scalp.

THE SPINAL PACK.

While less frequently employed than many other forms of 1355
the heating compress, the spinal pack is sufficiently useful as
a hydriatic procedure to be worthy of brief description.

iS40 RATIONAL HYDKOTHEKAPV-

Requisites* — The requisite are : an ordinary towel, a
piece of woolen blanket sufficiently large to cover the entire
back when folded four thicknesses; if special protection is
required, a piece of mackintosh a little larger than the folded
flannel, and a roller cheesedoth bandage one foot wide, three
thicknesses, and four yards long*

Method. — The towel is folded lengthwise and wrung dr)'
from water at 60"^, and applied the whole length of the spine
from the cervical region to the coccyx^ after first rubbing the
skin surface with the hand dipped in water at 50^ until red-
dened. The flannel is laid over the towel, over this the mack-
intosh, and the cheese-cloth bandage is then applied in such
a manner as to hold the pack in snug contact with the skin.

Therapeutic Application^.— The spinal pack produces,
first, strong fluxion in the spjnal vessels; later, hyperemia
of the skin, whereby the spinal cord is drained. If imper-
vious protection is employed, the superheating of the skin
finally produces accumulation of blood in the spinal vessels*
This procedure may therefore be employed either to combat
anemia or kyperemia of the cord^ according as it is more or
less protected. Partial protection (1344) maintains active
fluxion in the spinal vessels, and thus combats passive con-
gestion. The prolonged protected spinal pack, by congest-
ing the spinal vessels, antagonizes chronic degenerations of
the cord. It is very useful in some cases of insomnia.

The neutral pack, applied at So"^, covered with tw*o thick-
nesses of flannel only, without mackintosh, is a calmative
procedure of great value in spinal irritation with hyperes-
thesia of tlie spine, and in conditions in which irriiability
of the spinal centers exists, as in locomotor ataxia and other
degenerations at certain stages,

THE HOT AND COLD COHPRESS.

1356 This procedure consists in the simultaneous and contin-
uous applications of a hot and a cold compress to separate
skin surfaces collaterally related to a single internal part

r\

THE TECHNIQUE OF HYDROTHERAPY. 84 1

This unique procedure is not applicable to all parts of the
body, but may be applied under appropriate conditions to the
head, chest, spine, abdomen, pelvis, and legs. The hot and
cold compress is a combined application of peculiar interest
and value, since it can be relied upon to accomplish, under
certain conditions, results which can be attained in no other
way, and sometimes affords relief in cases of great suffering
and imminent peril.

Method. — The adjustment of the hot and the cold
compresses respectively varies for different parts of the body
and the different viscera, the circulation of which it is desired
to influence. The management of the cold and hot compress
should be the same as previously indicated for continuous
applications; that is, the nervous sensibility of the cutaneous
surface to which the cold application is made must be kept
alive by rubbing the parts with a dry warm flannel' for one
minute each time the compress is changed. The compress
should be renewed every 10 or 15 minutes, or as soon as its
temperature begins to approach that of the body. The hot
application likewise should be exchanged every 15 or 20
minutes for a cold application of 30 seconds to i minute, so
as to empty the veins, restore the tone of the vessels, and
prevent too great accumulation of heat in the deeper parts.

The duration of the hot and cold compress may be from
1 5 minutes to one or two hours, or even longer. A good rule
is to continue the application until the effect desired is pro-
duced, unless decided indications for its interruption appear.

In the employment of the hot and cold compress it must
be borne constantly in mind that the application should be
made in such a way that the blood-vessels of the congested
organ in the interest of which the application is made will be
caused to contract by the cold compress, the veins or the arter-
ies of the part being at the same time drained into another
collaterally related cutaneous area by means of the hot applica-
tion, in accordance with principles explained elsewhere (1290).

To secure the best effects, the compresses should be

i'.^

li

J,

adjusted with special relation to internal
for each special forni of this procedure.

Physiological Effects- — The hot and cold compress is a
hydriatic measure of great power It is perhaps the most
effective means of controlling the movement of the blood in
internal parts. It acts both reflexly and derivatively* A
cold application applied to one cutaneous surface causes con*
traction of the vessels of the associated internal organ
through stimulation of its controlling vasomotor centers,
while the hot compress applied to another cutaneous surface,
the vessels of which are collaterally related to those of the
part, drain off a portion of blood into the dilated cutaneous
veins and arteries> The partial reaction following the first
impression made by the cold compress and the frequent
renewal of the cold application facilitates the movement of
blood through the affected part, thus insuring a constant sup-
ply of oxygen, fresh nutrient material, the removal of wastes,
and the influx of leucocytes, while at the same time the hot
application combats stasis by drawing the blood into collateral
venous and arterial channels, at the same time facilitating the
rate of movement of the blood through the arteries of the
parts by lowering the pressure in the veins. By this combina-
tion of effects the distension of blood-vessels and stasis of
blood is prevented, while the movement of blood is acceler-
ated, thus restoring the normal status of the circulation
and greatly facilitating the healing processes. How this may
be accomplished in the interest of any particular internal vis-
cus may be clearly seen by a careful study of paragraphs
1262 129L

Therapeutic Applications — The conditions under which the
hot and cold compress attains its special successes are those in
which ordinary hot or cold applications, if they afford any
relief at all, secure no more than partial amelioration of the
urgent symptom present, the beneficial effects which might
be obtained through the revulsion produced by cold being
antidoted by the thermic effects produced by the application;

i

THE TECHNIQUE OF HYDROTHERAPY. 843

while, on the other hand, hot applications prove too exciting,
depressing the heart when long continued, or causing other
untoward effects. By a combination of the two, however,
in these cases the evil effects resulting from each are anti-
doted, while the good effects of each are intensified.

The following forms of the hot and cold compress have
been tested and found practical and useful: —

The Hot and Cold Head Compress. — Place an ice-bag to the 1358
back of the neck and the ice compress to the vertex (Fig. 184).
Apply very hot compresses to the face and ears. The hot
compresses should not extend below the level of the jaw, thus
avoiding the heating of the large vessels of the neck. The
ice-bag causes contraction of the vertebral arteries ; the cold
compress to the vertex causes reflex contraction of the menin-
geal and cerebral vessels, and cools the brain; while the
fomentation to the face and ears dilates the external branches
of the carotid artery, thus establishing collateral anemia of
the brain. The fomentation also dilates some of the venous
channels by which the cerebral sinuses are drained (1262).

A reverse method may sometimes be used advantageously
in applications to the head, as follows : —

A rubber bag filled with hot water and covered with a
moist flannel, or a fomentation, is applied to the upper and
back part of the neck, while a soft cheese-cloth compress
wrung out of cool or very cold water is applied to the face
and the top of the head.

The effect of the compress in relieving cerebral congestion
is greatly increased by the application of the ice compress or
ice-bag to the front of the neck, whereby the blood supply of
the brain is lessened by contraction of the carotid arteries.

The combination of heat and cold to the head in this
manner renders it possible to make applications of heat to the
head for a much longer time than could otherwise be tolerated,
the cold antidoting any ill effect which might be produced by
the heat, while encouraging the good effects of the appli-
cation.

844 BATIOMAL HYDROTHBRAPT.

The author has made use of this application for many

•^ years as a means of relieving certain forms of nemras-^

..' .'J thenic headache. It is exceedingly useful also In so-called

' . 1 nervous headache accompanied by marked congestion of the

:^| brain.

\ This procedure is especially useful in passive congestion

^ ■ of the brain, and serves a useful purpose as an adjunct pro-

^ r cedure in the treatment of insomnia when due to ceiebral

hyperemia. It should be avoided, however, in/ases of inaom-

'- •.:^ nia due to excessive excitability of the cerebral cellSv and is

-'■'* of course contraindicated in insomnia due to anemia.

i'l ' 1359 The Hot and Cold Lung Compress. — A thick and very

• V 5 hot fomentation is applied over the back, reaching from the

;, ^i middle of the neck to the lumbar region, and extending to

.'I the axillary line on each side. The cold compress should

■\ ' cover the top of the lungs, the lower half of the neck in front,

; .: \. and the whole anterior surface of the chest to the level of

. ' ^]: the lowest ribs. The fomentation diverts the blood from the

' *!; bronchial arteries by dilating the cutaneous branches of the

intercostals, while the cold compress contracts the bronchial

arteries through reflex stimulation of the vasomotor cen-

iers controlling them. The effects of the application may

be intensified by hot applications to the arms and legs applied

simultaneously, especially hot packs, which produce decided

derivative effects.

This procedure is exceedingly useful in the early stages of
pneumonia, in broncho-pnenmoniay in pulmonary hemor-
rhage, acute pulmonary congestion, and the congestion result-
ing from the use of ether in anesthesia. Its use in the
last-named condition is especially important when much
mucus is present, and when cyanosis, or blueness of the skin,
indicates stasis from cardiac weakness or interference with
oxygenation. It has for some time been the author's custom
to apply a heating chest pack immediately after removing the
patient from the operating table when the foregoing symptoms
were present. More recently the plan of applying the hot and

THE TECHNIQUE OF HYDKOTHERAPV.

845

cold lung compress in cases in which an anesthetic fs admin-
istered has been tested. When ether is employed, the appli*
cation extends to the whole chest surface, as above described;
when chloroform is used, a hot bag is placed to the back and
an ice-bag or a cold compress over the heart* The compress
should be at least as large as the snrface covered by the
patient *s two hands placed side by side. The cold compress
should be removed for a few seconds every ten minutes, and
the surface rubbed with a dry, warm flannel till red, so as to
maintain the cutaneous reflexes upon which this compress
depends for its efficiency as a cardiac stimulant.

The author has made use of the hot and cold chest pack
for fifteen years or more^ and believes it to be one of the
most valuable of all means for combating pulmonary conges-
tion. The circulation of the lungs is controlled by the vaso-
motor centers located at the upper portion of the dorsal
region, and the purpose of the hot application is to stimulate
the activity of these centers; while the cold application to the
anterior portion of the chest causes first a contraction^ and
later active dilatation and fluxion of the vessels of the lnngs»
thus combating passive hyperemia and inflammation.

This is an excellent means of relieving acute congestion
of the lung in pulmonary hemorrhages, and combating the
hypostatic congestions which occur in fevers of a low type.
The application may be continued for half an hour or more,
and should be repeated two or three times a day.

This measure is of very great value for removing the pul-
monary congestion which follows etlier anesthesia, and thus
combats the tendency to bronchial pneumonia, which is often
a greater risk in old subjects than the opt:ration itself,

A special form of the hot and cold compress is of particu-
lar service in asthma. An ice compress is applied to the back
of the neck and head while a fomentation is applied to the
whole front part of the chest* extending from the clavicles to
the umbilicus. The back may be included. The cold appli-
cation lessens the blood supply of the medulla, and so dimin

1360

1361

136S

ishes the excitability of the respiratory centers,
fomentation relaxes the spasm of the bronchioles.

The Hot and Cold Renal Compress (Fig. 185) The hot

application covers the back from the middle dorsa] region to
the coccyx. The cold application should consist of an ice-
bag or a cold compress covering the lower third o£ the ster-
num. The connection of the portal circulation with the renal
vein makes it undesirable that any of its outlets should be
closed or its tension raised by reHex impressions from the
general abdominal surface* The fomentation diverts the blood
from the branches of the lumbar artery which are distributed
to the capsule of the kidney and leads off a portion of the
blood from the renal vein into the anastomosing muscular
branches, while the cold application causes reflex contraction
of the blood-vessels of the kidney and increases its activity
(1098) (See Fig. 152.)

This measure is of special service in cases of acute conges-
tion of the kidney^ especially in connection with acute febrile
diseases, as scarlet fever, typhoid fever, smallpox* and diph-
theria. It should be used in connection with the hot blanket
pack or other general hot applications in the intervals as a
means of continuing the effect of the general hot application.
Care must be taken that the patient does not become chilled
by the cold application.

The Hot and Cold Oast ro^ Hepatic Compress^ — This
compress influences not only the stomach and liver, but also
the spleen and the pancreas through the intimate association
of the circulation of these organs. The application is almost
exactly the reverse of that of the renal compress. The fomen-
tation is applied anteriorly from the fourth rib to the umbili-
cus, extending to the axillary line on each side, while a coid
bag at least eighteen inches lon^ is applied to the dorsal and
lumbar spine. Through the dilatation of the branches of the
internal mammary arteries and associated veins, the blood
ts drawn off from the stomach, liver, spleen, and pancreas
while the reflex stimulation of the controlling vasomotor cen*
ters contracts the vessels of the arterial circulation.

THE TECHNIQUE OF HYDROTHERAPY.

H7

The Hot and Cold Intestinal Compress* — The cold com- 1363
press is applied over the whole abdominal surface, extending
from the xyphoid cartilage to the pubes. The fomentation is
simultaneously applied to the lumbar region and the left side,
as it is desirable to divert the blood from the left kidney both
by estabhshing collateral hyperemia of the overlying struc-
tures, and also by diverting the venous blood from the kidney
I into the anastomosing muscular channels.

This procedure is of special value in chronic duodenitis
and colitis.

The Mot and Cold Pelvic Compress*^ The cold compress 1364
is applied to the hypogastrium in combination with a fomen-
tation across the lower part of the back. The fomentation
may also profitably become a hip pack, or a hot leg and hip
pack. When the inflammation is confined to one side, an
ice-bag instead of the cold compress may be placed over the
affected part. The ice-bag may be used in combination with
the hot pelvic pack (Fig. 155,).

This measure is especially valuable in the treatment of
acute inflammations of the uterus, tubes, ovaries, and diad-
tier, in appendiciiis and pelvic peritonitis ^ In cases of
inflammatiifn of the prostate, in proctitis, and tystitis, the
ice-bs^ may be applied to the perineum in connection with
the hip pack* or with the hip pack and the hot leg pack or
foot bath applied -simultaneously.

THE HOT AND COLD HEATING COMPRESS OR PACK,

This procedure differs from the hot and cold compress in 1365

I the same way in which the ordinary heating compress differs

Ifrom the cold compress. In the hot and cold compress

{the hot apphcation is made continuous, or practically so,

[by the frequent renewal of the compress. In the hot and

[cold heating compress or pack the cold application is not

renewed, but allowed to accumulate heat through reaction*

The area covered by the cold application in this procedure is

usually much greater than in the hot and cold compress,

LThe duration is usually from one to two hours.

848 RATIONAL HYDROTHERAPY.

This procedure is especially applicable to the chest, the
abdomen, and the pelvic region.

Physiological Effects. — The hot and cold pack is, next
to the hot and cold compress, perhaps the most powerful
of all known means of controlling the movement of blood
through the viscera of the chest and abdomen. The heating
pack depends for its special features upon the anatomical
fact that the collateral relation between the arteries and the
veins with internal parts does not closely coincide as regards
the location of the related vessels in the skin, thus making
possible the simultaneous application of two procedures differ-
ing in method, but each assisting the other.

The explanation of the effects of the hot and cold com-
press (1356) applies only in part to the hot and cold heating
compress or pack. In the former, the action of the cold
application is continuous or nearly so, while in the heating
process the stimulant effect of the cold soon disappears, giv-
ing place, under the influence of the powerful reaction, to
extreme dilatation and great activity of the cutaneous vessels.
As the heat accumulates, venous stasis is developed, produc-
ing powerful derivative effects upon the associated venous
trunks, and thus by lessening the pressure in the veins, has-
tens the movement of blood through the arteries of the con-
gested part. At the same time, the hot compress, being
applied to a cutaneous area, the arteries of which are col-
laterally related to those of the deeper structures which it is
designed to influence, produce powerful collateral anemia of
the vessels of the congested organ. Several very powerful
therapeutic factors are thus brought to bear simultaneously
upon the diseased part as follows : —

1. By the application of the cold compress the vessels of
the part are made to contract, thus forcing the stagnating
blood onward into the veins.

2. As the heating compress warms and the cutaneous
veins become filled with blood, the veins of the congested
viscus are emptied, thus draining the tissues of the toxins
which have accumulated in them.

THE TECHNIQUE OF HYUROTHKKAPy.

849

3. By lowering the pressure in Ihe veins, the arterial cir-
culation through tlie affected part is (acilitated, thus encourag-
ing the nutrition and functional activity of the cells which are
engaged in combating living germs, or which are seeking to
repair damages which may have originated in any way.

4. The hot application diverts the blood into the cuta-
neous branches of the collateral arteries or into anastomos-
ing vessels, thus preventing undue accumulation of blood and
consequent embarrassment of the affected tissues, The
anatomical relationships through which these results are
attained have been described elsewhere (I2(i2-1278),

The Hot and Cold Chest Pack.™ The chest pack is ap-
plied in the ordinary way* The form known as the square
chest pack {1374) is preferable. After the wet pack has
been adjusted and before the woolen wrapping is arrangedp
a spine bag filled with water as hot as can be borne safely
{140'^ to 160) is applied between the shoulders, reaching
from the lower cervical to the lumbar region. The woolen
wrapping is then brought snugly in place, and fastened in
such a manner as completely to cover the back^ leaving no
openings about the neck. As an extra precaution it tsa good
plan to adjust a flannel about the neck in the manner shown
in Fig. 186.

The Hot and Cold Abdominal Pack (Fig, idy),— In this
procedure the moist bandage is placed around the trunk
at the level of the utnbiljcus in the usual manner for
the umschlag^ or wet girdle (1 34-7)- A rubber or aluminum
coil is placed upon a wet towel just over the epigastrium.
The blankets are then tucked snugly about the patient, and
a stream of hot water is kept flowing through the coil contin-
uously during the application, at a temperature as high as the
patient can bear. The author has made use of this applica-
tion ever since it was first suggested by Professor Winternttz,
using instead of a coil, however, a rubber bag filled with very
hot water, a thermophore, or a syphon sack.

The first information printed in this country in relation

54

1366

i:i67

850 RATIONAL HYDROTHBRAPY.

to this valuable hydriatic measure was an article coDtribota
by Professor Wintemitz, by request of the author, to his jcmi
nal, Modern Medicine.*

If necessary to continue the application for a considorabl
length of time, the hot water bag may be refilled (Mice 0
twice, or if it is necessary to prolong the procedure for two t
three hours or more, it is well to use the coil, the syphon sad
or the thermophore.

• The hot and cold abdominal pack has rendered mofl
valuable service in a great number of cases; and so positive
and satisfactory have been its results in the hands of th
author that in his estimation it stands almost unrivaled as i
hydriatic procedure in the certainty with which it prodace
the effects expected from it. This measure has proved eqpe
cially successful in both sensory and motor disturbances c
the stomachy especially in cases in which the patients com
plain of pain soon after eating, flatulence^ eructations an
regurgitations of food and vomiting of bile.

In one case in which a lady had suffered four months fron
regui^tation of bile into the stomach, being reduced to a ver
low state, the reflux of bile was at once controlled by th
application of this pack. It was applied half an hour befor
each of the two daily meals given the patient, and wa
retained two hours, so that the process of digestion was begui
under the influence of the pack. During the first fe^
weeks of the treatment the difficulty returned occasionall
when the compress was omitted, but after a few months, th
patient was able to dispense with the pack, and was nc
only entirely relieved of the distressing symptom, but ha
gained twenty-five pounds in flesh, and was restored to health
In another case a man had been for years afflicted in the sam
manner, having frequent attacks, lasting for several weeks
during which time vomiting occurred within a few minute
after each meal. The patient was brought to the Battl
Creek Sanitarium in an extremely feeble condition. The he

'^Modern Medicine^ Vol. I, page 50.

THE TECHNIQUE OF nyOROTHERAPy.

851

and cold abdominal compress, however, controlled the vomit-
ing in a {ew days, and the patient's stomach was soon trained
to the digestion of a reasonable amount of wholesome and
simple food* Scores of similar cases might be related.

Hyperesthesia of the lumbar ganglia of the abdominal
sympathetic and of the solar plexus, when extreme in degree,
also requires the applicatioo of this powerful analgesic pro-
cedure* liy its daily application for a few wrecks, cases in
which the gangha are so sensitive that even very slight pres-
sure excites almost excruciating pain* and in which as a result
the abdominal viscera are subject to painful affections of vari-
ous sorts, may often be made completely comfortable, other
constitutional measures being of course employed at the same
time. In nervous asthma and disturbances due to disorders
of the abdominal sympathetic, this measure renders invalu-
able service, as may also be noted in the majority of case^ of
nervous headache^ or migraine^ which is likewise a sympa-
thetic nerve disorder. Obstinate vomiting, nausea, including
the nausea and vomiting of pre^nanej, yield to this procedure
with most satisfactory readiness in nearly all cases.

The hot and cold trunk pack has been found of great
service in cases of hyp^rpepsia and in hypoptpsia attended by
gastric irritation.

The Hot and Cotd Lumbar Pack. — This application is
made the same as for the hot and*cold abdominal pack» except
that the hot bag or coil is applied over the lumbar region. A
large stjuare bag is used for this purpose. This application is
of special service as a means of combating portal or renal con-
gestion. Care most be taken to apply the heat over the left
kidney, as there is a direct communication between the left
renal vein and the portal system.

The Hot and Cald Spinal Pack — A hali sheet, one thick-
ness, wrung otit of very cold water, is placed about the
trunk in the usual manner for the trunk pack- The patient
then rolls to one side, and a long rubber bag half filled with

nm

1369

I

852 RATIONAL HYDROTHERAPY.

hot water is placed in such a position that when he returns to
the dorsal position, the bag will lie in contact with the center
of the back its whole length. The blankets are then drawn
around the patient in the usual manner.

This procedure is especially valuable in cases of spinal
irritation which are aggravated by cold applications, and in
which there is general passive congestion of the viscera of
the chest and abdomen, — conditions present in a large pro-
portion of cases of chronic dyspepsia, especially in women.
In these cases there is generally an exceeding tenderness of
the lumbar ganglia, of the intercostal nerves, and of the whole
dorsal region. Hot applications to the spine usually afford
temporary relief, but are exhausting and weakening when
long continued or often repeated. Much better results are
obtained by the application of heat and cold as described.
1370 .The Hot and Cold Pelvic Pack.— This measure is applied
in the same manner as the ordinary cold pelvic pack (1390)»
with the exception that a rubber bag filled with hot water
or a coil is placed over the lower abdomen next the wet sheet
The effect of this application is to afford relief in congestions
of the pelvic viscera, in which it is as useful as is the hot and
cold abdominal pack (1367), in congestions of the abdominal
viscera.

Method. — The mode of application is precisely the same
as that of the ordinary pelvic pack (1390), except that a hot
water bag or coil is slipped in between the folds of the blanket
with one thickness intervening, and so placed^ as to fall over
the uterus and bladder.

Therapeutic Applications. — The hot and cold pelvic pack
is indicated in hyperesthesias of the uterus, ovaries, and
bladder, in acute congestion of any of the pelvic viscera^
accompanied by pain or niuscn/ar spasrn^ as tenesmus of the
bladder or rectunty and vaginismus. Painful ovarian conges-
tiony congestion and hyperesthesia of the uterus, vesical irri-
tation, ovarian irritation, — these and other like conditions
indicate the employment of this useful measure, and are gen-

THE TECHNIQUE OF HYDROTHERAPy,

«S3

erally very readily relieved by it. Sixi/itl treihism, irregular
and painful meu^truaiitjn, and the heaviness and indescrib-
able but distressing symptoms with which so many invalid
women suffer, yield to this remarkably efficient measure,

SPECIAL FORns OF COHPRESS.

In addition to the various forms of compress which have
been described in the foregoing pages, there are several
special compresses worthy of description because of their
great practical utility, and concerning which there are various
practical points %vhich need to be understood > especially in
relation to the technique of their application. These are
the cephalic compress, the chest pacl\ the ihroat compress ^
the neck compress^ thBJaint compress, the f&ttoH poultice, the
hip pack, the pelvic pack, the leg" pack, the foot pack, and
the hat and cold compress.

The roller compress consists of a long strip of cheese-cloth
folded to three thicknesses, and of proper width. Thus pre-
pared, the bandage is rolled up. When wanted for use, it is
immersed, wrung out quickly, and applied as soon as possi-
ble, so that its temperature may not be modified by contact
with the air of the room. A number of such bandages of dif-
ferent widths should always be in readiness for use*

THE CEPHAUC COHPRESS (Bg* 188)*

The application is usually made to either the top or the
back of the head. When applied to the back of the head,
the upper part of the neck is usually included in the appli-
cation. The application may be made to the top of the head
and the face, to the face and the neck, or to the entire head,
— scalp, face, and neck.

In the application of the cold cephalic compress it ii
necessary to bear in mind the fact that a cold application to
the face may have the effect to produce collateral hyperemia
of the brain, by contracting the external branches of the ca-
rotid artery (1282, 1 2fi2) * A napkin moistened with ice-water

1371

854 suktumja. uvdiotuekaft.

and laid opon the forehead may do more harm than good,
coci trading the supmorbital bfanch of the interna] carotii
and Ibtts diverting more UocmI into its internal braoches 1
the eerebntm. This eStct may be readily antagonized Ij
a cold application aboat the aeck. which will contract tl
carotids and the vertebral arteries and all their branches,
thus aid the reflex action from the face and scalp in lessenl
the volume o( blood in the brain, i

These contrai^^ and aQdeslrable e0ects of cold appttcattod
are most likely to occor id conditions in which the vascull
tension is low and flactuatiQg. They may give rise to \oc^
or rirc urn scribed cyanosis from vascular spasm » and simul
taneons collateral congestion. |

In making cold applications for the relief of cerebral co4^
gestion, special care should be given to the eyes. The con
press should always cover them, and should be well pressel
down upon them, so as to utilize the powerful reflex relatioi)
which exist between the eye and the brain through tl)
sympathetic. ^

The same principle governs applications to the hands as
feet for relief of inflammatory conditions involving dee
structures. An ice-bag over the trunk of the supplying arter
(axilla, bend of elbow, groin, popliteal space) will lessen th
local congestion, as well as or even better than an applicatio
to the whole arm or leg; while an application to the pai
alone might produce collateral internal congestion.

Physiological Effects.— The effects of the application c
cold to the head have already been considered (1315). It ma
be mentioned further that the head compress is less excitin
and more sedative than the cephalic douche. Applied cob
tinuously, or frequently renewed, the prolonged cold hea
compress is highly sedative, lessening the cerebral blood supplj
and diminishing the activity of the brain. In active conges
tion, a continuous verjy cold application is best; in passiv
congestion, it is better to secure vasomotor exercise an
fluxion of the brain by means of the repeated impressions oh
tained by frequent renewals of the cold compress, allowing

THE TECHNIQUE OF HYDROTHERAPY.

85S

only time for the begin oiog ot reaction effects or slight warm-
ing of the compress.

The short cold compress increases the cerebral blood
supply by reflex reaction effect

The hoi or warm cephalic compress, or fomentation to
the heat], congests the cerebral vessels when long applied,

A skori hoi application acts by revulsion to diminish the
blood supply of the deeper parts.

Therapeutic Applications. -- All forms of ccrebrai conges-
iion^ insomHia from cerei^rai hrptremia^ the deiirium of
infectious fevers, and coMgesiivc Aendtuiw, require the cold
head compress.

The hot head compress, or fomentation to the head, excites
cerebral activity, and is of great service m anemia in syn-
cope, shocks and in coUapse from any cause when associated
with cerebral anemia.

The sharf cold compress, followed by drying and rubbing
of the scalp, may be used in the same conditions. The hot
compress is to be preferred when pain is present, because of
its powerful revulsive and analgesic effects.

Continuous cooling of the head may be secured by wetting
the hair and allowing the head to remain uncovered. Tliis
mode of cooling, however, as also the use of the evaporating
compress, is likely to give rise to rheumatic pains of the
scalp, because of the loug-contiuued action of a degree of
cold sufficient to chill by slow abstraction of heat, but not
vigorous enough to induce reaction. The pain is doubt-
less due to disturbance of the blood supply of the nerve
trunks.

The ice-bag applied to the back of the head Is a valuable
measure in spi-rmatorrhca accompanied by frequent losses.
The application should be prolonged. It should be applied
before going to bed at night, being so adjusted as to rest
against the base of the skull while the patient is asleep. In
vttginismns, and in $tiasturlmiion in women due to sexual
erethism, the ice-bag may be applied with advantage to the
upper cervical region for twenty minutes several times a day.

I|6 RATIOlfAL HYDROTHERAPY

In anemic headache, the ice-bag may be applied to the
jpper part of the neck for i to 3 minutes. The reiu:tioii
bUowing increases the supply of blood to the brain, la
icrvous asthma, prolonged applications of the ice-bag to the
)ack of the head will be found advantageous (1360)- For
"er>^ rapid beating of the heart, apply the ice-bag for 10 to
!0 minutes to the back of the head or to the neck. A pre-
cordial compress should be applied at the same time,

, THE COLD SPINAL COMPRESS.

1372 Cold may be applied to the spine by means of the ooM
wet compress, or by long rubber bags filled with ice, ice-
water, or some cooling mixture. The application may be
made to the entire spinal c lumn, or to a particular region,
as may be desired. Those portions of the spine which it is
most commonly designed to influence are the cervical, central,
upper dorsaK middle dorsal, and lumbar regions.

In all cases in which the very cold spinal compress is
employed for reflex effects, the compress should be removed
every 15 or 20 niinutes^ and the stufare rubbed with wArm
dry flannel for half a minute, or until reddened. The surface
should never become blue or numb. The frequently renewed
cold compress (60^, changed every 1 5 to 30 minutes) produces
powerful fluxion of the spinal cord, and is a useful means of
improving the nutrition of the cord, and combating degenera-
tive processes.

Therapeutic Applications — By means of ice-bags or ice
poultices, or cloths wrung out of ice-water and renewed every
3 or 4 minutes, most powerful and useful antiphlogistic effects
may be obtained in meningeal inflammation of the spine.
The same measure is useful in apoplexy of the spine, in cases
of fever with very high temperature when spinal complication
is feared. Localized cold applications to the cervical region
are useful in congestion of the brain, paroxysms of dyspnea
in nervous asthma, and irritation of the cerebellum; to the
upper dorsal region for pulmonary hemorrhage; to the lower

THE TECHNIQUE OF HYDHOTHERAPY.

857

dorsal region ia nervcus vomiting; to the lumbar region in
fiterine and renal kcmvrrhagc; to the whole spine in certain
cases of hysteria, and in connection with the cephalic com*
press in the epileptic state; to the lower dorsal and the upper
lumbar regions in cases of extreme irritability of the genito-
urinary centers.

Cold appHcations of all sorts to the spine are cantraindi-
catedin most cases of so-called spmal irritation^ and in cases
of locomotor ataxia in which lightning pains or gastric crises
are present.

THE CHEST PACK.

This procedure does not differ essentially from packs to
other regions^ except that it is confined to the chest. It is
commonly applied to the entire chest, both front and back,
extending from the neck to the level of the floating cartilages.

Method. — The chest pack may be conveniently applied by
means of a sort of jacket fitted to the patient, or better stilK
by means of a bandage made of one or two thicknesses of
linen, or four to six thicknesses of cheese-cloth. The bandage
should be eight to ten inches in width, six to eight feet in
length, and should be loosely rolled up, dipped into water
at the proper temperature, and wrung out without unrolling.
The bandage is applied in a sort of ''figure 8" fashion,
which may be described as follows: The nurse taking the roll
of bandage in her right hand, and seizing the end of the
bandage with her left, stations herself in front of the patient,
who is sitting or standing with the clothing removed to the
waist. The end of the bandage is placed against the right
side of the chest, and held in place by the patients hand;
or, the application may begin under the patient's right arm,
which is pressed against the bandage to hold it in position* The
bandage is then carried obliquely across the chest and over
the left shoulder; then, passing obliquely downward across
the back, it is carried forward under the right arm and then
horizontally across the chest in front, under the left arm
obliquely upward to the right shoulder, over which the end

1373

8S8 RATIONAL HYDROTHERAPY.

of the bandage is drawn and tucked under the transverse folc
I crossing the chest. The transverse portion of the bandage is

then pulled up toward each shoulder, and fastened as snygly
as possible by means of safety-pins* The wet bandage should
be made to fit the patient tightly every^where (Figs. 189-192).

A flannel bandage of the same width and a little gtealer
length is applied over tixe moist bandage in precisely the f
same manner, care being- taken to cover the wet bandage
completely, and to n: fit snugly at every point so as

wholly to exclude the «.*, The flannel bandage may be lonf
enough to extend several tir les about the chest so as to pro- fl
tect the wet bandage as tho ^ughly as necessary. A bandage
of mackintosh cut as in tl square pack (Fig, 1 93) may be
placed next the wet bar e when needed.
1374 The Square Chest Pack, — This is one of the mo9t con*
venient and perhaps on the whole the most satisfactory of all
the several forms of the che*t pack (Figs. 193-197).

R^quisite^ — A rectangular linen bandage of the pmper
length, and a woolen bandage of the same shape but laigo*.
The length of the linen bandage should be one and one-liaU
times the circumference of the patient's chest over the latest
part, and the width should be sufficient to reach from the
top of the shoulder to the lowest rib; the woolen bandage
should be two inches widrr nnd the same length. The
thickness of the linen bandage depends upon the effect desired:
a single thickness of heavy linen toweling is sufficient; if linen
sheeting is employed, two thicknesses will generally be re-
quired, or four thicknesses of cheese-cloth. The woolen
bandage should be of blanket stuff, heavy, soft, and at least
two thicknesses. Starting at a point one third the dis-
tance from the upper edge of the linen bandage, a slit is torn
one third its length; a similar slit is torn at the other end.
The woolen bandage is prepared in the same way; also a
mackintosh if needed.

riethod The woolen blanket is spread out on a smooth

surface. The linen bandage is now wrung dry out of water

y :«

THE TECHNIQUE OF HYDROTHERAPY.

859

at 60^, and spread out upon the woolen blanket (Fig. 193),
The patient having been previously prepared, he sits or is
held up for a few seconds while the bandages are spread out
on the bed beneath him in such a position that the end of
each slit falls exactly at the top of the axilla on each side.
When the patient lies down, the upper edge of the woolen
bandage should just reach the hair.

The upper tail of the bandage on one side is now drawn
across the shoulder toward the opposite side, and the surplus
folded back (Fig, 194)* The corresponding part of the bandage
on the opposite side is adjusted likewise. The rest of the
bandage is then adjusted, one side and then the other being
drawn over, as shown in Fig. 195, In cases of pharyngitis
in connection with acute catarrh of the lungs, the edges of
the two shoulder pieces may be brought together close up
under the chin, thus making a throat compress. The flannel
bandage is now brought across in like manner, care being
taken to cover thoroughly all portions of the moist bandage
so as to prevent cooling by evaporation. This bandage has
the advantage that it is simple, can be very easily and quickly
applied, and completely envelops the chest.

The Trianinilar Chest Pack,^This is a very convenient
form of bandage for use in cases of acute inflammatory proc-
esses in the lungs, as pleurisy, pneumonia, bronchitis, tuber-
cular disease, and in patients too feeble to sit up, as in some
typhoid cases.

Requisites.— One thick woolen blanket, one linen sheet
folded twice lengthwise, one woolen sheet folded cornerwise,
a triangular linen or cheese-cloth bandage of three thick-
nesses, with base four to six feet, height of triangle, three feet.

Method— Spread the woolen blanket on the bed. Lay
the linen sheet folded lengthwise across the bed at such a
point that the upper edge will fall an inch above the level of
the axilla when the patient lies down. Lay the triangular
woolen bandage across the bed with the apex down and the
base at such a point as to be level with the occiput when the

t37&

^ft of tbe bzQda^c

kftvne tlie arms out.

bfuogfal afiMmd the chest, first otie
biiidnig all togeiber (F%. 199).
the compress, it may be emsSy

w^ ant

tli<^ "^tifCTt and under tlie
Tile woolen trai^gfe is 1
lastly the fold^ ^k^ s
ecid ^nd then tbe
Wheo De<^:ssarj to

witiidfa^ii alter openiaf the woolen mTappiags.
1376 The T<mel Cbest Paclc^Thts ts the simplest and one of
tbe best of all tbe variotks forms of the chest compress m
pack. It differs from the preceding only in having two
towels used in place of the linen triangle. Th^^ are
oot very dry. and then applied one over each shoulder atid
across the chest in front and behind, care being taken to cover
tbe whole surface of the chest (Fig. 200). The onter i%-rap-
ptngs are then closed about tbe chest as in the triangular
pack. The wet towels must be wrung as dry as po^ble
In applying the chest pack in either form described, it h
of the utmost importance that the application be made accu-
rately. If the compress is applied in such a way that evap
tion takes place, the parts will be chilled, prodacing an eftect

THE TECHNIQUE OF HYDROTHERAPY,

86t

the very opposite to that desired. On the other band,
overheating with too much covering, or by impervious cover-
ing, is equally harmful in cases in which it is desired to
maintain vascular tone rather than to produce strong hyper-
emia for derivative effects*

The temperature should be 60"-' or less, except for very
feeble patients who are not accustomed to cold, in which
case it may be 70° to 75^, for the first application, If from
previous experience it is known that the patient is not able to
warm the bandage rapidly, the hand should be dipped in water
at SO^j and this should be applied to the chest and neck with
vigorous rubbing, followed by drying and rubbing with a warm
flannel just before the bandage is applied. This insures good
reaction*

The Half Chest Compress. — fn certain cases it may some-
times be best to confine the application of the cold compress
to one half of the chest. The following simple device answers
the purpose admirably, covering the top as %vell as the sides
of the chest, a precaution which should not be forgotten in
the treatment of chest affections: —

A broad towel about two feet in length is split down the
middle one third its length* It is then wet and wrung out in
the usual way, and applied in such a manner that the arm
occupies the slit, while one of the two legs passes in front of
the shoulder, falling over the top, while the other covers the
back of the shoulder (Fig. 20r)* The flannel covering is then
applied in the usual way, and lastly a flannel bandage ot
square or triangular form, as most convenient*

Another method employs a wide towel of the ordinary
length. After being wet and wrung out, it is laid across the
shoulder* The upper corners of the towel are carried across
thechestt one in front, the other behind, and made to over-
lap close under the axilla, well covering the side (Fig. 202).
The application of the flannel bandage secures the towel
in position- The towel may be doubled if necessary » and if
long enough, or two towels may be used If necessary, a

1377

Un

Mietjr-pisi voAj be applied at the top d tlie !
a wajr as to attach the towd to the £ai
ilippifBlf dr/ira orer the sboolder.

The hot and cold diest pack (1366) mni tlie
€xAA long compress iVSiS!%) hare been fullf
where. They are important modificatkms of the
press which are of special vahie in the mortMd
which they are particolarly indicated, The special «
(or the use of the chest compress in pDettnhociia
puimonaiy maladies aie given ebewhere.

197^ PbysMoffcal effects.— There is no therapeutic sgcBH
u%e of which rests opon a more thcwoogfaly sannd aod ralifl
basis than does the employment of the compress in |
monary affections, especially in pneumonia. 1

The experiments made by Wintemit^ and Schljkoff sho«|
that the temperature of the cavity of the chest is diminia
within ten minutes after the application of the cooling thoil
comprens. The blood-vessels of the chest are made to g|
tract instantly when contact with the coid compress is md
The tichil air is increased more than one third in volni
(Exp. 71).

1970 Therapeutic Applications — The chest pack acts pow
fully upon the pulmonary mucous membrane. It is of gn
value in pulmonary congestioji, and has also been used w
considerable success in pulmonary tuberculosis. In this c
ease it controls the cough ^ lowers the temperature, lessens t
night sweats, and facilitates the healing process by aidi
leucocytosis. In bronchial catarrh it is of very great servi<
relieving the congestion by bringing the blood to the 8urfa<
thus relieving the cough and the expectoration.

In spasmodic asthma the application of the chest ps
sometimes brings on a paroxysm of difficult breathing. T
ttjudency m.iy be largely obviated by the appHcation of fomi
tations to the chest just before the application of the cold co
pn!SH. The chest pack is a very valuable measure in all caj
kA chronic bronchitis, chronic pneumonia, 7\xiA chronic pleuru

in connection with fomentations^ which should in these cases
precede the application of the pack, and especially in that
very common affliction known as a cold on the lungs. The
fomentations should be very hot and of short duration — j to
8 minutes.

The cooling chest compress is applicable in all cases of
range si ion and infiammaiiQU of the lungs and in pulmonary
hemorrhage. Its employment is especially important at the
beginning of pulmonary inflammation. In cases of hemor-
rhage, very cold compresses should be applied and frequently
renewed. Special attention should be j^iven to the surface
above the clavicle. The effect of the compress may be
intensified by applying ice-bags to the apices of the chest
over the cold compress,

A cold compress over the whole chest or over the cardiac
region alone is valuable in cases of over-action of the heart,
cardiac irritability, or threatened cardiac failure. The effect
secured by this application is often very remarkable and
almost immediate.

The heating chest compress has great therapeutic value
in the treatment of tuberculosis and in chronic bronchial
catarrh. When employed for this purpose, the compress
should be covered with thin mackintosh or gutta-percha tis-
sue if the patient is feeble and reaction defective. When
febrile action is marked, flannel covering only should be used.

The heating chest compress is very useful in cases of
chronic pleurisy accompanied by affusion. The pack should
be removed once in three or four hours for the applica-
tion of the revulsive compress, consisting of a fomentation for
4 or S minutes^ followed by a cold compress tor 15 to ao
seconds, the alternation being repeated three or four times.

In cases of chronic bronchitis, the compress should be
covered with mackintosh, and should be changed as often as
once in every four hours. If allowed to remain too long, so
that it becomes superheated, palpitation of the heart and
faintness arc likely to occur,

864 RATIONAL HYDROTHERAPY,

^Tien cx»Dsiderable fever is present, as indicated by a tern-
peratiire of loi^ to 102^, the complies should be w«t to coot
water^ or water at a temperature of 60" to 70^, and wrung
lightly, so that it may contain, wfaea applied, as much Heater
as possible wtthoat dripping. While the fever lasts^ this
chest compress should be worn night and day. It should be
covered lightly, with flannel only^ in the summer-time. In
the winter- time, if the temperature of the sleeping -room falls
below the ordinary living-room temperature, and the patient's
powers of reaction are deficient, the impervious covering may
be applied. When the cough and the fever are both trouble-
some, the compress may be worn both night and day*

Precautions, — i. Every precaution must be taken to avoid
chilling the patient. If the towel is too wet, a feeble patient
may not be able to wami it up, and may chilL

2, Especial care must be taken to make the dry flannel
bandage extend an inch beyond the wet towel above and below,
in order to prevent the air from getting under the bandage.

3. When the chest pack is applied at night, the chest
must be bathed with cold water and vigorously rubbed on
arising in the morning, and a thick flannel wrapping must
take the place of the pack, to be worn during the day,

THE HOT CHEST PACK.

1380 This differs from the ordinary chest pack chiefly in that
the wet bandage is of flannel, doubled, and is wrung out of
hot water. The square form of pack is preferable (1374).

The hot chest pack stimulates the circulation of the sur-
face of the chest, thus withdrawing the blood from the bron-
chial arteries into the intercostals. The pleura is drained
into the cutaneous branches of the internal mammary.

The hot chest pack relieves the pain of pleurisy ^nApneu-
monia, cardialgia, and spasm of the bronchioles in nervous
asthma.

It should not be forgotten that in applying heat to the
chest the heart, as well as the lungs, is profoundly affected;

I

THE TECHNIQUE OF HYDROTHERAPY. 865

hence care must be taken to avoid this application in cases in
which there is grave organic disease of the heart, especially
when cardiac weakness is marked.

THE THROAT COHPRESS.

In this compress it is desirable to bring under the influ- 1381
ence of the application the skin covering the lower jaw from
the chin backward, the sides of the face from the angle of
the jaw to the ear, and the sides and back of the neck. The
compress wound about the neck is of very little use for the
ordinary sore throat in which the fauces and perhaps the ton-
sils are involved.

The compress is prepared as follows: For the wet com-
press, fold a piece of cheese-cloth to four or six thicknesses,
four inches in width, and length sufficient to reach one and
one-half times around the neck. For the flannel covering,
provide a piece of soft blanket flannel eight inches wide and
long enough to reach around the head and beneath the chin
and overlap an inch. Fold the flannel crosswise, and split it
down the middle to within an inch of this fold. Open, and
split again each of the two legs of one end. Apply first the
wet bandage from behind, crossing the ends under the chin
and folding up against the sides of the neck, covering also
the back of the cheek to the 3ar. Now apply the flannel
bandage as shown in Figs. 203, 204, 205. If protection is
required, apply a strip of mackintosh next the wet cloth.

This is a very excellent application for the relief of chronic
sore throat. It may be applied at bedtime and removed in
the morning. On removal rub the throat with very cold water.

The throat compress in acute inflammation should be
covered with flannel only. If mackintosh is used, apply
flannel outside to prevent too rapid radiation.

The hot compress for sore throat is applied across the
jaws behind the chin and to the sides of the face. The dry
ends may be fastened above the head, and a cold compress
applied about the neck at the same time.
55

866 lATmUL HTDBOTBEKArr.

NBCX aiMPSESS(RK-

tS8t This consists simply of a linen doth wmng out of
at the right temperatore and wound about the neck,
with flannel or flannel and ofldoth.

For acute laryngitis the bandage should be wet in water aft
60^ to 70^. wrung moderately dry, and covered iritfi 1
only. It should be changed just before the bandage
dry. In cases of chronic laryngitis the bandage dioald be
wrung out of very cold water, and covered widi flannd and
mackintosh* On removing the bandage in the monuii^ the
parts should be thoroughly rubbed with cold water, and dwald
be protected by the dry bandage during the day.

Physiological Effects.— Through the reflex effects to be
obtained by the application of this bandage to the skin over
the laxynx, and through its influence upon the sympathetic
centers of the neck, the procedure is capable of exerting a
very decided influence upon the mucous membrane of the
larynx and the various otgans concerned in speech, promoting
activity of the mucous membrane, and relieving congestion
and irritation of the larynx and the pharynx, which are often
the cause of chronic cough.

It must be remembered, also, that warm applications to
the throat enlarge the great arterial trunks conveying blood to
the head, and hence may produce cerebral congestion. For
this reason, throat wrappings should not be unnecessarily
warm. The compress should generally be covered with flan-
nel only, and should not be left ui place after it becomes dry.

Therapeutic Applications.— The heating throat compress
is useful in colds, acute inflammation of the larynx and
pharynx, in whooping-cough, diphtheria, croup, clergyman's
sore throat, and in all cases in which a derivative effect is
indicated in this region of the body.

Sore throat, catarrh of the larynx, and so-called **cold in
the head '* arc promptly relieved by the heating compress, if
applied immediately after the cold has been contracted. The
compress should be wrung out of cold water; and if applied

for sore throat, should be lightly covered with flannel, and
changed every four hours; if for chronic catarrh ol the larynx,
it should be covered with impervious material, so as to secure
vigorous revulsive effects* General treatment is also required.

The continuous warm compress to the throat may some-
times render useful service in cases of marked cercifral ane-
mia^ as also in perniciaus anemia^

When used for antiphlogistic effects, a simple compress of
six or eight thicknesses of cheese-cloth is required. This is
freshly wrung out of cold water every four or five minutes.
It should never be allowed to become heated, it being neces-
sary to suppress reaction completely and contract the deep
vessels, in order that the antiphlogistic effect desired may be
produced*

Duval* reports a case of very severe foriict^ifis curetl by
the heating compress in connection with general cold ablutions.
The compress was renewed every two hours, and remained in
place until profuse sweating was occasioned.

THE PRECORDIAL OR CARDIAC COMPRESS.

The application consists of a compress applied to the por- 1383
tion of the chest wall over the heart. This comprises the
space bounded by the second rib above, the right border of
the sternum, a line falling one-half inch to the right of the
nipple, and the sixth rib below. The compress should bg
large enough to cover this space and to extend at least two
inches outside it Ordinarily, the best effects are produced
by employing water at a temperature of about 6o^\ The
compress should be wrung moderately dry, and should be very
lightly covered. It is desirable that cooling by stow evapora-
tion should be encouraged, and should continue for some time.
The heating compress, when applied over the heart, may
produce a depressing effect. The compress should be
changed as soon as it becomes decidedly warm, or before.

♦** Ann, de Cbcrfft d'Onhod.,** it^/\ l\, 71, 76.

868 RATIONAL HYDROTHERAPY.

Ordinarily the cooling compress will need to be changed
every 1 5 to 20 minutes. The ice-bag may be used in place of
the cold compress, and has even been used continuously with
excellent results to control high temperature. A single thick*
ness of flannel should protect the skin.

Physiological Effects. — The effect of the precordial com-
press is first to increase the activity of the heart. The heart
makes stronger, more vigorous and frequent contractions than
before the application; within a few minutes, however, the
rate of the heart-beat will become slower; and within half an
hour, when the application has been rightly adapted to the
case, the pulse-rate will be considerably slowed, arterial ten-
sion increased, and the first sound of the heart considerably
accentuated, the upstroke in the sphygmographic tracing being
much quicker and longer, indicating a larger movement of
the heart (Fig. 207, A and B). (Exp. 72).

Experiments made with the heart separated from the
body have shown that cold water dropped upon the heart
slows its action, while hot water quickens it. That the op-
posite effects are produced by the application of hot and cold
water to the skin is due to the fact that the impression made
upon the heart by cutiincous applications is reflex. When
the heart is directly cooled by an ice-bag long applied, the
uniform effect is slowing of its action.

The effect of cold upon the heart has been quite fully dis-
cussed elsewhere in this work, and need not be further dwelt
upon here (514-).
1384 Therapeutic Applications.— Frequent application of cold
over the heart is indicated in the feeble heart of loiv fevers,
especially when cardiac failure is threatened, in the early
stage of the disease. Very cold or continuous cold applica-
tions should not be made when there is evidence of cardiac
degeneration resulting from neglect of proper treatment of the
case during the first week or two after the beginning of the
attack. If continuous applications arc employed, the com-
press or ice-bag should be removed every half hour, and the

I'
5
•1

^

THE TECHNIQUE OF HYDROTHERAPY. 869

skin surface to which the application is made should be
rubbed vigorously, or sponged with hot water. In many cases
of cardiac weakness, especially in chronic cardiac insufficiency,
bradycardia^ tachycardia^ and other functional disorders of the
heart, the cool or cold compress may be applied three times
a day (15 to 30 minutes). This measure is also valuable in
cases of overaction and irritability due to valvular disease of
the heart in which there is no degeneration of the heart muscle.

In the acute form of endocarditis, and in myocarditis^ the
cool compress should be applied continuously. Each time
the compress in changed the moistened surface should be
rubbed with the warm hand until red through reaction. In
chronic endocarditis, the cold compress should be applied for
half an hour three times a day. The effects of the precordial
compress are greatly augmented by general cold friction and
other general procedures.

The cold compress is indicated in most cases in which the
prevailing practice calls for alcohol, digitalis, or strychnia.
All the good effects which it is possible to obtain from these
drugs may be secured by the precordial compress, combined
with other hydriatic measures, thus avoiding the undesirable
effects of the drugs. Alcohol lowers the blood pressure instead
of raising it, and adds to the toxic elements in the blood,
lessening vital resistance, and also weakening the heart.
Digitalis and strychnia, while they seem to strengthen the
heart, at the same time increase its work, and add to the
toxins already present in the body another powerful poison.
The precordial compress is valuable in cases of aortic in-
sufficiency with dilatation, or beginning degeneration of the
vessels, also in endocarditis, whether acute or chronic.

A very useful application for the cold precordial compress
is during chloroforvi anesthesia. It is the author's invariable
custom to employ a cold compress for this purpose whenever
the administration of chloroform is necessary. An ice-bag is
used, which is applied, not directly to the skin, but over one
tliickness of thin flannel. Every ten minutes the ice-bag is re-

870 RATIONAL HYDROTHBRAPy.

moved, and the parts rubbed with dry flannel until wann and
reddened. A failure of the parts to react or the appeannoe
of an areolar cyanosis (a mottled bluish appearance) coosti-
tutes a warning sign of excessively depressed nerve centerBp
so that the application becomes a guide to the physician ad-
ministering the anesthetic. Its most important use, however,
is to support cardiac activity by maintaining powerful reflex
stimulation of the cardiac centers. It is the author's opinioo
that few deaths from chloroform would ever occur if this
measure were uniformly resorted to. The ice-bag shotdd not
be applied at the beginning of the anesthesia, except in cases
of extreme cardiac weakness. The proper time for the appli-
cation is after the first or irritant effects of the anesthetic have
disappeared, and the secondary effects have become pro-
nounced. This will usually be within five to six minutes
after the beginning of the administration.

The same measure is also of value in ether anesthesia^ but
it is well in the latter case to employ a cheesecloth compress
rather than the ice-bag, and to extend the application to the
whole anterior surface of the chest. The compress should
be applied at 60^, and changed every 1 5 or 20 minutes. The
square compress wrapping may be advantageously used in
these cases. If the anesthesia be prolonged, the pack may
be changed once in 10 to 15 minutes and the precordial region
vigorously rubbed with the hand dipped in ice-water for 20
seconds. This procedure may be employed in connection with
anesthesia with very little inconvenience, and enormously
lessens the risk of death from heart failure in chloroform
poisoning or from acute pulmonary congestion or broncho-
pneumonia after ether administration.
1385 Indications for the Application of the Cold Cardiac Com-
press.— According to Winternitz, the indications for this
measure are the same as for digitalis: —

" I. The application of cold over the heart diminishes its
temperature, and is therefore useful in inflammation of the
heart and pericardium.

THE TECHNIQUE OF HYDROTHERAPy.

871

*'2. The temperature of the blood is by this means
reduced, and hence this measure may be usefully employed
in fever in connection with other antithermal measures. If
antithermal drugs are employed, cold applications should be
applied over the heart, for the reason that aiitipyrin acts
injuriously upon the heart, and lessens the tone of the vessels^
thus leading to collapse; whereas the cold precordial com-
press has the opposite effect.

'•3. In all conditions of cardiac weakness, no matter from
what cause, cold applications over the heart may be employed,

*'4. When the blood pressure is low, the application of
cold is especially useful; hence this measure may be employed
in all serious disturbances of the heart, as to adynamic fevers
and in functional disorders of the heart,

** 5. By aiding the pulmonary circulation, cold applications
over the heart are useful in a congested condition of the
lungs, in bronchial hemorrhages, and bronchial catarrh result-
ing from stasis in the pulmonary vessels. **

A moderately hot compress may be applied over the heart
in the weakness of that organ which occurs in hysteria with
anemia (i 10^ for 10 min.),*

Contraindications. — The cold precordial compress is to be 1386
avoided in the ftitiy degeneration of the heart muscle which
•occurs in the advanced stages of cardiac disease, and in dm-
bites and nephritis. In emphysema, when the disease is
well advanced, the beneficial effects of cold applications upon
the heart are diminished, because of the condition of the
lungs. One of the most important, but not sufficiently
appreciated, effects of hydric applications consists in the
modification of the elasticity and tonus of both the vessel
walls and the tissues. As a loss of tonus and elasticity in the
vessels produces stasis, hyperemia* and predisposes to inflam-
fnation, the restoration of the tonus of the vessels and tissues
removes the disease of the vessels thus caused.

•Thermes* Ann, Sm, ffydt^L Med,, Paris, 187^-SOf XXV. 224-295.

8/2 RATIONAL HYDROTHERAPY.

It has been clearly demonstrated that diminished tone of
the vessels and tissues produces a positive and decided dimi-
nution of cardiac energy, and that the restoration of the
vessel tone will, to a marked degree, remove the deiange-
mcnts which may be produced by organic ailments of the
heart. From a hydriatic standpoint, the loss of vessel tone is
a symptom the removal of which is of the highest importanoe
to restore normal conditions of the circulation.

THE JOINT COMPRESS (Rg. 3o8;.

1387 ThiB consists simply of a bandage wet in water of the
proper temperature, wound around the joint, and covered with
flannel, cotton, and oiled muslin, or some other impervions
material. In cases of acute joint disease with pain and swell-
ing, a moderately wet compress should be applied, at a tem-
perature of ()Qp to 70^^, and flannel or cotton-wool protection
should be used. In chronic joint affections accompanied by
stiffness, exudates, etc., the compress should be wrung dry,
out of very cold water, and should be very thoroughly pro-
tcrt<;d by means of several coverings of flannel or a thick
mass i)l cotton and oiled muslin or mackintosh outside of all.
In the acute form of the disease, the compress should be
changed often enough so that it will not become dry. In
chronic cases, the compress may be worn at night only, in
(^nlinary cases. In the morning tlie joint is rubbed first with
the hand dipped in cold water, then with oil, and protected
by several thicknesses of flannel bandage, properly adjusted,
to be worn during the day.

THB COTTON POULTICE (Fig. 209).

1388 This consists simply in the application to a part of a mass
of dry cotton covered with mackintosh or other impervious
material. The cotton is soon moistened by the retained per-
spiration, and thus the effect of a poultice is obtained, but in
a much more cleanly and convenient manner. The cotton
poultice is especially valuable in chronic Joint affections.

I

THE TECHNIQUE OF HYDROTHERAPY. 873

THE HIP PACK (Fig. 210).

This application is confined to the skin area extending 1389
from the umbilicus to the middle of the thighs.

The materials needed are the same as for the half-pack
(1196), and the method is the same. For the cold pack a
folded linen sheet is used; for the hot pack, a folded woolen
blanket.

The cold hip pack has a pronounced effect upon the pelvic
viscera, just as the trunk pack affects profoundly the abdom-
inal viscera. Judiciously used, it has a powerful tonic and
alterative effect upon the organs of the pelvis.

The cold pack should be avoided in cases in which severe
neuralgic pain is present, in acute inflammation of the append-
ages, chronic uterine or ovarian pain, and menstruation.

The hot hip pack is a highly stimulating procedure, and one
of the most excellent means of relieving, temporarily at least,
menstrual pains, whether of uterine or ovarian origin, by the
powerful revulsion produced. If the menstrual flow is in-
creased by the application, this tendency may be counteracted
by the hot vaginal douche applied immediately before or after-
ward, the patient remaining in bed.

Not infrequently the good effect of a hot hip pack is lost
by exposure of the body to chill directly afterward. It should
be remembered that, like all other very hot applications, it
usually gives rise to general sweating, and hence may readily
expose the patient to chill with all the resulting consequences,
if proper precautions are not adopted.

Some form of the cooling bath, as cold friction (1209),
the wet-hand rub, or cool towel rub, should be employed
directly after the hot hip pack, and care should be taken to
secure gradual cooling off.

THE PELVIC PACK (Figs. 211,213,313).

Spread a woolen blanket on the couch as for the wet-sheet 1390
pack. Fold a woolen sheet once lengthwise, place transversely
across the couch in such a way that when the patient lies

874

\

it, the saoum wiQ fall in tlie crater of the sheet
eadb way. Fold aiMitber woolea siieci oofncfmse;. eim) Imy
acn»s the Cable with the apex potntii^ down and the base al
ioch a point that when the patieet lies down, the upper edge
of the blanket will fall a couple oi inches ^>ove the ambilicos
and a Utile below the sheet folded lengthwise. Now wring
out a cotton sheet ctit or folded com^^vise in the shape of a
tmng\& a little smaller than the wooten triangle, and place
upon the cotich with the apex down and the base an inch
below that of the woolen triangle.

The patient should now lie down npon the conch face up-
ward, and in such a position that the upper border of the wet
sheet will fall at about the leve! of the timbilicas* The legs
are draiv^ up and the knees widely spread, and the feet placed
one on each side of the apex of the triangular wet sheet. The
apex of the wet sheet is drawn upward until it fits the peri-
neum tightly, the apex lying upon the sternum, the sides being
spread out over the abdomen as much as possible. The legs
are now extended, and the lateral triangles of the wet sheet
are brought over one by one and wrapped about the thighs io
such a way that the skin of the abdomen, hips, thighs, and
perineum is everywhere covered by one thickness of sheet.
The apex of the triangle is now turned down over the abdo-
men so that the fold will come at the level of the umbilicus.

The woolen sheet is adjusted in just the same way, only
the lateral angles are carried over and tucked under the op-
posite thigh. Now draw over the ends of the folded sheet,
and tuck under the sides, drawing as snugly as possible, so
the patient will warm up very quickly. Last of all, wrap the
patient in the large woolen blanket first spread upon the couch.
The remainder of the procedure is now the same as for the
general wet-sheet pack.

Three stages may be recognized : —

I. The ^om'c stage, — from the beginning of the pack until
the patient feels warm and comfortable. The effect upon the
pelvic viscera is to excite vascular and nervous activity.

(

THE TECHNIQUE OF HYDROTHERAPY.

87s

2, The neutral si2.ge,— "while the patient is reacting until
the normal temperature of the skin is reached. When the
temperature of the skin begins to rise^ the neutral stage ends.
This stage is quieting^ calmative,

3, The htating stage commences when the temperature
of the skin begins to rise» and continues to the point when
perspiration begins. This stage is derivative,

4, The sweating stage begins at the end of the heating
stage, and lasts as long as the patient continues to perspire,
which may be two or three hours. This stage is exciting.
It is rarely used with the pelvic pack

In cases in which reaction is poor, a hot €\lz may be
administered for 4 or 5 minutes just before the pack, or a
hot hip pack for 6 to S minutes, or a fomentation over the
hypogastrium. This pack is generally used for tonic effects
and as a training for the cool sitz bath. The application is
continued from 20 to 30 minutes, or until the patient feels
comfortable.

In the hot and cold pelvic pack when used to relieve
chronic pain, ovarian irritation, etc., for which it is a most
excellent measure, the procedure is precisely the same,
except that a bag filled with hot water is slipped between the
blankets over the lower abdomen in such a way that one
thickness of flannel will intervene between it and the wet
sheet. The temperature of the bag should be as high as the
patient can bear. The thermophore is preferable to the hot
water bag, as the heat is more evenly distributed, and lasts
longer. The duration of the pack varies from 20 minutes to
two hours, according to the indications.

In applying the hot pelvic pack, the procedure differs
somewhat from the preceding. The several coverings are
arranged exactly as in the wet-sheet pelvic pack, except that
the triangular Wn^n sheet is folded so as to be about two feet
greater in width, and is not wet. The triangular woolen
sheet is wrung as dry as possible out of water at 160°, and
laid over the triangular sheet. The patient, bis head having

•76

1 imvriuwijr pfotccted bjr oooGdi^ sumI tbe <
ocild UweL lies dcwn opoo the ocxkIi, and b
prevkwflf described, the diy triancelar sheet
fo as to mainfatn dose contact with the bodf at <
Tbeo the side ani^ are brougfat op and tocfced in; iht :
is firmly drawn op between the legs and secuicly I
Tbe cc4too sheet is then adjosted in like manner, and a folded
woolen Uanket drawn aboot the hips.
1991 PkytUogk^t Effects^ The pelvic pack is intended
ctally to infloeoce the pelvic viscera, tbe bladder, the
ccJoD, the rectom, the testes and prostate in men, and the
ovaries and otems in women. Applied in the mamify indl*
catedf it acts opon those sorfac>es which are in most intimate
reflex relation with the viscera of the pelvis; namely, the
cotaneoos sorfaces of the lombar region, the lower abdomen,
the inner sorface of tbe thighs, and especially the cotaneoos
covering of the external genitals. If tbe sheet is simply
wrapped about the hips, instead of being drawn op between
the legs in the manner described, the genital surfaces and
the inner surfaces of the thighs are not reached, and hence
these most important reflex areas are not brought under the
influence of the procedure.

The effects of this procedure upon the pelvic viscera
depend upon the exact mode of application, the temperature
of the water employed, the length of the application, and the
Hpecial conditions or susceptibility of the patient, as is the
cjisc with other hydric procedures. If the wet sheet is
wrung very dry out of very cold water, and the application
continued only until reaction is well established, the effect
is to encourage the circulation of the pelvic viscera and to
energi^se all the other functions. Such an application is in
brief an excellent physiological tonic for the pelvic viscera.
If an application given in the manner described is continued
fr)r an hour or two, or until the skin is strongly excited, a
powerful revulsive eflect is exercised upon the viscera of the
pelvis. This is one of the most effective means of decon-

THE TECHNIQUE OF HYDROTHERAPY. 8/7

gesting these organs. The application of the pelvic pack at
a temperature of 60^ to 70^, the application being renewed
every 20 to 30 minutes, exercises a powerful influence upon
the pelvic blood-vessels. By its continued excitant effect
upon the vaso-constrictors, permanent contraction is pro-
duced in the small vessels of the pelvic circulation. If the
wet sheet is slightly wrung out of very cold water, the effect
is to produce powerful constriction of all the pelvic vessels.

The hot pelvic pack exercises a powerful revulsive effect
upon the pelvic viscera. If continued for some time, pro-
nounced excitant effects are produced through the stimulation
of the sympathetic nerves in relation with these parts. Very
pronounced and permanent derivative effects may be pro-
duced by the hot pelvic pack, followed by a prolonged cold
pack applied to the same surface.

Therapeutic Applications. — Of the four principal methods 1392
of applying the pelvic pack, each has its special therapeutic
indication. The short cold pack, with the wet sheet wrung
very dry, is tonic in its effects, and is of the greatest value in
most cases of chronic pelvic disease in which neither active
inflammation nor acute congestion is present, and in which
pain is not a prominent symptom. It is indicated under the
same conditions as the rubbing sitz, but is a less vigorous pro-
cedure, and may be employed with very feeble patients who
have poor powers of reaction or who are too fatigued to react
properly to the rubbing sitz. It is a hydriatic procedure of
great service in cases of uterine and ovarian prolapse due to a
relaxed condition of the muscles and ligaments connected with
the pelvic viscera, in amenorrhea^ irregularities of menstrua-
tion, chronic inactivity of the lower bowel ^ backache y enter op-
tosiSy sexual weakness, and impotence.

The cold-sheet pelvic pack, prolonged until cutaneous ex-
citation is produced, or as it may be termed, the heating pelvic
pack, may render special service in cases of chronic passive
congestion of the pelvic viscera, as chronic colitis, chronic
metritisy chronic ovarian congestion, amenorrhea resulting

n nested <levelo|iniefit« excessive invi^iuiwn alter child-

[II. Il should be followed by a short cold applicatioD, as
t0e cotd doocbe, cold Eriction, affosion, or coM rubbing sitx
for 20 to 30 seconds, at a temperature of 70"^ to 75 ^ The
length of the application and the temperatiife must of coi^bc^
be suited to the particular case in band. fl

The repeaiid pelvic pack, employing water at 60'^ to 70^,
with a quite wet sheet, changed every 30 to 40 miniit^, is a
measure ol great etf*^'*'*''y in cases of acute con gat ion or
i^fiamm<iti0n of the privu viscera. The blood- vessels of
the viscera are not only contracted, thus preventing stasis and
an increase of the tnJIammatoiy* process, but the vital activi-
ties are excited and maintained by siimulatLng impulses con-
tinually received from the surface; and tbos the disease process
is antagonized and brought to an early and successful issue.
This measure is of great value in nQH-SHp^urating infiamma^
iietts of the ovaries and tubes, pelvic pcriioniiis^ &cuie mctri^'^k
ii$^ vaginitis, proctitis, dysentery^ prostatitis^ aretkritis^
and orchitis. By the application of water at a moderate .
temperature to the entire cutaneous surface reflexly associated ^
with the peivic circulation, much more pronounced ejects may
be obtained than by water at a lower temperature applied to
a smaller surface. These cool and moderately cold appli-
cations are also much more effective than extreme cold in
relieving visceral congestion. Their efficiency is greatly
increased by a hot leg pack given at the same time.

When an acute inflammation or congestion is accompanied
by pain, a hot pelvic pack or fomentation may be substituted
every hour or two for the cold application; but the duration
of the hot pack should not be more than 1 5 to 20 minutes,
and the temperature should be as hot as can be endured.

The very cold pelvic pack sometimes renders valuable serv-
ice in cases of uterine hemorrhage. The author has been
able by this means to control at once uterine hemorrhages
which had resisted all other measures for weeks. A hot appli-
cation must be made to the feet simultaneously.

THE TECHNIQUE OF HYDROTHERAPY.

879

^The koi pelvic pack is most useful as an analgesic measure
in all painfui affections of the pthns. It renders the highest
service in cases of dysmeu&rrkea, ovarian neuralgia, and
all nenratgiac affections of the pelvic viscera, also in tnier-
aig-ia^ sciatica, and ct^ccjg-odynia.

The Aot a fid cold pelvic pack (1370) may render special
service in cases in which the combined influence of heat and
cold is desirable. The procedure may consist of a hot pelvic
pack with an ice-bag over the inflamed part, or a cold pelvic
pack with a hot bag over the part interested.

Contraindications and Precautions* — The pelvic pack, to
be of real service, must be carefully adapted to the condition
in hand. For eicample, prolonged cold applications must
not be made in cases in which pain is a prominent symptom,
as the almost certain result will be a great increase of the
pain. The very cold pack should also be avoided in inflam-
matory conditions, because of the resulting reaction and the
collateral hyperemia induced. Long-continued hot appltca^
tions also tend to increase inflammatory action in salpingitis,
peritonitis, and other similar conditions. In such cases the
hot pack may be used only at intervals of three to four hours,
the cooling pelvic pack being employed in the interim.

Care should be taken in the employment of the cool or cold
pelvic pack that general chilliness is not induced, or the proper
effect of the application will be negatived. Likewise, in
applications of the hot pelvic pack profuse perspiration is
to be avoided.

THE LEO PACK (Fig, J14).

Either one or both legs may be included in this procedure.

Requisites* — The same materials are needed as for the
trunk pack, though the wrappings may be smaller

nethod.— In the application of a leg pack» each leg should
be wrapped in the wet sheet separately and closely (Fig, 214).
The legs may be rubbed outside the wrappings, if necessary,
to encourage the circulation. The temperature should be

I39:j

WjO rational hvlrotherapt.

60'' for the cold pack, and as hot as can be borne for the hoi
\fHfM. A hncn sheet is used for the former, a biaoket for the
latter.

PhyftiolosiCAl Effect^*— The leg pack is a powerfal deriv*

ative rneaMjre. Applications made to the l^s affect to a
marked degree the circulation in the head, throat, chest, and
j;^;lvis.

Therapeutic Applications.— The leg pack may be used to
exci:llent advantage as a derivative measure in quite a large
class of cases, as in cerebral coJigestion^ pubnonary congestion^
coldness of the feet and legs, resulting from irritation of the
sympathetic nerves and spasm of the blood-vessels of the
lower extremities. The cold leg pack is of special value in
cases of paralysis in which the skin is cold, purplish, and
inactive. The application should be preceded by a hot leg
bath. The hot leg puck is exceedingly useful in cases of
neuralgia iA the legs, in hemiplegia^ and paraplegia with
defective circulation, as shown by a purplish tint of the
skin. It is also a very useful measure in cases of chronic
rht Hwatisvi confined to the knee and ankle joints, and as
a derivative measure.

Till: rOOT PACK (Fig. 215).

IIIO'I This r(!seinl)l(js i\\r. lr^( puck, but differs from it in that

lh(* feet jMwi ankles only ani invr)lv((l.

Tli(^ patient lies upon a cot while each foot is separately
wrapped in a towel wrung out of cold water, and a blanket
can'fully foKliid about the feet and le;^^s to the height of the
kniM^s. Tlu^ entin* body is then wrapped in another blanket,
so as to suppress any disposition to chilliness.

Therapeutic Applications — The foot pack is of great
value as a means of relii^ving cold or sweating feet, and for
iiiMnnttia. The park shouKl be applied at night, and allowed
to remain in plaeo fc^r a few hours, ox overnight. On its
removal, the feet shouM bo carefully sponged with cold water,
and afterward dried and rubbed.

THE TECHNIQUE OF HYDROTHERAPY.

88 1

THE PERINEAL COMPRESS-

For rectal, bladder, or genito-urinary affections requiring 13S5
antiphlogistic treatment, the cold compress may be applied in
such a manner as to cover the perineum and the external
genitals, extending over the bladder in front and the anus
and nates behind. The temperature of the water employed
should be about 60° to 70'^ F. The compress should be
changed every 20 to 40 minutes* It should be lightly covered

Therapeutic Applications. — This measure is especially val-
uable in cases of recta! irriiaiian, kucorrhca of the rectum^
acute injiammaiwn of the prostate, chr^nii gleet, vaginal
leucorrhca, and uterine and ovarian congestion. Fomenta-
tions may be applied to the region when required for revulsive
effects, or to relieve pain or tenesmus in the rectum, bladder,
urethra, or uterus. A hot perineal compress combined with
a heating pelvic pack (1390) is a most efficient analgesic and
antiphlogistic procedure.

IRRiaATIDN.

Irrigation differs from the douche in the fact that the
element of mechanical excitation is entirely eliminated through
the application of water without pressure. Irrigation is
applied to both the skin and the mucous membrane. The
application is made by means of a reservoir or fountaixi
placed a few inches above the surface to be irrigated, the
water being allowed to flow through a small rubber tube, and
the stream regulated to the amount desired by compression
of the tube or regulating the height of the reservoir. Either
hot or cold water may be applied by this as well as by
other means, or alternate applications may be made.

The principal applications of this procedure are to the

ear. eye, nose, throat, stomach, rectum, bladder, vagina, and

uterus,

IRRIGATION OF THE BAR,

Fig- 216 shows an excellent method of applying the 1396
irrigation to the ear by means of a glass or hard-rubber de-

S6

S82 RATIONAL HYDROTHERAPY.

vice. The water passes into the ear and out through a lube»
thus enabling the patient to receive the treatment in any
position, as the instrument exactly fits into the outer extremity
of the external canal o( the ear. The temperature may be
from I GO' to 130% according to the effect desired. The
fountain should be on a level with the top of the head. Force
should never be employed, for the reason that perforation of
the ear often exists^ and serious injury might result from the
introduction of the water into the middle ear with any con-
siderable degree of force. The head should be incUned
toward the side under treatment.

The canal of the ear should afterward be carefully dried
and covered with a napkin or with the warm hand for a few
minutes. In cold weather the ear should not be exposed
out of doors for at least an hour after the application of a
warm ear douche, and even then it is well to protect the canal
by a little cotton placed in the outer extremity.

This measure affords great relief in the pain of acute
otitis media and earache due to other causes. In chronic
suppurative disease of the ear, this measure is indispensable
as a means of cleansing and disinfection.

NASAL IRRIGATION.

1397 Nasal irrigation may be administered by means of an ordi-
nary good fountain syringe, a properly constructed tube being
passed into one nostril, and the water allowed to flow into
one and out the other, the head being held forward to permit
of this taking place. This measure of treatment was for-
merly considered indispensable as a means of cleansing the
nasal cavity in catarrh, but is now seldom used, and might
well be entirely discarded, as it is a fruitful source of acute
and chronic disease of the ear. The nasal cavity can be
much better cleansed by means of antiseptic volatile oils,
or by cleansing solutions introduced into the nose by means
of vaporizers or atomizers.

The very hot nasal irrigation (104° to 105° F.) is useful

I

THE TECHNIQUE OF HYDROTHERAPY.

883

for checking hemorrhage from the nose. A saline solution,
one or two drams to the quart, is best for the purpose*

POST-NASAL IRRIQATION.

The post-nasal dooche or irrigation is administered by 1398
means of a curved tube passed into the post-nasal space by
introducing it behind the uvula, and throwing a stream of
water forward toward the anterior nares. The irritation pro-
duced in the region of the Eustachian tubes is frequently a *
source of serious inconvenience, and it is probable that more
harm than good results from the use of this measure in chronic
nasal catarrh.

This measure, which was once very generally employed,
is now rapidly becoming obsolete.

IRRIOATION OF THE EVE (Fig* 317)*

This application should be made with very little pressure, 1399
The reservoir should be placed not more than six inches
above the head* With the eyes closed » the water is allowed
to fall upon the outer surface of the lids and the forehead
above the brow. The hot eye douche is very valuable in
cases of chronic inflammation of the mucous lining of the
eyelids.

Hot irrigation of the eye has been proved to be more useful
as a means of relieving even acute inflammatory troubles of
the eye than cold applications. The beneficial effects are
I lie result of powerful revulsion, producing hyperemia of the
skin with collateral anemia of the inflamed mucous membrane.

IRRIGATION OF THE THROAT*

This is perhaps the proper term to be applied to the appli- 1400
cation commonly known as '* gargling/* A large sip of water
is taken into the mouth and passed to the back of the throat
and held there by closure of both the esophagus and the epi-
glottis. Air is then forced upward through the epiglottis,
thus producing a violent agitation of the liquid, and so bring-
ing it in contact with all the structures of the post-nasal

884 BATIOMAL HYDSOTHBSAFT.

region. The application of very hot water by Una
may be recommended in cases of chronic pkatymgUis^
tickling of the mucous membrane and diyness of Uie I
irritation^ hacking cough ^ and rawness^ giving rise to-im*^
qnent clearing of the throat or a tickling cough.

IRRIQATION OP THB STOMACH* OR QASTRIC LAVMHI j*:*,
(FIfS. ai8, ai9» aao). , ^

1401 This procedure does for the stomach predady '

enema or the coloclyster does Ux the colon. By its mid ttH
stomach may be washed out, hot or cold applications w^
be made to it, and cleansing and medicated solutions may hH
applied to the gastric membrane.

Method. — In the use of the stomach-tube, several pointt
require special attention: First, the tube should be of the
most approved pattern, of medium size, very soft anfl fleriMe,
and perfectly smooth. It should not be forced into the stom-
ach, as in the use of the old-fashioned stomach-pump, bat
should be simply swallowed as one would swallow food or
drink. One end of the tube being passed into the mouth and
well back into the throat, the patient makes movements of
swallowing, while the attendant gently urges the tube along
into the stomach. Water at about the temperature of the
body is poured in either with or without the addition of com-
mon salt and soda in the proportion of a teaspoonful of each
to a quart of water.

A powder consisting of three parts of bicarbonate of soda,
one part of sodium sulphide, and one part of chloride of
sodium may be advantageously used in cleansing the stomach.
Use one teaspoonful of this powder to each pint of wattf.
After a pint or so of water has been poured into the stomach,
the outer end of the tube is lowered, and by coughing or
similar movements the contents of the stomach are forced
through the tube into some proper receptacle. The opera-
tion should be repeated until the water is clear.

In withdrawing the tube it should be pinched tightly be-

f

THE TECHNIQUE OF HYDROTHERAPY.

S8s

tween the thumb and finger just in front of the teeth, so that
it is completely closed, before beginning the withdrawal. It
should then be drawn out quickly. The object of this is to
prevent the entrance into the larynx of the fluid or portions
of food which the tube may contain. Such an accident has
sometimes resulted in serious dyspnea and even syncope.

When lavage is employed in cases of catarrh of the stom-
ach, or for removing decomposing contents, the cleansing
solution of which the formula has been given above, or some
similar preparation, should be employed. It should be
remembered, however, that washing the stomach is not in
itself a radically curative measure. The stomach is simply
cleansed for the time being of mucus or decomposing food
or of noxious substances which may have been swallowed.
It is not directly curative except through the fact that removal
of the products of disease from the stomach greatly aids the
natural curative process by which the organ may be brought
back to its normal healthy state.

The application of very hot water to the mucous mem-
brane of the stomach in cases of hyperpepsia and gastrorrhea
may be made by means of the ordinary stomach-tube or by
the use of a return-flow tube. The maximum temperature of
the water employed for this purpose should be 140^, the
application being begun with the water at no^, and the
temperature rapidly increased to the desired degree. The
temperature must be regulated somewhat by the patient's
sensations. Two or three pints of water may be passed
through the stomach in this way with advantage. Care must
be taken to employ the tube very gently*

The cardiac excitation resulting from very hot irrigation
may be readily controlled by an ice-bag over the the heart

(1383).

Rosenbaum maintains that great benefit is derived from
the application to the inside of the stomach of a spray con-
sisting of many streams of water applied with considerable
pressure, at a temperature of 95^ to 1 10^. This measure he

886 RATIONAL RYDROTHEJlAPir.

finds especially beneficial in so-called nervous di^spepsia and
gastritis. Dn Tiirck, of Chicago. IlL , has made large use of
this measure in gastric disorders, and places a high value
upon it. A return fiow tube is employed for the purpose
(Fig, 221).

In cases of kypcpepsla and ^pepsia the tonic circulatoiy
reaction and excitation which follow cold applications may be
advantageously induced by the aid of the stomach- tube. The
depressing effect of severe cold, however, when applied to
such large surfaces as the gastric membratie, suggested to
the author the advisability of employing alternate applica-
tions instead* The variations of temperature should not be
so great as those employed upon the skin, because of the
active sympathetic reBexes connected with the stomach.

At the beginning of the treatment, the temperature of the
hot water should be 105^; that of the cold, So^; The tem-
perature of the hot water may be gradually raised, and that
of the cold water lowered, one or two degrees at a time,
until a temperature of 115" for the hot and 70° for the cold is
secured. The application must be made with the greatest
care, and should be discontinued at once* on the appearance
of any untoward symptoms. By means of this application,
powerful stimulation of the stomach and its glands may be
induced, resulting in the return of the patient's appetite, an
increase in the amount of hydrochloric acid secreted, and a
radical change for the better in every way, in many cases
which have resisted ordinary measures of treatment.

The hot water should be introduced first, the quantity
being about a pint. This should be retained from 20 to 30
seconds, and then passed out, and an equal quantity of cold
water introduced. At first only one alternation should be
made; but later, after the patient has become accustomed to
the treatment, the number of alternations may be increased
to five changes. Patients to whom the lavage is adminis-
tered should also receive the alternate douche or cold epigas-
tric douche daily.

I

THE TECHNIQUE OF HYDROTHmRAPY.

887

When necessary to employ lavage for infants, a small-
sized tube, as a No. 8 Nelaton catheter, is employed. The
child is held in an upright position by the ourse, while the tube
is introduced, A large glass funnel or fountain should be
in readiness, with two or three pints of water at 100"^', con-
taining one-half teaspoonful each of salt and bicarbonate of
soda to the quart. The rubber tube should be connected
with the catheter, and the tube completely filled with the
liquid to avoid introducing air*

After introducing from four to eight ounces, according to
the si^e of the child, the tube is disconnected, and the liquid
allowed to escape. The greater portion generally passes out
around the tube, as the catheter is so small that it will not
allow free exit for the hard and undigested cords of cow's
milk which are often found present in these cases. The
catheter should be held firmly in place, drawn to one side
during vomiting, but kept in the stomach if possible.

Lavage for young children is perfectly safe» and is by no
means so difficult as might be supposed. The younger the
child, the more easily the maneuver is executed. The tube
passes without difficulty, and the whole operation is over in a
short time, to the great relief of all concerned. Clinical
evidence is overwhelming that gastric dilatation and the
retention of undigested food in the stomach, giving rise to the
development of microbes and of ptomatns resulting from
their growth, is one of the chief causes of the gastric dis-
orders of children which prevail so extensively in the summer-
time- The use of unmodified cow's milk is without doubt
chiefly responsible for the intestinal disorders of children, and
these maladies will continue rife among them until a more
natural and appropriate diet can be generally provided for
young human beings.

Therapeutic Applications*^ Gastric lavage is absolutely
necessary as a means of cleansing the stomach in cases of
i^bsirHi'tioH of the pylorus from any cause, when the closure
is complete or nearly so. In such cases it must be employed

1402

RATIONAL HYDROTHERAPY.

syi natically daily, or in some instances even twice a dayj
In cnronic dilatation of the stomach, in which organic changes'
have taken place in the walls of the stomach, resulting in the
formation of pouches or an extreme degree of motor insiif&^
ciency, the habitual use of the stomach-tube is sometimes"
requiredi although it is not always necessary that lavage
should be administered daily. Complete emptying and clean9«M
ing of the stomach every other day or three times a week is
generally sufficient to maintain a comfortable degree of asepsis.

In cases of gastric catarrh in which large quantities
ucus are present, the stomach -tube must be used; but it
snould be dispensed with as soon as possible. In cases
hypopcp$ia^ in which there is little or no irritation of th€
mucous membrane, the use of the stomach- tube once
twice a week for a short time sometimes affords useful stimu* '
lation of both the muscular and the secreting structures.
Occasionally the use of the tube may be advantageouslyfl
resorted to in gastric ulccr^ though generally it is contra-
indicated in this condition,

\tv persistent vomiting, especially when the vomited mat-
ters have a green color, or consist of bile, and even in fecal
vomiting, gastric lavage not infrequently produces the most
happy results.

The therapeutic indications for gastric lavage are, in the
author's opinion, by no means so numerous as is generally
supposed. It was at one time the author's custom, after
making a bacteriological examination of the stomach fluid and
finding many germs present in it, to order systematic washing
of the stomach twice or thrice weekly; in occasional cases,
lavage was applied daily. But more careful study of the sub-
ject, and larger clinical experience in the adaptation of dietetic *
remedies to these cases, has convinced him that lavage is
necessary only in a very small proportion of cases, even when
the stomach is thoroughly infected. A fruit diet will starve
out all the microbes that can grow in the stomach, with the
exception of yeasts and molds, and even these disappear when

THE TECHNIQUE OF HYDROTHERAPV.

S8g

a simple, rational dietary is adhered to for a reasonable
length of time. Many persons have injured themselves greatly
by the too frequent use of the stomach-tube. Even in gastric
catarrh a properly adjusted dietary will accomplish all that
can be done by means of lavage, and much more, except in
cases in which large quantities of tough, tenacious mucus have
accumulated in the stomach, and require removal as a foreign
body, or when the stomach is enormously dilated from atony
or pyloric obstruction. This measure is of immense utility in
cases in which it is required* but it may be easily abused.

A very useful application of lavage is to abort a threatened
attack of migraine. Repetition is sometimes necessary.

The introduction of two or three ounces of ice-water after
a cleansing lavage is useful in increasing motility in cases of
atony or motor insufficiency. This measure should not be
employed when hyperpepsia or gastric catarrh is present.
In chranic gastritis, water at a temperature of 105 ' to lao^
should be employed in washing the stomach.

Gastric irrigation is recommended by Turck as a cardiac
stimulant It is certainly a powerful means of exciting the
heart, but the inconvenience of its use leads the author to
recommend as preferable the precordial compress (l;183), the
effects of which are decidedly marked, rendering it a most
efficient remedy in cases of cardiac failure.

Lavage of the stomach may be successfully employed as a
preliminary remedy in cases of iniesiiitai olntructioH in a
large proportion of cases. The author has been able to
relieve what seemed to be hopeless cases by this means. It
may be said that, as a rule, whenever ficai poifiitsng occurs,
gastric lavage may be properly administered, as the powerful
peristaltic movement thus set up not infrequently restores the
normal relations of the disturbed parts* and so relieves the
obstnictioD.

Contraindiciitionj — The habitual use of the stomach-tube
is highly detrimental to the stomach, and should be pro-
hibited except when made absolutely necessary by ot^ganlc

890

RATIONAL HYDROTHERAPY.

disease. The habit many patients have of passing a stomach^'
tube and emptying the stomach whenever they feel a slight
inconvenience in the gastric region or experience headache or
other slightly unpleasant symptoms, is a most detrimental
practice. In recent years, since the use of the stomach-tnbe^
has become so very common, the author has found himsel^l
under the necessity of prohibiting its use as frequently as he
has been called upon to recommend its employment, ^m

The use of the stomach-tube should be carefully avoided!
in cases of ulceraiion accompanied by kemorrhage, and in
cases of cirrhosis of the Hver in which there is reason to sus-
pect an accompanying varicose condition of the gastric veins.
In hetnarrhagic tubercular cases, in aneurism of the aorta
within the chest, in advanced cases of arteriosclerosis, and in
cases in which cerebral apoplexy has occurred, the use of the
stomach- tube must be either wholly interdicted, or undertakei;
with most extraordinary' precaution*

THE WATER EMETIC.

e^^

1403 Copious drinking of water at a temperature of 95° to JOO'-'
is an eiccellent means of provoking emesis. A single glassful
will not generally produce the effect desired, but three or four
glasses are almost sure to do so. If any medicinal agent is
employed, as mustard or other substance by means of which
emesis may be provoked, a copious draught of water at the
temperature named should be employed at the same time. If
the desired effect is not produced after three or four glass
have been swallowed, another glassful to which a teaspoon!
of common salt has been added, should be taken.

The emetic is by no means a certain means of emptyin
the stomach; even though there may be considerable quanti-
ties of liquid removed from the stomach by vomitings it is
impossible to say that there is not a considerable quantity still
left; and in any case it ts evident that the stomach can not
be thoroughly cleansed by this method. The stomach -tube is
in every way preferable to the emetic, the use of which is

J

THE TECHNIQUE OF HYDROTHERAPY*

891

necessary only in cases in which the stomach-tube can not
be safely employed, or when the pat lent *s fear of the stomach-
tube is 50 great that its use is quite impossible, it is
sometimes useful to suggest to an apprehensive patient con-
templating the use of the stomach-tube with great horror and
distress, that it is not necessary to swallow the whole tube,
but only the tip end of it. As a rule, it is only the nervous
fear of the patient which makes the use of the stomach-tube
at all painful or even seriously inconvenient*

JRRIOATION OF THE COLON.- THE ENEMA.

This very useful procedure consists of the tntroductiort of
a quantity of water into the colon. The author employs the
enema in three forms : First, the simple enema^ the method
of using which is welt known; second, the graduaicd enema,
a method devised by him a few years ago for the purpose of
enabling persons who had become accustomed to the daily
use of the enema to dispense with this very inconvenient
procedure; third, the cohdyster, termed by the French '*en-
teroclyster," which consists in an enema taken in the right
Sims's position or the knee-chest position, a long rectal
tube being employed.

In the simple enema the water is commonly employed at
about the temperature of the body, or 98'^. Better results are
obtained by employing water at 70^ F. The water is intro-
duced by the aid of a syringe of some sort. Various excellent
forms of syringes have been devised, of which the accompany-
ing cuts illustrate the most useful and typical forms (Figs*
222, 223, 224).

The temperature must also be adapted to the use for
which the measure is employed. If for mere mechanical
efiects, a temperature near that of the body is proper. It is
generally better to introduce the water gradually, so that the
bo%veIs may not be stimulated to contraction, causing the
fluid introduced to be discharged before a sufficient quantity
has been received.

1404

RATIONAL HYDROTHERAPY,

While the water is being introduced, the patient lies opon
[lis back, with the hips slightly elevated. If a strong desire
LS experienced to expel prematurely the liquid introduced,
the difficulty may be overcome by asking the patient to resist
the expulsive impulse strongly, if necessary by compM^essing
the anus with a napkin for a short time, until the peristaltic
movement has ceased.

In the employment of the enema only such an amount of
water as is necessary* should be used. Many persons have
been damaged by disten the colon so as to compel it to

receive three or four qu^i k> of water at once, as advised by
a well-known empiric of New York City. On the very day
of this writing the author has been called upon by a patient
who was seriously damaged by following the advice of the
charlatan referred to. The colon had evidently been stretched
and dilated to such an extent that it had never returned to
its normal condition, although considerable progress had been
made in overcoming the obstinate intestinal inactivity caused
by the habitual mechanical emptying of the colon.

In the apphration of the enema great care must be taken
to avoid the introduction of air into the bowels, as this may
be a source of severe colic pain. It is also important that the
quantity of water employed should be only sufficient to accom-
plish the purpose sought.

The enema may be usefully employed in the cases of
feeble patients as a preparation for surgical operations. In
such a case, the bowels should be first washed out, then two
or three pints of water at ioo° should be slowly introduced
into the rectum, the purpose being to increase the volame
of the blood by absorption.

The warm enema (98° to 100°) may be usefully employed
as a means of introducing water into the system in cases in
which for any reason the patient can not swallow liquids with-
out injury, as after operations upon the stomach, in cases of
persistent vomiting requiring complete gastric rest, in hemor-
rhage from the stomach, in typhoid fever with gastric dila-

THE TECHNiyUE OK HYDROTHERAPY.

893

iatian, aod similar cases. Absorption takes place from the
intestine much more rapidly than from the stomach.

The enema is certainly most useful as a means of tempo-
rarily relieving chronic intestinal inactivity; but great care
must be taken to avoid creating dependence upon it. Haw-
ever, it is far better to be a slave to the enema than to ** alter-
dinner pills. ''

A small cold enema is usually preferable to a large warm
one, A pint of cold water maybe introduced into the rectum
at night or before or after breakfast to be retained.

The warm enema soon loses its efficiency because of its
relaxing effect upon the intestines. The tone of the mus-
cular walls is gradually lessened from day to day, until the
bowel may become enormously stretched. Large quantities
of water should never be used, as they overstretch the bowel
and produce atony, Three or four pints is the limit for a
daily application, The colon will hold a considerable quan-
tity more than this, but should not be stretched to its full
capacity under the relaxing influence of the warm water. The
introduction of cold water into the small intestine is entirely
free from this objection. Half a pint or a pint of cold water
may be employed daily without injury, for the reason that
the cold water energizes the muscles and nerves of the intes-
tine. In the ordinary use of the enema, the temperature
should be (So* to 70"*),

In cases of extreme atony of the colon the enema some-
times fails to produce evacuation^ the water being in large
part retained, in these cases contraction of the colon may be
induced by applying a cold wet towel to the abdomen, lower
back and perineum while the patient is at stool or by mas-
sage of the colon or by a small enema of very cold water-
Not the least valuable service rendered by this simple pro-
cedure is the post-operative management of cases of abdom*
inal surgery. It is the author*s custom to administer an
enema immediately after the operation in all cases in which

RATIONAL HYDROTHERAPY.

I ns have been broken up, for the purpose of ' * placing ^

the intestines, as a precaution against obstruction. The valtj
oi this procedure, in combination with other measures, per-
taining chiefly to regimen and care, is attested by the fact that
in dealing with more than seven hundred cases of abdominal
surgery, nearly all ovariotomies or hysterectomies, the autho^J
has never once been compelled to reopen the abdomen to
relieve obstruction, and has been able to record a mortahty^
rate of less than three per cent, and a series of one hundred^
and sixty- five successive operations for the removal of uterine
or ovarian tumors and diseased appendages, without a single
death.

The Cold Enema,— The enema is recognized as one of
the most valuable means of reducing the temperature in
febrile conditions, and not simply as an antithermic, but as a
measure which aids in the removal of the causes of the abnor- ^
mal temperature by exciting renal and cutaneous activity, f

Tlie cold enema was employed by the DeHahns in Ger-
many in 1737 in the treatment of fevers. The same measure
was also used by Dr. Benjamin Rush in the treatment of
yellow fever in Philadelphia in 1794 with "good effects,"

The enema renders invaluable service in typhoid fever,
not only as a means of reducing the temperature, but of en-
couraging the action of the liver and kidneys, and especially
in cleansing the alimentary canal. For twenty-five years it
has been the custom of the author to begin the treatment of
every case of typhoid fever with copious enemas.

A simple illustration will show the efficiency of the enema
as a means of lowering the temperature: Suppose, for exam-
ple, the quantity of water introduced to be five pounds (pints),
and the temperature 70°, the patient's temperature 105°, and
his weight 1 50 pounds. If on the withdrawal of the water,
its temperature is found to be increased to 85°, there will
have been absorbed by the water 75 pound Fahrenheit heat
units (5X 15=75)- This would be an equivalent of one half
a heat unit to each pound of the body weight, or . 5° fall in

THE TECHNIQUE OF BVDROTHERAPV.

«9S

temperature for the whole body. In other words, if there
had been, in the meantime, no increase of heat production,
the temperature of the body would be low^ered .5*^.

A very convenient method of administering the cooling
enema is to supplement the ordinary tube of a fountain
syringe by a shorter piece of tubing, two or three feet in
length, connected to it in such a way that it can easily be
disconnected. The short piece of tubing should be some-
what larger than the ordinary size, so that it will not be
easily obstructed. After being slowly introduced, the water
should be retained for s» 10. or 15 minutes, if possible. Then
by disconnecting the short tube, and without removing the
rectal tube, the water may be allowed to escape into a suit-
able vessel » and another portion of cool or tepid water may
be immediately introduced.

In a fever case under the author's care a number of years
ago» the cold enema was employed in this manner contin-
uously for two or three hours, with the result that the tern*
perature of the patient, which was between 105- and 106^,
and had proved refractory to every other measure p w^as reduced
to 102° and was thereafter readily controlled by the repetition
of the same procedure.

The lower the temperature of the water employed, the
greater will be the effect. Ordinarily it is not necessary to
employ water at a temperature lower than /o'^, and excellent
effects may be obtained by means of the enema at So"^, pro-
vided a large quantity is introduced and the measure repeated
a number of times in immediate succession. To prevent pre*
mature expulsive efforts, it is well to begin at a temperature
loear that of the body, gradually but quite rapidly lowering
[it by adding cold water in sufficient quantity to produce the
itemperature desired. Suppose, for example, that it is desired
I to administer an enema of four pints of water and to obtain
'the effect of water at 70^^; the enema is started with a pint of
water at a temperature of icx>^, and three pints rapidly added
at a temperature of 60°,

Sg6

NATIONAL HYDROTHERAPY.

Stol^, in experiments to determine the antithermic effect
of the cold enema in cases of typhoid fever, found that by
the administration, at intervals of 5 to lO minutes^ of thij
enema at a temperature of 46^, the pulse was slowed twent
to thirty beats, and the temperature as taken in the mout
was lowered 3.6^.

The cold enema has rendered great service 10 the treatJ
ment of jaundice, as first shown by KnilK* The author pre-^
fers the enema at 105° to i lo^^ followed by the cold enemi

(eo«).

The cold enema is most effectual as a means of relieving
con sti pat ion through its tonic effects upon the structures of
the rectum and mucous membrane,
14U6 The Hot Enema. — The hot enema, or hot irrigation of
the colon, is a useful means of combating an inflammatory
condition of the pelvic viscera. Hot water introduced into
the rectum and colon is broyght nearer to the ovaries and
other pelvic viscera than is possible in any other way. For
this purpose it may be administered three or four times a
day, or if necessary once every three or four hours. The
temperature should be 110° to 120®.

Reclus prefers very hot rectal irrigation (130^) to vaginal
irrigation or injection, in congestions of the pelvic viscera.
It is of great value in the treatment ol prostatic inflammation^
causing disappearance of the swelling and pain and difficulty
in micturition, often in a few hours, and in the majority of
cases securing a complete cure of acute prostatitis in three
to four days.

The hot enema is one of the most valuable of all hydri-
atic measures for combating threatened collapse in typhoid
fever as well as in cholera and other conditions in which the
vital failure is due to toxemia. The hot enema may even be
used in cases of typhoid complicated by intestinal hemorrhage,
and with marked benefit, when there is reason to believe that

•YMi\Bertinir Ktin^Woch,, 1877.

THE TECHINQUE OF HYDROTHERAPY. 897

the patient is suffering in consequence of absorption of toxins
resulting from the decomposition of retained blood clots. An
immediate change in the aspect of cases of this sort is often
apparent after freeing the colon of the fetid clots with a simple
hot enema. The application should not be made while the
hemorrhage is in progress, as the increase in arterial tension
would involve serious risk. But a day or two later the bowel
may be washed out without apprehension. The coloclyster,
or copious enema, is the most rational method of establishing
intestinal asepsis, at least when combined with an aseptic
dietary of farinaceous gruels, fruit juices, and systematic
water drinking.

The hot enema (104° to 115^) may be used with great
benefit for its relaxing effect upon involuntary muscular tissue,
in cases of hepatic or biliary colic. It is found equally useful
in quieting excessive uterine pains during parturition^ and in
combating irregular contractions of the uterus.

The large hot enema has for many years been employed
by Cantani and Wonte in the treatment of colic and infantile
diarrhea. These sagacious observers also recommend its use
in intestinal occlusion and pseudo-membranous colitis.

The hot enema is one of the most helpful of all measures
in surgical shock and other forms of collapse. It may be
safely used in all cases of shock in which the skin is pale
and the pulse weak. The temperature should be from I lO°
to 120^. It should be followed by cold friction.

THE COLOCLYSTER. OR ENTEROCLYSTER.

The purpose of this mode of applying the enema is to fill 1407
the entire colon, or at least to introduce the largest quantity
of water possible without overdistending the colon. In the
ordinary enema it is difficult to introduce more than a pint
and a half to three pints of water; but by placing the patient
in the right Sims's or knee-chest position (Fig. 225), the
amount of liquid may be increased to four or even five or six
pints, and in some cases even more, without inconvenience to
57

RATIONAL liVDROTHERAPlT.

I'

the patient In the right Sims's position the water is passed
upward through the sigmoid flexure, and then nins ^ong rbe
descending colon* and on reaching the transverse colon, follows
down toward the ascending colon, in which it accumulates
until the colon is gradually filled. In the knee-chest position
the action of gravity is still more helpful in completely filling
the colon. This filling of the colon is necessary in cases in
which fecal accumulations are present in the cecum; in catarrh
of the cecum, a condition often mistaken for appendicitis, and
which is doubtless the precursor of appendicitis in the great
majority of cases; also in cases in which the cecum is infested
with threadworms; and in cases of pseu do- membra nous colitis.

PhysJological Effects — The physiological effects of irriga-
tion of the intestine have been carefully studied by Krull,
Stadelmann, and Kemp. KruU held the cold enema to be a
powerful hepatic stimulant^ but Stadelmann concluded from
his researches that its action is mechanical only, aiding the
liver by removing from the intestine large quantities of
decomposing stuffs^ with swarming microbes and the pto-
mains and toxins produced by them. This result seems
rather surprising when one considers the powerful influence
upon the mesenteric circulation, of cold water introduced into
the intestine. Very powerful fluxion of the liver must be
excited by this measure, and the reaction following must cer-
tainly be attended by decided increase in the activity of the
portal circulation.

The introduction of very hot water into the colon increases
blood pressure, improves and accelerates the heart action,
and produces a marked effect upon renal secretion. A tem-
perature of iio^to 120^ has been^ found much more effect-
ive in increasing renal secretion than a lower temperature.
The author has often noted in cases of patients to whom the
enema has been administered, the passage within a very
short time of a large quantity of clear urine. This was
observed and pointed out by the empirical hydropaths more
than fifty years ago.

THlil TECHNigUE OF HYDROTHERAPY,

S99

Cold water produces a movement of fluid toward the
intestine by the reaction which follows the application.
This fact renders the cold enema of value in the treatment
of constipation due to excessive dryness of the fecal mat-
ters. When used for relief of an acutt^ inflammaiian^ as in
dysentery^ the application must be moderate, prolonged, and
continuous.

The hot enema^ on the other hand, stimulates absorption
from the alimentary canal, and raises the blood pressure by
Ailing the blood-vessels and by reflex stimulation of the heart.

For most pronounced effects upon the heart and kidneys,
the temperature should be i lo^ to 120°, The author is con-
fident that he has saved the lives of a number of persons suf-
fering from renal suppression by the repeated employment of
this simple measure during periods varying from one to three
or four hours. He has used the hot enema for this purpose
for more than twenty years. The effects obtained are much
more prompt and in every way more satisfactory than those
obtained from jaborandi or any other diuretic dru^.

The ordinary hot enema at 100^ to 104° produces little
effect upon blood pressure, but has a marked diuretic effect.

Cerebral congestion may result from the use of the warm
water enema, as shown by the experiments of Schtillen*

According to M» Von Generscht it is possible by the
employment of the coloclyster to introduce a liquid into
the small intestine, through which it may be rejected by
the mouth.

Therapeutic Applications — The coloclyster affords marvel-
ous relief in a class of patients, unfortunately by no means
small in number, who, suffering from ai&ny and diiaiatimi of
the cchn^ are always carrying about with them an enormous
accumulation of fecal matters. The patients are variously
classified as nettraathtnics^ hypcchmitiriacs, simple dyspep-

1408

f Von Gencffch, Pr&p^t Mfdk&f^ 1 893. p, 1^3.

900

RATIONAL HYDROTHERAPY.

iicj, etc, and are treated for biii&$tsness^ ins&fnnia, esIinHS"
thftf and a multitude of ailmentSf all oE which condittons are
the simple result of chronic autaintoxtcatioH^ and arc
promptly relieved by a cleansing bath administered to the
large intestine* The quantities of fecal matter removed in
these cases is sometimes enormous; and not infrequently
quantities of old putrefying fecal masses, semi-hardened by
long retention, make their appearance after a free coloclyster
has been thoroughly administered every day tor a week or
more, showing that a single irrigation of the colon, no mat-
ter how thoroughgoing, is not sufficient to estabhsh the fact
of its thorough cleansing. In this class of cases the colocl3'S
ter should be administered daily for two or three weeks if
need be, or as long as the patient complains of gaseous dis-
tention of the bowels and fetid flatulence.

After the discharge of the warm water, the temperature
of which should be 92° to 95"^, a pint of water at 60^ to 70^
should be introduced and retained if possible, as a tonic bath
for the colon. Care should be taken to avoid distending the
colon with an excessive quantity of water at once* The
amount need never exceed two quarts, and the quantity should
be reduced from day to day after the colon has been thoroughly
cleansed, until only a pint or a half pint of cold water is em-
ployed. Cold water stimulates and tones the bowel, whereas
hot water is relaxing. The cold coloclyster may be used
indefinitely without producing constipation, if the quantity of
water employed is small. It acts as a sort of gymnastic
trainer for the bowel, strengthening its muscular structures,
and increasing the activity and energy of its controlling nerves
and nerve centers.

The author's attention was early called to the observations
of Krull, already referred to, and he has for more than
twenty years made use of the enema in cases of jaundice^
whether suspected to be due to gall-stones, or clearly due to
infection of the liver and catarrh of the bile ducts in so-called
^^ infectious jaundice.'' The results have been almost uni-

THE TECHNIQUE OF HYDROTHERAPY,

901

formly excellent. Patients rarely fail to show marked
improvement within a few days* and complete recovery has
been secured in all cases of infectious jaundice. Careful
regulation of the diet and other measures have been employed
at the same time, but the coloclyster has been regarded as
a measure of primary importance. The temperature for the
clyster should be 90^ to 100'=', the purpose being to flush the
portal circulation while at the same time cleansing the ali-
mentary canaL A mtich larger quantity of water can be intro-
duced by this method than when a lower temperature is
employed, and may be retained for a much longer time, A
small cold enema (70^, one pint) should be injected as soon
as the warm water is discharged, to counteract the depressmg
and relaxing effect.

The coloclyster by means of the Sims*s position is an
eKceedingly useful measure in fevers. By placing the patient
in this position a much larger quantity of water may be intro-
ducedf and in certain cases this method is one of the most
effective of all means of lowering the temperature.

That many cases of intestinal obstruction may be relieved
by the coloclyster properly administered has been abundantly
proved by Lesage, von Genersch, and others. Four to six
quarts of fluid are often employed. The patient should take
the knee-chest, or right Sims's position, or may be inverted,
and the water should be introduced with a long rectal tube.
The temperature should be 104 ', and care should be taken
to introduce the liquid slowly, the fountain being placed at
an elevation of eight to twelve feet.

THE ORADUATEO ENeMA.

This form of intestinal irrigation is administered in the 14011
same way as the ordinary enema or the coloclyster, and dif-
fers from it only in the fact that each day the amount of
water is diminished and the temperature lowered. A very
good plan to adopt is as follows: Beginning with three pints
of water at a temperature about that of the body, the amount

902 SATIONiiL HYDROTHBRAFT*

of warm water introduced each day is diminished by lulf «
pint, one-fourth pint of cold water being added» makliig ^im
total amount of the fluid one-fourth pint less each day^. JjH
the end of the twelfth day the enema will consiBt of fo^
ounces of cold water. In the majority of cases the decraa^
in temperature will compensate in stimulating effeot ior tlie
diminished quantity; so that the bowel is thnsr broagfajl tQi«
^ more natural state, and weaned from the necosity <tf ^b-
tension with warm water in order to provoke an evacnathpe
movement The graduated enema is exceediAgly osefiil M
a means of overcoming the enema habit

RECTAL LAVAQB OR IRRIQATION.

1410 The author a number of years ago devised a hard-Aibbor
instrument for this purpose, which has proved very conven>
ient (Fig. 226). Numerous other forms of irrigators have
been devised for the same purpose.

The temperature of the water used should be 100^ to 125^,
beginning with the lower temperature at first, and gradaally
increasing as tolerance is established. A normal saline solu-
tion, about a dram and a half to the quart, is more serviceable
when the purpose is to relieve local irritation. When a
cleansing effect is desired, as in catarrh of the bowels, a mix-
ture consisting of equal parts of carbonate of soda and com-
mon salt (one dram and a half to the quart) may be used.

Hot irrigation of the rectum or the small hot enema
frequently repeated is very useful in cases of infiammatian
of the prostate. Hot irrigation is also valuable as a means
of relieving Icucorrhcay catarrh of the rectum, rectal irri^
tation, spasm of the sphincter, and rectal ulcer.

Cold rectal irrigation is useful as a means of allaying acute
inflammation (60° to 40^, 5 to 10 min.). Repeat hourly.
Fig. 227 shows an instrument for dry cooling.

Alternate irrigation (to^, 15 sees.; iio^to 120°, 15 sees.,
repeating) may be usefully employed in cases of constipation
due to loss of normal nerve sensibility. Employed daily, or
twice daily, at night and after breakfast.

; 4

i! 'i

THE TECHNIQUE OF HYDROTHERAPY,

903

IRRIGATION OF THE BLADDER,

The instruments required for this procedure are a fountain
syringe (Fig. 228) or a funnel with three or four feet of rub-
ber tubing attached, and a smooth, soft-rubber catheter.
Special forms of catheter are necessary in some cases of pros-
tatic disease. The connection of the syringe with the cathe-
ter should be made by means of a *'Y" connection piece to
one arm of which a piece of tubing two or three feet in length
is attached for the purpose of conveying the water into some
proper receptacle. The patient should lie upon a couch 01
treatment table with the clothing conveniently adjusted. The
fountain should be placed a foot and a half or two feet above
the couch Both the supply and the waste tubes of the mstrti
ment should be furnished with convenient stop-cocks» so that
the flow of water may be easily and perfectly controlled.

Great care should be taken in introducing the catheter to
preserve strict asepsis, Not only should the catheter be
thoroughly aseptic, but the genitals^ and the hands of the
physician or nurse, must be as carefully prepared as for a sur-
gical operation. When these precautions are taken, the
so-called ** catheter-fever*' will very rarely occur. The tern
peraturc of the water employed should be, for ordinary cleans-
ing purposes, 100^. Water containing chloride of sodium, m
the proportion of one and one-half drams to the *iuart, is less
irritating than fresh water. The water should be boiled after
the salt is added, so as to make sure that it is thoroughly
sterile.

The bladder should first be emptied, then the water should
be introduced in small quantities, from one to three ounces at
a time. It should flow in with little force^ and should be
allowed to pass out immediately; but the bladder should not
be pressed upon to hasten the discharge of the fluid, and
a new quantity of fluid should be introduced before the bladder
is completely emptiedi so as to avoid the irritation produced
by strong contraction of the bladder upon itself.

1411

THE TECHNIQUE OF HYDROTHERAPY,

90s

cleansed » and without running the risk of injury, catheter
fever, etc, which is so likely to occur even when great care
is practiced, in the daily passage of an instrument into the
bladdcn Of course there are cases in which tills simple device
will not answer the purpose on account of obstruction at the
bladder outlet; but it is practical in a very large proportion
of cases, even in cases of enlarged prostate, and can be used
by the patient himself atter proper instruction.

Physiological Effects. — The mucous membrane of the
bladder is exceedingly sensitive to temperatures either above
or l>e!ow the average temperature of the interior of the body,
The healthy bladder expels with great force water at a tem-
perature of 77^, even when the quantity is not more than two
or three ounces (Melle^), and at a temperature of 41^- so small
a quantity as one or two drams will cause prompt and vigorous
contraction. Very hot water likewise produces powerful con-
tractions of the bladder.

Therapeutic Applications — The bladder douche at a tem-
perature near that of the body is a highly valuable measure
in the treatment of vesical catarrh or chronic cystitis. This
measure is in fact indispensable in dealing with that form of
bladder catarrh which is met with fn old men stiffering from
enlarged prostate, and who have lost the power to empty
the bladder without mechanical assistance. In such cases it
may be employed daily, twice a day, or every other day. as
may be indicated by the conditions present. When mucus
is formed rapidly and in large quantities, when the bladder is
infected and decomposition takes place to such an extent that
the urine is amoioniacal when withdrawn from the bladder,
the irrigation should be sufficiently often to prevent accu-
mulation of mucus and advanced decomposition.

In inoperable cases of calculus of the bladder, vesical
irrigation renders valuable service as a palliative measure, the
patient's suffering being greatly mitigated by its use. Irriga-
tion is indicated in most cases of aion^ of the bladder and in
cases of paralysis of the organ associated with paraplegia^

RATIONAL HYDROTHERAPY.

locomotor ataxia, and other affa:tiojis of the nervous system"
Vesical irrigation is usually required whenever the urine is
ammoniacal, and when it is turbid when passed; when pus or
blood is present; and when minute calcuh\ so-called graved,
are sometimes passed. In certain cases of atony in which
there is no irritation, and in which no evidences of vesical
catarrh are present, the powerful stimulus of cold water may
be carefully tried. The first injection should consist of one
or two ounces of water at So"^- If this produces no unpleas-
ant effect, the temperature may be gradually lowered to 60^.
Hot applications may likewise be employed with advantage in
these cases, but the temperature should not exceed \\$^ to
120°. Alternate hot and cold irrigation of the bladder is the
most powerful means of stimulating its muscular structures.
The extreme temperatures should at first not exceed 11 o^
and 85^, and the highest and lowest temperatures should be
gradually approached. ^|

In hemorrhage from the bladder, very hot irrigation (iiS^
to 122") may be employed. An ice-bag may be applied over
the bladder at the same time, and a hot foot bath or a hot
blanket pack to each leg separately may be employed with
advantage.

Contraindications — Irrigation of the bladder must gener-
ally be avoided in acute cystitis until after the extreme sensi-
tiveness of the mucous membrane has to some degree sub-
sided. Irrigation can generally be undertaken if special care
is employed within two or three days after the onset of the
disease. Most relief will be obtained in the early stages of
cystitis by external applications, such as the hot pelvic or hip
and leg pack or the very hot sitz (110° to 120^) for 5 or 10
minutes, followed by a very gentle affusion at 80^.

Special care must be taken to avoid the baneful effect of
cold in cases of either acute or chronic cystitis. Chilling of
the patient during the treatment may produce an acute exac-
erbation of the inflammation, and greatly aggravate all the
symptoms. To counteract any tendency in this direction, it

THE TECHNIQUE OF HYDROTHERAPV.

go;

is well to administer a hot or warm sitz bath immediately
after irrigation of the bladder^ in cases in which the patient
is able to sit erect* Special care must be taken to keep the
feet warm during the apphcation, and there should be as little
exposure as possible. The limbs should be wrapped in flannel
blankets, and the patient should on no account be allowed to
ieel the slightest sensation of chill iness.

Irrigation of the bladder must be avoided in cases of
aiftU' urethritis, in consequence of the danger of conveying
the infection backward into the bladder and other of the deep
passages.

IRRIQATION OF THE URETHRA.

Numerous instruments are employed for the application of
liquids to the urethra* One of the best of these is the hydro-
phora of Shutz (Fig. 230). which consists of a fluted tube,
with small openings in the sides. As this instrument is intro-
duced, the water flows backward toward the meatus, cleans-
ing the canal as the tube advances^ thus preventing the
conveyance of infection to the deeper parts of the urethra.
The instrument should be introduced until it passes beyond
the sensitive area> but should be checked at this point, Dag-
gett's instrument (Fig, 229) may also be used. When it 13
desired to treat the urethra exclusively, as in gonorrhea, for
example, the urethra should be shut off from the bladder by
pressure upon the perineum with the finger. It is sometimes
important to distend the urethra, so as to spread out the folds
of the mucous membrane, and thus secure complete cleansing
of the surfaces* To accomplish this, it is only necessary to
compress the parts at the meatus about the catheter with suf-
ficient firmness to prevent the escape of liquid, while also
compressing the urethra at the perineum.

Ordinarily, the temperature of the water employed for
irrigating the urethra should be about ioo°, Curtis reported
many years ago (1833) remarkable results in the treatment of
ckrofiic urethriiis by very hot water. He employed simply
a fountain syringe, consisting of a tm pail with a rubber tube

1413

attached, and a No. 8 English catheter. An alcohol lamp
was adjusted under the pail, so as gradually to elevate the
temperature of the water during treatment. The temperature
was allowed to rise very slowly, by which means a tolerance
was established to such a remarkable degree that a tempera-
ture of more than iSo"^ was sometimes employed. This
was probably the temperature in the fountain, the tem-
perature of the water actually in contact with the mucous
membrane naturally becoming considerably lowered by cool-
ing while passing through the tube. The catheter was intro-
duced into the urethra to within about an inch of the prostate,
and the fountain hung high enough to give sufficient force to
the stream to carry it backward through the urethra, but not
into the bladder. Curtis claimed for his method that it cut
short the disease very promptly; that it gave almost imme-
diate relief from pain and swelling; and that it was equally
successful in acute and chronic cases. The author has found
the very hot urethral douche a very effective procedure.

The employment of hot urethral irrigation (uo^ to 130^
in gonorrhea secures the early absorption of exudates, and
thus prevents deformity, cicatrization, and stricture. This is
also the best remedy for chordee. The quantity of water
employed should usually be several quarts, or until the pain
is relieved. A short hot sitz bath (110° to 118^ for 5 or
10 min.) is a valuable measure to be used in combination
with hot urethral irrigation. In chronic cases, with exu-
dates, employ alternate hot and cold irrigation.

VAQINAL IRRIGATION.

1413 This procedure, more commonly but incorrectly termed the
vaginal douche, consists of the injection into the vaginal canal,
with little or no pressure, of a stream of water, either hot,
cold, or of intermediate temperature. This procedure has
rendered immense service in the treatment of uterine, ovarian,
and other pelvic disorders in women, but a lack of under-
standing its physiological effects and therapeutic application

THE TECHNiyUE OF HYDROTHERAPY,

909

at various temperatures has resulted in nanierous failures and
disappointments.

Following the example of Peasley and Emmetti who
were among the firat to champion the vagiDal douche as a
therapeutic measure in gynecological practice in this country,
must American practitioners make habitual use of vaginal
irrigation at as high a temperature as the patient can com-
fortably bear, or from roj'^ to 122^^ F. Fortunately, vaginal
irrigation at this temperature is applicable to a large propor-
tion of cases; but utber temperatures* higher or lower, may
often be employed to much better advantage. The appUcation
is best made with a fountain syringe, which consists of a res-
ervoir containing water placed at a height of two to three feet
above the patient, By means of a rubber tube of suitable
size (the size ordinarily employed is too small) and a glass or
hard rubber vaginal nozzle, the water is conducted to the vagi-
nal canal. The patient lies upon her back with the hips ele-
vated, a proper receptacle being arranged to catch the water
as it flows out from the vagina.

Fig, 231 shows a douche table devised by the author*
which has borne the test of many years' use. The top
consists of a marble slab, hollowed somewhat to fit the form
of the body, and provided with an opening and channels to
conduct the water rapidly away. The arrangements tor
asepsis are perfect, and the patient^s clothing never becomes
wet or soiled.

In introducing the vaginal tube, care should be taken to
direct it backward behind the cervix uteri, to the very far-
thest limit of the mi de sac, so as to avoid any possible
danger of forcing the water into the uterine cavity* As the
water enters from the fountain, it flows about the neck o(
the uterus, and circulates through the vagina, bringing every
part of it under the thermic influence of the application, thus
affecting not only the mucous membrane with which the
water comes in actual contact, but through reflex influence
the circulation of all the pelvic viscera.

^

RATIONAL HYDROTHERAPY

I

t4 ly years ago Max Runge made an exhaustive study of

t etlects of vaginal irrigation upon the circulation and mus^
CI : excitability of the utenis^ applying a gentle stream of
water at different temperatures to the exposed uterus in liv-
ing rabbits. As a result of these interesting studies, he found
that the application of water at 41^^ F. produced at first strong J
tetanic contractions^ lasting for a full minnte, which were fol-
lowed by rhythmical contractions and relaxations, continu-
tng for some time. When the cold application was continued j
for 10 to 15 minutes, the contractions slowly ceased, the pale
color of the uterus induced by the primary contraction of the
uterus under the influence of the cold, giving rise to a pro-
nounced red colorization, showing active movement of blood
through the organ. After the close of the experiment, the
parts returned to their normal state at the end of a half houn
That the cessation of the contraction was not due to the
exhaustion of the uterine muscle, was shown by the fact that
subsequent applications of heat or electricity gave rise to
violent contractions.

Applications of hot water at a temperature of ISS'^ pro-
duced, on the other hand, rhythmical contractions of the
uterus, but less vigorous than after applications of cold, and
without any tendency to tetanic contraction, as after the cold
application. When the hot application was continued for 10
minutes, the contractions finally ceased, leaving the uterus
as before, and of a bluish color, but incapable of contracting,
as shown by applications of cold, electricity, strychnia, and
other excitants. No effect whatever was produced, showing
that the uterine muscle was, temporarily at least, completely
paralyzed. After the lapse of half an hour the uterus acquired
its normal condition. Further investigation showed that the
passively congested and paralytic state of the uterus, as de-
scribed, was produced only by temperatures above 104° or
very hot applications.

It is interesting to note the similarity, with marked differ-
ences, however, between the applications of heat and cold to

THE TECHKIQUE OF HYDROTHEHAPY.

911

the uterus. Stron^^er and more prolonged contractions were
produced by the cold than by the heat Muscular excitability
was not diminished, but was palpably increased by the cold
application p whereas in ten minutes it was completely oblit-
erated by the hot irrigation.

From these facts it will readily appear that both hot and
cold applications may be employed for relieving hemorrhage
due to uterine congestion, but that the cold application is a
more powerful hemostatic agent than heat. Hot applications,
on the other hand, possess remarkable power to lessen and even
completely to annul uterine excitability and contractility of the
uterine muscle, which is decidedly increased by cold irri-
gation. But the tendency of cold irrigation to produce pain-
ful uterine contraction and to provoke an exacerbation of
neuralgic and other pains to which the pelvic viscera are so
particularly subject, accounts for the almost universal prefer*
euce for hot irrigation in the treatment of pelvic disorders of
women. The author has found not a few cases in which tem-
peratures above 104^ were badly tolerated, a fact which was
doubtless due to the paralytic congestion produced by high
temperatures. The douche at 90^ is found highly useful in
relieving pelvic congestions^ which are extremely productive
of discomfort. The author has never found it expedient to
employ as low a temperature as 41^, but vaginal irrigation
at 75*^ to 80"^ has often produced excellent antiphlogistic
results in cases in which hot irrigation could not be tolerated.

liai irrigation is indicated when the effect desired is to
relieve pain, to promote the absorption of exudates, and to
stimulate vascular activity in cases of salpingitis or so-called
cellulitis; also in cases of chronic metritis, ovaritis, and so-
called endometritis.

Very hat irrigation, as sbowB by Emmett and proved by
the experience of nearly every other gynecologist, is of high
value as a means of checking hemorrhage. For this purpose
the application must be made at as high a temperature as can
be borne, a temperature of 125'^ to 130'^ being desirable.

1415

RATIONAL HVDROTHERAFY-

Such an application must not be continued for too long a
time, for, as has been clearly demonstrated by Max Runge, the
prolonged application of water at a temperature above 104°
gives rise to paralytic phenomena with venous CDngestion of
the uterus. In case the high temperature fails to accomplish
the purpose desired, cool or cold irrigation may be employed
in the case of uterine hemorrhage, in relaxed conditions of the
vaginal walls, in subinvolution, and in passive congestions of
the uterus. Cold irrigation should never be employed when
its use produces pain or other unpleasant pelvic symptoms;
but the low temperature may be tolerated^ when indicated,
if the patient is prepared in advance by giving of a hot sitz
bath at 1 15'^ to 120^ for S to 8 minutes. On the other hand,
hot irrigation is rendered tolerable and beneficial by the pre-
vious application of a sitz bath at 78^ to 85'^ for 5 to 8
minutes, with rubbing of the submerged surfaces during the
application. Hot vaginal irrigation carried to the paralytic
stage is of service in the first stage of labor as a means of
dilating the cervix and causing relaxation of the perineal
muscles.

In relation to vaginal irrigation during pregnancy, it may
be remarked that careful vaginal irrigation, even at a tem-
perature of 115° to 118^, may be made at any time during
gestation before labor has begun, without the slightest danger
of producing uterine contractions or any tendency to mis-
carriage. After the beginning of labor, however, very hot
irrigation produces prompt and very marked dilatation of the
cervix, and by this means great service is rendered the partu-
rient woman in shortening not only the first stage, but the sub-
sequent stages of labor.

Intra-Uterine Irrigation — The application of water to
the interior of the uterus requires a special instrument for the
purpose, so constructed as to allow a ready outflow of the
liquid introduced, known as a double current or irrigating
sound. In uterine irrigation only distilled or well-boiled water
should be employed. If no other medicament is used, it is

THE TECHNIQUE OF HYDKOTHERAPV,

913

well to add to the water common salt, one gram to 100, or
ro grams to the gallon. The application should be made
with all antiseptic precautions after curettement or other
operations upon the interior of the uterus, and in obstetrical
cases in which blood clots or membranes are retained, from
which the patient is liable to infection through absorption of
septic matter from the uterine cavity.

mEAMS OF mAKING MOT, COLO, AND ALTERNATE APPLICA-
TIONS TO THE MUCOUS PASSAGES.

Fig. 232 illustrates an instrument devised by Professor MIO
Winternitz, known as the psyckropkore, and intended (or
making applications to the urethra when hot or cold appli-
cations are desirable. Thtj author has found this measure
serviceable in the treatment of certain cases of extreme hyper-
esthesia of the urethra. Both prolonged cold apphrations
and short hot applications may be used with success. In
some of these cases alternate hot and cold apphcatioDS are
most effective. This is especially true in cases in which the
tone of the parts is lowered or passive congestion exists.

Alternate cool or tepid and very cold applications may
sometimes be made with advantage, the warm at 78-' to 8a'^
for 5 minutes, then an application at 50^^ to ^f' for J minutes.

The bladder should be emptied just before the use of the
psychrophore, and should not be emptied again for a couple
of hours after the treatment.

The psychrophore likewise renders valuable service in the
curative treatment of nociumaf enuresis.

The author a number of years ago devised a series ol hol-
low applicators shown in the accompanying cuts (Figs, 233-
235), which have proved very successful for the several pur-
poses for which ihey were designed. By means of a hollow
uterine sound (Fig. 233) eiihcr hot, cold, or alternate applj*
cations may be made to the interior of the uterus with great
convenience. By compressing the outflow tube, the rate at
which tlie water passes through the instrument may be regu-
58

KATIOHAL trVDEOTHBRAFTH

latedf and by the same means also the fjemperatore. If
the water at the outlet ts made to fall upoti a tbennoaieter,
the temperature of the water may be observed at evefy
moment^ and may be made to me or fall by adjustment of
the gauge. The author has frequently made applications to
the body of the uterus at 160^ with excellent effect, althoi^h
this temi>erature is somewhat painful. A temperature of t40^
1^ usually sufBciently high to accomplish the desired results.
The instrument also proves useful in cases of subinvolution^
vi^etations, catarrh of the cervix, and 6exion or relaxed uler*
fne walls and arrested development.

In Fig* 254 IS shown a hard-rubber instrument which has
been found very useful as a means of applying heat to the
pel tscera through the vagina, in cases in which the bed-
douche apparatus can not be used without injurious
bance to the patient. The instrument is simply intro-
:ed into the vagina, and a current of hot water passed
through it. The patient may lie in any position, and thus is
in nowise inconveoienced by the application; the relief expe-
rienced from this procedure is often very remarkable. The
effect of moist heat is easily obtainable by simply covering the
instrument with a mass of absorbent cotton and saturating
with water*
1418 Fig. 255 shows an instrument constructed on the same plan
as the preceding, but smaller in size, and designed for tker-
mic applicatiotis to the rectum. Either hot or cold applica-
tions or alternate hot and cold applications may be made as
desired. This measure is of great value in the treatment of
rectal irritation, and constipation due to lack of tone in the
structures of the rectum, as well as in cases of enlarged or irri-
table prostate, etc. Short cold applications or alternate hot
and cold applications are employed in cases in which excitant
effects are desired, as in relaxed conditions in which there is
loss of muscular tone, in hemorrhoids, and in some cases of
chronic ulcer requiring stimulation. The extremes of heat
and cold should in such cases be made as great as possible, or

J

THE TECHNIQUE OF HYDROTHERAi'Y,

915

great as the patient will bear. Very hot applications are
useful in cases of internal kvmorrkoids, rectal catarrh, rectal
nicer and fissure^ enlarged pr&stale^ and spasm of the
spfiincter.

The analogous instrument for the vagina the author has
used with great satisfaction in relieving the pain which is often
most distressingly persistent after a laparotomy involving the
pelvic viscera. The instrument may be applied with water
at any temperature desired. Most excellent analgesic effects
may be obtained with cold water in local inflammatory proc-
esses*

Ar^berger, to whom the credit of having first employed
instruments of this sort Is ascribed, employs a temperature gf
70° to 60^. The temperature at first may be higher (80^ to
8 5*^), and may be gradually lowered. Numerous modifica-
tions of these instruments, possessing varying degrees of merit*
have been constructed by various instrument-makers.

STEAM INHALATION,

The inhalation of air saturated with moisture and warmed
by mixture with steam » improperly called steam inhalation »
is a very old-fashioned but an extremely valuable remedy for
both acute and chronic inflammations of the air- passages.
The so-called *' croup-kettle,'* though a crude aflair, lias been
the means of saving many hves, and alleviating the sufferings
of hundreds of little ones. When it is desirable that the
patient should breathe the vapor continually, very effective
means may be conveniently arranged by aid of the portable
oil -stoves and gas-stoves now in use. The stove should be
placed by the bedside of the patient, with a teakettle, or in
the absence of anything better, a basin in which water may
be continuously and vigorously boiled. By means of a jnard of
wire mosquito netting, rolled into the proper shape, and cov-
ered with oil-cloth, rubber cloth, or newspapers, it is possible
to construct a cone whereby tlie vapor may be brought
to the face of the patient lying close to the edge of the bed; or

1419

I RATIONAL HVDROTHERAPY,

for a small sum a tinner may be employed to make a more
convenient and durable arrangement for conducting the steam
from the boiler to the patient It is not necessary nor desir-
able that al! air should be excluded except that which comes
through the apparatus. It is only important that the patient
should breathe the air as moist and at as high a tempera-
ture as possible.

In cases of croup and diphtheria^ the moist, hot inhalation
aids greatly in maintaining the resistance of the tissues^ and
facilitates the separation of the false membranes. It must be
remembered, however, that complete saturation of the air
with moisture seriously interferes with the absorption of oxy-
gen by the lungs; so that if marked cyanosis is present, the
imialing apparatus must be removed, or the inhalation of pure
oxygen gas may be employed in connection with it.

By far the most important use for steam inhalation is in the
treatment of acute or chronic catarrhal affections of the nose
and throat. The simplest form of inhaler consists simply of
a tin cup with a loosely fitting cover, through which a tube
passes, by which the patient is enabled to draw from the inte-
rior of the cup, warm sautrated air, which finds its way in
about the edge of the cover. More than twenty years ago the
author devised a convenient inhaler which is illustrated in the
accompanying cut (Fig. 236). This construction permits
the addition of some medicament to the water when desir-
able, and provides an extra water compartment outside the
inhaling cup, by which the heat of the latter is retained for a
long time. In acute inflammations of the pharynx^ the post-
nasal region, the larynx, and even in acute bronchitis, the
faithful employment of the steam inhaler aids greatly in secur-
ing early recovery. The inhaler should be used many times
a day in order to secure the best results. Ten or fifteen min-
utes in each hour is the usual prescription. In acute condi-
tions, in which the parts are very sensitive and painful, the
temperature of the inhalation should be moderate. The
effect of the application should be soothing. In chronic con-

THE TECHNIQUE OF HVDEOTHEKAPY.

SV7

ditions, especially when there is thickening of the mucous
membraine and hypertrophy of the glandular structures, as in
cases of large or tiongatcd uvula, cHiargid iopisils, foilicuiar
hypertrophy of the tonsils, or adciwids^ the temperature of
the inhalation should be as high as can be borne. A tolerance
for heat is quite readily established by the mucous membrane,
so that after a few minutes a higher temperature can be
employed than at first It is not necessary to change the
temperature of the water on this account, however* At the
beginning of the inhalation the patient makes short, quick
drafts through the inhaler; then, as tolerance is established,
he draws longer and deeper breaths, especially if the bronchial
mucous membrane is involved. It is easily possible to maimji^e
the inhalation so as to confine the efiect almost wholly to the
naso-pharynx,

The effect of the hat vapor upon the mucous membrane
is precisely that of circumscribed applications of heat to the
cutaneous surface* The tissues are excited to increased octiv-
ity, the movement of blood through congested parts is
encouraged, and the improved circulation aids the reparative
processes, assists the absorption of exudates, and promotes
the resistance of the tissues ngainst invasion by parasitic
microbes, to which the chronicity of catarrhal affections of
the naso-pharynx is chiefly due.

Another method of administering steam inhalation, de- 1421
vised by the author, has been shown by experience, to be
possessed of so much merit that it is entitled to brief mention
here. It consists of the inhalation of steam from a receptacle
to which it is conducted by a pipe communicating with a
powerful generator or with the steam-beating system of the
building. The receptacle is of such shape that the entire
head in front of the ears may be pushed into it, thus exposing
the skin of the face to contact with hot steam, at the same
time that the heated moist air is drawn in through the nose
or the nose and mouth. By this means the entire mucous
surfaces and a large part of the cutaneous surface, associated

9l8 EATIOHAL mOROTHERAFY.

diiaclly and reflexly with the diseased paits, are hrc
mNler Ibe influence of the hot applicatioa. Thos wliile
vasomotor Mimulatitig iitfluenee of the heat is actixig upoti
the m aeons mem brace of the oose and throat* th^ do^ect
action is greatly assisted by the strong hyperemia ol the skin
prodaced, and consequent draining of coUaterally associated
iresseU of the mucous membrane. Patients experience ffom
ihb treatment a degree of immediate relief such as ts afforded
by no other measure with which the author is acqaainted.
Obstructed nostrils are opened up, viscid and inspissated
masses of secretion are loosened and discharged, pain and
pressure are removed, hoarseness is relieved, and the patient
recognizes so thoroughly the benefit received that it is aot
necessary to urge him to persevere in the employment of the
measure until permanent results can be obtained. The treat-
ment should be administered three times a day. 15 minute
each time. At the conclusion of the treat ment, a towel
wet in ice- water is applied to the face for half a minute. The
latter procedure restores tone to the relaxed cutaneous ves-
sels, while at the same time securing continued activity and a.
lasting hyperemia, thus prolonging the effect of the treatment^

In cases in which there is great loss of tone of the vessels
of the naso-pharynx, exposures to the hot steam may be alter-
nated with ice- water applications, the steam being employed
one minute and the ice compress 15 seconds. The alterna-
tions should be repeated ten or twelve times.

In the apparatus shown in the accompanying cut (Fig
237), devised by the author, a strong draft of cold air is pro-B
duced by the aid of an electric fan. The patient controls the
fan with a button, and exposes his face alternately to the
action of the hot steam and the cold air. By this means a
powerful alterative effect is brought to bear upon the naso^
pharyngeal membrane with most excellent results. The treat-
ment is, of course, associated with the inhalation of antiseptic
vapors and the application of antiseptic sprays to the affected
membranes, for the purpose of maintaining an aseptic condi- '

THE TECHNiyUE OF UYDEOTHEKAPy.

919

tion until the parts have become sufficiently restored to resist
successfully the attacks of their microbic enemies.

Adopting the suggestion of Brown-Sequard, the author has
also utilized the cold draft as a means of training sensitive
patients in such a way as to establish immunity against slight
exposures to cold air or drafts, allowing the breeze from the
electric fan to fall upon the back of the neck or other sensi-
tive parts, while they are at the same time submitted to a
vigorous rubbing to encourage their ability to react. As the
training advances^ the application of the breeze is made
longer and stronger, while the force of the rubbing is dimin-
ished until the skin becomes capable of taking care of itself
without either protection or the mechanical aid of rubbing.
This condition being one which must be reached by every per-
son who desires to become free from catarrhal affections, any
system of treatment which does not accomplish it, or which
confines itself to the txeatment of the diseased mucous sur-
faces, will certainly fall short of the object sought.

The whole skin must be made so healthy and vigorous
that it will be proof against the circulatory disturbances which
give rise to colds. A relaxed skin which is bathed in perspira-
tion by slight exercise renders the person very liable to colds.
By cold bathing the skin becomes accustomed to contracting
its blood-vessels firmly, so that the loss of heat which gives
rise to chill and the accompanying internal congestion, does
not occur. This condition can be secured only by long train*
ing by means of daily cold applications,

THB STEAM JET.

The steam or vapor jet is so called only by the license of 1422
common usage, as steam proper can not be brought in contact
with the living tissues without destructive effects, although a
Russian physician (Snegirjow) a few years ago called atten-
tion to the value of this agent at 212- for controlling hemor-
rhage, and Pincus Kiliani, who continued the experiments
and observations, has clearly shown that steam has powerful

>20 RATIONAL HYDROTHERAPV.

typtic properties, and that it might be used advantageously
n operations upon the liver, kidoeys, lungs, and other paren-
chymatous organs. Bleeding from quite large arteries is readily
:ontrolled by it. Under the influence of the steam jet^ the
jarts shrivel, and acquire a cooked appearance. This action of
;team does not, however, appear to interfere with immediate
union of the cut surfaces to which the application has been
made. The steam jet has also been advantageously used in
morbid conditions of the uterus, accompanied by bleeding,
especially in malignant disorders.

The steam jet is applied by means of an ordinary steam
generator such as was formerly used for surgical operations by
Lister's spray method- The steam is conducted to the part to
which the application is to be made by rubber tubing, as short
as possible without inconvenience, provided at the end with a
suitable holder. The author has devised a special nozzle for
applying the steam jet, which prevents the ejection of the
water of condensation which, having a greater specific gravity
than steam, is likely to fall where not desired. The nozzle is
so arranged as to combine handle and nozzle in one piece,
and provides for the safe disposal of the water of condensa-
tion (Fig. 238). The value of the steam jet for the purpose
suggested has yet to be determined by the test of further clin-
ical experience. It may prove to be an exceedingly useful
measure in certain classes of surgical cases.

WATER DRINKING.

1423 Water drinking as a therapeutic measure is of very ancient
origin. Hippocrates prescribed it as a remedy in fevers, and
the drinking of cold water has been practiced among the
Egyptians from the most ancient time in the treatment of
fevers. Cold water drinking was used by Hahn in the treat-
ment of fevers in Germany in the first half of the eighteenth
century, fully sixty years before Priessnitz prescribed the
internal use of water in such prodigious quantities at
Graefenberg.

I

THE TECHNIQUE OF HYDROTHERAPY.

92 1

Todano^ an Italian contemporary of HahOf made his fever
patients drink five pints of ice water every three hours. The
patient was placed in a hammock without covering, and the
treatment was continued until perspiration occurred* If he
became comatose, ice was placed over the heart. This extraor-
dinarily vigorous refrigerative treatment must have sometimes
produced most undesirable results, and it is these excesses in
the use of an efficient and valuable remedy which are doubt-
less to a great degree responsible for the slowness with which
the merit of water drinking as a systematic procedure has
acquired recognition and appreciation.

Sir John Chardin, a French traveler in Persia, relates how
that in May, 1674, he was treated by a native Persian physi-
cian for a very grave intermittent or *• fever of Bender." One
of the most important measures to which he was subjected
was the drinking of large quantities of water cooled with snow.

Currie also recommended water drinking in the treatment
of fever, as follows: *' While the different modes of applying
water to the surface are employed, ft ought also to be poured
into the stomach in large quantities when the patient*B heat
will permit it. and the presence of nausea and vomiting are
no objection to this practice/'

The importance of water to the vital economy must be
recognized when w^e remember that the living organisnjs which
compose the human body, as well as those of all other
animals, are submerged in water,

Bernard, the great French physiologist, sagaciously re-
marked concerning the aquatic life of man, " Life exists only
in a liquid medium. It is only by certain artifices of construc-
tion that the organisms of man as those of other animals, can
live in the air; but all the active cells upon which their func-
tions depend^ live, without exception, like the infusoria, in an
interior liquid medium/' ♦

*'* Etudes PhysloLogiqiiea aur Quclqn^ Poisoni Am^ricAiDs/* CL BeromHi

g22 RATIONAL HYDROTHERAPY,

Water drinking is an internal bath; it dilutes the fluids of
the body in which the cells and fibers are bathed; it purifies
L the body by diluting the medium in which it lives. By the

free use of water the movement of the mass of liquid in which
the living elements of the human body perform their work is
quickened, and the stream of life runs clear and pure. It has
been shown that water is absorbed from the stomach very
slowly. This takes place chiefly in the intestine. Absorption
is stimulated, however, by the presence of COe. Distilled
water charged with COg is the best of all drinks as a beverage
for use in connection with hydrotherapy. It is soothing to
the stomach, and is rapidly absorbed; hence more readiJy
quenches thirst. The presence of mineral salts of any kind
lessens the rate of absorption. M

1424 Schult^ has shown that copious water drinking increases
the proportion of water in the blood nearly six percent; but
Bocker has shown that this increase lasts only a short time, ■
not more than fifteen to tw^enty minutes- Half an hour later
the blood is thicker than before, and contains a smaller pro- .
portion of water than when water has been wholly withheld
for twenty-four hours. Another effect upon the blood noted
by Bocker was that blood clots formed after copious water
drinking contain a smaller number of damaged corpuscles,
which indicate their incapacity to absorb oxygen by not turn-
ing red when exposed to the air, — an evidence of the great
value of water drinking as a means of improving the quality of
the blood through bettering its constituents as well as by
elimination of waste matters through assisting their solution.

To the great thinning of the blood which follows copious
water drinking is due the remarkably increased activity of
the kidneys, skin, and bowels which it produces. Examina-
tion of the urine shows not only that the quantity is increased
by water drinking, but that the urea and other solid constitu-
ents are also increased. Fleming,* in experiments for the
purpose of determining the physiological effects of the Turkish

* " Physiology of the Turkish Path," Glasgow.

THE TECHNIQUE OF HYDROTHERAPV*

9^3

bath, showed that the perspiration produced in profuse sweat-
ing after copious water drinking contains a larger per cent of
the chloride of sodium than does the urine. An increase in
the amount of urea and other nitrogenous principles {{*$$
per cent) was also noted.

Baron Liebig showed long ago (and his observations have
been many times confirmed) that water drinking powerfully
influences metabolism, increasing both assimilation and disin-
tegration, but especially the former

Water is the medium by which nutritive material is con-
veyed to the tissues and waste matters conveyed out of the
I body. Thus it is evident that by increasing the ,amount of
water introduced into the body, the movement of the vital flu-
lids, the blood and lymph, may be accelerated almost at will
By the increase in the volume of blood, the blood pressure is
raised, the heart movements become more energetic, and the
functions of the glands and other forms of activity are increased.
This is true of the secreting glands as well as of the kidneys
and other excreting glandular organs. Increased movement
of blood through the lungs secures greater absorption of oxy-
gen by which the various metabolic and catabolic processes
are facilitated; retrograde metamorphosis is more completely
accomplished; uric acid, urates, oxalates, and other products
of imperfect oxidation are diminished or made to disappear
entirely; in short, the patient lives a more highly vitalised
J and functionally active life*

Therapeutic AppIJcatt0ns*^^The effect upon the blood ol H26
copious water drinking suggests it as a valuable measure in
leases of dropsj, whether general or local in character, esjie-
cially the latter. The increase in the specific gravity of the
blood due to the rapid withdrawal of water by the kidneys
and the skin, even to the extenl of impoverishing the blood,
-prepares the way for the absorption of the dropsical fluid; and
by a repetition of this measure from day to day most re*
markable therapeutic results may sometimes be obtained.
Distilled water charged with carbonic acid gas should be em-

I

924 RATIONAL HYDEOTHERAPY

ployed, without the addition of sugar or any substance^ unless
it be fruit-juices of some sort. The dose should be from one
to two pints, and should be taken preferably before breakfast fj
or an hour or so before dinner The author well remembers
a case with which he became acquainted while in Bellevue
Hospital nearly twenty-five years ago, under the late Dr,
Austin Flint A patient under treatment for general dropsy
from organic disease of the heart, which had proved so refrac-
tory to all measures which had been employed, including
diuretics of all sorts, was finally given up as a hopeless one, ■
and the patient was permitted to drink copiously of water »
which had previously been denied or allowed only in very
stinted quantities. She drank in the course of the day two or
three quarts of water. As a result, profuse diuresis occarred,
the dropsy disappeared, and the patient made, for the time
being at least, a very good recovery, and was soon able to
leave the hospital.

Profiting by this experience, the author has made use of
this measure in many cases of dropsy with most gratifying
results, and has never found it necessary to require dropsical
patients to refrain from drinking water freely. It should be
taken /;/ large quantity and rapidly. When practiced for
the purpose of carrying off the dropsical effusion, the water
drinking should be confined to two periods daily, morning and
evening, no fluid whatever being taken between these hours.

When it is desired to increase the volume of the blood and
to introduce permanently a larger proportion of water, the
water drinking should be managed in quite a different manner.
A small quantity should be taken at frequent intervals, and
the amount in the course of a day may sum up to several
pints; but the quantity taken at any one time should not
exceed four to six ounces. This quantity may be taken every
hour or hour and a half with advantage.

When the amount of water supplied to the body is insuffi-
cient, the condition of the body becomes in some degree
comparable to that of a stagnant pool; while an abundant

I

THE TECHNIQUE OF HYDROTHERAPY.

92s

supply o! liquid so encourages its activities that it may not
inaptly be compared to the flowing mountain stream.

Coiti Water Drinking. — Priessnitz required his patients to
drink large quantities of water, many patients taking as high
as twenty to forty glasses a day. It is curious to note that at
the time when this empiric was requiring his patients to swal*
low such prodigious quantities of water, he had a rival, an old
schoolmate, by the name of Schrott, living in a little village
four miles from Graefenberg, who required his patients to
abstain wholly from water for five to eight days at a time.

Water is not a mere mechanical conveyor of poisons out
and of foods in; it is a powerful vital stimulant, a divinely
appointed agent which the vis medicafrix fmiartr can use
in her healing work. Dietl, the famous pupil of a world-
renowned master, Rokitansky, writing so long ago as 1845,
uttered the following wise and philosophical words, which
every physician who undertakes to rely upon the virtues of
water and other physiological agents in dealing with human
maladies should accept as a confession of faith:^

** Nature alone can cure; this is the highest law of prac-
tical medicine, and the one to which we must adhere. . * .
Nature creates and maintains; she must therefore be able
to cure/'

The deluging practice of Priessnitz is still recommended
by the German water-cure empirics and by some scientific
hydrotherapists, but cases are certainly very rare in which
such quantities of cold water can be swallowed with ad-
vantage. As a measure of treatment, water drinking may
be practiced to the extent of six or eight or even tea
glasses a day with advantage, when required, but not
infrequently three or four glasses are suflficient, and there
are cases in which it is more important to interdict the
use of liquids by the stomach than to commend their use.
In such cases water may be introduced by the enema in
small quantity, to be retained.

Cold water drinking is especially indicated in all the

14S6

t

926 RATIONAL HYDROTHERAPY*

cachexias and diatheses. In rheumatism it is useful as a
means of diluting the blood so that it can dissolve and
carry out of the body a larger amount of uric acid and
allied substances; and as a means for encoura^ng activity
of the skin and kidneys, it is always useful in this disease.

In obesity, water drinking is essential as a means of dis-
solving and carrying out of the body the large amount of
broken-down material which results from the increase in tissue
destruction set up by exercise, hot and cold baths, and other
means employed to reduce weight To forbid the free use
of water in obesity is a grave error.

In diabeies the free use of water is not injurious,
but advantageous. The blood contains an excess of sugar.
All the sugar that is not oxidized must be removed from
the body by the kidneys and skin* chiefly by the former.
The specific gravity of the urine in these cases is always
high, indicating a similarly high specific gravity of the
blood. It is evident, then, that water is needed in cases of
this sort for the purpose of maintaining a proper degree of
fluidity of the blood and for facilitating the removal of the
unused sugar, the presence of which interferes more or less
seriously with the various vital functions. While the free use
of water in diabetes will of course have the effect to increase
the quantity of urine daily discharged, the amount of sugar,
which is a matter of most serious importance in this disease,
is not increased. Indeed, the amount of sugar has appeared
to be somewhat decreased, doubtless as the result of the
increased oxidation which takes place within the body under
the influence of free water drinking.

In fevers water drinking is essential as a means of aiding
the kidneys and the skin in the elimination of the toxins to
which the rise of temperature is due, in aiding the liver in
its work of destroying the fever poisons, oxidizing leuco-
mains, and promoting the reduction of temperature by
securing an increased evaporation from the skin.

Winternitz and numerous other observers have shown that

THE TECHNigUE OF HYDROTHERAPY.

927

when water is taken in sufficient quantities, the temperature
of the body may be lowered by the absorption of heat Irom
the water Suppose, (or example, a patient having a tem-
perature of 102'^ should swallow three pints of water at 60^,
In acquiring the temperature of the body the water swallowed
will absorb 1 26 heat units. In the case of a patient weighing
120 pounds this would induce a fall of temperature of more
than i'^, provided, of course, that the heat production and
heat elimination continued at a uniform rate*

A general fall in the temperature of the body of .4^^ C,
sometimes more, was observed after drinking water at a tem-
perature of 60^ to 65^- Water taken at a lower temperature
and in larger quantity has been shown by Winternitz to be
capable of reducing the pulse twenty beats and the tempera-
ture .8'^ C, (1.4^ F,). The temperature of the urine was
found to be .7^ C. (i.j"^ F.) below the normal.

Winternitz, by means of a thermometer introduced into
the stomach itself, made interesting observations upon the
effect of water drinking upon the local temperature. A half
hour after drinking a pint of cold water the temperature of
the stomach was found to be ,6^ C. (1,08^ F.) below its
normal temperature. The rectal temperature was found to
be still lower, sinking gradually from the time the water was
taken for nearly half an hour, when the maximum reduction
of more than i^ C. (1-8^ F,) was found. The axillary
temperature at first rose slightly, then fell, the temperature
remaining below normal for more than an hour The pulse
was decreasecf ten beats. This curious fact was noted, —
that the temperature reduction was greater in the rectum than
in the stomach. On reversing the experiment and introduc-
ing the water into the rectum, it was. found that the tempera-
ture in the stomach was reduced more than was that of
the rectum, falling to ,9^ below the normal

A decided fall of the surface temperature at the epigas-
trium may be observed after cold water drinking, as well as
general reduction of temperature, indicated by thermometers

g28 RATIONAL HYDROTHERAPY,

placed in the axilla and rectum (Exp. 73). This fact
first observed by my assistants, Drs. Otis and Edwards,
while conducting a series of observations (1898) to deter-
mine the effect on temperature reduction of water taken at
different temperatures.

In cases of chronic inactivity of the skin^ cold water
drinking is an exceedingly valuable measure, but it must be
employed with discretion, as inactivity of the skin usually
means an inactive mucous membrane, so that liquids axe
absorbed with difficulty. In cases of chronic dilatation of
the stomach, water drinking, while indicated as a means of
relieving the general condition, may be inadmissible on ac-
count of the state of the stomach. In these cases water
may be introduced by enema

Copious water drinking is one of the most effective means
of relieving a common cold, by aiding in the elimination oE
tissue poisons, the accumulation of which gives rise to Ibe
difficulty known as '*a cold/'

One or two glasses of cold water taken half an hour or
an hour before breakfast prove in many cases an almost per-
fect panacea for chronic inactivity of the bowels. Hun-
dreds of patients have been cured by the use of this simple
remedy alone. At a meeting of the New York Academy of
Medicine attended by the author more than twenty years ago,
a leading physician of New York City stated that he had
successfully treated more than one hundred cases of constipa-
tion by this simple means.

Chronic biliousness, which is nothing more or less than
chronic toxemia resulting from the putrefaction of animal
food substances in the alimentary canal, requires the free use
of water. Eight or ten glasses a day would be none too
much in cases of this sort.

In cases oi gall-stones and infectious jaundice, water drink-
ing is certainly indicated. The amount taken should be ten
or twelve glasses a day, if possible, so that the liver will be
thoroughly flushed and the bile so diluted that it will be able

THE TECHNIQUE OF HYDROTHERAPY.

929

to dissolve and remove any concretions which may be present
In cirrhosis of the liver arising from either indigestion or
alcohol, water drinking is essential as a means of aiding the
Hver and the kidneys to perform the work required of them in
the removal of a large quantity of alimentary poisons in addi-
tion to the toxins naturally produced within the body by the
physiological processes of tissue change.

In the treatment of the opium, alcohol, tobacco, and
other drug habits, water drinking renders important service
by hastening the elimination of the drug and in aiding liver
work and general oxidation.

The tt'tfiferaiuri of the water drunk should ordinarily be
about 70"^ F, In special cases water at 60-' and even 50^
may be employed* Very cold water is indicated only in
leverSp in constipation, and in small quantities in hypopepsia.

Th^ quauiiiy of waicr taken must depend on the effect 148?
desired. In fevers, a good rule is to take a glass of water
every hour In hypopepsia, one third or one half a glassful
of cold water may be taken half an hour before eating.
For inactivity of the bowels, one or two glasses of cold
water should be taken on retiring at niglit, and as much more
on arising in the morning. A thirst for water is almast
always an indication that it may be taken with advantage, no
matter whether such use is in harmony with the established
canons of hygi€ne or not. It is safer to trust to the natural
instincts than to pin one's faith to a theory. Almost the only
decided contraindication is in connection with meals when free
water drinking prevents proper insalivation of the food.

The Brsi Wilier, — The purest water is universally the 1-138
best. Whatever beneficial efiects are obtained from water
drinking must be attributed to the water itself, and not to any
ingredients which it contains. Mineral waters are simply
diluted drugs- The ingredients may be obtained at any dTug-
store, and if diluted to the same extent as that in whit h they
are found in the so-called natural waters, the effects obtained
from their use would be the same* Medical experience has
59

930

1439

RATIONAL HYDROTHERAPY.

shown that the best of the so-called mineral waters are the
which contain the least niineral ingredients. The very
best water is distilled water which has been welt aerate
Water obtained from natural sources is generally more or Ic
contaminated, that from lakeSj streams, and rivers beii
necessarily defiled by the fish and other creatures which In
in natural bodies of water, and by surface drainage^ wt
after every rain, washes out quantities of filth.

Water obtained from public supplies should always
boiled ; indeed, this precaution is a wise one under nearly
circumstances.

Hard water should always be boiled for a long time
eliminate, so far as possible^ the lime which it contains; but
even when boiled it is by no means free from this injurious
ingredient. The larger the amount of sahne ingredients, tbi
more slowly the water is absorbed. The presence of a
encourages absorption. Carbonated distilled water and dtlt
fruit juices without sugar are the best drinks*

HOT WATER DRINKING-

Hot water drinking has of late years been enormously
overdone. In the United States, and doubtless in other]
countries, many persons have been injured by deluging their
stomachs with quantities of hot water several times daily^
The author has met a number of patients who were takin^J
three or tour glasses at once in this way at a temperatureif
which would seem positively incredible. In one instance aj
gentleman was found sipping a glass of water at a temperature
of 160°. The free use of hot water has been largely encour-l
aged by physicians who recommend an exclusive meat diet- J
ary, experience having] taught them that the free use of J
meat must be accompanied by copious water drinking as oA
means of ridding the system of the pto mains, toxins, andlj
various other poisonous substances which are always to be
found in the body of a dead animal. Water drinking in
these cases is doubtless a means of saving the patient's life

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THE TECHNIQUE OF HYDROTHERAPY*

931

jgfkder conditions which would otherwise lead to speedy
^haustion of the defenses of the body, and thus precipitate
some acute and perhaps fatal malady, as Bright*s disease*
organic changes in the Hver, arteriosclerosis, etc.

The fact that hot water has proved serviceable in some
cases has led to its excessive use by a large number of
persons who have suffered serious consequences from the
practice. The general effect of hot water drinking is to de
bilitate the digestive system, while cold water acts as a
tonic. Heat and cold, when brought in contact with the
mucous membranes, produce effects entirely analogous to
those resulting from their application to the skin. When
heat is applied, the result is first a stimulation, quickly fol-
lowed by a tonic reaction lasting for a considerable length
of time. In this condition the blood-vessels of the stomach
are contracted, the circulation is less active, and the activity
of the peptic glands, if not entirely suspended, is greatly
diminished, so that the quantity of hydrochloric acid produced
is smaller than under ordinary conditions* When cold is
applied, the opposite effect is produced. The blood-vessels
are first contracted, but later, tonic reaction occurs, the
movement of blood in the vessels is accelerated, the glands
become more active, and the functions of the stomach are
quickened.

From these facts it is apparent that hot water drinking is
a measure likely to prove of great service in hyprrpepsia, and
likewise in gastrorrhea, as in these conditions there is an
excessive production of hydrochloric acid* In order to be
beneBcial in cases of this sort, the water swallowed must be
very hot, the temperature being 130^ to 140 ; and should
be swallowed rapidly, so that it may be cooled as little as
possible before coming in contact with the stomach.

The tonometer of Gcertner, an instrument by means of
which the level pressure may be quickly and exactly deter-
mined, may be advantageously employed in connection with
water-drinking. The two forms of this instrument are shown
in Figs. 239 and 240.

^32 RATIONAL HYDROTIIEKAPY:

Hot water drinking is very useful in gastra/^ia^ especially
wheh accompanied by vomiting. Slowly sipping hot water

will sometiines relieve vomiting not only in gastral^ia, but m
^- other conditions. Hot water drinking also affords relief in
the colic pains frequently the result of the habitual use of
milk from a neglected nursing- bottle or scwne similar caase.
It is an invaluable remedy in chronic gastritis^ or gastric
catarrh.

In cases of hypopepsia and apepsia, a few ounces of cold
water should be rapidly swallowed half or three quarters of
an hour before the meal, the purpose being to produce a
vigorous reaction in the mucous membrane of the stomach.
The result is an improved appetite and increased digestive
power
1430 Wh^^n Free Water Drinking Should Be Avoided. — In

extreme dilatatio?i of the stomach, water drinking must be
avoided for the reason that a dilated stomach does not readily
absorb, and from lack of muscular tone it can not readily
relieve itself of its contents by transferring the water to the
small intestine. Very little absorption takes place in the
stomach, the intestine being the great absorbent organ of
the body. Thus when water is swallowed freely in cases of
this sort, the stomach is simply filled up, and the thirst is not
relieved until the stomach is completely filled, so that it
runs over into the small intestine.

The effect of this overburdening of the stomach with Hquids
which are not readily disposed of, is to increase the dilatation
or prolapsus of the already disabled organ.

In colic, cold water drinking should be entirely avoided,
though hot water often affords relief if taken in ample quan-
tity. At the same time that the hot water is taken into the
stomach, the hot enema should be employed.

Dr. Lawson Tait laid down a law that liquids of all sorts
should be avoided for two days after an abdominal section.
His idea was that by withholding liquids in this way, the
intestine would be compelled to absorb the stagnant fluids

J

THE TECHNIQUE OF HYDROTHBRAPY.

9J3

from the abdominal cavity. This method is quite a hard-
ship to patients who are subjected to it, many suffering more
from thirst than from the pain of the operation. It is
certain, however, that as Mr, Tait has pointed out, patients
do better under this regimen. The withholding of fluid from
the stomach is certainly a useful means of combating the
nausea and vomiting which so commonly follow operations of
this kind, and the author is inchned to think that this latter is
the most important advantage obtained by withholding fluids
in cases of this sort. No harm has seemed to result from the
use of the tepid enema as a means of affording the necessary
amount of liquid.

Drinking very freely of cold water must be strictly avoided
when a person is both fatigued and sweating profusely. It is
generally better not to drink freely of cold water when per-
spiring freely, even though one may not be seriously fatigued;
as when the body is actively perspiring, the elimination of
heat is very great, several times the normal amount, and the
additional loss of heat occasioned by the cold water is some-
times sufficient to produce a chill, with internal congestion
and serious results. If very cold water be taken when a
person is perspiring freely, it should be in very small amount,
and should be very slo%vly sipped.

Feeble patients should avoid the free drinking of cold
water except when walking, when just setting out for a
vigorous walk in the open air, or when about to engage in
some other exercise. Water drinking is also entirely safe just
before and during a hot bath* Avoiding the free use of water
at meals is a very iinpurlant hygienic rule. The cold water
interferes; with the digestion of starch, delays peptic digestion,
and is the cause of many other mischiefs.

934 RATIONAL HYDROTHERAPY.

ELECTRICITY AS A COHPLEMENT TO HVDRO^

THERAPY IN THE TREATMENT OF

CHRONIC DISEASE*

1431 The efforts of some enthusiasts to find in electricity a
panacea for all human ailments, and the subsequent failure
of this agent to accomplish in the hands of others all that
was claimed for it, has been a fruitful cause of prejudice
against its use as a substitute for the empirical, irrational*
and artificial methods which have come down to tis as a
legacy from the infantile days of our beneficent art, or
which were engrafted upon it during the ages when all
the arts and sciences were stifled by the universal preva-
lence of superstition and intellectual darkness, — methods
which still cling to us like the barnacles upon the bottom
of an ocean steamer, and hinder our advancement toward
the goal of all scientiBc progress in medicine; viz,, the
attainment of a system of dealing with the sick in which
every measure employed and every application shall have for
its basis a thoroughly rational and physiological foundation.
No medical practice can properly claim to be strictly rational
which is not at the same time physiological. Those measures
which accomplish so-called therapeutic results by means of
toxic effects are pathological rather than physiological agents ;
and with the onward march of laboratory research, clinical
observation, and physiological and pathological knowledge,
they must in time be wholly eliminated from our therapeutic
armamentarium.

The author has for more than twenty-five years given
special and earnest study to the practical application ol
physiological agents of all sorts in the treatment of disease.
Water, gymnastics, massage, manual and mechanical exer
cise, heat, sunlight, diet, and other agents, as well a;

THE TECHNIOOE OF HYDROTHERAPY.

955

electricity in its various forms, have all been carefully studied
and utilized in the treatment of the various forms of acute
and chronic disorders. Relying upon none of the agents as
a cure-allp the effort has been made so to combine them all
as to secure tor each the greatest possible efficiency, utilizing
each one for those things to which it is best adapted, and
applying two or more in succession or simultaneously in such
a way as to enable the effects of each one to supplement or
complement the effects of each other one. Special attention
has been given to the utilization of water and electricity^ (or
the reason that these two agents have been the object of'
more exact scientific study and research than any others
employed in physiological therapeutics.

The chronic invalid rarely has a fair chance unless he
can have brought to bear upon his case simultaneously all Uie
various physiological agents which are indicated. To nnder^
take to cure a chronic dyspeptic by diet alone, by water
alone, or by electricity or exercise alone, or by any other
single agent, is very much like trying to raise a great building
with one jack-screw. All the lifting agencies possible must
be set at work to get these chronic sufferers out of their
pathological ruts.

It requires but a very superficial study of the subject to
show the remarkable siniilarity between the methods of
hydrotherapy and electricity in effecting results. The most
important results of each are attained through their influence
upon the nervous system, as the therapeutic effects of both
agents are based upon their physiologtcal effects.

The researches of SchtSlIer, Vinaj, WinterniUf, and others
have shown that prolonged moderately cold applications to
the surface produce prolonged contraction and decongestion
of internal vascular areas reflexly connected with the cuta-
neous area acted upon* Local cold applications in this respect
differ from general cold applications^ which cause dilatation
of the visceral and cerebral vessels through contraction of
the surface vessels.

936 RATIONAL HYDROTHERAFT.

Warm applications, that is, a temperature of 92° to ^^,
on the other hand, cause immediate contraction of the vessels .
of the interior of the body, corresponding with dilatation of ■
the cutaneous vessels.

Every portion of the cutaneous surface is reflexly asso-
ciated with some internal vascular area, the conditions of
which may be controlled by the application to the associated
cutaneous area of thermic or other agents capable of produc-
ing vascular changes ; for example, any agent which caus^
contraction of the cutaneous vessels will cause a correspond-
' ing action of the associated visceral vascular area, this being
also true respecting vasodilatation*

From clinical observations and from the study of practical
electrotherapy in connection with hydriatry or rational hydro-
therapy, the author is fully convinced that many of the effects
of percutaneous applications of electricity are produced by the
same means through which most hydriatic effects are obtained ;
viz., through nervous impressions propagated from the skin to
the spinal cord through the sensory nerves, and sent out from
the spine as motor influences, then carried outward by the non-
medullated vasoconstricting fibers of the sympathetic and the
medullated inhibitory fibers which pass directly from the
vasomotor centers of the cord to their distribution in the ves-
sels. In other words, the condition of anelectrotonus and
catelectrotonus, as the case may be, established in the
cutaneous vessels, is propagated through a reflex arc
to the associated internal vascular area. It seems to the
author that this view alone affords a rational explanation of
the influence of percutaneous applications of galvanism upon
the internal organs.
1482 A galvanic current of twenty to forty milliamperes applied,
the anode electrode over the hypogastric region, the cathode
over the lumbar region, produces decided effects in relieving
uterine and ovarian congestion. Yet the location of these
organs is such as to bring them practically at the neutral
point between the two poles, and hence outside the sphere of

THE TECHNIQUE OF HYDROTHERAPY.

937

influence of either I lie cathode or the anode. It is true that
by increasing the strength of the current^ the neutral point
may be moved nearer to the cathode ; while decreasing the
current moves the neutral point nearer the anode, thus bring-
ing in cither case a larger area under the influence of the
opposite pole, Knoviring this fact, and taking advantage of
it, we may bring under the influence of either pole desired,
structures not too far removed from the surface ; but in the
case of organs located approximately in the center of the
body or far beneath the surface, as the uterus, the ovaries^
the abdominal viscera in general, and the spinal cord, it is
evident that we are powerless to produce in them an electro-
tonic condition of any considerable degree of intensity.

In the case of the pelvic oi^ans, and likewise with the 1433
stomach, we are able to produce either anelectrotonus or
catelectrotonus, as we may desire, by means of suitable
electrodes ; but in the case of the spinal cord, the sympathetic
ganglia, and most of the abdominal viscera, and indeed, nearly
all the deep-seated structures of the body, we are unuble to
produce elect rot onic states, for the reason that the action of
electrical currents, when applied to the body, is practically
confined to the immediate vicinity of the electrodes. As the
current leaves the electrodes, it spreads out, utilizing the
whole body as a conductor instead of passing from one
electrode to the other, as might be supposed by one not ,
familiar with the laws of elect rophysics.

These and other considerations show us that in explaining
the effects of percutaneous applications of electricity vvc must
keep in mind the interesting anatomical and physiological
relationships which form the basis of a large share of the
applications of water in rational hydrotherapy.

The researches of Brown-Sequard, Charcot, Winternit^, 1434
Beni-Barde, Fletiry, and other hydriatrists, have established
a distinct reflex relationship between the principal internal
organs and particular cutaneous areas, as elsewhere desig-
nated (372-382).

938 KATJONAL HYDROTHBRAPV,

In general, the skin overlying an internal or^an is reflexfy
associated with it. This is the reason why percutaneous
applications of electricity made over an organ usually affect
it, and not altogether because the electrical current is passed
through the organ.

1435 For nearly twenty years, the author has made use of this
principle in the application of electricity, especially in the
treatment of genitourinary diseases, and has seen excellent
results from the application. For example, in applications
intended to influence the genital glands and associated
organs, — the uterus^ ovaries^ and tubes in women, and the
testicles and prostate in men,— it has been found distinctly
advantageous to make applications to the inner surface of the
thighs and perineum, as well as to the epigastric and lumbar
regions* The anatomical relations of the nerve supply of
these regions suggested the method before the reflex relation-
ships between cutaneous and visceral vascular areas was so
thoroughly understood as at present. The author has also
for many years utilized anodic applications of the galvanic
current to the face as a means of relieving coryza, and has
often seen a patient relieved of headache, presumably congest-
ive in character, by applications of the galvanic current to
the abdominal and cervical sympathetic.

It requires but a cursory review of the physiological effects
of water and electricity to note the remarkable parallelism
between the effects of hydriatic applications and those of
electricity. With equal readiness it may be seen how, by
simultaneous or successive use of electricity and water, if
applied with scientific precision, these two potent agents
may render mutual aid in a great variety of conditions.

1436 Special note may be made of the following points : —
Water moistens the skin, and thus increases electrical

conductivity.

Hot applications cause immediate dilatation of the blood-
vessels, increasing the vascularity of the skin, and thus also
increasing its electrical conductivity; while cold water causes

THE TECHNIQUE OF HVDROTHERAPV.

939

first a contraction of the small vessels, lessening^ the blood
supply of the skin, and diminishing its conductivity for both
heat and electricity. In the reaction which follows, however^
the amount of blood in the skin is greatly increased, thereby
lessening its resistance.

Both very cold and very hot applications to the skin
diminish the sensibility of the nerves, and thereby lessen
their susceptibility to electrical effects. Anemia of the skin,
on the other hand, increases sensibility, while saturation of
the skin with moisture diminishes irritability and nerve sensi-
bility. Steiner has shown that temperatures below 59^ and
above 'j'j^ lessen the velocity with which nerve impulses are
conducted, while Hermann has shown that the application of
cold diminishes notably the phenomena of electrotonus.

Heat, being relaxing, produces effects analogous to the
cathode; while cold, produces contraction or anodal effects.

Neutral applications are likewise sedative, thus resembling
the anode in their effects. Short cold applications, because
of the reactionary excitation produced, give rise to effects re-
sembling the cathodic influence of the galvanic current or
the excitation of the (aradic; while the atonic reaction which
follows prolonged hot application results in sedative effects
similar to those of the anode.

Granting the truth of those statements respecting the
mode of action of percutaneous applications of electricity upon
the visceral circulation, it needs no lengthy argument to show
the great advantage of combining electrical and hydriatic
applications in a great variety of morbid conditions.

According to the author's personal experience, two general 1437
rules may be established for applications of this sort: Firsts
increased movement of blood and accelerated functional
activity of ati internal oigan may be induced by short, vigor-
ous, cold applications in combination with cathodic applica-
tions of galvanism* The electrical application may be eitlier
simultaneous or may immediately follow the cold application.
Bipolar, faradic, or sinusoidal currents may also be applied

940 RATIONAL HYDROTHERAPY.

with advantage, but the effect is less distinct than that of the
galvanic current. The electrical application should, in geo-
eral, be as strong as the patient can bear without pain, ■

Secondly, congestion and undue functional activity of an
internal organ may be diminished by a prolonged, moderately
cold apptication (60^ to 70^ continuing from thirty minutes to
; several hours), combined with the simultaneous anodic appli*

; cation of the galvanic current of moderate stren^h.

i By the apphcation of these principles, results which appear

\ really marvelous to one not familiar with applications of this

sort, may be obtained in cases of congestion of the brain,
lungs, liver, uterus, ovarieB, likewise in atonic conditions of
the stomach and bowels, and in amenorrhea and hypopepsia.
1488 In applications for the relief of pain, in which electricity
so often renders most valuable service, the association of heat
with the electrical application is an exceedingly valuable
measure. When the pain is neuralgic in character, the strong
application of the sinusoidal or faradic current, combined
with a fomentation at a temperature high enough to produce
slight pain when first applied, contimjed for 15 or 20 minutes,
gives very positive and gratifying results. The current
should be as strong as the patient will bear. When the pain
is due to congestion or inflammation, an anodic application of
the galvanic current should be employed instead of an
induction current. The application should be prolonged, and
not so strong as to produce decided sensation.
1439 Anodal galvanic applications may likewise be associated
with cold as an analgesic measure. In cases of cardiac
insufficiency in which the application of electricity may be
thought to be a necessary or useful measure, advantage may
be gained by the application, two or three times daily, of a
cold compress for 40 to 60 minutes, over the anterior surface
of the chest. Slowing of the pulse and an increase in
arterial tension, as indicated by a sphygmographic tracing,
indicate at once the therapeutic power of this simple appli-
cation.

THE TECHNIQUE OF HYDROTHERAPY.

941

In cases of atony of the bladder, and inactivity of the 1410
bowels due to dilatation of the colon, the cold douche to the
feet and over the lumbar, umbilical, and hypogastric regionSt
in combination with faradtc and sinusoidal applications to the
rectum and abdominal walls, achieve prompt success in many
most obstinate cases which have failed to yield to other
measures* Cold douches applied to the parts named may
also be used to advantage in combination with the galvanic
current applied percutaneously to the abdominal and lumbar
surfaces. The strength of the current should be 60 to 80
milliamperes.

In cases of apepsia and hypopepsia, in which hydrochloric H41
acid is absent or greatly deficient m quantity, most excellent
results may be obtained by the application of the cathodic
galvanic or the sinusoidal current applied to the epigastrium
in combination with the ice-bag, tor half an hour before each
meal. Painful congestion is reUeved by very hot fomenta-
tions half an hour after a meal in combination with a faradic
or sinusoidal current of moderate strength.

Very short, very hot applications over the Uver(i30^to 1448
140'^, for 5 to 8 min.), combined with a prolonged anodic
galvanic application, act powerfully in relieving hepatic con*
gestion.

Very hot fomentations over the lumbar regions, combined 144S
with an anodic galvanic application to the same parts and to
the lower third of the sternum, are indicated in renal con-
gestion.

The hemostatic effects obtainable by hydriatric applica- 1444
tions in connection with the galvanic current have been proved
of invaluable service in hemorrhage due to ovarian conges-
tion, intra-uterine vegetations, and intra-uterine and sub-
mucous and interstitial fibroids of the uterus. In cases in
which persistent hemorrhage follows the employment of elec-
trolysis, the cold pelvic pack and the hot vaginal douche in
many cases render continuation of the treatment possible
when otherwise its interruption would be necessary.

RATIONAL HVDROTHERAPy.

[n amenorrhea* the effects of cathodic, faradic, or siou*
SQidal applications to the uterus are greatly increased by short
cold applications to the lumbar regionSp the Inner surface of
the thighs^ and the feet.

In applications of electricity to paralyzed and paretic
muscles, the effects of the electrical apph'cation may be
greatly increased by the previous appHcation of cold water m
the form of the ordinary cold douche^ the percussion douche,
the Scotch douche or cold friction, or the heating compress.
The marked increase of mnscular irritability produced by
hydriatric applications of this sort increases the susceptibility
of the muscle to the influence of the electrical current, whether
the galvanic, faradic, or sinusoidal current be employed.

For reUef of pain in neuralgic joints, hot applicattones
followed by the sinusoidal or galvanic current, are a mi>st
useful measure in cases in which joints are not painful nor
stiffened or thickened by inflammatory products* The alter-
nate hot and cold douche and other exciting hydriatric mea$>
ures may vi^ith much advantage be employed in connection
with cataphoresis. The author has found this combination
exceedingly useful in treating many cases of this sort.

In chronic congestion of the pelvic and abdominal viscera,
the good effects obtained from local electrical applications^
either internal or percutaneous, may be continued and intensi-
fied by the use of the heating compress, consisting off a towel
wrung dry out of very cold water, placed over the parts and
covered with several thicknesses of flannel sufficient to main*
tain the heat produced by reaction, but not an excessive
accumulation,

Faradic, sinusoidal, and cathodic galvanic applications may
be employed in connection with the revulsive douche and
other revulsive applications in all cases in which pain is not
a marked feature, but in which the purpose is to produce
strong circulatory reaction. When pain is present, the
faradic or sinusoidal current should not be employed; the gal-
vanic current should be used instead of the cathode.

I

The form of revulsive applications referred to consists of
a prolonged hot application followed by an exceedingly short
cold application. The respective times of the applications
may be hot, 5 to 1 5 minutes, cold, 15 to 30 seconds, if
compresses are employed ; or 3 to 5 minutes for the hot
douche, followed by a cold douche of 4 to 10 seconds.

For general hypnotic effects, applicable to nearly all cases 1450
of insomnia, a neutral bath — that is, a bath at a temperature
of 92^ to 96^' for 30 to 40 minutes, or a douche with little
pressure at the same temperature, with a duration of i to $
minutes — ^ succeeds in securing sound sleep without the use of
hypnotic drugs of any sort, especially when combined with
the static insulation and breeze to the head and spine, or a
galvanic application to the inferior cervical sympathetic and
solar plexus, the anode being placed at the neck.

The neutral full bath, combined with the galvanic, faradic, 1461
or sinusoidal current, is perhaps the most powerful of all
hypnotic measures. The author has employed this bath with
success tor nearly twenty-five years; and it has rendered
valuable service not only in reUeving insomnia, but in helping
patients through the trying time which immediately follows
the withdrawal of opium, cocaine, and other drugs, in the
treatment of variQUS forms of drug addiction.

The faradic, sinusoidali static, and high frequency currents 1453
are all tonic in character, stimulating metabolism, arousing
the nerve centers, and directly exciting the brain and ail
portions of the central nervous system. Short applications
of cold water, especially when accompanied by strong me-
mechanical effects, as in the cold douche, constitute the most
powerful of all known tonics. By combination of the cold
douche with the faradic and sinusoidal electrical currents, the
tonic effects of each measure are intensified. The electrical
application should be made soon after the douche, when
reaction is well established, the nerve and muscle lone
elevated, and the nervous reflexes in full swing.

I

944 RATIONAL HYDROTHERAPY.

S The most powerful of all tonic appIicatioQs of water
the percussion douche. Applied to the spine, especjally, this
powerful hydriatric procedure awakens the whole iiervoiiiH
system in a most remarkable manner, and prepares it to
receive the greatest possible benefit from applications of
electricity which may follow^ such as general faradization.
general application of the sinusoidal current, the static
charge, etc.

1454 The analgesic effects of water may be most advao-
tageously employed in connection with the electrolytic treat-
ment of uterine fibroids for the relief of the pelvic pains
which are not infrequently awakened when currents of large
quantity are employed. It has always been the authors cus-
tom to administer a very hot vaginal douche just before and
just after the electrical treatment. A very hot sitz, 115^ to
120^, for 3 to 5 minutes, followed immediately by a dash ol
cold water over the hips, is also a most valuable measure to
follow applications of electrolysis to the uterus^ relieving both
the congestion and the pain which are likely to result from
this application. By the employment of these measures, the
troublesome bleeding which sometimes follows the first few
applications of electrolysis may be promptly relieved or
wholly prevented, and thus the interruption of the treatment
and the discouragement of the patient may be avoided.

1455 In applications for the relief of headache due to cerebral
congestion, in which the cold applications do not produce
favorable results, applications of galvanism may be made to
the head in the usual manner in connection with very hot
applications to the cervical region. Excellent and almost
immediate results may thus be frequently obtained in cases
which are rebellious to other measures.

1456 Dana, in his masterly work, ** The Clinical Study of Neu-
ralgias," fixes the location of a considerable number of areas
which are the seat of transferred pain in neuralgias, and
which have by clinical observation been definitely associated
with internal pathological conditions.

THE TECHNIQUE OF HYDROTHERAPY. 945

By the combined application of fomentations, revulsive
compresses, or other analgesic hydriatic procedures with the
sinusoidal, faradic, or static electrical currents, most excellent
results may be obtained, such as could not be looked for by
other means than by the combination of water and elec-
tricity,— the two most powerful known agencies in influencing
the nervous system. These several areas as located by Dana
may be enumerated as follows : —

1. Vertex (anemia, endometritis, bladder).

2. Frontal region (constipation, hypopepsia, error of eye
refraction, caries of incisors).

3. Occiptal region (pharyngitis, diseases of the ear and
teeth).

4. Sternal region (gastric irritability, hypopepsia).

5. Mammary region (uterine disease).

6. Dorsal area below right shoulder-blade (liver).

7. Dorsal area below left shoulder-blade (spleen).

8. Central dorsal region of the spine (gastric disease).

9. Wrists (ovaries).

10. Thumbs (uterus).

1 1. Fingers (bladder).

12. Area between crest of the ilium and ribs (dyspepsia
and constipation).

13. Sacral region (uterus).

14. Outer surfaces of hips (broad ligaments and ovaries).

15. Groins (spasm of ureter).

16. Inner aspect of knee-joint (the hip-joint).

17. Heels (neurasthenia, disease of the ovaries, rheumatic
diathesis).

The location of these areas may be clearly seen by refer-
iurc to Figs. 122, 123, for which the author is indebted to
Dana's work previously mentioned.

THE ELECTRO-HVDRIC, OR ELECTRIC-THERMAL, BATH.

This bath is simply a water bath with the addition of 1457
electricity. The author employs the faradic, galvanic, or

Il I •

946

RATIONAL HYDROTHERAPY-

. J

sinusoidal electrical currents in this way. The electricity
CDmmunicatt:!d to the patient in a porcelain tub by means o(i
a stationary head plate and sliding metallic electrodes on eitbef \
side (Fi^. 241). The electrical apparatus may be placed M tBr
head of the tub or in any other convenient place within easy
reach of the operator The temperature o( the bath depcfub
upon the effects desired. The temperature most commoaly
e^nployed is from 92° to 98^.

When tonic effects are desired, the faradic current is gfm~
erally found preferable. The temperature of the bath raay
be from 92^ to 95°^ for 5 to 6 minutes, and at the last eod
cooled to 80^, the patient being rubbed in the mcantiiiie tn I
prevent chilling. The strength of the current should be SQcb^
as to produce distinct tingling in the various parts of the body
to which it is directed, but not sufficiently strong to cause
contraction of the muscles.

When sedative cfTects are desired, the temperature of the
bath should be 92^ to 97-' (ordinarily about 95 '^^), and the
galvanic or sinusoidal current should be employed. The balb
should be continued for [2 to 15 minutes. The direction of
the current should be from head to foot; that is, the positive
pole should be connected with the head of the bath, the
negative with the foot.

The neutral electro-hydric bath is an excellent application
for the relief of insomnia. It is, in fact, adapted to all classes
of cases in which the nervous system is abnormally irritable.
The sinusoidal current is especially useful in cases in which
neuralgic pains are a prominent feature of the nervous irri-
tability.

In administering the electro-thermal bath the current
should be entirely turned off before the patient enters the
bath, and then turned on very gradually until the current is
just sufficient to produce decided sensations of tingling and
prickling. Great care should be taken to avoid giving the
patient a shock of any kind by the sudden interruption of
the current. This is of special importance in the case of the

THE TECHNIQUE OF HYDKOTHERAPY.

947

galvanic bath. If the bath is supplied with electricity fmm a
street-current of high tension, as a 500- volt or ijOOO-volt
current, great care must be taken to avoid the possibility of a
sudden afflux of current, which might be in the highest
degree dangerous to Ufe. On this account, it is better to
supply the galvanic bath with a current from a cell battery of
such size that the total amount furnished by it will not be
capable of producing more than temporary inconvenience.
Electro- Vapor Bath. — This bath consists of a cabinet
arranged as for an ordinary vapor bath. In addition, sta-
tionary electrodes are placed upon the foot rest, the seat, and
the back rest, and several movable electrodes arc provided
suitable for application to the abdomen, or chest, or to be
held in the hand. These electrodes are connected with a
switch board placed upon the outside of the cabinet* An
ordinary faradic battery is connected with the switch board
in such a way that the current maybe directed through the
body in various directions by connecting the different elec-
trodes through the switch board.

It is possible that certain therapeutic advantages may be
gained by the combination of electricity with the vapor bath.
The skin when moistened by vapor is certainly rendered a bet-
ter conductor, and the entrance of the electric current into
the body is thus facilitated* The tonic influence of electric-
ity will| to a certain extent, counteract the sedative and
depressant effects of the heat of the bath, and thus, the
patient may possibly be enabled to endure a longer applica-
tion when prolonged sweating is required for eliminative pur-
poses. It can not be clearly shown^ however, that equally
good effects may not be obtained by the application of elec-
tricity after the bath; and it is probable that the tonic effects
obtained from the electrical current are so much less intense
than those derived from the cold application which should
always follow the vapor bath# that the advantages gained by
the combination of electricity, with this procedure are hardly
worth considering.

U58

i i

I i

Thermo- Electric Bath In this bath, an applicadon of

electricity is combined i^ilh a hot*air bath (1233). The
physiological efTccts are essentially the same as have been
elsewhere indicated in the descriptioii of the hot-air bath
(1234)* The mechanical arrangements are essentially the
same as those described above lor the electro-vapor i^tb;
the only difference is that provision is made for heatitig the
air without adding moisture to it. The cabinet may be so
arranged that it may be used for either the vapor or the
thermo-electric bath. The remarks made above respecting
the therapeutic vahie of the electro-vapor bath apply equally
to this procedure, and need not be repeated.
1460 El^tro-Chem leal Bath.— This bath is simply aa electro-
hydric bath in which a solution of some chemical substance
is employed instead of plain water. Various compounds
have been used for this purpose. The addition of chloride of
sodium increases the conductivity of the water, and is a meas-
ure which may be usefully employed to increase the intensity
of the bath when the electrical current is too feeble to
obtain the effects desired. For this purpose two to ten
pounds of salt may be added tu the water of the bath^

The bath may be rendered alkahne, if desired, by the addi-
tion of sal soda in quantity of two to four pounds. This
combination is thought by some to be especially desirable in
cases of rheumatism in which the perspiration is strongly
acid. If the bath is administered at a temperature of 90^
or less, it is possible that there may be some slight absorp-
tion of alkali into the system; but the amount thus taken in
isp as has been experimentally shown, exceedingly minute,
and scarcely worth considering.

Certain observers claim special tunic effects from the
employment of an acid solution, the water of the bath bein^
acidulated by the addition of an ounce or two of sulphuric
acid* It is doubtful whether any special advantage is
gained by this means.

In cases of cardiac and renal disease in which thecfferves-

4

/^

THE TECHNIQUE OF HYDROTHERAPY. 949

cent bath is indicated, an electrical current may sometimes
be advantageously added, thus enhancing the tonic effects of
the bath, and rendering it possible to repeat it at more
frequent intervals and to prolong the duration of the appli-
cation, thus producing a more intense degree of cutaneous
stimulation, the special object aimed at in the employment
of this procedure.

Some attempts have been made to combine applications of
static electricity with hydriatic procedures, but without very
appreciable results. It is possible that this current might be
substituted for that obtained from the induction coil, but it is
doubtful whether any material advantage would be gained
thereby. Possibly future experimentation may develop some-
thing of interest in this direction. The writer has long made
use of the static current obtained from a very powerful influ-
ence machine in connection, but not in combination, with
hydriatic procedures, and has found it a valuable aid, espe-
cially as a hypnotic, particularly in cases of insomnia and as
an analgesic in cases of chronic articular rheumatism and
neuralgia of the joints.

MASSAGE WITH HYDROTHERAPY.

In addition to the remarks made elsewhere (1221-1230), 1461
there remain to be discussed a few points in relation to the
combined use of massage and hydriatic measures. The value
of massage as a measure associated with hydriatic procedures
depends chiefly upon the following characteristic physiolog-
ical effects: —

1 . Increase of circulatory activity.

2. Stimulation of all the functions of the skin and pro-
motion of reaction.

3. The promotion of nutritive changes in the muscles.
Massage may be advantageously associated with hydriatic

procedures not only as an accompaniment of the hydriatic
process entering into the technique of the application but it

95 O RATIONAL ItVDROTHERAPY,

may be employed either as a preparatory or a supplemental;
measure.

All the procedures of massage may be associated with
hydrotherapy. Friction, percussion, and deep massage ane
especially of service.

Friction. — Friction, as elsewhere explained (1225), h
almost universally employed as an essential means of pro-
moting reaction after general cold baths. It has other uses
of almost equal importance, of which the foltov^ing may serve
simply as illustrative examples:—

1. Friction of the skin at intervals of 1 5 to 30 minutes in
connection with the cold compress, to prevent benumbing of
the skin and obliteration of the reflexes upon which the effi-
ciency of the compress depends. This measure is especially
of use in connection with the cold precordial compress
(1383}i the cold chest compress m pneumonia (1374), ice-
bag to the back of the neck (131*)» the ice-cap (1314), and
the spinal ice-bag (til9, 670)- Friction should be avoided

l!if71fl when the purpose of the cold application is to allay super-

r I ficial inflammation. The hot fomentation fl328) should be

employed instead of friction in cases in which deep-seated
pain exists, which is aggravated by the friction, and in cases
in which the superficial parts are tender. The friction should
be applied with sufficient vigor and duration to redden and
warm the parts.

2. Friction may often oe employed advantageously before
an application to accelerate the surface circulation, and pre-
pare the parts to react quickly after a cold application is
made. This method is of special value in connection with
the wet girdle (134'7), the abdominal compress (1351), and
the chest pack (1373). It may also be usefully employed as
a general measure before cold applications when there is a

: tendency to gooseflesh or the patient complains of slight

chilliness, or when reaction is difficult, especially when the
' • application of heat as a preparation for the cold procedure

can not be conveniently utilized.

n

THE TECHNIQUE OF HYDROTHERAPY. 95 1

3. Vigorous friction may be advantageously used after
either hot or cold localized applications which are employed
for derivative effects, such as the cold running bath (1296),
the standing shallow (IIT*), Scotch douche to the feet and
legs (1037), and the revulsive compress (1341). It is only
contraindicated in connection with these measures when pain
or cutaneous hyperesthesias or eruptions are present.

Percussion may be employed in the same manner as fric-
tion and for the same purposes, either by itself or in connec-
tion with friction, but is a less useful procedure, its specific
effects being less frequently indicated.

1. Percussion is especially indicated in cases in which
very powerful circulatory reaction is required, and in which
pain is not a marked symptom and the superficial parts not at
all sensitive. When percussion is employed, it should be
continued until the surface is well reddened. The special
purpose of percussion is to produce a very intense and pro-
longed circulatory reaction.

2. Percussion as well as friction may be employed after
the Scotch douche (1037) to the legs for relief of asthma or
cerebral, pulmonary, or spinal congestion. It may likewise
follow the leg pack (1393) or the leg bath (1299).

3. Percussion as well as vigorous friction must be avoided
in cases in which inflammation is present, as in peritonitis and
all acute inflammation of the pulmonary or abdominal cavi-
ties, in pelvic inflammations, and in most cutaneous eruptions
and hyperesthesias of the skin.

General Massage. — General massage, including massaging
of the muscles, so-called petrissage, or deep massage, may be
administered with special advantage after general cold appli-
cations for the reason that the application of cold to the skin
produces a marked effect upon the muscles, rendering them
susceptible to the circulatory and nervous impressions made
by the manipulations of massage.

I. The application of massage after the cold bath is espe-
cially useful after prolonged cold procedures such as are

9S2

RATIONAl- HYDROTHERAPY-

appropriately employed in obesfty and fat diabetics, as
the plunge (1108), the shallow (1174), the prolonged cold
douche (1010), and the dripping sheet (1210). Massage foJ-
losing the cold bath is indispensable in cases of obesity m
which the patient is too weak to secure good reaction by
vigorous exercise after the cold bath.

2, Very vigorous massage may be appUed with advantage
after the cold bath in cases of rheumatism, especiaJly in casc^
in which the patient is so crippled that vigorous or prolonged
exercise is impossible, either on account of general weakness
or of a crippled condition of the limbs,

3. Gentle massage may be administered with very great
advantage after moderate general cold applications in Bright 's
disease. These measures are not applicable to cases of
advanced Bright' s disease, but are especially useful in case^
in which the patient has been gradually trained to the
employment of cold water at a moderate temperature. Mas^
sage should not be employed in cases in which active mdam-
mation is present as shown by elevation of temperature.

General and thorough massage may be advantageously
employed to promote sweating in connection with the Turkish
or the Russian bath, or the hot immersion bath. It is espe-
cially indicated in cases in which the skin is dry and inactive
so that perspiration begins with great difficulty. It should be
employed during the first fifteen minutes of the Turkish bath
and the first two or three minutes of the Russian bath. It
may be discontinued as soon as perspiration begins. .

5. Massage may sometimes be administered with special
advantage in connection with the hot immersion bath, the
bath having the effect to relax the tissues and to lessen their
sensibility. In this way, manipulation for the purpose of
reducing joint dislocations may be made to succeed. Taxis
for returning the prolapsed bowel into the abdominal cavity
in case of hernia often succeeds with the patient in a hot bath
after most persistent efforts oi other means have failed.

Abdominal massage for replacement of prolapsed viscera

THE TECHNIQUE OF HYDROTHERAPY. 953

is, in some cases, only possible when the patient Hes in a
warm immersion bath because of the abnormal rigidity of the
abdominal muscles. The hot immersion bath also facilitates
manipulation of the abdominal and pelvic viscera in certain
cases, thus rendering valuable aid in diagnosis.

6. Massage may by employed with great advantage after
various localized applications, as the cold abdominal douche
(1081), the cold plantar douche (1083), cold muscle douche
(1101), in cases of degeneration of the muscles from neuritis,
spinal cord disease, or other disorders of the central nervous
system. These combined procedures are indicated in a gen-
eral way in all cases of localized paralysis.

7. General massage may sometimes be employed after the
general hot bath as a means of promoting vigorous perspira-
tion, especially in cases of chronic rheumatism. This meas-
ure is also useful for the removal of exudates such as are
found about joints after the subsidence of acute inflammatory
processes; in the muscular shortening and rigidity which fol-
low muscular rheumatism ; in cases of sciatica after the em-
ployment of the Scotch douche (1037), and in cases of old,
badly united fractures in which pain is a prominent symptom.

MISCELLANEOUS BATHS.

1162

1463

}

Hydrotherapy, strictly speaking, relates solely to the
employment of water-baths applied in such a way as to pro-
duce thermic impressions by communicating heat to the body,
or abstracting heat from it. It may not be out of place,
however, to make brief mention of a few special forms of
baths in which other substances are employed, either alone
or in connection with water.

ErtioUient Bath& — In certain forms of cutaneous irrita* J
tion great relief is afforded by the employment of an emo!- *
lient bath, which consists of an ordinary full or immeT*
sion bath at a temperature of 93° to 96^ to which some
emollient substance has been added. Either one of the fol*
lowing may be employed, the quantity of each substance
named being calculated for 30 gallons of water; 4 to 6 pouB^
of bran previously softened by soaking for fifteen niinutesiii
a sufficient quantity of water to completely saturate and cove
the bran; or, 1 pound of corn-starch previously made into
a thin smooth paste, with i or 2 gallons of water; or, r
to 2 pounds of isinglass dissolved in i gallon of water. Of
the above, corn-starch or gelatin are to be preferred.

Alkaline Baths. — The fame of many mineral springs, as
Vichy, Ems, and various American mineral spring resorts is
wholly due to the agreeable effects of the alkaline ingredients
of the water upon the skin. All the beneficial effects of these
waters may be obtained by adding to the water of an ordi-
nary full-bath, carbonate of soda or potash in proj>ortion of
4 to 12 ounces of the carbonate to 30 gallons of water.
The water should have a neutral temperature, — 92° to 96°.
This bath is useful in many forms of skin diseases and also
as a means of relieving the intense itching of jaundice rjid
urticaria.

Alkaline solutions may be employed in various partial
applications, particularly the hot sponge bath for relief of
urticaria, and the evaporating compress in certain forms of

/^

4

THE TECHNIQUE OF HYDROTHERAPY. 955

eczema. Carbonate of soda or potash should be employed
in proportion of ^ ounce to the quart of water.

Saline Baths. — The typical saline bath is the sea-water 1464
bath. The water of the sea contains in solution from
J to J pound of solids to the gallon of water. The prin-
cipal ingredients are common salt, magnesium chloride,
and magnesium sulphate. These substances have a decided
stimulating effect upon the skin and thus encourage reaction.
This enables the patient to tolerate the bath at a tempera-
ture two or three degrees lower than when fresh water is
employed, thus increasing both the tonic and the derivative
effects of the bath. For an artificial sea-water bath employ
8 pounds of sea-salt, for 30 gallons of water, or the following
mixture: Chloride of sodium, or common salt, 7 potinds;
magnesium chloride i pound; magnesium sulphate ^ pound;
water, 30 gallons. Practically identical effects may be
obtained by the employment of ordinary salt in the propor-
tion of 5 to 8 pounds of salt to 30 gallons of water. Cuta-
neous stimulation will be increased by the addition of half
a pound to i pound of chloride of calcium (do not make the
mistake of employing the substance commonly known as
chloride of lime, the proper chemical name for which is cal-
cium hypochlorite). The stimulating effects of various par-
tial applications may be increased by the addition of common
salt, in the proportion of 4 ounces to the quart of water.
This solution may be used in place of common fresh water in
connection with cold friction (1201, 1209, 1213, 1216).

The Pine-Needle Bath. — To an ordinary full-bath add pine- 1465
needle extract. The amount required is small, but should be
sufficient to cause reddening of the skin of the whole body.
The temperature of the bath should be adapted to the patient's
condition. The temperature may be somewhat lower than
when ordinary water is employed. This bath produces power-
ful cutaneous stimulation. It is useful in chronic renal and
cardiac disease, at a temperature of 92^ to 94° and may be used
in the place of effervescing baths.

RATIONAL HYDROTHERAPY-

vi

i

I

n

1466 The Mustard Bath.— Add to the water of an ordinary ftilf

bath 2 ounces of freslily ground nmstard which has previously
been steeped for ten minutes in a quart of hot water. The
mustard should be thoroughly stirred into the bath before the
patient enters it; the effect is much the same as that of the
pine-needle bath.

For a hot mustard sponge, add to the water employed
ground mustard in proportion of i ounce to the quart and
proceed as in an ordinary hot sponge bath,

For a hot mustifrd fomrntaiion, wring a towel or i
cheese-cloth compress out of hot water to which groucd
mustard has been adik^d in proportion of \ ounce to iht
quart. Spread this upon the part to which the applies*
tion *is to be made, then apply the fomentation over B-

Alcohot Spon]^ Bath, — To 5 parts of water at the tesi*

1467 perature desired, add i part of proof spirit* The atcohd
sponge is useful in relieving the night-sweats of phthisis. The
efficiency of the evaporating sponge bath as a cooling meas* fl
tire is also increased by the addition of alcohol to the water. ^
Vinegar may be employed in the place of alcohol, and in
the same proportions.

The Sulphur Bath. — In certain forms of skin disease the

1468 sulphur bath is sometimes employed, although the writer has
never found it necessary to resort to it. It may be easily
administered by simply burning a small quantity of sulphur
in connection with the hot-air or vapor bath. One-half ounce
of sulphur may be burned in an iron basin placed over an alco-
hol flame in the hot-air or vapor bath cabinet. Great care must
be taken to protect the patient from the sulphur fumes by
tightly closing all the openings in the cabinet. Special care
must be exercised during the removal of the patient from the
bath. An excellent plan is to connect the bath with a
ventilating shaft, so that by suitable arrangements the sul-
phur fumes may be removed before the cabinet is opened.

1469 The Carbon Dioxide Bath — The carbon dioxide bath has foi
many years been used in some parts of Continental Europe

THE TECHNIQUE OF HYDROTHERAPY. 957

in two forms: simply immersing the body in an atmosphere of
carbon dioxide gas, the head being of course excluded, and in
the form of the carbon dioxide gas douche. The effect of
these procedures has been said to be a marked stimulation
of the skin. The writer, however, feels exceedingly doubtful
whether the application of pure carbon dioxide gas in this
manner is capable of producing any very decided physiological
effect. It seems more probable that whatever effect may
have been observed, was due rather to the systemic disturb-
ance induced by the incidental inhalation of the gas during
the administration of the treatment. The gas, carbon dioxide,
(CO2) is an inert substance; but when this gas is concen-
trated in water, it is capable of producing decided effects if
brought in intimate contact with either the cutaneous or the
mucous surfaces. '^

Observation of the effects of the effervescent bath (1139)
led the writer to devise a method for a carbon dioxide bath.
This bath consists simply in the application of water artifi-
cially impregnated with carbon dioxide. The saturation of
the water with the gas is effected by means of the apparatus
ordinarily employed for charging so-called '* carbonated " or
"aerated" drinks and mineral waters (see Fig. 242). The
water thus charged may be used for immersion baths, the full
bath, the foot bath, or other partial immersions, or in the form
of the general or localized douche. This bath is of the
greatest service in the form of the douche. It must be adminis-
tered at a low temperature in order to secure its characteristic
effects. At a high temperature, the gas is rapidly dissipated.
The stimulating effects of the bath encourage reaction, and
thus permit the employment of a lower temperature than when
ordinary water is used; by this means both circulatory and
thermic reaction are encouraged to an unusual degree. When
the jet douche alone is employed, any desired degree of pres-
sure may be obtained by opening the valve and connecting

* Verricr, Precis d'Hydrothcrapic ScientiBque.

RATIONAL HYDROTHERAPY.

with it a cylinder containing liquid carbon dioxide ^as. For
iocalizing this douche, an ordinary siphon bottle with a con-
necting rubber tube and nozzle may be utilized in Ibe
absence of any better apparatus.

Professors Winternitz and Gaertner, of Vienna, have
recently devised an apparatus for administering a cold shower
bathf which they have named the **Onibrophor " fFig*
243). This apparatus, which through the courtesy of Prof-
Winternitz the writer has been permitted to add to his collec-
tion of hydriatic devices, consists essentially of the following
parts: First, the water cylinder, with which is connected a
small cylinder containing liquid carbon dioxide. With the
water cylinder connect pipes, valves, and nozzles suitable for
a shower and a spray bath. By means of an ingenious valve
either the spray or the shower may .be employed separately
or together as may he desired. While the application is
being made, the patient stands in a metal-lined box which
also serves as a case in which to pack the instrument for
transportation when desired- The whole apparatus is exceed-
ingly ingenious, practical, and convenient. In their descrip-
tion of the apparatus the inventors do not mention that they
expect to derive any special effects from the carbon dioxide
gas in connection with the apparatus, but by taking pains to
agitate the water cylinder after admitting the gas, or by fill*
ing the cylinder with water and bringing the gas in contact
with it some hours in advance of the bath, the water may
be well impregnated with carbon dioxide gas, and the appa-
ratus may thus become an efficient means of administering
the carbon dioxide bath.

The carbon dioxide bath is especially indicated in cases
in which it is desired to obtain good circulatory reaction
with as little thermic or mechanical irritation as possible. It is
most advantageous in connection with the short cold douche.
It is valuable as a remedy for insomnia when due to cerebral
hyperemia, and when there is no considerable irritability of
the cerebral celh It may likewise be used with advantage in

chronic cardiac and renal cases, but in cases of this sort its
use must be managed with a high degree of discretion, and it
must be employed only when a proper preparation of the
patient has been made, so that injury may not be done by
the induction o( too powerful retrostasis.

The Air Bath-^ The effect of cold air when brought in
contact with the surface of the body is essentially the same as
that ol cold water, though less intense. The powerful tonic
effects of cold air are well illustrated by the refreshing influ-
ence of a current of air when one is greatly oppressed by heat
The fan, so much in vogue with ladies of all countries,
owes its existence and popularity to this (act. The remark-
ably refreshing effect of a gentle breeze on a hot day, even
though the temperature of the air may remain the same, is
another common illustration of the physiological influence of
air when applied to the surface of the body.

Air, as well as water, may be applied to the body m either
a quiescent or an active state; that is, the body may be sim-
ply surrounded by air of a given temperature, — what might
be called an immersion air bath coiresponding to the full or
immersion water bath; or the surface of the body may be
exposed to a current of air having any desired temperature
and rate of movement, which I have named the fan bath or
air douche. Benjamin Franklin was one of the first to call
attention to the value of the air bath, and it was the custom
of this great philosopher to administer such a bath to himself
just before retiring at night by removing his clothing, and
walking about in his apartment. He declared that he derived
great benefit from thus exposing the surface of the body to
contact with the air.

There can be no doubt that the constant protection of the
body from air and light by clothing, which is rendered neees«*
sary by the artificial customs and conditions imposed by civi-
lization, in no small degree interferes with the normal functions
of the skin by overheating this organ, retaining noxious sec re-
tions in contact with it, and depriving it of the normal stimu-

1470

96o

RATIONAL HYDBGn^UAFT.

lating effect of the actinic rays of the sun aod the importam
gymnastic exercise of the vasomotor nerves and centert and
the contractile tissues of the small vessels and captUaEies
resulting from the never-ceasing storm of thermic impreft'
sions made upon the unprotected skin by contact with the
ever-changing atmosphere.

The writer has for more than twenty-five years made u9c
of the air bath in connection with various hjdriatic prDceduns
in the systematic treatment of chronic invalids, and has
employed it in various forms, the principal of which may be
briefly described as follows: —

1. The Outdoor Bath. — This bath is best adniinistef^ hf
means of the outdoor gymnasium: A high-waJIed enclosmt
provided with dressing rooms and all necessary convenience
for out-of-door exercise at all seasons of the year. An out^
door gymnasium arranged under the writer's direction, coci*
sists of the following: A wide walking or running track
extending around the outside of the enclosure, just i-io of a
mile in length; a swimming tank 75 feet long, 30 feet in width,
4 feet in depth at one end and 8 feet at the olher» with ao
arrangement for an abundant supply of water so as to keep
the contents of the tank always fresh and clear and at the
proper temperature (from 65^ to 70 ); a supply of wood-
saws, axes, and plenty of material in the shape of logs of
different sizes, from 3 inches to 3 feet in diameter, a targe
pile of fine white beach sand for those who wish to indulge in
the sand bath, swinging rings, horizontal ladders, a May-pdie,
appliances for lawn-tennis, pitching quoits, and various gym-
nastic games (Figs. 244, 245).

On entering the outdoor gymnasium the patient remove
all his ordinary clothing, and dons a thin bathing-suit or a pair
of trunks; shoes, stockings, and hat are discarded, (or he
desires to bring himself as nearly as possible into a state of
simple savagery, and to throw off all the unwholesome re-
straints of conventionalism. A pair of sandals may be WOM
if desired, but it is better to expose the soles of the fe6t to

H

THE TECHNIQUE OF HVDROTHERAFY,

961

contact with the earth and the grass. He imagines himself a
boy again, IroUckingin the freedom of unrestrained activity^ —
he walks, runs, leaps, rolls about on the grass, buries himself
in the sand, chops or saws wood, laughs, shouts, whistles, and
fairly runs wild with exhilaration as he feels the impulses of
new life and vigor thrilling through his nerves and bounding
in his veins, and finally plunges into the pool for a swim,
which cools and tones the skin. As he re turns again to the
prison house of conventional clothing in which civilized human
beings are compelled to live, he wishes heartily that civiliza-
tion and nature bad not drifted so far apart*

The outdoor gymnasium is a marvelously potent means
for developing the restorative and healing powers of the body,
and is the natural complement of the various thermic pro-
cedures of the hydriatic method. No sanitariuin can be
considered as scientifically complete without a well -equipped
outdoor gymnasium.

More or less of the benefits of the outdoor gymnasium
may be obtained by such out-of-door exercises as cycling,
horseback riding, walking, boating, surf-bathing, swimming.
mountain-climbing, golfing, and various other out-of-door
sports, to which may well be added horticulture, floriculture,
and light gardening. The outuoor gymnasium has the ad-
vantage, however, that it may be employed at all seasons of
the year, that the exercises may be accurately regulated
and under the constant supervision of a competent director,
and that the seclusion of the gymnasium affords opportunity
for a more thorough exposure of the body to the influence of
light and air than ordinary out-of-door e^eerctse.

For feebler patients, carriage riding provides a partial sort o(
air bath, which may be advantageously utilized while strength
for more vigorous exercise or a more considerable degree of
exposure is being accumulated. Very feeble patients may be
allowed to lie out on the verandas or in sheltered places on
cots or reclining chairs. This measure the writer has em*
ployed extensively for more than a score of years, and with
61

RATIONAL HYDROTHBB^I*Y

962

most excellent results. The patient is as lightly cov^ied ajs
consistent with comfort, and the wraps should consbt of whito
woolen blankets in cold weather, and white fabrics at all sea^
sons, so that as much light as possible may penetrate to the
skin. The writer's general instruction to his patients is to
spend as much time as possible in the open air. Simply lytog
in the cool fresh air promotes appetite and normal metabolism
and greatly adds to the beneficial effects derived from oti
therapeutic measures.

2. The Sand Bath. — The sand pile, W'ith which every on
door gymnasium should be provided, aifords an exccUetit
opportunity for the sand bath. Under the influence of the
summer sun the sand becomes intensely heated and wheo
heaped about the body is a most effective means of calorifi-
cation. The head should be protected as in the hot water
bath by a cold napkin, and should be shielded from the dlrc^l
rays of the sun. Perspiration is quickly induced. By reg-
ulating the duration of the bath any desired eliminative effect
may be obtained. The bath is followed by a cold shower oc
a plunge into the swimming pool. This bath is especially
serviceable in cases of chronic rheumatism and inactive skin»
which is so commonly associated with dyspepsia, diabetes
and in certain forms of autointoxication.

Local applications of the sand bath may be made at any
season of the year by heating the sand in an oven and heap-
ing it about the part.

3. The Indoor Air Bath. — This bath may be admink-
tercd in different ways : The patient may simply remove his
clothing, and walk about the room, or sit, or lie, as his streogth
or inclination may indicate. The best effects are obtained fay
active exercise with the clothing wholly removed, rubbing and
chafing the surface with the hands, and executing free-hand
gymnastics or resistive movements. Feeble patients may fais
assisted by an attendant. Chilling is prevented even whek
the temperature of the air is quite low, by vigorous rubbing .of
the surface and the employment of active and passive move-*

THE TECHNIQUE OF HYDROTHERAPY. 963

ments. Systematic massage may be administered advanta-
geously in many cases. The temperature of the air should
be as cool as it can be secured without artificial means during
the summer, spring, and autumn months. During the winter
months the temperature may range from 50° to 60°. A
lower temperature may be tolerated for a short time, but for
very feeble patients it is not advisable when the whole surface
of the body is exposed. A much lower temperature may be
employed, however, by affording the body the protection of a
white woolen blanket, exposing only the head and a single arm
or leg or some other circumscribed portion of the body where
friction is being applied to maintain an active cutaneous
circulation. For best effects, the indoor air bath should be
combined with the sun bath.

4. The Air Douche or Fan Bath. — This bath consists of
exposure of the whole body, or a circumscribed portion of the
surface, to the influence of a current of air set in motion by an
electric or blast fan. The writer first made use of this method
in the year 1883, when he had constructed for the purpose an
apparatus by means of which air artificially heated or cooled,
might be applied to any desired portion of the body. The
bath may be employed as a general tonic measure or as an
antipyretic procedure. Cold air only is utilized for this bath.
The hot fan-bath has a very limited range of usefulness.

When employed for general tonic effects, the patient is
exposed to a strong blast of cold air while being at the same
time vigorously rubbed by two attendants, so that strong cuta-
neous circulation is constantly maintained. By this means
powerful thermic impressions may be made upon the skin
without wetting it. Very satisfactory effects may be obtained
by the employment of ceiling fans or any of the several forms
of movable electric fans, which may now be readily obtained
(Figs. 246 and 247).

For the most intense effects, as when it is desired to
reduce the temperature of the tody, the surface may be
moistened by sprinkling or by covering it with a wet sheet.

Vutt F0i:rf •

1 •

J

HYDRIATIC PRESCRIPTION MAKING.

A CLEAR conception of the nature of disease is the first
essential in the buiMiDg of a hydriatic prescription and
in searching for therapeutic indications. To say thai
disease is disharmony, a morbid state, a perverted vitil
activity, is merely to say that when a man is sick, he is not
welL In a condition of health the body is not only in a state
of ease and comfort, but possesses the ability to maintaitr
itself in such a state. This faculty which the body possess^
of maintaining a physiological equihbrium, of resistiog the
encroachments of microbes and other enemies^ is termed vital
resistance. This most important factor is always to be taken
' into consideration in formulating a rational prescription.

The diseased body heals itself by precisely the sai
processes by which it maintains itself in health. Napoleon
recognized this fact when once he protested against the pjoly-
pharmacy of his day, exclaiming, '*Lifc is a fortress. Why
throw obstacles in the way of its defense? Its ow^n means
are superior to all the apparatus of your laboratories/'* To
say that the thoroughly well man never falls sick> is not a
paradox. The morbid manifestations or pathological states
which are commonly known as disease, either acute or
chronic, result nut only from the recognized immediate or
exciting cause, but from a kssening of the natural resistance
to disease, or the innate ability to keep well. For example,
typhoid fever, as Bouchard has shown, chooses for its victims
persons whose stomachs ha%^e lost the power to destroy the
typhoid bacillus which thus finds entrance to the intestines,
and finding there a favorable habitat, rapidly grows and
produces the series of morbid processes which constitutes the

* Emerson's Essays.
#4

r\

HYDRIATIC PRESCRIPTION MAKING.

9fi5

clinical picture ol typhoid lever. Cholera germs, likewise, ^re
anable to develop in the healthy alimentary canal, but only
obtain a permanent tooting in the body when the stomach has
been weakened by indigestion or subacute gastritis. The
tubercle bacillus is not able to establish itself in the thoroughly
healthy organism, but thrives in the body which is rendered a
favorable soil for this parasitic organism by errors in diet,
neglect of exercise, and other unhygienic habits.

The rational treatment of disease requires first of all the
removal of causes. The second step is to stimulate and regu-
late the normal physiological activities. This is the essential
particular in which rational medicine differs from empiricism
and the artificial method, the evils of which were so well
pointed out by Dr. Jacob Bigelow, of Boston, half a century
ago. When the body is in a disordered state, it is evident
that it is far better to restore the physiological equilibrium by
removal of the disturbing element or by encouraging those
physiological activities which constitute the normal defenses
of the body, than simply to antidote or neutralize one disorder
or disturbance by creating a counter-disorder, or in other
words, as suggested by the famous Baron Liebig, to under-
take to cure one disease by producing another. There are of
course conditions under which such measures may be com-
mendable, but only as a last resort for relief of pressing symp-
toms which do not yield to other measures, or in cases
recognized as incurable* and in which only palliation can be
expected.

The Natural Defenses of the Organ Ism. ^^The natural meth-
ods by which the body resists disease must be clearly under*
stood. First of all is the blood, of which Holy Writ declares,
*' The blood is the life/' The nerve supply of a part may be
destroyed, — a limb, for example, may have lost entirely both
sensation and power of motion, yet its life is maintained
through the fact that the living blood is still circulating
through its vessels* Cut off the blood supply, and even
though no other injury be done to the limb, death will

1471

^

>9

I 'I

Speedily occur. Thi

but is the ^eat healing agent of the body.

Id disease, the blood carries oxjgen directly to the part m
which the hfe-battle is being fought, whereby the cells engaged
in the conflict are stimulated and sustained while the accnmn*
lated poisons are burned, or are carried away by the seniiQ
with which the tissues are bathed. Through the control of
the general blood movement and of the local blood supply,
h}drotherapy is capable of iufluenciog almost every morM
process.

One of the njost remarkable and useful methods by whidb
the body defends itself against morbid processes is that known
as phagocytosis, in which the white corpuscles of the blood
destroy or remove from the cuxulation disease-produciitl
microbes of various sorts which may find entrance.

The destruction of germs is also carried on in the body by
other cells than the white corpuscles of the blood. The spleefl
doubtless possesses the power of attenuating parasitic ojgaii-
isms, even though they may not be entirely killed. The lympb
glands wage a fierce and often successful battle against the
encroachments of microbes of various sorts. It is this fad
which gives rise to the rapid enlargement of the lymphatic
glands in the vicinity of an infected part. The same eoJajge-
ment and increase of activity of the glands and other struc-
tures usually takes place after removal of the spleen. Various
cells lining the nasal cavity and the alimentary canal are able
to destroy microbes of many sorts^ and thus to protect the bod>*
from disease.

The destruction of poisons by the liver, by the thyroid
gland, the suprarenal capsules, and doubtless by other struc-
tures, is a most important and admirable method of automatic
defense, which is of the highest value in both health and dis-
ease; but in certain forms of disease, especially in acute infec-
tious fevers, it is indispensable to the saving of life*

As pointed out by Charrin, the alkalinity of the blood plaj'S
a most important part in the defense of the organism, both in

HYDRIATIC PRESCRIPTION MAKING. 967

ordinary health and disease. A lowering of the alkalinity of
the blood diminishes the activity of the leucocytes, lessens the
energy of the normal reflexes, diminishes the promptness and
energy of those manifold reactions upon which so many of the
life processes depend. The alkalinity is lowered in various
diseases, especially in fever, in rheumatism, gout, diabetes,
and in many cases of indigestion. This lessening of the
alkalinity is always accompanied by lowered vital resistance.
This is well shown in the frequency with which skin diseases,
gangrene, cataract, and various other affections due to lowered
resistance occur in diabetes. Milch cows are not infrequently
subject to diabetes, and when in this condition, suffer more
than usual from phlegmon.

The thyroid and perhaps other glands not only destroy
poisons, but act as general regulators of nutrition through the
internal secretions formed. These secretions produce various
physiological effects, as vaso-dilatation and stimulation of the
spinal cord.

The kidneys aid in the defense by eliminating poisons,
especially those resulting from the oxidation of proteids. The
suprarenal capsules are active in destroying certain poisons.
The liver purifies the blood by removing the alkaline wastes,
and forming urea from uric acid and other more highly toxic
substances.

The skin plays a very important part in defending the
body, not only in acting as a non-conductor and a regulator
of the bodily temperature, but by opposing the entrance of
germs, and by maintaining the various interesting reflex activi-
ties whereby the internal machinery of the organism is kept
in motion.

General Indications — The general indications for the
employment of hydriatic procedures which are encountered in
the management of different acute and chronic maladies, may
be enumerated as follows: —

Activities to be Encouraged.
I* General vital resistance.

a. Destruction of toxins,

b. Elimination of toxins*
» r. Destruction and elimination of bacteria.
> 2. Oxidation.

5. The functions of the automatic and reflex centers,

4. General and local metabolic processes, blood fonnatroti,
glandular activity, etc.

J. Cardiac activity and general blood movenieiit
local blood supply.

6. Heat production.

7. Heat elimination.
Activities and conditions to be diminished^ c^m^aied^

mitigated*

I* Nervous irritability.

2, Bacterial g^rowth,

3. Blood movement and volume.
^ 4. Exaggerated metabolism.

5. Heat production.

6. Heat elimination.

In addition to the above indications which are drawn
chiefly from a study of the etiology and pathology of disease,
we may find through a study of the clinical history, course,
complications, and termination of various chronic and acute
diseases, a great number of special indications for the em-
ployment of both palliative and curative measures. Many of
these have already been indicated in the section on ''Thera-
peutic Effects,** to which section the reader is referred to
avoid unnecessary repetition here.

To deal exhaustively with each one of these several indica
tions would require an extensive volume. We will undertake
to present in the briefest manner possible only the most
useful facts in relation to the use of hydriatic measures in
meeting these several important indications.
1472 Procedures for Increasing: Vital Resistance. — Vital resist-
ance, as Charrin has suggested, is a property of the individt

HyDRIATIC PRESCRIPTION MAKING.

9^9

cells. To increase the vital resistance, the energy and ac-
tivity of the cell must be increased. Hydrotherapy alfords a
most excellent means of accomplishing this in the application
of cold water to the cutaneous surface. It is generally con-
ceded that the increase of vital resistance is one of the
greatest advantages presented by the Brand bath (1150) in
the treatment of typhoid fever and other infectious diseases.
The Brand bath is not applicable^ however, to all cases in
which it is necessary to increase vital resistance. Fortunately,
there are numerous procedures whereby vital resistance may
be increased which differ sufficiently in form and intensity to
make possible the most complete adaptation of the therapeu-
tic means to the requirements of every case. The most use-
ful of these procedures are elsewhere named in the order of
their intensity (1625).

There are various partial or mixed procedures of greater
or less value as a means of increasing the vital resistance
through their exciting or tonic effects, of which the following
may be especially mentioned: The wet-sheet pack (1179),
the wet girdle (1347), the chest pack (1373), the rubbing
sitz (1309), atternate sponging of tlie spine (1342), the
alternate spinal compress (1340). cold water drinking
(1426), the small cold enema (1405)*

Any of these tonic procedures may be preceded by a short
hot application as a preparation for the cold procedure, bui
the hot application must be very brief and the cold applica-
tion must be prolonged sufficiently to produce the dominant
effect. It must be remembered, however, that cold is pri-
marily a depressing agent, and hence applications intended
to increase the vital resistance must be very brief, and must
be promptly followed by reaction. The lower the temper-
ature, if the duration is short, the more highly tonic the
effect of the application (632). Nearly every case of chronic
disease requires cold applications of some sort twice a day,
even if nothing more intense than the cold mitten friction
(1209)* In cases of fever, cold applications, such as the
cold mitten friction (1209), or the cold towel rubbing (1213),

970 KATIONAL HYDROTHERAFV.

should be applied every three or four hours, unless a cold
bath of some other sort, such as the wet sheet pack (11
or the Brand bath (1150), has been administered-

The principal ways in which the body resists the encr«
ments of disease are, (a) destniction of toxins, (^) eluni-
nation of toxins, (c) destruction and elimination of bacteria*

1473 a. Procedures Whick Encourage Destructiapi of Toxins. —
All procedures which encourage vital resistance, at the same
time encourage the destruction of toxins by stimulating the
toxin-destroying cells of the th)rroid gland* the liver, the ^
spleen, the lymphatics, and other tissues. The efficiency of
these organs is also increased by the increased rate of blood
movement which always follows tonic cold applications. The
hepatic douche (1096) and the splenic douche (1097) increase
the activity of the two largest glands in the body, while the
general cold douche (1010) powerfully stimulates all the bodilf^
activities by which destruction of toxins is promoted,

1474 ^, Procedures To Encourage the EHminaiion of Toxins ^-^
In observations made upon rabbits some seven or eight
years ago, the writer demonstrated that the perspiration of
the ordinary healthy man contains toxic substances in such
quantity that from 100 to 120 c.c. of the liquid collected from
the surface of a sweating man, is, when injected intravenously.
capable of killing a rabbit weighing one kilogram. It has
been shown that in epileptics the toxicity may be enormously
increased. In one case of this disease, 20 ex, of the sweat
thrown off during a paroxysm was found to be sufficient to
kill a rabbit weighing one kilogram. Bouchard has also
shown that certain poisons are thrown oS by the skin.
Hence eliminative baths (642-659), especially the electric-
light bath (1250), the sweating wet sheet pack (1179), and
the vapor bath (1246), are valuable means for encouraging
the elimination of toxins resulting from bacterial action
or perverted metabolic processes. The kidneys, liver, and
bowels are the most important outlets for toxic substances.
The liver disposes of alkaline wastes, the kidneys remove

HYDRIATtC t>RE$CRIPTION MAKING. $71

urea, also uric acid and other products of deficient oxidation,
while a variety of poisons find their way out through the
intestines.

c. Water can not be employed in such a way as to act 1475
directly as a germicide; but by increasing the alkalinity of
the blood, and especially by increasing leucocytosis and the
activity of the lymphatic glands and other organs capable of
destroying bacteria, the encroachments of these enemies of
life may be successfully opposed.

The observations of Metchnikoff and others have shown
clearly the importance of leucocytosis as a means of combat-
ing bacterial infection. By the regulation of the local blood
movement and volume, leucocytosis may be encouraged to
almost any desired degree. Winternitz, Thayer, Thermes,
and numerous others have shown the enormous influence of
the general cold bath in producing general leucocytosis (383).
By means of the heating compress (134'4') frequently renewed,
and the alternate compress (IS^O), local leucocytosis may be
encouraged to a marvelous extent, and most admirable results
in utilizing the natural defenses of the body may be secured.
This fact has been demonstrated in multitudes of cases in the
management of pneumonia, typhoid fever, and other maladies
in which the pathological process is circumscribed and due to
micro-organisms.

The most effective procedures for encouraging leucocytosis
are the heating compress or pack (IS^^), the alternate com-
press (134-0), the Scotch douche (1037), and the alternate
douche lO^^). The elimination of bacteria by the skin and
kidneys is encouraged by sweating baths (1239-1250), copious
water drinking (14-23), and especially by the vapor bath
(124()), the sweating pack (1191), and the prolonged neutral
bath (1130), each followed by the cold mitten friction (1209),
the cold towel rub (1213), or some other cold procedure.

Procedures Which Increase Oxidation. — Strasser and others 1476
have shown that the application of the cold bath increases
the absorption of oxygen and the elimination of 00,(4-02),

t is evident that general oxidation is thereby iocreased
tnroughout the body. By the employment ol hot baths in
such a way as to elevate the body temperature, the oxida-
tion of proteid substances is increased (567)^ We are thus
in possession of means by vi?hich either the oxidatton of car-
bon— in other words, the burning up of sugar or fat — or
the oxidation of nitrogen^ and the more perfect combustion
and elimination, through conversion into urea, of uric acid,
Great in, creatinin, and other proteid wastes^ may be effected
at wilL

Cold applications for the purpose of increasing oxidation
should be general in character, or at least should be suffi-
ciently extensive to lower the body temperature a few tenths
of a degree, in order to develop the reaction necessary to
increase heat f)roduction, and consequently consumption of
the carbonaceous elements. More prolonged baths, such as
the dripping sheet (1217), rubbing shallow (1174), cold
immersion (1114-), plunge (1108), and the cooHng pack
(1189), are the measures most effective for stimulating oxida-
tion of fat and carbohydrates.

The hot immersion bath (1126), the heating pack (1197),
the dry pack (1192), the vapor (1246), hot air (1233), and
Turkish baths (1239), sun bath (125*), and especially the
electric-light bath (1250), are the most efficient means of
stimulating nitrogen oxidation. By means of these measures
the body temperature may be elevated a few tenths of a
degree, or even three or four degrees, according to the dura-
tion of the bath. These general hot applications should
always be followed, as has been elsewhere pointed out (64-4'),
by a very short general cold application, to counteract the
depressing effects of the hot bath, and to restore the tone of
the skin.
1477 Procedures Which Excite the Central Qanglia.-^ f n ady-

namic fevers, in many neurasthenic states, in cardiac failure,
hypopepsia, renal insufficiency, and various visceral conges-
tions, general or localized excitation of the central ganliag

IS clearly indicated. This may be admirably accomplished
by various hydriatic procedures, especially by very cold^
very hot, or alternate hot and cold applications. The alter-
nate general douche (1044')» percussion or alternate spinal
douche (1342), alternate spinal sponging (1342), alternate
spinal compresses (1340), alternate immersion (1113), with
all the various forms of cold (I318)» alternate (1340), and
hot and cold localized compresses (1356), are most efficient
means of exciting the central ganglia.

Measures Which Encourage Qeneral and LocaJ rtetaboUc
Processes, — In most forms of chronic diseases, there is either
primarily or secondarily a grave disturbance of the general
nutrition, arising from failure of the tissues to maintain
normal metabolism. The failure may be either general, as
in some forms of autointoxication, or localp as io hypopcpsia.
In both classes of cases, hydrotherapy furnishes efficient and
potent measures which may be relied upon to awaken the
sluggish organs to normal activity, provided the integrity of
their tissues has not been too extensively damaged. This
may be accomplished by the same measures which have been
mentioned above as capable of increasing vital resistance, and
stimulating the central ganglia. Tissues to which applications
may be directly made are most quickly excited by hot appH-
cations; as, for example, when it is desired to produce cuta-
neous activity, the results may be most quickly secured by a
general hot bath of some sort. The best and most permanent
efiects are produced, however, by somewhat prolonged hot
applications followed by a brief cold application. The most
effective means of stimulating visceral activity is by applying
to the related skin area a short cold douche (1070) with
strong pressure, the alternate douche (1044), the alternate
(1340) or the heating compress (1344). These measures
also increase blood formation and glandular activity, as else-
where shown (383'388t 390-399)^

That general cold applications to the cutaneous surface
promote to a high degree the processes of blood formation,

1478

f

\

HYDRIATIC PRESCRIPTION MAKING. 967

ordinary health and disease. A lowering of the alkalinity of
the blood diminishes the activity of the leucocytes, lessens the
energy of the normal reflexes, diminishes the promptness and
energy of those manifold reactions upon which so many of the
life processes depend. The alkalinity is lowered in various
diseases, especially in fever, in rheumatism, gout, diabetes,
and in many cases of indigestion. This lessening of the
alkalinity is always accompanied by lowered vital resistance.
This is well shown in the frequency with which skin diseases,
gangrene, cataract, and various other affections due to lowered
resistance occur in diabetes. Milch cows are not infrequently
subject to diabetes, and when in this condition, suffer more
than usual from phlegmon.

The thyroid and perhaps other glands not only destroy
poisons, but act as general regulators of nutrition through the
internal secretions formed. These secretions produce various
physiological effects, as vaso-dilatation and stimulation of the
spinal cord.

The kidneys aid in the defense by eliminating poisons,
especially those resulting from the oxidation of proteids. The
suprarenal capsules are active in destroying certain poisons.
The liver purifies the blood by removing the alkaline wastes,
and forming urea from uric acid and other more highly toxic
substances.

The skin plays a very important part in defending the
body, not only in acting as a non-conductor and a regulator
of the bodily temperature, but by opposing the entrance of
germs, and by maintaining the various interesting reflex activi-
ties whereby the internal machinery of the organism is kept
in motion.

General Indications — The general indications for the
employment of hydriatic procedures which are encountered in
the management of different acute and chronic maladies, may
be enumerated as follows: —

1

^66 RATIONAL HYDROTHERAPY.

Speedily occur. The blood is not only the source of life,
but is the great healing agent of the body.

In disease, the blood carries oxygen directly to the part in
which the Hfe-battle is being fought, whereby the cells engaged
in the conflict are stimulated and sustained while the accumu-
lated poisons are burned, or arc carried away by the serum
with which the tissues are bathed. Through the control ol
the general blood movement and of the local blood supply.
hydrotherapy is capable of inBuencing almost every morbid^
process. (

One of the most remarkable and useful methods by which
the body defends itself against morbid processes is that known
as phagocytosis, in which the white corpuscles of the blood
destroy or remove from the circulation disease-producing
microbes of various sorts which may find entrance, M

The destruction of germs is also carried on in the body by ^
other cells than the white corpuscles of the blood. The spleen
doubtless possesses the power of attenuating parasitic or|^*
ismsj even though they may not be entirely killed. The lymptt^
glands wage a fierce and often successful battle against the
encroachments of microbes of various sorts* It is this fact
which gives rise to the rapid enlargement of the lymphatic
glands in the vicinity of an infected part. The same enlarge-
ment and increase of activity of the glands and other struc-
tures usually takes place after removal of the spleen. Various
cells lining the nasal cavity and the alimentary canal are able
to destroy microbes of many sorts ^ and thus to protect the body
from disease.

The destruction of poisons by the liver, by the thyroid
^ ijj glandf the suprarenal capsules, and doubtless by other stnic-

}' V Wi tures, is a most important and admirable method of automatic

[tIi; Ijjj defense, which is of the highest value in both health and dis-

ease; but in certain forms of disease, especially in acute infec-
tious fevers, it is indispensable to the saving of life.

As pointed out by Charrin, the alkalinity of the blood plays
a most important part in the defense of the organism, both in

-n

.'i

.i^i

HYDRIATIC PRESCRIPTION MAKING. 967

ordinary health and disease. A lowering of the alkalinity of
the blood diminishes the activity of the leucocytes, lessens the
energy of the normal reflexes, diminishes the promptness and
energy of those manifold reactions upon which so many of the
life processes depend. The alkalinity is lowered in various
diseases, especially in fever, in rheumatism, gout, diabetes,
and in many cases of indigestion. This lessening of the
alkalinity is always accompanied by lowered vital resistance.
This is well shown in the frequency with which skin diseases,
gangrene, cataract, and various other affections due to lowered
resistance occur in diabetes. Milch cows are not infrequently
subject to diabetes, and when in this condition, suffer more
than usual from phlegmon.

The thyroid and perhaps other glands not only destroy
poisons, but act as general regulators of nutrition through the
internal secretions formed. These secretions produce various
physiological effects, as vaso-dilatation and stimulation of the
spinal cord.

The kidneys aid in the defense by eliminating poisons,
especially those resulting from the oxidation of proteids. The
suprarenal capsules are active in destroying certain poisons.
The liver purifies the blood by removing the alkaline wastes,
and forming urea from uric acid and other more highly toxic
substances.

The skin plays a very important part in defending the
body, not only in acting as a non-conductor and a regulator
of the bodily temperature, but by opposing the entrance of
germs, and by maintaining the various interesting reflex activi-
ties whereby the internal machinery of the organism is kept
in motion.

General Indications. — The general indications for the
employment of hydriatic procedures which are encountered in
the management of different acute and chronic maladies, may
be enumerated as follows: —

§78 ISATIOKAL HYDkaTHEiUry-

necessary to discourage heat elimination, except in cases ot
syncope, in which the dr>* pack (1192), the hot-blanket
pack (1197)» the hot enema {1406), and hot water drioking
( 14-29) are efficieBt means of preventing excessive heat
loss, and an aid to nature in accomplishing the end which it
is sought to gain, by contraction of the peripfaerat ve^els.
When hot applications are made, great care must be taken
to avoid exposing the patient during the changing of the
application or after it has been removed. It is wise to alter-
nate the hot application by a short cold application, with fric-
tion, vigorous cold wet-hand nibbing (1213), and cold mitten

U87 friction (1209), See 752.

Oenerml fletabolic Activity is Dtminjshed, first of all, by
maintaining absolute rest in bed. The neutral bath (1130)
is an efficient measure for the same purpose. In cases of
hypopepsia, intestinalp uterine, and vesical catarrh, overex*
citation of the secreting glands may be lessened by with-
drawing the blood from the part by various derivati\^e mea^
ures (667-682, 1286-1291).

14B8 Mydriatic Incompatibilities,— Wise discretion must be
used in the comliiiiatiun of procedures, lest one men sure
"*" shall undo the therapeutic work accomplished by another.
The combination of hydriatic processes in such a manner as
to enable one procedure to intensify or to prolong the effect
of another is pirhaps the best test of a physician's experience
and skill. The following meager suggestions barely touch
the surface of the subject.

1. Tonic procedures must be carefully avoided when a
sedative effect is desired, such as cold and neutral baths or
other measures. The tonic application may be accidentah
The contact with pure cold air after a neutral bath, or of the
feet with a cold floor, may destroy the sedative effect of the
bath altogether.

2. Sedative measures must be as carefully suppressed when
tonic procedures are employed for their specific effects.
When a hot bath precedes a cold bath, if too prolonged, or

TYPHOID FEVER.

979

if the cold application is too short, or if the patient is exposed
to an overheated atmosphere after the bath, the tonic effect
will be lost.

3. In the use of antipyretic measures, the procedures must
be so managed that heat production will not be increased
so much as to more than counterbalance the increase in
heat elimination; hence, short cold or cool applications may
be injurious. Coot sponging often raises the temperature by
increasing heat production.

THE ADAPTATION OF HYDRIATIC PRESCRIPTIONS TO
INDIVIDUAL DISEASES.
In the study of individual diseases with reference to the
making of a hydriatic prescription, we must first of all con-
sider in each case what are all the therapeutic indications
present or likely to be present m the case in hand. The in-
formation sought will be found by carefully studying, first,
the etiology of the disease; second, its pathology; and third,
its clinical history, including the clinical course, complications
and possible terminations and sequelae.

TYPHOID FEVER,

The hydriatic treatment of typhoid fever may be taken as a
type and model for the Ijeatment of all acute mfecticus fcvcra, al-
though each presents special iodicatioos to which attention will be
called.

Etiological iadlcstioos*

1. Prevent Furtlier Introductlaii of the Bacillus — Boil the
drinking water, or administer only distilled or other water known
to be free from micro-organisms.

2. Suppress the Growth In the Intestine of the Specific
Bacillus and Putrefactive Organisms. — Withhold all solid food|
and food rich in nitrogen. Especially avoid meat extracts, broths.
Give fruit juices and fruit purees, and dcxtriniied or predigested
cereals, as zwieback, granola, grflnut, syrupy malt extracts.
Pmthologica! tndlastlans^

5. Combat the Local Morbid Prcicess in the Intestine —
(«) Pay thorough attention to indications especially as regards

1480

I

g80 RATIONAI- HYDROTHERAPY.

a. dietsiry which will not furnish a favorable nutrient media for the
growth of the bacillus. Administer a coloclyster (1404) at ^S^fl
to So*^ twice daily t placing the patient in the right Sinitn's position
so as to insure a complete evacuation of the entire colon,

(^) Avoid irritating foods and dnigs^ especially purgatioo,
mercurialsj and salines,

(V) Increase the local resistance by the cold abdonaiaal com-
press (1 3 IK) changed every ten to twenty minutes, rubbing the sur-
face until red whenever the compress is changed. The compress
should be employed through the entire course of the disease. It
should never be allowed to remain sufficiently long to produce heat
accumulation,

(J) Relieve local congestion and pain by applying fomcn
tions (1328) to the abdominal snrface, or the hot trunk pack (119
for ten minutes every three hours, and by taking care to maintaiji
the acttvit>' of the cutaneous circulation by frequent rubbings and
proper covering in connection with the cold compress. See thit
the hands and feet are kept warm, if necessary by hot hand (1302)*
or foot bathii (1207), or by warm wrappings and hot-water bottles.

4. Increase and Sustain General Vital Resistance. Cm-
ploy the cooling pack (1189), the graduated bath (I I20K the v^^> ■
longed neutral bath (1130), the Brand bath (1150), the cold enema,
(1405), and other rational antipyretic measures. See 71 1 to 745.
The cold mitten friction (1209), cold towel rub (1213), or cold wet-
sheet rubbing (12 IG) in bed should be employed systematically
three or four times daily for general tonic effect.

Water drinking (1423), to the amount of 4 to 8 pints daily, half a
glass an hour, counting liquid food. Water may be administered
by enema (1404) when not readily swallowed.

5. Energize the Heart and Blood- Vessels and Facilitate
General Blood Movement — The cold bath, especially when
accompanied by friction, increases the energy of the heart and the
activity of the peripheral vessels. The cold mitten friction
(1209), the cold towel rub (1123), and the Brand bath (1150),
are most effective. Cold friction should be applied whenever the
surface is blanched and cold or cyanotic. When the spasm of the
blood-vessels is pronounced or the circulation feeble, precede the
cold application with a short hot application, hot affusion (1103),
large hot fomentations (1328), or hot sponging (1204). Apply

TYPHOID FEVER. 98 1

the cold precordial compress (1383) and the ice-bag (1314)
over the heart for fifteen minutes at intervals of two to four
hours.

6. Prevent Wasting: of the Muscles and the Tissues.—

Complete mental and physical rest. See also 4.

Clinical Indications.

The clinical symptoms of this disease are wonderfully miti-
gated by the application of those measures which are required to
meet the etiological indications as presented before. There are
various palliative measures, however, which may be employed for
the relief of special symptoms, and as means of preventing various
complications and sequelae, and which may be employed with
great advantage. Special indications also arise from variations in
the type of the disease, in mixed infections, etc. The indica-
tions presented by the leading symptoms of the disease are as
follows : —

7. Headache.— Cold compress (40^^ to 60"^) to the head (1371)
and face. Wet the hair thoroughly, and renew the compress before
warmed. If the pain is very severe, apply the ice-bag or ice com-
press to the head (1315), and ice-collar (1316) or ice compress
to the neck (1314); the hot and cold cephalic compress (1358)
for ten minutes, the cold compress during the interval. Sponge
forehead and neck with very hot water. Shampoo scalp with
fingers dipped in cold water.

8. Pain in the Neck. — Fomentations (1328) applied for
3 minutes followed by the heating compress (1344), changed
every 15 minutes. Repeat the fomentation hourly.

9. Nose-Bleed. — Ice to the back of the neck (1314); very
hot compress to the face (1286); ice to the hands (1302); hot
foot bath (1297); very hot nasal douche (1397). Compres-
sion of soft parts of nose against bone.

10. Cough. — Fomentation to the chest (1328) for 5 min-
utes. Heating compress (1344), changed every 2, hours or
hourly, when temperature is above 102°. Continue so long as
bronchial catarrh exists.

11. Foul Tongue and Sordes. — Cleanse the mouth with dilute
peroxide of hydrogen or hydrozone, i to 6, four times daily. Mois-

I

« 98 2 RATIONAL HYDROTHERAPY-

ten the raouth frequently with cinnamon water. Keep the tot^gae
moist by a mass of cotton placed between the teeth mobtened
I [ frequently with cinnamon water, made by adding ten drops of

ciuuamon essence to half a glass of boiled water,

12, Constipation. — Copious coloclystcr (1407) at 95*^, twice
daily, followed by enema, one pint at 70°; oil enema. ■

13, Diarrhea — - Copious coloclyster (141*7) at qs"" aftcf
^ every evacuation of the bowels; hot enema (105'') (140tt>. tT*^o or

three pints followed by cold (70*') one pint. Cold abdomiQAi
compress (1318) at 6o% changing everj' half-hour; hot leg pack
-• (1393), if extremities are cold. An exclusive diet of fruit jyrcet

:t for a day or two* ■

14, Tympanites. — Very hot fomentation (1328) for 5 min-
utes, followed by cold compress (1 318), changing every 15 mm-

^ utes. Coloclyster (1407) at 75"* to empty colon. Yellow soap

V may be added to the water, if necessary. This symptom is

4 rarely troublesome under hydriatic treatment.

■! IS* Fever,— Cooling pack (1189); graduated bath (1120);

^ prolonged tepid bath (1123) SS""; Brand Bath (1150): cold

?j towel rub (1213); cold mitten friction (1209); large cold cons-

press (1318); cooling enema (1405); cooling bath when lemperB-
ture rises about 101.5°. See 703-766.

a. High Temperature with Hot Dry Skin. — Cooling pack
(1189); graduated bath (1120); Brand bath (1150); prolonged
tepid bath (1123). See 744.

fi. High Temperature with Cold Skin. — Hot-blanket pack
(1197), 5 to 10 minutes, followed by cooling pack (1189); hot
full bath (1126) 3 minutes, followed by graduated bath (1120);
fomentation to spine (1328) or hot enema (1406), followed by
cold mitten friction (1209). See 745.

16. insomnia. — Prolonged neutral bath (1130) at 92°-95°,
neutral wet sheet pack (1182); cold compress to head (1371);
hot foot (1297) or leg pack (1393) when legs are cold.

17. Delirium — Ice-cap (1323); ice-collar (1316); alternate
sponging (1206) or compress to upper spine (1340); prolonged
tepid bath (1123), SS"", i to 4 hours; cooling pack (1189), three
to five changes, last application prolonged to heating stage; hot
foot (1297) and hand bath (1302), if extremities are cold; cool-
ing enema (1405) every 3 hours.

1 8. Coma-^^Cold
(1209); prolonged neutral bath (HIJO); wet-sheet pack (1119);
alternate spinal compress (134-0); cooling enema (1405) every
3 to 4 hours; alternate spinal compress (1342).

Compikatitws are due (o special hcaitzed manif^stttthm of the
discasf^ €hkfiy either to seetmdary infection of t/tr ^aetlitts itself ttr tc
intense heal action of the toxins,

19, Qastric lrfitatiaii.-^T,arge fomentations over the stomach
or around the body (ISIJ8), for 20 minutes. Repeat every 3
hours. Cold compress (1318) mt 60*^, renewing every 15 minutes,
during the interval: hot and cold gastric compress (13112); ice-
bag to epigastrium (IIIIO); ice piHs» feed by nutritive enemas,

20. Ifitestitial Ulcerations.^- Fomentation over the abdomen
(1338) at 60"^, 5 minutes every 1 hours, followed by coIlI com-
press (1318), changing as soon as warmed; hot fout bal!i (1397)
or leg pack (1393).

31. latestina! Hemarrhage, — Withhold food til! hemorrhage
ceases* Extreme quiet for 2 lo 3 days, ice-bag over abdo-
men (1314), hot foot bath (1297) or hot leg pack (1393).
Rectal irrigation with ice-water (^1410). After 2 days, a cleans-
ing enema to remove decomposing clots (1404)t 75*'*

22. tnflammation of Bile Ducts, — Large fomentation (1328)
over the right side for 15 m invites every 3 hours followed by
cold compress (1318) at 60°, changing every 15 tninnles during
the interval. Water drinking (1423); an exclusive diet of fruit
juices aiul fruit purees for 3 or 4 days; cooling enema (1405)
repeated every % hours,

23. Appendicitis*— Fomentation (1328) for 20 minutes over
right iliac region every 2 hours. Cold compress (1318) at 60^,
reneweii e%'€ry 10 minutes during the intervals. Hot foot bath
(1297) or leg pack (1393) with the fomentation.

24. Laryngitis,— Fomentation (1328) to the throat for 10
minutes every 2 hours. Cold compress (1318) renewed every 15
minutes during the interval. Steam inhalation (1419).

55. Bronchitis^ Broncho- Pneumonia, l^bar F*neumonia.^
Fomentation to the chest (^1328) for 10 minutes every 2 or 3
hours, followed by cool chest compress (1321) renewing, every
151030 minutes during the intervals, Sec 1570^ 1571, 1498,
taking into coutiitle ration the patient's conditjoa,

984 RATIONAL HYDROTHERAPY.

a6. Pulmonary Congestion.-- Alternate compresses (13101

to the chest for 15 niititites, renewed every 3 hours; heati^
chest pack (1374) during the interval, at 60"^ changing once an
hour. Rub the chest we31 at each change. Hot foot bath (1297)
OF kg pack (1393).

27. Cardiac Failure Cold mitten frictioD (1209) when-
ever the skin is cold or cyanotic. Avoid the Brand bath and cji-
treme general cold baths. Lower temperature by cold mitten
friction (1209), graduated bath (1120), prolonged tepid ba^
(1123); ice-bag over heart (620, 1314) for 15 minutes at intei-
vals of 2 hours. (Avoid in endocarditis,) Hot fomeotatioaa
(1328) over the heart for j4 minute followed by cold compress for
10 minutes when cold alone is tiot sufficiently stimulating.

2- sS. Endocarditis — Pericarditis.^Hot fomentation (13281

for 30 seconds followed by ice-bag (620. 1314) to be taken of

;; and parts nibbed till red every 15 mi antes. Repeat the f omenta*

4 tion hourly, if necessary to relieve pain,

*| 29. Myo<^rditis, — ^Fomentation (1328) 30 seconds, foUoiitd

'^ by compress (1314) at 6o°j 15 minutes. Repeat hourly or every

2 hours. General cold friction (1209)* Avoid the cold immer-
sion bath and general cold applications.

30. Arteritis and Phlebitis — Fomentation (1328) for 15
minutes every 2 hours. After each fomentation apply a heating
compress (1344) or a dry cotton poultice (1388) to remain
until the next fomentation. Complete rest of the affected
parts.

31. Mania. — Neutral wet-sheet pack (1182); prolonged neu-
tral bath (1130), 92° to 95°; cold to the head and neck.

32. rieningitis. — Hot-blanket pack (1197); ice-cap (1323);
ice-collar (1315); ice-bag to spine (1372); hot immersion bath
(1126), 103°, 2 to 5 minutes, followed by wet-sheet pack (1179)
with ice-bag (1323) to head and ice compress (1314) to neck
during bath. The wet-sheet pack should be prolonged in the heat-
ing stage (1183). Prolonged neutral bath (1130). Copiousenema
or coloclyster once or twice a day (1407).

33. Apoplexy. — Cold compress (1314) to the head and
neck; hot leg pack (1393) for 30 minutes every 2 hours; dry
pack to legs (1192) during intervals; brief application of cold
friction (1209); catheterization of bladder (1411).

TYPHOID FEVBK,

985

34. Hysteria* — Hot-blanket pack (1197) followed by neutral
wet-sheet pack (1183); ice to head (I3U) and spioe (1372)]
cooling enema (1405).

35. Neuritis. — For general neuritis, prolonged neutral bath
(1130) I to 3 honrs, twice daily. Water drmking (1424),
copious cooling enema (1405), hut-blanket pack (1197), 15
minutes, followed by heating pack (1188)* For local neuritis,
fomentation every 2 hours, with heating compress during

^interval, or revulsive compress for 5 to 10 minutes every
hour or two.

^6, illittiple Sclerosis. — ^Fomentation to the spine (1328)
every 3 hours; followed by heating spinal compress (1344)
renewing every 30 minutes during the intervals; prolonged neutral
bath (1130); cold friction (1209); warm enemas (1406); cooling
enema (1405) at 75^ three times daily.

37. Contractures. — Fomentations to spine (1328) and affected
parts followed by heating compress (1344)»

38. Periostitis. ^^ Fomentation (1328) to the affected part
for 30 minutes repeated every 3 hours; continuous heating com-
press (1344) during intervaL

39. Arthritic — Fomentation (1328) for 15 minutes tv^ry 3
hours; heating compress (1844) during interval, changing hourly
or more often when the local teiiij>eraiure is high.

40. Abscess of the Muscles. — Fomentation (1328) for 10
minutes every 2 hours followed by continuous heating compress
(1344) at 60^ during the Interval. Prevent general septicemia by
prolonged neutral baths, copious water dnnking, laVge enemas
twice daily, and early opening and antiseptic treatment.

41. Suppurating Kid tiey<>^ Fomentation for to minutes over
the kidney, repeating every 3 hours; continuous healing com-
press (1344) during interval; revulsive compress every 3 hours
(1341); irrigation of bladder (1411).

42. Orchitis..— Fomentation (1338) for 20 minutes every 2
hours followed by the cooling compress (1318) extending over
the hypogastrium and inside the thighs; hot pelvic pack (1390)
foi 15 minutes every 3 hours; hot foot bath (1297); ice-

ft^ag (1372); take care to maintain vigorous surface circu-
lation.

43. Ovaritis. — Hot and cold i>elvic compress (1364); ice-bag

1

3

986 RATIONAL HyDKOTHERAPY,

over ovary, removing for 5 minutes every half -hour, with hot
pack (1393)i keep the extremities warm,

44. Pelvic Hematocele,-^ Hot pack to the hips (13S9)
legs (1393 and 1197)t 10 to 20 minutes; repeat every 2 to

hours; ice-bag over tumor during intervals. After first 24 ho
revulsive compress flSll) three times daily j hot rectal (1410) d
vaginal irrigation (1413) twice daily; fomentation (1338); h^
enema (140*5). 1

45. Acute Nephritis, Albumin In Urine. — Hot-blanket pad
(1197) continued, if possible, to vigorous perspiration; repeaj
(1314) every hour. Ice-bag over heart during pack. Hot full
bath (1126) 103^ to 105^ for 6 minutes, followed by neutral batj
(II 30) 92* to 94** for I to 2 hours; fomentation to back (1 328) foi
20 minutes every 2 hours ; heating compress (1344) applied at 60*
during intervals; enema (1404) at 92° three times daily; small ic9
bag (1314) over lower third of sternum, remove for 5 minutd
every half-hour; copious water drinking (1423)^ '

46. Scanty Urine, — Enema (1405) at So° every 4 houn^
copious water drinking (1423) from i to 2 pints every 4 houmj
employing carbonated distilled water if possible; may add frail
juices, but avoid cane sugar, which causes tympanitis; small cold
compress (1318) or ice-bag (1314) over sternum; fomentation
(1328) over the loins for 15 minutes every 3 hours, well-pro-
tected heating compress during intervals.

During Convalescence.

47. Subnormal Temperature. — Fomentation to the spine
(1328) accompanied by cold mitten friction (1209); dry pack
(1192). Hot enema (1406); hot water drinking (1429); warm
flannels and hot water bottles.

48. Cardiac Weakness. — Cold (60°) precordial compress
(1383), 15 minutes, 3 times daily; cold mitten friction (1209) 01
cold towel rub (1213) twice daily.

49. Palpitation of Heart — Cold precordial compress (1383)
or ice-bag (1314) over heart; may be relieved by the use of the
stomach-tube (1401), if due to retained, undigested food stuffs;
enema (1404) if bowels distended.

50. Lack of Appetite, Hypopepsia. — Fomentation (1328]
over the stomach for 5 minutes followed by ice-bag (1314) half an

hour before eating; wet girdle (1317) worn at night; cold mitten
friction (1209) or cold towel nib (1213) twice daily,

51. Anemia. — Graduated tonic treatment (Hi25), twice
daily* Out-of-door life; nitrogenous diet,

52, Qeneral Weakness, — Alternate spinal sponging (1342)
or compresses (1340) twice daily, followed by cold niitlcn friction
(1209) or cold towel rub (1213) twice a day; massage (1224,
1461); manual Swedish movements.

Complicstioifs,

5 J, BoiISp Phlegmons, and Bed-Sores.*^ Scrupulous cleanli*

ness of the skin; hot soap bath twice daily; dependent parts, the
axilla, groins, nares should be smeared with laundry soap, which
should be allowed to remain for 10 minutes; apply alternate com-
press (1340) to parts subjected to pressure for 15 minutes twice
daily; the parts should be careful iy massif ed (122 1 ♦ 14<il). tak-
ing care to avoid abrading the surface; piuiples should be dressed
antiseptic ally. Hot fomentation (1338); neutral compress
(1339); ice-bag or ice compress (1314)^

54. Ataxo-Adynamlc State — Hot full-bath (1136) i^^r 5
minutes followed by cold affusion (1103) for 3 minutes at 75^ to
73^; the affusion should be followed by vigorous rtdjbing. Hot
full-bath (1126) 104° to 105'' followed by cold alTusion (1 103), 75*"
to shoulders, head, and spine, the patient being held in sitting
position during the affusion. The affusion should begin with two
pails, increasing in number to 6, adding one at each application
if effects are satisfactory. Ice-bag (1314) over heart to minutes
every 2 hours. Prolonged neutral bath (1130), 92^10 95^, rub-
bing gently if inclined to chill; gradually lower temperature to
88*^; continue for several hours. A general cold friction (1309);
ice-bag to the spine; fomentations to the spine ( 132H), or hot-
blanket pack (11U7) followed by cold friction (1209).

55. Typhoid In Infants,— (Graduated bath (1120); prolonged
neutral bath (113(h; cooling pack (1189); continuous abdominal
compress (1351); cooling enema (1405)* Avoid Brand bath,

56. Typhoid in Aged Persons-— Graduated bath (1130);
prolonged neutral bath (IISIO); cooUng pack (llHfJ); cooling
enema (1405); cold friction (1209) over heart and chest every
3 hours, heating compress (1344) between. Special attention

gSS RATIONAL H\T)ROTHERAPY.

should be given to the administration of water by the moutli mS
by enema (1404)- Avoid Brand bath,

57. Typhoid with Puerperal Fevcr^^The prolonged nentral
compress (1339); graduated bath (1 120), avoiding tem£>erarure5
lower than 8o^ Cooling pack (1189); hot-blanket pack (H97),
followed by cold towel nib (1213) or cold mitten friction (1309);
hot pelvic pack (1390); hot enemas (1406); hot uterine irrigi-
tion (1415); hot vaginal irrigation (1413); cold precordial com-
press (1383) or ice-bag (1314) over heart; fomenUtion (132^1
over abdomen 5 to 10 minutes every a to 3 hours; heating coa-
press (1344) applied at 60^, renewing every 20 oiinutes during the
intervals.

58. Typhoid with Pregnancy — Prolonged neutral or tepid
bath (1130); cool enemas (1405); cold towel rubs (121S)j
cold friction (1209), Wet-sheet pack (1179); abdominal

press (1318). Avoid Brand bath. fl

59. Typhoid with Erysipelas,— The same measures 1$ W

ordinary typhoid, adding ice-cold compress (1314) to inflaiaef)
surfaces^ changing every 15 minutes; fomentation (1328) for 5
minutes every t hours; after 34 hours, cooling compress (1318) to
the inflamed parts, changing every 20 minutes- As inflainmarion
diminishes prolong the intervals (1344).

60. Typhoid with Diabetes. — Prolonged tepid bath (1123);
cooling enema (1405); fomentation to spine and abdomen (1328)
followed by neutral pack (1182); cold mitten friction (1209);
cold towel rub(1213).

61. Typhoid with Obesity — Cooling pack (1189); cold mit-
ten friction (1209); cold towel rub (1213); revulsive compress
(1341) to the chest twice daily; cooling enema (14:05); lightly
covered chest compress (1377) changed every 2 hours.

62. Typhoid with influenza. — Hot foot bath (1297) fol-
lowed by heating pack (1183) continued to sweating (1187) if
possible; hot leg packs (1393); prolonged neutral baths (1130,
1182). Short hot immersion bath (1126), with cold to the
head, followed by prolonged neutral bath (1130). Cold com-
press to head. See also indication 28.

63. Typhoid with Tuberculosis. — Neutral bath; cold towel
rub (1213); chest compress (1344) changed every 2 hours.
Avoid Brand Bath.

TVPUOID FEVER.

989

64. Typho-Matarlal Fever Short hot immersion bath

(1126) or hot-blanket pack (11J>7) foilowed by short cold pail
dotjche (1103)i spray (1055)* shower (I047)j or percussion douche
(1035) followed by dry pack (1192) just before chill begins.
During the chill the douche may be administered best as pail pour
(1103), patient sitting in tub; when temperature is high, cooling
pack (1189), cooling enema (1405)i cold abdominal compress
(1318). Treatment the same as for ordinary typhoid.

65. Contraindications.— The following measures are to be
avoided: prolonged hot applications, short cold applications, vig-
orous friction] and in cases complicated with myocarditis, hem-
orrhage, and perforation, avoid the Brand bath, affusion, and all
disturbing procedures. The same measures are to be avoided
also in cases complicated with nephritis, pelvic hematocele, menin-
gitis, appendicitis, pneumonia, bronchial pneumonia, mutUple
neuritis, spinal meningitis, arthritis, and ovaritisi diabetes, obesity,
or tuberculosis, in infants and aged persons.

General Method*— Antipyretic measures should begin at the
earliest possible moment without waiting to make the diagnosis
absolutely certain* Vigorous measures at the outset will shorten
the duraUon of the disease, greatly diminish ils intensity, lessen
the danger of a fatal issue, and abbreviate the period of con-
valescence. If the patient is first seen after the temperature has
reached a high point (loj'^ or 104*^), most vigorous hydriatic
measures should be employed at uncc to bring the fever under
control if possible. As the disease advances^ milder measures,
such as the neutral bath (1130), the graduated bath (IISO), the
rubbing wet sheet in bed (1216), and repeated wet towel rubbing
(1313) are the measures indicated. During the first few days of
the fever (3 to 7 days) the diet may consist exclusively or nearly
so^ of natural fruit juices, — ^ unsweetened grape-juice is best; later,
gruels prepared from heat-dextrinized cereals (ItiSO) or malted
preparations (1631) should be employed in addition.

By a careful study of the above paragraphs it will be noted
how many different indications are met by a single simple
hydriatic procedure, as for example, the abdominal cooling com-
press.

I

990 RATIONAL HYDROTHERAPY

I

MALARIAL FEVER — REMITTENT- INTERMnTENT.

1490 miQlQglcmi indlcmttonB.

1. To Suppress Infection. — ^Boil drinking water* and if 1

sary and possible remove to a salubrious locality, A%'oid

quilo bites.

PathoIo0CMi indfCMtions,

2. Increase General Resistance. — Tonic hycjriatic applia*

tions, especially the wet-sheet pack (1179); cold mitten frictioA
{ItjaO}: cold towel rubbing (1213); wet-sheet rub (1316); half*
baiJi (1174); cold douche (1010); cool coloclystcr daily (140J);
copious water drinking (1423). The vigor of the applicatiocit
must be suited to the patient's condition (1625). Repeat two 10
three times daily during remission or between the paroxysms.

3. Increase General Leucocytosis as a Means of Destroys
Ing the Parasites. — The hot bath followed hy vigorous coki
applications, — hot-blanket pack (1197) followed by cold tnwd
rub (1209); vapor bath (1246) or electric-light bath (1250)
followed by cold douche (1010) or wet-sheet rub (1216); tot*
blanket pack (1197) followed by cold douche (lOlO) or shallow
bath (1174); sweating bath (832, 1191) followed by wel-sfeect
rubbing (1216)^

4. Combat Hepatic and Splenic Enlargement* — Fomeau^
tions (1328) or the revulsive compress (1341) over the liver and
spleen three times daily, followed by the heating compress (1344)
be worn during the intervals.

5. Interrupt Malarial Paroxysm or Periodicity.-^ The hot
bath (1126) followed by a short very cold douche or affusion
(1103), with vigorous rubbing followed by dry pack- (1192X
Apply an hour before the chill and repeat in half an hour. Ap-
proach of chill is indicated by rise of temperature.

6/ Combat Anemia^ Changes In the Blood and Or^nk
Changes and Degenerations of the Liver, Spleen^ and Otbef
Viscera. — Copious water drinking (1424) to eliminate the poi^
sons; cold ap[)licatintis as indicated for increasing vital resistance*
hot baths followed by cold douches or affusions (1103); sweating
pack (1191) followed by wet-sheet rub (1216); enema, jo*^

r

(1404) or coloclystcr (1403) twice a day; careful feeding; easily
digestible foods, especially well-dextrinized cereals and fruits*

Clinical IndicmtiOBs.

7. The indications for the treatment of continued malarial
fever are almost identical with those for the treatment qf typhoid*
The typhoid state is not infrequently present. The ahdomina!
compress (1351) is as nseful in combating lesions of ihe liver
and spleen in the remittent or continued forms of malarial infec-
tion as in typhoid.

In the intermittent form special atteDlion is given to suppres-
sion of the chill and less to the employment of antifebrile
measures.

8. Fevcr^Thc temj>erature rises higher than in typhoid.
The cooling pack (1189) is especialJy indicated. The cooHng
enema (1405), graduated bath (I120)i rubbing wet sheet in bed
(I31<i)i cold towel rubbing (131 il). and cool spongtng (1304) are
in<]icated. Water drinking (1424). In intermittent fever care
must be taken to avoid precipitating a chill by cold applications,
which should not be made undl all tendency to rigor has disap-
peared.

g. Chill. — ^The prevention of the paroxysm, or interruption
of the periodicity uf the disease Is of the highest importance in
intermittent malarial fever* The best measures arc the sweating
pack (1191)j or the very hot immersion (1136) or shower
bath (1054), 3 to 5 minutes, followed by a very cold douche or
affnsiun (1103), and this followed by vigorous rubbing (9*i0), and
the dry sweating pack (1IU2). When the chill occurs, give the
patient hot water lo drink* wrap in warm blankets, place bags
filled with hot water, or heated bricks, to tlje sides and Ioids. Avoid
hydriatic applications of all sorts. Moistening of the sklu causes
chill by evaporation.

10. Sweatins* — Wipe with a soft cloth, taking care lo avoid
too much exposure of the body. If ihe sweating is greatly pro*
longed, sponge the surface with very hot (1204) water. Make
no cold apjili cations while the patient is sweating.

11, During: Interval — If intcrraittcnt» on well day admin-
ister a sweating bath followed by cold wet-sheet rub (1210) and
other vigorous touic measures. A fomeatatlon (1338) should

EATIOHAL HYDROTHERAPY*

i>e applied over stomach and liver, morning and night, Tlie wi
girdle (1347)i without impervious covering, should be worn cait
stantl^ and changed just before becoming dry, or tliree or fon^
times daily, \

T2. Mixed Infections: Typho-MafaHal Fever, rial a rial Dys-
entery, and So-^called flalarial Pneumonia. — Should be treated^
especially with reference to the primary or most prominent disorder, j
See Dysentery (1530), Pneumonia (H98), Typhoid (148S).

13. Hematuria. — Continuous rest in bed; hot-blanket pack
(1197) for 30 to 40 minutes, followed by cold mitten frictioii^
(1309)f twice or more times daily, administered so as to avoids
chilling. The skin must be well reddened and very active cutane-j
ous circulation maintained. Ice-bag (1S14) over sternum during 1
interval; withdraw ice-bag for 5 minutes every half-hour to alloTf^
reaction to occur. Fomentation (1328) to back for 15 tDiouteft^
every s hours followed by well-protected heating compress (1344) i
Between fomentations (1328), maintain vigorous surface circala*^^
tion by hot- water bags, etc* j

14. Syncope. — Hot-blanket pack (1197) for 15 minutes, iol*:
lowed by very cold and vigorous friction (1209), and wrapping
in warm, dry blankets. Hot fomentation over heart 1 mlntib^
followed by cold friction to the chest 2 or 3 minutes, repeated
every hour or more if necessary. Hot water drinking (1429); hot
enema (1406)- Induce sweating if possible by fomentation to
spine and over liver (1328). After a few minutes follow by
general cold friction (1209).

15. Convulsions. — Heat to back (1335) with ice to head
(1314), or hot immersion bath (1126) with ice cap (1323);
copious water drinking (1424) and hot enema (1406). After the
bath, wrap the patient in dry blankets.

16. Malarial Enlars^ement of Liver and Spleen. — Alternate
compress (1340) or alternate douche (1044), over liver and
spleen; wet girdle (1347) to be changed every 4 hours.

17. Malarial Cachexia. — Electric-light bath (1250), vapor
bath (1246), hot-blanket pack (1197), or sweating wet-sheet
pack (1187), followed by tonic cold applications suited to the
patient's condition, once daily, as cold mitten friction (1209)
or towel rubbing (1213), wet-sheet rub (1216), half bath
(1174) or douche (1010) once or twice daily; fomentation

MALARIAL FEVER.

993

(1328) over the liver twice a day with heating compress (1344)
during the interval; water firinking (1424); an aseptic dietary.

i8. Complications.— These are for the most part similar to
those of typhoid fever and require the same treatment

General Method, — In cases of intermittent malarial fever the
iirst object to be gained is the interruption of the paroxysm. If
the patient^s system is greatly deteriorated and his blood corpuscles
greatly diminished in number, either by the long continuance of
the malarial disease^ or some pre-existing malady p the ^'ital resist-
ance may be in nearly all cases sufficiently developed by means
of simple hydriatic procedures, carefully administered as above
described, to interrupt the paroxysm without the administration
of a medicinal agent of any sort. If^ however, after one or two
thoroughgoing attempts to interrupt the paroxysm by hydriatic
means, success is not attained, an li periodic doses of quinia (5
to 15 grains) tnay be administered* The drug should be given
Within the six hours just preceding the expected paroxysm. The
hydriatic measures recommended for interrupting the paroxysms
should also be employed^ and between the paroxysms strongly
tonic measures should be steadily kept up to fortify the patient
against a new attack. These measures should be continued for
several weeks after the interruption of the paroxysm. The use
of large doses or many- times repealed doses of quinine is never
necessary In the treatment of intermittent fever when the resonrccs
of hydrotherapy are effectively brought into oj>eration.

In chronic malarial infection, which is often refractory to qui-
nine, hydrotherapy is marvelously succcssfuL See ** Malarial
Cachexia'* C^7)-

Remittent malarial fever can not be so readily brought to a
quick termination as the intermittent form of the disease. The
general method is the same as in typhoid fever. When the tem-
perature is high, administer vigorous antipyretic measurest espe-
cially the cooling pack (1189); during the remission apply
fomentations (1328) over the liver, cold towel rubbings (1218)
every two or three hours, and thus build up the patient's resistance.
In cases which have resisted anti|>eriodic doses of quinine, arsenic,
and other drugs, a few days* application of hydriatic measures
rarely fails to effect a radical change for the better. If hydro-
hcrapy alone proves insufficient, one or two small an ti periodic
doses of quinine may be administered with the happiest results.
63

994 RATIONAL HVDROTHERAPV.

SCARLET FEVER,
1491 Pmthoiogica! indications.

1. Eticourai^e General Resistance Hot -blanket pack

(1 197), 5 to 8 miontes followed by cooling wet-sheet pack (1189). fl
(The cold sheet should be well heated before removing.) Or, the™
hot pack (1183) may be followed by cold towel rub (1213), wet-
sheet rub (1216) in bed, or tepid affusion (1103), 85° to So"", the
patient sitting in a bath tub. Cold mitten friction must he.
avoided.

2. Elimiiiate Poisons — ^ Copious water drinking (142$), j
two to six glasses in 24 hours. Carbonated water, fruit jtiice^J
fruit purees, etc-
Ciinicai indicMioQs,

3. Fever — Cooling pack (1189), hot-blanket pack (1197)J
followed by cold towel rub (1213) or wet- sheet rub (1216tf
graduated bath (1120), copious water drinkiDg (1423), cooliiagJ
enema (1405)^

4. Delayed Eruption — Wet-sheet pack (1183) prolonged to
heating stage*

5. Diarrhea.— Enema (1405), 75 "* to 80" after each move-
ment. Fomentation (1328) for 15 minutes over the abdomen tvcq
two hours, followed by heating compress (1344), changed every
half-hour. If the general surface is cold, the hot full-bath
(1126) for five minutes, followed by short cold towel rubbing
(1213).

6. Vomiting. — Hot and cold trunk pack (1367), ice-bag
(1314) over the stomach or spine opposite, lavage (1401) if
vomiting is persistent.

7. Convulsions. — Hot-blanket pack (1197) for 10 minutes,
followed by cold wet-sheet pack (1179) with ice to head
(1314). Hot bath (1126) for 5 minutes followed by neutral
bath (1130) 92° to 95°. Water drinking (1423); large enema
(1404).

8. Pharyngitis — Fomentation (1328) to throat 10 minutes
every hour with ice compress (1314) during inter\'al. Steam
inhalation (1419) 5 to 10 minutes every half-hour. Gargle throat
with very hot water hourly. Throat compress (1381) at 60*^
changed every 15 minutes; protected heating compress (1344)

SCARLET FEVER.

99$

changed once in 3 hours. Spray throat with weak solution of
peroxide of hydrogen or hydro^one every hour.

9, Deliriytn with Insomnia and Nervous Agitatton or
Chorea — Ice bag (i;i23) to head, hot fomentations (1338) to
spine, followed by prolonged wet- sheet pack (IITS)*

10, Desquamation — Neutral (92° to 95*^) alkaline bath daily
(lll!i!f I4G3), 15 rninutcs to i hour.

11, Nephritis, or Suppression of Urine,— Hot-blanket pack
(1197) for 20 to 30 minutes followed by heating comptess
(1344) to the loins. Copious water drinking (1 423) J enema
(1405) So'' to 90°, twice daily.

12, Pleurisy, — Foraentation to the chest (1328) for 15
minutes every 2 hours with heating compress (1344) during the
interval 1'ight muslin bandage about chest if pain is intense.

13, Rheumatism. — Sweating pack (1191); copious water
drinking (1424); fomentation (1328) to joints every 3 hours
with heating compress (1344) during intervaK

14, Pericarditis, or Endocarditis. — Icebag (1314) or cold
compress (1314) over heart to be removed for 5 minutes every
15 to to minutes.

15, Enteritis*— Hot trunk pack (U9J), with hot foot bath
(1297) or hot leg ]»ack (1393) for 20 minutes, followed by cold
abdominal compress 1 1318) at 60°, to be changed every 30 mm-
utes. Enema (1404) after each stool, at 95**,

16, Pneumonia,^ Fomentation (1328) for 15 minutes every
2 or 3 hours, cold compress (1344) at 60° during interval, chang-
ing every 10 to 20 minutes* Hot hip and leg pack (1393) once or
twice daily to relieve congestion. Keep skin warm and active.
Hot-blanket pack (1197) if patient is chilly, followed by heating
wet'shect pack (1183).

17, Enlarged Spleen or Liver*— Fomentation (1328) over
part for 10 to 20 minutes twice daily. Follow by ice- water com-
press» to be changed every 2 hours during interval,

18, Contraindications. — Avoid short cold baths, prolonged
hot baths, and all other measures which diminish heat elimination
or increase heat production.

General Method.^ At the beginning encourage eruption by
hot-water drinking (1429>p very hot baths (1126), heating pack
(1183),

996 RATIONAL HYDROTHEKAPY.

After eruption is fully developed, cooling pack (1189),
uated bath (1120)t cool enema (1405), and other anlipyrrl
measures. Copious water drinkitig (1426) is cspeciaUy imporUuit

Give attention to throat, to prevent infection of the ciis*
Steam inhalation (1419); irrigation (1400); healing cotnj
(1344).

If albumin appears, the blood must be kept in the skin by
packs (1197) and warm wrappings; and the cold applications
muit be ** partial," such as wet-hand rub (1201), cold mii-
Icn frictioti (1209), cold towel rub (1213),

Prolonged chilling of the skin must be carefully avoi<led*

i

MEASLES.
1492 Pathological fndicmtlons.

I. Maintain General Resistance, — Weishect pack (1179);

graduated bath (1120)-

1. Prevent Pulmonary Complications.--^ Fomentation tv
chest (1328) twice a day» chest pack (1373) during interval.
CHnical indications,

3. Naso-Pharynireal Irritation — ^ Apply light very liot com-
presses (1286) to the face. Inhale steam (1419) and vapors of ^
aromatic oils and balsams. Fomentation (1328) to the throai
every 2 hours, heating compress (1344) during the intcr\*3li
changing every 15 minutes at first, less frequently later, i

4. Headache. See 1554, 11-15; 1562. ^

5. Delayed Eruption. — Hot-blanket pack (119 J) to minutci
followed by heating wct-shcot pack (1183)'

6. Inflammation of Middle Ear.^ — Ice to throat of same side ]
(1314); fomentation (1328) over ear,

7. Nephritis. See 1537^

S. Hemorrhagic Form.— Hot-blanket pack (1197) or short
hot immersion bath (1120) followed by heating wet-sheet pack
(1183)* Repeat every 5 or 4 hours. Prolonged neutral (1130)
bath at 95° to 93^

9. Bronchial Catarrh. — Fomentation to chest (1328)» cold
towel rub (1213), or cold mitten friction (1309) twice daily.
Moist chest pack (1373) niti'^^ ^^^^ *^^y-

10, Lobar Pneumonia — Broncho- Pneumonia. — FomenU-
tion (1328) for pain anil irritable cotigh, repeated every 2 or

ERYSIPELAS.

997

3 hours; cold compress (1344) durmg interval, at 6o°, chang-
ing every 15 to 30 minutes; hot hip and leg pack (1197) if the
local inflammation is severe. See Fneumonia (1498)*

11. Cough.— See 1570, 4-7'

12. Nosebleed See 1496, 4.

tj. Inflammation of the Eye or Byelids. — ^Scc ItiO'i,

ERYSIPELAS,
PatboiogicMl indications,

1. General,-^ Cold mitten friction (1209) or towel rub (1213)
every 3 hours.

2. Combat Local Enflammailon and Extension of the Dis**
ease, — Cold compress (1318) during the early stage of the dis-
ease, renewing before it becomes warm, later, less fietiuenlly.
Avoid ice-bags or ice compresses, which involve risk of sloughing;
Fomentations (1338) for 2 to 5 mimiles every 2 hours, Ice-colbr
(ISlti), when the skin of the head or face is affected,
Cliaicai indications^

3. Fever. — Graduated bath (1120); prolonged neutral bath
(1130); cooling enema (1405); cooling wet-sheet pnck (1179).

4. Recurring Chills — Dry pack (1192); hot water drinking,
(1429).

5. Vomiting. — ice-bag (1314) over stomach; hot and cold
trunk pack (1367)^

6. Pericarditis, Endocarditis, — ^Sec 15711, iomcntation
(1328) over heart 30 seconils* foihjwcd by precordial compress
(1383) at 60°; change every half-hour.

7. Myocarditis.— See 1489, 29; 1570, 5.

8. Arthritis.— See 1499; UKO. 39.

9. Albuminuria, Acute Nephritis. — See 1537.
10. Delirium,— Sec I4H9. 17.

Oeneral Jlethod.— During the early stage of the disease, while
the surface is bright red and the inflammation extending, apply
cooling measures, changing evefy few minutes (3 to 5), as often
as warm. Prevent extreme depression by a fomentation (1238).
not too hot, every hour or two. When the parts become a dull
red color, or the rapid extension is checked, employ the heating
compress (1344)i changing at intervals of 15 to 30 minulcs* pro-
longing the interval as tlic fever and inflammation subside*

1493

ggS HATIONAL HYDROTHERAPV,

SMALLPOX,

1494 Pathoiozicsl indicatiQns,

u aeneral. — Sparc, aseplic diet (1626);
(1423). See Scarlet Fever (1491, i).

Clinical Indications,

t. Lumbar Pain,— Fomentation (1328) or hot trunk pact
(H97) every three hours; heating pack (1183) during interval^
change every 30 to 40 minutes.

3. Nausea and Votnltiiig — Ice-bag (1314) over stom^b^
hot and cold trunk pack (1367)^ M

4. Constipation — Cold enema (1405) daily; coloclyiief ™
(1407) 7°° daily.

5. Diarrhea — Enema (1404) at 95"* after each movottieiit; I
fomentation (132S) to abdomen; cold compress (131^) to be
changed every honn

6. Delayed Eruption — Hot-blanket pack (1197) or hot
bath (1126) foliowed by sweating wet-sheet pack (1183)-

7. Fever.— Graduated bath (1120); prolonged tepid tali
(1133); cooling wet-shcct pack (1189); cool enema (140SX
with simultaneous fomentation (1328) to back if necessary to
prevent chill; large cooling compress.

8. Stage of Suppuration. — Prolonged or continuous neutral
bath (1130).

9. Tumefaction of Face — Hot compress (1286) to face for
5 minutes every hour; cold compress (1318) during inter\*al,
at 60°, renewed every 20 minutes.

10. Pitting. — Cooling compress, using red cloth, covering
face completely. Red curtains to windows.

11. Headache and Delirium. — Ice-cap (1323), ice-collar
(1316). Hot and cold cephalic compress (1358).

12. Broncho- Pneumonia. — See 1576^ 5.

13. Endocarditis. — See 1573.

14. Laryngitis. — See 1568.

15. Nephritis. — See 1537.

16. Inflammation of Eye. — 1602-

17. Contraindications. — After the eruption appears, avoid
the wet-hand rub, cold mitten friction, and all friction baths.

5BROSPINA1, MENINGITIS,

999

General fletliod. — Keep the temperature down, and maintain
activity of the skin by prolonged neutral (1 130} and tepid baths
(1123); aid elimination by copious water drinking (1423); pre-
vent visceral complications by continuous cold to the head (1323)
and the frequently changed abdominal Cfjmpress (1318)* In
confluent cases, general septicemia is prevented by prolonged
imtnersioo baths (1136).

CEREBROSPINAL MENINQITIS.

Pathofogksf indications.

1. General. — Careful cold mitten friction two to four times
daily,

2, Combat Congestion of the Brain and Cord. — Ice-cap

(1333); ice-collar 1 131G); cooling coil to the head (.1323)] ice-
bag to the spine (1372). General derivative treatment; hot
hip (1389) and leg packs (1393); hot^blanket pack (1107);
hot immersion bath (1136) i03°* The head should be protected
by the ice-cap (1323)i cooHng coil, or the ice-collar (ISIG)
daring all hut applications. Foineutatton to the spine every z
hours. Spinal ice-bag during intervals* Vigorous cutaneoys cir-
culation must be maintained.

J. Prevent Bronchitis — ^Fomentation (1328) to the chest
twice daily; well-protected heating compress (13 14) during inter-
vaK Keep shoulders dry and well protected while in bed. In
cold bath, sec that water covers shoulders. The chest compress
must cover the shoulders.
Ci'micml indications^

4. Headache^^Foincntation (13281 to the back of the neck;
ice compress (1314) tu head and neck; hot and cold head com-
press (1358)<

5. Pain in Back and Legs.-^ Fomentation (1328) to back;
hot hip pack (13H!I). Repeat every 4 hours or more often.
Heating compress (1344) or icc-bag (1314) duntig intervaU

6. Vomiting,^ — Ice-bag (1314) over stomach; hot and cold
trunk pack (J3(>7).

7. Diarrhea^ — Enema (1404) at 95® after each nioveraent
During interval cold abdominal compress (1318) at 6o^p renewed
every fifteen mtnutcs with fomentations to the abdomen 15 min-
utes every two hours i^l328j.

um

lOOO RATIONAL HYDROTHERAPY,

8. Muscular RiirWity — Hot-blanket pack {1191);^^
immersion bath (1126); hot fomentation (1328), faJiowcd

I well-protected heating compress (1344)-

9. Hyperesthesia,— Neutral bath (1130), 94"" to 96^,

10. Delirium or Mania» — Prolonged wet-sheet pack (I17S)|
ice-cap (1323) and ice-^coUar (1316).

n. Muscular Spasm.-^Hot immersion (1136) 102° for 15 to
30 minutes, with ice-cap (1323) and ice-coUar (1316)* Pnit—
longed neutral bath (1130)* Heating spinal compress (1335)||
13. Gintraiodications. — Cold immersion bath. Brand bati,
r ' and other general cold procedures. ^

.t General riethod.^The object to be sought by treatmenl is d|

relieve congestion of the brain and spinal cord by diverting ti
much blood as possible into the skin, hence the skin must be kept
constantly warm. Creneral cold procedures such as the cold
5^ immersion bath and the cooling pack must be avoided- Undue

excitement of the brain and cord during hot applications is pre-
vented by protecting these parts by ice compresses (13141 and
the application of an ice-bag (1314) over the heart. Partial cold
applicationSj as cold mitten friction (1209)^ should be admims^
tered several times daily to maintain vital resistance, care bciug
taken to maintain surface warnith by the application of heat to the
spine and legs (13^8, 1393) or other parts during the treatment,
so as to avoid retrostasis,

MUMPS.
1496 PBihologic^! indications,

1. General*— Cold mitten friction (1209) or cold towel rub
(1213) two to four times a day. Neutral bath one hour daily
(1130); copious water drinking (1423),

2. To Combat Local InfiamniatJon. — Hotblanket pact

(1197) followed by heating or sweating wet-sheet pack (II81).
continued i to 3 hours. Repeat the application twice a day-
Fomentation (1328) over the affected parts every 2 hours for 15
mmutes, followed by heating compress (1344) at 6o°^ to k
changed every 10 minutes or as soon as warmj ice-bag ovtr
swollen glands until active inflammation is subdued. Retnov*
ice every half hour and apply fomentation for 5 rninutes.

DIPHTHERIA AND TONSILITIS.

lOOI

Clinical imiicatiQns.

3, Headache Cool compress (1314)*

4, Nose- Bleed.— Ice (1314) lo back of neck; hot com-
press (1286) over face^ ice to hands; elevate hands to vertical
positioEij if necessary, hot foot bath (1297), or hot leg pack
(1393); very hot nasal douche (1397)^

5, Diarrhea — Enema (1404) at 95*=* after each movement
Abdominai compress (1318) at 60^, renewed every 15 to 30
minutes. If pain is present, abdominal fomentation (1328) for
15 minutes or until relieved, every 2 hours; large hot soap
enema to empty colon if due to fecal accumulation.

6, Vomiting. — Ice (1314) over stomach or spine opposite,
or hot and cold gastric compress (1362); i^e pillsj sipping very
hot water,

7, Earache* — ^Ice bag (1814) to neck of the same side,
fomentation (1338) over earj hot ear douche (1396) if neces-
sary. Protect the ear with warm cotton to prevent chilling by
evaporation after treatment.

S. Qinvuislons. — Hot blanket pack (1197) or hot immer-
sion (los"" to las'") (1126) with cold to head.

9, InflamfTiation of the Mammce.^ — Fomentation (1328)
over the breast for 15 minutes every 3 hours. During interval,
heating compress (1344) at 60** renewed every 15 to 30 minutes.
Hot pack (1197) to arm of the same side. Hot hip (1389) and
leg pack (1393) for derivative effect if pain is severe.

10, Inflaitimatton of Testicle. — Ice compress (1314) cover*
ing entire genitals and inner surfaces of thighs with simultaneous
hot hip (1389) and leg pack (1393) for 30 minutes. Repeat
every 4 hours. During mterval, heating compress (1344) at 60^
in place of ice compress, renewed every 15 minutes.

DIPHTHERIA AND TONSILITIS^
PBthologicmi fndicMtioBS.

I, Increa^ and Maintain Vital Reslstatice. — Hot f omenta*

Uon (1328) to the spine or short hot bath (1126), followed by
cold mitten friction (1209) or cold towel rub (1213) two to
three times a day.

1497

L

ICMD3 RATIONAL HYDROTHERAPY,

To Combat Local Infiamrtiation, — ^Fomentation (13^
tliroat every 2 hours for 15 minulcsj ice compress (1314) to Ihmii
during interval. If inflammation becomes intense, and sttppuratiitt
or sloughing is threatened, the heating compress (1344i at 6e*,
changing every hour. Steam inhalation (1-419); antiseptic
lotions to throat J hot- water gargle,

2. Combat Qeneral Toxemia and Resulting De^eneratioiy
and Local i zed Inf Jam mat lonsp — Copious enemas ^ 1 404) twice
daily* Copious water drinking (1423), three to six pints dill}
The irct vise of fruit juices. Hot fomentations (1328) to tk
spine or short hot bath (1126)5 followed by cold mittea irkim
(1809) or cold towel rub (1213) two to three times a day.

3. To Combat Local Inflammation — Hot-blanket pack (1 Idl
followed by sweating wet-sheet pack (1183); repeal evcij j
or 4 hours if necessary. Fomentation (1328) to throat c*cn
2 to 3 hours for 15 minutes; ice compress (1314) to throat dunK
interval; ice pi I Is j if inflammation becomes intense and slou^iiE
is threatened, the heating compress (1344) at 60^, changing even
hour. Steam inhalation (1419); antiseptic lotions,

dinical Indications-

4. Fever,— Hut 4>lankct pack (1197) followed by wet-^lwct
pack (1179); pniiongcd neutral bath (1130) when rectal ten^
pcrature rises above 101°; fo:nentation (1328) followed by ccJc
towel rub (ItJI'j); cold eneina (1403) with simultaneous fomci^
tation (1328) to the back; hot enema (1406) followed hy coW
towel rub (1213) or cold mitten friction (1309).

5. Coma or Collapse,— Hot- blanket pack (1197); cote'
clyster (1407) at 80^; alternate compress or sponging to spin
(1342); cold mitten fricticm (1209); hot and cold cephalic cor
press n35R); in case of collapse, short hot immersion hid
(112(5) followed by dry pack (1192); hot enema followed bf
dry pack (U92).

6. Albuminuria^ Nephritis,— See 1537,

7. Broficho-Pneumonia,— Bee 1573,

8. Paralysis — Fomentation to spine (133R) with cold mrtw
friction (1309); short hot-blanket pack (1197) ut ciccinc-ap
bath (1250) followed by cold mitten friction (1209); hot as
cold friction over the affected part; applications of galvanism as

LOBAR PNEUMONIA*

1003

sinusoiflal current; gymnastics^ massage, and appropriate cxer-
cise.

9. Neuritis. — Fomcntalion (I$28) over the course of the
affected nerve for 15 minutes every 2 tfi 4 hours; during the inter-
val, the heating compress (1344)* well protected, Coloclyster
(1407) daily; water drinking (1423), two to four pints; aseptic
diet (1626); rest of affected part

10, Croup. — Steam inhalation; inhalation of vapor arising
from slaking Umej fomentation to throat 15 minuics every a
hours; cold or very cold compress^ changed every 15 minutes
during the interval; hot bJanket pack (llS?); keep skin warm*
Surgical interference is often necessary.

It, Threatened Suffocation. — Put the patient In a bath (102**
to 105°), and pour cold water over the chest and spine. Cold
mitten friction.

LX>BAR PNEUMONIA,
BtiofoMlcaf indications,

1. Exercise sjiecial care to prevent ptdmonary congestion from
exposure of the shonldcrs or chest to chill by evaporation. Pro-
vide the patient with abundance of jmre warm air; have a supply
of oxygen at hand for immediate use if required,

Patitaiogicai indimtians*

2. MaititBin General Vital Resistance.— Cold mitten friction
'(1200) or cold towel rub (1313) two to four times daily, after

some appropriate heating procedure, as fomentatiim (133S) to
chest or back, hotblanket pack (1 197 h or sweating pack (1 101 ),

3, Combat t^ocat Conjcestlon of the Lungs and Invaslan of
the Specific Bacillus.^ FutncntiUlon (I32H) ttj the chest before
and bchindi for 15 minutes every 5 hours. During interval,
apply cold compress (1318) at 60**, changing* every 15 minutes, or
as soon as warmed, l^cngthen the i>enod between fomentations,
and rhange the compress less frequently as iem[>craturc is lowered,
the pain less, and the stage of the disease more advanced. Sevcrai
ice-bagsi may be used in place of the cold compress, but the bags
should be rcmovcil at least every half hour, and the chest should
be rubbed until red and warm to maintain surface circidation
aufl skin reflexes. The skin musi be kept warm,

4, HU mi nation of Poisons, — Sweating pack (1191) continued

1408

1004 EATIOKAI- HYDROTHERAPY.

for 2 to 4 hours followed by cold mitteD friction ( 1 209) carefutl
administered. The sweating bath may be preceded by the shoij
hot bath. Copious water drinking (14S3)- Neutral enema twi^
daily (1404).
Clinical Indications,

]

\

5. Cough*— Fomentations (1338) every 3 hours; heatiq|
compress (1341)i changing every 15 to 30 minutes daring lutei^
val. Steam inhalation (1419) 15 minutes every hour; sipl
ping half a glass of hot water (1429) when inclined to coughj
careful protection of neck and shoulders from chilling by cotitod
with wet bedclo tiling. Keep shoulders covered. Fig. (186.) 1

6. Pain in Chest.^ — Revulsivrc compress (1341) covering x%
whole chest before and behind. \

7. Exudate^ — Alternate compresses (1340) for ao tnltititc
three times a day, with continuous well-protected heating comprei
(1344) during inten^als after convalescence; for unresolv^ed exi^
date, alternate fan douche (1061) or alternate spray (1055V

8. Constipation. — Daily cold enema (1405) or colodyst^
(1407).

9. Diarrhea. — Enema (1404) at 96^ after each movemem; col
abdominal compress {131B). renewing every half hour. Fomen*
tation (1328) every 2-4 hours if pain or tenderness is present

10. Tympanites. — Hot enema (1406) followed by small
cool enema (1405); cold coloclyster (1407) with soap; cold ab-
dominal compress (1318) changing hourly.

11. Qastro-Duodenitis. — Fomentation (1328) over stomach
and bowels or hot trunk pack (1197) every 3 hours. Dur-
ing intervals, cold compress (1318) at 60°, changing every 30
minutes; neutral enema (1404) daily.

12. Jaundice. — Large hot coloclyster •(1407) at 105^, fol-
lowed by small cold enema (1405) twice daily. Fomentation
(1328) over the liver and stomach every 2 hours. During the inter-
val, heating compress (1344), changing every 30 minutes.

13. Weak Heart, Feeble Pulse. — Cold compress (1314) or
ice-bag (1314) over the heart for 15 minutes every 2 hours.
Cold mitten friction (1209) every 2 hours. Prolonged neutral
bath (1130) with ice-bag over heart, cold pour to back of head
and upper spine at the end of the bath.

LOBAR PNEUMONIA. 100$

14. Cyanosis. — Hot-blanket pack (1197) for 15 minutes, fol-
lowed by cold mitten friction (1209). Avoid exposure of the
body to chill by evaporation.

15. Headache. — Ice compress (1314) to head, or ice-cap
(1323); hot pack to legs (1393) and hips (1389), or other deriv-
ative treatment; hot and cold cephalic compress (1358).

16. Nose-Bleed. — Ice-bag (1314) to back of neck; short
hot fomentations (1328) to face. See 1496, 4.

17. Delirium. — Heating wet-sheet pack (1183); ice-cap
(1323) to head; prolonged sweating pack (1197).

18. Insomnia. — Neutral wet-sheet pack (1182).

19. Cerebral Congestion. — Hip and leg pack (1189); ice
head cap (1323).

20. Fever. — Prolonged neutral bath (1130); wet-sheet pack
(1179), cooling enema, 1405. See 1485.

21. Subnormal Temperature. Sec 752, 1486.

22. Pain in Abdomen and Back. — Hot-blanket pack (1197)
or large fomentations (1328) over affected parts, followed by
heating compress (1344).

23. Capillary Bronchitis Hot-blanket pack (1197) fol-
lowed by sweating wet-sheet pack (1187). Hot enemas (1406)
followed by cold friction (1209) carefully given. Fomentation
(1328) to the chest followed by heating compress (1344) or chest
pack (1373), to remain in place an hour, or until thoroughly
warmed. Repeat bath when temperature rises to 102°.

24. Contraindications. — Brand bath and cold immersions.
General Method. — Maintain warmth and activity of the skin,

taking special care to avoid chilling of the shoulders, which should
be especially protected by a wrapping closely applied. Combat
pulmonary congestion by local applications made as above
directed. Keep the temperature down by carefully managed
hydriatic measures such as the heating pack (1183), the hot-
blanket pack (1197), followed by cold mitten friction (1209),
and like measures, rather than cold immersion baths and cooling
packs, which aggravate pulmonary congestion by producing retro-
stasis. Promote vital resistance by frequently repeated partial cold
rubbings (1209), and thus sustain the vital powers until oppor-
tunity has been afforded for the development of antitoxins and the
suppression of the disease by the natural healing processes.

I006 RATIONAL HYDROTHERAPY.

ACUTE ARTICULAR RHEUMATISM.
1499 BUologlcml Indicaiioas,

1. Absolute rest in bed. AbstiQcnce from a!! solid food fiir^
few days, allowing only ripe fniils, fruit juices, well dcxtritiiie
cereals (1630), and maltcti foods (1631)> Avoid meats^ animi
broths, beef tea or extracts, eggs, oysters, cheese, and all foo^
rich in proteids.

Pathological Indications-

2. Combat Inflamtnatory Process in Joint^.^ Secure acti^
cutaneous circulation by hut-blanket pack (1197) and sweadji
wet-sheet pack (1187); hot fomenlaUons (1328) to the jointi
followed by heating compress (1344)- Keep the patient sweati^
until acute pain ceases and temperature falU. J

3. Prevent Extension of the Disease to the Heart, Lucie
Pleura, and Mening^es by promoting activity of the skin aQ)
kidneys, and building up the general vital resistance by carcfutl
administered cold applications. The hot-blanket pack (1 197), hi
enemas (1406), hot trunk pack (1367)* following each hot applj
cation by cold mitten friction (1309) administered carefully to a
portions of the body free from local inflammation.

Clinical Indications.

4. Encourage Elimination. — The prolonged sweating bail
administered by means of the hot-blanket pack (1197) continues
for several hours, is a most valuable measure. The patient shoulc
not be taken out of the pack suddenly, but gradually, cold mittez
friction (1209) being applied to each part until good reactioi
occurs before uncovering another portion. After rubbing, the
surface should be carefully protected by flannel blankets. Fie<
water drinking; large enema twice a day (1404).

5. Pains In Joints.— Hot-blanket pack (1197) followed bj
dry wrapping; fomentation (1328) to joints, repeated every 2 hoursj
during the interval a well-protected heating compress (1344]
applied as soon as the fomentation is removed. Smear joints witl
vaseline, daily.

6. Fever. — Hot-blanket pack (1197) continued to sweating,
followed by sweating wet-sheet pack (1191) prolonged for several

ACUTE ARTICULAR RHEUMATISM.

1007

hours, is the best means of lowering the temperature- Whea the
temperature is very high, the neutral bath (1130)« 93**-9S°t niay
be employed. Ice compress to head and neck. Cold mitten fric-
tion (120{» or cold towel rub (1213) may be adminisiercd after
the sweating pack (1191) or the hot-blanket pack (1107) two to
three times daily.

7. Profuse Perspiratioii — Do not check during early stage;
simply wipe the patient with a dry cloth. If the temperature is
very high, 104^ to 105*^, the graduated bath (1 120) may be adminis-
tered; the temperature should not be lowered below 85^, As ihe
temperature is lowered, the patient should be rubbed with stiffictent
vigor to prevent chill The cool enema (1405) may also be used
in connection with the fomentation (I32S) Uy the Imr.k, Be care-
ful not to check perspiration suddenly, nor at all until acute
symptoms snbsidc-

8. In Convalescence encourage blood making by graduated
colli baths (1625), especially cold mitten friction*

9. Hyperpyrexia (temp. 104° to 106*").— tt* Prevent by ice-cap
(1323), cold mitten friction { 1201)) at 50* to 40^ or cok! towel
tub (1213) at 60^ to 50^ two of three times a day, whan tem-
perature rises above 101.5° !'• ^*y precede cold application by
very hot sponging (1204).

A. Combat when temperature rises above 10J.5** by mitten friC'
tion (1209), temperature 60"^, every two or three hours, continuing
until temperature fails to 101^. Continue appHcatitm to each part
until reddened, so as to prevent retrostasis (61 1)* (jraduated baths
(1120) (102*' to 85*^) may be resurled tq in obstinate cases, alsti
the cool enema (1406)* In all cases apply ice*cap (1323) and
ice-collar (1310) to antagoni/.e cerebral congestion and coma.

10. Endocarditis, Pericarditis,— The hot fomentation (1 328)
(not fWT hot) sKould be ap|>lied over the heart for half a minute
at intervals of i hour. This should be followed by the icc*bag
(131-1) or cold precordial compress (1383).

11. Pleurisy and Pneumonia,^- Sec H98, I533t IS74.
t2. Cerebral Rheumatism,^ Ice (1314) to head; prolonged

neutral baths (1 UW), 92-; coloclyslers (HOT) at So^ three times
a day; ice to head and neck; cooling pack; sweating pack^
repeating two or three times daily,

I J. To Prevent Permanent Damage of Joints. — Simple Ilex-

1008 RATIONAL HYDROTHERAPY.

ions of the joints as soon as the fever declines; short applicatjom
of alternate compress or alternate douche two to tbree times dailffl
after convalescence begins, with a we 11- pro tec ted heating comprcM
during the intervah

14. Articular Affusions. — Alternate compress (1340) ora^lber-
nate douche (1044) three times a day, well -protected headng
compress (1344) during interval; galvanism to joint; cataphofc-
Bis; static electricity; massage; bandaging.

15. Nodosities, — Scotch douche (1037) or fomentatio
(1328) three times a day, heating compress (1344) during inter-'
val until tenderness is removed, then alternate douche (1044)
three times a day, followed by well-protected heating comprea
(1344); massage; galvanism.

16. Arteritis and Phlebitis — Fomentation (1338) om
affected part every 2 or 3 hours for 20 minutes; heating compress
(1344) during interval, wrung very dry, and protected with mackia*
tosh (1344). f

17. Neuralgia, — Revulsive compress (1341) followed by dtj
cotton poultice; renew every hour or two.

18. Neuritis — ^Complete rest of part; fomentation cveir 1
to 3 hours, followed by well-protected heating compress (1344)^^

19. Tachycardia.— t7u!tl precordial compress f 1;|S;|^ f^^r i;
minutes every hour; avoid hot food and drinks; ice-bag over heart
(620) during hot applications to joints and other parts.

20. Diarrhea. — Neutral enema (1404), 95°, 'after each stool;
cold abdominal compress (1318), 60®, during intervals, changed
every hour.

21. Qastralgia. — Hot and cold gastric compress (1362), heat
to epigastrium (1332), cold to spine (1372). Hot water drinking
(1429); dry diet of well-dextrinized cereals (1630).

22. Periostitis and Osteitis. — Very hot fomentation (1328)
for 15 minutes every 2 hours, heating compress (1344) during
intervals, well wrung and well protected with flannel and mackin-
tosh. If suppuration, early opening with knife.

23. Urticaria. — Sponging with very hot water (1204); hot
saline or alkaline sponging (1206); prolonged neutral bath
(1130).

24. Contraindications. — Cold immersion baths and cold
douche.

CHRONIC RHEUMATISM. IOO9

General Method. — Aid the elimination of lactic acid by pro-
moting cutaneous activity. This is also the best means of reliev-
ing the articular pains. The patient should be drenched with
water through both the stomach (1423) and rectum (1404), to
encourage profuse perspiration, and prevent undue increase in the
specific gravity of the blood. Tonic and antipyretic measures
must be used with great care, and so managed as to avoid retrosta-
sis. Chilling the patient will increase the pain. The cold rubbings
applied to maintain general vital resistance must be accompanied
by hot applications to the joints, and if necessary, more extensive
hot applications to the spine (1328) or legs (-1393) to prevent
chilling of the surface. Those hydriatic measures are most appro-
priate and efficient which aid heat elimination by dilating the sur-
face vessels rather than by lowering the temperature of the skin.

CHRONIC RHEUMATISM.
Etiological Indications.

1. A nourishing dietary excluding meats; avoid fruits and vege-
tables at same meal, all indigestible foods and dishes, tea, coffee,
condiments, and excess of salt. Carefully graduated cold bathing
daily (1625).

Pattiological Indications.

2. Increase General Vital Resistance. — This is the most im-
portant indication in this disease, as in malarial infection, and in
acute rheumatism and other infectious maladies. Short sweating
procedures (1246, 1250) of any sort followed by short and gradu-
ated cold applications (1625) are the most important general
measures.

3. Swelling of Joints. — Fomentation three times a day; dur-
ing intervals, heating compress (1344) wrung dry and well pro-
tected by mackintosh; derivative massage.

4. Pain.— See 1499, 5; Scotch fan douche (1037).

5. Stiffness of Joints. — Fomentation three times a day, well-
protected heating compress during intervals; alternate articular
douche (1100); massage of joints and muscles (1461); massage
douche (1066); prolonged neutral bath (1130).

6. Cardiac Disease. — See 1576.

7. Dry Skin. — Sweating pack (1191); electric-light bath
(1250); oil rubbing (1232); cold mitten friction (1209); cold

1500

lownl mb (1213); wct-shcct rubbing (1216); vapor bath (124fi)a
hot*aJr bath, especially eleetric-light bath (1250); Turkish \mm
(1239); sun bath (135*1. |

8, ContraindicatlcHis. — Very cold baths, especial Jy irauicr*^
siotis. See 1010, 1 10^% 1 174, 124)1, 1209, 1213, 1216^ 1317.

See also Acute Rbenmatlsm^ 1499.

T\ RHUS FEVER.
Haihatogical indications^

1. QeneraL— See 1489, 4, 5. 6.

2. Prevent Visceral Congestion and Degeneration, — Hot
blanket pack (1197) followed by sweating wet-sheet pack (1IS7)
and prolonged neutral bath (1130)^ once or lwiC€ dally.
Cilnicat indications,

3. Fever. — The graduated bath (1120), the prolonged te]
bath (1123 J, and the prolonged cooling pack (1181) atr pref-
erable to the Brand bath (1150), as tending less to produce
visceral and cerebral congestion,

4. Insomnia. — The wet-sheet pack (1179) continued to the
heating (1183) or sweating stage (1187). Repeat often SM
necessary and continue 2 hours or more if patient sleeps* Qon-
linaouii en Id to the head; ice-bag to neck and head,

5. Delirium, — Ice compress (1314) to head andoeck; pro-
longed neutral bath (1130) or prolonged or repeated wet-sheet
pack (1179).

6. Cerebral Congestion. — Fomentation (1328) to the upper
spine; ice compress (1314) to the head aird face; ice-coUar
(1316); ice-cap (1323); hot and cold cephalic compress (1358);
w^ct-slicct pack (1179); hot-blanket pack (1197)*

7. Pain in Legs. — Fomentation (1328) to the lower spinej
hot hip (1389) and leg pack (1393) followed by wet-sheet pack
(1179) or cold towel rub (1213)/

8* Persistent Vomiting,— Tce-ba^t: (1314) to the epigastrium;
hot and cold gastric compress (1362); hot and cold trunk pack
(1367); lavage (1401), if persistent.

fj. Complications, — See 1507.

General J*lethod— Combat cerebral congestion by carefully
maintaining a warm and active skin. Cold immersion baths
(1114) when applied must be of brief duration and the brain

!»>

J

YELLOW FEVER. lOI I

must be carefully protected by an ice-collar (1316) and ice-cap
(1323) during the application. Less intense refrigerative meas-
ures are preferable because of the danger attending strong retro-
stasis in this disease. In other particulars the management of this
disease is essentially the same as that of typhoid fever,

YELLOW FEVER,
Pathological Indications. 1502

1. Maintain General Vital Resistance Short hot applica-
tions followed by cold mitten friction (1209) or wet towel rub
(1213) every 3 to 6 hours. Copious water drinking (1424); cool
enema (1405) twice a day, more often if vomiting is persistent.

2. Elimination of Poisons. — Prolonged neutral bath (1130);
water drinking (1424); enemas (1404). See 1473, 1474.

Ciinical Indications.

3. Chill Dry pack (1192); hot water drinking (1429).

4. Headache. — Ice-cap (1323); hot and cold head compress
(1358).

5. Pain in Loins and Legs. — Hot hip and leg pack (1197),
trunk pack (1196). Fomentation over lower back (1328).

6. Delirium. — Ice-cap (1323)*, wet-sheet pack (1183) to
healing stage.

7. Cerebral Congestion. — Ice-cap (1323), or ice-collar
(13i«); hot leg pack (1393); prolonged neutral bath (1130).

8. Gastric Irritation. — Fomentation (1328) over stomach
every 2 hours; during interval heating compress (1344) at 60®
renewed every 20 minutes; ice-bag (1314) to epigastrium; hot
and cold gastric compress (1362) or hot and cold trunk pack,

9. Vomiting. — Ice pills; if necessary, withhold liquid foods.
and administer food and water by enema (1404); gastric lavage.
Ice-bag over sternum; ice to spine; fomentation over stomach.

10. Constipation. — Cold enema (1405) twice daily; soap
enema.

11. Albuminuria, — Fomentation (1328) to the back every
2 hours for 15 minutes; during interval, heating compress
(1344), well protected; hot-blanket pack (1197) for 30 minutes,
followed by short cold friction (1209) and wrapping in dry
blankets (1192); repeat every 4 hours. Ice-bag over ster-

i

m

Hum; continuous abdominal heating compress (1S44),

ing every 20 or 30 minutes. Copious enema twice daily (140&).

12, Cailapse*— Hot-blanket pack (1197); hot enema (1406);
cold mitten friction (1209)^ cold compress over heart (6S0);
fomentation over heart (1338) for 50 seconds, cold cximprcsf
(1314) 10 minutes; repeat* hH

13, Jaundice,— Prolonged oeutral bath (1130); laige fc^
enema (1404) twice daily; copious water drinking ( 1423); fomdi'
tation (1328) over liver every 3 to 6 hours for fifteen minute^
heating compress (1344) during the intervals.

14, Convubliiiis.— Short hot bath (1126) followed or
accompanied by cold affusion (1103) to head and spine; ailer^
nate compress (1342) to spine; heating wet sheet pack (1183).

15, Comai. — Alternate spinal compress (1342) or spoi^iof
(1342); hot enema (1406); cold friction (1209); ice-cap
(1323).

General Method. — Combat visceral congestion from the start
by maintaining a warm and active skin. Copious enemas (1404)
and water drinking (1423) will encourage elimination of the paK
son while the frequently repeated cold rubbings stimulate villi
resistance. The hydriatic method bids fair to rob this disease ol
its terrors, as shown by the experience of Jackson and others more
than a century ago and numerous observers in more recent years.

INFLUENZA, LA GRIPPE.
1503 Pmthological indicaHons.

1. Increase Qeneral Vital Resistance and Aid Elimiiuitloaof
Poisons. — Sweating baths followed by vigorous cold applications;
hot-blanket pack (1197) or hot immersion bath (1126); hot leg
bath (1299) with fomentations (1328) to chest or spine, followed
by cold mitten friction (1209), cold towel rub (1213) or wet-
sheet rub (1216); sweating pack (1191, 1197). Copious water
drinking (1424); large enema (1404) once or twice daily.

Clinical Indications.

2. Pain In Mead, Back, and Legs — Very hot leg pack (1393)

till general perspiration begins, followed by cold mitten friction
(1209), or cold towel rub (1213), keeping limbs very warm.

INFLUENZA — LA GRIPPE. IOI3

3. Fever. — Sweating wet-sheet pack (1187) and neutral bath
(1130); cold mitten friction (1209); cold towel rub (1213);
copious water drinking (1424); cooling enema (1405).

4. Bronchitis, broncho-Pneumonia, Pleurisy. — See 1570,
1671, 1572, 1573, 1574.

5. Headache. — Hot and cold head compress (1358)f fomen-
tation to face (1328) especially over eyes.

6. Nausea. — Ice-bag (1314) over stomach.

7. Vomiting — Hot and cold trunk pack (1367); withhold
liquids.

8. Diarrhea. — Neutral enema (1404) after each movement.
Cold abdominal compress (1318)* changing every 15 minutes.

9. Colic— Hot enema (1406); hot fomentation (1328) over
abdomen.

10. Inflammation of Eye or Ear. — Fomentation (1328)
over affected part; derivative treatment to legs — hot leg bath
(1299); hot foot bath (1297); prolonged leg pack (1393).

11. Neuritis See 1543.

12. Typhoid Influenza — See Typhoid State (1507, 17).

13. Rheumatoid Influenza. — Hot-blanket pack (1197) 2 to
3 hours once or twice daily, followed by cold mitten friction
(1209) carefully administered, and wrapping in dry flannels. Re-
peat pack twice a day. Fomentation (1328) over especially
painful parts, several times daily, followed by heating compress
(1344) during interval.

14. Thoracic Influenza, Bronchitis. — See 1570.

15. Lobar, and Broncho-Pneumonia. — See 1498, 1573.

16. Catarrhal Jaundice. — See 1534, A.

17. Meningitis See 1495.

18. Nephritis.— See 1537.

General flethod. — Combat pulmonary and visceral congestion
by maintaining warmth and activity of the whole cutaneous surface,
giving special attention to the lower extremities so as to divert
blood away from the cranial and pulmonary cavities. Sweating
procedures (1197, 1233, 1250) may be employed with vigor
and frequently repeated if followed by short cold rubbings (1209)
administered in such a way as to avoid general chilling of the
surface.

CHOLERA,

BtioiagicBl indications.

1. Prevent Further infection, — Boil drinking water, adminu^

I tering acid fruit juices to destroy cholera germsj avoid milk, memt

juices, broths, which afford excellent tiutnent media for the
comma bacillus. Also avoid all solid food till convalescence is

established.

^ Patboiogicmi Indizaiions.

2. Increase Vital Resistance, — Hot full-bath (1120) or
hot-blanket pack followed by cold mitten friction (1209) or cold
towel rub (1213); hot-blanket pack (1197); short hot bath

I (1126) or hot enema (1406), followed by cold friction (l'>09)

until surface is red.

5. Com Imt VEsceral Congestion,— Hot -blanket pack (1197)
followed by vigorous cold rubbing with mitt (1209) or towel
(1213),

4. Encourage Elimination. — Prolonged neutral bath (95^ to
gS^) (1130); copious water drinking.

1^ ^ Ciinlcai indlcstfans.

5. Vomiting.— Lavage (1401); lavage with dis^tiUed water
or boiled water containing i part pure hydrochloric acid to 4,000
parts of water (ro to ra drops pure hydrochloric acid to the quart
of water).

6. Diarrhea. — Large wann enema after each stool (1406)*
at first adding soap to the water. Cold compresses to the ab-
domen, changed every 20 minutes. Hot enemas, loS^ to iio^,
three to four pints. Hot enema, three to four pints, containing five
to eight drams of tannic acid to the quart. Repeat every :i hours.

7. Cyanosis, — Vigorous cold friction (1209); hot-blanket
pack, followed by cold friction; dry pack with cold over heart;-
hot enema {110°), followed by cold friction.

8. Scanty Urine. — Hot enema (1400), frequently repeated;
ice-bag (1314) over lower third of sternum. Hot-blanket pack
(1197).

9- Coilapse. — Alternate spinal sponging (1206, 1342) or com-
press (1340); cold friction (1209); hot enema (110''); alternate
compress over heart.

DENGUE — BREAKBONE FEVER. IOI5

10. Cramps, — Hot fomentations; short hot immersion bath
(1126); rubbing of limbs.

11. Heart Failure, — Ice-bag or cold compress (1314) over
heart for 15 minutes every 2 hours with general cold friction
(1209).

12. Contraindications. — Prolonged hot baths; prolonged fo-
mentations to abdomen.

General flethod. — Relieve intense visceral congestion by
maintaining warmth and activity of the skin; stimulate vital resist-
ance by repeated cold rubbings (1209); while at the same time
cleansing the stomach and bowels by frequent thorough washings,
— gastric (1401) and rectal lavage (1410).

DENQUE, BREAKBONE FEVER.
Ciinical indications. 1505

1. Chill — Dry pack (1192).

2. Fever Cooling pack (1189); hot-blanket pack (1197),

followed by sweating wet-sheet pack (1187): prolonged neutral
bath (1130); copious enema (1405) twice daily.

3. Swollen Joints. — Fomentation (1328) every 3 hours; dur-
ing intervals, heating compress (1344), changing every hour.

4. Cerebral Congestion. — Ice-cap (1323); ice-collar (1316,
1327).

5. During Remission, — Sweating wet-sheet pack (1187) fol-
lowed by cold mitten friction (1209) or towel rub daily (1213).
Moist abdominal bandage (1351) at night. Copious water drink-
ing (1423). Cold mitten friction (1209) twice daily.

6. Convalescence. — Graduated tonic treatment (1625); asep-
tic diet (1626); wet girdle (1347) at night.

General Method. — During the febrile period of the disease
the method is essentially the same as that of other infectious
fevers. Advantage should be taken of the intermission to build
up the patient's resistance and fortify him against a return of the
malady by means of cold friction (1209), towel rubs (1213), or
wet-sheet rubs (1216) two or three times a day, and a simple,
dry, highly nutritious, aseptic dietary (1626). The treatment
should be continued for some weeks after the fever has disappeared,
so as to prevent relapse.

mi

■■ ^< !

I

r f :

r

PLAGUE.
PathoiugloMl ladicatioas*

1. Combat Visceral Congestion and In flam mat Ion,— Hot-
blanket pack (1197) for one-half hour, foUuwed by prolonged
sweating wet-sheet pack (1187) i to 2 hours, repeating thice
times daily; copious water drinking (1423); large enctm
(1404) twice daily.

2. Stimulate Resistances^ Cold towel rub (1213) or taittca
friction (1209) after each hot application, and at least as often
as every 3 hours.

Clinic^ indications.

3. Pain in the Neck and Legs.^ Hot hip (1389) and li^

pack (1393) or fomentation (1328) to the back every 5 or 4
hours, foHowed by heating compress (1344) to the back^ changiijg
hourly during the interval.

4. Pain in the Head,— Fomentation (1328) to the back af
head for 5 minutes every 2 hoursj followed by ice*cap or cold com*
pre^s (1314); hot and cold head compress (1358).

5. Gastric Hemorrhage* — Hot trunk pack {11*>7) for 5
minutes, foliowed by ice-bag (1314) over the stomach; hot pack
to hips (1389) and legs (1393), followed by continuous heating
compress (1344) to each leg separately. Repeat every few honn
if necessary.

6. Intestinal Hemorrhage. — Hot hip (1389) and leg pack
(1393) for 10 minutes, followed by heating pack (1344) to each
leg separately, ice-bag (1314) to abdomen. It is well to apply
the ice-bag during hot applications.

7. Renal Hemorrhage, — The same as preceding, except that
the ice-bag (1314) should be applied over the lower third of the
sternum.

8. Typhoid State,— See (1507, 17)

9. Collapse. — Short hot immersion bath (1126) or hot-blan-
ket pack (1197) for 15 minutes, followed by vigorous cold fric-
tion (1209) and warm wrapping of the body, repeated every 2
or 3 hours, if necessary.

10. Cramps in Legs — Hot pack to legs (1393) followed by
friction of the limbs wnth oil or vaseline.

I

i i^'

V

COMPLICATIONS IN ACUTE FEBRILE DISORDERS. IOI7

11. Buboes. — Fomentation (1328) every 2 hours for 15 min-
utes; during interval, ice compress (1314) or heating compress
(1344), whichever affords most relief. Lancing if suppuration
occurs, then apply a cotton poultice over an antiseptic dressing
with thorough drainage.

12. After Reaction. — Neutral bath for an hour to an hour
and a half twice daily, followed by oil rubbing. Feed patient with
fruit juice and well-dextrinized cereals (1630); grape juice, rasp-
berry juice, buttermilk, kumyss.

General Method. — Maintain most intense activity of the skin
by sweating baths (1197, 1233, 1250), followed by short cold
rubbings (1209), thus relieving visceral congestion, and exciting
vital resistance to combat the disease.

COMPLICATIONS COMMON TO ACUTE FEBRILE
DISORDERS.

Digestive System. 1507

1. Qastritis. — Fomentation (1328) every 3 hours, followed
by heating compress (1344) at 60*^, to be changed every 30
minutes during interval.

2. Entero-Colitis. — Large hot enema (1406), 105*^, followed by
neutral enema (1404), 96®, after each movement. Fomentation
(1328) to abdomen every 3 hours. Heating compress (1344) at
60° during intervals, changed every 30 minutes.

3. Peritonitis. — Hot soap enema (1406)3 times daily; fomen-
tation (1328) every 3 hours; heating compress (1344) at 60°
during interval, changing every 30 minutes.

4. Pericarditis, Endocarditis. — Fomentation (1328) for 30
minutes every hour, followed by ice-bag (1314) or cold compress,
(1318) to be removed for 5 minutes every 15 minutes. Hot
hii) (1389) and leg pack (1393) if extremities are cold. Cold
mitten friction (1209) to maintain surface circulation.

5. Phlebitis, Arteritis Hot-blanket pack (1197) followed

by cold mitten friction (1209), carefully avoiding the affected part;
or hot pack (1197) to affected limb 15 minutes every 3 hours.
The hot application should be followed by the heating compress
(1344) which is changed after the next hot application, and
retained during the interval.

6. Laryngitis, — Steam inhalation (1419); fomentation H

throat (1338) every 3 hours with heating compress (1S44) dtirii^
interval, renewed every 15 minutes at first, later once an houii
Derivative applications to legs, — hot foot baths (1297), hot Id
packs (1393), heating leg pack (1183)- Repeat three to io^
times daily- Fomentation (1328) for 15 minutes every 3 hoyd^
with well' pro tec ted heating compress (1344) between, chsingll^
once an hour* Derivative treatment to lower extremities* Stea:^
inhalation (1419) 15 minutes every hour.

7. Broncho- Pneumonia* — Fomentation to chest (13*38) evci^
2 hours, heating compress (1344) at 60^ during the interval^ chand
ing every 30 minutes; hot* blanket pack (1197) for 15 minntel
followed by heating (1 183) or sweating wet-sheet pack (11S^7]
one to three applications each 24 hours. I

8. Pleurisy r^ — Fomentation (1328) every 15 minutes und
pain is relieved. Repeat every 3 hours; well-protected hea(
ing compress (1344) during interval. Tight bandage abo^
chest if necessary to control pain. ]

9. Nephritis, Albtimitiuria.— Hot blanket pack (1197) t4
30 to 60 minutes two to three times in 24 hours. Follow il
cold friction (1209). Protect the stjrface, and maintain vigof
ous surface circulation. Large enema (1404) 3 times a day
copious water drinking (1424); fomentation (1328) to lutnba
region every 4 hours for 30 minutes, followed by heating com
press (1344) during interval; ice-bag over lower sternum.

10. Edema. — The same treatment as above (9) with the addi
tion of the cold precordial compress (1383) 15 minutes every:
hours.

11. Delirium — Ice-cap (1323); ice-collar (1316); heatln]
wet-sheet pack (1183) continued i to 2 hours. Prolonged tepit
or neutral bath (1130).

12. Paralysis — Ice-cap (1323), ice to spine (1372); altci
natc with fomentation (1328) for 3 minutes every 15 minutes
repeating four times. Repeat every 4 hours.

13. Convulsions. — Ice-cap (1323); ice to spine (1372); ho
hip (1389) and leg pack (1393). Hot immersion bath (1126
^°5°> 5 to 8 minutes, with ice to head and neck (1314).

14. Abscess. — Fomentation (1328) for 15 minutes ever
2 hours; heating compress (1344) at 60° during interval. Renei
every 15 to 30 minutes.

PULMONARY TUBERCULOSIS. IOI9

15. Visceral Inflammation. — Large hot fomentation (1328)
over inflamed part for 15 minutes every 2 hours. During the
interval, heating compress (1344^) at 60°, renewed every 15
minutes during the acute stage. Later, fomentation (1328) 3
times a day, with continuous heating compress (1344) during
intervals.

16. Threatened Gangrene. — Alternate compresses (1340)
every 3 hours, heating compress (1344) or dry heat during
intervals.

17. Typhoid State. — Aseptic diet (1626); copious water;
drinking (1423); neutral enema (1404) (95°) daily; prolonged
neutral (1130) or tepid bath (1123); graduated bath (1120)
Brand bath if no contraindications (1150^ 1489, 65). Sec
Typhoid Fever (1489, 5, 15, etc.).

PULMONARY TUBERCULOSIS.

Etiological Indications. j^q

I. Destroy sputum; avoid swallowing sputum; live in the open
air and sleep in cool, well-ventilated rooms.
Pathological Indications.

3. Increase General Vital Resistance. — Graduated cold baths
(1625), twice daily; fattening dietary; systematic exercise; out-
of-door life; cool, dry, elevated climate; very short electric-light
bath (1250) daily, or three times a week.

Clinical Indications.

4. Anemia. — Cold bath twice daily; food rich in fat and
blood-making material; easily digested foods rich in proteids, such
as kuinyss, buttermilk, purees of peas, etc., (1626, 1630, 1631.)

5. Indigestion — Anorexia. — Dry aseptic dietary (1626),
kumyss, malted cereals (1631). Wet girdle (1347); ice-bag over
the stomach half an hour before meals. See Gastric Catarrh
(1520) and Hypopepsia (1521).

6. Chill. — Rest in bed, dry pack (1192), .hot water drinking
(1429).

7. Cough. — Fomentation (1328) to chest, followed by heating
chest ])ack (1373); sipping hot water when inclined to cough.

8. Pain. — Revulsive compress (1341) 15 minutes two or three
times daily; during intervals, well-protected heating compress
(1379).

g. Ptjlm0nary Hemorrhage, Pulmonary Congestion. — Very
hot application to spine between shoulders. Ice to chest (13I4)t!
ice to hands ( 130^2). Hot leg pack (131*3)^ Keep the extremi^
ties warm. Elevate the chest and shoulders, ]

10. Fever-— Neutral pack (118!J), 15 to 20 minutes. Fre^
water drinking (1423)- Rest in the horizontal position until tbe^
daily evening temperature becomes nearly fiormah \

11. Night Sweats. — Very hot sponging (1204) at bedlimek^
la, Hypopepsia — Atonic Dyspepsia.— Daily general coldj

applications (1625); ice-bag (1314) over stomach for half an houd
before meals. |

13, Diarrhea*^ Enema (1404) at 95°, after each movement
followed by cold abdominal compress (1318) at 60°, changj
every half hour Rest in bed till checked,

14^ Cough,— Sec 1570, 4-7-

15. Laryngitis,^ See 1568.

16. Emaciation* — See 1516.

17. Contraindications, — Avoid general cold baths wheii
hemorrhage is threatened, as immersion bath, affusion and cold
sitz-bath« also Turkish and Russian baths* ^

General Method. — The great object to be kept in mind in the
hydriatic treatment of this disease is to build up the patient's vital
resistance by carefully graduated cold applications repeated two
or three times daily. The intensity of the application should be
steadily increased from day to day in order to secure good results.
No patient is too feeble to receive hydriatic treatment of some
sort, and by careful graduation persons of feeble physique but in
whom the disease is not yet far advanced may be trained to receive
very vigorous cold applications with excellent effects. In making
the cold applications care must be taken to avoid chilling of
the patient, the ill effects of which will be at once manifest by
aggravation of the cough (1625).

TUBERCULOSIS OF LYHPH GLANDS, SCROFULA.
1509 Pathological Indications.

I. Increase General Vital Resistance — Graduated cold
applications (1625); sun baths (1254); cold air baths; gymnas-
tics; out-of-door life; aseptic diet rich in fats and proteids
(1626); residence in elevated region.

WHOOPING COUGH, LITHEMIA. I02I

Clinical ladlcsilons.

2. Revulsive (1341) or alternate compress (1340) over swol-
len glands twice a day. During intervals, flannel-covered heating
compress (1344) renewed before becoming dry.

3. Suppurating glands must be treated surgically. Removal of
the glands is sometimes necessary.

WHOOPING COUQH.

1. Increase Vital Resistance.— Cold mitten friction (1209) 1510
or cold wet-hand rub (1213) three times a day.

2. To Relieve Cough.— Chest and neck pack (1373) changing
every four hours. Copious drinking of hot water (1429) especially
just before coughing paroxysm. The patient should drink three to
eight pints of water daily.

3. Neutral bath (1130) daily for a half-hour, followed by
cold mitten friction (1209) to promote activity of the skin and
kidneys.

4. The disease can not be greatly shortened, but the strength
may be maintained, suffering mitigated, convalescence facilitated,
and grave sequela prevented by the faithful employment of the
above measures, which should be continued, not only during the
active stage of the disease, but for several weeks after the begin-
ning of convalescence.

LITHEMIA, URIC ACID DIATHESIS.

Etiological Indications. IgjI

1. A spare aseptic diet (1626), especially avoiding beef
tea, animal broths, and also tea, coffee, or cocoa. Use fruits
freely. Kumyss or buttermilk is preferable to raw milk. In extreme
cases, fruit diet for a few days (1627). Out-of-door life; abun-
dant exercise; dry, cool climate; daily cold bathing.

Pathological Indications.

2. Increase Oxidation of Proteid Wastes. — Hot bath
(1126), prolonged sufficiently to elevate body temperature 2® to
4°; sweating wet-sheet pack (1191); dry pack (1192); vapor
bath (1246); hot-air (1233) or Turkish bath (1239). Electric-

1022

RATIONAL HYDROTHERAPY.

:•;/

light bath (1250), or hot fiill^bath (11*26), followed by dry pack
(1192); follow all hot baths by a short, cold application
adapted to the patient's condition, cold mitten friction (1209),
cold towel rub (1213), wet-sheet rub (1216), dripping sheet
(1217), shallow bath (1174), cold rain douche (1047). Follciir
bath by prolonged moderate exercise, or massage and manual
Swedish movements. Inhalation of oxygen; oxygen enen^x

3. Encourage Elimination of Tissue Wastes.^ — In addition
to above, water drinking (1423); free use of fruit juices aad
carbonated distilled waterj wet girdle (1347) day and nt^t;
coal coloclyster (1407) daily, if bowels are sluggish.

4. increase Alkalinity of BEood. — Ei^ercise; cold baths; cold
air bath (1470) ; sweating balhsj fruit diet (1627)-

Cllnicat iQdicstions.

5. Swollen and Painful Joints. — Fomentation (1328) two to
four times daily, heating compress (1344) during intervals, well-
protected with mackintosh and cotton or flannel covering.

6. Painfui Joints, not Swollen. — Revulsive compress (1341 ♦
three times a day, follow^ed by deep massage of limb above the
joint and light centrifugal friction (1224) of the joint; duriiiir
intervals, dry pack or cotton poultice (1388) to the joint.

7. Stiff and Enlarged Joints.^ Alternate jet or spray ( 1044,
1055) or the alternate compress (1340), followed by thorough
massage of the joint with passive joint movements, applied twice
daily, well- protected heating compress (1344) during intervak

8. Headache and Migraine-^- See 1562| 6, 7, 8, 11, u,

9. Neurasthenia. — See 1554.

10, Neuralgia, — Sec 1545,

11, Insomnia. — See 1564.

12, nuscular Pains. — See 1513.
ij. Gall Stones.-- See 1534 B.

14. Renal Colic— See 1536.

15. Irritable Prostate. — See 1594, 3.

16. Arterio-Sclerosis. — See 1577, 8*

17. Brighrs Disease.— See 1538.

18. Contraindications. — Prolonged cold baths.

General Method.^ Diminish the production of uric acid bt
regulation of diet (1626); increase the destrucfion of nric add

I
1

GOUT. 1023

by exercise, prolonged hot baths (1197, 1233, 1250), fol-
lowed by short cold applications (1209, 1213); increase elimi-
nation of uric acid by copious water drinking (1423).

GOUT.
Etiological iadicaUoas. 1512

1. Avoid meats, tea, coffee, tobacco, sometimes even milk and
eggs; take daily sufficient exercise in the open air to cause
perspiration, followed by short cooling bath. Diet.: fruits, dex-
trinized cereals, nuts, kumyss, buttermilk (1626-1631).
Pathologicai Indications.

2. Encourage Tissue Change, Especially Oxidation of Pro-
teid Wastes. — Prolonged sweating baths — vapor (12-1:6), Turkish
(1239), electric-light (1250) or hot-air bath (1233), sweating
wet-sheet pack (1187), dry pack (1192), hot-blanket pack
(1197), followed by daily cold bath, carefully given, and nicely
graduated (1625). Out-of-door life.

3. Maintain Normal Alkalinity of the Blood. — Tonic gradu-
ated cold applications (1625), free use of fruits; avoid flesh
foods, tea, coffee, and alcohol.

See Lithemia (1511).

A. Acute Form.
Ciinica! Indications.

4. Headache Water drinking (1423); enema (1404); hot

and cold cephalic compress (1358) with hot foot (1297) or leg
bath (1393).

5. Migraine. — Lavage (1401); revulsive compress to seat of
jKiin (1341); hot leg (1299) or foot bath (1297); enema
(1104); hot enema (1406); fomentation over stomach (1328);
fomentation over spine (1328); alternate spinal compress (1342).

6. Constipation. — Cold enema (1405).

7. Hemorrhoids. — If inflamed, hot fomentations (1328) to
relieve pain, followed by cold compress (1314) to anal region
and buttocks; cool enema.

8. Pruritis Ani Very hot anal douche (1087).

9. Pain and Swelling of Joints, — Elcvnte limb; cooling com-
press (1318); change soon as warm.

10. Fever. — Hot-blanket pack ^197) followed by prolonged
neutral bath (1130).

I024

RATIONAL HYDROTHERAFY-

:=■'!

I

i.<

IK Scanty Urine*-^ Water dritiking (1423) (disdlled carboi^j
ated water) (1428); enema (1404) twice dally. Sec 1537»

T3. Retrocedent Qoiit*^For coma or deJiriunif cold to hcid
and neck (1314); large enema (1404); hot-blatiket pack (H97^i
hot immersion (1126)-

13. Cardiac Com pHcat ions, Syncope,^ Hot enema (HM);
alternate compress to spine (1342)*

14. Castro-Intestinal Disturbance by Retrocession.^ F<j-
mentation (1328) over stomach; hot trunk pack (1197): liol
immersion (1126) or hot-blanket pack (1197) with healing
gastric compress (1344) during ititen^aL

15. Contraindications* — Avoid cold baths; avoid immem'ott
of affected parts in cold water, and general cold baihs.

B. Chronic Fornix

16. The general measures indicated above. Sec also 1311*

17. Increase circulation in affected parts by hot fomenutioni
(1328) followed by dry cotton pack (1388) or healing compft^'
(1344); massage, at first derivativ^e only; later, to joint itself.

18. Constipation,^ Relaxing diet; wet girdle (1347); cold
water drinking (1423); abdominal massage. M

If] Hepatic Congestion. — Revulsive hepatic compress (1341)
every 3 hours; heating compress (1344) during interval.

20. Qravel, — Copious water drinking (1423) and large enema
(1404) daily. See Uric Acid Diathesis, 1511.

21. Melancholy. — Vigorous sweating baths (1191, 1250)
followed by short cold percussion douche to the spine (1074)-
See Melancholia (1558).

22. Bronchitis. — See Chronic Bronchitis, 1570.

23. Asthma. — Scotch douche to legs (1037); large enemi
(1404); prolonged neutral bath (1130); fomentation (1328) to
chest followed by the chest pack (1373).

24. Epilepsy. — See 1551.

25. Angina Pectoris. — Fomentation (1328) over heart fori
minute followed by cool compress (1314) for 10 minutes, repeat;
hot foot bath (1297). or hot leg pack (1393); ice bag to spine
(1372); rest in bed; keep extremities very warm.

General Method. — The general methods to be pursued in this
disease are essentially the same as those applicable to the Uric
Acid Diathesis, or Lithemia, 1511.

ACUTE MUSCULAR RHEUMATISM — DIABETES 102$

ACUTE MUSCULAR RHEUMATISM.
Pathological indications. 1^13

1. See Acute Rheumatism, 1499.
Clinical indications.

2. The same as for acute articular rheumatism (1499) except
that the local applications are made to the muscles instead of to
the joints. Sweating baths (1197, 1191) especially the elec-
tric-light bath (1250) and the vapor bath (1246); long neutral
baths (1130); fomentation (1328) over painful parts followed
by the well protected heating compress (1344); water drinking
(1423); aseptic diet (1626).

DIABETES.
Patliologicai indications. 1514

1. Increase Oxidation of Sugar. — A large amount of moder-
ate out-of-door exercise, especially respiratory exercise and daily
cold baths.

2. increase Absorption of Oxys^en. — Graduated cold baths
(1625); out-of-door exercise; breathing exercises; oxygen inhala-
tion.

3. Improve Intestinal Digestion. — Cold percussion douche
(1035) to spine; short cold fan douche (1061) to abdomen; wet
girdle (1347) day and night; fomentation to abdomen twice daily;
abdominal massage.

4. Diabetic Diet. — Eggs, buttermilk, kumyss, gluten biscuit,
zwieback, fruits, except dates and figs, green peas, strawberries,
spinach, greens, nuts and nut products of all sorts except chestnuts.
Clinical Indicatltma.

5. Sciatica — Hot leg pack (1393); Scotch douche (1037);
rest in bed.

6. Rheumatic Pains. — Electric-light bath (1250) or sweat-
ing pack (1191) until patient perspires 5 to 8 minutes. Follow
by a suitable cold application.

7. Obesity. — Vigorous exercise; monotonous diet; sweating
baths (1191, 1197) three times a week; vigorous cold applica-
tions daily; dripping sheet rubs (1217); half bath (1174); cool-
ing pack (1189); plunge bath (1108).

8. Emaciation — Rest in bed; cold mitten friction (1209)
or towel rubbing (1213); massage; diet rich in fats and proteids.

1026 EATIONAL HYDROTHERAPY.

♦

9. Bolls. — Prolonged neutral baths ( 1 130);tri- weekly so*p^

shainpoo.

10. Pruritis — Prolonged neutral baths (1130) foHowed by
cold mitten friction (1209) to sound parts of skin; neutral c 010^
press (1330).

11. Somnotence — Copious water drinking (1423); hot
enema (140(J), repeated every 3 or 4 hours; prolonged neutral
bath (1130) with cold affusion (1103), 60% to head and spine M
intervals of 15 minutes. Hot-blanket pack, 15 minutes (1I9||.
followed by cold friction (1209) and dry pack (1192).

12. Constipation.— Enema (140+) at 70° daily; wet giidk
(1347). See 1524.

13. Insomnia — Prolonged neutral bath (1130) at bedtime:
neutral pack (1182), 3c> to 40 minutes; neutral spray (1051) ^
broken douche (1031), 3 to 4 minutes at bedtime.

14. Bronchitis-— Chest pack (1373); steam inhalatioa
(1419); Scotch douche (1037) to legs.

15. Pulmonary Congfestion* — See 1572.

16. Edema of Legs.— Rest in bed; cold precordial ccmb-
press (1383), ^S to 30 minutes three times daily. Revulsive eom-
press 0341) or Scotch douche (1037) to legs three times a daj,
ollowed during interval by heating compress (1344).

17. Pneumonia. — See 1498.

18. Cardiac Dilatation — Cold precordial compress (1383)
or ice-bag (1314) over heart 15 minutes three times a day; effer-
vescent bath (1 139). Carefully graduated exercises by the Scbott
method.

19. Threatened Gang^rene. — Alternate compress (1340) or
pour (1103) to affected part and large adjacent area three times
a day; protected heating compress (1344) during interval.

20. Cirrhosis of Liver. — Alternate hepatic compress (1340)
or douche (1044) twice daily. During interval, well-protected
heating compress (1344).

21. Nephritis.— See 1537.

22. Cystitis.— See 1539.

23. Eczema — Alkaline bath (1113, 1463); or neutral bath
(1130), 30 minutes twice daily; zinc ointment.

24. Thirst. — Frequent drinking of small quantities of cold
water, as half a glass every hour. Sipping very hot water.

OBESITY.

1027

25. Dry 5kiii.^ Vapor batfi ( 1 24 *J) or prolonged neutral bath
(llftOj, fuHuwcd by oil rubbing daily (1232)^ or two or three
times a week.

26, Cantraindications — H emaciated, avoid exercise aud
prolonged hot or cold baths.

General Method. — The general plan of treatment in this
disease is essentially the same as that required in the treatment of
obesity, which this disease closely resembles, but ju cases of dia-
betes accompanied by emaciation, very cold procedures, especially
cold immersions (1114), which are applicable to cases of obesity
and cases of diabetes in which the patients are flesh y, must be
carefully avoided, and the principal reliance must be placed upon
short cold procedures which build up the patlcni^s resistance while
increasing oxidation of carbon to a moderate degree* Special
attention must be given to improving the intestinal digestion, the
faulty character of which is doubtless largely responsible for this
disease*

OBESITY.
Pathologicmt indications^

1. Increase Oxidation of Hydrocarbons. — Moderately pro-
longed cold baths, especially wTt-shcet pack (1179); shallow
bath (1174); cold rain douche (1047); dripping sheet ClS17)i

I shallow bath (1174); plunge bath (1108); exercise to the extent
of fatigue several times daily. The cold bath may be advan*
tageously preceded by the electric-light bath (1250), or some
other form of sweating bath (1191, 1197) not too prolonged*
Exercise should always be preceded by a cold bath of sufficient

» duration to lower the temperature a few tenths of a degree.
Ctlnlcal Indications,

2. Cardiac Weakness,^ Cold precordial com press (1383)
(except in fatty degeneration of heartj 15 tq 30 minutes tjirce
times daily; graduated exercises, effervescing bath (1140).

3. Bronchitis. — ^See 1570.

4. Albyminuria. — See Nephritis 1&37-

5. Diabetes.— See 1514.

6. Rheumatic Pains.— Sec 1499, 5.

7. Con traitidicat ions. — Avoid prolonged hot baths unless
immediately followed by cold bath.

1515

I038 RATIONAL HYDROTHEiLArV

Oenend MettHXl. — Increase tJie consamptioD of carbon bj
prolonged cold baths (llllr) and vigorous exercise while r^ucing^
Ihe daily ration to the lowest point consistent with the mainte-
nance of the patient's strength. Tlie treatment mitst never be '
conducted in such a way as to diminish the patient's muscular or |
nervous energy. If the patient complains of feeling weak or ;
debilitated, ihc vigor of the treatment must be diminished* *
' There should be a steady gain in muscular strength accompa-
nying the los§ of flesh. The patient's strength should be deter-
mined at least weekly by the dynamometer so that his condition 1
may be exactly known. Hot baths are especially debilitating. i

EMACIATION.
1516 Ratbologlcai iadicstioos,

1. Rest in bed, fat- and blood-making diet (kumy^ss^ butter- .
milk, eggs, dextrmi^ed cereals [1630]) mailed or predigesled
cereals [1631 j); graduated tonic treatment (1625). FomenU- ,
tion (1328 J over stomach twice daily followed by wet girdle
(1347).
Clinical Indications.

2. Persistent Vomitingp— See 1519, 3.

3. Gastric Ulcer. — ^Yithhold food by mouth; rectal feeding;
fomentation (1328) over stomach twice daily; well-protected
heating compress (13*1:4) during interval. Graduated hydriatic
treatment. See 1625.

4. Chronic Gastritis. — Rest in bed; abdominal fomentations
(1328), 2 to 3 times daily; protected healing compress (1344)
during interval. See 1520.

5. Intestinal Catarrh — Enema (1404) at 95° after each
stool. During interval heating compress (1344) at 60°, chang-
ing every 30 minutes. See 1529.

%. Hypopepsia — Graduated tonic treatment (1625); ice-bag
(1314) over stomach half an hour before each meal. See 1521,

7. Hyperpepsia — See 1522.

8. Diabetes See 1514.

9. Insomnia — See 1564.

10. Tuberculosis See 1508.

11. Chronic rialarial Infection See 1490.

12. ChronicBronchitis.— See 1571.

i

RACHITIS — SCURVY. 1029

13. Asthma. — See 1671, 4.

14. Drug Habits See 1612.

15. Pelvic Disease.— See 1586-1592, 1696.

16. Rachitis — See 1617.

1 7. Scurvy, Purpura. — See 1518.

18. Contraindications. — Avoid prolonged hot baths and cold
immersion baths.

General Method. — The general plan of treatment must be
such as to secure increased income of tissue-building material with
a diminished outflow, hence the diet must be very simple, easily
assimilable, and taken in as large a quantity as possible. Exercise
must be diminished, or in grave cases suspended altogether. Mod-
erate exercise may be allowed if necessary to maintain the appe-
tite. Special attention must be given to increase of the appetite
and improvement of digestion by suitable hydriatic applications.
Cold applications must be very short and intense, sp as to produce
strong nervous impressions upon the nerve centers without to any
considerable degree removing animal heat or increasing oxidation.

RACHITIS. RICKETS.
Pathological indications. 1617

I. Increase General Vital Resistance. — Carefully graduated
hydriatic treatment (1626) applied twice daily; aseptic dietary
of substances rich in fats and proteids. Massage (1461); oil
rubbing (1232); sun baths (1264); out-of-door life.

SCURVY, PURPURA.
Pathological Indications. 1618

1. Increase General Vital Resistance. — Neutral bath
(1130) three times a week, 30 to 60 minutes; cold towel rub
(1213) carefully administered twice daily; gentle massage.
Aseptic dietary (1626); abundance of fruits, kumyss, butter-
milk, dextrinized (1630) and malted foods (1631).

Clinical Indications.

2. Local Pain. — Alternate sponging (1204) or compress
(1340); fomentation (1328), followed by heating compress
(1344); rest in bed.

3. Edema. — Alternate compress (1340) or spray (1055);
leg pack (1393); dry bandaging. Centripetal friction(1221).

lO^O RATIDKAL HYDROTHEttAl'V,

ACUTE GASTRIC CATARRH,
1519 Etiofogicai Indicsiions.

1. Rest-^ Withhold foot! if necessary, admimstenug food and
water by enema for several days (1404:)-

Patbtitogical indications. ^

2, Combat Local Inflaniniatiafi* — Fomentation (1338) fftf
15 rainutes over stomach and bowels every 2 hours. Darm£
intervals, heating compress (1344) at 60**, changing every |o
minutes. Hot foot bath (1S97); hot leg pack (1393),

i?Sr

Ciinical indications.

3. Vain iting*— Ice bag (1314) to epigastrium; hot anrf^

gastric compress (1362); hot and cohl trunk pack (13C7)£
ice (1372) to spine opposite stomach; careful lavage (1401)^
vomiting is persistent and rejected matters oflfensive,

4. Pain, ^Revulsive compress (1341) 10 minutes every how.
Heating compress (1344) during interval. m

5. Peven^ Jlot-blanket pack (1107) 20 minutes, foUowcd l»^
cold half pack (1 136); prolonged neutral bath ( 1 1 30) ; cooJia|
pack (1189), following fomentation (1328) over stomach.

6. Contraindications. — Cold immersion baths and general
cold douche.

CHRONIC QASTRITIS,

1520 Etiological indications.

1. Avoid causes, as, mustard, pepper, vinegar, strong acids,
even acid fruits; sugar, preserves, cheese, alcoholic beverages,
tea and coffee, all indigestible and irritating substances, coarse
vegetables, pickles, confectionery, and hasty eating.

2. Physiological Rest — Avoid the use of fish, fowl, game,
and all flesh foods, which excite the secretion of HCl and remain
long in the stomach. Coarse vegetables, fried foods, fats, except
in a natural emulsified condition, large meals, tea, coffee wines,
and all liquors are to be avoided.

Patliologicai indications.

3. Increase General Vital Resistance. — Graduated cold

baths (1625) twice daily.

4. Combat Local Congestion. — Gastric fomentation (1328)

CHRQNtC GASTRITIS.

1031

three times daily, 15 min*; during intervals, heating compress
(1344j. Hot leg pack (1393) followed by heating compress
[(1344) to legs; Scotch douche (1037) to legs; hot leg bath
(129fl)j followed by cold friction (1209) to legs* In acute exac-
erbation !j. withhohl all food, rest in bed.

Clinical Indlcmtlons.

5. Mucus Vomiting in JVlorfiing,— Omit the evening meaL

Fomentation (1338) over stomach in eveniug followed by heating
compress (1341) to be worn during the night; lavage (1401)
at bedtime.

6. Vomiling Soon after Eatinjc* — Hot and cokl gastric com-
press (1363) or trunk pack (^13B1) half an hour before eating,
10 be retained 2 hours ; dry food in small quantity; rest in bed
after eating; ice-bag to spine after eating,

7. Qaseoys Eructations.-- Lavage (1401) once or twice a
week; dry diet of predigcsted cereals (1630). Cold compress
(1814)^ heating compress (1344) over stomach at iio^, changing

' every 4 hours. Massage for half an hour z hours after ealingt
if local irritation or tenderness does not contraindicatc. Drink
pint of hot water half an hour before eating* Avoid use of veg-
etables, or of vegetables and fruits at same meal.

8. Abdominal Tympanitis, — Abdominal heating compress
(1351), 60"^, changed every 4 hours; large soap enema (1404) or
coloclystcr (1407) two or three times a week» at 70^.

9. Constipation, — Graduated cold enema (1409) lo"*, daily.
Abdominal massage; wet girdle (1347); cold douche to abdomen
(1081), fan (1061) or broken jet* (1010), ao seconds; cold
rubbing sitz (1309).

10. Hepatic Congestion,^ Fomentation (132H) over liver
twice daily; during interval, continuous heating compress (1344)*

11. Emaciation. — Rest in bed; mild tonic hydriatic treat-
ment, carefully graduated (1625)* Ice-bag (1314) over stom-
ach half an hour before eating. See 1516*

13. Pain in Stomach. — Revulsive compress (1341) over
epigastrium; repeat several tinics daily if necessary. Avoid acid
fruits, very hot foods, very cold foods, and concentrated sweets if
they cause pain.

F

1032 RATIOKAL HYDROTHERAPY

HYPOPEPSIA AND APEPSIA*
1 PattQtfigical Indications*

t. Increase Ocneral Vital Resistance Graduated to

hydriatic ircaiment (1625) twice daily; out-of-door life^ cold-iu
bath (733, 1470); swimming, M

2. Increase Activity of Qastrlc Olands.- — Cold fan douclJS^
(1061) over stomach; cold pcrcussioa douche (1035) to dorsal
spine; general cold douche (1010) or other cold procedure
(1625); wet gird!e (13+7); external and mtemal galvanism oi
stomach. Drink a third of a glass of cold water half an hour
before eating. J

3. Increase Motility. — Cold gastric douche (1094) 3 hoal^
after meals; small cold enema, retained, three to four hours after
eating; abdominal massage; manual and mechanical Swedish move-
ments; galvanization of cervical and abdominal sympathetic ^
Clinical Indications. f

4. iitdigestiofit BiliousnesSp — Hydrochloric acid being ab*
sent, flesh meats must be withheld. Aseptic diet (I62C); avoid
fried foods, rich gravies and animal fats, which lessen the secit-
tion of HCl (Pawlow), cane sugar, and concentrated sweets. Hot
applications over the stomach an hour after eating.

5. Loss of Appetite, — Ice-bag over stomach half an hour
before each meal; hot and cold gastric lavage (page 886); cold
mitten friction (1209) before breakfast; repeat before dinner if
necessary; small cold enema (1404) or cold rectal irrigation
(1410) before breakfast.

HYPERPEPSIA,
1522 Etiological Indications.

1. Avoid irritating food substances, mustard, i>epper, spices,
condiments of all sorts, flesh foods of all sorts, excess of proteids,
hot foods, mushes, farinaceous and sweet desserts, frequent meals.

Pathological Indications.

2. Increase General Vital Resistance. — Graduated tonic
hydriatic treatment (1625) twice daily.

3. Combat Irritation of Gastric Glands, or liypersecretlon.

— Revulsive compress (1341) twice daily, an hour before meals;
continuous heating compress (1351) without mackintosh during

interval. Avoid cold douche over stomach and spine opposite,
and prolonged cold baths. Hot douche (1024) or fomentation
over stomach and spine opposite 3 to 4 times daily. Hot immer-
sion bath (1126) at 105° for 15 minutes, or electric-light bath 10
minutes, half an hour before dinner. Follow by cold mitten frictLon
(1209)p Sip half a glass of hot water half hour before eating*

4. Combat Toxemia. — Sweating procedures; clectric-light
bath (1250); sweating pack (1191); vapor bath (124C); pro-
longed neutral bath (1130); follow hot baths by short cold
application, as a wet-sheet rub (1216), cold towel rub (1213),
cold shower (1047), douche with broken jet (1010)* Water
drinking (1123)» Enema (1404) daily for a wxek or two, 70°^
injecting a second portion to be retained.

5. Flatylence of Stomach and Bowels,— Cold abdominal
compress (1318^, changed every 4 hours; cold enema, following
fomentation for 15 minutes twice a day,

6. Painful Digestion,— Hot fomentation (1328) an hour
after eating for 15 minutes, followed by heating compress (1344)
to be worn until next meaU

7. Gastric Irritation witli Vomiting After Eating, — Hot
and cold gastric compress (1362) or hot and cold trunk pack
(1307) applied half an hour before eating and continued for 2
hours.

8. Contraindications. — Cold douche over stomachi cold
shower^ and prolonged cold baths of all sorts.

DILATATION OF THE STOMACH.
BiM^cai indlcattonB,

Aseptic diet (163ft); avoid overeating, frc^iucnt eating, and
gas- forming foods» also drinking large quantities at once. Give
very simple dry dietary of well-dextnnized (1630) or prcdigested
(1631) cereals or liquid diet.— kumyss, acid buttermilk, purees,
or gruels prepared from prcdigested cereals, nut creams or emul-
sions.
Pathoiogicmi indicmtions.

I. Combat Gaseous Distension of Stomach.-- Lavage
(1401) at regular Intervals as required to prevent food accumu*
atioii. Cold gastric compress (131i) without impervious cover-

1623

J

1034 RATIONAL HVDRQTHERAPY.

ing, changed every 4 hours; cold fan douche (1061) over stoitud^.
twice daily. fl

2. Increase General Vital Resistance^ Comtmt Autointoii-
cation. — Shorl sweating baths, — electric-light bath (12^0),
sweating wet-sheet pack (1187); hot immersiofi <'I12I») 4 lo 6
minutes, at 105°; hot-blanket pack (1197); hot enema (1405),
Follow each hot bath by a tonic application (1625).

Cfinical tttdicsitoas.

J. Vomiting.— Lavage (1401); withholding food; if pem
ent, feeding by nutrient enema; ice-bag (1314) over stomach and

to spine opposite.

4. Pyrosis.— Hot water drinking tl429) before retiring it
nigM; fomentation (1328) over stomach at bedtime, with »tt
girdle (1347) overnight; sipping half a glass of very hot wat^r
on rising in the morning, A few ounces of orange juice or otjjfr
natural, nnsweetened fruit juice a half-hour before eating.

5. Enteroptosis*^ Massage with replacement" of viscera^ elec-
tricity to abdominal muscles; manual Swedish movements to
strengthen abdominal muscles; cold fan douche (1061) to abdo*
men] abdominal supporter.

6. Constipation .^ — Graduated coM enema (14 CHI) ; colddoudir
(1010) to abdomen; wet girdle (1347); regularity at stool.
Sec 1524.

6. Pain, — Fomentation over the abdomen (1328) followed by
heating compress (1344), protected by flannel only.

Complications.

7. Neurasthenia. — See 1554.

8. Hysteria.— See 1553.

9. Delirium.— Hot-blanket pack (1197) followed by cold
mitten friction (1209); heating wet-sheet pack (1183), suc-
ceeded by dry pack (1192); lavage (1401); coloclyster (1407).

10. Coma. — Lavage; coloclyster; hot and cold head compress
(1358); hot and cold to spine (1342); hot-blanket pack (1197):
hot enema (1400); ice-cap (1323); cold towel rub (1213) or
cold mitten friction (1209).

11. Cardiac Palpitation — Lavage (1401); ice-bag (1314)
over heart 15 minutes every hour.

12. Aortic Palpitation. — Rest in horizontal position* ice-bag

CONSTIPATION. 1 035

(1314) over aorta; abdominal supporter when on feet; enema
(1404) if colon is distended; gastric lavage (1401) if the stom-
ach is foul.

13. Anorexia — Graduated cold baths (1626); wet-sheet pack
(1179) once or twice a week; short electric-light bath (1250)
two to three times a week; sun bath (1254) daily; cold-air bath
(733, 1470) daily; ice-bag over stomach half an hour before
meals; cool sitz (1305); general and abdominal massage; manual
Swedish movements; application of faradic or sinusoidal current
to principal groups of muscles so as to cause contraction.

14. Hiccous^h. — Lavage (1401) when due to gastric irritation
and stasis of food. Faradization, one electrode to spine, the other
below ribs, right and left sides, of sufficient strength to contract the
muscles strongly. Continue 5 to 15 minutes. Slowly sip half a pint
of iced carbonated water; hold breath for half a minute; pressure
with hands over the stomach, forcing the viscera up against the
diaphragm. Hot and cold gastric compress (1362); ice-bag to
back of neck; ice pills; ice-bag to epigastrium (664).

CONSTIPATION.

I. Increase Peristaltic Activity. — Drink half a pint to a 1524
])int of cold water before breakfast, preferably carbonated water.
Increase bulk of food, with free use of fruit, esi>ecially apples,
oranges, and figs. Granose is especially to be commended; also
nut ])roducts, malted nuts, cereals, bran cakes, and figs. Small
cold enema (1404); graduated enema (1409); fomentation
(132H) over liver twice daily followed by heating compress
(1344) during interval. Wet girdle (1347) at night. Abdomi-
nal massage. Cold fan douche (1061) to abdomen; cold per-
cussion douche (1035) to spine. Cold plantar douche (1083)
I to 3 minutes; cold rubbing sitz, 70° to 75° (1309), 5 to 20 min-
utes. Avoid complete emptying of colon, using small cold
cncnia instead of a 'large quantity of warm water, except when
necessary to relieve autointoxication, or remove hardened or im-
pacted feces. If necessary, introduce into rectum, as high as
possible, at night or before breakfast, to be retained till next
stool, a small i)ledget of cotton saturated with raw linseed oil or
with glycerin.

1036 RATIONAL HYDROTHERAPY.

2. Increaiie Activity of Intestinal Qlands,— Ha]f a pint
a pint of water at bedtime, to be retained overnight: abdomiiul
massage; wet girdle^ without mackintosh (1347)* Bftracic teid
powder before breakfast, introduction of absorbent cotton satttr-
ated with oil or glycerin at night or before breakfast,

3. Remove Accumulated F^:al Hatters.^ — Large hot enessa
or coloclyster; neutral enema; warm soap enema; oil enema;
g! y ce ri n enem a ( one pa rt gly c eri n to four w ate r ) (1 404 -
Repeat the application till bowel is thoroughly emptied, then injeet
a pint of water at 70° to 60*^ to tone the bowel.

4. Dilatation of Colon. — Graduated enema (1409); cold fan
douche (lOGl) to abdomen and spine opposite; running cold fool
bath (1296); cold rubbing sitz (1309); cold wet girdle, withont
mackintosh (1347)> changing every 4 hours,

5. Increase Strength of Abdominal fluscles -Cold fao

douche (1061); cold plantar douche (1083); percussion
abdominal douche (1081); cold abdominal compress (I31Sk
renewed Qycry 4 hours, without impervious covering; stnusoidJ
electricity; massage; special exercises^ particularly head raising
and legs raising while lying upon the back.

6. Emeroptosis— Restore prolapsed bowels to positioi];
strengthen abdominal muscles as indicated above; correct sitting
position; abdominal supporter; replace viscera daily. See 1525.

7. Hemorrhoids. — Long cold sitz bath (1305); cool anal
douche (1087); cold anal compress (1395); small cold enema
(1405); if inflamed, rest in bed, fomentations over the nates fol-
lowed by cold compress (1395). Repeat fomentations every
3 hours. Surgery if necessary.

8. Pain. — If due to fissure ^ hot applications; sitting over
steam. If due to irritable reciumy hot irrigation (1410). For
pain in the abdomeny revulsive compress (1341); Scotch
douche (1037); hot enema at 110°, followed by small cool enema
(1404); revulsive sitz (1311>^).

9. Relieve Spasm of Sphincter Ani iluscle Prolonged

neutral (1312) or hot sitz bath (1311); warm rectal irrigation
(1410); hot rectal irrigation (1410); fomentations (1328) over
the nates. Dilatation sometimes required.

10. Restore Sensibility of Rectum.— Alternate irrigation of
the rectum (1410); cold douche to lower spine and nates (^1076)-

ENTERO PTOSIS.

1037

Shallow cold sitz (1305); cold anal douche {108?} J alternate
anal douche (1046); sinusoidal electricity to rectuoi*

II. Contraindications* — Sweating baths sometimes induce
constipation (1170)1 also abuse of the fomentation and the
habitual use of the warm enema, which should be strictly avoided.
II the enema is used daily ^ the temperature, at least at the con-
clusion, should be 65° to 75% so that a tonic effect may be secured.

Qetieral riethod. — Each case must be carefully studied wiih
reference to the leading cause or causes which arc operative in
the individual case. Most important of these are, — a paretic or
atonic condition of the intestine through disturbed or defective
innervation* diminished intestinal secretion or an abnormal absorp-
tion of intestinal secretion resulting in unusually dry and solid fecal
mass; dilatation of the colon, giving rise to accumulation; relaxation
and weakness of the abdominal muscles with lowered intra-ab-
dominal tension; hemorrhoids and other diseases of the rectum;
prolapse of the colon and other abdominal viscera; loss of normal
sensibility of the rectum; spasm of the anal sphincter*

ENTEROPTOSIS.

Etiological indications. 15«5

t. Correct sitting and standing positions; corrective gymnastics
and manual Swedish movements; sintisoidal electricity to muscles

of the trunk* Avoidance of waist constriction by belts, corsets, or
heavy skirts* Cold fan douche (1061) to abdomen; cold plantar
douche (1083).

Pathoiogicai indications.

2. Replace the Viscera, ^Replace viscera daily by abdominal

massage, genu- pectoral position, inspiratory liftings etc; abdominal
stspporter; combined support of abdomen and shoulders* '

3. Strengthen the Abdamlnal Muscles,^ Cold fan douche
to abdomen (1061); cold plantar douche (1083; special exer-
ciseSi particularly raising head, both legs, head and legs simulta-
neously or in alternation, inspiratory lifting; knee-chest position;
electricity, applied so as to cause rhythmical contraction uf ab-
dominal muscles, preferably the slowly alternated sinusoidal cur-
rent; swimming; Swedish gymnastics; abdominal massage.

L

-M

' I
1

1038 RATIONAL HYDROTHERAPY.

CiiiilGai indlcatioBS.

4. Abdominal Tenderness and Discomfort Fomentadcm

(1328) twice daily; wet girdle (1347); abdomina] supporter;

hot enema fallovvcd by small cold enema (1404)*

5. Indigestion. — Aseptic dietary (1636); massage to empty
the stomach 2 hours after eating. Massage (1461) when required.
See Hypopepsia and Dilatation of Stomach (1531| 1^33).

6. Pain between Shoulders,— lamentation (1338) to back;
gastric heating compress (1344); abdominal supporter.

7. Backache — -Fomentation (1328); revulsive compress
(1341); alternate sponging (1206) or compress (1340^); beating
-spinal compress (1353); Scotch douche (1037); abdominal
supporter.

S. Neurasthenia-^ See 1554.

9. Headache,— See 1554, 11-15, 1563.

10. Mysteria— See 1553,

11. Nervous Asthma. — Hot enema ( 1406); hot water drink-
ing (a pint or more); fomentation to abdomen (132S); foraentA-
tion to back; wet girdle day and night (1347); hot and cold Inmk
pack daily (1367); abdominal supporter; galvanism to abdomi-
nal sympathetic; abdominal massage with replacement of viscera.

12. Constipation. — Graduated cold enema (1409). See 1524.

General Method. — General tonic treatment to improve inner-
vation ; special massage to restore viscera to position ; a properly
adjusted abdominal supporter; special gymnastics for exercising
the abdominal muscles; the daily application of electricity as a
means of passive exercise of the muscles of the abdomen and loins;
and the cultivation of an upright and forcible attitude in sitting
and standing, the abdominal muscles being well drawn in, are the

' essential features of the rational method of dealing with this

^ > disorder.

; { GASTRIC ULCER.

1 1526 Etiological Indications.

I. Rest in bed; rectal feeding for 2 weeks, repeating after a
^\ few days if necessary; bland aseptic liquid diet (1626f 1628);

I avoid solid food, condiments, flesh foods.

I

k . : 1 1

NERVOUS DYSPEPSIA. IO39

Pathological Indications.

2. Revulsive compress (1341) three times a day, heating com-
press (1344) during intervals; hot fomentation (1328) or hot
douche to spine (1074).

Clinical Indications.

3. Pain. — Revulsive compress (1341); gastric fomentation
(1328); heat to spine (1335); hot-blanket pack to hips and legs
(1393).

4. Vomiting:. — Ice pills; carbonated water; lavage (1401) if
stomach is foul and no recent hemorrhage.

5. Heinorrhas:e. — Rest in bed; ice-bag over stomach; hot hip
and leg pack (1197). Withhold foods and drink by stomach,
administering water and food by enema.

NERVOUS DYSPEPSIA.

Pathological Indications. 1527

1. Irritation of Solar Plexus and Abdominal Sympathetic.

— Fomentation (1328) twice a day; during interval, apply heat-
ing compress (1344), changing every 4 hours, except during
sleep. Abdominal compress (1351) during the night; dry band-
age (1353) during the day; abdominal supporter when enteropto-

sis exists.

Clinical Indications.

2. General Weakness. — Graduated cold baths (1625) twice
daily; percussion douche to spine.

3. Heartburn. — Dry aseptic dietary (1626); gastric fomenta-
tion ( 1328) followed by heating compress (1344).

4. Eructations and Regurs:itatlon5 of Food. — Fomentation
(1328) over the stomach twice daily; continuous heating compress
(1344) during the interval, without impervious covering, renewing
every 4 hours.

5. Spinal Irritation — Fomentation (1328) at night followed
by heating spinal compress (1355) to be worn during the night;
wet girdle (1347).

6. Cold Extremities. — Scotch douche (1037); running cold
foot bath (1296); leg pack (1393); massage (1461).

\

-,b-

1040 RATIONAL HYDRDTHEHAPV

7. Headacbe. — Hot and cold head compress (1358); alter-
nate spina) sponging (1342), cool compress if congestion is pees- I
ent; massage to head and neck,

8. Anorexia. — Ice-bag over slomacli half an hour before
eating; cold spinal douche (1074) j cold air bath (733^ 14itt);
out-of-door life; small cold enema before breakfast, retained.

9. Abdominal Weight and Tenderness. — Abdominal ^iip^
porter; hot fan douche (1063) to abdomen; hot foot bath (1297);
revulsive sitx (1308); fomentation (1328) twice daily^ followed
by healing compress (IS'fM-

10. Excessive Ferlsta ", — Hot and cold abdominal com-
press (1356); abdominal for en la ti on twice daily, followed by wet
girdle (1347) protected wii mackintosh; abdominal supporter.

11. Asthma. — Nervous or reflex asthma^ is commonly asso-
ciated with dilated or prolapsed stomach, and irritable lumbar
sympathetic ganglia. The most important palliative measures art
the hot and cold trunk pack (1367); fomentation (1328) over I
abdomen twice daily, followed by heating compress (1344) to be
worn during intervals; hot enema (1406); hot immersion bath
(1126); general tonic treatment (1625); Scotch douche to leg^ ■
See Enteroptosis (1525) and Dilatation of the Stomach (la23V

General Method. — The general method consists in improving
the nerve tone, allaying general nervous irritability, lessening
gastric irritation and improving the general nutrition by the appro-
priate measures as indicated above.

ACUTE QASTRO-INTESTINAL CATARRH IN CHILDREN,
1528 CHOLERA INFANTUn, SUMMER DIARRHEA

1. Withdraw all food; hot-blanket pack (1197) till skin is
reddened; follow by cold mitten friction (1209) or cold wet-hand
rubbing (1213). If temperature is high, heating wet-sheet pack
(1183), repeated if necessary. Rest in bed.

2. Persistent Vomiting. — Gastric lavage (1401); ice-bag
(1314) to stomach.

3. Frequent Stools. — Hot enema (1406), at 105^ to 110°
after every stool; fomentation (1328) to abdomen every 3 hours,
followed by heating compress (1344), changing every 20 minutes.

4. Pain in Abdomen. — Revulsive abdominal compress (1341)
for 15 to 20 minutes every hour or two.

CHRONIC INTESTINAL CATARRH. IO4I

5. Collapse. — Hot-blanket pack (1197) until warm, followed
by prolonged neutral bath (1130) at 92** to 95°. Hot water
drinking (1424); large warm (98°) enema (1406).

CHRONIC INTESTINAL CATARRH, CHRONIC DIARRHEA.
Pathological Indications. 1529

1. To Lessen Congestion. — Rest in bed. Enema (1404),
95°, after each stool, followed by half a pint of cold water.
Fomentation (1328) to abdomen twice daily, 15 minutes; during
interval, heating abdominal compress (1351) renewed every 2
hours. The heating compress should be covered with flannel
only.

2. To Discouras:e Bacterial Qrowtli. — Aseptic dietary, espe-
cially fruit juices, purees, dextrinized cereals, kumyss, beaten
eggs. Cleanse colon by large hot enema daily, following by small
enema (pint) of gallic or tannic acid solution (dram to pint).

3. To Combat Weakness and Autointoxication. — Short
sweating baths, 3 to 8 minutes, and graduated cold baths (1625).

Clinical Indications.

4. Pain in Abdomen with Tenderness. — Fomentation (1328)
to abdomen every 2 to 3 hours; hot enema (1406), no**, after
each stool; heating abdominal compress (1344) after each hot
application, to be changed once an hour until the next hot
application is made.

5. Gas in Intestines See 1520, 8.

6. Gastric Symptoms — See 1520-1523.

7. Neurasthenic Symptoms. — See 1554,

8. riucous Stools — Large hot enema (1404) at 95° fol-
lowed by small cold enema (1405); cold abdominal compress
(1318) changed every hour. Revulsive sitz (1308) or compress
to abdomen (1341); Scotch (1037) fan douche (1061) to
abdomen.

9. Frequent Stools. — Abdominal compress as above; prolonged
cool sitz (1309) at 75°, 15 minutes, followed by short hot
affusion (1103) to spine, and wet-sheet rub (1216).

10. Alternating Constipation and Diarrhea. — Large warm
(98°) soap enema (1406), or coloclyster (1407), once or twice
a week; follow with small cold enema (1405); wet girdle (1347).

4 »

4r

:.i

.1 ^.

IK Contraindications* — Cold
compress, prolonged fomentations.

General flethod^— Increase the general vital resistance and
improve gastric conditions^ regulating the diet so as to render tht
Intestme an unfavorable habitat for the bacteria which coasdttile
the chief cause of this disease; remove bacteria and masses of
mucus and pseudo membrane by neutral enemas ( 1404), and follow
by small enemas of gallic or tannic acid solution, which destroy
the germs associated with this disease.

1630 ACUTE dysentery; COLITIS.

r. Free water drinking (1423); an aseptic dietary; no animai
broths or meat preparations (1(126)* Browned rice, kumiss,
buttermilk, fresh ripe fruit, fruit juices, with well'dexirinized cereals
(1B30), arc proper foods.

t. To Combat Visceral Inflammation. — Hot-blanket pack,
(1197) ^vith hot hip and leg pack (1197), followed by heating
abdominal compress (1344)> 60"^, changed every 20 to 40 minutes;
ice suppositories if the inflatnmation extends into the rectuoL
Cold sitz (1305), 75 ^ 15 to 30 minutes, with hot foot bath
(1297). Cold irrigation of the rectum (1410). Rest in Led

3. To Relieve Pain. — Very hot i)elvic pack, with hot fo<>t
bath (1297); very hot enema (1406), no^ followed by cold
rectal irrigation (1410); repeat hourly if required.

1631 CHRONIC DYSENTERY, CHRONIC COLITIS.

Rest in bed; aseptic dietary (1626); graduated cold baths
(1625) twice daily; cold rubbing sitz (1309); hot revulsive sitz
bath (1311) 6 to 10 minutes daily, immediately preceded by a
hot enema (1406).

If much pain is present, revulsive sitz (1308, 1311) once or
twice a day. Moist abdominal bandage (1347).

1532 CHOLERA HORBUS.

1. Secure physiological rest of stomach and bowels by with-
holding food. Rest in bed.

2. Vomiting.— Ice-bag (1314) over stomach. Ice pills; ice
compress to the throat. (1314). Fomentation (1328) to spine;
ice-bag (1314) to spine; hot and cold trunk pack (1367);
lavage (1401).

I

1533

APPENDICITIS — JAUNDICE. I O43

3. Diarrhea. — Hot enema (1406) after each stool; fomenta-
tion (1328) over abdomen every 2 hours, duration 20 minutes
during interval, heating compress (1344) at 60*^, renewed every
30 minutes. If the temperature is above 102*^, prolonged neutral
bath (1130) or hot-blanket pack (1197) followed by cold friction
(1209) or cold towel rub (1213).

4. Collapse. — Hot-blanket pack (1197) 15 minutes, followed
by cold mitten friction (1209).

5. Cardiac Weakness — Ice-bag (1314) over heart.

APPENDICITIS.

1. Withhold food. Rest in bed. Large hot enema (1406),
repeated every 6 hours; fomentation (1328) 15 minutes every hour;
during interval, heating compress (1344) at 60°, changed every
10 minutes. As inflammation is subdued, prolong interval between
fomentations, and change cold compress less frequently. Fomen-
tation at night followed by heating compress over affected region
(1344) for several months, if necessary.

2. Intestinal Obstruction. — Large hot coloclyster (1407);
hot bath (1126). If speedy relief is not obtained, surgical
measures should be employed.

JAUNDICE. 1534

A. Catarrhal Form.

1. General. — Cold mitten friction (1209); cold towel rub
(1213); rest in bed; aseptic diet (1626).

2. Pain. — Fomentation (1328) over stomach and liver for 15
minutes every 2 or 3 hours; during interval, heating compress
(1344) at 60°, renewed every 30 minutes. Copious hot enema
(1406), 1 10°, twice a day. After discharge of hot- water, an enema
of one pint water at 70°. Hot trunk pack (1197); hot immmer-
sion bath (1126) 104°, 10 min.; cold towel rub (1213), or wet
sheet rub (1216).

3. Fever. — Sweating wet sheet pack (1191); vapor bath
(1246); electric light bath (1260); copious water drinking
(1423).

4. Headache. — Hot and cold head compress (1358); evapo-
rating head compress (1324); cold cephalic compress (1371);
hot sponging (1204) of back of neck.

5. Itchins:- — Neutral saline bath (1464); hot sponging (1204).

1044 RATIONAL HYDROTHERAPY.

6, Chtll,^ Hot water drmkirig {I43»); dry pack (II»S>

7. Gastric Catarrh, — See Chronic Gastritis 152IK

B, Biliary Colic ^Gall-stone.
1. General — Fruit diet ( 1637); water driaking (14lJ8);lM
aseptic dietary (1628)^

3. Palo.^ — Revulsive compress (13il) every two hours; coo*
tiauous hot applicatioas to hepatic region; hot coloclyslcr ( 144i)p
or enema (1406), every 2 hours; hot irumersion bath (ll^IG)*

3. Fever,— Prolonged neutral bath UlSOj; hot blanket pack

(1197) followed by wet i pack (1210); coid tiiittcii friction

(1209) or cold towel n^h ;12I3)*

4. Nausea and Von — Lavage iHtlt ) if peraUtcai. Sec
1519, 3

5. After acute attack, ad inister treatment for G astro- itit^d*
nal Catarrh. See 1529.

CIRRHOSIS OF THE LIVER,

1535 BiioiQgicai iadicatlOBS.

1. Avoid tea, coffee, tol ceo, alcoholics, couditnents. Asep-
tic dietary (1626)-

PaiHotogicai ittdicstioas.

2. Organic Changes in Liver.^ Alternate douche (I0I4)#

alternate compress (1340); Scotch douche (1037); flannel-cov-
ered heating compress (1344). Follow local application by gen-
aral douche (1010,) or wet-sheet rub (1216).
Clinical Indications^

3. Pain. — Fomentation (1328); revulsive compress (1341)
or douche (1041), with hot leg bath (1299) or pack (1393)
followed by compress (1344), twice a day.

4. Jaundice. — Wet sheet pack (1179) followed by wet sheet
rub (1216); electric-light bath (1250) followed by graduated
shower (1047) or wet-sheet rub (1216).

5. Dropsy. — Scotch douche (1037) to legs and abdomen;
trunk pack (1349); strong faradic application to abdomen.

6. General Weakness. — Carefully graduated tonic baths
(1625); neutral bath (1130); neutral galvanic bath (1451);
sun baths (1254); out-of-door life.

7. Contraindications. — Cold immersions and very cold gen-
eral or prolonged cold douche.

RENAL COLIC — ACUTE NEPHRITIS. IO45

RENAL COLIC.

1. During Attack — Rest in bed; diet of fruit (1627), kumyss, 1636
or buttermilk; hot water drinking (1423); hot enema (1406),
repeat every two hours; hot immersion bath (1126) cold to head

and over the heart, if the bath is greatly prolonged; hot trunk pack
(1197) renewed hourly; revulsive sitz (1308); cold precordial
compress (1383) if heart is weak or much excited.

2. To Prevent Attacks.— Combat lithemia. See 1511.

3. Vomiting:. — Ice pills; ice to throat.

4. Urinary Suppression. — Hot-blanket pack (1197) followed
by dry sweating pack (1192).

ACUTE NEPHRITIS.
Pathological Indications. I537

1 . Relieve Renal Congestion. — Congest the skin by means
of the hot trunk pack (1197), hot-blanket pack (1197), or hot
immersion bath (1126) continued to perspiration, followed by
friction, avoiding deep massage procedures. Rubbing until
vigorous perspiration is induced. Maintain active cutaneous circu-
lation; fomentation to loins for 30 minutes every 3 or 4 hours,
heating lumbar compress (1344) during interval.

2. Encourage Renal Activity. — Ice-bag (1314) over lower
third of sternum; hot enema (1406); hot water drinking (1429);
prolonged neutral bath (1130).

3. Encourage Elimination of Toxins. — Hot (1406) or cold
enema (1405) twice daily. Prolonged hot-blanket pack (1197);
sweating wet-sheet pack (1191); electric-light bath (1250); vapor
bath (1246); copious water drinking (1423).

Clinical Indications.

4. Nausea. — Hot and cold gastric compress (1362); ice-bag
over the stomach (1314); sipping very hot water (1429).

5. Diet. — Fruit juice; fruit purees; buttermilk or kumyss.

6. Cardiac Weakness. — Ice-bag (1314) over heart for 15
minutes every 2 hours; cold mitten friction (1209); cold towel
rub (1213) 2 or 3 times daily.

RATiOKAL HYDROTHERAPY.

V

Iv

Ji

7, Contraindications. — Prolonged general cold applications.

Brand b^ith, cold douche, cold affusion,

Oeneral Method. — Absolute rest in bed; raaintaiDiiig a w^ra
and active skin even to the extent of perspiration; an aseptic,
liquid dietary (1638) to encourage free diuresis^ copious water
drinking.

CHRONIC NEPHRITIS, BRIGHT'S DISEASE.

1538 I, General-^ Aseptic dietary (1626); especially avoid meats
and condiments; buttermiik or kumyss diet or exclusive fruit diet
(1627) during acute attack; tea, coffee, tobacco, and alcoholic
Hqnors to be strictly avoided.

2. Maintain activity of skin by warm woolen clothings drf
friction (1221 )i applied daily; cold mitten friction (1209) fol*
lowed by dry friction (1221)i oil rubbing (1232)* CarefnUi
graduated cold applications (1625). Electric- light bath (1250}
followed by cold towel rub (1213). Sweating batb (1 197 ) twi»
a week at bedtime, followed by cold mitten friction (1209)-

3. Acute Exacerbation. — Apply treatment recommended for
acute B right's disease (1537)^

4. Dropsy. — Short electric-light bath (1250), followed hy
cnld mil ten friction (1209) or cold towel nib (1213), wattr
drinking (1423), one to two pints twice daily; efferverscent bath
(1139)

5. Contraindications. — Cold immersions, prolonged cold
douche, frequently repeated, or prolonged hot baths.

General Method. — The essential features are a carefully regu-
lated regimen adapted to the patient's condition, warm clothing,
avoidance of chill, frequent neutral baths (1130), very gentle
tonic measures, copious water drinking (1423), i>erfect digestion
and bowel action, an aseptic dietary (1626), out-of-door life,
avoidance of exposure to cold and excesses of every description
especially sexual and dietetic excesses.

CYSTITIS AND IRRITABLE BLADDER.

1539 I. Inflammation. — Copious water drinking (1423), revulsive
sitz (1308) twice a day; hot leg packs (1393) followed by dry

heat to legs; neutral bath(1130)2o to 40 minutes two or three times
a week; prolonged neutral sitz (1312); cold friction; cold towel
rub (1213); fomentation (1328) over bladder; bladder irriga-

P:

; 1/

INCONTINENCE OF URINE. IO47

tion (1411); hot enema (1406); hot pelvic pack (1390); asep-
tic dietary (1626).

2. Irritable bladder, inflammation not present. Very hot sitz
(1311) for five minutes, followed by neutral sitz (1312) for 10
to 20 minutes. Hot pelvic pack (1390); heating compress
(1344) over perineum and genitals; revulsive sitz (1308); hot
rectal irrigation (1410).

3. Contraindications. — Cold sitz, cold immersion, cold
douche, cold foot bath.

INCONTINENCE OF URINE.

1. To Increase Energy of Bladder. — Cold plantar douche 1540
(1083) I to 2 minutes; cold running foot bath (1296); cold per-
cussion douche (1035) to hips and legs, 60° to 65°; cold douche
(1076) to lumbar region; cold fan douche (1061) at 65° over
bladder. Cold rubbing sitz (1309). Irrigation ' with normal
saline or boracic acid solution; begin at 100**, and lower tem-
perature I** daily to 80**.

2. Relieve Vesical Irritation — Revulsive sitz (1308); hot
pelvic pack (1390); prolonged neutral sitz (1312) following
revulsive sitz (1308). Neutral douche to lower spine (1103);
Scotch douche to feet and legs (1037); hot bladder irrigation,
1 00°- 1 15°.

3. Improve General Nerve Tone. — Cold mitten friction
(1209) or cold towel rub (1213); cold pelvic pack (1390);
general cold douche (1010); shallow bath (1174); wet-sheet
rub (1216).

NOCTURNAL INCONTINENCE IN CHILDREN.

1. Improve General and Local Nerve Tone. — Cold affusion 1541
(1103) at 75** at bedtime, followed by neutral pour (1103) to
spine, 2 minutes, 96°. Sea-bathing (1147) and swimming. Avoid
water drinking for 2 hours before retiring. Aseptic dietary (1626).
Meats and salt especially to be avoided.

2. Relieve Constipation and flatulence when present by wet
girdle (1347), graduated enema (1409); if necessary, carefully
graduated cold baths (1625); cool enema (1405)i and proper
diet.

3. Diminish Acidity of Urine» by free use of fruit and
water drinking in the forenoon.

PERITONITIS,
A- Acute FcM-m,

r. Rest in bed; fluid diet; fruit*juice without sugar; gmds of
dextrini^ed or malted cereals ( 1G3(V); withhold food 24x0 4S hotirs.

a. Albumin In Urine. — Hot-blanket pack (1197) and otfeer
sweating measures to maintain cutaneous activity, repeated every
a to 4 hours.

3. Fever — Hot-blanket pack (1197) foUowed by cold mittea
friction (1309)] prolonged neutral bath (1130); fomemadoa
(1328) to abdomen w
sarae time.

4. Enema (1404) at
to water if necessary i
every 2 hours for 15 l^
compress (13+4) at 60^,
body temperature is eleval
Copious water d rink mg (14
cold precordial compress (

oling wet-sheet pack (1189) at the

repeating, to remove gas; add soap
e movement. Fomentation (132S)

minutes. During interval, heating
^langing every 5 minutes while tiie
less frequently as temperature falls.
J); prolonged neutral bath (1130):

83) or ice-bag (1314) over heart

for 15 miniUes 2 or 3 times l iay for cardiac weakness.

Prevent Obstruction — Large enema (1404) three times a daf

from beginning, temperature 75°; soap and turpentine enema.

B. Chronic Form.

Aseptic dietary (1626), liquid diet (1628). Hot enema
(1406) followed by fomentation (1328) to abdomen for 20 min-
utes, three times daily; well-protected heating compress (1344)
during the interval. Copious water drinking (1423); graduated
cold applications twice daily (1625). If temperature is elevated,
neutral bath (1130) half an hour to an hour daily.

Contraindications. — Cold immersions, prolonged cold douche,
cold affusion, cold wet-sheet rub, and cold sitz.

NEURITIS.
1543 Etiological Indications.

1. Rest of affected parts until acute stage is over.

2. Combat Toxemia — Sweating bath two or three times a
week, preferably the electric-light bath (1250); follow sweating
bath by a suitable cold application (1625).

I

MULTIPLE NEURITIS. IO49

Pathological Indications.

3. Combat Inflammation. — Local revulsive compress (1341)
for 15 minutes every 2 to 4 hours, followed by heating compress
(1344) during intervals; suitable derivative applications (682).

Clinical Indications.

4. Pain — Scotch douche (1037); vapor douche (1102) fol-
lowed by graduated fan douche (1061), gradually reduced from
100° to 80°; protect by dry cotton pack (1388) or heating com-
press (1344) covered with mackintosh.

5. Paralysis. — Alternate compress (1340); alternate douche
(1044); percussion douche (1035) to spine and affected parts.

MULTIPLE NEURITIS-
Etiological Indications. 1544

1. Rest in bed while the disease is rapidly progressive.

2. Combat Toxemia. — Prolonged neutral bath i to 2 hours,
daily. Aseptic dietary (1626); avoidance of tea and coffee,
tobacco and alcoholic liquors, and all excesses. Sweating, espe-
cially by electric-light bath (1250), 10 to 20 minutes, followed
by cold mitten friction (1209).

3. Combat Local Inflammations. — Revulsive compresses,
then heating compress or packing in dry cotton (1388); fomenta-
tions to spine, followed by heating compress. When affecting the
lower extremities, hot foot or leg bath (1299); hot leg pack
(1393); complete rest of the affected part.

4. Improve the General Nutrition by graduated cold baths
(1625); massage; galvanic neutral bath (1451); out-of-door air
with careful protection; sun baths (1254); aseptic diet (1626)*

5. Pain.— See 1543, 4.

6. Paralysis.— See 1543, 5.

7. Atrophy. — Alternate douche (1044); galvanism or sinu-
soidal electrical current; massage; manual Swedish movements.

Contraindications. — During acute stage, carefully avoid cold
applications unless very short and preceded by heat; avoid
percutient applications so long as tenderness exists, that is, all
forms of the douche. Avoid especially cold immersion baths,
and very prolonged hot baths.

Ml

:a

-!1

1!^

NEURALGIA,
1545 PathQiogicMi indications.

1, Combat Toxemia when Present.— Sweating bath foUon

by appropriate general cold balh (^1625) three limes a week; iht
electric- light bath ( 1350), vapor bath (1246), sweating wet-sheet
pack (1191), are especially serviceable. Copious water drinkiog
(14^3); aseptic dietary (1626); dry friction (1231) of skin or
oil rubbing daily after short sweating balh (1250)p followed by
tonic cold application (1625),

3. Comlmt Anemia and Qentral Weakness,^ Graduated
cold applications (1625)- Avoid increasing pain by preceding or
accompanying the cold bath by a hot application to the affected
part; cover or avoid the part during the cold applicatiotu

Cliaicmi indications,

3. Pain* — Fomentation (1328) or revulsive compress (1341)
to the seat of pain. Scotch douche (1037) or alternate douche
(1044); ice-bag (1314) sometimes more effective than heat
This is often the case when the parts are congested as shown by
redness of the skin or throbbing sensation, and also when the
nerves affected are extremely superficial.

4. Reflex Neuralgias. — Usually due to enteroptosis or hyper-
esthesia of the lumbar ganglia. Fomentation (1328) to abdomen
twice daily; wet girdle (1347) during intervals; abdominal sup-
porter. Avoid chilling after baths, and general prolonged cold
applications, such as immersions, shallow and wet-sheet pack.

5 . Neuralg^ia of the Head. — Employ derivative measures, as hot
sitz bath (1311); hot leg bath (1299); hot pack to legs (1393);
hot foot bath (1297); cold running foot bath (1296); heating wet-
sheet pack (1183); fan douche to head (1061); hot and cold
compress to head (1358); heat over the seat of pain. Fomen-
tation (1328) to the abdomen twice daily, followed by heating
compress (1344); very hot application to forearm of opposite side.

6. Spinal Neuralg^ia and Lumbago. — Fomentation (1128)
to spine two or three times a day; during interval, heating com-
press (1344); hot and cold spinal pack (1369). Alternate com-
press (1340); Scotch douche (1037); hot trunk pack; hot half
blanket pack; spinal fomentation with hot leg bath; rest.

ACUTE MYELITIS. IO51

7. General Neuralgic Pain. — Hot immersion bath (1126)
4 to 5 minutes followed by prolonged neutral bath (1130), 95**;
hot-blanket pack (1197), electric-light bath (1260), vapor bath
(1240) or sweating pack (1191) followed by dry pack (1192).

8. Neurals:ia due to Chronic Neuritis. — Alternate compress
(1340) or douche (1044); filiform douche (1064). In sciatica,
Scotch douche, if persistent; nerve-stretching.

9. Neurals:ic Affections of Ovaries, Uterus, Rectum, Blad-
der, and Coccyx. — Revulsive sitz (1308); hot pelvic pack
(1390), followed by cold mitten friction (1209); hot enema
(1406); hot vaginal irrigation (1413); hot and cold pelvic pack
(1370, 1390); revulsive compresses over affected parts (1341).

10. Qastrals:ia. — Very hot fomentation (1328) over stomach
and abdomen; hot trunk pack (1196); revulsive compress (1341)
for 10 to 30 minutes over stomach, repeated every 2 hours, or as
often as needed; hot leg pack (1393); hot water drinking (1429);
hot enema (1406). Withhold food until pain is relieved. Aseptic
diet (1626); if necessary, liquid diet for a few days (1628).

11. Enteralgia. — Abdominal fomentation (1328) 15 minutes
every hour; hot enema (1406); heating compress (1344) applied
at 60° during interval; graduated tonic treatment (1625).

12. Erytliro Melalg:ia — Red Neuralgia. — Rest; elevation of
the affected part. Cold compress (1318) changed every 20 to 30
minutes. Application of faradic current and the rapidly alter-
nated sinusoidal current. Graduated tonic treatment (1625).

13. Herpes Zoster. — During eruption, dry cotton pack
(1388); after, revulsive compress (1341) several times daily,
heating compress (1344) during interval.

14. Contraindications. — Cold applications increase pain un-
less very carefully graduated, but are usually necessary for a per-
manent cure.

ACUTE HYELITIS
Pathological Indications. 1546

I. Combat Inflammatory Process In Cord. — Ice-bag (1314),
continuously, changing for fomentations 5 min. every half-hour.
Revulsive compress (1341) to the spine; fomentation (1328) for
20 minutes every 3 hours, during interval. Heating compress
(1344) to spine, 60°, renewed every 15 minutes.

RATIOKAL HYDROTHERAPY*

t. After Acute Sta^e Has Subsided. — Alternate compreff

(1340), or alternate douche (1044) to spine three timesadij.

CiinicMi iadlcations. 1

3, Pain and Paresthesia In Legs — Hot leg pack (1393)i
hot foot bath (1299); hot half-bath (1174); revulsive compress
(1341) to spine several times dailyj duration 15 to 6a mmtiles.

4, Qlrdle Sensation. — Hot trunk pack (1197) followed by
cold friction (1209) i wet girdle, well-protected (1347); fomet*
tation to spine foU^^

5, Neur
sponging (]

6, Parapt.
(1061) to spitic an
electrical applic

7, Sensory L ^.
nate sponging (] ,
douche (1035) twice d

S. riuscular Spasm.-
Fomentation (1328) over

sating spinal compress (1355)^
tin — ^Fomentation (1328) or iot
)llowed by heating compress (1344V
ite compress (134:0) or fan doudi€
assage] galvanic, faradic, or siniisoidii

Alternate spray (1044, 1055); alter-
male compress (1340); percussioi

Static or fa radio electricity. ■
levulsive compress (1341) to spint
ritated muscular groups, followed bj
continuous heating comprcLi (1344)i repeating twice daily oral
often as neccessary; heating spinal compress (1355).

9. Hiccous:h — See 1523, 14.

10. Gastric Crises. — Hot and cold trunk pack (1367); revul-
sive gastric compress (1341); fomentation (1328) to spine; hoi
foot bath (1297); hot leg pack (1393); hot immersion (1126)
or hot sitz (1311); galvanism to back of neck and epigastrium.

11. Contraindications. — Cold immersion and other general
cold applications. Carefully avoid burning or blistering the patient
with hot applications.

CHRONIC HYELITIS.

1547 Pathological Indications.

I. Short sweating procedures, followed by graduated cold ap-
plications (1625) twice a day. Revulsive compress (1341) or
fan douche (1061) to spine, temperature, 120*^, 70®; prolonged
neutral (92°) immersion baths (1130), i to 6 hours; heating
compress to the spine (1356). Later stages, alternate douche or
compresses to the spine (1342.)

SPINAL SCLEROSIS. IO53

Clinical Indications.

2. Prickling Sensation in Legs. — Scotch douche (1037)i hot
fomentations or affusion (9*6°) (1328) to spine and legs.

3. During early stage and exacerbations, neutral pour (1103)
to spine, 96°, two to ten minutes, two or three times daily;
absolute rest in bed; spinal fomentation every four hours, heating
compress during intervals.

4. Contraindications. — Cold full bath, very cold douche,

cold affusion, and all prolonged general cold applications. 1548

SPINAL SCLEROSIS.

A. Lateral Sclerosis — Posterio-Lateral Sclerosis — Dissemin-
ated Sclerosis.

Pathological Indications.

1. To Improve General Nutrition and Blood Movement. —

Graduated tonic baths (1625); massage carefully administered;
manual Swedish movements; nutritious aseptic dietary (1626);
sweating baths, especially the electric-light bath (1250) followed
by cold mitten friction (1209), carefully administered; copious
water drinking (1423).

2. To Combat Local Morbid Processes.— Fomentation (1328)
to the back twice daily, followed by heating spinal compress
(1355) The heating compress may be applied at night and
retained until morning. Hot leg bath (1299) with fomentation
to the spine ; prolonged neutral bath (1130), i to 4 hours daily.

Clinical Indications.

3. To Relieve Clonic Spasm and Nervous Irritability. — Warm

bath (96° to 100°); prolonged neutral affusion to the spine (93° to
to 98°) heating spinal compress (1355) at night; neutral gal-
vanic bath (92° to 98^) (1451), 10 minutes; galvanism of the
dorsal spine and abdominal sympathetic with simultaneous spinal
fomentation. Rest in bed when symptoms are progressing.

4. For Muscular Weakness or Paralysis. — Massage; manual
Swedish movements; exercise of muscles by slowly alternated
sinusoidal electrical current. Special gymnastics.

5. Contraindications — The cold douche and other general
cold baths; prolonged hot baths; exercise to the extent of fatigue.

4

the

"I

li.*J»

The patient should be kept in the open air as much as possible
Out-of-door gyranastics are especially useful

B, Amyotrophic Lateral Sclerosis.

1. See (A) I, above.
a. Prolonged neulral baths (1 1 30), i to 3 hours daily; tnassa^^

manual Swedish movements.

5. Cotitraltidications — Avoid the use of electricity, the cold
douche, prolonged hot baths, and general cold baths. fl

General Method. — Build up the general health by gentle tonic
measures slowly increased in intensity (1626), suppressing the
formation of toxic substances and promoting their elimination
a suitable dietary (1626), improvement of digestion and
employment of the other measures above indicated.

By the suppression of the active causes of the disease and the
adoption of rational means for the improvement of general nutn-
tion and especially of the nutrition of the cord, it is usually possi-
ble to arrest the disease, and not infrequently a considerable degree
of improvement may be secured. Therapeutic measures must be
most thoroughly and perseveringly employed. The progress ol
the disease may be delayed, even when it can not be altogether
arrested. 1

LOCOMOTOR ATAXIA.

1649 I. Improve General Nutrition — Careful cold mitten friction
(1209) or cold towel rubbing (1213). Very carefully gradu-
ated cold baths (1625). Tonic pack (1179), protecting the spine
by a dry towel, followed by cold friction (1209) and affusion
(1103) or half-bath at 85° (1174).

2. Combat Toxemia by short sweating baths (1191, 1246
1250), followed by appropriate graduated cold baths (1625).
Prolonged neutral bath (1130), beginning at 96° and daily lower-
ing the temperature to 90°; increase duration from 30 min-
utes to 2 or 3 hours daily. Copious water drinking (1428);
coloclyster daily (1407).

3. Improve Nutrition of Cord — Fomentation (1328) to the
spine 1 10° to 120° twice daily, with heating compress (1355) during
the interval. Thorough massage of the back ; suspension, or
spine-stretching by flexion of the trunk upon the thighs, or flexion
of the thighs upon the trunk.

CEREBRAL APOPLEXY.

I0S5

Clinical indications.

4. Ata?ctc Movenients, — Special exercises in small movements
of each of the affected muscular groups*

5. Lightning Fains. — Prolonged warm fan douche to spine
(1103), 95° to too**, two or three times a day (pressures to 5 lbs.),

6. Oastric Crises. — Very hot fomentation to the abdomen
(1328) several times a day, followed by heating compress (1344)
when lumbar ganglia are sensitive; continue for several weeks,
Revulsive gastric compress (1341)* See 1545, 10.

7. Local Pains.^- Revulsive compress (1341) and Scotch
douche (103j ) fallowed by healing compress (1344)<

8. Rectal Pain. — Very hot anal douche (1087), iiS^'to tt2%
with little pressure. Revulsive silz (1308). Fomentation (1328)
over buttocks. Hot rectal irrigation (1410)*

9. Paresis of Bladder,^' Daily irrigation THID- Cold plan-
tar douche (1083)^

10. Consti|>atIon.~ See 1324.

11. Trophic Cttange* ^ Charcot's Joints. — Fomentation
(1328) to the parts when painful, three times daily, with heating
compress (1344) during the intervals. Apply mechanical support
when necessary. Galvanism and the rapidly alternating sinu-
soidal electrical current.

12. Contraindications. — Cold immersions, cold applications
to spine, general cold douche^ very hot applications.

Generai Method.^ Build up the patient's general health by
gentle tonic measures, carefully avoiding such applications of cold
water as are found to increase pain or aggravate other symptoms;
combat the local morbid process in the spine by the measures
above indicated, and restore the power of co-ordinated movement
in the affected muscular groups by special gymnastic tiaining*

CEREBRAL APOPLEXY,

I, Oyring Attack — Rest, head and shoulders raised; cold
compress to head (1371); tepid enema (1404); warm extrem-
ities by hot-water bags or hot pack, Ice-collar (1316).

I. Alter Attack. — Cold mitten friction (1209) twice daily; well-
protected wet girdle (134?) night and day; carefully graduated
cold baths (1625); prolonged neutral bath (1130); wet-sheet pack
(1179)^ After a few weeks, electricity to affected muscles; man-

1550

1056 RATIONAL HYDROTHERAPY.

ual Swedish movements; carefully graduated exercises; massage;
cold or alternate douche (1044) to affected muscles.

EPILEPSY.

1&51 I. Abstemious, dry^ aseptic dietary (1626), chiefly frui Is and

grains; vigorous out-of-door exercise to the extent of fatigue daily.
Prolonged neutral bath (1130) daily; sweating process (642,
1 233-1 25&) two or three times a week; graduated cold proced-
ures (1635), avoiding prolonged and intense applications.

t. When Attack Is Threaten d, — Colociyster (1407) twice
daily; copious water drinking 23); neutral pack (1182); ice

to head (1314); rest in bed, it aura in hand or foot precedes
attack, the seizure may sometimes be averted by placing the part
in cold water.

3. After Attack.^ — R€St;(|Cold to head; cold mitten friction
(1209) or cold towel rub (1213); half -bath (1174); Scotch
douche (1037) to legs, and percussion douche (1035) to spine.

General Method*— Train the patient to a vigorous regimeUi a
simple abstemious dietary (1626), abundance of outdoor exercise,
the daily employment of the prolonged neutral bath (1130); fol*
lowed by shorty moderately cold applications (1625) j copious
water drinking (1423); regulation of all the vital functions, avoid-
ance of all sources of nervous irritation and exhaustion.

CHOREA.
1552 BUological Indications.

1. Combat anemia and improve general nutrition by graduated
tonic applications (1625); copious water drinking (1423); large
enema or colociyster (1407). Fomentation to abdomen (1328)
morning and night, heating compress during intervals. Secure
mental quiet by isolation if necessary. The patient should be
kept in the open air. Out-of-door life and rhythmical gymnas-
tics are especially useful.

Clinical Indications.

2. Insomnia. — Prolonged neutral bath (1130) or . douche
(1031); wet girdle (1347).

3. Agitation — Neutral spinal pour (1103); wet-sheet pack
(1179).

MULTIPLE NEURITIS. IO49

Pathological indications.

3. Combat Inflammation. — Local revulsive compress (1341)
for 15 minutes every 2 to 4 hours, followed by heating compress
(1344) during intervals; suitable derivative applications (682).

Clinicai Indications.

4. Pain — Scotch douche (1037); vapor douche (1102) fol-
lowed by graduated fan douche (1061), gradually reduced from
ICC® to 80°; protect by dry cotton pack (1388) or heating com-
press (1344) covered with mackintosh.

5. Paralysis. — Alternate compress (1340); alternate douche
(1044); percussion douche (1035) to spine and affected parts.

MULTIPLE NEURITIS.
Etiological Indications. 1544

1. Rest in bed while the disease is rapidly progressive.

2. Combat Toxemia. — Prolonged neutral bath i to 2 hours,
daily. Aseptic dietary (1626); avoidance of tea and coffee^
tobacco and alcoholic liquors, and all excesses. Sweating, espe-
cially by electric-light bath (1250), 10 to 20 minutes, followed
by cold mitten friction (1209).

3. Combat Local Inflammations. — Revulsive compresses,
then heating compress or packing in dry cotton (1388); fomenta-
tions to spine, followed by heating compress. When affecting the
lower extremities, hot foot or leg bath (1299); hot leg pack
(1393); complete rest of the affected part.

4. Improve the General Nutrition by graduated cold baths
(1625); massage; galvanic neutral bath (1451); out-of-door air
with careful protection; sun baths (1254); aseptic diet (1626)*

5. Pain.— See 1543, 4.

6. Paralysis,— See 1543, 5.

7. Atrophy. — Alternate douche (1044); galvanism or sinu-
soidal electrical current; massage; manual Swedish movements.

Contraindications. — During acute stage, carefully avoid cold
applications unless very short and preceded by heat; avoid
percutient applications so long as tenderness exists, that is, all
forms of the douche. Avoid especially cold immersion baths,
and very prolonged hot baths.

HATIONAL HVDROTHERAfy,

cold douche (1047); massage douche (1066); massage; mafiiiil
Swedish movements; electricity,

8. Contractians— Fomentations to affected parts (1328)
followed by heating compress (1344). Revulsis^e douche (1041)*

9. TremWingp^^ Neutral affusion (1103) to spine, 91* to 96*
15 minutes.

10. Iticoittinence of Urine.^ Percussioo douche (1035) to
spine; neutral sitz (1312) 15 to 30 minutes.

11. Retention of Urlne,^*Hot sitz (^1311), S minutes, foil owed
by cold plantar douche (1083). Cold perineal douche (1084);
cold douche to the lumbar region (1076) and hypogastrium
(1079); cold rubbing sitz. (1309).

12. Anesthesia or Paresthesia. — Alternate douche (1044)
or compress (1340)3 cold percussion douche (1035) to spine;
cold rubbing of afifected part with hand or friction mitt (1209)
after a hot fomentation (1328) for 5 to 10 minutes.

13. Hyperesthesia^ Pain ^Hot fan douche (1061);

fomentation (1328) followed by heating compress (1341); re-
vulsive compress (1341)^ Cold douche to the symmetrical part
of the opposite side (1022).

14. Loss of Muscular Sense — Alternate douche 1044);
massage douche (1066); cold percussion douche (1035).

15. Visceral Neuralgia. — Very hot fomentation (1328) over
the affected part 20 minutes twice daily, followed by heating com-
press (1344) during the interval; revulsive compress (1341);
Scotch revulsive fan douche (1041).

16. Motor Paralysis — Alternate douche (1044); massage
douche (1066); cold percussion douche (1035).

17. Hiccough. — Hot trunk pack (1196); heating gastric com-
press (1344); sipping ice-cold carbonated water; lavage (1401)-

18. Syncope — Heat to neck (1382); short cold application
to chest and face. Alternate compress to spine (1342); percus-
sion of the chest with the hands dipped in cold water or with the
end of a cold towel; vigorous centripetal friction (1223); rhyth-
mical traction of the tongue.

19. Spinal Irritation Fomentation (1328) to the spine

twice a day, followed by continuous heating compress (1844)
during the intervals; Scotch fan douche (IO6I9 1037); fomenta-
tion (1328) followed by affusion (1103) for 5 minutes, 80** toSs^

J

NEURASTHENIA. IO59

20. Anal spasm. — Hot anal douche (1087) or hot, shallow
sitz (1311) (102° to 106®). General applications of faradic,
static, galvanic, or sinusoidal electrical currents are also useful in
connection with massage, manual Swedish movements, and regu-
lated gymnastics.

21. Aphonia. — Ice-bag to the throat (1314); with general
cold douche (1037).

General Method. — Improve the patient's general health by
vigorous tonic measures continued during many months or even
years. Improve the general nutrition by a nutritious, simple,
unstimulating dietary (1626). Combat special symptoms by the
hydriatic measures indicated above, together with suitable mental
and moral treatment.

NEURASTHENIA.

This is not a distinct pathological entity, but a group of symp- 1654
toms due to various etiological influences and connected with vari-
ous morbid states.
EiMogicai indications.

I. Rest-cure for those who have been overworked nervously
and physically, and for those who need a rapid gain of fat and
blood; muscular exercise and diversion for those who are men-
tally and nervously tired.
Pathological Indications.

2. Combat Autointoxication. — Aseptic diet (1626); fruit diet
(1627); daily neutral baths (1130) (1-3 hours); sweating proce-
dures (642, 1233-1255) of short duration (3-6 fcinutes) fol-
lowed by suitable cold applications (1625); hot enema (1406)
daily; copious water drinking (1423); out-of-door life.

3. Combat Exhaustion. — Rest for the overworked. Im-
prove digestion in cases of starved dyspeptics by appropriate
measures. Foods rich in fats and proteids are especially impor-
tant. Tonic cold applications carefully graduated (1625); espe-
pecially percussion douche to spine.

4. Check Exhausting Dischars:es by appropriate measures
as Menorrhagia (1688), Lcucorrhea (1591, 3), Spermatorrhea
(1596).

5. Relieve Reflex Irritation. — If sexual, rectal, prostatic, or
urethral irritation, employ revulsive sitz (1311), prolonged neu-

tral sitz {1312), rectal and urethral irrigation, hot foot bath
(1297), hot pelvic pack (1390)^ For ovarian trritaiion. In
additioti to above, hot vaginal irrigation (1413), ij to 20 min.

6. IfHtation of Solar Plexus and Sympathetic Qan^ia. —

Fomentatioti (1328) over abdomen three times daily; daring
intcrvalsi heating compress (1344); abdominal supporter

Cilaical indications,

7, Improve QeneraJ Nerve Tone ^Graduated cold applic^-

tions (1<j25). The cold percussion douche (1035) to spine is
the most efficient of all measures^ general cold douche (lOlO)i
very hot douche (1024) (no** for 30 seconds), followed by grad
uated or cold douche (1037)-

B. Indigestion,— See 1520-1525*
9* Constipation — ^ Sec 1524,

10. Intestinal Catarrh — See 1529.

11. Headache. — Hot and cold compress (1358); revulsive
compress (1341); alternate spinal compress or sponging (1342);
hot foot bath (1297);^ running foot bath (1296).

12. Frontal Headache,-^ Revulsive compress (1341) to fore-
head and eyes; hot and cold trunk pack (1367); derivative appli-
cations to feet and legs (682).

13. Congestive Headache — Ice-bag (1314) to back of head
and cold compress (1314) to face; ice-collar (1316); hot and
cold cephalic compress (1358); hot foot bath (1297); hot leg
pack (1393); heating compress to legs (1344); cold running foot
bath (1296); alternate foot bath (1298); felt shoes.

14. Occipital Headache. — Hot compress (1286) or spong-
ing (1200) to upper spine and occipital region. Revulsive com-
press (1341); hot and cold cephalic compress (1368).

15. Nervous Headache — Fomentation (1328) to seat of
pain, with simultaneous hot foot bath (1297); gastric lavage
(1401). Daily cold enema (1405) to relieve constipation if
present. Special attention to the diet; a dry aseptic (1626)
diet is indicated, avoiding milk. See Migraine (1556).

16. Sensation of Band around Head. — Hot sponging
(1200) or hot compress (1286); alternate sponging (1206) of
neck and upper spine; massage to head.

17. Sensation of Pressure at Vertex. — Hot foot bath

I

NEURASTHENIA. I o6l

(1297), cold compress (1314) to head; ice-collar (1316); sleep
with head elevated; heat to feet and legs if cold.

1 8. Pain in Eyes, Intolerance to Ligtit or Use in Reading.

— Light fomentation over eyes and forehead (1264); protect
eyes from bright light; facial massage and massage to eyes; an
oculist should be consulted, as the temporary use of glasses to
correct muscular insufficiency due to deficient innervation or some
slight optical defect may be useful or necessary.

19. Backactie. — Fomentation (1328) to abdomen; wet girdle
(1347); abdominal supporter; alternate spinal sponging (1206)
or compress (1340); Scotch douche (1037) to spine; revulsive
sitz (1308).

20. Neuralgia — See 1545.

21. Insomnia. — Sec 1564.

22. Vertigo — Fomentation (1328) to stomach followed by
wet girdle (1347). Gastric lavage (1401) when indicated.
Bathing face or top of head with very hot water, or hot compress
(1286) for 2 minutes, followed by cool compress (1318), 15 sec-
onds; heat to back of neck in anemia of the brain (1262).

23. Anorexia. — Cold bag (1314) ovet stomach for half an
hour before meals, with cold compress or water bag (1314) to
epigastrium; cold mitten friction (1209) or cold towel rub
(1213).

24. riuscular Weakness, Especially in Legs. — Cold percus-
sion douche (1035) to spine; alternate douche (1044) to legs.

25. Mental Depression. — Sweating bath followed by short
general cold" douche (1010); neutral bath (1031) for i hour daily;
neutral pack (1182); cold percussion spinal douche (1035); alter-
nate spinal sponging (1342) or douche (1044).

26. Fidgets — Fomentation (1328) to abdomen followed by
wet girdle (1347); empty colon, if loaded, by enema (1404);
abdominal supporter; revulsive sitz (1311); neutral pour to spine
(1103).

27. Dreams.— Neutral bath (1031) for half an hour before
going to bed; wet girdle (1347); evaporating head cap (1324);
elevate head of bed; avoid eating after 4 p. m. except fruit.

28. Flushings. — Scotch fan douche (1061) to abdomen,
especially the umbilical region; percussion douche (1035) to
spine; alternate spinal douche (693, 1342); wet girdle (1347).

RATIOKAL HYDROTHEEAPY\

29, Cold Extremities— Scotch douche (1087) to legs and
feet, followed by standing shallow bath (1174); fometitation
to abdomen (1328) twice daily, followed by heating compress
(1344) during iatervals; alternate foot bath (1298); massage to
feet and legs; cold friction (1209)^

30. Perspiration when Sleeping. — 1508, n.

General Method. — While not recognizable as a distinct malady,
it is convenient from a practical standpoint to consider neuras-
thenia as a disease. The tonic effects of cold water are essential
in the treatment of neurasthenic conditions. The management of
cold applications in such a way as to secure the tonic effects
desired without aggravating any of the patient's symptoms is a
problem which taxes to the utmost the skill and experience of the
hydriatic physician. Special attention must be given to the diges-
tlon^ improvement of nutrition, reflation of the bowels and the
relief of prominent and distressing symptoms by suitable paiUa'
tive measures,

MIGRAINE.
1555 BMogicai iadic^ions,

I* Prevent Formation of Uric Acid, — Avoid use of mtSL^

also tea and coffee^ etc.; aseptic dietary (1625); out-of-door ife.

Pathological Indications.

2. Eliminate Uric Acid — Hot baths, especially moderately
prolonged sweating baths (1191) followed by short cold baths;

electric-light bath (1250); wet-sheet pack (1179); vapor bath
(1246); prolonged neutral bath (1130); water drinking (1423).

3. Lower Arterial Tension. — Hot immersion, 102**, 5 to 10

min. (1126); hot leg bath (1299); or pack (1393); hot enema,
100° to 204® (1406); rest in bed; exclusive of light.

Clinical Indications.

4. Pain. — Hot foot bath (1297); alternate spinal compress
or sponging (1342); revulsive compress (1341) to seat of pain;
local application of ice-bag (1314) in some cases: hot leg pack
(1393); protect the eyes from light..

5. Nausea and Vomiting. — Lavage (1401); ice pills; ice
(1314) to stomach and spine opposite.

6. Constipation.— Coloclyster (1407). See 1524.

INFANTILE CONVULSIONS.

1063

7. Qastrlc Disorders— 1519-1527.

8. To Prevent Attack — ^ Lavage (1401); fruit diet (1627);
large coloclpter (1407); water drinking (1423)^

9. To Relieve Hyperesthesia of Lumbar Qan^lla. — Abdom.
inal fotnentalion (1328) twice daily; coiitiiiuous heating compress
(1344) during interval. Abdominal supporter.

Qenerai Method. — Every case is curable by sufficiently pro-
longed treatment, carefully managed. The general nervous system
must be built up by measures essentially the same as those indi-
cated for neurasthenia (1&545 5) and other conditions requiring
tonic treatment The causes must be removed, especially auto-
intoxicatioa and morbid reflex influences arising from dilatatiQH
of the stomach, en tero ptosis, and indigestion.

INFANTILE CONVULSIONS-
Btiologioil indications*

1. Regulate diet, withholding meats and all indigestiblcs.
Avoid cow's milk if ciirds are present in the stools. Daily cold
bath, wet-hand rub (1201) or cold towel rub (1213)-
FatiioiQgi€Mi iaaicatiQBS.

2. When due to autointoxication from intestinal ^rrltation^
large hot enema. (1406)^ If undigested food is present in the
stomach, lavage (1401). For immediate relief, hot blanket pack
(il97)i warm bath (95'^ to gB"^) (1123), t to 2 miauies. If not
qtiickly relieved, remove from bath, and employ cold affusion
(1103) to head and spine. Alternate hot and cold affusion if
necessary. Apply wet girdle (1347), changing every 4 hours,

WRITER'S CRAMP,

I. General — Scotch douche (1035, 1074) to spiue and
affected muscles twice daily. Neutral affusion (1103) to spine
10 minutes daily; neutral bath (1130), i hour at bedtime. Cold
mitten friction (1209) twice daily following other treatment.
Shallow bath i to 3 minutes (1174); prolonged neutral bath
(1130); massage and passive exercises (1461).

3. Paresis, — ^ Cold percussion douche to spine (1037, 1074)
following warm rain douche (1047). Alternate douche (1014)
to affected muscles. Gymnastics; passive exercises and iDassage
of affected parts; sinusoidal or galvanic electricity.

nm

1557

4

•' r

MELANCHOLIA
P&thoiogicai indications,

1. For Anemia and Malnutrition — Fomentation (1328) to

abdomen followed by cold mitten friction (1209) twice dailjr;
aseptic diet (1626); water drinking (1423); air baih (1470);
electric-light bath (1250); sun baths (12S4); rest in bed; mas-
sage; manual Swedish movements; galvanization of cervical aodJ
abdominal sympathetic. ™

2. For Cerebral Anemia (usually present), — Warm compress
(98° to 100^) to back of neck 15 minutes three times daily, U

3. To Diminish Blood Pressure (usuaJly excessive), — Warm'
immersion bath (1126), 98^^ to 100°, 10 to 2Q minutes, twice daily^
heating wet-sheet pack (1183); heating trunk pack (1196), $0
niinutes, twice daily; neutral douche (94*')^ pressure 10 to 10
poiindsj duration 2 to 4 minutes.

4. Por Autointoxication.— See 1559, 4.

Clinical Indiontions,

5. !nsomnia.^See 1564.

6. Anorexia* — Lavage; feeding with tube; see 1401 »

7. Constipation. — Laxative diet, fruit, granose, malted cereals
(1631); cool enema. See 1524.

8. Indigestion.— See 1521, 1522.

9. Cold Extremities.— See 1554, 29; 1627, 6.

10. Dry Skin.— See 1609.

11. Mental and Nervous I rritability. — Neutral bath (94** to
96°, 30 minutes to 2 hours); heating wet-sheet pack (1183);
wet girdle (1347); heating spinal compress (1344, 1355).

12. Contraindications. — Avoid cold immersions and all very
cold general applications, which by raising blood pressure and
exciting the irritable cerebral structures aggravate the condition.

General fletliod. — A patient suffering from melancholia re-
quires essentially the same therapeutic measures as the neuras-
thenic with the special moral treatment and control indicated.

MANIA.
1569 PBibologlcal Indications.

I. For Malnutrition. — Graduated tonic baths (1626); gener-
ous aseptic diet. See 1558, i.

^yy\

TOXIC INSANITIES,

io6s

2. To 1 ncrease Bl€M>(J Pressure. — Hot baths —electric-light
(1350 )» hot immersion (1126), loo^ to 102**, 8 to 15 minutes, hot
leg (1299) or sitz bath (1811), loS*' to 115^, 8 to 13 minuteSi
followed by shallow (1174) at 68*^ to 74'=', affusion (1103) at
70^ to 6q^j or percussion douche at 60** to 50^, duration 20 to 40
seconds; ice-bag over heart for 15 minutes every 2 hours,

3. To Diminish Cerebral Hyperemia,— Short hot imraersion
(1126) or shower (1047) followed by douche (1010) at 70*^ to
60'', 20 to 40 seconds, light pressure; hot (^106** to 115*^) leg
(1299) or stti bath (1311); ice-collar (p, 779); cephalic com-
press (1371 )> wet girdle, well protected (1347); heating wet-sheet
pack (1183).

4. For Autointoxication — Aseptic diet (1626), if necessary,
fruit (1627) or kumyss diet (1628); coloclyster (1407) daily
for a few days; long neutral bath (1130), 30 to 60 mmutes,

CUnicmt tndfcatfoBs.

5. To Relieve or Prevent Exhaustion* — Rest in bed; tonic
treatment (162&) twice a day*

6. For Fever, — Local antiphlogistic measures (698) as may
be indicated; neutral bath (1130)1 cooling pack (1189).

7. For insomnia. — ^^See I064*

8. For Constipation Cool enema (1409). See 1S24*

9. Indigestion,— See U21, 1 533.

10- Contraindications. — Avoid very hot or prolonged cv\d
baths; avoid cold to head when face is pale*

CONFUSIONAL, PUERPERAL; POST-FEBRILE, POST
OPERATIVE, TOXIC INSANITIES,

1- rialnutrition — Rest; careful tonic treatment (162&)

2. Autointoxication.^ — Aseptic dietary (1636); fruit diet
(1627) for 3 or 4 days; warm baths, electric-iighl (1260)^
sweating pack (1101) followed by short cold applications; wet*
sheet rub (1216) or douche (1010); copious water drinking
(1423); coloclyster daily (1407) for a week or two,

3. Puerperal Lesions or Complications, — Curettementi hot
vaginal irrigation (1413); neutral (1312) or tonic sitz (1309).

4. Fever,— Absolute rest in bed; prolonged tepid bath {SS^.
to 93?^ 30 to 60 minutes); cooling memas(140o); cold cepha-
lic compress (1371); copious water drinking (1423).

1560

^1

RATIONAL HYDROTHERAPY*

5. AlcohoHsm. — Withdraw alcohol at once; withhold food far
3 days; nutritive enemas; copious water drinking (1423); neutral
coloclyster (1407) daily for a week.

6. Uremia.-^ See Acute Nephritis, 1537*

7» For other CUmcal indications, sc« Simple Mania above.

S, ContraindtcatLons. — The same as those of Mania, when
conditions coincide. Especially avoid all intensely exciting pro-
cedures.

Qeneral Method. — In most cases essentially the same as for
Mania, giving special attention to the particular etiological element
which may be a prominent factor in the case. In certain cas^
the symptoms are those of Melancholia, and the treattnent must be
modified accordingly.

GENERAL PARESIS.
1361 FathQlQgicnl intUcstians,

1. Malnutrition. — Vigorous but graduated tonic measures
(1623); rest in bed. Sec 1558r ii also Neurastheniaj 1554*

2. Cerebral Hyperemia. — Continuous ice-cap (1323). Sec
1562, r.

3. Disturbed Arterial Tension.-^ If excessive, sec 1558,5;
if diminished, see 1559, 2.

4. Autointoxication. — See 1559, 4*

Clinical indications.

5. Insomnia.— Ice-cap (1323); neutral bath (1130) or
douche (1031); wet girdle (1347); wet-sheet pack (1179).
See 1564.

6. Constipation. — Cool enema (70^); wet girdle (1347);
cold abdominal douche (1081); abdominal massage. See 1524.

7. Retention of Urine. — Catheterization; irrigation of the
bladder (1411); cool rubbing sitz (1309), 70^ to 65*^, 3 to 6 min-
utes; cold spray to feet (1055); cold plantar douche (1083);
cold hypogastric douche (1080) (75° to 60°); running foot bath
(1296).

HEADACHE.

1562 The following grouping of headaches is made for practical
convenience alone, and is not offered as a scientific classification: —

HEADACHE. IO67

1. Hyperemic Headache. — Rest, head and shoulders ele-
vated; heat to feet and legs — foot bath (1297), leg bath (1299),
leg pack (1393), Scotch douche (1037); cold to head and neck
(1314), enema at 102° (1406); well protected wet girdle night
and day (1347); wet sheet pack (1179); neutral spray, 2 to 4
minutes (1057), moderate pressure.

2. Anemic Headache. — Hot bag to back of neck; fomenta-
tion (1328) over painful part; rest in bed with head low; general
treatment <or anemia. See 1580*

3. High Pressure Headache — Abstemious aseptic diet;
prolonged warm or neutral bath daily, with cool compress to head;
hot leg (1299) and foot baths (1297); Scotch douche (1037)
to legs; heating compress (1344) over heart.

4. Dyspeptic Headache. — Gastric lavage (1401) if stomach
is foul; enema (1405) if constipated; dry, aseptic diet (1626)
two meals a day, or fruit only at night.

See 1119 to 1523. For palliation, hot and cold cephalic
compress (1358); avoid sleeping soon after eating, though a short
nap is sometimes beneficial.

5. Headache Due to Enteroptosis. — Abdominal supporter;
wet girdle at night (1347); abdominal massage; cold abdominal
douche (1081); sinusoidal current to muscles; galvanization of
cervical and abdominal sympathetic; for palliation, alternate spinal
sponging (1342) or compress (1340); hot and cold head com-
press (1358).

6. Toxic Headache. — Due to uric acid, oxalates, urea, and
other wastes, or to decomposition products absorbed from the ali-
mentary canal. Sweating baths (1125, 1197, 1246, 1126) fol-
lowed by cold douche (1010), wet-sheet rub (1216), or shallow
(1174); copious water drinking (1423); enema (1405) or colo-
clyster (1407) daily or tri-weekly; out-of-door life; air-bath
(1471); aseptic diet.

7. Periodical Headache* Nervous Headache, Bilious Head-
ache, nigraine* Hermicrania. — Dry, abstemious, aseptic diet
(1626); out-of-door life; air-bath (1470); gastric lavage and
large enema (1401) the day before attack is due (1406); tonic
treatment (1625); wet girdle (1347); abdominal supporter if
enteroptosis exists.

8. Rheumatic Headache.— Sweating bath, 1499, 12, daily;

io68

BATIOI^AL H\T)ROTHERAl*y*

il

iiot foot bath (1297) or leg pack (1393), fomentation to painful
part for lo to 15 minutes, followed by heating compress (1344)*
See Uric Acid Diathesis 1511-

9, Neurasthenic Headaches.^ See 1554, 11— 15-

10, CUvus Very hot foot bath (1297)^ with fomentation

over pamfal point for 10 minutes, repeated every 2 hours; carefnllf
graduated cool baths (1635)* Heating compress at night; pro-
tect well from cold during the day,

1 1. Renal Headache.^ Copious water drinking ( 1423) ; enema
(1406); hot bath (1136, 1250, 1246, 1197); icebag over
lower sternum, with hot and cold compress to head (1358)- See
Acute Nephritis (1537); and Chronic Nephritis (1538).

i3t. Hepatic Headache,— Aseptic diet (1626); fniil diet
(l(i27); water-drinking (1423); graduated enema (1409)^
fomentation over liver twice daily, 15 min., heating compresi
during the intervals. Out ofdoor exercise; air-bath (1470);
breathing exercises; abdominal massage. For palliation * reviiJ-
sive compress to head (1341); hot and cold head compress ( 1 358\
with derivative applications to legs (1299s 1393, 1037, 1250)^
graduated tonic treatment ( 1625)^

13. Organic Headaches (tumors, InHammation^ syphilis, ab-
scess, trauma, general paresis). — Very hot and frequently repeated
derivative applicartions to legs, with short, often repeated revulsive
compress to head, followed by cold or heating compress.

14. Headache Due to Disease of Eye, Ear, Nose, and Teeth.

— Correct diseased condition by surgical or other means. Hot
foot (1297), or leg (1299) bath, with revulsive compress (1341)
over painful parts.

15. Coldness, Numbness, Pressure, Band Sensation, Etc

— Improve vasomotor tone by tonic measures (1625); massage
of head and neck; revulsive compress (1341) to spine, head, and
face; hot and cold head compress (1358); static breeze. Sec
Neurasthenia 1554.

Supra-orbital Headache. — Hot foot bath with revulsive com-
press above the eye-brow, but not covering the eye; avoid expos-
ure to cold; rest eyes, protecting from light; general tonic treatment
(1625). Hot foot (1297) or leg pack (1393).

16. Temporal Headache. — Fomentation (1328) over side of
head, face and ear, for ten minutes, followed by warm dry com-

I

I

HEAT EXHAUSTION. IO69

press, repeated every two hours, between attacks, tonic treatment
(1625), local massage, galvanism, sinuosoidal current. Fat- and
blood-making diet (1626). See Lithemia (1511).

17. Mastoid or Post- Auricular Headache. — Fomentation for
10 minutes to side of head followed by cotton poultice or well-
covered heating compress. Otherwise the same as 1 6, above. See
also 4 and 14.

18. Cervico-Occipital Headache. — Revulsive compress to back
of head and neck. Otherwise the same as 16, above. See
Neurasthenia 1554.

19. Uterine Headache (Pain or pressure at vertex). — Revul-
sive sitz (p. 766, 770); abdominal supporter; wet girdle (1347);
application of sinusoidal electricity to uterus; central galvan-
ization; hot and cold head compress (1358); massage of head;
static breeze to head. Correct any ovarian or uterine disease
present. See neurasthenia 1554.

20. Fever Headache. — Ice-cap or cold cephalic compress
(1371); ice-collar (1316); ice-bag over heart (1314): cooling
pack (1189); prolonged neutral bath.

THERMIC FEVER, HEAT STROKE, SUN STROKE,
HEAT EXHAUSTION.

1. Thermic Fever. — Increase heat elimination. Pour from a 1663
height water at 60° or less, while two persons rub the patient
vigorously. Give special attention to the spine. Ice compress to

the head and neck (1318). Continue until the temperature falls
to 101°; cool enema (1405); cold water drinking (1426) when
possible. Ice-bag to the head and neck (1314) during cold affu-
sion (1103). As soon as the temperature falls to near the nor-
mal point, sweating wet-sheet pack (1183, 1191).

2. After-Treatment should consist of daily graduated cold
applications (1625). The head should be thoroughly cooled
before each application.

3. Neurasthenia — See 1554.

4. Insomnia. — See 1564.

5. Heat Exhaustion. — Hot immersion bath (1126)> 3 to 8
minutes; hot-blanket pack (1197); hot enema (1406) followed
immediately by short cold mitten friction (1209), cold wet-
sheet rub (1216), afterward wrapping in warm blankets.

1

IO70

RATIONAL HYDROTHERAPY.

6. Threatened Cardiac Failure.^- Cold bag over hc^n
(1383) for 15 minutes every hour; cold mitten friction (1209)
every 3 hours; hot- blanket pack (1197) 10 minutes, followed by
cold towel rub (1213). Hot enema (1406) followed by coM

enema (1405); artificial respiration.

i

INSOMNIA.
1564 Patiialogicai inmcatiQas.

1. To Relieve Cerebral Congestion. — Noutral douclie (1031)
3 to 5 minutes at bedtime; cold douche (lOlOj; hot leg bath
(1299); running foot bath (1296); heating wet sheet pack
(1183) followed by rubbing wet sheet (1216) ; wet girdle
warmly covered and protected with mackintosh (1347) » heating
leg pack (1393); dry heat to the feet and legs; hot leg pack ■
(1393) followed by cold mitten friction (1209) to the kgs^
heating compress to legs, or leg pack at bedtime, to be prolonged
during the night; wet-girdle and leg pack over night; Scotch
douche (1037) to the legs at 102^, 2 minutes, 60^ 15 seconds;
neutral douche (1031), 3 to 5 minutes; evaporating head-cap
(1334); dowTiward stroking of head and neck; gatvantsation of
the cervical sympathetic.

2. ReBeve IrntabiUty of the Cerebral Cell, — ProIonLed
neutral bath (1130) at bedtime; neutral wet-sheet pack (1182).
Enema (1404) if constipation or flatulence are present.

3. Irritability of Solar Plexus or Lumbar Qansriia. — Ab-
dominal fomentation (1328) followed by abdominal heating com-
press (1351), changing every 6 hours. Avoid eating anything
but fruits after 4 p. m. Copious water drinking (1423). Colo-
clyster (1407), especially if the bowels are inactive, as constipa-
tion is a frequent cause of insomnia through producing irritation
of the abdominal sympathetic.

4. Excessive Cardiac Activity. — Ice-bag over heart (1383).
Galvanism to spine and cervical sympathetic.

5. Fidgets, or Restlessness, — Warm affusion to spine
(1103), 95° to 98^ Tepid sponging (1204); rubbing of limbs;
rubbing spine (1221); massage of head.

6. General Irritability — Neutral wet-sheet pack (1182);
neutral immersion bath (1130); neutral fan douche (1031) or
shower (1047) 2 to 4 minutes.

PRURITIS, NASAL CATARRH. IO7I

General Method. — There may be said to be three forms of
insomnia: Sleeplessness may be due to (0) congestion of the brain;
{b) irritability of the cerebral cell, or to (r) a combination of
these two conditions. Which of these conditions is present in
any individual case must be carefully determined, and the treat-
ment adjusted accordingly, as above indicated.

PRURinS.

1. Neutral fan douche (1061)» 95° to 100°, 10 to 15 minutes. 1666
Drying by gently patting over Turkish sheet or towel. Prolonged
neutral bath (1130) 94° to 96°. If temperature sense is per-
verted, employ higher or lower temperature.

2. Winter Pruritis of Lithemia.— Very hot Scotch douche,
(1037), I to 2 minutes, iis** to 122°, followed by cool douche 70°
30 seconds; prolonged neutral bath (1130)> 92°.

3. Pruritis of Qenltals or Anus. — Prolonged cold compress
(1318) or ascending douche (^1058, 1087) when no eruption
is present; with eruption, very hot spray followed by evaporating
compress and a suitable lotion or unguent. If the skin is thickened,
very hot or alternate douche (1044) or revulsive douche (1041)
to affected parts, with considerable pressure, three times a day.

NASAL CATARRH.
A. Acute Catarrh — Acute Coryza.

1. Sweating bath at bedtime (1216, 1126, 1191, 1260) 1666

followed by a short cold application, — wet-sheet rub (1216), cold
towel rub (1213), cold douche (1010); hot foot bath (1297)
with very hot compress to face (1286); steam inhalation (1419);
water drinking (1423).

2. To Prevent — Cold bath daily, or twice a day (1625);
out-of-door life; avoid excessively warm clothing and warm living
or sleeping rooms in winter. Wear linen next the skin summer
and winter.

B. Chronic Catarrh.

Btioioglcal Indlcatlona.

3. Avoid taking cold, and when an acute catarrh is contracted,
cure as soon as possible. See Acute Catarrh 1666» x» 2.

II RATIONAL aVDROTHERAPy.

PmttoiogtcsJ indiCMtioBS*

4. Increase Activity of the Skin and Tone of Cutaneou
Vessels. — Short sweating proceduresi especially the electric-ligbt
bath (1260) and wet-sheet pack (1179) continued untii the sweat-
ing stage, followed by short cold applications, — wet- sheet rob
(1216), shallow (1174), or cold douche (1010) j neutral bath at
bedtime (1130), 20 to 30 minutes, 3 times a week; daily cold
morning bath; cold towel ritb (1213); cold shower (1047) or
rubbing shallow (1174 )« All sweating baths ought, if possible,
to be taken just before retiring at night* During cold weather,
oil rubbing (1232) two or three times a week.

5. Improve GetieraJ Nutrition by Correctln^^ BxIstJn^
Digestive Disorders,— See 1520, 1521, 1523, Out-of-door
exercise, especially sun-baths (1254) and swimming.

6. Relieve Nasal Coiigestlon,— Alternate compresses to the
face (1340); alternate sponging or compresses to the cervical
spine (1342); running cold foot (1296) bath if extremities are
cold; nasal secretions must be removed by antiseptic spray or
vaporizer; hypertrophiesj polypi, etc., require surgical interference.

General Method, — Build up the general health by tonic meas-
ures, employing tonic cold procedures (1625) of some sort at
least twice daily* Avoid hot baths and too warm clothing and
expose the body as much as possible to the open air. Use great
care to avoid taking cold by undue exposures; but gradually train
the body to the point of enduring exposure without injury. The
intestinal disease, which is simply a local manifestation of a gen-
eral condition of lowered vital resistance, must have the benefit of
such local measures as are indicated above.

PHARYNGITIS —TONSILinS.

A. Acute Form.

1567 I. Rest in bed, room of uniform temperature. Spare diet con

sisting chiefly of fruits (1626, 1627). Avoid meats of all sorts.
Copious water drinking (1423), especially carbonated water.

2. Hot-blanket pack (1197); sweating wet-sheet pack (1183);
vapor bath (1246); electric-light bath (1250); hot immersion bath
(1126) followed by dry pack (1192, 1191) or other sweating
procedure once daily, followed by cold mitten friction (1209),
cold wet-sheet rub (1216), or cold douche (1010). Fomen-

LARYNGITIS. lOJS

tatlon (1328) to the throat three times a day; cold compress
(1381) between, changed every 15 to 30 minutes. Enema
(1404) if bowels are inactive. Hot gargle (1400) every few
minutes if throat is very sensitive. Ice-bag to throat if inflamma-
tion is intense. Inhalation of antiseptic vapors ; use of steam
inhaler (1419), 10 to 14 minutes hourly, or almost continuously.
If tonsil suppurates, it should be lanced.

B. Chronic Pharyngitis or Tonsilitis, Clers^rman's
Sore Throat.

1. Aseptic dietary (1626); out-of-door life; open air gymnas-
tics; swimming.

2. Fomentation to throat at bedtime (1328), followed by
throat pack (1381) during night; hot gargle (1400) three
times a day.

3. Electric-light bath (1250); sweating pack (1191); vapor
bath (1246), or other sweating bath, three times a week, followed
by suitable cold application (1625). Daily cold bath on rising.
Moist girdle (1347) to be worn during the night If necessary
remove tonsils and vegetations in throat or post-nasal region.

LARYNQITIS.

A. Acute Form.

See Acute Coryza (1565). Steam inhalation (1419), for 1568
10 minutes hourly; heating compress to throat (1382) without
mackintosh; avoid use of voice while very hoarse.

B. Chronic Form.

1. Increase General Vital Resistance, and Invigorate tbe

SIcin.— Graduated cold baths (1625); sweating bath (1197,
1246, 1260) or prolonged neutral bath (1130) at night, two or
three times a week. Follow sweating procedure by any suitable
cold application.

2. To Relieve Local Congestion. — Steam inhalation (1419)
every 4 hours for 10 minutes; fomentation (1328) at night,
followed by well -protected neck compress (1382) to be worai
during the night.

3. Cough — See 1669, 4-7-

1
I

1

CROUP.

1569 A. Acute Catarrh of Lparynx.

Hot bath with cold to head; hot water drinking (1429), cold
miticD friction (1209) every 3 hours; inhalation of vapor arisioi
from slacking Hme; cold compress, 6o^ over throat, changed every
10 to 20 minutes; hot-blanket pack every three or four hours,
15 minutes; keep feet, legs, and arras very warm. Surgical inter-
ference often necessary.

B. False Croupf Laryngismus Stridulus^ Spasmodic
Laryngitis.

&lotagiCMi imdIcmtloQM*

I. Frevetit attacks by hardening the skin by daily cold bath
(1635)- Remove nasal obstructioni hypertrophies, or adenoid
vegetations. Antiseptic mhalatmusp

a. Prevent ChilUnj^ of Shoulders during sleep, by wum
sleeping jacket Proper clothings

pMthoIoglcai indicMtlonB,

^y 3, Develop Resistance* — Graduated tonic appHcations

(1625); out-of-door life; careful regulation of clothing.

4. Relieve Congestion if spasm is severe by hot-blanket pack
(1197) or hot immersion bath (1126). Repeat every three to
six hours. Hot half-bath (1174) with cold affusion (1103) to
head, back, and chest. Follow bath by ice-cold heating compress
to neck (1382) to be changed every two to four hours. Fomen-
tation to cervical and dorsal spine for 15 minutes each time the
ice compress is changed.

5. To relieve spasm, compress the phrenic nerve by pressure
just above the sternal intersection of the stemo-cleido-mastoid
muscle; percuss chest with end of cold wet towel, or dash cold
water over chest and back.

6. Bronchitis. — If present, chest pack (1373); repeat in four
to six hours; cold mitten friction (1209) twice a day. Steam
inhalation (1419) and copious water drinking (1423) when
bronchial or laryngeal catarrh exists.

I

ACUTE AND CHRONIC BRONCHITIS. IO75

ACUTE BRONCHITIS.
Etiological Indications. 1570

1. Increase Resistance. — Graduated cold applications (1625)
daily; out-of-door life; daily air bath (1470); avoid excessively
warm clothing, and very warm sleeping or living rooms.

Pathological Indications.

2. Eliminate Toxins. — Moderately prolonged sweating pro-
cedures (1250, 1246, 1233, 1191) followed by cold applica-
tions.

3. Relieve Visceral Congestion. — Electric-light bath (10 to 20
minutes) (1250), sweating pack (1191), i to 2 hours, or vapor
bath (1246) 6 to 15 minutes, followed by rubbing wet sheet
(1216) or cold douche (1010); hot bath at bedtime (1126) for
6 to 10 minutes, followed by prolonged neutral bath (1130) 20
to 40 minutes. Apply daily or twice a day, hot hip (1389) and
leg pack (1393), followed by cold towel rub (1213).

Clinical Indications.

4. Cougli. — Chest pack (1373), to be changed every 6 hours.
If temperature is elevated, change chest pack every 2 to 4 hours.
Copious water drinking (1423), 2 to 3 pints daily.

5. Irritable Cougli, witliout Expectoration. — Sipping very
hot water; gargle hot water (1400); steam inhalations (1419);
avoid mouth breathing; keep air of room warm (75® to 80°),
and moist with steam; carefully avoid exposure of back of neck,
chest, or shoulders to drafts, or chill by evaporation during treat-
ment.

6. Cougli with Viscid Expectoration.— Copious hot water
drinking (1423); fluid diet (1628); fomentation to chest (1328,
1380) every two hours, followed by heating compress (1373).

7. Painful Cough. — Fomentation to chest (1328) every two
hours; tight bandage about chest to restrain movement if neces-
sary; revulsive compress (1341) for 15 minutes every two hours

or often as needed, dry cotton chest pack (1388) between ^^^^
applications.

CHRONIC BRONCHITIS.

I. Improve Qeneral Resistance. — Graduated cold treatment
(1625); aseptic dietary (1626); warm dry climate; outdoor life.

_ RATIONAL HTTDROTHERAPV,

2* Cough*^— Chest pack (1373> protected by impervious cor*

cring. Copious water drinking (1423 J, 3 to 6 pints dally^ steamJ
inhalation (1419). See 1570, ]

3. Ineffective Cougti.- — Increase expulsive power by mbbing-
or percussion of the chest with the hand dipped in ice water, OC;
slapping the chest with a cold, wet towel.

4. Asthma. — Cold fan douche to back of chest (IO01}|i
foUow^cd by heating chest pack (1373); revulsive compreit,
to chest (1341); Scotch douche to legs (1037); hot foot]
(1297) or leg bath (1299); hot leg pack (1393); hot cncm^
(1404); if sympathetic is irritable, wet-girdle (1347, 1348||
1367); chest pack (1373), well protected,

5. Emphysema. ^^ Alternate compress or douche to spine!
(1343); cold mitten friction (1209); cold towel rub (1313); i
wet-sheet rub (1216); wet girdle covered with flannel onlfi
(1347); leg packs (1393); cold precordial compress (1383);
15 to 30 minutes three times a day. '

General Method — The general method is the same as that :
for intestinal catarrh. See 1539- ■

PUUWONARY CONGESTION. \

1572 !■ Active Cortgcstion — Fomentation to back (1328), cold

compress to chest (1318) with hot leg pack (1393), followed
by cold friction and dry heat (1192) to legs; short cold applica-
tions to hands and arms (1209, 1213), followed by hot packs to
arms (1328); Scotch douche to legs (1037); hot leg bath (1299)
with very cold compress to chest (1314) before and behind.
Change compress as soon as warmed.

2. Passive Congestion of Chest. — Apply fomentation (1328)
over chest for 10 minutes every hour; during interval, cold com-
press (1314), renewing every fifteen minutes, rubbing surf ace weD
at each change. Most often occurs in fevers (hypostatic conges-
tion). Prevent by frequent change of patient's position. Apply
same derivative measures as for active congestion (See above).

3. Pulmonary Hemorrhage. — Ice compress to chest (1314);
remove, and rub the chest with dry warm flannel i to 2 minutes
every 15 minutes; hot leg pack (1393), very hot sponging of
the upper half of the spine. Place hands in ice-water i to 2
minutes; maintain skin circulation by dry rubbing (1221). Keep

BRONCHO-PNEUMONIA — PLEURISY. I O77

patient very quiet. After hemorrhage ceases, graduated cold treat-
ment (1625) to increase resistance and combat the disease to
which the hemorrhage is due. See Pulmonary Tuberculosis

1508.

BRONCHO-PNEUMONIA.

For general measures See Lobar Pneumonia (1498). 1573

1. Bronchial Irritation. — Steam inhalation (1419)> 15 min-
utes every hour; fomentation (1328) to chest every 2 hours for
15 minutes, followed by heating compress U373); hot-blanket
pack.

2. Cyanosis. — Short hot half-bath (1174); pour cold water
over head, spine, and chest to induce cough, if cough is checked
or inefficient while secretion is abundant. It is well to have the
patient sit in a tub with a small amount of hot water (1174),
while a cold affusion (1102) is administered followed by vigorous
rubbing, and wrapping in dry blankets in bed.

3. Heart Failure. — Cold precordial compress (1383) 15 min-
utes every hour. Also see 1578, i, 5.

4. After Convalescence Begins, — Chest pack (1373) night
and day. Graduated cold applications (1625) to build up gen-
eral resistance.

PLEURISY.

A. Acute Form.

1. General. — Improve general resistance by cold applications 1574
two or three times daily (1625, 1201, 1209, 1213); hot leg

bath (1299) if extremities are cold. Water drinking (1423);
aseptic dietary (1626).

2. Pain. — Very hot fomentation (1328) for 10 minutes over
affected side. Revulsive compress (1341); limit movement of
lung by tight bandage to the chest. Repeat every 2 hours. Dur-
ing interval, apply either cold (1318) or heating compress (1344)
as best suits the case.

After Convalescence Alternate chest douche (1044) or

alternate compress (1340) if necessary to absorb exudate. Apply
three times a day, continuous heating compress (1344, 1373)^
with mackintosh covering, during interval.

3. Exudate. — Alternate compress or spray three times a day;
graduated general tonic applications (1625). Prolonged neutral
bath (1130) half an hour to an hour daily.

«t

1. Neutral bath
mmutes' duratioB. Graduated cold (1620) daily. FomcaUtJoti
(1328) to chest three times a day, or revulsive spray ( lO+l), or
compress (1341); well-protected heating compress (13-1-1) daring
the intervaL

3. Aseptic dietary (162C). Gymnastics to e%pan dche^t after
removal of fluid if necessary to overcome adhesions.

3, Tubercular Pleurisy, — Short revulsive compress (1341)
(5 minutes) for relief of pain, three or four times a day, or often
as necessary; flannel-covered heating compress (1344) during
intervals; graduated tonic measures (1625).

NOCTURNAL ASTMAA,

1575 Neutral bath (1130) at bedtime; wet girdle (1347); copious
water drinking (li33); enema before retiring (1404); graduated
cold baths (1625); renal douche (1098). Cold coloclyster
(1407) daily in cases of toxemia with dilated colon. Correct
any existing j^astric disturbance.

Sweating process when skin is inactive (1250, 1246, 1197,
1191) followed by cold bath of appropriate form (1625).

PERICARDITIS, ENDOCARDITIS.

1576 I- '^^ Combat Inflammation. — Continuous ice-bag (1383)
over heart, or precordial compress at 60°, changed every 15 min-
utes. Remove ice-bag every 15 minutes, rub chest with dry flannel
until skin is red.

2. To Energize Heart and ilalntain Qeneral Vita! Resist-
ance.—Cold mitten friction (1209); cold towel rub (1213)
twice a day.

3. Fever. — Prolonged neutral bath (1130); neutral wet-sheet
pack (1182).

4. Pain. — Fomentation (1328) for i to 3 minutes every half-
hour; cold compress changed every 15 minutes during interval.

5. Myocarditis. — Employ all the means above recommended,
except, avoid ice-bag over heart.

ORGANIC CARDIAC DISEASES.

1079

ORGANIC CARDIAC DISEASE, VALVULAR DISEASE
OF THE HEART.

1. General tonic measures, carefully graduated (162S); mod-
erate antiseptic dietary (1636)i avoiding hot foods^ tea and coffee,
alcoholic drinks> condiments, flesh meats, and indigestibles,
Psthaiagicml IndlcatlanB*

2. To Increase Energy ol H^rt Ice-bag over heart (1383)

for 15 minutes, gradually increased to i hour, tidce a day. It
limbs are swollen, rest in bed until swelling disappears^ Efferves-
cent bath (1139) one to three times weekly; massage; leg packs*
Special gyratiastics (Schott)«

Clinical Indlcstions*

3. Dyspnea — Elevate the head and shoulders when patient Is
yingdown; cold compress to chest (1318) and hot pack to legs
(1393); change compress every 15 to 20 minutes; at each change,
rub the siirface of the chest with dry flannel until red.

4. PaitL — Very hot fomentation (1328) over scat of pain for
3 minutes; follow by heating compress (134i} at 60*^, changing
every 20 minutes; repeat every two or three hours; revulsive com-
press (1341).; hot and cold gastric compress (1356).

5. Insomnia. — Elevation of head and shoulders or head of
bed; wet girdle (1347).; neutral bath (1130) for half an hour
at bedtime, or neutral douche (1031) 3 to 4 minutes at bedtime*

6. Headache. — Prolonged neutral bath (1 130); copious water
drinking (1423); coui enema (1404); hot-blanket pack (1197)
with ice-bag over the heart (1383); ice^cap (1323, 1371). If
kidneys are diseased, apply fomentation over loins with ice-bag
over heart and lower third of sternum*

7. Dropsy. — Rest in bed; hot blanket pack (1197) followed
by sweating wet-sheet pack (Hill) ending with cold friction
(1209); leg packs (1393); electric-light bath (1260) or vapor
bath (1246) for lower half of body; ice-bag over heart during hot
baths; massage; effervescing bath (1139)*

8. To Bnerfci/^ the Heart and Encourag^e Peripheral CIrcu*
latiuiL~Wet sheet rub (1216); cold towel rub (1313); Scotch
douche (1037) at 102^ lowering without sudden change to So**
during first applications. At each succeeding ap|*Ucatiani a tern*
pcrature i'^ lower until 65^ or 60° is reached. Cold friction

1&77

t RATIONAL HYDROTHERAPY.

(1209); fan douche (1061) over chest without pressure at 75^
duratioQ 10 or 15 seconds.

9, Cardiac Hypertrophy-^ — Rest in bed; ice-bag over heart
for I hour three to four times daily; prolonged neutral bath
(1130), 9^^ to 94**, 20 to 60 minutes; neutral pack (1182) ^o to
40 minutes; graduated cold baths (1635); heating abdominal
compress (1361); fj^entle massage; centrifugal friction (1234)*

to. Hepatic Congestion and Hypertrophy (Nutmeg Liver).
— Alternate compress (1340); alternate douche (1044) with slight
pressure; heating compress (1 ), covered with flannel only

during the night; if pain is pi , revulsive compress (1341);

treatment for relief of portal con| istion. See 1278, 1270-

11. Pulmonary Hemorrhage, — See Pulmonary Congestion
(1572, 2, 3)^

12. Cough. — If acute, 1572, 2 j if chronic, chest pack, Oannel
covered (1373); warm covering of arms; heat to legs; intermit^
tent precordial compress (1383).

13. Palpitation-^ See 15 78 J 3*

14. Angina Pectoris. — Ice-bag to dorsal spine (1372); hot
leg pack (1393); short fomentation (jo sees,) over heart, foj
lowed by warm dry compress,

15. Gastric Catarrh See 1520.

16. Arterio-Sclerosis. — Prolonged neutral bath (1130) three
times a week at bedtime. Carefully graduated cold baths (1625).
Aseptic dietary (1626); gentle massage; moderate exercise.

17. Contraindications. — Cold immersion baths, cold douche,
Russian bath, very hot or prolonged warm baths. Avoid such
exercises as produce swelling of feet, cough, dyspnea. Ice-bag
over the heart, and the ice-cold precordial compress must be
avoided in cases of fatty heart.

In general, cases of valvular disease of the heart require, dur-
ing the Jirs/ s/age, carefully graduated cold baths with moderate
exercise. During the second stage, rest in bed, ice-bag over the
heart for 15 to 30 minutes two to three times daily; very
carefully administered tonic treatment, such as cold mitten fric-
tion, cold towel rubbing, graduated into more vigorous measures
(1625); skillful massage and carefully graduated exercises. In
the third stage complete rest in bed, with the application of special
measures for the relief of dropsy (1582), and the careful em-

3

rUNCTIONAL CARDIAC DISEASES.

lOSt

ployment of the same measures necessary for the second stage.
The general aim is to cnergkc the heart and lessen its work by
increasmg the activity of the peripheral heart (1139).

FUNCTIONAL CARDIAC DISEASES.

1. Shock, Collapse, C>^atiosis> — Hot fomentations (1328) or 1578
hot-blanket pack (1197) for lo to 15 minuleSi or hot immersion

bath (1126) 3 to 6 mint3tes» followed by cold mitten friction
(1209); cold towel rubbing (1313) or wet-sheet rubbing (1216),
continiied until surface is reddened, applying every 3 to 3 hours, or
two to three times daily, as may be necessary; ice-bag over heart,
or cold precordial compress (1383)* 15 minutesj repeating every
hour; alternate compress to spine (1342); hot enema (1406);
keep patient warm by hot bags and flannel blankets; alternate com-
press (1340) over heart if necessary; heat to head if face is pale.

2. Tachycardia — Rest in bed; ice bag over heart (1383)j
gastric lavage (1401) if indicated; cold enema (1404) or colo-
clyster (1407) to relieve constipation; if abdominal ganglia are
sensitive, abdominal fomentation (1328) followed by heating
compress (1344) to be repeated every 6 hours; neutral bath
(1130) for half an hour^ gi^ to 94^; gastric lavage if stomach
is foul,

3. Cardiac Palpitation. — Rest in bed; cold precordial com*
press (1383); ice-bag to the cervical region (1314); cold fric-
tions (1209); cold douche (1047) following hot foot bath
(1297); wet-sbeet rub (1216); shallow bath 78^^, onc-half minute
(1174); gradually accustom patient to cold applications (1625);
hot and cold gastric compress (1362), or trunk pack (1367);
gastric lavage (1401); enema (1404)-

4. Aortic Palpitation* — Usually due to toxins or other irri-
tants of the abdominal sympathetic. Fomentation (1328) to
abdominal region for 10 minutes followed by heating compress
(1351) to be renewed every 4 to 6 hours; if enteroptosis is pres-
ent, abdominal supporter; ice-bag over aorta. Relieve constipa-
tion if present by cool enema (1404), 75^ to 65*^. Gastric lavage if
required* Wet girdle (1347) at night without impervious covering,

5. Feeble Heart, without Fatty De^eneratioit Cold pre-
cordial compress (1383) 15 minutes daily; increase 5 minutes
each day uatil duration is 30 to 40 minutes. Percussion douche

RATIONAL HYDROTHERAPY.

to the spine (1035); vigoroEs cold friction (1209) to extreimtid
Avoid prolonged cold appUcations or prolonged chiUmg. |

6. Decrease Work Required of the Heart* — Dilate sudm
vessels and increase their activity by cold mittetx friction (1309]
cold towel rub (1213), wet-sheet rub (I2I6), shallow bath, 7a*!
75**, one-half minute (1174)- K necessary, precede the short cdi
application by a short heating procedure as a fomentatioji to tli
spine (1388), vapor (1246), hot immersion (1126), or electr^
Ught bath (1250) for 5 to 5 minutes^ or hot sponging (1300)

7. Remove Toxins.— Lavage (1401); coloclyster (1407)^
water drinking ( 1423)* j

8. Slow Pulse,^— Alternate sponging or compress to spia^
(1342); hot water drinking (1429); dry friction (1221); maii
sage; carefully graduated cold baths (1625)^

9. Avoid hot bathsj or if a warm bath is necessary^ maU
very short (loa** to 104'^), and follow with short, cold applicatioiL

iMom

CHL0R05IS.
1579 EtialogicMl indications.

I, Correct Enteroptosis- — Abdominal Supporter; at

inal massage; corrective exercises; cold abdominal douche

(1081); electricity,

Paiholagical Indications, ^

a. Increase Vital Resistance.— General graduated cold pn>

cedures (1625) twice daily.

3. Combat Autoxlntojcatlon. — Aseptic diet (1626); sweadn|

bath to beginning perspiration^ electric-light bath (1250) or sui
bath (1254) followed by short cold application (1625)*

Clinical Indications.

4. Low Blood Coynt. — ^See Anemia 1580, r-

5. Constipation— See 1524.

6. Vaso-Motor S|»5m. — General Scotch douche (1037);

alternate immersion (105° to 110°, 30 seconds, 80° to 70% 15
seconds); simultaneous Scotch douche (1037)^

7. Visceral Anemias. — Visceral douches (1088-1099),
alternate (1044), Scotch (1037) short percussion (1035); alter^
nate compress over part (1340), followed by well -pro tec ted heat*

ANEMIA. 1053

ing compress (1344); Mackintosh-covered wet girdle at night;
cool enema (75° to 68°), i to 3 pints, daily.

ANEMIA.
Etiological Indications.

1. Increase Blood-Making Process. — Graduated cold appli- 1680
cations (1625). The electric-light bath (1260) is especially
valuable as a means of heating before general cold applications
(1637); aseptic dietary (1626)^ substances rich in proteids and

fats; rest in bed, if patient is emaciated; out-of-door life; cold air

baths (1470); sun baths (1264); sea bathing (1147); massage;

manual Swedish movements; electricity; oxygen inhalation.

static.

Clinical Indications.

2. Neuralgia. — See 1545.

3. Hyperpepsia.— See 1622.

4. Hypopepsia.— See 1521.

5. Chronic Qastro-lntestinal Catarrh.— See 1619» 1629

6. Loss of Appetite. — See 1521, 5.

7. Vomiting — See 1523, 3.

8. Constipation. — See 1524.

9. Enteroptosis. — See 1625.

10. Gastric Dilatation.— See 1523.

11. QastricUlcer.— See 1526.

12. Fever. — Prolonged neutral bath (1130) daily; fomenta-
tion to spine (1328) followed by wet-sheet pack (1179).

13. Nervous Excitability.— Neutral bath (1130); heating
compress to spine (1344); neutral rain douche (1060).

14. Dropsy,— See 1682.

15. Palpitation of Heart or Aorta. — See 1678, 3, 4.

16. Metrorrhagia or Menorrhagia. — See 1588.

17. Chronic Nephritis.— See 1538.

18. rialarial Cachexia.— See 1490, 17.

19. Vaso-Motor Spasm. — See 1579, 6, 7.

General Method. — Cold water is the most valuable of all
curative measures in anemia. Apply twice daily, graduating care-
fully (1625). Autointoxication arising from dilatation (1523) or
prolapse (1525) of the stomach, or chronic constipation (1624),
is often the principal cause to be combated (1473-1476).

RATIONAL MYDEOTHERAPV.

PERNICIOUS ANEniA.

1681 I. CoTfilmt Autointoxication Electric-light bath (1260Ji

vapor batli (12^6), or hol-blanlcct pack (1197)^ S minutes, fol

lowed by cold bath (1625) twice a week. Aseptic dletaq

(1626). \

2. Indierestioti. — See Hypopepsia (1621)- Aseptic di«|

(1626). ]

5. Promote Genera! Nutrition and Blood iVlaking^p — G r ad ti^^

atcd tonic baths daily (1625); ice-bag over the stomach half ai|

hour before each meal. See Anemia 15 SO* |

4. Cerebral Anemia. — Rest In bed with foot of bed raised^

Warm flannel about the neck to promote cerebral circulatioaJ

Warm compress to back of neck if patient is Inclined to faint^

5. Qeiteral Method > — The same as for simple anemia (1580) J

GENERAL DROPSY, ANASARCA, OR MALEOLAR EDEflA.

1582 I. Rest in bed; ice-bag over heart 15 to 30 minutes three
times a day; graduated cold treatment twice daily (1625); heat^
ing pack to legs (1393); water drinking (1423); sweating pri>J
cedures when due to renal disease (1250, 1191); wet girdle

(1347), changing every 2 hours.

2, Palpitation,— See 157H, 3.

3. Nervous Irritability .^ — Prolonged neutral bath (1130) 30
to 60 minutes every other day; alternate spinal compress.

4. Vomiting, — Lavage (1401 ) ; ice-bag over stomach; hot and
cold tmnk pack (1367); ice-bag to lumbar region.

5, Fever, — Prolonged neutral bath (1130), daily or more
often; cold mitten friction (1209); cold towel rub (1213).

EXOPHTHALMIC GOITER, d

1583 PaihotoglcEl Indications.

1* Enlarged Thyroids — Ice*bag over gland, continuouslyj re-
TOOving for five minutes every half-hour; galvanization of cervical
and abdominal sympathetic.

3. Anemia. — Carefully graduated cold wet hand rub (1 201 ),
mitten friction (1209), and towel rub (1213). See 1580.

3. Autointoxication. — Aseptic diet (1626); coloclyster
(80^) daily; neutral bath, lo to 30 minutes dailv (1130); water
drinking (1423).

MYXEDEMA — RHEUMATIC GOUT. IO85

4. Nervous Irritability and Exhaustion. — Rest in bed; care-

^illy graduated cold baths (1625).
Ciinicai indications.

5. Genera! Feebleness. — Graduated cold applications (1626).

6. Emaciation. — Rest; diet rich in fats and proteids (1626).

7. Palpitation.— See 1678,3, 4-

8. Insomnia. — See 1564.

9. Neuralgia. — See 1545.

10. Diarrhea.— See 1529.

11. Constipation — See 1524.

12. Gastric Irritability. — Hot and cold gastric compress
(1356); revulsive compress (1341). See Chronic Gastritis
(1520), Hypopepsia (1521), Hyperpepsia (1522V

13. Jaundice.— See 1608.

14. Tremor. — Short spinal fomentation (5 minutes) followed by
heating compress (1344) for several hours daily.

15. Contraindications. — Very hot or cold general applications.
General Method. — This disease is probably an autointoxica-
tion. As the patients are generally very feeble, the measures
employed must be at first very gentle, and must be very carefully
graduated to avoid any aggravation of symptoms (1625).

MYXEDEMA.

Graduated cold baths (1625); massage; galvanism to abdomi- 1584
nal sympathetic; electric-light bath (1250) or other sweating pro-
cedure (1246, 1233, 1191) followed by appropriate cold baths
(1213, 1216, 1010). Ice-bag over heart during hot applications.
Train patient to use of cold douche (1010, 1017, 1625) as soon
as possible. Strong percussion douche (1035) to spine when
it can be borne.

General flethod. — This condition is doubtless due to auto-
intoxication and lack of some element supplied to the body by the
thyroid gland. Hydrotherapy alone is beneficial in many cases,
but hydriatic measures may be best employed in connection with
the systematic use of the dried sheep's thyroid.

ARTHRITIS DEFORMANS, RHEUMATIC GOUT.

I. General Restorative Measures. — The diet must be specially 1586
nourishing and digestible, rich in fats and proteids (1626). See

Emaciation (1516)- A warm, rather dry^ and tiaiform cli

is most desirable. j

2, Carefully graduated cold applications (1625)* preceded f
very short hot applications; fomentation (1328) to spine or li
electric-light bath (1250) 3 to 5 minutes, and the sun bi
(1264), followed by cold mitten friction (1209) are especial
snl table; massage; manual Swedish movementsi oil nibb^
(1232); wet girdle (1347)- |

CHnical indiCBtiOQs.

3, Fever. — Prolonged neutral bath (1130) at 92*^; fooienl
tioB (1328) to spine followed by cold friction (1209) or towel ri
(1213).

4, Frequent Pulse«^ — Cold precordial compress (1383) \
ice-bag for 15 to 30 minutes three Limes a day.

5, Pain in Joints. — Revulsive compresses (1341) followed t
cotton poultice (1388); local vapor bath (1249); local electil
light bath (1250).

6, Neuralgia of Hands — Hot hand bath (1303) followed I
cotton poultice (1388). 1

7, Radiating Pains. — Fomentation (1328) to spine tfaij
times a day, heating compress (1344) during interval, well pre
tectcd with mackintosh; revulsive compress (1341) to spine; gai
vanic or sinusoidal electricity to trunk, arms, or Ic^^s, as indicated

S, Numbness and Tingling of Hands and Feet* — Fomen
tation to spine, hot or alternate sponging of limbs (1204), repeat©
three times a day; faradic or sinusoidal electricity.

9. Muscular Cramps,— Fomentation (1328) or hot immer
si on of affected parts two or more times daily; during interval
well-protected healing compress (1344); hot spoiiging; firr
bandaging* Protect patient from chilU

10. Muscular Atrophy.— Alternate douche (1044 )i compres
(1340) or sponging; massage; massage-douche (106G); sinus
oidal electrical current (1446) applied to affected muscles.

11. Joint Deformities, — For thickening of synovial membraoj
or accumulation of fluid in joints or bursa*i apply ahernale doucb
(1044); alternate compress (1340); massage-douche (1066)
Apply to joint dry flannel bandage or cotton poultice (1388)

12. Contraindications. — Cold douche to painful joints; Ion,
sweating processes and prolonged general hot applications.

DYSMENORRHEA. I OS/

General Method. — Improve the general health by general
tonic measures, especially carefully graduated cold baths (1635)»
massage and general applications of electricity, combating local
manifestations of the disease by local applications of massage and
other palliative measures above recommended.

PELVIC PAIN.

1. Remove all known causes — tight bands, heavy skirts, tight 1686
shoes, cold extremities, sexual excess.

2. Rest in horizontal position^ with proper general treatment for
any existing general or local morbid condition, as anemia (1580)}
neurasthenia (1554), hysteria (1553)» enteroptosis (1535), con-
stipation (1524), or any discoverable pelvic disease. See 1590,
1591, 1592,1619.

3. If neuralgic^ hot hip and leg pack (1389> 1393) or very hot
revulsive sitz (pp. 766, 770) three times a day; hot bag over seat
of pain, heat to feet and legs. Very hot vaginal irrigation (1413).

4. If due to chronic congestion^ hot hip and leg pack (1389,
1393) every 2 to 4 hours^ with abdominal heating compress
(1351); and heating leg packs (1393) during interval.

5. If due to inflammation or acute congestion^ hot hip and leg
pack (1389, 1393) or hot and cold pelvic pack (1370) every 2
to 4 hours, followed by continuous heat to legs with cooling compress
to lower abdomen, external genitals and inner surfaces of thighs.
Vaginal irrigation (1413) at 105** for 15 minutes every 3 hours,
apply ice-bag over seat of pain during hot vaginal irrigation and
hot hip and leg pack.

DYSMENORRHEA.

1. Rest in bed during period. 1587

2. When Due to Ovarian Disease (beginning before flow).
— Hot hip and leg pack (1889, 1393); hot-blanket pack
(11^7); fomentation (1328) over hypogastrium; hot pelvic pack
(1390); revulsive siU (pp. 776, 770); hot rectal irrigation
(1410) followed by hot foot bath (1297) if flow is checked;
hot douche (99® to 102**); very hot immersion (105** to 110°)
5 to 8 minutes.

3. When Due to Uterine Disease (beginning with and ac-
companying flow). — Hot hip pack (1389) with hot foot bath

1588

RATIONAL HYDROTHERAPY*

(1297) followed by cold compress to hypogastrium and ui
surfaces of thighs for 30 to 40 seconds* For treatment betn
periods, see 1591^

4. When Due to Inflammatory Disease of Appendage^

Hot enema (1406); hot fomentations (1328); bat pelvic |i
(1390) i hot-blanket pack (1197). j

General Method. — In addition to the local measures for id
of pain which have been indicated above, it is in mast cases 11
essary to combat some general disorder to which the local disc
may be more or less directly related. See Anemia ( 1 580), Neui
thenia (1554), Hysteria (1553)- General tonic measures ol
be employed between the menstrual periods. In chronic ovii
congestion, apply the hypogastric compress (1318) during]
night; administer daily the revulsive sits (pp. 766, 770) or j
pelvic pack (1390), and the very hot vaginal irrigation (14lj
115*^ to I a o*^, 15 minutes* In cases of deficient developm^it^
in infantile ntertis or vasomotor spasm of the uterine vcs$|
employ the rcvvilsive s\li, alternate geni to -urin^y douche (109|
tonic silt (1309), pelvic and general massage, and local galviJ
and sinusoidal electrical applications.

Applications of electricity and surgical measures are of^
required for permanent relief, but a surprisingly large number
cases are curable without surgery j hence hydriatic measures shoB
be persevering! y tried before resorting to surgical procedures,

METRORRHAQIA AND MENORRHAQIA,

I. Hot vaginal irrigation (1413); short hot hip pack (1389
hot foot bath (1297), followed by cold compress to hypogastriu
(1314) and inner surfaces of thighs* In obstinate cases^ ca'
vaginal irrigation (1413)* Moderately prolonged, very col
shallow sitz (50^^ to 65'' for 5 to 15 minutes) (1309)^ accompani<
by hot foot bath (1297) when other measures fail; hot doucl
(1024) to lower spine, hypogastrium, inner «>urfaces of thigh
twice daily during intervals.

2* Contraindications. — Prolonged hot sitz, hot douche, hot le
footj and sitz baths, and in some cases even fomentations and b
vaginal irrigation must be avoided* It is equally necessary
avoid short cold applications to the lower spine, abdomen, thig:
and feet, as the reflex cfiects of such applications increase pelv
and uterine congestion.

PELVIC PERITONITIS.

1089

Qetteral Method. — It is alwajrs highly important to inquire
closely for all possible causes of the profuse flow. The cause may
be simple anemia (1580) from defective nutrition^ constipation
(1524). sexual excess, enteroptosis (1525)i uterine displacement
( Uil9)> ovarian or tubal disease (15S>3), uterine inflammation or
congestion (1591)* The most common cause is vegetations of
the endometrium, which must be removed by surgical measures.
The operation must be followed by treatment for chronic metritis
(1691). In many instances, several of these conditions may be
combined. Such general and local measures must be employed as
have been suggested above and elsewhere, and it is rare that treat-
ment IS not very speedily followed by most gratifying results,

AMENORRHEA.

1, Tonic sitE (1309); cold pelvic pack (1390, i)j graduated
tonic baths ( 1635) twice daily; short very cold douche to lower
spine (1076). hypogastriuni and inner surfaces of thighs; pelvic
massage daily, and especraily when period is due*

2, Suppressed Menstruatiofi. — Short cold douche to spine,
thighs, and hypogastrium (1099) daily or twice a day; hot foot
bath (1297) or hot-blanket pack (1197) during interval between
the jicriods. Intrauterine applications of the faradic or sinu-
soidal electrical current^ hot hip pack (1389); warm vaginal irri-
gation (U13), 95^ ^o ^oq""*

3, General Method,^ It is very necessary to treat the patient
rather than her malady. Apply such measures as may be required
for relief of anemia (1580)* chlorosis ( 1579)^ indigestion (1521-
1523) or any other disturbance of the nutritive functions.

PELVIC PERITONiTIS, CELLUUTIS.

BtiaiogicMi iijdicmiiaas*

1, Surgical and puerperal asepsis; care to avoid exposures
at menstrual periods; protection of feet &nd icgi in damp and
cold weather; proper clothing.

/^thoiogicai indicBtioms.

2. Increase Resistance,-- Cold mitten friction (1209) or cold
towel rub (1313) two to four times a day, protecting pelvic vis-
cera by simultaneous hot foot or leg pack (1393^ 1394) or by hot
bag to sacrum and cold compress to hypogastrium.

69

1589

1590

logo RATIONAL HYDROTHERAPY

3. Combat Local loflammatlon. — Hot hip and leg p4
(1389, 1393) 20 minutes every a hours; during intervals, q

compress (1318) at 60° to hj^pogastnum, pudenda and inner i
faces of thighs, with heat to feet and legs, or ice-bag o\*er sea|
pain, hot bags or fomentations to feet, hips and thighs; hot ^
cold pelvic compress (1364) with ice-bag over seat of pi
continue 20 to 40 minutes, and repeat when needed; hot vagi
irrigation (lilS) (110° to 120°)^ one galloni every 4 hour^

4. Encourage Resolution, — ^ After acute ^tage has pasi
apply alternate compress (1310) for 30 minutes three times a dd
during interval, heating compresses (1344)* changing everj
hours, or as soon as well warmed; graduated tonic baths (16!il
alternate vaginal irrigation (iio^^i So*^ to 70^} ; later, pel
massage.

Ciiiticai indications*

5. Pain, — Fomentation (1328) or revulsive compress (134
every 2 to 4 hours, or oftener if necessary,

6. Const ipatlon«^ I.arge hot enemas (1406) twice a d
during acute pain and inflammation; later^ graduated cold end
(1400). 1

7. Chill. — Anticipate chill by wrapping patient in warm bla
kets with hot bags to trunk and limbs; hot water drinking (1429

8. Septic Fever, — Add to local measures, if fever is high, he
blanket pack (1197) 10 to 15 minutes, followed by sweating wc
sheet pack (1183, 1191) prolonged neutral bath (1130).
suppuration occurs, surgical interference is generally indicate!

9. Anemia. — See 1580.

10. Contraindications. — Avoid cold immersions; partial col
applications, such as the cold-mitten friction and the cold-towi
rub, must be used instead.

CHRONIC METRITIS AND PELVIC CONGESTION,

1691 I. Graduated cold applications (1625); hot vaginal irrigj

tion (1413), 10 to 15 minutes, twice daily; hot-blanket pack to 1^
(1393) with cold pelvic pack (1390), continued to sweatir
stage, followed by cold friction (1209, 1213) or wet-sheet m
(1216).

OVARITIS, SALPINGITIS,

1091

Clinical Indications,

2, Pain*— Prolonged netitral sitx bath (1312) 95"* to 97^
duratioti, 15 to 20 minutes.

3, Leucorrhea,^ In addition to the above measures, anti-
septic vaginal irrigation, bichloride i to 5,000, or permanganate
t to 200. In certain cases, cool irrigation, 75* to 65% produces
better results than hot irrigation. Constipation (I53I-) a^id portal
congestion (12 79) niust be relieved. Cervical catarrh and
erosions often require the use of the curette.

4, Acute Inflammation* — If attacks of inflammation occur,
rest in bed; hot hip or leg pack (ISHft, 13t)#l); liot and cold
pelvic compress (1364) or hot and cold pelvic pack (1370)«

OVARITIS AND SALPINQITIS.
A. Acute Form»

1, Rest in bed; hot vaginal irrigation (HIS) twice daily; hot
pelvic pack (1390); hot leg pack (1393) or hot foot bath
(1397) twice daily, followed by cold friction (1209). H sup-
puration of tubes occurs, oijcration Is nsiially necessary. Dur-
ing the first few days, ice-bag over inflamed part, interrupted at
intervals of 1 to 5 hours by fomeniatatlon for 15 minutes or hot
and cold pelvic compress (I3fi4) for 30 minutes; heat to limbs.

2. Contraindications* — General cold applications, and cold
applications to the feet*

B. Chronic Form.

I. Rest in bed with hips elevated; neutral bath (IISO) 15 lo
30 minutes three times a week; hot pelvic pack (1390) morning
and night followed by general cold friction (1209) and heating
compress (1344) over the hypogastrium to be retained until the
next hot application. The heating compress should be well cov-
ered. If pain is intense, employ a hot hip and leg pack (l3N9p
1393) twice dallyj with the beating compress during the interval.
The circulation of the lower extremities may also be encouraged
by a prolonged heating compress applied lo each leg separately
(1393) 3 or J hours once a day. Vigorous cold friction with
towel or milt should be applied to the legs on removal of the
pack (1209-1213)* Keep the feet and legs warm,

;!. Hot vaginal irrigation twice daily (1413); hot rectal irriga-

1692

1092 KATIONAL HVDROTHERAPy,

, tion (1410) once daily if exudate in pelvis is extensive; sj^

soidal current with very rapid alternations; pelvic massage, '

5, General tonic applications (163&); general massage; matij
Swedish movements; sun baths (1264); out-of-door exposure wl
proper protection, carefuUy avoiding chill; fat and blood-buil^
diet See Emaciation (1516)* '

4. If suppuration is present, drainage. Removal of the it

eased appendages is sometimes required, but in most cases t]

may be obviated by the proper application of hydriatic oieasii;

at the outset i

STERILITY IN WOMEN, i

1593 Whea not due to organic diseases, may often be cured by!
course of hydriatic treatment A course of graduated cold apfi
cations (16!i5) is most efficient The cold rubbing si tz (130l
is highly usefuK Remove catarrhal conditions of uterus M
vagina and subinvolution by means of hot vaginal fnigatll
(1^13) followed by tonic sits (1309). J

PROSTATITIS. \

1594 I' Revulsive sitz bath (p. 770); hot rectal irrigation (14101
irrigation of bladder (1411), if bladder does not empty itseE
Neutral sitz (1312), 30 to 60 rain. Cold mitten friction (1209)

2. When painful, revulsive sitz (pp. 770, 766). Fomentatioi
or the Scotch douche to perineum (1084), with little pressure
Rectal irrigation (1410) in chronic cases. Hot enema (1406'
when bowels are constipated.

3. Chronic Enlargement with Induration. — Good result
often follow the use of the following measures: alternate recta
irrigation (1410); shallow cold rubbing sitz (1309) 4 to 8 min.
cold pelvic pack (1390) with hot leg pack (1393); massagt
of prostate; graduated tonic baths (1625); ice-bag to perineum
with hot hip and leg pack, 15 to 30 min.

4. Contraindications. — When pain is present, avoid genera
cold baths, cold sitz and foot baths, and chilling of feet Absolut
sexual continence is essential.

ACUTE ORCHITIS,
1696 Rest in bed. Elevation of scrotum upon a tense broad ban<
of cloth placed about the thighs close to hips. Hot pelvic pad

SPERMATORRHEA — IMPOTENCE PRIAPISM.

1093

(1390) or hot hip pack with cold compress over genitals (1364)f
every 3 hours. During intervals, cold compress at 60* over
perineum, genitals, and hypogastrium, with heat to feet. Tepid
enema (1404) twice daily; cold mitten friction (1209) or cold
towel rub (IS 13) twice a day; prolonged neutral bath (1130)
or neutral pack (1182) to control temperature if necessary.

SPERMATORRHEA,

I* Graduated cold applications (1625) to improve general con- 1596

dition.

CHnhat indicBtioas.

2. General Nervous IrritAbilily. — Prolonged neutral bath
(1130) at night See Neurasthenia (1064)^

5, Irritable Prostate, Irritable Urethra.^ Prolonged neutral
sitz (13I2)> 30 to 60 minutes, at bedtime; Scotch douche to
perineum (10S4) with little pressure; tepid rectal irrigation
(1410) at 8o^

4. Relaxed Ejaculatory DuctA,— Rubbing cold si 12 (1300),
cold or alternate irrigation of rectum (1410); cold douche to feet
and legs (1082); cold percussion douche to lower spine (1074)*
Bowels must be kept regular by the cool enema (1405) if neces-
sary, and proper diet An aseptic dietary (1(126) is essential
Condiments must be strictly avoided. Cooling sound (1416)t
70°, for 5 minutes daily*

5. Contraitidlcatlons« — ^When losses are frequent or parts
irritabtet avoid cold sitz baths and prolonged hot baths*

SEXUAL IMPOTENCE,

Graduated cold baths (Ifi26); cold douche to spine (1074). 16ft7
especially lower part; cold rubbing sitz (1309), beginning at 60°,
lowering temperature 5* daily to 6o*| duration of bath ^ to 8
minutes. Patient should be vigorously rubbed to prevent chilling.
II urethral irritation is present, short (2 to 4 minutes) revulsive sitz
(pp. 766, 770); cooling compress (1396)r S minutes daily,

PRIAPISM,

Immersion bath (1112), too** for i minute, 90** for 5 minutes; 1598
^adually lower temperature to 75"*, and continue for s minutes;

1094 RATIONAL HYDROTHEltAPY.

lower minimum temperatures i° daily to 60**^ hot daucbe I
lower spine (^1074) and thighs for 50 seconds; follow by genen
neutral douche (1031) a to 3 minutes with considerable press^i
(20 to 30 lbs. ) J prolonged general neutral bath (1130) 50 to ^
minutes J Spinal atfusion (1103) 5 minutes, 98°.

4

IRRITABLE RECTUM,
1&99 PattoIogicMi fndlcAiioas.

t. Increase Vitat Resistance* — Graduated tonic bmt^
(1625).

2. Conibat Local Inflammation. — Prolonged cool sit
(1308) I 75** for 15 minutes; cooling compress (1395) to natd
anus, perineum^ and genitals; cleanse rectum after each stool
render fecal matters soft and bowels regular, by diet and otb«
measures. See 1534* Rest in horizontal position; hot recti
irrigation (1410) daily or oftener; prolonged cold anal doucbi
(1087) with little pressure,
Ciinica! indlcmtlans. \

Pain. — Revulsive compress ( 1 341) ; ice-bag to anus j foment*
tion (1338) to nates and perineum; hot hip pack (1389); hoi
footbath (1297); hot hip and leg pack ' (1388, 1393); hot va-
ginal irrigation (1413).

Spasm. — Hot sitz (1311); sitting over hot water (p. 707).

Constipation.— See 1524.

Pain in the Back. — Scotch douche to back (1037); hot sitz
(1311); wet-girdle (1347).

HEMORRHOIDS

1600 I. Portal Congestion Running cold foot bath (1296); hot

foot (1297) or leg bath (1299); hot leg pack (1398); scotch
douche to feet and legs (1082); wet girdle (1347). (See also
1278, 1279).

2. Constipation — See 1524.

3. Diarrhea See 1528.

4. Irreducible Prolapse. — Rest in bed; lying on the face;
knee-chest position if required. Ice compress (1314); bathing
parts with ice water; daily small cold enema after stool; relieve
bowels while lying in horizontal position; avoid straining; abdom-
inal supporter. In many cases, surgical measures are necessary.

SVPHILIS.

1095

5. Inflamed Hemorrhoids. — Rest in bed with feet ami hips
elevated; ktiee- chest position if necessary; ice-cold compress
(1395) pressed firmly against anus; ice suppositories j very shal-
low ice-cold sitz.

6. Pain. — If due to inflammation, short hot fomentatioti
(I33S) followed by cold compress applied to the anus and nates
(1395 n with hot foot bath (1297) at the same time; repeat
fomentation hourly or every two hours; prolonged tepid sitz
(13(H), temperature 85^ lo So*"; hot hip and leg pack (1389,
1393)} followed by cold compress over nates, perineun*, and
lumbar region (1395)^

SYPHILIS*

1. First and Second Stashes, — Eliminative baths — vapor
(1246),electric4ight (1350), sweating pack (1191), followed by
short cold tonic applications — wet- sheet nib (1216), graduated
douche (1017), or cold towel nib (1209); outdoor life; reg-
ular habits, aseptic dietary (1026), especially careful avoid-
ance of meats, tea and coffee, tobacco, akoholic drinks^ and
all indigestible and unwholesome foods.

2. SNin Eruptions — Prolonged neutral bath (1130).

3. SyphiUtic Cachexia— Electric-light baths (1250); sun
baths (1254); water drinking (1423); wet girdle (1347); cold
mitten friction (1209j; cold towel rub (1213); rubbing wct-shecl
(1816).

4. Anemia Due to Long^-Continued Vm of Mercury or
iodide of Potash. — Galvanic bath (1457) two or three times
a week, and carefully graduated tonic baths (1626)^ water drink-
ing(U23).

5. Nocturnal Pains. — Prolonged neutral douche (I031)i
5 minutes at bedtime; fomentation to the spine; alternate com-
press to spine,

6< Insomnia. — Prolonged neutral bath (1130) at bedtime;
wet girdle (1347) to be worn during the night j See 1564*

7. Syphilitic Ulcers. — General eliminative and tonic measures,
sweating bath daily (1250, 1191) followed by short cold appli-
calions (1626); prolonged immersion of the affected parts
(1107)i or antiseptic dressing,

8. Indolent Ulcers, — Alternate spray to ulcer, with measures
indicated above^ twice daily for 10 minutes.

1601

1 'i

1602

li' i

g. To Induce Absorptioo of Quntm«ta« — A fmh dkUff
(1627) for 5 days, prolonged sweating bath (1191) dailf,
electric-light bath (12S0), vapor bath (1246)* or swcatiog wel*
sheet pack followed by a vigorous cold applicadon^ as a cold
douche or rubbing shallow (1174)* Continue long as Indicated

10, Contraindications. — Avoid prolonged very cold baths^
especially cold immersions* Such baths are especially harmful
when mercury is being taken. Avoid prolonged hot baths in
cachectic and anemic patientSp also when patient's tenaperature U
elevated

General Method. — The important thing to be accomplished la
the treatment of this malady is the reconstruction of the body by
the regulation of the patient's habits, and by the employment of
proper hydriatic measures. Hydrotherapy often affords an excel-
lent means of determining the diagnosis in a doubtful case by bring-
ing out the characteristic ernplion.

INFLAMMATIONS OF THE EYE,

1, External Itiflaminations,^ Light fomentations (I
for 15 minutes every 2 hours; frequently renewed cooling (|
compress during interval*

2. Inflammations of Eyeball. — A fomentation (1328) cover-
ing the eye and extending to the forehead, for 15 to 20 minutes or
until the skin is well reddened (1282). Repeat as often as neces-
sary to relieve pain. Employ the frequently renewed (5 to 15
minutes, 60*^) heating compress (1344, 1282) during the inter-
val between hot applications.

SKIN DISORDERS.

1603 Chilblains.— Alternate foot bath (1298); Scotch douche to
feet (1037); alternate douche (1044, 1082); hot foot bath
(1297) followed by flowing foot bath (1296); foot pack (1394).

1604 Burns — The evaporating compress (1324); the cool irrigating
compress (1326); if very extensive, the prolonged or continuous
neutral bath (1130).

1605 Erythema. — Cool evaporating compress (1324), or irrigating
compress (1326); neutral compress (1339).

1606 Pruritus — Prolonged neutral bath (1130); copious water

i

SKIN DISORDERS. IOg7

drinking (1423); large enema (1404); daily aseptic dietary;
(1625) effervescing bath (1139).

Eruptions. — If dry, not irritable, prolonged neutral bath 1607
(1130). If scaly, alkaline bath (1468). If moist and irritable,
cool evaporating compress moistened with soda solution, i ounce
to the gallon; emollient bath (1462). If skin is thickened, as in
chronic eczema, hot or alternate spray or compress for lo to 15
minutes three times a day. If skin is extensively damaged, as in
pemphigus, confluent smallpox, bad burns, the continuous neutral
immersion bath (1130) until the skin is healed.

Jaundice. — Copious water drinking (1423); large enema 1608
(1404) twice daily; sweating bath for 15 minutes, — electric-light
(1250), vapor (1246), hot immersion (1126), wet-sheet pack
(1179), followed by prolonged neutral bath (1130). Admin-
ister sweating bath once daily, or even twice, if patient is not too
weak. For general tonic effects apply cold mitten friction (1209)
or cold towel rub (1213) twice daily. Alternate compress over
the liver twice daily, with heating compress (1344) over the liver
or flannel covered wet girdle (1347) during intervals.

Dry Skin.— Short sweating bath, electric-light (1250), vapor 1609
(1246), hot air (1233), Turkish (1239), hot immersion (1126),
hot-blanket pack (1197), dry pack (1192), sweating wet-sheet
pack (1187, 1191), followed by a cold bath suited to the patient's
general condition (1625), and massage (fulling and friction)
(1461).

Hyperidrosis. — Vapor bath (1246), sweating electric-light 1610
bath (1250), followed by Scotch douche to spine (1037, 1074)
and general cold douche (1010).

For sweating feet, Scotch douche (1037) to feet with ex-
tremes as great as possible; alternate foot bath (1298), heating
compress to feet during night (1394) with cold friction of feet
in the morning on rising.

Baldness. — General tonic measures (1625); shampoo of 1611
scalp with cold water three times a day; some antiseptic
lotion to destroy the parasitic cause of the disease.

1098 RATIONAL HYDROTHERAPY-

DRUa HABITS,

A. Alcoholism.

1612 General. — i. Aseptic dietary (1G26), especially fruil
Mea.t5 and Hesh foods must be strictly prohibited^ also imsi
juices, broths, and all preparations of flesh. Fomentation (132|
over the stomach twice a day with wet girdle (1347) betwe^
applications; short sweating baths, — electric-light bath (1S5(K
sweating pack (1191) followed by wet- sheet rub (1316}- Gm
uated cold baths (1625) twice a day, ^

2. Insomnia. — Neutral bath at bed- i me, 94^ to 96^, 20 to i
min. J wet girdle at night* See Insomnia (1564)*

3. Vomiting. — Ice pills, ice-bag over stomachy hot and cq|
gastric compress (1363)< See 15l9j 3- 1

4. Delirium Tremenj. — Rest in bed; hot immersion bai
(1126) 5 minutes, hot-blanket pack (1197) followed hy swea
ing wet-sheet pack (1179, 1191); neutral bath (1130) i to
hours or longer twice a day; ice-cap (1314, 1371 ) ; hot fomei]
tations (1328) over stomach and abdomen, every 3 hours for i
nunuies; during interval, heating compress (1344) changing crel^
50 to 60 minutes. Copious water drinking (1423); large eneoi
(1404) daily. Exclusive fruit diet (1627) for 2 or 3 days.

5. Counteract Narcotic Effects of Alcohol. — Cold shower
water drinking (1423) or enema (1404) followed by short coh
douche to spine (1074) and lower sternum. Repeat every hour o
two if necessary, until the toxic effects disappear. Gastric lavag<
(1401), followed by cold or alternate irrigation (1401).

6. Nephritis. — Usually present in acute alcoholism. Sei
1537.

7. Gastritis.— See 1519.

General Method. — The patient must be placed in a propei
environment; isolation and confinement may be required. Suit-
able mental and moral influences must be brought to bear.

B. Opium, Cocaine, and Chloral Habits.

I. Rest in bed. Sweating baths, — electric-light bath (1260),
vapor bath (1246) twice a day for 3 days before withdrawing the
drug. Follow bath by vigorous cold applications. While with-
drawing the drug, the leading symptoms may be successfully com-
bated as follows : —

DRUG HABITS.

1099

2. Nervousness, Restlessness^ ** Indescribable Sensations."

— Prolonged neutral bath (llflO) 92^ to 94°, ten minutes; neutral
douche (1031 )i 92*^, 2 to 4 minutes.

3. Cardiac Weakness ^Cold precordial compress (13S3) or

ice-bag over heart (1314) ; alternate applications to spine (1343);
cold tnittea fnctioii (1209); cold towel mb (1213), repeating
treatment hourly if necessary*

4. Vomiting* — Hot and cold trunk pack (1367); ice-bag over
stomach and spine] hot-leg pack (1197).

5. Diarrhea. — Hot enema (1406) after each movement; cold
abdominal compress (1284, 1314) changed every 30 minutes.

6. Local Pain. — Revulsive compresses (1341); alternate or
hot and cold compress (1340, 1356)*

7. Insomnia after Withdrawal — Wet^sheet pack (1179);
prolonged neutral bath, ao to 60 minutes (1130); prolonged neu-
tral spray (1031) 3 to 5 minutes; heating leg pack (1393); wet
girdle (1347); coM head cap (1314, 1371). See 1564.

General flethod Same as for alcoholism (1612). With-
draw gradually within two or three days.

C. Tobacco Habit*

Drop the drug at once. Put the patient to bed. Sweating
procedures, — electric-light bath (1250), vapor bath (1246),
sweating wet-sheet pack (1179^ 1191)* twice da.ily; follow with
short cold application, as shallow bath (1174), wet^shcet rub
(1216), or cold douche (1010, 1023). Alternate spinal com-
press (1342) three times a day; wet girdle (1347) day and
night, renewing three times daily. Copious water drinking
(1423); large coloclyster (1407) daily,

D. Tea and Coffee Habit.

I. Discontinue the use of the drug at once. If necessary,
employ some harmless cereal substitute. Neutral batb (1130)
at bedtime. Fomentation over abdomen (1328); alternate
sponging of the spine (1342); cold mitten friction (1209)
or cold towel rnb (1213) before rising in the morning. Wet
girdle (1347) night and day, changing morning, noon, and night;
short sweating wet-sheet pack (1191) or vapor bath (1246)
two or three times a week followed by a cold applicatloa (1625)*

noo

RATIONAL HYDROTHERAPY-

a. Constipation.^ Graduated enema {1409)- See 1524,

3, Diarrhea.— Neutral enema (1404) after each movcmi
cold abdominal compress (1318) every half -hour.

4, Nervous Headache.^ — Sec 1554f 15^

5, The diet should consist chiefly of fruits (1627) and liquid
foods (1638) for a few days; the patient should be gradtixUf
accustomed to a dry dietary (1629).

\w

APPLICATIONS OF HYDROTHERAPY IN SURGICAL
CASES,

1613 Contusions,— Fomentation (1328) three times a day, 10
15 minutes, with protected heating compress (1344) during die
interval; if heat and swelling arc great, change the compress eveiy
15 minutes; as swelling and heat diminish, renew less frequentJj*

1614 Fractures,^ Apply a fomentallon (1328) or a revulsive coto-
press (1341) for 10 or 15 minutes before application of the
permanent dressing. When possible, the revulsive compress should
be applied two or three times daily. This will afford the patient
much comfort in relief from pain, and will expedite the bealti^
process. Apply massage to portion of the limb which 15 accessi-
ble. In cases of compound fractures which are luoperable, the
continuous neutral bath may sometimes be employed with
advantage.

1615 Dislocations. — If necessary, apply large fomentations (1328)
over the joint, or a hot immersion bath (1026) to relax the mus-
cles before reduction; after reduction, apply the revulsive com-
press (1341) three times daily with heating compress (1344) dur-
ing intervals. Apply massage to the limb, carefully.

1616 Sprains Very hot foot bath (1297) or hot pour (llOJ)

for 15 minutes three times a day; firm bandage and absolute rest
during intervals. Derivative massage (1225) the second day,
increasing the vigor of the application and approaching nearer to
the joint daily. Gentle massage and flexion of joint after third day.

1617 Pott's Disease. — In the early stage, when fever is present,
rest in bed with careful tonic hydriatic measures in addition to
the proper surgical treatment. Cold wet-hand rubbing ( 1 201 ), the
cold mitten friction (1209), and the cold towel rub are especially
valuable measures. Later, more vigorous measures may be em-
ployed (1625). See Pulmonary Tuberculosis (1508).

J

f

r\

Scoliosis. — The treatment of this and all other forms of spinal 1618
curvature due to deficient muscular development or irregular mus-
cular action, may be greatly facilitated by combining wilh cor-
rective gymnastics, massage, and electricity^ the tonic and cner-
giiing effects of hydrotherapy. Administer daily or twice daily,
carefully graduated tonic measures (1625)j and in addition apply
to the back the cold jet (1074), cold percussion douche (1035)t
or alternate douche (10i4).

Uterine Displacements Retroversion, procidentia, and some 1619

other forms of uterine displacement require mechanical and surgi-
cal treatment In most cases, but hydrotherapy h almost essential
for a radical cure. Administer daily vaginal irngation (iio'^ to
115^ when pain Is present, 80*^ to 70° when pain is not a prominent
symptom); tonic sit^ (1209); graduated tonic measures (1625)-
Sec also Enteroptosis (1525)*

Abdominal Surgery.^^ Hot vaginal irrigation (1413) daily, 1620
the hot or cool cleansing enema or coloclyster daily (1407), water
drinking (1423)? and general tonic hydriatic measures (1625)
either alone or in combination with eliminative procedures^ elcc-
iric^ight bath (1250), vapor bath (1346), hot-air bath (1233),
sweating pack (1191), are of the highest value as means of pre-
paring a patient to undergo the ordeal of an abdominal operation*
In suitable cases, in which immediate operation is not imperative,
these simple measures, combined with an aseptic dietary (1686)»
employed for one or two weeks, enormously increase the patienf i;
prospects for a safe and quick recovery, and prevent many of tlic
complications to which this class of patients are csiiecially liable*
Tonic hydriatic procedures are equally useful in hastening llie
progress of convalescence; and such measures as the cold wet-hand
rub (1201) and the cold mitten friction (1209) are most valuable
means of increasing vital resistance, energizing the heart and cen-
tral nervous system, and combating shock and collapse immedi-
ately after operation and may be advantageously employed two
or three times a day during the weeks following.

A hot enema (1406), hot vaginal irrigation (1413), hot foot
bath (1297), even a hot bag to the spine or the epigastrium, will
often obviate the use of an opiate to relieve the suffering in a
laparotomy case, a very important consideration as every abdom*
xnal surgeon will recognize*

RATtOHAL BYDgOTHfiftAFV,

Pelvic inllammatioii followiiig operation slioiild be combated bf
the measures elsewhere indicated. See 1590.

The ice-bag renders invaluable scmce iD eombatiti^ threateiKii
cardiac failure; Apply over the heart for rj mincites everj 2 houn
wlicn necessary, but not contitmoosly, Tbe ice-ba^ to the throat
or over the stomach, or applied to the spbe opposite, wit] often
check vomiting. Persistent vomiting may l>e relieved in many
cases by gastric lavage, whether following an abdominal operatJOft
or in any case after the use of an anesthetic.

1631 Surg^ical Shock*^^ Hot bags d blankets about the patkntr^
hot enema (1405); alternate coi ress to spine (1342); fomcfi'
tation to spine (1338) immediate^ oUowed by cold mitteti friction
(1209); ice-bag over heart ^ for 15 minutes everj 2 or 3
hours; hot or alternate irrig? if stomach (1401}-

1633 Aiicsthesla.^ — ^Cold compress ^^60'' F.) or ice-bag over heart
during operation. Change every r5 minutes, with nibbing of
chest until red at each change* After ether^ apply heating chest
pack (1374) to be changed every 4 hours. In all cases when
not contraindlcated, as in rectal casesj for example, administer
an enema at 96"^ to encourage renal activity. Control vomiting by
ice-bag to throat, over stomach, or to the spine opposite- Lavage,
if bilious or fecal vomiting occurs and is persistent.

1623 Hemorrhage — Hydriatic procedures, both hot and cold,
afford most admirable means of checking hemorrhage when prop-
erly used, as has been elsewhere indicated. See 697 and 1496, 4-

1624 Surgical Fever. — The various antipyretic measures which
have been elsewhere recommended (711-745) are of equal value
in the treatment of febrile conditions due to surgical procedures,
or to traumatism. The ice-bag (1314), the cooling compress,
(1318) and the frequently renewed heating compress (1344)
are of great service in combating local inflammation, which is a
most common cause of febrile conditions in surgical cases. The
cold mitten friction (1209), cold towel rub (1213), cool enema
(1405), cold head compress (1371), and usually copious water
drinking (1423), are measures of the greatest value in combat-
ing surgical fever and preventing septic infection by building up
general vital resistance.

i

d

ASEPTIC DIETAHV.

I 103

QRADUATED SCHEME FOR TONIC COLD APPLICATIONS.

1. Wet-Hand Rubbing (I201)*— In extremely feeble patients 1635
apply to back only, then from day to day increase the area, add-
ing chest, arms, and lower legs; then cover arms, chest, back, and
•ntire legs; finally the entire surface. Begin the application with
water at 65 ** or even 70*^, and lower the temperature i^ or 2"
daily to 40^, or even to 54^*

2. Cold nitten Friction (1209)*— Begin with water at 6o%
dipping once only. Lower the temperature i** or 3*^ daily to 40°,
then gradually increase the number of dips from one to four.

5. Cold Towel Rub ( 1213).— Begin at 65 "^i lower the temper-
ature I*' or 2*" daily to 40^ Wring towel at first very dry.
Wring less from day to day, until a saturated towel is used.

4. Wet-Sheet Rub (1216),— At first wring the sheet very dry,
in water at 6^°. Lower temperature i° daily to 55'; wring sheet
less dry at each application till a saturated sheet is used. Increase
the duration of application from j4 minute to 2 minutes.

5. Dripping Sheet (1217).— The same as preceding until
- rubbing is completed, then, the sheet being well warmed, a pail of

water 5"^ lower than the water in which the sheet was wet is poured
over the patient and the rubbing renewed. This may be repeated
three or four times.

6. Shallow Bath (1 174), — Begin at 75*^; lower temperature
1° daily to 60**; duration at first j4 minute, gradually increas*
ing to 3 minutes.

g 7. Pail Douche (1103)— Begin at 75°; lower the lempera-
' ture 2° daily to 60°; at first two pails only, gradually increase
to six.

8. Cold Douche (1010) Temp. 70" to 6o^ Precede by a

warm shower Lower the temperature i*^ daily, increasing the
pressure; the duration is also increased from 5 or 10 seconds to 15
or 20 seconds. Percussion douche (1035) to spine when possible.

ASEPTIC DIETARY.

Meats of all sorts, oysters, fowl, game, meat juices, beef tea, 1626
animal brothsi and all meat preparations are carefully and rigidly
excluded because of the presence of tissue wastes, uric acid, erea-

RATIONAL HYDROTHERAPV*

tini crealinin, and other toxic substances, together with ptomaiiis^
the product of putrefactive change.

Coarse vegetables, as cabbage, celery, lettuce, roots of all sorts,
string beans^ spinach, and greens, must generally be avoided, for die
reason that their indigestibility leads to their retention in the stom-
ach and colon, and thus encourages fermentative processes, Cao-
liflower, tender asparagus roots, green peas, purees of peas, beans,
and lentils, excluding the skins of these seedsj are allowable^ ii
not the very b<5st. Eggs in the form of egg-nog, prepared without
wine or brandy, slightly boF' ' >oached eggs, and soft custards^
prepared without sugar, arc taken. In many cases of gas-

ric dilatation, eggs must :d. Raw, fresh milk is admis-

blc in a small proportli^ ses only* In the majority of

cases, milk is well tolerat _ in the form of kumyss, kumy-
zoon, buttermilk, cottage ^ t,^^ peptonized milk, junket, or in
combinalion with cereals, u^ *.i milk gruel or porridge, and in not
a few cases nothing containing milk can be eaten without injury.

Ripe fruits of all sorts are of the highest value because of the
germ-destroying acids which they contain. Fresh fruits are best,
but cooked fruits are valuable. Cane sugar as sweetening is admis-
sible only in small quantities. Some fruits, as prunes and figs,
are most digestible in the form of purees. Olives should be taken
only when thoroughly ripened, as indicated by a black or very
brown color. Dried fruit must be very thoroughly cooked. Fresh
fruits, with hard flesh, should be discarded, especially apples, pears,
and cherries that are not thoroughly ripened. Fruit juices, espe-
cially grape juice, orange juice, and the juice of limes and lemons
or raspberries, and blackberries, and jellies made without sugar,
are wholesome. Preserves and pickled fruits are indigestible, and
must be discarded.

Cereals have a high nutritive value, and are readily digestible
when cooked at a sufficiently high temperature (300® to 320°), to
thoroughly dextrinize the starch, as in zwieback, granose, granut,
granola, browned rice, and crystal wheat. Mushes, farinaceous
gruels, blancmange, boiled potatoes, mashed potatoes, puddings,
farinaceous desserts, fermented breads, dumplings, ordinary crack-
ers, biscuit, and most ordinary cereal preparations are difficult of
digestion in the dilated or feeble stomach, and give rise to fermen-
tation and other changes and encourage gastrointestinal catarrh.

ASEPTIC DIETARV.

1105

IS

Malt, malt ho^ey (meltose), honey, if sterilized by beating m
a double boiler at boiling point lor half an hour, malted milkf
malted nuts, and bromose, represent preparations which contain
starch in the predigested form of maltose (in honey, levulose,
and glucose).

Nuts are practically free from starch, consisting chiefly of fats
and albuminous substances. They closely resemble meat in compo-
tion> but are more nourishing and palatable when properly pre-
pared. They may be eaten fresh or crushed in the form of nut
butter and various other combinations and preparations, such as
nuttolene, protose, nut meals, bromose, and malted nuts. Ordi-
nary fresh nut meats are very digestible if thoroughly chewed.
Peanuts are more nearly allied to beans than to nuts, and must be
cooked to render them digestible; roasting renders them very Indi-
gestible, unless very carefully managed.

Fruit Diet, — When rapid sterilization of the alimentary canal 1637
is required, fasting, or better still, an exclusive fruit dietary^ is the
est course. Fruits consist chiefly of water, with a small amount
I thoroughly digested starch in the form of fruit sugar or levu-
lose, and various acid flavors, and almost nothing requiring the
ction of the digestive fluids. It is important that the fruit
ould enter the stomach in the form of a smooth pulp. Fruit
swallowed in masses is very difficult of digestion. Imperfectly
^^pened apples or pears, and grapes swallowed without separating
^Httie seeds are often a source of indigestion, being retained so long in
^■Aie stomach that fermentation occurs. Fruit skins and seeds
^■Ihould always be rejected.

^V When the dietary consists wholly of fruit, food may be taken
four times a dayr ^^d the patient may be allowed to take as much
^Bs he likes.

^V A modified fruit dietary is often sufficient. At dinner the
patient takes fruits and grains, and perhaps a small amount of nuts
r nut preparations, with fruits only for breakfast, and the same
r supper, if a third meal is taken.
Intestinal asepsis may also be promoted by an exclusive dietary
acid buttermilk or kumyss. The patient should take three or
ur quarts of kumyss in four portions, say at 7 a, m , tt a. m,,
K M., 7 P. M, Zwieback, or toasted granose flakes or biscuits,
ay be eaten at the 7 a. m. and 3 i*. m. meals.
70

II06 RATIONAL HYDROTHERAPY.

An exclusive diet of fruit or kumyss is usually not required to
more than a short period, as two to six days. If gtcadypn

longed, the patient will be weakened.

An aseptic dietary is best for all, sick or well. It is i
demanded in typhoid and all other acute fevers, in the :
or uric acid diathesis, in diabetes, obesity, and other
disorders, in indigestion accompanied by a dilated stomach jOr t
prolapsed stomach, in intestinal catarrh and all cases of ]
infection of the stomach or intestines, in infectious ja
arteriosclerosis, hepatic cirrhosis, all forms of nntnintnTtcstijW
in Bright's disease of the kidneys, malarial cachexia,
tuberculosis, eczema, and other forms of skin disease,
neurasthenia, anemia (Haig has shown that flesh-eating
anemia in consequence of the uric acid present), especially wi pel
nicious anemia, and acute infections and inflammatory disoi4efi
visceral inflammations of every description, — acute and cdinmic^-
cpilepsy, insanity, hysteria, in diseases of children of all foQH
in insomnia, before and after grave surgical operations, in A
treatment of the alcohol, morphia, cocaine, and toba<xo hMU
and most acute and chronic disorders.

Indigestible substances and dishes of all sorts must be avoided
In this list must be included pickles, spiced pickles, green olives
preserved and brandicd fruits, fried foods, rich pastry, cheese
griddle cakes, ices, ice cream, tea, coffee, cocoa, beer, and alco
holies of every description. Condiments of every sort must als4
be interdicted, as mustard, pepper, peppersauce, ginger, cayenne
capsicum, horseradish, chillies, curries, and hot sauces of every sort
1(>28 Liquid Diet. — Fruit juice, malted nuts, almond cream, glutei
gruel, granola, softened zwieback, malted milk, buttermilk, kumyss
kumyzoon, kumyss-nog, protose broth, vegetable broth, fruit soup

1629 Dry Diet. — Toasted granose flakes, toasted granose biscuit
zwieback, toasted whole-wheat wafers, toasted wheat sticks
blanched almonds, blanched filberts, steamed figs, bromose, mal
honey, malted nuts, nuttolene, nuttose, granola, granut.

1630 Dextrinlzed Cereals. — Well-toasted bread, zwieback, browneci
or roasted rice, parched wheat or corn (gofio), granose, granola,
granut, crystal wheat, toasted wheat flakes.

1631 Malted or Predigested Foods.— Syrupy extracts of mall,
malt honey, malted milk, malted nuts, bromose, granut.

n

A BRIEF SUMMARY OF EXPERIMENTAL WORK
DONE IN THE MYDRIATIC LABORATORY
OF THE BATTLE CREEK SANITARIUM.

The first experimental work done by the author in the study of
scientific hydrotherapy was begun in the summer of 1875. During
the twenty-six years which have since elapsed, experimental
inquiries of various sorts have been carried on almost constantly,
and particularly during the last ten or twelve years. Within the
last year an attempt has been made to review th6 entire field of
physiological experiments upon which the fundamental principles
of hydrotherapy rest. In this work a large share of the experi-
mental work which has been done by others has been repeated, and
a considerable number of new experiments have been devised. In
the following pages the author presents the results of a few of the
many hundreds of experiments made in the laboratory under his
supervision. Most of the work has been done under the author's
direction by one of his able assistants. Dr. Elmer F. Otis,
aided by trained nurses and medical students. The faithful work
of Messrs. Wolfscn, Swartwout, Larson, Lemon, and Seimon,
medical students, entitles them to mention among the many who
have contributed excellent service in various capacities in prose-
cuting the extensive and laborious studies briefly presented in this
summary, which have involved an amount of painstaking effort
which can be appreciated only by those who have engaged in
similar work.

The purpose of presenting the results of these laboratory studies
is to place before the profession some of the tangible facts that
constitute the data upon which the foundations of scientific hydro-
therapy are laid, and which constitute this the most thoroughly
rational of all branches of therapeutics.

Experiment i. — Showing the increase of heat production resulting
from vigorous exercise (^page 81).

(a) R. A. S., a young man aged 21, weight 140 lbs., rode twenty-
two miles upon a bicycle in two hours over an ordinary country

1107

iio8

RATIONAL HYDROTHERAP\^

road. The rectal temperature on starting was 98.9^. At the dost]
of the ride the rectal temperature was 105.3**; increase^ 4.4^
The patient perspired very freely, showing increase of elimina-
tion; but notwith Stan ding, the increase in heat production was suffi-
cient to cause an accumulation of heat amounting to 554*4 heit
units (140X4- 4X^9 =554' 4)^ ■

(i!&) F, W, W,j aged 35, weight 160 lbs,, Sept. 30, 1900, ran four ■
miles in forty minutes. The rectal temperature on starting was
98.8°^ at the end of the course, it was 102,2^; increase, 3.42%
indicating an increase in the rate of heat production sufficient
to store in the body, notwithstanding increased heat eHminatio%
heat amounting to 490 heat units (i6oX3*4X.9 — 489.6). M

(r) L. H. W., a young man aged 30, weight 150 lbs., OcL |, "
1900, swam for twenty- five minutes in water at 70**. The rectal
temperature on entering the water was 99'; immediately on
coming out of the waier^ it was found to be 100,2'*; increase, 1*2°*
In this case a considerable amount of heat was without doubt
absorbed by the water, so that the actual increase in heat produc-
tion is not shown by the increase in temperature; nevertheless the
amount of heat accumulated was considerable, amounting to not
Itm than i6z heat units (150X1-^ X.9^162).

Experiment 7. — Shewing that heat production is increased iy ioid
appiicaiiom of i^rief duration {page 82).

L. H. W., a young man aged 30, weight 166 lbs,, received a per-
cussion douche for thirty seconds, followed immediatety by moder-
ate exercise. The rectal temperature before the application was
99^; immediately aftervtard, 99.6^, an increase of .6^, The
elevation of temperature was maintained for forty-five minutes.
This observation has been repeated upon many subjects with
similar results. The reaction following a short cold application
results in increased heat elimination; notwithstanding, heat ac-
cumulate oti occurred in this case to the extent of 90 heat uniu
(i66x 6x^9 =89.6), During the first moments following a shon
cold bath there is an elevation of temperature from diminished
heat elimination.

Experiment 3. — Showing the method of determining (he rate pf
heat eiiminatian hy means of the ha$h*tub calorimeter {page Sy)*

SUMMARY OF EXPERIMENTAL WORK. IIO9

This method was first used by Liebermeister more than a score
of years ago. It was independently devised and utilized by the
author in 1892.

Four hundred pounds of water at a temperature of 68.4® was
placed in an ordinary bath tub, the temperature of the room being
71.5*^. Under these conditions the temperature of the water
remained practically stationary. A young man, F. W. W., aged
25, weight 160 lbs., with a rectal temperature of 98.8*^, was
immersed in the water. At the end of fifteen minutes the tempera-
ture of the water was found to have risen 1.5*^; the subject's tem-
perature had also risen .2®. By simple calculation, it appears
that the water had absorbed 600 heat units from the subject
(400X1.5=600), while his temperature had not only not fallen,
but was actually slightly raised. The ordinary rate of heat pro-
duction and elimination is about 7.2 heat units per minute.
Under the conditions above named, the loss was 40 heat units
per minute without lowering of the body temperature, showing an
increase of heat production amounting to more than five and a
half times the ordinary rate (40-^7.2=5.55).

Experiment 4. — {Page 87,)

The conditions being the same as in the preceding experi-
ment, the subject, £. F. O., a young man aged 26, weight
105 lbs., temperature 98.4®, was immersed in the bath for five
minutes. At the close of the experiment the body temperature
was found to be 98.6**. The temperature of the water was
raised .4**, amounting to 160 heat units, sufficient to reduce the
temperature of the patient, if heat production had been sus-
pended, 1.5** (160-5-105 = 1.5). The normal rate of heat
elimination for a patient weighing 105 lbs. would be about 30 heat
units in five minutes. In the calorimeter, the amount eliminated
was 160 heat units, or more than five times the normal amount.

Experiment 5. — {Page 87.) •

{a) The subject, A. W. P., a young man aged 27 years,
weight 165 lbs., was placed in the bath calorimeter with water at a
temperature of 75.3*^. At the end of five minutes it was found
that the temperature of the water had risen to 76**, an increase of .7
of a degree, indicating that the body had given off 280 heat units.

RATIONAL HYDROTHHSAPT.

The body temperature had also fallen from 98. 4° to 98*, represectii^
a loss of 59 heat units. Subtracting 59 from 23a we have 2:^1 h^
units, representing the amount of heat actually produced by th^
body during the five minutes. At the ordinary rate, the acnckM
of heat produced during this period would be about 37.5 bell
units* There was hence an increase in heat production amountiid
to 183^5 heat unitSi and heat production was excited to the exteiil
of about five times the ordinary rate (221 —37-5:^183,5 -s-jj, 5^

4-89>- '

(^) The young man was men given a hot shower bath for ted
minuteSf at which time the b ' temperature was found to be 93**^
He was then placed in the 1 meter with the 'water at 76^- A|

the end of five minutes the Lcm erature of the water was raised to
77,1*^, while the patient's tempt ature had fallen to 98% indicatit^
a loss of 440 heat units.

(r) On removal from the bath, the patient was wrapped In
blanketSg and allowed to remain covered until warm, when he was
returned to the calorimeter with the water at a tero per ature til
77.5^, At the eud of five minutes the temperature of the wateii
had risen .3**, showing a loss of heat communicated by the subject
to the water amounting to 120 heat units.

(d) T. J., a young man aged 23, weight 160 lbs, in the second
week of typhoid fever The mouth temperature was 104.4^; rectal
104.8*^. The patient was immersed in the bath-tub calorimeter
containing 400 pounds of water at 70.2**, with room temp)erature
at 63°. He remained in the calorimeter five minutes, during
which time surface friction was kept up constantly. At the end of
the experiment, the patient's temperature by mouth was 101.2**,
by rectum, 102**. The temperature of the water had risen to 72.1*^.
As previously noted, the temperature of the water was cooling by
evaporation at the rate of .2^ every five minutes.

From the above it appears that the water of the bath absorbed
in five minutes 680 heat units (72.1 — 70.2 — .2= 1.7X400 = 680).
Of this amount, 403.2 heat units is accounted for in the lowering
of body temperature (104.8** — 102** = 2.8° x 160 X. 9* = 403.2).
There was thus a temporary, increase of heat production during the
b«th. amounting to 7.4 times the normal, while heat elimination

*» The ii|>crific heat of the body »> .9 that of water.

SUMMARY OF EXPERIMENTAL WORK. I II I

was increased to i8 times the normal rate. Heat elimination was
thus increased in a febrile case nearly two and a half times as much
as heat production. The heat elimination was increased 2.4 times
as much as in a normal subject (Exp. 5 («)), while heat production
was. increased only 25 per cent. This explains the great value of
the cold rubbing bath as a means of reducing temperature in fever.

ExPERixMENT 6. — Observations respecting the influence of various
procedures upon heat elimination by means of cTArsonvaPs calorim-
eter {Fig. 24, page 8p).

(tf) The subject, L. H. W., a young man aged 30, weight 166
lbs., was placed in calorimeter such as is shown in Fig. 24, page
89, with his clothing removed, in a room at a temperature of 70°.
The rate of air movement as shown by the anemometer, was 123
feet per minute.

{b) The same subject was placed in an electric-light bath
for sufficient time to redden the skin, but not to produce per-
spiration, and then placed in the calorimeter. The rate of air
movement was found to be 140 feet per minute.

(c) The same subject was given an electric-light bath to the
extent of producing profuse perspiration. He was then placed in
the calorimeter, and the rate of air movement was found to be 170
feet per minute, showing a very considerable increase in the rate
of heat elimination due to elevation of the temperature of the skin.

(//) The same subject was given a cold percussion douche for
two minutes (temperature of the water 60° F.). When placed in
the calorimeter, the rate of air movement was found to be 70 feet
per minute. In ten minutes, when reaction had taken place, the
rate was found to be no feet per minute.

Experiment 7. — (Page 8p.)

(a) The subject, R. A. S., a young man aged 21, weight 140
lbs., was placed in the calorimeter in a room at 86°. The rate
of air movement, as shown by the anemometer, was found to be 70
feet per minute. After the administration of a cold wet-sheet rub,
the rate of movement was found to be 97 feet per minute. Seven
minutes later, when reaction had taken place, the rate of move-
ment had increased to no feet per minute.

RATIONAL HYBROTHERAPY.

f^) After a very cold percussion douche (56**) the
movement was found to be reduced to 92 feet per minttte,

(r) The same subject was placed in a wet-sheet pack, and
removed at the begiuuing of the heating stage. When placed in
the calorimeter, the rate of air movement was found to be 98 f
per minute.

(d) After a hot blanket pack and while perspiring freel)% tfie
same subject produced an air movement of 12a feet per minutjc.

(^) The subject was made to exercise moderately tin tit general
perspiration was induced. He wa i then placed in the calorimeter
with the result of producing an air movement of 90 feet per min-
ute. The difference between the results in this experiment and in
{r) was doubtless due to the fact that in the latter the temperature
of the skin was raised by the prevention of heat elimination, while
in the former there was increase of heat elimination, with increase
in heat production.

Experiment S. — Shmtfing the effects €f partiai cold appii^atiams im

iowerin}^ tht surf act itmpcraiure (page 104)*

The subject was a young man aged 26, weight 153 lbs. The
temperature of the hand, as obtained in the palm with the hand
closed, was 98.4^. The hand was immersed in water at 40^ for one
minute, then removed and lightly dried, when the temperature was
found to be 90°. The temperature rose to 95° in five minutes, and
to 97.8° in tep minutes. Only at the end of fifteen minutes was
the initial temperature reached.

Experiment 9. — Comparison of the reaction produced by percussion
and friction with that of the heating compress {page lOj).

A heating compress was applied to the upper arm of a healthy
young man for twenty minutes. The compress consisted of a linen
cloth wrung as dry as possible out of ice-cold water, wrappe dabout
the arm, and covered with several layers of flannel tightly applied.
Immediately afterward, percussion and friction movements were
begun upon the arm of the opposite side, and continued during the
whole period of twenty minutes. At the end of this time, the pack
was removed. On comparison, it was found that the degree of red-
ness of the skin on the two arms was practically equal.

SUMMARY OF EXPERIMENTAL WORK.

IflJ

Experiment lo. — Shawinj^ ihe infiuenie 0/ C0M uptm persfiiratwn
{page rosy

The electric-light bath was applied to the leg of a young man
for fifteen minutes until profuse perspiration of the limb was pro-
duced. Water at 60"^ was then dashed upon the leg, with the result
that perspiratory activity was instantly suspended.

P Experiment 11.— {Fagf 106.)
The subject, M. M. M., was a young man aged 35, By means
of an asthesiameter the normal tactile sensibility of the subject wa«
found to be such as to enable him to recognke the two points of
the asthesiometer when separated 2 mm. After immersion for
^■five minutes in water at 60**, it was necessary to separate the pofnis
^K.5 mm, to enable the subject to distinguish them* Five minutes*
^^unmersion at 40^ increased the distance to 6 mm.

Experiment 12, — Slwwing the effect nf siwri coid appluaimns up^n
cardiac activity {page 10/).

(a) The subject, R* R. H,, was a young man aged 21 years,
weight 115 lbs., pulse 74. Gently slapping the chest over the
heart with the end of a towel wrung out of cold water, half a
|ozen times, raised the pulse rate to 86,

(^) In another subject with normal pulse (66), the cold per-
fcussion douche at 65^ increased the pulse rate to 86.

SxpERiMENT 13, — Shimnng the imremc of arterial itmi&n remiiing
from c&ld appUeaiions 0/ ik^rt duration {page ro/).

The subject, R. A* S., a young man aged 21, weight 140

lbs,, presented a normal pulse rate of 81, with a tension, as shown

_Uy Gpertner's tonometer (Figs. 239, 240, page 931), of 9.5 en*, of

oercury. Upon the application of a douche at 55", the pulse

|ate was immediately increased to 90, and the tension to 10 cm*

Experiment 14.^- S/nm>ing the effect tf pndanged cald appiieatiom

in siinving the heart {page 10?).

{a) The subject, a man aged 40, weight 140 lbs,, pulse rate 76,
Iras in water at 55^ for ten minutes, when the pulse rate was
?und to be reduced to 50*** The tension was decidedly increased.

1 1 14 RATIONAL HYDROTHERAPY.

Experiment 15. — (^Page 107.)

{b) The subject, £. F. O., a young man aged 26, weight 105
lbs., pulse 74, was placed in a shallow bath at 70^ for three via^
utes. The pulse rate at the close of the bath was 60, with ti^j^^h
greatly increased. This observation was made by the auAMMi
colleague, Dr. W. H. Riley, in August, 1895. i.

Experiment 16. — Showing thai ice held in one hand produces m
contraction of the biood- vessels of the opposite hand (^page zoff).

The subject was a young man of 35 years, weight 172 lbs. One
arm was placed in the glass cylinder of a plethysmograph. A
piece of ice was placed in the opposite hand, with the result shown
in the accompany inggraphic, which is a photo reproduction of the

original (Fig. 249). •

Experiment 17. — Sho7ving that the application of ice to tlu axiOm
causes contraction of the arteries of the arm {page roS),

The subject was a young man aged 27, weight 165 lbs. The
accompanying tracing was obtained by means of Dudgeon's
sphygmograph (Fig. 4, page 60) immediately before and after the

application of ice to the axilla (Fig. 250 a and b.)

Kxi'KKiMr.NT 18. — S/i owing the effect if the application of ice to the
bctid (f the elbow in diminishing the iccight of the up stroke in
sphygmographic tracings obtained from the radial pulse {fagr 108),

The subject was a young man aged 26, weight 105 lbs. By
Marcy's sphygmograph the accompanying graphic was obtained,
showing the normal tracing and the effect produced by the appli-
cation of ice to the bend of the elbow (Fig. 251).

P^xpF.RiMRNT 19. — Shoiuing by means of the phthysmograph the effect
of the application of ice to the bend of the clboic in diminishing
the capacity of the blood-vessels of the hand and forearm (^J*ig»
2S2, page lOp).

Experiment 20. — Showing the effect upon the pulse rate of a prtn
longed cold immersion with friction.

The subject, J. T. M., a vigorous young man of 32 years, weight
170 lbs., with normal pulse rate of 80, was j)laced in a cold immer-

fit frwrnfurrfiy

hhhhhhhhhhhhhKhhKHH>i>in>vhKMi>i>i>1>UVTJ^^

Fig. J4*> (Eip. 1 6), Pklhysmographic Tracing Showint? Shrinkage of Blood-venelft in
H«nd Produced by Ice Applied to OpjHBsitc Hand (p. nt4J.
Before. After.

P»i. as* (Kxn. T7>. Sfthyintioi^r^phic: Traciniyr Shl>^m^ Cuntrftttion of Vesself of Ar
by AppLiealiom <>f Icr lu Axilla Ijj. -iM>^

Flg^ its I tExp* i»)h Stihygttiogruphic Tracing; of Radial PmIsc Showing ( omractioti of the Ve&scli
of tbc Forearm Rrsultinir from AppHcation of Ice ti» Beml of Elbow ^p. 1H4.

'-aM|v

r/y^£: m j£€t}f^D3

"%w^

^V;::];:,..^^

I \:\[: 1 9), Plethysmwgrflphic Tracing Shoihini^ iJuinnni ri m ike Volume of
the Forearm RciuUing from Apptica.tiDri of ke tt> Etbow (p, tm^).

SUMMARY OF EXPERIMENTAL WORK. 1 11$

sion bath at 45® for twenty minutes, friction being applied at the
same time. At the end of the experiment the patient's pulse was 58.

Experiment 21. — Showing the effect 0/ cold beverages upon the
pulse rate and tension (^page lOp).

The subject, A. £. L., was a young man aged 26 years, weight
165 lbs., a normal pulse of 66, blood pressure 13.5 cm. as deter-
mined by Gsertner's tonometer. Five glassfuls of weak lemonade
at 50^ were swallowed quickly. Examination of the pulse, made
almost immediately after, showed it to be slowed to 52, while the
arterial tension, as indicated by the tonometer, was 14.5 cm.

Experiment 22. — Showing the effect of the cold enema in lowering
the body temperature (^page no).

{a) For the purpose of determining the effect of a cold enema
on the normal subject, water at 70** was passed in and out the
colon continuously for forty-five minutes, the subject being a
young man of 21 years, weight 140 lbs. The mouth temperature
rose from 97.8® to 98*^ during the application. Forty-five minutes
after the conclusion of the experiment, the rectal temperature
was 94°, and at the end of one hour and a quarter 98.1®, still
neariy 2° F. below the normal rectal temperature.

(^) The subject, M. G., a young man aged 22, suffering from
typhoid fever, first week presented a temperature of 104.2°. Three
large enemas were administered in rapid succession, the tempera-
ture being 66°, 62°, 62°. The result was a reduction of the body
temperature within one hour to 99.2°. So marked a result as this
is not always obtainable, but temperature reduction is decided
whenever this measure is faithfully employed.

Experiment 23. — Showing the effect of the application of the cold
douche to the chest in increasing the depth of the respiratory
movements {page no).

The accompanying tracing was made by the author's pneo-
graph (see Figs. 25, 26, p. no). The increased amplitude of the
respiratory movements continued for fully one minute. When
the cold application is general, the amplitude is still more decided,
and continues or a longer time (see Fig. 26, p. no).

RATTOKAL HYDROTHERAPY,

ExPEaiMEKT 34. — Shpwiftg the r€siaralivf effects iff ike e^
iiimche {^p<ige i/2)^ 1

M* J, N*, a man of 21 fears> weight 136 lbs., rode, Aug. i^^'^
^9^0^ 55 miles on a bicycle within two and a half hours, at the!
end of which time he was very much fatigued^ not being accus-
tomed to long riding. The muscular capacity of the subject, as
show^n by the author*s dynamometer (Fig. 253), was 6,870 lbs. At;
the conclusion of the ride, the dynamometer showed reduction
of nearly 1,000 foot pounds, or 5,955 lbs, A cold (55^) percus-
sion douche was administered for thirty seconds, having been
preceded by a hot shower for thirty seconds. A second test
with the dynamometer wai^ then made, and the total strength was
found to be increased to 6,555 ^^^'* ^ i^*^ ^^ ^^^ ^^^* The
sensation of freshness and vigor experienced by the subject as the
result of the cold douche was so marked that he expressed himself
as being quite relieved from any sense of exhaustion. i

Experiment 25. — Showing diminution of the rate of iransmissiam
tf imfressii^ns over a nerve trunk as the result qf a coid
applieation made along the course if the nerve {pages iro, //^)-

In the subject selected, the rate of time required for the patient
to make a signal after an impression made upon the finger was . 1 1
seconds. After the elbow of the same arm had been packed in ice
for fivQ minutes, the time required was . 2 2 seconds.

Experiment 26. — Showing the local increase in the blood count
resulting from a cold application {pages no, 121).

To the subject, W. E. P., a medical student, a short, hot
abdominal fomentation was applied, followed by a snow compress
at 40° applied to the abdomen for twenty minutes. The blood
count made before and after the application gave the following
results: Before, 4,450,000 red blood cells, 4»9oo white corpuscles;
after, 4,950,000 red cells, and 10, 100 white cells. The hemoglobin
was 96 per cent before and 99 per cent after the application.
Examination made fifteen minutes later showed the blood count to
be practically the same as before the application.

SUMMARY OF EXPERIMENTAL WORK. III7

Experiment 27. — Showing the effect 0/ the cold epigastric douche, or
the ice-bag applied to the epigastrium, in increasing the amount of
hydrochloric acid in the gastric secretion {page 122),

The subject, L. H. W., was a vigorous young man aged 30,
weight 166 lbs. A careful examination of the stomach fluid drawn
at the end of an hour after an Ewald test meal, showed the total
calculated acidity to be .150, free hydrochloric acid .126.

A second test meal was given after the application of a cold
percussion douche to the epigastrium and the spine opposite at
55® for two minutes. The chemical examination showed the cal-
culated acidity to be .286, and free hydrochloric acid .156. An
increase in the calculated acidity of 90 per cent, and in the amount
of free hydrochloric acid of 24 per cent.

Experiment 28. — Showing the influence of thermic applications upon
heat production and heat loss* {page I2j),

The subject, F. W. W., a young man aged 25, weight 160
lbs., was placed in a bath-tub calorimeter containing 400 pounds
of water at a temperature of 68.4^. At the end of five minutes the
temperature of the water was raised . 7 of a degree, representing a
heat loss by the subject amounting to 280 heat units. The body
temperature during the application fell .8 of a degree, representing
115. 2 heat units (i6oX.8x.9 = ii5.a), leaving 164.8 heat units
resulting from heat production during the time covered by the
experiment.

Experiment 29. — Showing the effect of a hot spray in lessening
heat production ( page I2J ) .

The subject, A. W. P., aged 27, weight 165 lbs., was placed in a
bath-tub calorimeter at 77. 5*^, after taking a spray bath at 106*^. At
the end of Ave minutes, the temperature of the bath had risen .3^,
showing the absorption of 120 heat units (400X. 3 = 120). The
rectal temperature showed a drop of .6 during the application,
amounting to 99 heat units. Subtracting 99 from 120 leaves 21
heat units, representing the amount of heat actually produced
during the five minutes. The normal amount of heat produced
during this time should be, for a man weighing 165 pounds, at the
rate of about 7.5 heat units per minute, or 37.5 heat units for the

*For the method of employing the bath-tub calorimeter, see page 87.

RATIONAL HYDROTHERAPY*

5ve mmtites, from which it appears that there was a lowering of
the heat production amounting to 16.5 heat units in five minutes,
presumably as the result of the short hot spray, the natural
effect of which is to diminish heat productioE by reflex in^uencc
upon the thermic centers.

Experiment ^o.^^Pa^e 126.)

(^) The subject, S* R. A,, a young man aged 26, weighing iiS
lbs., waH Grst placed la a bath-tub calorimeter with water at a
temperature of 83,4°, The temperature of the water was raised , iS^
in five minutes. The patient's temperature at the beginning of the
bath was 98*6°, at the cud 98.3*- From this data it appears that
400 pounds of water absorbed from the subject 73 heat units, o
which amount 34.2 is accounted for by the fall of the body tem-
perature, and 37*8 heat units were produced during the five min-
utes> an amount of heat practically the same as that normally
produced within the time named*

(^) Later the same subject was placed in a bath at 77°,
being rubbed during the entire period of five minutes, at the
end of which time the temperature of the bath was found to be
raised .54* The subject^s temperature had \n the meantime fallen
. I of a degree (from 98.8° to 98. 7**). Of the heat absorbed by the
water, 216 heat units, 11. 5 heat units were accounted for by the
fall of body temperature, leaving 204 heat units to be accounted for
by increased heat production, about six times the amount that
would have been developed if heat production had continued at
the normal rate. The great increase of heat loss shown as the
result of friction, in this case amounting to nearly 300 per cent,
was without doubt due to the fact that there was very marked con-
striction of the surface vessels during the first immersion (Exp.
29), with goose-flesh appearance, whereby the heat elimination
was interfered with to an unusual degree.

Experiment 3 1. — Showing the effect 0/ the application of the cold

proximal compress to the arm {page 128).

The subject, R. R. H., was made to immerse his elbow in a
bath at so*'. The temperature of the hand at the beginning of the
experiment was 90.5. After two minutes, the temperature of the
hand was 87^. The temperature still remained below normal
twenty minutes after removing the arm from the bath.

SUMMARY OF EXPERIMENTAL WORK. 1 1 IQ

Experiment 32. — Showing the effect of cold water in. the stomach
upon the temperature of the overlying skin {page 128).

The subject, R. A. S., a healthy young man, was made to
take seven glasses of water at 55**. The surface temperature at the
epigastrium, taken before the water was swallowed, was found to
be 97. 6*^; after, 95.1°, a loss of 2.5*^ (see Exps. 64, 65, and73).

Experiment 33. — Showing the influence upon the general tempera-
ture and the circulation of the ice-dag applied over the heart
{page 128),

The subject, A. C. S., having a normal pulse of 80, and a
tonometer reading (Gaertner) of 10 cm. o( mercury, with mouth
temperature of 99^, was placed in a reclining position, and an ice-
bag applied over the heart. After three minutes, the pulse was
found to be 72 and the tonometer reading was raised to 12 cm.
At the end of one hour, the mouth temperature was found to be
98.5°. The rectal temperature was lowered one degree (from
100° to 99°). •

Experiment 34. — Showing the effect of copious water drinking and
large cold enemas, in lowering the general temperature (page 128),

{a) The subject, A. C. S., was a young man of 23 years,
weight 137 lbs. His mouth temperature was 98**; rectum, 100**.
Copious enemas at 70® were administered at intervals of twenty-
five minutes for an hour and a half. The mouth temperature was
then found to be 96. 9*^, and the rectal 95. 2*^.

(^) The subject, A. J. M., was made to drink seven glasses of
weak lemonade at 59® F. The rectal temperature was reduced from
100° to 98.7°. The surface temperature at the epigastrium was
reduced from 94° to 92°.

Experiment 35. — Showing that friction accompanying partial cold
immersion favors reaction (page ijj).

The subject placed his hand in water at 4o^F. for one minute.
Before immersion, the surface temperature of the hand taken in
the palm with the hand closed, was 98.4^. After removing the
hand and wiping it, the temperature was found to be 90^. In a
room at 70^ the normal temperature was regained at the end of
fifteen minutes.

Repeating the same experimeixt under the same conditioosj with
the exception that the hand was rubbed vigorously during immef'
sion in the water, the normal temperature was regained at the end
of ten minutes*

Experiment ^6. — Shaufing that percnssi&n accampanymg a coid
application favors react hn ipag€ IJ4)*

{a) The subject, A. C. S., aged 23, weight 137 lbs., was im-
mersed in a bath at 56° for 40 seconds^ then gently dried and
wrapped in a woolen blanket The initial temperature of the
surface was 97-6^* Immediately following the bath the surface
temperature was found to be 94.1°. At the end of thirty minutes
the temperature of the skin had become the same as before the
immersion.

(^) To the same subject was administered a percussion douche
at a temperature of 50°, pressure 35 lbs*, duration 40 seconds*
The initial temperature was 97-6°. After the douche, the skin
temperature was found to be 94-6** The initio temperature was
recovered at the end of ten minutes.

(r) In an experiment with the same subject under like condi-
tions, the ordinary jet douche with pressure of 35 lbs, was fol-
lowed by complete reaction with return of normal surface tem-
perature, in twelve minutes.

Experiment 37. — Showing the advantage of friction in connection
with general cold immersion in promoting reaction {page 134).

(a) The subject, A. C. S., a young man aged 23, weight 137
lbs., was placed in an immersion bath at 56° for forty seconds.
The initial surface temperature (abdomen) was 98. i®; immediately
following the bath, 96. i*'. The initial temperature was regained at
the end of twenty-seven minutes.

(^) The same subject was immersed in a bath at 56^ for 40
seconds with vigorous friction during the bath. The initial sur-
face temperature was 97.6°. Immediately after the bath the sur-
face temperature was 94.1°. The initial temperature was regained
in eighteen minutes.

(r) A wet-sheet rub was administered to the same subject,
the sheet being wrung from water at 40°. The initial temperature
was 97.6®; immediately following the bath, 96. 1°. The initial tem-
perature was regained at the end of five minutes.

SUMMARY OF EXPERIMENTAL WORK. 1 121

Experiment 38. — Showing the influence of exercise upon reaction
. (Jage 134)'

(a) A cold bath at 55°, duration 20 minutes, with friction,
was administered to J. T. M., a young man aged 32, weight 170
lbs. Full reaction, as indicated by a return of the surface tem-
perature to the initial point, was complete only at the end of four
hours, the patient in the meantime remaining quiet. The subject
was cold and shivered considerably for some time after the bath.

(^) The same procedure, in the same subject, with identical
conditions, but followed by moderately vigorous exercise, secured
complete reaction in fifteen minutes.

Experiment 39. — {Page ijp.)

The subject, H. R. P., placed his hand in water at 50° for
one minute. The initial temperature taken with the closed palm
was 97°. Immediately after the immersion it was found to be
90^. The normal temperature was regained in nine minutes.

Experiment 40. — Showing the effect of heat and cold upon the
surface circulation {page 14J).

(a) The subject, L. S., was a young woman aged 23, just con-
valescing from typhoid. The blood pressure, as determined for
the middle finger of each hand by Gaertner's tonometer (Figs. 239,
240, page 931), indicated a pressure of 7 cm. mercury. The two
hands were immersed, the right hand in ice-water, the left hand in
hot water, for five minutes, at the end of which time the tension
was found to be, for the right hand, 5.5 cm.; for the left, 9 cm., a
difference of 3.5 cm.

(^) The same experiment made in healthy subjects showed a
difference of about i cm. of mercury.

This experiment very clearly shows the influence of cold in
contracting the surface vessels, and of heat in dilating the vessels
and exciting the surface circulation.

Experiment 41. — Showing the influence of heat upon the tactile
sensibility {page 145^^

The subject, A. C. S., was a young man aged 23, weight 137
lbs. The two points of the asthesiometer were distinctly felt upon
the back of the hand at a distance of 20 mm. After immersion in

1122 RATKXUI. UlJMHMIIUUWt:

water at 117^ for f<Nir aad
tinct only at 30 mm. Ti
effect.

ExpcRiMrNT 42. — Skemrimg ike e^ta^fgrmtrmii
ike blood fr€ssm9e mmd fmlse rmie (/*^ i^\

The subject, R« R. H., was a young m» aged jfld^fi^lii ii
lbs. Before the experiment, with the sob|cct recilnni^, the
was 92, radial tenuon 9 cm., as detemuDcd by G«r^i^*s tc
ctcr (Figs. 239, 240^ page 931). The conch* the «y||cct lyi
upon it, was pushed into an electiic-ligtit cabinet wiiliottt any
ertion on his part. Within a minute the radial pube fell to 54, m
the tonometer showed a rise of piessnie tn the peiiplieii^
10 cm. At the end of five minntes^ the subioct wa» pcivptni
moderately. The pulse was then found lo be 66, the lono;
reading 8 cm. At the end of 20 minutes the p«lse wms ^x,
tonometer reading 7 cm. The subject wu then withdrawn
the cabinet. The pulse rate immediately fell to 86, but
time elapsed before the blood pressure rose to normaL ^

KxPFRiMENT 43. — Showing the effect of heat and coid mpcm tkt
volume of the tidal atr of respiration ( page 14^)^

(a) The subject, R. A. S., was a young man aged 21, weigh!
140 lbs. The normal amount of tidal air was determined to be
43 cubic inches. The patient was placed in an immersion bath
at 108°. At the end of twelve minutes, the amount of tidal aii
was found to be 27 cubic inches. Ten minutes after the bath, the
tidal air was ;^^ cubic inches; 30 minutes after, 37 cubic inches.
This experiment shows a loss in the volume of the respired aii
amounting to 37.5 per cent

(fi) A wet-sheet rub at a temperature of 40^ was administered
tea young man, O. R- C, aged 25, weight 142 lbs. The initiaJ
volume of tidal air was 28 cubic inches. The volume of tidal ail
immediately after the treatment was 35 cubic inches, an increase
of nearly 26 per cent.

(c) The subject, F. J. W., was a young man aged 25, weight
127 lbs. The initial volume of tidal air was 33 cubic inches.
Cold mitten friction was administered at 45^ for two minutes.
Immediately after the application the tidal air was found to be
SI cubic inches, in increase of 55 percent

SUMMARY OF EXPERIMENTAL WORR,

II23

(i/) K F. O., a young man aged 25, weight 105 lbs,, was given a
vret-sheet pack for one hour. The sheet was wrung as dry as pos-
sible, from water at 45°* The amount of tidal air before the applica-
tion of the wet sheet was 27 cubic inches* Two minutes after the
sheet was applied, the amount was 36 cubic inches, an increase ol
$Sys per cent; fifteen minutes later^ 33 cubic inches. The ampli-
tude of respiratory movement gradualty lessened^ until at the end
of an hour, when the cxi>eriment terminatedj the auioimi of tidal
air was 28 cubic inches. The experiment thus showed an increase
in the amount of air received into the lungs during the entire
period, amounting to an average of 18.5 per cent. The subject was
lightly covered to prevent excessive heat accumulation, thus mam*
taining the pack in the neutral stage.

Experiment 44.^S/Hm'inf^ the ihpr^ssitt^i^ effects of the generai hi^i
bath fy its nifiuemr r^/ft^n mus^u/ar eaptuiiy { fagc iso)'

The subject, W, l\ L., was a young man ol 21 years, weight
140 lbs. His total muscular strength^ as shown by the Universal
Dynamometer (sec Fig, 255) ^ ^as 6^480 lbs, (Fig, 254), The
fill! immersion bath was administered at 112*'^ dti ration twelve min*
utes. At the conclusion of the bath, the strength was tested
again, and found to be 5,415 pounds, a loss of 1,065 pounds, or
more than 16 per cent* The subject felt very much weakened and
depressed by the experiment, from which he was quickly recovered,
however, by the application ol a spray douche at so*' for thirty
seconds. His strength was again tesiedj and found to be 6,480
pounds, or exactly the same as at the beginning of the experiment*
This experiment also illustrates the marvelous properties of cold
water as a restorative agent.

ExPERiHLNT 45, — ShiftoiHg tht tfft^ts ufioH mustklar atpa^ity 0/ a
€oid bath faihwing a hot immersi&n bath {pag€ fSO*

(a) The subject, R. A. S., was a yonng man aged 21, weight
140 lbs* The strength of the flexor muscle of tiie middle finger
of the right hand was determined by means of Mosso^s ergo*
graph (Fig* 255), and is shown in the accompanying graphic
(Fig. 256)* The total work was 5*290 kgm. A hot spray was
administered at 113* for fifteen minutes. Another crgogram was
obtained (Fig. 257), and the amount of work done was found to

1 124

RATIONAI* UYDRaXHERAEni*.

be 5.835 kgm., showing a low of .569 kgm., or tt per cdiL ,
cold spray was then administered at 60^1 duratioii ten miout^
and the eigogram shown in Fig. 258 was obtainefl- The amoni
of work recorded was 6.094 kg m*, an im mediate increase cf moil
than 16 per cent, and an increase af 15 per cent over the mu
work recorded at the beginning of the e^tperiment.

(^) In a similar experiment with the same subfectf in which th
Universal Dynamometer was used as a means of detertninii^ ihi
efects of the applications, the hot bath produced a k»ss of 911
pounds, or 13 per cent of the total strength^ while the cold ba^
produced a gain of 1,267 pounds, or 18 per cent, the stibjcct bav^
ing a total muscular capacity at the end of the experiment 5 pel
cent greater than at the banning.

Experiment 46. — Showing ike effects upon iht k^ irmp^rmimr^ 4
a general applicaiien of hoot ( page ijS),

(a) The subject, A. C. S., was a young man aged 23, weight 1 j;
lbs. A Russian bath was administered at 115^, duration twenty^
five minutes. The initial body temperature was, mouthy 9^*6^
rectal, 99. 9^. At the conclusion of the bath» the mouth tempef&-
ture was 103.4^ and the rectal temperature loz^, an increase oi
258.9 heat units (137X2. i X. 9 = 258. 9). '

(^) An electric-light bath was administered (1S91) to a
young man aged 22, weight 145 lbs. The subject's
ture was normal at the beginning of the experiment, and
by the bath in five and one-half minutes 1.6° F. (mouth). The
surface temperature was elevated during the same period 2.3^ F.

Experiment 47. — Showing the effects of the hot immersion hmik on
the body temperature {page 1^8).

The subject, W. E. P., was a young man aged 35, weight iso
lbs. He was placed in a full bath at 104^ for thirty niniites.
The initial body temperature was, mouth, 98.7°; rectal, 99.6^. At
the end of the experiment, the mouth temperature was foond to
be 102.3®; ^^^ ^^c rectal temperature, 102.8°, an increase of 3,s*j
representing 345. 6 heat units ( 1 20 x 3. 2 x . 9 =345* 6). The amount
of heat normally produced in thirty minutes would be 216 heat
units (7.2X30 = 216). This leaves 129.7 heat units to be ac-
counted for by absorption or increased heat production. Some

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I'lg. J56 (lixj). 45>, Ergogram Uhuined by Mcaiis of Moiiso's Ergt>*5ra[)h, Stiowm^
Normal Fatigue Curve of a Young Man, R. A- S, Total work, 4*994 kgm. (p. H-^i)

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Fig, J 57 I Kv|i 4O- Krgogratn Showing Fatigue Curv<? of K. ,\^ i^. after Ji Spray jt 1 1 ,v^
for Fifteen Minutea, Total work, 4.4 j J kfm. (p. it^j)-

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Fig 558 (E%p. 4s), Brgogram Showing Fatigue Curve of R. A. S. after a CoKl Spray
Folio winf ■ Hot Bath. Tot*j work, tf.094 kffra. (p. it*4)<

Seat was doubtless absorbed by the body during the bath, but it
seems reasonable to believe that the great accumulation of heat was
due to diminished heat elimination with increased heat production^
rather than to the mere absorption of heat.

All general applications which interfere with heat elimination
at the ordinary rate, produce similar results.

Experiment 48. — Showing the effect on body temperature of a ^ath
at the temperature &f ike body {page IS9)*

The subject, W. E. P.» was a man aged 35, weight 120
lbs. The body temperature determined just before the experiment
was, mouth, 98.5'*; rectalp 101,2*^, The subject was placed in an
immersion bath at too^ for one hour. The mouth icmperature
was then found to l>e 101.9'^; the rectal, iot.S°,

ExPERtMENT 49. — Showing the effect of dry friction upon the surface
tempera It/ re (page /66),

Friction with the dry shampoo brush was administered for thirty
minutes to a subject, W. E. P*, aged 35, weight 120 lbs. The
surtace temperature, taken at different parts of the body before
and after the experiment, showed a gain of from 1.5° to 4% an
average of 3.7°*

Experiment 50. — Showipfg the effects of a partial coici applieaSion in
increasing muscular capacity {page j 00).

The subject, A. E. L,, was a young man aged 26 years, weight
151 lbs* His normal ergogram is shown in Fig. 259. The total
work recorded was 5*395 kgm. After the application to the fore*
arm for one minute^ of a dotiche at 60°, the ergogram shown in
Fig. 260 was obtained, and the total work recorded was 6.925 kgm.p
an increase of 50 per cent*

Experiment 5 r,^ — S/imeang the effect of friction in connection with
the cold bath in increasing heat elimination (P^g^J04}^

The subject, E. R O., a young man aged 26, weight 105 lbs.,
was placed in a bath-tub calorimeter containing 400 pounds of
water at 70*^. Without friction the temperature of the water rose at
the rate of .72® F. in five minutes. When friction was applied,
the temperature of the water rose at the rate of i*o§® F, every five

1 126

KATIQNAL .HinHKOTHBt APV.

minates. By calculatioii it appears tliat the rate of heat elimiti-
ation was, without frictioii, 57.6 heat units per minute; with
friction, 86.4 heat units, an increase of 50 per cent

Experiment 52. — Showing ike efeeis of the c&id tnema uf^mt he
body iemperaiure in a iwrmal^ hioitky pir^09i ( pugejiS).

The subject, L. H. W.^ was a young man aged jo, weight 166
lbs. The initial temperature was, mouth 99°^ rectal, 99. 7^* The
temperature of the water administered was 70"" P., the amount, S
pints. This quantity was introduced, in three portions within 57
minutes, each succeeding portion being introduced immedlateJf
after the dischaige of the preceding. At the end of the experi-
ment, the mouth temperature was found to be 98,4°, a decrease of
.6^; the rectal temperature was 94^. The axiUary temperature at
the beginning of the experiment was 97.8^; at the end, 97.6°, The
rise in axillary temperature which usually occurs in connection with
the cold enema is due to the contraction of the mesenteric vesselsr
producing a movement of blood toward the surface, especially of
the upper portion of the body.

Experiment 53. — Showing the effects of percussion in inaroanmg
the intensity of the reaction from cold.

{a) The subject, W. P. L., was a young man aged 21, wieight
140 lbs. The initial surface temperature obtained by placing m
surface thermometer at a point near the umbilicus was 97. 6^, A
percussion douche was administered at 55^, duration forty sec-
onds. Immediately after the application, the surface temperatnie,
determined at the same point, was 94.6^. The initial tempera-
ture was reached at the end of fourteen minutes. (See |dao
experiment 36.)

{d) The subject, A. G. F., was a young man aged 23, weiglit
132 lbs. The cold compress and the percussion douche were simul-
taneously given at 65^ for five seconds, to opposite and cone-
sponding parts. After the cold compress, the time required for
reaction was forty seconds, whereas after the percussion douche
with pressure at 30 lbs., the circulatory reaction appeared in five
seconds.

i

^^H^ Fi|f. J65 (E*p, 55). Fatijfue Curve of A* ¥L L* afler ii General Douche at 60^ for

^^^^fe Three Minutes. Total work, n.966 kgto. (^^ fujli.

SUMMARY OF EXPERIMEXTAL WORK. 112/

ExPEfclMEKT 54.^ — S/itmftX^ the effect of cold appikati&ns up&n the
muscular rtspome to electrical currents {/age 4jS).

The amount of work done before and after the ap'plication was
measured by Mosso's ergograph (see Fig. 255, page 1 123), in which
a spring resistance was substituted for the weights (this tnodi5ca-
tion was suggested by Dr. E. Otis), The resuUs obtained are
shown in Figs, a6i, 262, and 263. Fig, 261 shows the normal
curve. The amount of work done was 1.3 12 kgm. After a
douche at 55^ for fifteen seconds, as shown in Fig. 262, the work
done was 1*527 kgm. After a douche at 115^, duration five min-
utcs> the ergogram shown in Fig, 263 was obtained, and the
amount of work registered was .927 kgm. The capacity for

I muscular work was thus increased 16*4 per cent by the cold douche
to the arm, and diminished 29.3 per cent by the hot douche. The

, increased amount of work done was due to the more energetJC con-

(traction of the muscles.

The observation was constantly made that the resistance of the

Iftkin is increased to a marked degree after a cold application; that
is, after the application of cold to the parts while the current is

Ppassing there is immediate decrease in the reading of the niilltam-

|p^>remeter, while an application of heat produces the opposite
effectj without any change in the adjustmeni of the rheostat.

(Experiment 55* — S/iowing the effect of the i^encral cqU doUihe on
the capacity f if r mmcalar w&rk { page 4jS).

The subject, A, E. L., was a young managed 26, weight 151

IJbs, His normal fatigue curve is shown in Fig. 264, After the ad-

rtninistration of a general douche at 60*^ for three minutes, a second

ergogram was obtained, shown in Fig, 265, The amount of work

registered before the douche was 8,282 kgm,; after the douche the

Itotal work was 1 1.966 kgm, an increase of 44 per cent

CXPEHIMKNT 56, — Shaunn^ the effects of heat and cold m the ca-
pacity far muscular w**rk ( page 4jS).

{a) The subject^ A* E* L,, a young man aged 26, weight 151
libs., gave the normal fatigue curve shown in Fig. 266; total work,
[6,371 kgm. A general douche at 56° for fifteen seconds was
[then administered, and another ergogram obtained, shown in

I 128 RATIONAL HYDROTHERAPY.

Fig. 267. The amount of work registered was 8.448 kgm., an
increase of 32 per cent. A general hot douche (temperature xxa**,
duration fifteen min.) was then administered, and another cigo-
gram obtained, shown in Fig. 268. The total amoimt of work
done was 4.155 kgm., a decrease of 33 per cent

(^) On another occasion, a hot immersion bath was given the
same patient at 104^ for twenty minutes with the following result:
Normal fatigue curve, shown in Fig. 269; amount of work regis-
tered, 8.033 ^g"^* After the bath, the fatigue curve shown in
Fig. 270 was obtained, showing a notable depression. The amount
of work registered was 4.459 ^g™-> ^ decrease of 44 per cent

Experiment 57. — Shcnuing the effects of very hoi appHcaiUns in

producing an initial slowing of the pulse with subseqneni #jf-

creasc {page 448),

In the subject, A. C. S., a young man aged 23, weight 137 lbs.,
the normal radial pulse rate was found to be 70. The arterial
tension, as indicated by Gaertner's tonometer (see Figs. 239, 240,
page 931), was 9 cm. The subject was placed in an immersion
bath at 102°, The pulse immediately fell to 61. At the end of
fifteen minutes, the pulse rate was 87, and the tonometer registered
6 cm., showing a marked fall in blood pressure.

By comparison with Experiment 40, it will be noted that local
hot applications produce a rise in blood pressure, as indicated by
the tonometer, while general hot applications produce a fall, as
shown above. Thirty minutes after the bath, the pulse rate was 60
and the tonometer reading 8 cm.

Experiment 58. — Slum'ing the effects of the cold and the neutral
immersion bath on capacity for muscular work {page ^2g).
{a) The subject, A. E. L., was a young man aged 26, weight
151 lbs. The normal fatigue curve obtained is shown in Fig. 271.
The total amount of work done was 5.817 kgm. After a general
douche at 55° for fifteen seconds, the fatigue curve shown in Fig.
272 w^as obtained, and the amount of work registered was 8.642
kgm., an increase of 48.5 per cent.

{If) A neutral immersion bath administered to the same sub-
ject produced practically no effect on the capacity for muscular
work, as shown in the normal fatigue cur/e presented in Fig. 273.
Total work, 5.789 kgm.

I

SUMMARY OF EXPERIMENTAL WORK. I 1 29

Experiment 59. — Showing the effects of the cold shallow bath on
capacity for muscular work(^page ^gj).

The subject, W. P. L., was a young man aged 21, weight 140 lbs.
A shallow bath was administered at 65^ for two minutes, with the
result of increasing the capacity for muscular work 32 per cent,
as shown in the fatigue curves presented in Figs. 274 and 275.

Experiment 60. — Showing the effects of a tonic application of the
wet-sheet pack upon muscular work {page 6/j).

The subject, W. P. L., aged 21, weight 140 lbs., gave the
normal fatigue curve shown in Fig. 276. The wet-sheet pack was
applied at 60° for twenty minutes, after which the fatigue curve
shown in Fig. 277 was obtained. The amount of work registered
was increased from 4.791 kgm. to 5.456 kgm., or a gain of 14 per
rent.

Experiment 61. — Showing the effects of oiling the skin upon heat

elimination by conduction {page 68 j).

The subject, E. F. O., was a young man aged 26, weight 105
lbs. When placed in a d*Arsonval calorimeter (see Fig. 24, page
89) in a room at a temperature of 82*^ F., the movement of air
was at the rate of 100 feet per minute. The subject was then
removed from the calorimeter and smeared with vaseline. Upon
returning to the calorimeter, the rate was 55 feet per minute, a
decrease of 45 per cent.

Numerous observations made with the bath-tub calorimeter
agreed with the above results.

Experiment 62. — Showing the effects of /Russian, electric-light,
and Turkish baths upon the body temperature {page y 04),
{a) The subject, A. C. S., a young man aged 23 years, weight
137 lbs., was given a Russian bath at 115° for twenty-five minutes.
At the beginning of the bath, the pulse rate was 56; rectal tem-
perature, 99.9°. At the conclusion of the bath, the pulse rate
was 130; rectal temperature, 102°, an increase of 258.9 heat units
(137 X 2.1 X. 9 = 258. 9). The normal amount of heat produced in
twenty-five minutes is about 180 heat units, leaving 78.9 heat units
to be accounted for either by increased heat production or absorp-
tion. Other observations indicate the probability of an increase
in heat production.

(3) The subject, V, P., aged 26 years, weight 13a Hm^^
placed in an electric-light bath for twenty-three minntesu At the
beginning of the bath the pulse imte was 82; rectal tesq^eci^liire^
99.9^ At the end of the bath, ^e pulse rate was 134; iwtd
temperature, 10X.4®; mouth temperature, 102^, an inciease . of
175.5 ^'^^^ ^^^ (^3oXi.SX.9t=^i75.5). The amount of heat
normally produced during the time covered by the experiment k
about 165.6 (23x7.2), almost exactly the amount fepfesenfodli]^
the elevation of temperature. As Iteat elimination, eitlier by Hidi-
ation or evaporation, is not interfeied with during this balli, the
increase was probably, the result, in part, at least, of augaici^bed
heat production.

{<) P. H., a young man aged 95 years, wdght 150 lbs., was
given a Turkish bath for one hoof al 146^ to X58^ At tho bcpft^
ning of the bath, the pulse was 49; rectal temperature, 9&ff«
At the end of the experiment, the pulse rate was 59; rectal tempera-
ture, 100.6*^, and respiration increased from 13 to 19 perndikiile.
The elevation in temperature represented an accumulation of 229.5
heat units. In many subjects more marked effects are produced.

Experiment 63. — Showing the influence of the cold firoximal com-
press upon the temperature of distal parts {page 760).

The subject, A. C. S., was a young man aged 23, weight 137
lbs.; initial temperature, axilla, 99.8°; palmar surface, hand
closed, 98.1°. The elbow was immersed in water at 42^ for
thirty minutes, at the end of which time the axillary temperature
was 100.8°, and the hand temperature, 96.1°.

Experiment 64. — (,'Page 774.)

The surface temperature of the cheek was determined to be
97.3°. Ice was then placed in the mouth, and held in contact
with the mucous surface of the cheek for fifteen minutes. The
temperature of the cutaneous surface was reduced to 89.6**.

Experiment 65. — (-Page 774,)

The temperature of the inner surface of the cheek was taken,
and found to be 98.6°. By the application of -ice to the outer sur-
face of the cheek for fifteen minutes, the temperature of the innei
surface was reduced to 90° F.

SUMMARY OF EXPERIMENTAL WORK. II3I

Experiment 66. — {Pag^ 774. )

The subject, F. G. L., was a young man aged 21, weight 135
lbs. The rectal temperature was taken and found to be 99.8^.
An ice compress was applied to the abdomen and sacrum. At the
end of thirty minutes, the rectal temperature had fallen to 98.6^,
clearly showing the value of these applications in rectal and pelvic
inflammations. It should be borne in mind that the reduction in
internal temperature resulting from a cold application to the cu-
taneous surface is not due to the abstraction of heat from, or direct
cooling of, the internal part, but is brought about indirectly through
the reflex contraction of the blood-vessels of the part, and the les-
sened tissue activity resulting from diminished blood supply.

Experiment 67. — {Page 774.)

In a subject whose initial rectal temperature was 99.8**, an ice
compress to the abdomen and sacrum, combined with the hot foot
bath, reduced the rectal temperature in one hour and ten minutes
to 97.4°.

Experiment 68. — {Page 791,)

(a) An ice compress was applied to the knee of a young man,
W. P. L. The initial temperature of the foot was 94°. At the
end of thirty minutes the temperature was reduced to 91.5°.

(^) An ice compress applied about the thigh for forty-five
minutes reduced the temperature of the foot from 94*^ to 91°.

(r) An ice bag applied to the axilla for thirty minutes reduced
the temperature of the hand from 97® to 96*^.

(//) An ice collar applied to the neck produced the following
results: The initial pulse of the subject, V. P., was 77; the temper-
ature, taken in the external auditory meatus, 98®; mouth tempera,
ture, 97.8°; rectal, 99°. At the end of fifty minutes the pulse was
reduced to 56; the temperature of the external auditory meatus
was 93**; mouth temperature, 93.7®; rectal, 98.4**. The pulse was
reduced 2 1 beats; the temperature of the external auditory canal,
5°; the mouth, 4.1^; and the rectal temperature, .6**.

113^

RAXIONAI. HYDROTHERAPY

1

Experiment 69. — Shawing the rate of heaimg of the akJamih
compress prat€€ ted with Bannci only {page Sj6). ^^

Three experiments were mode oti a subject^ a young man^ A^|
E. L.y aged 26, weight 151 lbs. The procedure consisted of the
application of an ordinary heating abdominal compress, tismg a
linen cloth for the moist layer, covering with ilannel, employing
different thicknesses in the different experiments. The tempera
ture of the water used was 59° y,, the room temperature 77* E
The temperatnre was taken at the end of the first and secom
minutesi then every two minutes afterward until the maxlmu!
temperature was reached. >The'i^ults were as follows: —

(a) Employing one layer of flaimel to cover the wet comprea%
the temperature at the end of the first minute was found to be
81.5^; the maximum temperature, 86.5^, was reached at the eiuf bl
eight minutes.

(^) With two layers of flannd^ the temperature was found it
the end of the Hrst minute as in tibe preceding experiiaaity, Ex^j^*
The maximum temperature of 89.3° was reached at the end^ of lea:
minutes. %

(r) The moist bandage was covered with four thickne^^ ot
flannel. Temperature at the end of one minute was 82.5°; the
maximum' temperature of 91.8° was reached at the end of ten min-
utes.

Experiment 70. — Showing the rate of heating of the heating ab-
dominal compress, when protected with mackintosh or other im-
pervious material {page 826).

These experiments were made with the same subject as the
preceding and the conditions were the same: —

{a) With one thickness of flannel, the maximum temperature
91.4° was reached at the end of fifteen minutes.

(^) With two thicknesses of flannel, the maximum temperature
of 92.1° was reached at the end of twenty minutes.

(r) With four thicknesses of flannel, the maximum temperature
of 93.6° was reached at the end of twenty minutes.

(//) With eight thicknesses of flannel, the maximum temperature
of 94.7° was reached at the end of twenty minutes.

SUMMARY OF EXPERIMENTAL WORK. I 1 33

Experiment 71. — Showing the effect of the chest compress upon the

volume of tidal air {page 862),

The subject, J. C. B., was a young man aged 27, weight 132 lbs.
The normal amount of tidal air was 507 c.c. The application of
the chest compress, wrung from ice-water, produced an immediate
increase in the depth of the respiratory movements and the volume
of the tidal air rose at once to 751 c.c, an increase of 48 per cent.
At the end of twenty minutes, when the experiment terminated, the
amount of tidal air was 604 c.c, 20 per cent more than at the
beginning. The average increase for the whole twenty minutes was
170 c.c, or ^^ per cent.

Experiment 72. — Showing the effects of the cold precordial com-
press upon the rate and force of the heart beat {page 868),

(a) The subject was a young man aged 35, weight 122 lbs.
A sphygmographic tracing obtained before the application of the
compress, is shown in Fig. 207 (a), page 868; pulse rate, 72. A
cold application, consisting of an ice-poultice one foot square, was
applied over the heart and left chest. The effect was an immediate
increase of the pulse rate to 76 for two minutes. The pulse was
then slowed, becoming at the end of three minutes 72. A second
sphygmographic tracing was then taken, shown in Fig. 207 (^),« page
868. Comparison of the two tracings shows clearly the increased
tension resulting from the application.

{d) The subject was a patient, Mr. W., suffering from severe
collapse following a prolonged and complicated abdominal opera-
tion for the removal of impacted gallstones. Before the applica-
tion of the compress, the patient's pulse was so weak that it could
not be felt at the wrist. When counted by means of the stetho-
scope placed over the heart, it was found to be 120. An ice-bag
was applied over the heart with the result that the pulse could
be counted at the wrist, the rate was slowed to 87, and the tension,
which was zero as indicated by Gaertner's tonometer, rose to 5 cm.

(r) The subject, R. M. B., was a young man aged 23, weight
130 lbs. ; pulse, 80; tonometer reading, 13. After the application of
cold to the precordial region, there was an immediate increase in
tension to 17. In two minutes the tension fell to 16, and the pulse
to 70. At the end of twenty-five minutes, the pulse was 64, and
the tonometer reading 15.

i«34

RATIO]

ExFBSiifEirr 73. — ShmmmgUu €fitci of cM-waUr dri$§kimg t/fm
the axillary temper tUmre and ike surface iemperuimre or deier*
mined ai ike efigoMiriuM ipa^j^S).

The subject, A. G. BiL, was a youi^ man aged 26, in^;iit^ 153
' lbs.; axillary temperatiuey 97*7*;niMt]i, ^.7^; fecial, 99.2^; sariaoe
temperatme at the epigiatriitii^ 1^7*^. The pati^it drank in rapid
succession seven glasses of temotiade at 58®. A fall in ^bt mz&larf
temperature was noted hi #ve nunutes. At the end frf tipentjr
minutesy the axlHary temperature #as 96*1^; moudi, ^^; iHttld,
^^; surface temperatnre at tiietp^lE^triumt 92®.

The great fall in surface temperature at the ep^astrinm, ifter
drinking ice-water, may bentiliziMl as a jtneans of locating the
stomach and determining its size and contour. The intercstiog
fact that a very marked depression in the surface temperature of
the skin overlying the stomach takes place as the result of
drinking a quantity of ice-waler, was first noted by Dr. F. J. Otis
(1898)9 while a m^cal student^ oigaged iii carrying out expen^
mental resi^rches under the direction of the author.

BIBLIOGRAPHY.

With very few exceptions all the following authorities have been
consulted in the preparation of this work, and a considerable nuQiber
are referred to in foot-notes in the preceding pages. This list, how-
ever, is not presented as by any means complete. The bibliography of
hydrotherapy has within *the last few years grown to enormous pro-
portions. It is believed, however, that the major part of what is
worth reading upon this subject may be found in the works named
below. The authorities indicated by numeral reference marks arc
referred to in Parts I and 11.

1. Landois & Sterling. Text-book of Human Physiology, 1891,

page 174.

2. I^ndois & Sterling. Text-book of Human Physiology, 1891,

page 113.

3. Waller, Augustus. Human Physiology, 1891, page 59.

4. Landois & Sterling. Text-book of Human Physiology, 1891,

page 228.

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6. Landois & Sterling. Human Physiology, 1891, page 230.

7. Waller, Augustus. Human Physiology, pages 280-281.

8. Schiiller. Archiv fiir Klinische medicin., 1874.

9. Landois & Sterling. Human Physiology, 1891, page 427.

10. Naumann. Zur Lehre von dem Reflex, 1872.

11. Gillebert-Dhercourt. Annales de la Societe d'hydrologic mMi-

cale, 1870.

12. Franck, Francois. Trauvaux dur laboratoire du professeur

Marey. Tome i.

13. Vinaj & Maggiori. Blatter fiir Klin. Hydrother., 1893.

14. Centralblatt fur innere Medicine, 1893, page 1017.

15. Archiv fur experimentelle Pathologic und Pharmakologie.

16. Thayer, W. S. Johns Hopkins Hospital Bulletin, 1893.

17. Strasser, A., and Buxbaum, B. Fortschritte der Hydrothcrapic,

1897.

18. Landois & Sterling. Human Physiology, 1891, page 548.

19. Fleury, Louis. Traits Therapeutique et clinique d'hydrotherapie,

page 144.
20. Fleury, page 160.

"35

113^

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midicale, 1895.
2Z. CMiYcr. London Lmm^'iS^
:^ Boii-Barde. L^ydroaKhragic dans ks malaffict chroeiftte d fci

maladies nenrenses^ i^M.

24. Maggiori & Vinaj. Blatter IBr Klimsdie Hydrotherapi^^ ig^

VoL n, Na IS; Vdl. m. No. 7, adso page 67.

25. ifI6iocqn^ Albert Annd^ de la SodM de Biologic ^^jr.
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j^. Beni^Barde. Lm dondies locales en liydimlifera^^ Coniii

iThydrologie^ l88s^ ^

08. Bottey, Femand. TraittS iM(kkfift et pratiQae dliydnlitefie

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391 Bottey, Femand. Aimalts de h Soci6t£ dTiydroiogie nrfiBfUi,

1886^ page 60.

30. Draper. New York MeAcal Jdoriial, 18B8L

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_^_— ^ , ^..

Baginsky. Lehrbocli der Kinder Kraiddieiten» 189^ page 993L
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Causes and Treatment of the Summer Diarrhea of Infants, Med-
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The Status of Water in Modern Medicine, 1890.

A Plea for the Practical Utilization of Hydrotherapy, Gaillard's
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Hydrotherapy in Europe, Medical Record, Oct. 11, 1890.

Hydrotherapy and Mineral Springs (Hare's American System

of Practical Therapeutics), Phila., 1891. Vol. i, page 453-

A Plea for the More Methodical Management of Chronic Dis-
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The Uses of Water in Modern Medicine, Geo. G. Davis, Detroit,
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Conditions Indicating Change of Air and Baths in the Summer
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Practical Data on the Application of Water in Some Intractable
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BIBLIOGRAPHY. II 37

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1893.

Rationale of Hydrotherapy, Medical Record, Oct. 27, 1894.

Water the Ancient and Ready Remedy, Editorial, Medical Re-
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Methods of Fostering the Interests of Medical Science, Presi-
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Fehlgriffe in der Hydrotherapie, New York Medical Monatschr.,
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Lecture on the Practical Application of Hydrotherapy, Philadel-
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Faulty Hydrotherapy, Jour, of the Amer. Med. Assn., May 13, 1897.

1 1 38 BIBLIOGRAPHY.

Discussion of Typhoid Bathing at the County Medical Society,
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Pneumonia, Editorial, Medical Record, Jan. 9^ 1897, page 14.

Some Desperate Cases of Typhoid Fever Treated with and with-
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The Principles and Practice of Hydrotherapy, Wm. Wood and
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Die praktische Anwendung der Wasserheilkunde, Monatschr. L
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145-155-
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Vol. 75, No. 28, 1899.
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February, 1899, page 49.
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"39

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U40

BiBUOGRAFHr.

i

\

fil

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£14^

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"%

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INDEX.

Abdomen, cutaneous hyperesthesia of,

614.
Abdominal bandage, dry, 858.

compress, heating, 749, 835-8.

compress, sedative effects of, 264.

douche, 500-1.

douche, contraindications, 370.

douche, cold, 766.

dropsy, 837.

muscles in constipation, 1036.

muscles in enteroptosis, 1037.

muscles, relaxed, 513.

pack, hot-and-cold, 850.

sponging, 638.

supporter, 497.

surgery, iioi.

sympathetic, hyperesthesia of, 266.
495. 771. 801, 831, 836, 851.

sympathetic, irritation of, 501,
622, 832, 839.

tenderness in enteroptosis, 1038.

tenderness in nervous dyspepsia.
1040.

viscera, congestion of, 832.
Ablution, 634-6.
Abscess, 1018.

in typhoid, 985.
Abscesses, 780.
Absorption, effect of cold upon, 121.

by skin, 67.

of toxins, 897.

of water by nerve filaments, 551.
Acne of face, 808.
Actinic ray, 196, 711.
Addison's disease, 829.
Adenoids, 917.
Adncxa, disease of, 1091.

of uterus, subinvolution of, 768.
Adynamic febrile states, 637.
Affusion, 295, 515. 752, 863.

alternate, 196.

in Brand bath, 520.

cold, in fevers, Currie, 522.

contraindication^, 522.

to head in typm>id, 493.

hot, to head, 494.

local, method of. 517.

physiological effects of, 518.

use of, by Currie, 295.

use in Italy, 29.

used by Chinese, 21.

therapeutic applications, 519.
Africa, oil rubbing by natives, 52, 685.
Ague cured by baths, 29, 990.
Air bath, cold, 313, 959.

bath, hot local, 259, 692.

bath, indoor, 962.

influence of, upon heat produc-
tion, 82. 90.

physics of, 42.
Albuminuria, 413.

in diphtheria, 1002.

in erysipelas, 997.

in febrile disorders, 1018.

in obesity, 1027.

in peritonitis, 1048.

of pregnancy, 624.

in tonsillitis, 1002.

in yellow fever, loii.
Alcohol. 869.

in cold bath, 586.

effect upon heart, 205, 587.

narcosis, 822.

sponge bath, 956.

substitutes for, 297.
Alcoholic exhaustion, 508.

intoxication, 533~4. 818.

poisoning, acute, 705.
Alcoholism, 512, 521, 553, 618, 809,
1098.

in insanity, 1066.
Alkaline bath, 954.
Alkaline sponge bath, hot. 638.
Alkalinity of the blood, 9(56.

of blood, increase under cold
applications, 413.
Alterative effects, 227. 257, 258,
Alternate affusions, 196.

applications, 747.

applications to head, 823.

applications to mucous passages,

913.
applications, revulsion by, 250-1.
applications to spine. 820.
ascending douche, 481.
bath, Finkley, Galen, Vinaj, and

Pfiiiger on, 312.
compress, 196, 816, 817.

"47

hs

INDEX.

Alternate douche, 470-^.

douche ill liypcrtrophy of pro?*-
t^te and vesical pate^b^ 481.

Pfoot bath, 758,
spinal doitche, 264.
sponging. iq6* 264* 6jO^
Alteniating fan douche, 484^
Alveolar iri flam mat ion, 778,
Anion orrhea, ^41, 244, 47 j, 513, 545,
877* 940, io8q.
caliper douche in, 4H2,
cathodic, farad ic, or sinusoidal

applica lions in. 942,
tonic hip pack in, 241,
America, hydroihfrapy in, 32.
Amyloid kidney, S2g.

liver, 61S, 829.
Amyotrophic lateral sclerosis, T054.
Anal dutiehc, 504.
^L douche, cold, in constipation.

fuche,

douche, contraindications, 505.

douche in hemofrhaids, 504.

douche, very hot, 505,

fissnrt^ warm douchi^ in. 481*

insufhciency, cold ascending
douche in, 481.

muscle^, weakening of, 503.

spasm in hysteria, 1059,

tenesmus, 769.
Analgesic effects, 799, 944.
Anasarca^ 1084.
Anatomy, relation of, to hydrothcr-

apy, 5J.
Ancient use of vaginal irrigation, 29.

use of water drinking, 24.
Anemia. 231, 369, 471, 597, 609, 633,
637, 646, 661, 71S. 723, 753. 82S,
839. 844, S55. 1083-

cerebral, 494, 508, 677, 751, S55,
867. ^

cerebral, ia pernicious anemia^
1084

chronic, 823.

cofd applications in. 21B, 443.

collateral, 241, 759,

of cord, 840.

dropsy from, 231,

headache due to, 80 r. 856.

in malaria. 990.

in melancholia, 1064.

methods of combating, 24^-3,

in neuralgia, 1050,

in pelvic peritonitis, 1090.

pernicious. 867. 1084.

m pulmouEiry tuberculosis, 1019.

of skin, 597, 935.

spina), 495,

AnemiEi in syplults, 1095.

in typhoid. 987.

visceral, 24 j. 244.
Anemic headache, 1 067,

tn&omnia. 829.
Anesthesia. 1102.

in hyfiteria, 444, 1058.

of plantar region, 75S.

treatment during, tuo, fkxK
844. 845. 869, 87a
AneMlietic effects. 270.
Angina pectoris m gout, 1024,
Angioneurotic edeitia, 8og.
Animal hcnat, 77-8*
Ankylosis, fibrous, 515.
Anodal gah-anic applications, 940^!

941^
Anodynes, 26^.
Anorexia. 412, 647, 776,

In anemia, 1683.

in gastric dilatation, 1035,

in bypopepsia, 1032,

in hysteria, &jq, 1057,

in melancholia, 1064.

in nervous dyspepsia ^ lo^fOL

in neurasthenia, io6f.

in typhoid, 986,
Anterior pohoniye litis. 810.
Antiphlogistic effect s* 272, 280, 856.

effects of articular douche, 51^

effects of heat, 2791 1

Antipyretic, cold compress as. jo4

31 3-

cold sponge bath as, 307.

effects, 283, 287, 288,

effects of enema, 318, 320.

effects of wet-sheet pack, 2(84.

measures, precautions conccm-
ing. 329, 615,

methods, 293, 295-342.

wet sheet as an^ 603.
Antipyretics, 287.
Antipyrine, effect on blood fx>unt.

582.
Antispasmodic effects, 270.
Antithermic effects, 283, 615,

measure, cool compress as, 783.

methods, general principles of.

Apepsia, 498, 6$t, 768. 8C16. 93a*

cold gastric douche in, 5 to.

sinusoidal current in, 941.
AE>bonia, hysteric^, 445, 1059.
Apoplexy, 445, 55 J 560,

in typhoid, 9^4,

of spine, 856*
" Apotheraphia,'* 23.
Apparatus, douche^ 427.

INDEX.

1 149

Appendicitis, 781, 810, 829, 832, 847,
898, 1043.

in typhoid, 083.
Appetite, loss or, 412.
Arc light bath, 708, 711.
Arm bath, 759.
d* Arson val, calorimeter of, 89.

on effects of cold. 121.

on effects of luminous ray, 169.
Arterial pressure, instruments for de-
termining, 540.

tension in general paresis, 1066.

tension in migraine, 1062.
Arteriosclerosis, 445, 683.

in lithemia, 1022.

in organic cardiac disease, 1080.
Arteritis, 621.

in acute febrile disorders, 1017.

in acute rheumatism, 1008.

in typhoid, 984.
Artery, cold to, Wintemitz, 791.
Arthritis, 716.

deformans, 1085.

in erysipelas, 997.

in typhoid, ^5.
Articular douche, 5y-i4.

antiphlogistic effects of, 513.

douche m chronic exudates, 514.

therapeutic applications of, 514.

rheumatism, 515. 804, 828, ioc6.
Ascending douche, 480-1.

paralysis, acute, 823, 829.
Ascites, 457. 618, 829.
Asi!itic cholera, 810.
Askatchensky, on control of epis-

taxis, 508.
Asphyxia, 522. 639, 822.

from drugs, 779.

of newborn, 547.
Assimilation, effect of wet-sheet pack

on, 611.
Asthma, 457, 484, 598. 614, 676, 779»
845.

baths in, 237.

in chronic bronchitis, 1076.

in chronic gout, 1024.

nervous, 466, 499, 501. 851, 856,

• ^ ^

m nervous dyspepsia. 1040.

neutral douche to chest in, 509.

nocturnal, 1078.

short cold fan douche in, 484.
Ataxia: See Locomotor Ataxia.
Ataxic cases of typhoid, 777.
Ataxo-adynamic state in typhoid, 987.
Atomizer, 882.

Atonic condition of bowels and stom-
ach, 940.

Atonic effects from heat, 228, 262, 447.
Atony of bladder, 480, 484, 500, 503,
513, 764, 768, 90s, 906, 941.

of colon, 837.

of ejaculatory ducts, 503.

of genitals, 244.

genito-urinary, 471, 683.

of stomach and bowels, 484,
498.
Atrophy, muscular, 823.
Autointoxication in chlorosis, 1082.

chronic, 900.

in general paresis, 1066.

in mtestinal catarrh, 1041.

in insanity, 1065.

in mania, 1065.

in melancholia, 1064.

in neurasthenia, 1059.

in pernicious anemia, 1084.

vapor bath in, 705.
Back, applications to, 311, 496, 497.

pain in, 1094.
Backache, 465. 497, 77i» 831, S77.

in enteroptosis, 1038.

in neurasthenia, 1061.
Bacteria, measures which combat,

976.
Baginsky on cooling compress, 781.
Baldness, 839, 1097.
Baltz, Professor, of Japan, on effects

of hot baths, 541.
Bandage, dry abdominal, 838.
Baths, average temperature of. 422.

calorific, 709.

continuous : See Continuous bath.

duration of, 345.

drying after, 407, 408.

exercise in connection with, 348^
353.

heat to be avoided aft^r, 353.

miscellaneous, 954.

precautions relating to, 396.

sand, 962.

temperature of, 346.
Bathroom, equipment of, 397.
Beaumetz, Dujardin-, 302.
Bed-sores, 471, 560, 818.

in typhoid, ^7.
Beer on asphyxia, 779.
Beirs palsy. 618, 647. 810.
Below on electric-light bath, 720.
Beni-Barde on renal douche, 512.
Bernard. C, on life in liquid media,

921.
Bernard, P.. on filiform douche, 485.
Bert on light, 723.
Bcverlcy-Kobinson. 318.
Bigclow on empiricism, 965.

1NI>EX.

Bile, vomiting of, S50.
Jiilc*4ucu« caiarrh ol, goOk
in tjri^boid. 0B3.

dyspe|>iiA. 457-
Bilious headache, 1067.

in Iiypopep^ia^ JOjj.
1> ladder, achate catarrh of, 771-

jicutc itinattirtialion of, &17.

alooy of. 480, 484, s«30, 503, 51;!*
7^-4, 76S. 905. 906, 94F.

blood supply of* 7J9-

Otarrh of, 245, 771.

cotitractitwi of, 754.

flouclw, therajwtiUc applicAiion^
of, 90s*

hyperesUie^ia of, 4B1.

in flam ma lion of, 445, 804,

irngaLioti of* 903-6.

irrtubilily oi, 481, 495, S**l* 77*-
1046.

titotor insufTictency of, 49S~^

neiiralgm of, ^00, 76g. 1051.

pain fill alTcctions of^ 766.

paralysi!^ of, 905,

spa^m of neck of, 497t 7^

See Vesical
Blanket pack, hot, 230. 310, 5913, 623.

hot^ contraindications^ 625,

hot, method, 6^.

hot, in nephritis. 230.

bor. physio tcf^ical eflfectSi 6^

bots reqtitsitc?!, 623'

hot, rcvtilstve effects of, 254-

hot, therapeutic applications, 624.

hol^ in uremia I 235.
Bleed in i^r fibroid*!, Ckx>.

from wounds^ 777-
Blood, alkalinity of, 413, p56y 1023,

circubtion of, 54.

corpuscles, influence of heat
upon, Mawrel, 583*

count in fever. 582.

effects of cold upon, 120,

effects of heat upon, 156.

healing power ot, 242.

movement, means of controlling,
977*

movement, procedures which in-
crease, 074-

movement in spinal sclerosis, 1053.

pressure, 59.

pressure, high, headache from,
1067,

pressure increased by very hot
douche, 447'

pressure in mania, 1065.

J

Blood prtssnre in mdastciioli^ lofi
vesfsels^ effects of cold &ptm^ I
BlcKkdj sweat, 66.
Bockcr cm w^ter drittkcfig. 9221
Body temperature aad beat |iro4
tioft, 91,

in diabetes, iQa6i

m ty^lio*d, ^.
Booes^ dislocatkit and fracture 1
St». ^

Bottey, effeds of &M dooclie

kidney, s^^^
Bouchard on autointoxication, 70^

on graduated bath, 536.

00 perspiratioa^ 606.

oil skin etiininatioa, 5^

Kti flowed n^tritioitf 661.
Bougarel on Scotch dotidie, <|66u ;
Bowels, atonk totid'tioci, 484, 90Bi

Tronic inactivity of, gA.
Bradycardia. 869,
Brain« chronic inSammatioii of, S

congestion of, 764, 844* 940L

cfFects of neutr^t! rain doucbe I
475^

passive congeslion of, 841.

temperature of, 86.

and viscera, effect of bot
on, 448.

See Cerebri.
Brand bath, 520, 569. sgfi. 5oci,
645.. 680.

contraindications for, ^29^ 393,

method, sp9*

phyeiological effects* 571,

therapeutic applications, 573.
Brand, statistics m typhoid, ^S-
Breathings effects on tempcrattti

3*4 315-
Brights disease, 373. 47»- 5i^ <S:
676, 691, 1046^

acute, 624,

hot batb in, 229.

in lithemta, toaa.
Broken jet, 431.

Bronchial catarrh in measles, gg6.
Bronchioles, spasm of, 779* 8^
Bronchitis, 466, 616, 82S.

acute, 616, 700, 805, 916, 1075.

capillary, 52t, 544, 1005*

chronic, 545, 612, 66o^ 676, S
863, 1075.

in croup, 1074,

in diabetes, ioa6.

in emaciation, 1026L

in gout, 1024.

in influcnzap loij.

J

INDEX.

1151

Bronchitis in meningitis, 999.

in obesity, 1027.

in typhoid. 983.
Broncho-pneumonia, 278, 521, 544,

. 844-5, 1077.

m acute disorders, 1018.

in diphtheria, 1002.

in influenza, 1013.

in tonsillitis, 1002.

in typhoid, 983.
Brown, Graham, on contractility of

capillaries, 57.
Brown- Sequard on local tempera-
ture, 128, 760.

on cold draught, 919.

on skin reflexes, 937.
Bruises, 268, 640, 790.
Brunner, skin elimination, 578.
Buboes in plague, 1017.
Bunions, inflamed, 754.
Burgonzio on plantar douche. 502.
Bums, 268. 269, 558, 561, 759, 761, 790.

1096.
Cabinet, electric-light bath, 711, 947.
Cachexia, malarial, 457, 992.

malarial, with anemia, 1083.

syphilitic, 1095.
Calculus, renal, 512, 624, 800.
Caliper douche, 481-2.
Calorific effects of cold, 222, 258,
259.

effects of heat, 259.
Calorimeter, 87-9.
Calorimetry, 47, 51.
Cancer, 600, 778.
Cantani on water drinking, 318.

on hot enema, 897.
Capillary bronchitis, 521. 544.
Carbon dioxide compress, 773,

bath, 956.

elimination, effect of cold upon,
125.
Carbonated water, 930.
Carbonic acid gas compress, 773.

poisoning, 822.
Cardiac action diminished, 282.

collapse, 603.

compress, 777* 809, 867.

compress, cold, indications for,
870.

dilatation, 565, 691, 1026.

disease, 371, 450, 718.

disease, douche in, 443, 509.

diseases in chronic rheumatism,
1009.

diseases, functional, 1081.

diseases, organic, 1079.

dropsy, 228, 637. 646, 662, 691.

Cardiac failure in sunstroke, 1070.

failure in typhoid, 984.

hypertrophy, 1080.

insufficiency, 272, 445, 646, 662,
785, 833, 869.

irritability, 499, 622.

irritability in insomnia, 1070.

palpitation, 499.

palpitation in gastric dilatation,*
1034.

tone, to maintain, 647.

weakness, 204, 565, 598, 619, 844,
869, 871.

weakness in acute i^phritis, 1045.

weakness in cholera morbus, 1043.

weakness in drug habits, 1099.

weakness in obesity, 1027.

weakness in typhoid, gB6.

See Heart.
Cardialgia, 864.
Catarrh of bile ducts, 900.

of bladder, 245, 771.

bronchial, 700, 828, 862.

bronchia], in measles, 996.

of cecum, 898.

duodenal, 490.

gastric, 462, 499, 661, 831, 836, 888,
1030.

gastric, in organic cardiac dis-
ease, 1080.

gastro-intestinal, 837.

intestinal, 245, 445, 462, '482, 612,
647. 661, 798, 829, 831, 836, 1040.

intestinal, chronic, 1041.

intestinal, in emaciation, 1028.

intestinal, in neurasthenia, 1060.

of larynx, 867, 1071.

nasal, 466, 776, 839, 916, 1074.

of rectum, 245, 902, 915.

of stomach, 885.

of throat, 376.

of urethra, acute, 771.
Catarrhal jaundice, 618. 837. 1043.
Cathodic, faradic, or sinusoidal appli-
cations in amenorrhea, 942.

influence, cold short applications
resembling, 939.
Cavernous sinus, 735.
Cecum, inflammation of, 832.
Centigrade scale, 46.
Cephalic compress, 197, 198, 264, 777^
853. 857.

compress, antipyretic effects of.

compress, physiological effects
of, 854.

compress, therapeutic applica-
tions. 855.

I 152

INDEX.

Cephalic douche, 493 » 854 -

dotiche, cold, in typhoid, 493 ^
douche, physiological effects of,

493.
doucKe, therapeutic applications

oi, 493-
Cerebelhim, irritation of, 856*
Cerebral activity, to excite^ 775-
anemia, 494, 508. 677, 7$l. 855f 867.
apoplexy, 1055.
congestion, 466, 478. 404* so8< 610,

622, 660, 661, 749< 754* 756. 764*

776, 807. 837. 844- 85s. 856, 8S0,

8«)g. JP40.
congestion in dengue, 1015.
congestion in insomnia, 1O70.
congestion in meningitis, ggg.
cotigtstton in pneumonia, 1 005.
congestion in typhus, toia
congestion in yelbw fever, loii.
douche* 506^ ^
douche, physiological effects of,

507-
excitation, tepid douche to head

in, 494-

gangtia, reflex activity of, 610.

hypcremiaH 50Jh 502* 61 3, ^^44^ 855.

irritation, 4^4, 610,

rheumatism, 1007,

See Brain.
Cerebrospinal douche, S07^

mcnmgitis. 51*1, 545, ggg.
Cervico -occipital headache, 1069.
lyphoidn 587
lyphoid, 587.
Chapman on cold to spinal cord, 77^

on hot hag to spine, 8t2.
Charcot on the douche, 43 6, 937.
Charcot's joints in locomotor ataxia,

T055^

Chard in. Sir John, 30,
Charrin on the alkalinity of the
111 00 d, rj66.

defense of the nrs:anismj 574*
Chest compress, half, 861-63.

compress, heating, 863.

dropsy of. 6S3.

exudates in, 748.

ice to, in pneumonia, 787.

neutral douche to, in asthma,

pack, 238. 8S3, 857.

pack, hot, 864.

pack, hot and cold, 849.

pack, method, 857.

pack, physio logtcal effects of,

mi.

pack, precautions respecting, 864-

Chest pack, square. 858,

pack, therapeutic appTicd
862,

pack, towel, 860. J

pack, triangular, 859. *

Chilblains, 471, 632, toq6.
Children, convulsions of, 624.

incontinence in. 495, 1047.

lavage for, 887.

nocturnal enuresis of, 768, If

typhoid in, 647, 987. ]

Chill 8j8. ,

in dengue, 1015. j

in jaundice, 1044, ^

in malaria, 99'-

in pelvic peritonitis, fogo.

in pulmonary tuberculosis, ri

recurring, in erysipelas, 997,

in yellow fever, ton*
China, wet-sheet pack in, 21 . '
Chinese, affusion used by, 21,

massage, 675.
Chioroforni anesthesia, 823, 845*:

collapse, 8?3-
Chloral habit, logS.

neutral bath in, 553.
Chlorosis, 609, 637. 646, 661, 723, i

cold douche in, 443, 476. J
Giolagogic effects, 239. i

Cholera, Sg/S, 1014. 1

infantum, 810, 1040, \

morbus, 624, 8to. 1042*
Chorea, 560, 610, 809, 1056.

habit, 718.

major, 647, 809,
Chordee. QoS.
Circle douche, 483,
Circulation of blood, 54.

effect of cold upon, 107-10, j4

effect of heat upon, 96* 146,

effect of wet- sheet pack on, 6

Kiernnn on, 741*

peripheral, 646.

peripheral, in organic cmrdiae
ease, 1079.

portal, 740,

sedatives of, 263.
Circulatory reaction, 129, 162, 24]

by cold friction, 645.

following Scotch douche, 464

by neutral percussion dot
456.

of percussion douche, 454.
Cirrhosis of liver. 1044.

of liver in diabetes, T026.
Classification of hydriatic cff

191.
of tcmperalurcSj too.

INDEX.

II53

Clavus, 1068.

Clergyman's sore throat, 866, 1073.
Climacteric, Scotch douche in, 465.
Cocaine habit, 1098.
Cocainism, 553, 809.
Coccygodynia, 513, 77ii 879.
Coccyx, neuralgic affections of, 105 1.
Coefficients, physical, 356.
Coffee habit, 618, 1099.

in typhoid, 5i87.
Cold air, influence upon heat produc-
tion, 82.
applications, excessive, 451.

general principles of. 193, 935.

graduated scheme for tonic,
1 103.

local, 127-8.

partial, in fever, 321.

prolonged, 127.

after sweating baths, 226, 236.

resemble cathodic influence,

m bums, 269.

changes produced by, 163.

effects of, anesthetic, 270.

analgesic, 265.
depressant, loi.

physiological, 98, 181.

primary, 193.

primary and secondary, 100.

reflex, 116.

restorative, 208.

revulsive, 248.

secondary, 193.

summary of, 181.

thermo-electrical, 129.

untoward, 217.
effect of, upon absorption, 121.

the blood, 120.

CO2 elimination, 125.

circulation, 107-10.

electrotonus, Hermann, 939.

excretion, 124.

heat elimination, 105.

heat production, 105.

metabolism, 122.

muscles, 11 1-2.

nervous system, 112-20.

perspiration, 105.

respiration, no, iii.

secretion, 122.

the skin. 104.

the small blood-vessels, 104.

temperature, 125.

temperature sense, 106.
thermo-electrical currents, 129.
indications for use of, 215, 325.
in inflammation, 277.

Cold jet contraindicated, 445.

in rheumatism, 221.

spots, 69.
Cold bath, 22.

alcohol with, 586.

in alcoholic intoxication, 533.

in anemia, 218.

in cerebral congestion, 220.

in constipation, 29.

contraindications for, 208, 221,

335, 391, 405, 531.
Dujardin-Beaumetz on cold bath,

303.

Edwards's observation on, 127.

effect of, upon blood cells, 582.

effect of friction in, 126.

effect upon temperature, 125-8.

in fever, 295-342.

general directions for, 344-6.

immersion, 527.

in hypochondria, 221.

in insomnia, 29.

in nutrition, 530.

in old age, 392.

in renal disease, 233.

in rickets, 28.

short, 208.

Strasser, 971.

sympathetic centers excited by,
530.

in typhus, 530, 532.
Cold-blooded animals, 78.
Cold compress, 282, 780-7.

as an antipyretic,^ 306.

congestion diminished by, 940.
Cold douche, 203, 610, 621, 942, 1103.

alterative effects of, 258.

ascending, 480.

calorific effects of, 258.

Descantes on, 426.

in genital weakness. 480.

effect of, on metabolism, 437.

effect of, upon muscular capacity.

438.
effect of. upon kidney by Bot-

tey, 512.
increase of muscular capacity by,

430.
physiological effects, 436-40.
plantar, 502.

therapeutic applications, 440-5.
training for, 441.
in uterine prolapse. 481.
Wertheimer, Storoscheff, and

Schuller on, 437.
Cold friction mitt, 308, 642, 1103.
Cold towel rub, 307, 446, 632, 647,

1 103.

4'

Colds, ja^asi .

breaking up, 6ai.

m hfttd, 839.

sweattfl^ bath to, a3&
Coil, cgolmg, 787-

therapeutic aj^cftlioiis d, jM.
Colic, 566, SIC, 80/. ,

biliary* zc

aiejbaiii,

gustrtc^ 546.

hepatic or Hilary, a66^ 897.

m influenza, 1OZ3.

mtesttnal, 546.

renal, a6& 54^^ IQ45.

renal^ IS litiiemiai loaa.

uterine^ 769.
Colitis, chronic, 847, lo^a.

p^ettdo-mendwranoos, 897» 80&
Collapse. X97, flQ9b <$tl« Jtl^ 4i% te,
622, 651, '^

in anesmei

cardiac^ 603.

in cardiac aisenfc;, liMu

in cholera, 624, ioi4»

cholera innafttm, 104a. .

m cholera motiHii, 104^;

in diphtheria, looi. . ^

in hemorrhage, 600*

hot affusion to head ifli» 494*

In plague, 1016.

in tonsillitis, lOOl.

m typhoid, 896.

in yellow fever, lOiI.
Collateral anemia, 759.

hyperemia, 241.
Coloclyster, 891. 897-9. 901.
Colon, atony of, 837, 899.

dilatation of, 661, 768, 832, 837,
899.

dilatation of, in constipation,
1036.

irrigation of, 891.
Coma, 647.

in diphtheria, 1002.

in gastric dilatation, 1034.

in hysteria, 1057.

in tonsillitis, 1002.

in typhoid, 983.

in yellow fever, 1012.
Complications, cardiac, in gout, 1024.

in febrile disorders, 1017.

in gastric dilatation, 1034.

in malaria, 003.

in typhoid, ^7.

in typhus, lOio.
Compress, 771.

abdominal cold, Le Drau on, 786.

abdominal heating, 749, 835-i5.

Con^^'css,

tioDtaiid.
abdominal^ aedattve

J64.
alternate, 8x6.
alternate, thempeutie tM

in appendicitis* 781.

'C6,/'773-

carbonic acid gas, 773.

cardiac : See Cardiac coni

cephalic: See Cephalic coi

chest I See Chest comprei
clay; Benjamin Rush on, 773

cold : See Cold compress.

cool 783, 784.

cooling: See Cooling confl

evaporating, 7S8, 7S9,

gastro-hepatic hot and ^

graduated, 317- j

half -chest, 861-2. '

head, 854. i

head, hot and cold« 843.

heating: See Heating coi

hot, 197, 74S.

hot and cold: See Hoi a
oonq>r^».

ice: See Ice compress.

intestinal, hot and co|d» ft|
y irrigataig, T^-iKH

joint, 853, 57^

lung, in anesthesia, 845.

lung, hot and cold, 844.

neck. 853. 866.

neutral, 748, 814.

pelvic, hot and cold, 847.

perineal, 881.

physiological effects of. 77

precordial : See Precor
Cardiac compress.

proximal, 275, 746, 790.

proximal, useful applicat:
791.

renal, hot and cold, 846.

revulsive, 818-20.

roller, 853.

special forms of, 853.

spinal, 264, 313, 777* 856.

therapeutic applications, 7

thoracic 862.

throat, 853, 865.

very cold. 772.

warm, 748.

warm, and sponging, a
modic effect of, 270.
Confusional insanity, 1065.
Congestion, 451.

of abdominal viscera, 832.

INDEX.

"55

Congestion, acute, of pelvic viscera,

852, 878.
acute pulmonary, 844.
active, 500.
in anesthesia, 844.
of brain, 764, 844, 940.
causes of, 272.

cerebral: See Cerebral conges-
tion,
cutaneous, 611.
deep passive, 245.
derivative measures for relief of,

276.
diminished by cold, 940.
enteric douche in, 510.
gastric, 820.
hepatic, 239, 245, 457, 4^2, 466,

on, 661, 831.
hypostatic, 521.
of intestines, chronic, 461.
of kidneys, 808, 832.
of liver, 445. 457, 461, 5", 599,

612, 798, 832, 940.
of lungs, 616, 749, 786, 940.
means of combating, 273-75.
ovarian, 462, 759, 852, 877, 881,

936, 940, 941-
passive, 500, 877.
passive of brain, 844.
passive, visceral, 245, 877.
pelvic, 245, 462, 600, 1090.
portal, 272.
pulmonary, 501, 646, 759, 805, 845,

862, 880, 1076.
renal, 462, 497, 512, 808, 832.
renal, in acute nephritis, 1045.
renal, anodic galvanism in, 941.
of spinal cord, 245, 661.
splenic, 245, 445, 461, 462, 466,

599, 611, 612, 661, 764, 798, 829.
of stomach, 282, 445, 461.
uterine, 852, 881, 9^5, 940, 944.
visceral, 245, 612, 820, 856, 877.
visceral, in acute bronchitis, 1075.
visceral, in cholera, 1014.
visceral, in plague, 1016.
visceral, in tjrphus, loio.
Congestive headache, 855.
Conjunctivitis, chronic granular, 809.
Constipation, 456, 472, 496, 500, 503,

510, 598, 599. 609, 612, 661, 677.

683, 764, 768, 807. 828, 831, 832,

836, 837, 896, 1035.
in anemia, 1083.
in anemia, 1083.
caliper douche in, 482.
cold anal douche in. 504.
cold ascending douche in, 481.
cold bath in, 29.

Constipation of colon, 500.

in chorea, 1057.

in diabetes, 1026.

and diarrhea in chronic intestinal
catarrh, 1041.

and dilatation of stomach, 1034.

enema in, 893, 1035.

in enteroptosis, 1038.

in exophthalmic goiter, 1085.

in gastritis, chronic, 1031.

in general paresis, 1066.

in gout, 1023.

in gout, chronic, 1024.

in hemorrhoids, 1094.

in incontinence, 1047.

in locomotor ataxia, 1055.

in mania, 1065.

in melancholia, 1064.

in migraine, 10O2.

in neurasthenia, 1060.

in pelvic peritonitis, 1090.

and perspiration, Rohrig, 598.

in pneumonia, 1004.

in rectum, irritable, 1094.
Consumption, 676.

night sweats in, 638.
Continuous bath, 280, 556.

bath, partial, 760-1.

bath, physiological effects of,
558.

bath, therapeutic application of,
558-62.

tepid bath, Riess on, 539.
Contractions in hysteria, 1058.
Contractures, in typhoid, 985.
Control of heat functions, 93.
Contraindications, abdominal douche,
370..

abdominal compress, 83O.

affusion, 522.

anal douche, 505.

Brand bath, 329, 593-94-

cold bath, 208, 221, 344, 369^3,
531.

cold bath in fever, 335-42.

cold compress, 780.

cold foot bath, 754.

cold immersion bath, 531.

cold jet. 445.

cold plunge, 525.

cold precordial compress, 871.

cold rubbing sitz, 768.

cold shower Dack, 617.

cold sitz, 766.

cold towel rub, 653.

cooling compress, 787.

douche, 432.

flowing foot bath, 756.

1 1 $6

INDEX.

G>ntraindications, half-pack, 622.

hot bath, in heat stroke, 197.

hot blanket pack, 625.

hot immersion bath, 548.

irrigation of bladder, 906.

massage douche, 491.

neutral bath, 555.

perci^^sion, 683.

fomentation, 810.

rubbing wet sheet, 663.

Russian bath, 700.

shallow bath, 599.

shallow foot bath, 756.

sitz bath, 764.

sponge bath, 640.

stomach tube, 889.

sweating pack, 619.

Turkish bath, 698.

vapor bath, 706.

wet girdle, 834, 836.

wet hand rubbing, 633.

wet-sheet pack, 613.
G>ntusions, iioo.
Convalescence, 609, 646, 676.
Convulsions in acute febrile disor-
ders. 1018.

of children, 624.

in hysteria, 1057.

infantile, 547, 1063.

in malaria, 992.

in mumps, looi.

neutral douche in, 452.

in scarlet fever, 994.

in yellow fever, 1012.
Cool compress, 783, 784.
Cooling coil, therapeutic application,

788.

Cooling compress, 780-7.

Baginsky and Winternitz on, 781.

chest, 863.

contraindications, 787.

Hippocrates on. 780.

physiological effects of, 781.
Cooling pack, 615-16.

antithermic effect of, 615.

therapeutic application, 616.

Winternitz on, 603.
Cooling sound, 913.

stage of wet-sheet pack, 606.

wet-sheet pack, 304.
Cornea, inflammation and ulceration

of, 802.
Corpuscles, effect of cold bath on.

582.
Coryza, acute, 828, 829, 839, 866, 1071.
Cotton poultice, 278, 8j3, 872.
Couette on the douche, 430.
Cough in bronchitis, acute, 1075.

Cough in bronchitis, chronic, i<

hacking, 884.

in hysteria, 1057.

in laryngitis, 1073.

in measles, 997.

in pneumonia, 1004.

in pulmonary tuberculosis
1019, 1020.

tickling, 884.

in t3rphoid, 981.
Counterbalancing reaction, 138.
Counter-irritation of filiform d<

485.
Cramp, writer's, 1063.
Cramps in cholera, 1015.

in legs in plague, 1016.

muscular, in arthritis defer
1086.

neutral douche in, 452.
Crawford on effect of cold bath.
Crises, 385.
Croup, 866, 916, 1074.

in diphtheria, 1003.

false, 1074.
Crural neuralgia, 465, 599.
Cullen's use of water, 27.
Currie, on physiological effec
cold, loi.

on effects of temperature, I4

on immersion bath, 526.

method of, in cold full bath

on neutral bath, 552.

principles of, 30.

on sponge bath, 637.

statistics by, 530.

use of warm affusion by, 29,

use of cold affusion, 519, 522

on water drinking, 921.
Curiosities of common water, i;
Curtis on urethritis. 907, 908.
Cutaneous affections, 446.

areas useful for derivativi
fects, 733.

circulation, 747.

congestion, 611.

disease, 385.

eruption, 419, 446. 622, 680,

hyperesthesia, 479. 560, 680, ;

irritation, effects of, 102.

reflex areas, 117. 118.

respiration, 67.

stimulation by electro-che
bath. 949.

thermic applications, reflex (
of, 96.
Cyanosis. 559, 632, 647. 844

areolar, 337. 870.

in broncho-pneumonia. 1077.

INDEX.

II57

Cyanosis in cholera, 1014.

in ftinctional cardiac disease,
1081.

in pneumonia, 1005.
Cystitis, 445, 546, 600, 847, 1046.

in diabetes, 1026.
Daggett, bladder irrigation, 904.
Dana, friction areas, 677.

areas of transferred pain, 944.
Dauchez, tepid bath in hysteria, 561.
De Fontaine on electric light, 173.
De Hahns, Germany, on enema, 894.
De Laure on filiform douche, 485.
Delirium, 519, 560, 776.

in dilatation of stomach, 1034.

in erysipelas, 997.

in febrile disorders, acute, 1018.

of infectious fevers, 855.

in scarlet fever, 995.

in meningitis, 1000.

in pneumonia, 1005.

in smallpox, 998.

tremens, 547, 809, 1098.

of typhoid, 610, 982.

in typhus, loio.

in yellow fever, loii.
Delmas on exercise, 351.
Dengue, 616, 624, 647, J015.
Depressant, cold a, loi.

effects of heat, to avoid, 197.

effects of Scotch douche, 464.
Derivative effects, 241, 254.

effects, cutaneous areas which
may be utilized for, 733"5i.

effects of Scotch douche, 457.

measures for relief of congestion,
276, 747.

procedures, 255, 747.
Dermalgia, 453, 680, 809.
Dermatitis, 785.
Dermographism, 167.
Descantes on the douche, 428.
Desquamation in scarlet fever, 995.
Diabetes, 377, 472, 512, 598, 661, 686,
700, 718, 723, 810, 926, 1025.

in emaciation, 1028.

insipidus, 496.

massage in, 952.

in obesity, 1027.

typhoid in, 647, 988.
Diarrhea, 1041.

in cholera, 1014.

in cholera morbus, 1043.

chronic, 501, 554, 560, 765.

in drug habits, 1099.

in exophthalmic goiter, 1085.

in hemorrhoids, 1094.

infantile, enema in. 897.

Diarrhea in influenza, 1013.

in meningitis, 999.

in mumps, looi.

in pneumonia, 1004.

in pulmonary tuberculosis, 1020.

in rheumatism, acute, 1006.

in scarlet fever, 994.

in smallpox, 998.

summer, 1040.

in tea and coffee habit, iioa
Diathesis, uric acid: See Uric acid

diathesis.
Dicrotic pulse, 647.
Diet in diabetes, 1025.

of dextrinized cereals, 1106.

dry, 1 106.

fruit, 1 105.

liquid, 1 106.

of malted or predigested foods,
1106.

in nephritis, acute, 1045.
Dietary, aseptic, 1103.
Dietl on nature cure, 925.
Dieulafoy, ice-bags in typhoid, yyy.
Digestion, effect on temperatre, 81.

improvement in, 530.

pamful, in hyperpepsia, 1033.
Digestive viscera, disorders of, 660.
Digitalis, 869, 870.

effect on heart, 205.
Dilatation, cardiac, 601.

of colon, 661, 768, 832, 837, 899.

gastric, in typhoid fever, 892.

of stomach, 472, 498, 661, ^(S>, 832,
887, 1033.

of stomach, cold gastric douche
in, 510.
Diphtheria, 547, 802, 866, 916, lOOi.
Diphtheritic paralysis, 485.
Dislocations, 800, iioo.
Disorders, incurable, 381.
Displacement of uterus, 503.
Distension of stomach, 750.
Distilled water, 930.
Diuretic effects of cold douche, 238.
effects of cold trunk pack, 238.
Dorsal douche, cold, 495.

hot, 496.

tepid, 495.

physiological effects. 495.

therapeutic applications, 495.
Douche, abdominal, 500-1, 76(S.

alternate, 470.

alternate, in hypertrophy of pros-
tate, 481.

alternate, physiological effects,
470.

alternate, spinal, 264.

«15«

tlOtlSy 47iy

alternate, in vesical
' SeeAnal

4^

' j^panittity ^17.
artioilar: See Artieidar
ascending; 480-x.
tiladder, tiierapentic iqn^icalioii^,

cardial 909.
caations, res^,
cephalic: Seie
oerdbra^ ^cuSr^,
ceft^xrospoialy 5^*

cold, 43^

c(^ graduated, 441.

Couette on, J30.

contraindications, 43% 445.

dorsd,4W.

enteric, 510.

See Bpigastrii}

effect npoo temperatinre, 430t>

hn: See Fan doodle.

Wform: See Filiform

^486.

log. uierapeiitic q^^ieations, 4K»

to feet, 460, sent.

gastric: See Gastric douche.

genito-urinary, 513.

graduated, 441.

Heggelin on, 446.

hepatic, 239, 510.

horizontal, 632.

hot : See Hot douche.

hypogastric : See Hypogastric

douche,
improvised, 440.
Lemarchand on, 433.
localized, 491.

lumbar : See Lumbar douche,
massage : See Massage douche,
muscle, 514.
nasal, i^.

neutral : See Neutral douche,
in opium addiction, 444.
pail, 515, 610.
percussion: See Percussion

douche,
perineal: See Perineal douche,
physiological effects of, 429.
plantar, 502.
pulmonary, 508-9.
rain : See Rain douche,
renal, 238, 512.
revulsive: See Revulsive douche.

DoodK^ SooCcit: See Scoidi 4a
aedatiit^ aSi-
slioalder, 497. _^

j^lfKy^ip^^l^^^y^H oCOSCox 4D0L

s^inadl, 4^*

\^ '*^

See xi^Mi wMidieu
. Botic ajpdfipationa td,^
tiioraoe: See Tlioiack doaei
i^sed bv GredcB, xl
vaginal, 9osr*i2»
"ffpoei See Vi^or.4oiieli&

irisoera], fonmo^So^

visceral, piifsioiogical dKhdt
SOS.

trarm, abdominal, son.

warm, in anal fisMire, 4St.

warm, in initdile ftectaoL 4S
Draper on temperatare in ban^ x
Dreann in nenraallienia, uA.
Drmldng after lapaiotomyf Talt, <
Drmldng water: See Wnter-di

' ing.
J>npgm^ sheet, &^ 653,^6, iiog

j^Qf&ki^c^l eifocls^ $A

tfjerapentic applicalieaa, Imu
Dropsy, 4^, 4^1, S4^ sfi^ &t,
1083.
abdominal. 611, 837.

in anemia, 231, 1083.

cardiac, 228, 637, 646, 662, 69

in cirrhosis of liver, 1044.

of chest, 683, 818.

general, 1084.

hot bath in, 228.

in nephritis, 230.

in org^anic cardiac disease, 10;

renal, 637.

water drinking in, 923.
Drowning, 522, 822.
Drug habits, 647, 1098.

habits in emaciation, 1029.

h3rpnotic 8^3.

poisoning, 818.
Drugs, asphyxia from, 77Q.
Dry abdominal bandage, 838.
Dry friction : Sec Friction, dry.
Dry heat. 260.
Dry pack, 619.

contraindication, 621.

method, 619.

physiological effects, 620.

requisites. 619.

therapeutic applications, 620.
Dry protection, 613.

INDEX.

II59

Duodenal catarrh, 499.
Duodenitis, chronic, 847.
Duval on torticollis, 867.
Dysentery, 647, 899, 1042.

chronic, 501, 809, 1042.

visceral inflammation in, 1042.
Dysmenorrhea, 545, 759. 808, 879, 1087.
Dyspepsia, 476, 618, 661, 676, 832, 899.

atonic, in pulmonary tuberculosis,
1020.

bilious, 457.

cold douche in, 443.

chronic. 472, 554. 686, 691, 718,
723. 831, 852.

chronic toxemia of, 700.

nervous, 609, 886, 1039.

painful, 499.
Dyspeptic headache, 1067.

liver, 471, 660.
Dyspnea, 614.

in organic cardiac disease, 1079.

paroxysms of, 856.

under hydriatic treatment, 416.
Ear, 736.

headache due to disease of, 1068.

inflammation of, in influenza,
1013.

inflammation of middle, in meas-
les, 996.

irrigation of, 881.
Earache, 801, ^2.

in mumps, looi.
Eclampsia, 624.
Eczema. 376, 472.

in diabetes, 1026.
Edema in acute febrile disorders,
1018.

angioneurotic, 809.

of ioints, 471.

of legs and joints, 471, 1026.

maleolar, ic^.

in scurvy, 1029.
Edwards on temperature, 116.

observations on cold bath. 127.
Effervescent bath, 562, 957.

physiological effects, 564.

precautions, 566.

therapeutic applications, 565.
Effusions, 471, 705, 828.

articular, in acute rheumatism,
1008.
Ejaculatory ducts, atony of, 503.

hyperesthesia of, 504, 771.

in spermatorrhea, 1093.
Elbow bath, 759.

of Priessnitz, 760.
Electric arc-light, 721.

bath, 180, 708. 711.

Electric-light bath, 176, 180, 196, 599,
612, 675, 705, 707.

M. Below on, 720.

cabinet, 708, 711.

incandescent, 708.

Conrad Klar on, 715.

local, 259.

method, 708.

physiological effects, 712.

prophylactic effects, 719.

revulsive effects, 709.

as sweating procedure, 236.

therapeutic applications of, 717.

Winternitz on, 710, 714, 715.
Electric-thermal bath, 945.
Electricity, analgesic effects of water
combined with, 944.

as a complement to hydrotherapy,
934.

in paretic muscles, 942.

static, 949.

stimulation of metabolism by,

943.
Electro-chemical bath. 948.
Electro-hydric bath, 945.

cautions respecting, 946-7.

in insomnia, 946.

sedative effects of, 946.
Electrolysis, hemorrhage following,
941.

to uterus, 944.
Electrotonus, cold in, Hermann, 939.
Electro-vapor bath, 947.
Elimination, C0». effect of cold upon,
125.

heat : See Heat elimination.

skin, 578.

skin in typhoid, Leyden, 578.

by sweating bath, 235.

of tissue toxins, 607.
Eliminative baths in toxemia, 236.
Emaciation, 647, 676, 1028.

in diabetes, 1025.

in exophthalmic goiter, 1085.

in gastritis, chronic, 103 1.

in pulmonary tuberculosis, 1020.
Emetic, water, 890.
Emissions, diurnal, 513.
Emmenagogic effects, 206. 240-1.
Emmett, vaginal douche, 909, 911.
Emollient baths, 954.
Emphysema in chronic bronchitis,

1076.
Endocarditis, 869, 1078.

in chorea, 1057.

in erysipelas. 907.

in febrile disorders, 1017.

in rheumatism, acute. 1007.

ii6o

mimx.

1!

m i

Endoc^ditts in scarlet fever, 995.

in smallpox^ 998,

in typhoid, 984.
Eodomeiritis, 500.
Eocma, E/^i-gQ2.

in abdominal surgery, Sgj.

antipyretic effects of, 318. jao,

cold, 766, 894-^.

cold, effects upon the heart, jcw:

cold in fever, Jacques on, jao»

in constipation, 893.

De Hahns, Germany, on, 894.

gradtaated, 891, 901-3,

hot, 896^,

in constipation, 893*

in infantile diarrEiea, 8^7,

in jaundice, 896, goo.

Kemp. Krull, and Staddmann otu

in ovanotomy, 894.

in pelvic pain, ^65^

in temperature reduction, 894.

in typhoid, 896,

warm^ Schiiller, 899-
Energy, nervous, ail.
Entcralgia, 465, 501, 510, 766, Sjo,
829, 832, 879,

in neuralfifia, 1051.
Enteric doucnc, 510.
Enteritis, 600, 66f.

in scarlet fever. 995*
Entemclyster; 8gi, ^7^
En tero -colitis in febrile disorders. [ 01 7.
Enteroptosis, 456, 48^1, 496, 500. 503,
771, 8^3* 877. 1037.

in anemia, 1083.

in chlorosis. 1082.

in constipation, 1036,

and dilatation of stomach. [034.

headache due to. 1067. 1

Enuresis, nocturnal, 913. j

nocturnal, of children* 768.
Epigastric douche, 239, 498.

Scotch, 499,

therapeutic apphcitions, 498.

very hot, 498, 1

Epigastrium, fomentation to, 239, 803.

ice-bag to, 240.
Epilepsy, 561, 6to, 618. 1056.

m chronic gout. 1024.
Epflepttc state. 857,
Epistaxts, 503, 760,
Erethism, sexual, 853, 853-
Ergograph, 150, 514, 615.
Erotomania, 453, 771,
Eructations, gaseous, in chronic gas-
tritis, 1031.

in nervous dyspepsia, 1 039,

I

EHiptions, 10^,

cutaneous, 419^ 444 622, GSo.

delayed in measles. 996.

delayed in scarlet fever, 994.

delayed in smallpox, 998.
Eruprtive fevers, 611, 68ol
Erysipelas. 278, 616. 765, 803, 997.

typhoid with, 988.
Erythema, 680, 789, 1096.

nodosum, 471,
Erythro^meialgTa, r«l oeuralgia, lOSl.
Esophageal veins, 741.
Ether spray, 270.
Evaporating compress, 76&*9.

sheet, 625-7-
sheet, cold* 306.

sheet, hot, 309,

sheet, pbysiologieal eflfeCtJ al,
626.

sheet, iberapeutic applic3tionSk6a6
Evaporation, 626.

heat elimination by, ago; 315, 317.
Exei lability of spinal centers. 453.
Excitant effects of aUemaie douche.
470.

of fomentation, fgS.

of hot douche, 447.

local, 222.

primary, i^$-307.

of rain douche, 474.

of Scotch dourhc, 463,

secondary 207.
Excretion, 124. 6ti,
Exercise and bathing, 349-50^

Delmas on, 351*

effect on temperature, 81.

with hydrotherapy, 348.
Exhaustion, 900. ^

alcoholic, 508,

hot douche in. 430.

in mania, 1065,

in neurasthenia, 1059,
Exophthalmic goiter, 501, 662, 1084.
Expectorant effects. 237^-8,
Experiment on dogs, 783.

of Finkler, 312.

of Franck, 116.

upon rabbits, Schullcr, 604*

on rate of heating, S26.

Schuller's, 95, 103, 114, 610.

of Schult/c, on tem{keratiu-c 7^

Strasser's, 123,

of Vinaj, 95.

Wertbeimer*s, loa.
Experiments, summary of, 1107,
Extractives, Robin on, 576.
Extremities, <^ld, in mclandiolisu 1064^

INDEX.

II61

Extremities, cold, in nervous dys-
pepsia, 1039.

cold, in neurasthenfa, 1062.
Exudates, 471, 490, O40, 705, 748, 828,
872, 911.

chronic, articular douche in, 514.

meningitis with, 597, 705.

in pleurisy, 1077.

in pneumonia, 1004.

rheun^tic, 484.
Eye, inflammations of, 1096.

inflammation of, in influenza, 1013.

irrigation of, 883.

treatments of, 268, 677, 785, 820.
Eyeball, 736.

diseases of, 269, 780, 8o'i, 802.

inflammation of, 1096.
Face, ache of, 808.
Fallopian tubes, diseases of, 771, 847,

878.
Fan douche, 483-5.

alternating, 484.

in asthma, 484.

cold, 484.

to head in typhoid, 493.

hot, 484.

neutral, 270, 484.

physiological effects of, 483.

revulsive, 484.

Scotch, 497.

tepid thoracic, 499.

therapeutic applications, 483.
Farquharson on mcontinence, 801.
Fasting, effect of, on heat production.

Fat glands, 66.

Fauces, inflammation of, 802.

Febrile conditions, 637, 646.

disorders, complications in, 1017.

disorders, visceral inflammation
in, 1019.
Febricula, 616, 810.
Fecal vomiting, 889.
Feebleness, general, 508.
Feet, cold, 472, 503, 686, 756, 779» 801,
880.

douche to, 462, 501.

sweating, 1097.
Felons, 759.

Fenwick, on cold in pneumonia, 286.
Fever, 90, 335-42, 549» 573-94. 599.

602, 646, 676, ^^b, 788, 926.

in anemia, 1083.
in arthritis deformans, 1086.
bathing in, 335, 338, 530, 547-
Brand bath in, 573-94.
of " Bender." water drinking in.
Sir John Chardin, 921.

Fever calorimeters, 88.

cases neglected, 340.

cephalic compress in, 855.

from catheter, 903.

cold enema in, Jacques on, 320.

cold mitten friction in, 646.

cold towel rub in, 652.

continued, 554.

convalescence, 6op, 676.

cooling pack in, 0)3, 615-16.

in dengue, 1015.

in diphtheria, 1002.

in dropsy, 1084.

dry pack in, 620, 621.

eruptive, 611.

in erysipelas, 997.

evaporating sheet in, 626.

in gall-stone, 1044.

in gastric catarrh, acute, 1030.

^stric juice diminished in. 284.

m gout, 1023.

headache. 1069.

heat elimination in, 289, 583.

heat production in, 289, 583.

hot blanket pack in, 62^.

hydriatic treatment of, Wintcr-
nitz, 592.

infectious, 597, 609, 855.

in influenza, 1013.

in insanity, 1065.

intermittent, 599, 609, 620.

in jaundice, 1043.

low, 868.

in malaria, qpi.

in mania, 1605.

partial cold applications in. 321.

in peritonitis, 1048.

in pneumonia, 1005.

prolonged, 521.

m pulmonary tuberculosis. 1020.

of reaction, 385.

relapsing, 609.

in rheumatism, acute, 1006.

in scarlet fever, 994.

septic, in pelvic peritonitis, 1090.

shallow bath in, 598.

in smallpox, 998.

spinal complications in. 856.

sponge bath, 637-9.

in tonsillitis, 1002.

in typhoid, 982.

in typhus, loio.

value of affusion in, 520.

water drinking in ^20, 020. 921.

wet-sheet pack in, 003, 610.

wet-sheet rub, 659.
Fibroids, 941.

bleeding, 600.

Il62

■a1

i
i

Fidgets m insoMKL io^ql

F3iKifTn doocfac .^8$.
Finkkr 00 22reniaxe bodi. iLZ.
FiafaDd. Rs&Has todi io. 699.

iwcaxzig fttdi io. 719.
Fmscn oa 'ght 721.

cw sniaQpCrX. 171.

oa tcbercalosi*. 7ZI-
Fbtnloice. 4^1. 4^ fia S^2L 8561 Syk
85a 1033.

in hjpcrpcpsa. 1033.
Flenmic on Tmidsh badi and vater

drinkmf^ y?
Flesh, reduction of. 596-
Flcnry. 95, 126.

redex relatioaships. 9157.
FlmL Atistnu 306. 924.
Fhudon, 242, 7291

effects of cold massage doache,
490-
Fog doocfae, 486.
Fomentations. 612, 791.

to abdomen. 311.

analgesic effects. 797-9.

cakmfic effects of. 259.

combined with elecbic corrent.

941.
contraindications. 8ia
derivative effects. 798.
to cpigastriom. 239.

excitant eftects. 7^.

over liver. 239.

method. 702.

mustard. 814.

physiological ettectf. jr/f_

requi-ite-. 792.

to ?pine. 311. 802.

therapeutic applications. t«>S.
Fonssagrive-. 279.
Food, heat vahie of. 77.

regurgitations of. 850.
Foot, neuralgia of. /^.
Foot bath, alternate, j^.

cold. j^:^.

cold, contraindications for. 754.

cold, physiological effects. 754.

cold, therapeutic applications. 754.

flowing, contraindications. 756.

flowing, therapeutic applications,

hot. 756.

hot. emmenagogic effects of. 240.
hot. physiological effects. 757.
hot. therapeutic applications. 757.
running, or flowing. J^S-
shallow. 755.
Foot douche. 462. 501.

Foot pack. 853. 88ql

tiioa|>eLJic ap|>3icanoos. 880.
Forges 00 drag aspfarxia. T79-
FractBrcs. 80a iioo.
Franck. experiments of. i id
Fncxiao areas, Dana. 677-

faoth. Gotd. 3DI.

old- 197. 203. 259^ 446. 632. 655.
637. 642-7. 827. 837. ^12.

wixh cold baths. 9^

Ocd. cootraindiotiQos. 647.

cold, method. 613.

cold, pfarsioiogical effects. 644.

cold, requisites. 643.

cold, iherapentic applications. 645.

cold wet. ycB.

dry. 202. 663-81.

dry. contraindications. 677.

dry. method. 644.

dry. physiological effects. 672.

dry. theraoentic applications. 674.

effects of. in cold bath. 126.

with hydriatic nseasnres. 95a

plnrsiological effects. 164^7.

and reaction. 603.
Fniit diet. 1105.
Frye. Hermann, effects of alcohol on

heart. 587.
Full bath. cold. 527^-35.

cold, in alcoholic intoxication. Dr.
Robertson. 534.

cold, in fevers. 530.

cold, af a hygienic measure. 53:.

cold. meth.iKi of. ^12.

cold, method of Currie in. 527

cold, physiological effects nf. 52^

cold, therapeutic applicaf-ons of.

529.
Gxrtner, tonometer of. 931.
Galen on alternate baths. 312.

warm bath in fever. 547.
Gall-stones. 239. 511. 546. ."^X). 90?.
928. lOJa.
in lithemia. 1022.
Galvanic current, hydriatic applica-
tions combined with, 936. 93S.
940-4.
Ganglia, central, procedures which
excite. 972.
lumbar, irritability of. in insom-
nia. 1070.
sympathetic. 75. 245. 266. 801.
Gangrene in diabetes. 1026.

in febrile disorders, acute. lOio
senile. 761.

of skin. Hebra on. 558.
Gargling. 883.
Gastralgia. 266. 496. 408. 510. 932.

INDEX.

1 163

jastralgia in neuralgia, 105 1.

in rheumatism, acute, 1008.
jastric catarrh, 499, 661, 831, 836,
885, 888, 1030.

catarrh, chronic, 462.

catarrh in jaundice, 1044.

catarrh in organic cardiac dis-
ease, 1080.

colic, 546.

congestion, 282, 445, 461, 820.

crises, 266, 498, 820, 857.

crises in myelitis, acute, 1052.

dilatation, 472, 498, 661, 768, 832,
887.

dilatation in anemia, 1083.

dilatation, complications in, 1034.

dilatation in typhoid, 892.

disorders, 375, 831.

disorders in migraine, 1063.

douche. 509.

douche, cold, 510.

douche, hot, 282, 509.

douche, Scotch, 510.

flatulence, 482, 510, 832.

glands in hypopepsia, 1032.

hemorrhage in plague, 1016.

irrigation, Turck, 889.

irritability, in exophthalmic goi-
ter, 1085.

irritation in typhoid, 983.

irritation in yellow fever, ion.

juice, production stimulated, 239.

lavage, 884-90.

lavage, contraindications, 889.

lavage, method. 884.

lavage, therapeutic applications,
887.

neurasthenia, 503, 598.

pain, 677, 803.

rheumatism, 498.

symptoms in chronic intestinal
catarrh, 1041.

ulcer, 446, 465, 510, 810, 829, 888,
1038.

ulcer in anemia, 1083.

ulcer in emaciation, 1028.

See Stomach,
astritis, 498, 820, 886.

in alcoholism, logS.

chronic, 445, 482, 798, 510, 609,
660, 661, 810, 833. 837, 889, 1030.

chronic, in emaciation, 1028.

in febrile disorders, acute, 1017.
astro-duodenitis. 499, 510.

in pneumonia, 1004.
astro-hepatic compress, hot and

cold, 846.
astro-intestinal catarrh, 837, 1040.

Gastro-intestinal catarrh in anemia,
1083.

disturbance in gout. 1024.
Gastroptosis, 498.
Gastrorrnea, 498, 510, 885, 931.
Gautrelet on thermo-electric currents,

129.
General paresis, 1066.
Genital weakness, cold douche in, 480.
Genitals, atonv ot, 244.

hyperesthesia of, neutral ascend-
ing douche in, 481.
Genito-urinary atony, 683.

douche, 513.

organs, affections of, 453, 495,
770, 771, 857.
Gestation, 809. 834.
Giddiness, 801.
Girdle sensation in acute myelitis.

1052.
Girdle, wet : See Wet girdle.
Glands, sebaceous, 66.
Glatz on Scotch douche, 466.
Gleet, chronic, 764, 881.
Glenard on graduated bath, 303.
Gout, 457, 618. 661, 705, yi^f 1023.

acute form, 1023.

chronic form, 1024.
Graduated bath, 303, 535-8.
method, 535.

physiological effects. 537.
therapeutic applications, 537.

compress, 317.

enema, 891, 901.
• rain douche, 476.

Scotch douche, 459.
Graduated scheme for tonic cold ap-
plications, 1 103.
Graduation of douche, method of, 377.
Gravel in chronic gout, 1024.
Greeks, cold bathing among, 22.
Gummata in syphilis, 1096.
Hahn, water drinking in fever, 920.
Half-bath, 595.

hot, 599.
Half -pack, 622.

contraindications, 622.
Halm on antipyretic effects of enema,

330.
Hamilton, continuous bath, 761.
Hancocke, John, water drinking. ^18
Hand bath, 760.

cold, 198.
Hands, cold. 801.

inflammation of, 759.
Hare, heart action, 579.
Head, affusion to, in typhoid. 493.

alternate applications to. 823.

n

•ymgsutg, ^5

">r

• '^.- -.err xT ijj^

-y^ >' V/: ¥.'. ¥^

aHZ til "T.

icmi-rcuzic t:r-?tr

."•*-'< 1 ^. -^ '. - '/->.. : -> :

//'-.i^ ir> ;,Ti*-f:rry/nlk. 1004.

H*-itri),'irri in n^rvotn dy^p«p§ia, 1039.
M#-;it ;,ri)f;i;il 77,

.ifif»|;)iloj^r.fi/' ^rffCT% of, 279.

fo ii'.fml f]ri,rfh'i.unt t^ffccts f/i, 197.

ca-5«< »h:ch iricreai^. Si.

errect of or'd upon. 105.
effect oi fasting and sle^>

upon. 82-
tffect of heat upon. 158.
cftect of hot and cold air

upon. Sz, 90.

INDEX.

I 165

Heat, Helmholtz, 81, 83.

indications of increased, 291,

583.
rate of, 80, 326.
relation of, to antipyretic
methods, 289.
prolonged application of, 192.
radiation, Schumann, 685.
reaction after, 159.
regulation, 83.
restorative effects of, 15 1-2.
revulsion by, 247.
secondary effect, 192.
sedative effects, 261.
short application of, 192.
stimulant effects of, 142.
stroke, 809, 1069.
stroke contraindication for hot

bath, 197.
summary of effects of, 185.
tmits, 46.

imits, daily production of, 78.
use of, in vaginal irrigation, 912.
value of food, ^^,
Heating compress, 239, 772.
abdominal, 749, 8^5-^.
• abdominal, method, 8^.

abdominal, physiological effects,

836.
abdominal, therapeutic applica-
tions, 836.
calorific effects of, 258.
chest, 863.

in erysipelas and pneumonia, 278.
frequently renewed, 747.
hot and cold, 847.
method, 824.
or pack, 824.

physiological effects, 825.
precautions, 829.
prolonged, 749.
protected, 825.
therapeutic applications, 826.
Heating effects of wet-sheet pack, 604.
pack, 610, 824. 837.
pack, hot and cold, 847.
procedures, 225.
rate of, experiments, 826.
stage of pelvic pack, 875.
Hebra on continuous bath, 558.
on bums, 558, 561.
on pemphigus, 558, 561.
Heggelim on the douche, 446.
Heimholtz on rate of nerve impulse,
114.
on heat production, 81, 83.
Hematocele, pelvic, in typhoid, 986.
Hematuria, 503, 992.

Hematuria, malarial, 624.
Hemicrania, 458, 705, 804, 1067.
Hemiplegia, 457, 560, 621, 880.
Hemorrhage, i^. 271, 600, 1102.
cold sitz in, 766.
collapse after, 620.
following electrolysis, 941 .
gastric, in plague, loio.
in gastric ulcer, 1039.
intestinal, 766, ^^t, 896.
intestinal, in plague, 1016.
intestinal, in typhoid, 983.
nasal, 883.
pulmonary, 198, 509, 760, 805.

844. 856, 863.
in pulmonary congestion, 1076.
pulmonary, in tuberculosis, 1020.
renal, ^^^, 857.
renal, in plague, 1016.
steam in, 919.
of stomach, 198, 892.
of urethra, 766.
uterine, 754. 766, yy^, 857, 878.
vesical, 198, 766, 776, 906.
Hemorrhagic form of measles, 996.
Hemorrhoidal plexus, 741, 742.
Hemorrhoids, 245, 267, 766, 769, 803.
1094.
anal douche in, 504.
cold ascending douche in, 481.
in constipation, 611, 1036.
in gout, 1023.
inflamed, 268, 778, 1095.
inflamed, internal, 505, 915.
painful, 267.
prolapsed, 505, 778.
strangulated, 771.
Hemostatic effects, 197, 271, 941.
effects of heat and cold, 271.
effects of sponging, 638.
effects of water, 271.
Henocque. on effect of heat on the

blood, 156.
Hepatic colic, 897.

congestion, 239, 245» 445, 457, 461,
462. 466, 511, 599, 611, 612, 661.
798. 831. 8j2, 940.
congestion m cardiac disease,

1080.
congestion in gastritis, 1031.
congestion in gout, 1024.
douche, 239, 510.
enlargement in malaria, 992.
headache, 1068.
inactivity, 244.
pain, 461. 5", 677. 800.
sclerosis, 272, 446.
See Liver.

Ii66

Herpes zmter* 815, 1051.

Hex 00 hcM damm^iMm, J*5» SSfi-

Hibcfintioo^ f^

HkoPdC^ in hfsUfi^ 10^

in ift7eUti»« aetiu, 105a.

ta dtkiMioa of isinHB*%. iDiS-

on ntn batlu 721*
on water drbikai^ 9n
€0 the u&e of watcfp ML
Homocria] do-ticbe. 632.
jeC 4J'. 432^-16, 49S-
tet, coQiramdsoiioD;- 44>

let. llietmpentk nppiicatxy^. 4^
Hor»le^. mk)plM»I on d>c bean, sSt-
Hot-air faitli, 6B7,

«xnociK Japoese, 693-

€OfitTmind»cat>ovi% 692.

loot Iberapcntic ^pXkxikm^

iQgiiiogu CB^.

fStfmolofki! tSt€%^ 690.

Khenpeotic apfilicaticifH, 6gfL

rffect of, tiposi beat ipm&etioci.
B^ 90.
Hot applkations, 748, 74^.

for bruiteSt 36&

general pnnctples, 192.

re0ex effects, is#-

for relief of paiitr 365-7,

for spfmiss, a6&

wised Tequiml. 335.
Hot teih, 2J0. 5j9l

in Bright*s disease, aag.

cautions re5j>ectmg, ^1,

in dropsy, 2A

in Japan, 541 « 54J.

in rheumati£in« Las^que. 54I&

short* 3og.

in ^'a.jfinil discharge, 547^
Hot blanket pack : See Blanket piick,

hot.
Hot and cold appUcatioft^. altcrEiate,
161. 747^

appljcationi to mncous pasfages,

bath, 512.

compress. 750. 8^, S53L
gastro-hepatic* &#6t.
to head^ 843,

• 75^^^

''V^corstTw^ esec^Sk 4r^

of, 1901
effects.

effects, 5enes^
efiectK reflei- gfci6.
heswt

39(3.

pre^crrptk'vxs, adapeajiop oL 9^
procediiTeT. mdkatiafk^ iior, ja^

I'.

INDEX.

I 167

Hydriatic training, 378.

treatment, dyspnea under, 416.

treatment of levers, Wintemitz,
592.

treatment, mortality of pneu-
monia under, 286.

treatment, mortality rate of ty-
phoid fever under, 285, 288.
Mydriatics, general principles of,

181.
Hydrochloric acid production, 931.

production, effect of heat, 158.

production, effect of cold, 388.
Hydronephrosis, 512.
Hydropathic headache, 382, 417, 501.
Hydrophore, 904.
Hydrotherapy in America, 32.

anatomy in relation to, 53.

electricity with, in chronic dis-
ease, 934.

exercise with, 348.

field of, Z7Z-

general rules, 343.

history of, 21.

massages with, 681, 949.

physiology in relation to, 53.

as a prophylactic measure, 388.

in surgical cases, iioo.

technique of, 423.

untoward effects of, 382.
Hygienic measure, cold full bath as,

531.

value of baths. 388.
Hyman, on absorption of water by

nerves, 551.
Hyneremia, arterial, 732.

cerebral. 501, 502, 612, 844, 855.

cerebral, in general paresis, 1066.

cerebral, in mania, 1065.

collateral, 241. 731.

of cord, 469, 840.

of skin, 759.
Hyperemic headache, 1067.

venous. 732.
Hyperchlorhydria, 751.
Hyperesthesia. 450. 462, 707. 749.

of abdominal sympathetic: See
Lumbar ganglia.

of bladder, neutral douche in,
481.

cutaneous, 560, 680, 707, 814.

cutaneous, of abdomen, 614.

cutaneous, hot spray in, 479.

of ejaculatory ducts, 504, 771.

general, 515.

of genitals, douche in, 481.

of genito-urinary organs, 770,
771.

H3rperesthesia in hysteria, 1058.

of lumbar ganglia, 462, 495, 503.

771, 832, 836, 851.
of lumbar ganglia in migraine,

1063.
in meningitis, 1000.
hysterical, cold douche in, 445.
local, 515.

of skin, 446, 453, 486.
of solar plexus, 499, 510, 801,

851.
of spine, 840.

of sympathetic ganglia, 245, 456.
of sympathetic ganglia of pelvis,

500.
of sympathetic ganglia, caliper

douche in, 482.
of umbilical ganglia, 801.
of uterus, 852.
of vesiculae seminales, 504.
Hyperidrosis, 1097.
Hyperorexia, 829.

Hyperpepsia, 282, 445, 466, 510, 751.
756, 7S9» 800, 829, 832, 833, 851,
885, 931, 1032.
in anemia, 1083.
in emaciation, 1028.
hot caliper douche in, 482.
fomentation to epigastrium in,
240.
Hyperpyrexia in acute rheumatism,

1007.
Hypersecretion in hyperpepsia, 1032.
Hypertrophy, follicular, of tonsil, 917.
of heart in organic cardiac dis-
ease, 1080.
of liver in organic cardiac dis-
ease, 1080.
malarial, of spleen, 511.
of prostate, 503.

of prostate, alternate douche in,
481.
Hypnotic drugs. 833.
effects, 553. 943.
effect of wet girdle, 933.
electricity as, 949.
Hypochondriasis, 370, 899.

cold bath in, 221.
H3rpogastric douche, 409.

douche, hot, cold lumbar douche

with, 462.
douche, physiological effects of,

499. . ,. .

douche, therapeutic applications,

500.
Hypogastrium. hot douche to, 496.
Hypopepsia. 240, 456. 472, 4&4. 498,

530, 598» 609, 647. (f77. 768, 828,

Ii68

m

1

m

Hypopep&ia — continued.

832* ^3^f 851, 886, 888. g^, g^,

in stncmia, X083.

and apepsia, 10^2.

caliper douche m, 4S2.

cold douche in, 443,

cold gastric douche in, 510.

in emaciation, 1028.

m pulmonary tuberculosis^ lOJO.

sinii!ioidal current in, 94^.
Hypostatic congestion^ 521.

congestion of lungs, 786.
Hysterectomy, enema in, 894.
Hysteria. 270, 384, 456, 495* ^7* 7°S^
718, 808, 809, 857. 1057^

in dilatation of stomach, 1034.

in en tero ptosis, 1038.

tepid bath in, s6t.

in typhoid, gSs-
Hysterical anesthesia, coM douche

in, 444-
anorcxia, 809,

aphonia, cold douche in, 445,
hyperesthesia, cold douche itii

445-

paralysis. 445, 485.
Ice to chest in pneumonia^ Mays, 787.

cooting tissue by, 773, 774.

water in fever, Todano, 921 .
Ice-bag, 244, 268, 27s, 773. 776, 77a
847, 855* 856.

Benj. Rush on, 313.

to epigastrium. 240.

over heart, 128. 202. 787.

therapeutic applications, 775.

in typhoid, Dieulafoy, 777.

Winternitz on, 313, 787.
Ice- cap, 128, 1 07, 198.
Ice-collar, t^S, 275, 779.
Ice-compress, T97, 202, 368, ^$2, 777.

to spine, iqSh 244, 856.
Icterus, chronic, 484- -

neonatorum, 829,

neutral bath in, 23-4,

sweating bath in, 234.
Immersion bath. 522, 5^), 5^7*

alterative effects of, 25S.

cold, 222, 2q6, 33Q, 527, 610,
calorific effects of. 259.

con tr aind i cat ion s, 531,
Currie on, 526,

hot, 530. S99, 675^

contraindications, 548^

and cold, 3^^-

emtnenagogic effects of, 241.

Japanese method, 541.

revulsive effects of, 253.

Immersion bath, hotp method, 540^
physiological effects, 540.
therapeutic applications, 544.

method, s^.

ph^fsialogical effects^ 5^, J

tepid, 5^. m^

tepid, physiological effects of*
538.

tepid, therapeutic appltcitioa||^
558. ■

therapeutic applications, 529. ■
Immersion treatment of wounds, 761
Impotence, 768, 87^, log^.
Incontinence in children, 495.

nocturnal, in children^ 764,
1047.

of tu-ine, 495^ 40* S^J, 801, 1017.

of urine in hysteria, jo^

Incurable maladies. 381 ,
Indigestion, 622. 723, 807, 82ft,

m chorea, 1057.

chronic, 642.

in enteroptosts, J038.

in hypopepsia, 1032.

in mania, 1065,

in melancholia, 1064.

in netu- asthenia, 1060.

in pernicious anemia, 1084

in t>ulmonarv ttibcrculosis, 1 01^ |
Induration in prostatitis, 1092.
Inebriety, cold douche tn, 444.
Infan^; 330, 087,
In fan It le convulsions, 547, 1063,

diarrhea, enema in, 897,

uterus, 496.
Infection of fiver, goo.

local, temperature due to, 522.

malarial, 512, 661, pgo.

malarial, chronic, 611,

malarial, chronic, toxemia ia,
609,

prevention of, in cholera. 1014,
Infectious fevers, 597, 609.

jaundice, 245, 482, 499. S'Ov SHt
624, 705. 800. 820, S37* 900, gaR
Infiltration, amyloid. 829.
Inflamed hemorrhoids, 268.
Inflammation, acute, 246, 680, 779^ 7S4.

acute, of pelvic viscera, 87S.

acute, precautions required, 346.

alveolar, 778.

of bladder, 445, 804, S47.

of brain, chronic, SS^*

of cecum, 832.

circum-uterine, 766,

cold in, 377^

of cord, chronic, 552.

of cornea, 802.

r\

INDEX.

I169

Inflammation of external eye, 785.

of eyeball, 780.

of Fallopian tubes, 266, 771, 847.

of fauces. 802.

of hands, 759.

of intestines, 445, 835.

in joints, 775, 780, 815.

of kidneys, 445, 804.

of larynx, 802, 866, 916.

of liver, 445, 511.

meninjreal, 788, 856.

of muscles, 514, 780, 799.

non-suppurating, of ovaries and
tubes, 878.

of ovaries, 266, 445» 11^^ 804, 847.

pelvic, 600, 766, 803, 835.

of pharynx, 866, 916.

of post-nasal region, 916.

of prostate, 267, 766, 804, 847,
881, 896, 902.

pulmonary, 863.

of stomach, 445, 835.

of testicles, 481.

of tonsils, 802.

of uterus, 445» 500, 771, 804, 847.

visceral, 783.
Inflammatory affections of muscles,

799.

affections of nerves, 799.
Influenza, 616, 647, 809, 1012.

thoracic, 1013.

typhoid with, 988.
Insanity, 496, 1065.
Insolation, 722.

physiological effects, 723.

suggestions and precautions, 724.

therapeutic applications, 723.
Insomnia, 222, 270, 416, 466, 484, 494i
549, 553. 610, 615, 638, 661, 752,
756, 759, 768, 789, 828, 832, 836,
844. 855, 900, 943, 1070.

anemic, 829.

in cardiac disease, organic, 1079.

in chorea, 1056.

cold bath in, 29.

in diabetes, i(X26.

electricity in, 949.

clectro-hydric bath in, 946.

in emaciation, 1028.

in exophthalmic goiter, 1085.

in general paresis, 1066.

in lithemia, 1022.

in mania, 1065.

measures to relieve, 264.

in melancholia, 1064.

in neurasthenia, 1061.

neutral fan douche in, 494.

neutral massage douche in, 491.

Insomnia, neutral rain douche in, 478.

neutral spray in, 480.

in pneumonia, 1005.

Schiiller on, 833.

spinal pack in, 265.

in sunstroke, 1069.

in syphilis, 1095.

in typhoid, 982.

ni typhus, 1010.

after withdrawal, in drug habits,
1099.
Institutions, hydriatic, 397.
Intercostal nerves, 852.

neuralgia, 465, ^99, 638, 804.
Intermittent fever, 020.

malarlial fever, 599, 990.
Intestinal catarrh, 245, 445, 612, 647,
661, 829, 831, 836.

catarrh, chronic, 462, 482, 798,
1041.

catarrh in emaciation, 1028.

catarrh, hot caliper douche in, 482.

catarrh in neurasthenia, 1060.

colic, 546.

compress, hot and cold, 847.

excitation, 206.

flatulence, 482, 832, 838, 1033.

hemorrhage, 766, 776, 896.

hemorrhage in plague, 1016.

hemorrhage in typhoid, 983.

inactivity, chronic, 893.

obstruction in appendicitis. 1042.

perforation, 338, 600, 631.

peristalsis, 754.

secretion, deficient, 599.

spasm, 244.

ulceration in typhoid, 983.
Intestines, 740.

chronic congestion of. 461.

chronic inflammation of, 445-

gas in, in chronic intestinal ca-
tarrh, 1041. .

irrigation of, physiological effects,
898.

irrigation of. therapeutic applica-
tions, 899.

pain in, 461.
Involution, excessive, 878.
Irrigating compress, 789.

suggestions and precautions, 790.
Irrigation, 881.

of bladder, 903.

of colon, or enema, 891.

of ear, 881.

of eye, 883.

eastric, Turck, 889.

of intestine, physiological effects
of, 898.

1 1 JO

INDEX.

M

HI

Irrigation, nasal, 882*
post-nitiiaL 883-

rectal 881. 902.

rectal, Reclus on, 896.

of stomach. 884.

of throaty 883.

of urethra, 007*

meritic, 198.

of urethra. Daggett OHt 004-

vaginal, 199, goS,

vaginal, ancient me of, 29*

vaginal. Max Runge on* 910*
Irritability of bladder, 495* 501, 771.

nentral a&ccnding douche in, 481 -

of genito- urinary center, 495, 857.

muscular^ effect of heat upon, 150.

of ner^^e centers, 610.

of ovaries, 501.

of spinal centers, 84a

of splanchnic?, 495, 50 1,

urethral, 504.

of uterus, 501,

of rectum* 4^^ loW-
Irritation, cutancous^y effects of, 102.

of lumbar ganglia of abdomitial
sympathetic. 501. 836.

phenomena of, 749*

of renal plextis, 49^.

of skin 789.

spinal. 840, 857.

of splanchnics* a^^^ 501.

thermic, effect of, upon circula-
tion, 96.

of throat, 884.

vesical 852.

visceral 833, 836.
Italy, use of affusion In, 29.
Itching of jaundice, 54^. 1043.
Jaborandi, 899.
Jacques on cold enema in fever, 320*

statistics in typhoid, 592.
Japanese, hot-air-bath among, 693.

method of hot immerfion baths,
541, 543.
Jaundice, 450, 4S3< 613, 618, ?05. 7^>
1097.

catarrhal, 618, 837, 1043,

catarrhal in infiuenza, 10 r 3-

in cirrhosis of liver, 1044.

enema in. 8q6, 900.

in CKOphthalniic goiter, 10B5,

infectious, 245* 482. 49Q, 5io* S",
624, 705. 800, 829, 837, 900, 928.

itching of. 546, 1043,

in pneumonia, T004,

in yclJow fever^ 1012.
Jardet, effect of continuous bath on
urinary secretion. 558 ,

IM^

Jet, broken, 4i8L.

horizontal : See Horiiontal jtL
steam, i97- 9i9~^2^-
Joint compress, 85 j, 872,

deformities in arthritis defonii-

aiis, 1086, H

Joints, edema of, 471. H

inflammation of, 77 5f 81 S*
inflammatory process in, in acute

rheumatism, 1006.
injur^^ of, 815.
neural gta of, 800.
pain in, 48a, 4^ 4^t 5^5* i«

1086.
pain and swelling of, m pvoi,

1023.
painful and swollen, in lithemia,

1022.
prevent damage to^, in acute rheti-

matism, 1007.
rheuniaiic, 480, C60, 693'
stiffened, 471 -^
stiffness of, in chronic rheuma-

tism, 1009.
swelling of, in chronic rbcttnu-

tism, 1009.
swollen^ 519.

swollen, in dengue, 1015,
tuberculosis of, 813,
Jurgensen, on cold bath, 126.
Kaltenleutgeben, 7^^ 72i>
Kaposi, use of continuous bath, 558L
Kellogg, John H., applicators, hoi*

low, 913, 915.
calorimeter, bath tub, 87, 327.
calorimeter, fever, 88.
on chest pack after operations,

^844-
circle douche, 240.
on cold in anesthesia, 253.
on cold applications in alcohol-
ism, S33-
on cold baths and quinine, 333-
on cold bath, restorative effects

of, 151.
on cold compress under anes-
thesia, 869. 870,
on cold for colds, 91S, 919.
cm cold bath, effect of on blood,

120.
douche apparatus, 427, 433.
douche table, 909*
dynamometer, 413.
electric cabinet, 711.
electric-light bath, 177, aig, ^ji,

380. 707. 716.
on electricity combined wttt

water, g^B, 944, nic; ^9,

tnsa-

I

INDEX.

II71

Kellogg — continued.

hemostatic steam jet, 920.

inhaler, 916, 917.

on location of stomach by means
of ice-water, 128.

neutral bath, 280, 554.

on outdoor gymnasium, 960.

pail douche, 518.

percussion douche, 455.

on physical coefficients, 356, 414.

rectal irrigator, 267, 902.

Scotch douche, simultaneous,
460, 464.
Kemp on enema, 898.
Keratitis, 809.
Kidneys, blood supply of, 739.

amyloid, 829.

effect of cold douche, Bottey, 512.

effect of neutral bath on, 551.

floating or movable, 496.

floating or movable, pain in, 512.

inflammation of, 445, 804.

neuralgia of, 496, 512.

suppurating, in typhoid, 985.

See Renal.
Kieman on circulation, 741.
Kiliani. steam in hemorrhage, 919.
Klar, Conrad, on electric-light bath,
715.

on heat elimination, 626.
Kneipp, 23, 28.
Kolliker, absorption of water by

nerves, 551.
Krebs, absorption of water by nerves,

551.
Krull on enema, 898.

enema in jaundice, 896, 900.
Kuhn on neutral bath, 549.
Kussmaul on wet-sheet pack, 602.
Labor, delayed, 768.
Landois on circulation, 56.
Langenbeck, partial continuous bath,

760.
Langlois on heat production, 81.
Laparotomy, 915.
Laryngismus stridulus, 1074.
Laryngitis, 828, 1073.

in febrile disorders, acute, 1018.

in pulmonary tuberculosis, 1020.

in smallpox, 998.

spasmodic, 1074.

in typhoid, 983.
Larynx, 737.

catarrh of. 866, 867.

inflammation of, 802, 866, 916.
Laschkiewitsch, 294.
Laseque. hot baths in rheumatism,
546.

Laur on tepid bath, 303.
Lavage, gastric, 884.
for children, 887-

contraindications, 889.

rectal, 902.

therapeutic applications, 887.
Lead poisoning, 809.
Le Drau, cold compress, 786.
Leg bath, 758.
Leg pack, 853, 879.

method, 879.

physiological effects, 880.

requisites, 879.

in sciatica, 268.

therapeutic applications, 880.
Legs, coldness of, 472, 880.

edema of, 471, 1026.

muscular weakness of, in neuras-
thenia, 1061.

prickling sensation of, in chronic
myelitis, 1053.

ulcers of, 472.
Lemarchand on the douche, 433. 450.
Lepine, observations on cold full

bath, 529.
Leprosy, 647, 722.
Lepto-meningitis, 618, 809.
Lesage on coloclvster, 901.
Leucocytosis, 971.

to encourage, 120, 174.

in malaria, 990.
Leucorrhea, 902.

in chronic metritis, 1091.

of rectum, 881.

vaginal, 881.
Leukerbad, 226. 552, 561.
Leyden on skin elimination in ty-
phoid, 578.
Liebermeister, heat production in

fever, 583.
Liebig, Baron, 965.

on water drinking, 923.
Light. 196.

Finsen, Bert, and Maklakow on,
723.

Institute, Copenhagen, 721.

physiological effects of, 16&-80.
Lightning pains, 457, 480, 484, 496,

519. 814, 857.
Lithemia, 647, 810, 1021.

pruritis in, 1071.
Lister's spray, steam jet, 920.
Liver, amyloid, 618, 829.

chronic enlargement of, 511.

cirrhosis of, 833, 929, I04-1-

cirrhosis of, in diabetes, 1026.

disorders of, 660.

dyspeptic, 471, 660.

II72

INDEX.

Liver, effects of heat upon, 158.

enlargement of, 471.

fomentation over, 239.

hypertrophy of, in organic car-
diac disease, 1080.

infection of, 900.

inflammation of, 445, 511.

and spleen, enlarged in scarlet
fever, 995.

temperature of, 80.

torpid, 807.

toxins, Rogers on, 576.

See Hepatic.
Lobar pneumonia, 278, 624, 1003.
Local electric-light bath, 259.

excitant effects, 222.

hot-air bath, 259, 692.

hot-air bath, therapeutic applica-
tions, 693.

hydriatic measures. 724.

vapor bath, 259, 706.
Localized applications, precautions,

751.
douches, 491.

Lockette, 33. 95-

Locomotor ataxia, 445, 453, 456, 457,
480, 484, 495, 496, 519, 552, 560,
810, 814, 820, 829, 840, 857, 906,

1054.
Loms, cold douche to, 240.

pain in, 801.
Lubansky on calorification, 162.
Lucas, wet-sheet pack, 600.
Ludwig on lymph, 430.
Lumbago, 457. 465, 484. 485. 490, 496,

497, 515, 683, 691, 804.
Lumbar douclie, 496.
cold, excitant, 240.
cold. with hot hypogastric douche,

462.
cold, in local anemia, 244.
hot, hemostatic effects of, 199.
Scotch, 497.
Lumbar ganglia of abdominal sym-
pathetic, 245, 462, 495, 501, 503,
771,810.832,836,851,852.
hyperesthesia of, in migraine,
1063.
Lumbar pack, hot and cold, 851.
Lumbo-abdominal neuralgia, 769.
Lung compress in anesthesia, 845.

hot and cold, 844.
Lungs, -jy]'

disorders of, 660.
hypostatic congestion of, 786.
See Pulmonary.
Lymph glands, tuberculosis of, 810,

McGregor, Surgeon, cold bath in

typhus, 532.
Malaise, Scotch douche in, 416, 465.
Malarial cachexia, 457, 718.

cachexia in anemia, 1083.

chill, 599.

fever, 616, 618, 621, 647, 809, 990.

fever, intermittent, 599, 990.

enlargement of liver and spleen.
511, 748.

hematuria, 624.

infection, 258, 511, 512, 661.

infection, chronic, 609, 611.

infection in emaciation, 1028.

neuralgia, 621, 705.

paroxysm, 622.

poisoning, 764.
Malnutrition, 723.

in general paresis, 1066.

in mania, 1064.

in melancholia, 1064.

in toxic insanity, 1065.
Maklakow, 173.

on light, 721, 723.
Mammx, inflammation of, in mumps,

lOOI.

Mania, 560, 1064.

acute, 549, 610, 615, 776.

in meningitis, 1000.

neutral douche in, 478.

in typhoid, 984.
Maniacal excitement, 494, 752.
Massage, 663. 951.

abdominal, for prolapsed viscera.
952.

Chinese, 675.

douche, 486.

douche, contraindications. 491.

douche, physiological effects. 487

douche, therapeutic applications.
489.

general, after cold applications.

in hernia. 952.

with the hot immersion bath.
952.

with hydrotherapy. 949.

after localized applications. 953
Masturbation, 855.
Maurel, influence of heat on blood

corpuscles, 583.
Mays, of Philadelphia, on pneumonia.

787.
Measles, 547, 611, 996.
Melancholia, 494, 610, 751, 1064.
Melancholy in chronic gout. 1024.
Mellez on bladder irrigation. 005.
Meniere's disease. 810.

INDEX.

I 173

Meningeal inflammation, 788.

inflammation of spine, 856.
Meningitis, 552, 560, 600, 'j'jd, 803.

cerebrospinal, 521, 545, 999.

in influenza, 1013.

in typhoid, 984.

with exudate, 597, 705.
Menorrhagia, 245, 392, 600, 765, 838,
1088.

in anemia, 1083.

hot calipher douche in, 482.
Menstrual flow, 749.

pains, 873.
Menstruation, 600.

cold bathing during, 391.

irregularities of, 877.

painful, 545.

painful and irregular, 853.

suppressed, 545, 759, 1089.
Mental depression in neurasthenia,
1061.

irritability, in melancholia, 1064. ^
Metabolism diminished by rest, 978.

effect of cold upon, 122.

effect of cold douche on, 437.

measures which encourage gen-
eral and local, 973.

stimulation of, by electricity, 943.

a study of, 387.
Metchnikoff on leucocytosis, 971.
Metritis, 462, 798.

acute, 878.

chronic, 766, 1090.
Metrorrhagia, 600, 1088.

in anemia, 1083.
Micturition, pain in, 896.
Migraine, 618, 647, 705, 718, 801, 1062,
1067.

chronic, 501, 829.

in gout, 1023.

hot affusion to head in, 494,

in lithemia, 1022.
Miliary fever, 810.
Miscellaneous baths, 954.
Morphinism, 647, 809.
Mortality of pneumonia under hydri-
atic treatment, 286.

rate of, in typhoid fever under
hydriatic treatment, 285.
Mosso's ergograph, 150, 514, 615.
Motor insufliiciency of bladder, 495,

496.
Movable kidney, 496, 512.
Mucous passages, means of making
hot, cold, and alternate appli-
cations to, 913.
Mud baths, 569.

Multiple neuritis, 445, 553, 1049.
Mumps, 1000.
Muscle douche, 514.

sedativeis, 263.
Muscles, abscess of, in typhoid, 985.

contractures of, 515.

effect of cold upon, iii.

effect of cold sitz upon, 763.

effect of heat upon, 150.

inflammation of, 514, 780, 799.

painful conditions of, 515.

paretic, electricity in, 942.

relaxed abdominal, 513.
Muscular atrophy, 823.

capacity, effect of cold douche
upon, 430, 438.

contraction, 809.

excitability, effect of Scotch
douche upon, 438.

fatigue, Scotch douche in, 465.

.fatigue, secondary, 514.

irritability, iii, 150, 438.

paralysis, Scotch douche in, 465.

rheumatism, 466, 471, 514, 515,
546, 624, 829, 1025.

rigidity in meningitis, 1000.

sense, loss of, in hysteria, 1058.

spasm, 419, 515.

spasm in meningitis, 1000.

spasm in pelvic viscera, 852.

strain, 514.

strength, loss of, under treat-
ment, 412.
Mustard fomentation, 814, 956.

bath, 956.
Myelitis, 445, 600, 810.

acute, 618, 624, I OS I.

chronic, 597, 618, 1052.
Myocarditis, 338, 600, 631, 785, 869.

in erysipelas, p97.

following pericarditis and endo-
carditis, 1078.

in typhoid, 984.
Myxedema, 637, 662, 1085.
Napoleon on defense of the organism,

964.
Narcosis, alcohol and opium, 822.
Nasal Catarrh, 466, 776, 839, 916, 107 1.

cavity, 737.

douche, 198.

hemorrhage, 883.

irrigation, 882.

secretion diminished, 839.
Naso-pharyngeal irritation in mea-
sles, 996.
Nauheim baths, 562.
Naumann, 103, 164, 672.

1174

KattMa ia g^H-fiUme^ 1044.

10 nuz^zin^ir 1062,

10 wr^^trhi*^ zcatt, IQ45.

Keck, fxiun in lack «>f, 801,
Neck o^osffceM, ^3, 866,

f^tiolofjcki effects, 866.

tbenpeauc apf>lkatJOCis, 866.
Hti^ni%, 2y^.4^ ^^60, 63'. 647.
705^ 718, 808, lots-

acate, «!>f iczrUx ierer, s#6.

ia aiccihotiim, 10^.

chroox; m zstetmz, 1083.

dirooic Brisbf ft disease, 1046.

ia diabetes, 1026,

ia dipbtberia and tonsillitis, 1002.

in iAriit ^wrdtn, acttte, 1018.

in mfltsenza, 1013.

in mea-tleft, 9^,

in %nuLi\ffOx, 9g8,

in scarlet fever, 9^.

in typhoid, 624, ^.
Kenre centers, 72.

centers, irritability of, 610-

drotniflex, |>aralysis of, 810.

diiorders, sympathetic, 801.

filaments, absorption of water by,

279. SSI-
tone in tncontmence, 1047.

tone in ncura'^thcnia, !o6o.

NVrv^-., mtl^irnrnatory affections of.

77>

s^rn^-.jbiliiy of. dimini-hcd by ab-
••/jT\)V.'m of water, 279. 551.

of ikJn. 67.
Vas^^C/n-trictor, influence on, 780.

va-.omotor, 73
Nervous affections. 445. 622.

asthma, 466. 499. 5''->i. 851, 856.
864.

asthma in enteroptosis. 1038.

dyspepsia, 609, 886, 1039.

energy, 211.

excitabih'ty, rain douche in, 478.

headache, 844. ^^^7-

heart, wet-sheet pack in, 614.

impressions, hydriatic effects ob-
tained through, 936.

irritability, 446. 453-

irritability of pelvic viscera, 771-

irritability in spinal sclerosis,

1 05.3-
irritability in melancholia, 1064.

system, 455. 555-

system, effects of cold upon, 112.
system, effect of heat upon, 153.
system, sympathetic, 61 r.

XenTwaBC**. 3^31

in <ir3^ 'b^'jCL^. -^399.
vex-ibeet pack is. 604.
Xeizra^g^ 450. 457- 484- 4^

62:. 75^. 718. 776L 8r,4 ■
in aar.":LA. 1(^3.
of KadcScr. 500. 769L
crcraL 25^ ^56. .^- 599.
in cxopfethainrjc goiter, i
fadaL 252. 705-
of Failopjan tubes. 771-
of foot 75S.

of gcnito-arinarr organs
of hands, in arthritis de:

loftS.
of bead. 839.
intercostaL 252. ^. 490.
of joint?, 800.
of kidney. 456, 512.
in lithemia. 1022.
Ittmbo-abdominaL 769.
malarial, 625, 705.
in neurasthenia. 1061.
ovarian. 465. 497. 500. •

766, 769. 879^
reflex. 801. 1050.
repulsive Scotch douche
in rheumatism, acute, 100
sciatic. 599, 600.
of skin. 446

of -r>errnat:c cord. 51. "J. 77
spina'. 456. 480. 515. 6:^.
of testicle-. 513. 76^^. 771
uterine. 465. 497. ^c^o. 513.
vi-c-ral. in hy-ter'a. 1058
Xeurnlj^ic prtection^ of pel

cera. 879.
joint-. 942.
pain. 940.
Neurasthenia. 2"^^. yVj. 384^ .

457. 4^^2. 472. V6, 484-

S^2>- ^- 6i^- ^18. 631. '

647, 661. 677. 680. 705. ;

756, 8or, 822, 899, 1059.
cold douche in. 443.
with cerebral congestion,
in dilatation of stomach. 1
in enteroptosis, 1038.
gastric, 503. 598. 686.
in lithemia. 1022.
neutral douche in. 453.
percussion douche in. 455
pulmonary douche in, 50c;
in sunstroke, 1069.
Neurasthenic headache. 844. i
symptoms in chronic ir

catarrh, 1041.

INDEX.

II7S

Neuritis, 484, 718, 820, 1048.

in diphtheria and tonsillitis, 1003.

general, 445.

inflammation in, 1049.

in influenza, 1013.

multiple, 445, 553, 1049.

neuralgia due to chronic, 1051.

in rheumatism, acute, 1008.

in typhoid, 985.
Neutral ascending douche in hyperes-
thesia of bladder and genitals,
481.

applications, 193.
Neutral bath, 160, 234, 270, 302, 395.

continuous, Jardet and Riess on,
558.

continuous. Hebra on, 561.

contraindications, 555.

Currie on, 552.

effervescent, 565.

in icterus, 234.

in insomnia, 395.

Kuhn of Niederbronn on, 549.

method, 548.

in neurasthenia, Vigoroux. 553.

physiological etiFects, 549.

therapeutic applications, 552.

use of, at Leukerbad, Switzer-
land, 552.
Neutral compress, 748, 814.

therapeutic applications, 814.
Neutral douche, 451.

ascending, 481.

compared with neutral full bath,
452.

to chest in asthma, 509.

in mania, 478.

physiological effects of, 452.

revulsive effect, 252.

spinal, 270.

therapeutic applications, 452.
Neutral fan douche, 270, 484, 494.

massage douche, 489, 491.

pack, 610.

percussion douche, circulatory re-
action by, 456.

rain douche: See Rain douche,
neutral.

sitz bath : See Sitz bath, neutral.

spinal douche, 270.

sponge bath. 639.

spray, for ataxia pains, 480.

spray, in insomnia, 480.

stage of pelvic pack, 875.

stage of wet-sheet pack, 607.

wet-sheet pack, 264.
New Zealanders, use of vapor bath
by, 702.

Night sweats of consumption, 638,

862.
Nitrogen oxidation, influence of heat

upon, 157.
Nocturnal asthma, 1078.
Nodosities in acute rheumatism, 1008.
Noir, Dr., on herpes circinatus, 808.
Normal temperature, 79.
Nose, catarrhal affections of, 916.

headache due to disease of, 1068.
Nosebleed, 778.

in mumps, looi.

in pneumonia, 1005.

in typhoid, 981.
Nutrition, disorders of, 716.

effect of heat upon, 156.

general, 611.

in locomotor ataxia. 1054.

in nasal catarrh, 1072.

in neuritis, multiple, 1049.

in pernicious anemia, 1084.

of scalp, failing, 839.

in sclerosis, spinal, 1053.

slowed, Bouchard on, 661.

slowed, cold bath in, 530.
Obesity, 373, 457, 545, 618, 661, 691,
705, 718, 723, 926, 1027.

cold full bath in, 530.

cold rain douche in, 476.

in diabetes, 1025.

massage in, 952.

typhoid with, 988.
Obstetrics, 374.

Obstruction, intestinal, in appendi-
citis, 1043.

of pylorus, 887.

in peritonitis, 1048.
v./ccipital sinus, 735.
Occupation neuroses, 809, 829.
Oil rubbing : See ivubbing, oil.
Oils, antiseptic volatile, 882.
Old age, cold bath in, 339, 392.

typhoid in, 647, gS7.
Oliver, of England, on arterial pres-
sure, 540.
Opium habit, 1098.

habit, the douche in, 444.

poisoning. 639. 800. 818. 822.
Orchitis. 778. 804, 878. 1092.

in typhoid. 985.
Organic changes produced by heat
and cold, i6,v

headache. 1068.
Organism, natural defense of, 574-

Q65.
Organotherapy. 359-
Oscillatory reaction. 347.
Osier, statistics in typhoid, 5S6.

1 176

INDEX.

Osteitis in acute rheumatism, 1008.
Otitis media, 882.
Outdoor bath, 960.

Ovarian congestion, 462, 804, 852, 877,
881, 936, 940, 941.

disease with dysmenorrhea, 1087.

disorders, 677.

displacement, 768.

neuralgia, 465, 497, Si3» 600, 879.

pain, 267, 676.

prolapse, 877.
Ovaries, inflammation of, 266, 445,

804,847.
irritability of, 501.
neuralgic affections of, 1051.
non-suppurating inflmmation of,

878.
subacute inflammation of, 771.
Ovaritis, 600, 798, 1091.
chronic, 829.
in typhoid, 985.
Ovariotomy, enema in, 984.
Oxidation, effect of heat upon, 157.
in gout, 1023.

of hydrocarbons in obesity, 1027.
in lithemia, 1021.
procedures which increase, 971.
of sugar in diabetes, 1025.
Oxygen, absorption of, in diabetes,

1025.
Pachymeningitis, 823.
Pack, abdominal hot and cold, 849.
chest : See Chest pack,
cooling, 615.
cooling, therapeutic applications

of. 616.
cooling. Wintcrnitz. 603.
dry : See Dry pack,
foot : See Foot pack,
half. 622.
head, 839.

heating, 610, 824, 837.
heating compress or, 824.
neating, hot and cold, 847.
heating, hot and cold, physio-
logical effects of. 848.
hip, 853j 873.

hip, tonic, in amenorrhea, 241.
hot blanket : See Blanket pack,

hot.
hot and cold : See Hot and cold

pack,
leg : See Lej? pack,
lumbar, hot and cold, 851.
neutral, 610.

pelvic : See Pelvic pack,
shower: See Shower pack,
spinal : See Spinal pack.

Pack, sweating: See Sweat
tonic, 609.

trunk, cold, diuretic eff
trunk, hot and cold, 240,
wet-sheet: Sec Wet-she

Pail douche, 515, 610, 1103.

Pail pour, method, 516.

in Persia, Sir John Ch;

519.
physiological effects of, .
therapeutic applications •
Pain, 369, 417, 445. 45i, 749, ^
in abdomen and back

monia, 1005.
in abdomen, in cholera i

1040.
in back in irritable recti
in back and legs in m

999.
between shoulders in

tosis, 1038.
in cardiac disease, orgai
caused by treatment, 417
in chest in pneumonia, i(
chronic, 800.
in chronic intestinal cata
in cirrhosis of liver, 1044
in constipation, 1036.
in dilatation of stomach,
in dysentery, acute, 1042
in dyspepsia, 499.
in the eye, 268.
in eyes in neurasthenia,
in the eyeball. 269.
in gall-stone. 1044.
in gastric catarrh, acute,
in gastric ulcer, 1039.
in head, back, and leg

fluenza. 1012.
in head in plague, 1016.
in hemorrhoids, 267, 109=
hot applications for the

265-9. .
in hysteria, 1058.
in jaundice. 1043.
in joints, 480, 484, 486, 5
in joints in arthritis de

1086.
in joints in lithemia, 102
in joints in rheumatisi

1006.
in legs in myelitis, acute
in legs in typhus, loio.
lightning, in locomotoi

457, 480, 489, 496, 512.

1055.
local, in drug habits, I09(
local, in locomotor ataxi;

INDEX.

177

Pain, local, in scurvy, 1029.

in loins and legs, in yellow fever,

lOII.

lumbar, in smallpox, 998.

in migraine, 1062.

muscular, in lithemia, 1022.

in neck and legs, in plague, 1016.

in neck in typhoid, 981.

and nervous irritability, measures

which relieve, 976.
in neuralgia, 1050.
neuralgic, general, 1051.
in neuritis, 1049.
in neuritis, multiple, 1049.
nocturnal, in syphilis, 1095.
pelvic. 267, 462, 599, 676, 759, 879,

1087.
in pelvic peritonitis, 1090.
in pleurisy, 1077.
in pericarditis and endocarditis,

1078.
in prostatitis, 1092.
in pulmonary tuberculosis, 1019.
radiating, in arthritis deformans,

1086.
reflex, 456.

relief of, 251, 265, 940.
rheumatic, 585.
rheumatic, in diabetes, 1025.
rheumatic, in obesity, 1027.
in rheumatism, chronic, 1009.
in shoulder-blades, 801.
spinal, in acute myelitis, 1052.
of sprains, 268, 800.
in stomach, in chronic gastritis.

1031.
superficial, 450.
and swelling of joints in gout,

1023.
transferred, Dana, 944.
transferred, table of areas of,

945.
visceral, 484.
in wounds, 268, 815.
Pallor with sun stroke, 751.
Palpitation, aortic, in dilatation of

stomach, 1034.
of heart, 499. 50i, 863, 986.
of heart under treatment, 414.
Palsy, Beirs, 618, 647, 810.
Pannus, 802.

Paralysis, 597, 621, 622, 880.
agitans, 647, 809.
ascending, 810.
ascending, acute, 823, 829.
of bladder, 905.
of circumflex nerve, 810.
cold fan douche in, 484.

Paralysis, diphtheritic, 485, 1002.
in febrile disorders, acute, 1018.
from gout, 705.
hysterical, 445, 485.
motor, in hysteria, 1058.
muscular, 465, 471, 942.
muscular, in hysteria, 1057.
in neuritis, 1049.
in neuritis, multiple, 1049.
peripheral, 705.

sensory, in acute myelitis, 1052.
in spinal sclerosis, 1053.
in tonsillitis, 1002.
Paraplegia, 457, 560, 621, 880, 905.

in acute myelitis, 1052.
Paresis of bladder in locomotor
ataxia, 1055.
general, 609, 823, 1066.
Scotch douche in, 465.

in writer's cramp, 1063.
Paresthesia, 453, 801.
in headache, 1068.
in hysteria, 1058.
in legs in acute myelitis, 1052.
in neurasthenia, idiSo.
Paresthesias, in arthritis deformans,
1086.
in drug habits, 1099.
Parker, Joseph, 766.
Paroxysms of dyspnea, 856.

malarial, 990.
Partial hydriatic measures, 724.
Parturition, 809, 897.
Passavant, continuous bath in bums,

559.
Patients, training of, 403.
Paulus of i^gina on sunstroke. 633.
Peasley in vaginal douche, 909.
Pelvic compress, hot and cold, 847.
congestion, 245, 462, 600, 765. 877.

1090.
disease, chronic, 877.
disease in emaciation, 1029.
displacements, 497, 500.
ganglia, hyperesthesia of. 500.
hematocele in typhoid, 986.
inflammation, 600, 803.
pack, 853, 873.

heating stage, 875.
hot, 750, 87s, 879.
hot and cold, 852, 875.
hot and cold, meth<>d, 8^.
hot and cold, therapeutic ap-
plications. 852.
neutral stage, 875.
physiological effects, 876.
repeated, $78.
sweating stage, 875.

11/8

INDEX.

•f
t

Pelvic pack, therapeutic applicatioas,
877.
tonic stage, 874.

pain, 462, 599. 676, 759, 879, 1087.
pain, hot sitz bath in, 267.
peritonitis, 847. 878, 1089.

sit^765.

visSra, congestion of, 660, 771,

852, 877, 878, 896.
viscera, inflammation of, 878.
viscera, delayed development of,

496.
viscera, muscular spasm in, 852.
viscera, irritabilitv of, 771.
viscera, neuralgic affections of,

.S79.
viscera, pain in, 852.
Percussion, 681, 951.
Peptogenic effects. 239.
Percussion, 681, 951.

contraindications, 683.
douche, 453» 495» 942.

circulatory reaction of, 454,

456.
cold, 496.

in neurasthenia, 455.
to spine, 455, 496.
therapeutic applications of,
455.
with hydriatic measures, 950.
physiological effects of. ^2.
therapeutic applications. 682.
Pericarditis, 1078.
in erysipelas, 997.
in febrile disorders, 1017.
in rheumatism, acute, 1007.
in scarlet fever. 995.
in typhoid. 984.
Perineal compress. 881.

therapeutic applications. 88r.
Perineal douche. 503.

therapeutic applications. 503.
very cold, 503.
very hot. 504.
Perineum, rigidity of, 504.
Periostitis in acute rheumatism, 1008.

in typhoid. 985.
Peripheral circulation. 646.
heart, 57.
paralysis. 705.
vessels, Paessler. 588.
vessels, Romberg. 579. 588.
Peristalsis, excessive, in nervous dys-
pepsia, 1040.
increased. 810.
intestinal. 754.
Peristaltic activity in constipation.
1035.

Peritonitis, 266, 313, 510, 554,
754^ 780, 798, 803, 829,
1048.

in acute febrile disorders

pelvic, 847, 878, 1089.
Pernicious anemia, 867, 1064,
Persia, pail pour in, 519.
Perspiration, Bouchard on, 6c

and constipation, Rohrig,

effect of cold upon, 105.

effect of wet-sheet pack
618.

in neurasthenia, 1062.

profuse, 450.

profuse, in rheumatism, i

profuse, Scotch douche in
Pfluger, 162, 165.

on alternate bath, 312.
Phagocytosis, 966.
Pharyngitis, 1072.

chronic, 884.

in scarlet fever, 994.
Pharynx, t^t.

acute inflammation of, 86
Phlebitis, in acute febrile d
1017.

in acute rheumatism, looj

in typhoid, 621, 984.
Phlegmons in typhoid, 987.
Physical chart, 152.
Physical coefficients, 356.
Physics of air. 42.

of heat, 44.

of water, 38.
Physiological effects of al
heating compress. 836.

ablution, 636.

affusion, 518.

alternate compress, 816.

alternate douclie. 470.

Brand bath, 571.

carbon dioxide bath. 956.

cephalic compress, 854.

cephalic douche, 493.

cerebral douche, 507.

chest pack, 862.

cold, 98.

cold foot bath, 754.

cold friction, 644.

cold full bath, 528.

cold plunge, 524.

cold rubbing sitz, 767.

cold towel rub, 651.

cold compress, 774.

continuous bath, 558.

cooling compress, 781.

dorsal or spinal douche.

douche. 429.

INDEX.

1 179

Physiological effects of dripping sheet,
658.
dry pack, 620.
effervescent bath, 564.
electric-light bath, 712.
evaporating sheet, 626.
fan douche, 483.
filiform douche, 485.
fomentation, 796.
friction, 164-7, 672.
graduated bath, 537.
half chest compress, 862.
heat, 141.

heating compress, 825.
hot blanket pack, 623.
hot air bath, 690.
hot and cold compress, 842.
hot and cold heating pack, 848.
hot and cold pack, 840.
hot douche, 447.
hot foot bath, 757.
hot immersion bath, 540.
hypogastric douche, 499.
insolation, 723.
irrigation of bladder, 905.
irrigation of intestine, 898.
leg pack, 880.
light, 168-80.
localized douches, 492.
massage douche, 487.
neck compress, 866.
neutral bath, 549.
neutral douche, 452.
neutral sitz bath, 770.
oil rubbing, 684.
outdoor bath, 961.
pail pour, 518.
pelvic pack, 876.
percussion, 682.
precordial compress, 868.
prolonged cold sitz bath, 76s.
rain douche, 474.
revulsive compress, 819.
revulsive douche, 468.
salt glow, 642.
Scotch douche, 463.
shallow bath, 596.
sitz bath. 763.
sponge or towel bath, 636.
sun bath, 723.
tepid immersion bath, 538.
thoracic douche, 498.
Turkish bath, 696.
vapor bath. 703.
very hot sitz, 769.
visceral douches, 505.
water, 95.
wet girdle, 830.
wet-hand rubbing, 630.

Physiological effects of wet-sheet

pack, 604.
Physiology of hydrotherapy, 53.
Pine-needle bath, 955.
Pitting in smallpox, 998.
Plague, 616, 647, 809, 1016.
Plantar douche, 502.

region, anesthesia of, 758.
Plethora, cold rain douche in, 476.
Pleuritic adhesions, chronic, 499.

pains, 465.
Pleurisy, 266, 278, 281, 339, 599, 805,
864, 1077.

chronic, 612, 862, 1078.

in febrile disorders, acute, 10 18.

in influenza, 1013.

parietal, 780.

in rheumatism, acute, 1007.

in scarlet fever. 995.

tubercular, 1078.
Pleurodynia, 499, 804.
Pliny on sun bath, 724.
Plunge, cold, 523.

cold, contraindications, 525.

cold, physiological effects, 524.

cold, therapeutic applications.
525.
Plutarch on sun bath, 723.
Pneumonia, 278, 281, 339, 599, 603,
610, 624, 683. 785, 786, 805, 828.
R^l^ 864, 1003.

broncho-, 278, 544, 844, 1077.

broncho-, in smallpox, 998.

chronic. 612, 862.

in diabetes, 1026.

ice to chest in, Mays, 787.

in influenza, 1013.

lobar, 278, 1003.

in measles, 096.

mortality of, 286.

in rheumatism, acute, 1007.

in scarlet fever, 995.

tepid bath in, 539.

in typhoid, 983.
Poisoning, alcoholic, 705.

carbonic acid gas, 822.

drug, 818.

lead, 800.

malarial, 764.

opium, 639. 800, 818.

prussic acid, 822.
Poisons, elimination of, 970.
Poliomyelitis, anterior, 810.
Pomare, Maui, on vapor bath, 702.
Portal circulation, 740.

congestion, 272.

reservoir, 277.
Pospischil. on effects of friction dur-
ing cold bath, 93, ia6. 165.

► 771. 1093.

im;9«

CMCtS i

tiiowcr iMidiy ^S!*!}*

; ti cold, 193'

exdtant effects^ 19^-^07.

and secondary effects of cold, 100.
Procedures, derivative, 255.

heating, 225.
Proctitis, 804, 847.

Prolapse, rectal, cold ascending
douche in, 481.

of stomach, 832.

uterine, 513.

uterine, cold douche in, 481.

uterine and ovarian, 877.
Prostate, acute inflammation of, 881.

alternate douche to, 472.

chronic inflammation of, 766.

congestion of, 245, 764.

enlarged, 513, 905, 915.

hjrpcrtrophy of, 503.

hypertrophy of, alternate douche
m, 481.

inflammation of, 267, 847, 896,
9Q2.

irritable in lithemia, I0!22.

irritable, in spermatorrhea, 1093.

painful affections of, 766.
Prostatitis, 503, 600, 804, 8;^ 1092.
Prostatorrhea, 503.
Pfx>tected heating compress, 824.
Protectiye applicatkms, ^fi.

SoBL
colli, for

Sl

84i8S?*3.

hemorrhage in tnberctilo!

inflammation, 863.
tuberculosis, 646, 862, 101
tuberculosis, cough in, 86
tuberculosis, night sweats

862, 1020.
See Lungs.
Pulsation of spleen, 59.
Pulse, 60.

dicrotic, 647.

frequent, in arthritis del

1086.
slow, in functional card
ease, 1062.
Punjura, 647, IQ29.

in emadatioD, 1029.
Pylorus, obstruction of, 887.
iryrosis in dilatation of stoma'
Rabbits, experiments upon, 5

604.
Rachitis, rickets, 647, 1029.

in emaciation, 1009.
Radiation, of oiled surface, 66
Rain douche, 473.

cold, combined widi Rossi

477.
exating effects of, 474.

INDEX.

II81

Rain douche, graduated, 476.

horizontal, 479.

hot, 475, 478.

neutral, effect on brain, 475.

neutral, local effect, 265.

physiological effects, 474.

Schiiller on, 475.

Scotch, 465.

soporific effect of, 478.

therapeutic applications, 476.
Ray, actinic, 169, 196.
Raynaud's disease, 456, 618.
Reaction, 129-40.

atonic, 262.

atonic, from hot douche, 447.

circulatory, 241.

conditions that control, 347.

conditions that favor, 133.

conditions that discourage, 134.

counterbalancing, 138.

deficient, cause of, 371, 417.

to establish, 408.

excessive, 418.

fever of, 385.

and friction, 603.

incomplete, 132.

internal, 727.

oscillatory, 347.

second, 132.

from sunlight, 169, 170.

supression of, 127, 348.

therapeutic sigfnificance of, 346.

thermic, 135-46, 241.

tonic, 131, 262.

vital, 16.
Rectal catarrh, 245, 902, 915.

fissure, 505, 915.

irrigation, Reclus, 896.

irritation, 881, 902, 1094.

lavage, 902.

prolapse, cold ascending douche
in, 481.

tenesmus, 504, 771, 852. 881.

ulcer, 267, 505, 707, 778, 915.
Rectum, 739.

affections of, 766.

irritable, 1094.

irritable, local inflammation in,
1094.

irritable, warm douche in, 481.

leucorrhea of, 881.

neuralgic affections of, 1051.

to restore sensibility of. in consti-
pation, 1036.

temperature of, 80.
Reclus on rectal irrigation, 896.
Reduction of flesh, 598.
Reflex action, 728.

activity of cerebral g^anglia, 610.

: Reflex areas, cutaneous, 117.
I effects of cold, 116.

effects of cutaneous thermic ap-
I plications, 96.

I effects of hot applications. 154.

effects, methods of producing.
; 119.

I irritations, 499, 610.

neuralgias, 1050.

relations, 725, 734. 936-^-
Reflexes, 73.
Relapsing fever, 609.
Remier, statistics in scarlet fever,

586.
Remittent fever, mo.
Renal activity, 496, 607.

activity in acute nephritis, 1045.

calculus, 512, 624, 800.

colic, 266, 546, 1045.

colic in lithemia, 1022.

compress, hot and cold, 846.

congestion, 462, 497, 512, 808, 832.

congestion in acute nephritis,

1045.

congestion, anodic galvanism in,
941.

disorders, 375, 450.

disorders, cold bath in» 233.

douche, 238, 512.

dropsy, 637.

headache, 1068.

hemorrhage, 777, 857.

hemorrhage in plague, 10 16.

insufficiency, 244, 472, 496.

plexus, irritation of, 496.

vessels, 739, 741, 777.

See Kidney.
Rendu on wet-sheet pack, 602.
Resolvent effects, 257.
Rest in acute gastric catarrh, 1030.

in bed in hemorrhoids, 1094.

metabolism diminished by, 978.

physiological, in chronic gastri-
tis, 1030.
Respiration, cutaneous, 67.

effect of cold upon, no.

effect of heat upon, 144, 149.
Restorative effects of cold, 208.

effects of heat, 151, 152.

effects of hot douche, 450.
Retention, urinary, 495, 49O, 497.
Retinitis, 809.
Retrostasis, 103, 461, 729.
Revulsion by alternate applications,
250-1.

as an analgesic measure, 251.

by cold, 248.

by heat, 247.

by heat and cold, 247-9. 640.

Il82

INDEX.

Revulsion for relief of pain, 251.
Revulsive ascending douche, 481.

compress, 818.

compress, physiological effects,
819.

compress, therapeutic applica-
tions, 820.

douche, 451, 466.

douche to back, 497.

douche, fan, 484.

douche, physiological effects of,
468.

douche, Scotch, 252, 500.

douche, therapeutic applications
of, 468.

effects, 241, 718, 799. •

effect of electric-light bath, 709.

eflFects, general, 253.

effects of hot blanket pack, 254.

effects of hot immersion, 253.

eflFects of neutral douche, 451.

effects of Scotch douche, 457.

effects, simple, 247.

methods to combat anemia, 242.

sitz, 267, 766, 770.

sponging, 640.

spray, 480.
Rickets, 647, 1029.

cold bath in, 28.
Riess on continuous bath, 539, 558,

559.
Rheumatic affections of head, 839.

exudates, 484.

gout. 1085.

headache, 1067.

joints, 457, 680. 693. 828.

pains, 385, 599. 700, 806, 829.

pains in scalp, 855.

pains in shoulder joints. 497.
Rheumatism, ZTJ, 457. 484. 618. 640.
661, 691, 705. 716, 719. 720, 723.

acute. 445, 815.

articular, 515, 804, 828, 1006.

chronic. 44s, 485, 545, 560, 621,
661, 828, 880. 1009.

cold applications in, 221.

gastric. 498.

hot baths in, Laseque, 546.

massage in, 953.

muscular, 466, 471, 514, 515, 546,
624, 829, 1025.

and neurasthenia, 553.

neutral bath in, Vigoroux, 553.

in scarlet fever, 995.

subacute. 624.
Rheumatoid influenza, 1013.
Robertson, cold bath in alcoholic in-
toxication, 534.

Robin on extractives, 576.
Rogers on destruction of to

liver, 576.
Rohrig on friction, 164, 672.
on perspiration and const

598.

Rokitansky, 925.
Roller compress, 853.
Romans, oil rubbing used by, (

Turkish bath among, 694.
Romberg on heart failure, 580

on peripheral vessels, 579
Roque, toxins in urine of

fever, 575.
Rosenbaum, gastric lavage, 88
Rub, cold towel, 307, 647.

contraindications, 653.

method, 648.

physiological effects, 651.

requisites, 647.

therapeutic applications, t
Rub, wet-sheet : Sec Wet-she<
Rubbing, oil, 612, 684.

among natives of Africa,

method, 684.

physiological effects, 684.

in Samoa, 685.

therapeutic applications, (

used by Romans, 684.
Rubbing shallow bath, 203, 64:

sitz bath, 645.

sitz bath, cold, 767.

sitz bath, cold, contraindi
768.

sitz bath, cold, physiolog
fccts, 767.

sitz bath, cold, therapeuti
cations, 768.
Rubbing, wet hand : See W

rubbing.
Rubbing wet sheet, 203, 660.

contraindications, 663.
Runge, Max, 271.

vaginal irrigation, 910.
Running or flowing foot bath.
Rush. Benjamin, clay compn

on enema, 894.

on ice compress, 313.
Russian bath, 675, 698.

cold rain douche with, 47;

contraindications, 700.

in Finland, 699.

therapeutic applications, 7
Saline baths, 955.

composition of, 955.
Salpingitis, 600, 829, 879.

chronic, 462, 1091.
Salt glow. 641.

INDEX.

II83

Salt, physiological eflFects, 642.

therapeutic applications, 642.
Salt with wet-sheet rub, 661.
Samoa, oil rubbing in, 685.
Sand bath, 620.
Scalp, failing nutrition of, 839.

rheumatic pains in, 855.
Scarlatina, 624.
Scarlet fever, 547, 611, 809, 846, 994.

acute nephritis of, 546.

statistics in, Remier and Schill,
586.

cold affusion in, Currie, 522.
Schiff, 57, 297.

Schill, statistics in scarlet fever, 586.
Schlikoff, 862.
Schrott, of Graefenberg, on water

drinking, 925.
Schiiller, 114.

on cold applications, 935.

experiments by, 95, 103, 114, 604.

insomnia, 833.

on rain douche, 475.

warm enema, 899.

wet-sheet pack, 610.
Schultz, on water drinking, 922.
Schultze, cooling of tissues, 773.

experiments on lowering tem-
perature, 783.
Schumann, heat radiation, 685.
Sciatic neuralgia, 599, 600.
Sciatica, 267, 445, 457, 465, 47i, 48.^
485, 486, 515, 560, 599, 600,
621, 691, 700, 705, 769, 804,

879.

acute, 820.

chronic, 683.

cold massage douche in, 490.

in diabetes, 1025.

hot massage douche in, 491.

leg pack in, 268.
Scleroderma, 809.
Sclerosis, 716.

amyotrophic lateral, 1054.

disseminated, 1053.

hepatic, 272, 446, 837.

lateral, 1053.

multiple, in typhoid, 985.

posterio-lateral, 1053.

spinal, 457, 496, 508, 560, 1053.
Scoliosis, I Id.

Scotch douche, 161, 456, 496, 497, 499,
675, Til. 837, 942.

abdominal, 501.

to back, 496.

Bougarel on, 466.

circulatory reaction after, 464.

in climacteric disturbances, 465.

Scotch douche, depressing effects of,
464.
derivative effects of, 457.
epigastric, 499.
exciting effects of, 463.
fan, 497.
forms of, 458.
Glatz on, 466.
graduated, 457, 459-
localized, 457, 465.
lumbar, 497.

physiological effects of, 463.
rain, 465.

revulsive, 251, 500.
revulsive effects of, 457.
revulsive, in neuralgia, 252.
simultaneous, 460.
special forms of, 461.
symmetrical, 462.
therapeutic applications, 464.
tonic effects, 458, 463.
Scrofula, 1020.
Scurvy, 609. 647, 1029.

in emaciation, 1029.
Sea baths, 567.

precautions in, 568.
therapeutic applications, 568.
Secretion, effect of cold upon, 122.

effect of wet-sheet pack on, 611.
Secondary effect of cold, 193.
effects of heat, 192.
excitant effects, 206.
Sedative applications, untoward ef-
fects of, 263.
effects, 260.

of abdominal compress, 264.
of cold, 261.
of douche, 264.
of electro-hydric bath, 946.
of fomentations, 796.
of heat, 261.
of warm baths, 264.
of wet girdle, 264.
of wet-sheet pack, 265.
Sedatives of the circulation, 262.
Seminal weakness, 453, 513, 764.
Senile gangrene, 761.
Sensibility, anemia of skin increases,

939-
of nerves diminished by absorp-
tion of water, 279.
Septicemia, 618, 621. 624.
Sexual dementia. 508.
erethism. 853. 855.
organs, atony of, 471.
weakness, 877.
Shallow^ bath. 594, 610, 837, 1103.
in chronic diseases, 597.

Ii84

INDEX.

■i

1

'}

i

f

>f

■i

;■!-

,■'.

■k'

i

■J •■
■i

I

i.

Shallow bath, contraindications, 599.

hot, 597, 599-

physiological effects, 596.

Pospischil on, 596.

rubbing, 203, 645.

standing, 596.

therapeutic applications of, 597.
Shallow foot bath, 755.

therapeutic applications, 755.
Shampooing, dry, 683.

dry, therapeutic applications, 683.
Sheet, dripping: See Dripping sheet.

evaporating : See Evaporating
sheet
Shock, 620, 809, 855.

expression of, 287.

in functional cardiac disease,
1081.

surgical, 1102.
Short cold bath, 208.
hot bath, 209.

Shoulder-blades, pain in, 801.
Shoulder douche, 497.

joints, rheumatic pains in, 497.
Shower bath, 472.

advantages of spray over, 480.

Priessnitz's use of, 473.
Shower pack, cold, 305, 616.

cold, contraindications, 617.

cold, therapeutic applications,
617.
Shutz. irrigation of urethra, 907.
Sick-headache, 808.
Sinnihancoiis douche, Scotch, 460,

461.
Sinclair, Jolin. wet-sheet pack used

by, 29.
Sinusoidal, catliodic, and faradic ap-
plications in amenorrhea, 942.

current in apepsia and hypopep-
sia, 941.
Sinus, cavernous, 735.

lateral, 735.

longitudinal, 734. 'j'SS-

occipital, 735.
Sitz bath, 761.

cold. 762.

cold, contraindications for, 764,
766, 767.

cold, as a derivative measure,
764.

flowing. 762.

hot, 599, 769.

hot. emmenagogic effects of, 240.

method, 761.

neutral, 770.

neutral physiological effects of.
770.

physiological d
therapeutic appli

applica

Sitz bath, neutral therapeutic appUc

tions, 771.
physiological effects, 76^-
prolonged cold, 764.
prolonged cold, phyiological e

fects, 765.
prolonged cold, therapeutic ai

plications, 765.
revulsive, 762, 766, 770.
rubbing, 645.
rubbing cold, 767.
rubbing cold, contraindicatiooj

768.

rubbing cold,

fects, 767.
rubbing cold,

cations, 768.
therapeutic applications, 763.
very hot, 769.
very hot, physiological effects oi

769.
very hot, therapeutic

tions, 769.
Wintemitz on, 765.
Skin, 62.

absorption by, 67.

activity of, in Bright's disease

1046.
anemia of, 597, 93s).
in chronic diseases, 224.
chronic inactivity of, 928.
diseases, 376, 446, y^^.
disorders, 700. 1096.
drv. 472. 1097.
dry in diabetes, 1027.
dry, heat elimination dimini^he'

dry, heat elimination of. Her?

5-8,

dry. in melancholia, 1064.
dry, in rheumatism, chronic. looc
effect of cold upon, 104.
effect of heat upon. 142.
elimination. Bouchard and Brun

ner and Leydcn on. 578.
eruptions in syphilis, 1095.
eruptive disorders. 419, 522, 680.
friction of, and increased elimi

nation. Wcyrich, 578.
gangrene, Hebra on, 558.
heat loss from, 84.
hyperemia. 759.
hy|)eresthesia of. 442. 446. 45^

486, 707.
inactive, 472, 661. 676, 723
inactivity of. chronic. 928.
irritation of. 789.
nerves of. 67.

INDEX.

1285

Skin, neuralgia of, 446.

as a regulator of temperature,

967..
sensitiveness of, 706.
Sleep, temperature during, 82.

neutral bath to encourage, 395.
Sleeplessness: See Insomnia.
Sloughing, 471.

Smallpox, 547, 611, 809, 846, 998.
Snegirjow, steam in hemorrhage, 919.
Solar plexus, hyperesthesia of, 499,
510, 801, 851.
irritability of, in insomnia, 1070.
irritation of, in nervous dyspep-
sia, 1039.
irritation of, in neurasthenia,
1060.
Somnolence in diabetes, 1026.
Sordes in typhoid, 981.
Sound, cooling, 913.
Spasm, 749.

anal, in hysteria, 1059.
of bronchioles, 799, 864.
clonic, in spinal sclerosis, 1053.
intestinal, 244.

in laryngismus stridulus, 1074.
muscular, 419, 515.
muscular, in meningitis, 1000.
muscular, in myelitis, acute, 1052.
muscular, in pelvic viscera, 852.
of neck of bladder. 497, 769.
in rectum, irritable, 1094.
of sphincter, 505, 902, 915.
vascular, 244, 245.
vasomotor, 272, 632, 756.
Spermatic cord, neuralgia of, 513.
Spermatorrhea, 420, 503, 504, 771, 855,

1093.
Sphincter muscles, spasm of, 505, 902,
915.
in constipation, 1036.
Spinal anemia, 495.
centers, 72.
excitability of, 453.

irritability of, 840.
compress, 264, 7^^, 856.

antipyretic effects of, 313.
cord in acute myelitis, 105 1.
anemia of, 840.
congestion of, 245.
effect of cold upon, Dr.

Oiapman, 778.
functional disorders. 705.
nutrition of, in locomotor
ataxia, 1054.
or dorsal douche, 495.

physiological effects of, 495.
therapeutic applications, 495.

75

Spinal douche, 462.

alternate, 264.

neutral, 270.

warm, 4^.
irritation, 265, 480, 484, 486, 495.
499, 638, 809, 820, 840, 852.

hot spray in, 480.

in hysteria, 1058.

in nervous dyspepsia, 1039.
neuralgia, 456, 480, 515, 8^9, 1050.
pack. 839.

hot and cold, 851.

ice, or ice compress, 244.

in insomnia, 265.

method. 840. .

requisites, 840.

therapeutic applications, 840.
sclerosis, 457. 496, 5o8» 560.
sponging, alternate, 264, 639.
Spine, alternate applications to, 820.
therapeutic applications, 822.
alternate sponging of, 639.
antipyretic effects of ice-bag to,

313.
apoplexy of, 856.
fomentations to, 802.
hot bag to. Dr. Chapman, 812.
hyperesthesia of, 840.
ice-bag to, 199, 244, 778.
irritable, neutral douche in, 453.
meningeal inflammation of, 856.
organic affections of, 597.
percussion douche to, 455, 496.
structural disease of, 496.
Splanchnics, 75. 495, 501.
Spleen, congestion of, 245, 445, 462,
466, 599. 611, 612, 764, 798.
congestion of. chronic, 461, 661.
disorders of, 660.
enlarged, 471, 511, 798.
enlarged, in scarlet fever, 995.
enlargement of malarial, 511,

748. 990, 992.
pain in, 461, 512, 677.
pulsation of, 59.
Splenic douche, 51 1.
Spoliative effects, 227.

of sweating pack, 607, 608.
Sponge bath, 634.
alkaline, 638.

cold, as an antipyretic, 307.
contraindications, 640.
Currie on, 637.
hot, 309.
method. 634.
neutral. 639.

physiological effects, 636,
tepid, 639,

US6

INDEX.

f

1^

Sponge batli, therapeutic appUcations,
636.

very hot, 638.
Spotjglng, alternate, ig6.

alternate spinal. 264. 6^.

hemostatic efifects of, 6^8.

hot, 638.

revulsive, 640.

very hot, for prurilis, 2,^

and warm compress antl- spas-
modic effects of, 270.
Sprains, 268, 640, 677, 754, 7sS» 800,
815* 1 100.

arm, 75Q.

hot applications for. 368,
Spray. 479.

advantages ovtT shower, 4S0.

douche, cold, 502.

eihcr. 106. 197. 270.

horboiiUlj 479.

hot. 479.

less exciting than full jet 4S0,

Lister's, gso.

neulraU in ataxic pains, 480.

revulsive, 480.
Square chest pack. 8^)8,
Stadelmann on enema. SgS^
Statistics in scarlet fever, Remkr and
SchiU, 586.

in typhoid. Brand, 585-
Jacqticz. S92,
O^ler, 586.

in typhus, Cirrric, 530.
Steam inhalation, 915.

jet, 197. 919'

jet in hemorrhage, Kiliani and
Snegirjow. gig.
Sterility, 768, 1092*
Srimulant effects of heat ^42.
Stob, enema in typhoid, 896.
Stomach, 739.

alternate douche to, 472.

atonic condition of, 484, 498, 940.

cancer of, 778.

dilatation of, 472, 498, 661, 768.
832. 888, 1033-

dilation of, gastric douche in,
510.

distension of, 750, 1033.

effects of heat upon, 158.

hemorrhage of, 198, 892.

inflammation of, 445.

irrigation of, 884.

irrrigation of, method, 884.

motor disturbances of, 850.

pain, in chronic gastritis, 103 1.

painful affections of, very hot
gastric douche in, 510.

prolapse of, 832.

Stomach, sensory disturbm^ oi» ig
ulcer of, chronic, 49gv 77S. ^
See Gastric. H

Stomach' tube, 884. ^

contraindications, 8qo»
Stools in cltronic inleiittnal caUn
1041,

in cholera infantum. 1040.
Storosc!^eff on cold doiiche* 437»
Strain. 754. 800.

Strangulated hemorrhoid*, T?!.
Slrasscr on effects of cold bsUH, gjt

eJtperiments of, 12X

exf>erimetits on rale of hmik
of compress. 8j«i. ^m

on wet -sheet pack, 600. ^M
Strychnia. 210, 869. ^B

Stupor. 647.
St, Vitus's dance, iteistral doticfac 1

, 453* ,
Subinvolution of utefUS^ M$m 0

Submuct:rus fibroids, 941, ^H

Sudorific effects, 223.

Suffocation in diphtheria ftfid lodfi

Sugar in sweat, 66. ^M

tn urine, 413. ^H

Sniphur bath. 956,
Summary of effects of cold.

of effect* of lieat, 185.
Sun bath, igC\ 722.

Diogenes and Plutarch on. 7^

Hippocrates and Phny on, 72+

physiofog:ieal effects. 723.

precatttions, 724.

therapeutic applications. 723.
Smibum, t6g.
Sunstroke, to6o.

with pallor, 404, 751*

PauUis of .-Eg^ina, and WiatG
nitz on, 633.
Supporter, abdominal, 497.
Suppurating kidney in typhoid, 985.

processes. 600.
Suppuration, localized, 817.

in smallpox, 998.
Surge bath, 567.

therapeutic applications. 567.
Surgery, abdominal, 638, 1101.

abdominal, enema in, 893.

abdominal, sweating bath in. 234
Surgical cases, application of hydr
therapy in, iioo.

fe»'er, 1102.

shock, 1 102.
Swartz, Dr., on effects of hot bath,
Japan, 543.

INDEX.

1 187

Sweat, 63, 66.

See Perspiration.
Sweating bath, 225.

circumscribed, 236.

in colds, 238.

contraindications, 236, 237, 335.

elimination by, 235. 236.

expectorant effects, 22^7.

in icterus, 234.

in malaria, 991.

prolonged, 236.

in surgery, 234.

use of, 393.

use of, by Finns, 719.
Sweating feet, 880.
Sweating pack, 611, 617.

contraindications, 619.

spoliative effects of, 607, 608.

therapeutic applications, 618.
Sweating procedures, alterative ef-
fects of, 258.

procedure, electric-light bath as,

stage of pelvic pack, 875.

stage of wet-sheet pack, 607.
Sweats, night, in pulmonary tubercu-
losis. 638, 862, 1020.
Sympathetic, functions of, 76.

ganglia, 75.

ganglia, hyperesthesia of, 456.
482. 828.

ganglia in neurasthenia, 1060.

ganglia of pelvis, 500.

ganglia, prevertebral, 75.

irritation of abdominal, 622.

nerve disorders, 801.

nervous system, 75, 611.
Syncope. 519, 752. 822. 855.

fatal, prevented, 807.

in gout, 1024.

hot affusion to head in, 494.

in hysteria, 1058.

in malaria, 992.
Syphilis. 618, 718, 720, 1095.

tertiary, 705.
Syphon hot-water bag, 812.

sack. 849, 850.
Table of areas of transferred pain.
945.

classification of hydriatic effects,

classification of temperatures,

100.
of comparative effects of heat and

cold. 188.
Tachycardia. 869.

in functional cardiac disease,

1081.

Tachycardia in rheumatism, 1008.
Tactile sense, effect of heat upon, 145.
Tamier, hot bath in vaginal dis-
charge, 547.
Tea habit, 618, 1099.

in typhoid, 587.
Technique of hydrotherapy, 423.
Temperature of baths. 346, 422.

Beni-Barde on, 591.

body, and heat production, 91,
158.

classification of, 100.

conditions which decrease, 92.

conditions which increase, 92.

due to local infection, 522.

effects of breathing on, 314, 315.

effect of digestion on, 81.

effect of douche on, 430-5.

effect of exercise on, 81.

experiments on lowering the,
Schultze, 783.

of internal organs, 80.

local, effect of hot massage
douche on, 488.

normal, 79.

to obtain without thermometer,

49.
of rectum. 80.
reduction of, 80, 783.
reduction of, enema in, 894.
sense, 69.

sense, effect of cold upon, 106.
sense, fatigue of, 70.
skin as a regulator of. 967.
subnormal, 334.
subnormal, in typhoid, 986.
in typhoid, 982.
of water, drinking. 929.
Tenesmus, anal, 769.

rectal, 504, 769, 771, 852, 881.
urethral, 881.
vaginal, 504.

vesical, 500, 504, 513, 769, 771,
852. 881.
Tepid bath in pneumonia and typhoid

fever, 539.
Tepid douche, 436.

douche, dorsal. 495.
douche, to head, in cerebral ex-
citation, 494.
douche, massage, 489.
douche, short, 752.
immersion bath, 538.
immersion, continuous, 539.
in hysteria, 561.
physiological effects of, 538.
therapeutic application of.
538.

l^UF-S.

Tepid spctiigc bath. Gsa

thumcic dcnichc, fan, 4fK>-

T«slicks, inflammation oi, 4^1, loOK
neuralgia oU 515. 7^ 771^

Tctmy. 610, 705. 71&. 909,

Tliaycr on <*(Tcct of coU batli on cor-
puscles. 582.
on Icucocytosisp 571.

Therarwiiiic applications, ablution.

ajiphcations, allematep to spine*

822.
baih. Brands 57^1.
coniini^ous, 558.

electric- light, 717,

footp eold. 754-
foot* flowing* 756.

foot* hot. 757.

full, ooH* 5:29.

graduated, 537,

hot air, 6no*

Itot air. WaL 6a,V

immersion, hoi* 544

immersion* tepid. 5,18^

mud* 569-

ncutral* 55^

outdoor, 960,

Rtis^i^n* 70a

sea. sfiS.

shallow. S97'

ste* cofd, 7*5.1.

sit2* cold rubbing, 768.

siu, nemraU 77^

sitE* prolonged cold. 765-

siti, very hot, 7^

sun* 7^

surge. 567-

Turkish. 697.

vapor* 704.

vapor, local* 7o5,
coloclyster. 899.
cornpress, 77 1»

abdominal heating* 836.
I alternate. 817

cephalic* S55.

cold, 784.

evaporating, 789.
*• * heating, &2B.

hoi and cold. 842.

nedc. 866.

neutral, 8T4.

perineals 88t,

prcoordial. 868*

rcvuTsi^TC* 83a
cooling coil. 7S8.
douche* 432.

aUemmte, 471, ,Ac

Therapeutic applkatkms — cjontivitt
douche* arttcular. 514,
bladder* 905.
cephalic, 4^
dorsal or spinal^ 4^
epigastric, 49**.
fan* 48 .V
61iform* 485.
fog* m*
hot, 44Q

hypogastric, SW-
mas^sage* 4^
neutral* 45*'
percussion. 455,
perineal. 50J.
rain, 4^
revulsive* 468.
Scotch* 464^
dnpptng sheet, 659

dry shampoomg. fA^
effec

fects of hydriaiic apofie^atiEii
190.
evaporating sheet. 6^.
fomentations* 5^98.
friction* 674-
friction, cold, 64 S-
gastric lai*ajge. 887*
horijouLal jet, 440.
irriga^tion of bladder* 1
pack, chesi, 862.

cooling. 616.
dry. 620.
foot. 880.
hot-blanket, 624
leg. 880.
pelvic* 877-

pelvic, hot and coliL 85^
shower* cold* 617.
spinal, 840.
sweating, 61 8L
wet'Shcet, 60?^
pail pour, $>*>-
percussion. 682.
plunge, cold* 5a<.
oi! rubbing. 685*
towel rubbiftg. cold. 6$^
wet -hand rubbing* 6jol
wet -sheet rtab. 659.
salt glow, 642.
water drinking* ^3.
wet girdle, 831.
Therapeutic signt6caiicc of reaetit

346,
Thermes on ieucocytosis, 97? .
Thermic applications, cutatteocrs« 1
flex effects of, 96.
fever, 1069.
functions* 9aL *---

INDBX.

1 189

Thermic reaction* i3S-4a
Thermo-electric bath, 948.
Thermo-clectrical effects of cold, 129.
Thermogenesis, lessened, 624.
Thermometer, 50.

temperature test without, 49^
Thermometry, 48.
Thermophore, 813, 84Q. 850.
Thirst in diabetes, 1026.
Thompson, experiments on dogs, 783.
Thoracentesis, 774.
Thoracic compress, 862. •

douche, 497.

douche, physiological effects of,
498.

douche, tepid fan, 499.
Threadworms. 898.
Throat, catarrh of, 376.

compress, 853, 865.

fomentations to, 802.

irrigation of, 8B3.

rawness of, 884.

sore, 866.

sore, clergyman's, 866.
Tic. 809.
Tissue cooling by ice, TJ^, 774.

toxins, elimination of, 607.
Tobacco habit, 611, 618, 1099.
Todano, ice water in fever, 921.
Tonic effects, 209.

effects of hot douche. 450.

effects of Scotch douche, 4=8

^^•^
pack, 609.

pack, hip, in amenorrhea, 241.

reaction, 131, 262.

stage of pelvic pack, 874.

stage of wet-sheet pack, 6o6w
Tonics, medicinal, 210.
Tonometer of Gaertner, 931.
Tonsillitis, 802. looi, 1072.
Tonsils, enlarged, 917.

follicular, hypertrophy of, 917.
Toothache, 778, 801, 820.
Torcular, 735.
Torticollis, 810. 867.
Tourette, Gilles de la, on exophthal-
mic goiter, 662.
Towel chest pack, 860.

rub. cold: See Rub, cold towel.

rub. wet. 307.

or sponge bath. 634.

or sponge bath, physiological ef-
fects of, 636.

or sponge bath, therapeutic ap-
plications, 636.
Toxemia, 457, 554, 639. 691, 718, 823.
8961

Toxemia, chronic, 609, 618, 624. 646,
705.

chronic, cold douche in, 443.

in chronic dyspepsia, 609, 700,
718.

in chronic malarial infection, 609.

in diphtheria, 1002.

eliminative baths in, 236.

in hyperpepsia, 1033.

in locomotor ataxia, 1054.

in neuralgia, 1050.

in neuritis, 1048.

in neuritis multiple, 1049.

in tonsillitis, 1002.
Toxic headache, 1067.

insanity, 1065.
Toxicity of urine in typhoid, 587.
Toxins, absorption of, 897.

in bronchitis, acute, 1075.

in functional cardiac disease,
1082.

in liver, Rogers on destruction of,
576.

in nephritis, acute, 1045.

procedures which encourage de-
struction of, 97a

procedures to encourage elimina-
tion of, 970.

tissue, elimination of. 607.

in urine in typhoid tever, Roque
and Wile, 575.
Training for cold douche, 441.

hydriatic, 378.

of neurasthenics, 457.

of patients, 409.
Traumatic arthritis, 64a
Treatment, appearance of sugar in
urine under, 413.

increase of blood alkalinity un-
der, 413.

increase of urea under, 413.

loss of appetite under, 412.

loss of flesh under, 410.

loss of muscular strength under,
412.

pain caused by, 417.

palpitation under, 414.
Triangular chest pack, 859.
Trousseau, ^09.
Trunk pack, cold. 238, 622.

pack, hot and cold, 240, 849.
Tubercular pleurisy, 1078.
Tuberculosis, 339. 609. 646, 818.

in emaciation, 1026.

Finsen of Copenhagen on, 721.

of joints, 815.

of lymph glands, 810, loao.

pulmonary, 646, 862, 10191

1ew.HT.miik &i7t «p. m. 7^

7^6, no% UfS. S^. 8g4, 979.
fe^cT, %'A\XTyc diUtUtioQ ia« 892.
frber. tnvJcr hydriatic treatment

ftver, mortalhy rate ondcr faydri-

atk treatment, 285.
frKrr. tepid hath in, S39-
fever. U>xin» in arine of, 575, 587.
ice bajj* in, Dieolafojr, 777.
in mi'^nxs, f/^y,
in influenza, 1013,
nephritift in. 624,
with fmtrperzl (crer, €0L
fkin elimination in, Leyden, 578.
$»tafe in acnte febrile diforders.

1019,
state in plague. lor6.
tutistscs in* 585, 586, .^ga.
tea in, 587.

tyminnitif of, 803, 962.
Typhr>- malarial fever, 621, 989.
Typha«. 616. 809.

cold bath in. Surgeon Mc Gregor.

532-
fever. 610. loto.
fever. Carrie's statistics with

cold bath in, 5ja
and scarlet fever, cold affusion

in, Currie, 522.

Urethritis. 878L

chronic 30V 9D7.
Cnrtis 00. 907. 9d6l
Uric acid diathesis, 39B. ;
1021.
acid in nrigraine, 1062.
Urinary incontinence, 495. f
768. 801. 1047-
incontinence in hysteria,
rete-niir#n. 495. 497. Tfa^
secretion, scanty. 503.
Urine, observations on effect
tinuous neutral baih <
det. 558-
scanty, in cholera, 1014.
>canty. in gout, 1024.
scanty, in typhoid, 966.
soppresston of, 807.
suppression of, in rens

ICM5-
toxicity of, in tirphoid

tcmcssc. 587.
of typhoid fever, toxins i
Urticaria, 450, 554. ^^

in acute rheumatism, 100
Uterine colic, 769.

congestion, 852. 881, 9

944-

disease with dysmenorrb

INDEX.

II9I

Uterine disorders, (fJT, 764.

displacement, 503, 513, 768, iioi.

headache, 1069.

hemorrhage, 754. 776, 857, 878.

irrigation, 198.

neuralgia, 465, 497, 500. 513, 766.

pain, 500, 897.

prolapse, 877.

prolapse, cold douche in, 481.

vegetations, 941.
Uterus, 739.

elclrolysis to, 944.

hyperesthesia of, 852.

infantile, 496.

inflammation of, 445, 503, 804,
847.

inflammation of chronic, 500.

inflammation, subacute. 771.

irregular contractions of, 897.

irritability of, 501.

neuralgia of, 497. 500, 105 1.

subinvolution of, 245, 503, 513,
768.

tenesmus in, 881.
Uvula, elongated, 917.
Vaginal discharge, bloody, 548.

discharge, hot bath in, Tamicr.
547.

douche, Emmett, 909, 911.

douche, Peasley, 909.

irrigation, 198. 199, 908.

irrigation, ancient use of. 29.

irrigation, Max Runge on, 910.

leucorrhea, 881.

tenesmus, 504.
Vaginismus. 453. 500, 505, 513, 769.

771. 852. 855.
Vaginitis, 804. 878.
Vapor bath. 599, 612. 701.

contraindications. 706.

fog douche combined with. 486.

French author on, 702.

local. 259, 706.

local, therapeutic applications. 706.

physiological effects, 703.

prolonged. 705.

therapeutic applications, 704.

use of, by New Zealanders. 702.
Vapor douche, 515, 599, 707.
Vaporizers. 882.
Varicose veins, 837, 838.
Variola, Hebra. continuous bath in.

558.

Vascular depression in alcoholism,
521.

effects, internal. 748.

spasm. 646.
VasiliefF, hand bath, 760.

Vasoconstrictor nerves, effects of
heat upon. 143.

nerves, influence of reflex im-
pulse upon, 780.
Vasomotor centers, y^.

centers, stimulation of. 832.

disturbance, 272, 675, 801.

effects of hot douche, 447.

nerves, yz-

spasm, 272, 632.

spasm of extremities, 756.
Veins, esophageal, 741.

varicose, 837. 838.
Venous stasis, 828.
Vertebral ganglia, 75.
Vertigo, 383, 416, 828.

in neurasthenia, 1061.
Vesical excitation, 206.

hemorrhage, 766, 776, 906.

irritation, 453. 481, 495, 50i, 17\,
852.

irritation in incontinence, 1047.

paresis, alternate douche in, 481-

tenesmus, 500, 504. 513, 771, 852,
881.

See Bladder.
Vesiculie seminales, hyperesthesia of,

504.
Vigoroux, neutral bath in neuras-
thenia and rheumatism, 553.
Vinaj, 162.

on hot and cold bath. 312.
on cold applications, 935.
expermients of, 95.
Viscera, effect of hot douche on brain
and. 448.
in enteroptosis, 1037.
Visceral anemia, methods of combat-
ing, 243.
congestion. 245. 466. 612. 820, 836.
coneestion in plague, 1016.
douche, 505.
(louche, terms of. 506.
douche, physiological effects of,

505.

inflammation, 783.

inflammation in plague, 1016.

irritation, 833. 836.

pain, 484.
Vital reaction, 162.

resistance, 630, 647.
Vomiting, 778.

in alcoholism. 1098.

in anemia, 1083.

of bile, 850.

in cholera. 1014.

in cholera infantum, 1040.

in cholera morbus, 1042.

1 192

INDKX.

A i

I

: <

■i r ;y

Vomiting in dropsy, 1064.

in drug habits, 1098.

in erysipelas, 997.

fecal. 889.

in gall-stone, 1044.

in gastric catarrh, acute, lojo.

in gastric dilatation, 1OJ4.

in gastric ulcer, 1039.

in gastritis, chronic, 1031.

in hyperpepsia, 1033.

in hysteria, 1057.

in influenza, 1013.

in meningitis, 909.

in migraine, 1062.

in mumps. 100 1.

and nausea in smallpox, 998.

nervous, 496, 857.

persistent, 888, 892.

persistent, in emaciation, 1028.

of pregnancy, 851.

in renal colic. 1045.

in scarlet fever, 994.

in typhus, loio.

in yellow fever, ion.
Von Genersch on coloclyster, 899,

901.
Warm bath, 776.

in fever. Galen, 547.

sedative effects of, 264.
Warm compress, 279, 748, 749.

and sponging, antispasmodic ef-
fects of, 270.
Warm douche, abdominal, 501.

in anal fissure, 481.

in irritable rectum, 481.

spinal, 496.
Warm enema, Scbiiller on, 8^9.
Wasting disease. 646.
Water absorption. sensibility of
nerves diminished by. 279. 531.

analgesic eflFccts of, combinetl
with electricity, 944.

the best, to drink, 929.

carbonated, 930.

cold, effects of. upon the heart,
202.

Cullen's use of. in fevers, 27.

distilled. 930.

emetic, 890.

expectorant eflfects of. 238.

hemostatic effects of. 271.

Hippocrates on the use of. 22.

hot, antipyretic effect of. 288.

physiological effects of. 95.

physics of. 38.

quantity of, to drink. 029.

temperature of. to drink, 929.

Wesley's use of, 24.

Water-cure, the first, 29.
Water-drinking, 318, 920.

in ague, 29.

ancient use of, 24.

Bocker on, 922.

cold, effects upon the heart, 202

cold. Priessnitz on, 925.

Currie on, 921.

in dropsy, 923.

in fevers, Hahn, 92a

in " fever of Bender," Sir Jol
Chardin. 921.

free, when to avoid. 932.

Hippocrates on, 9aa

hot, 930.

Baron Liebig on. 923.

Priessnitz on, 920.

quantity. 929.

Schrott of Graefenberg on, 925.

Schultz on, 922.

Lawson Tait on, 932.

therapeutic applications of, 923.

and Turkish bath, 823.

Winternitz on, 927.
Weirs disease. 810.
Wells, Spencer, on the cold coil, 313
Wertheimer on cold douche, 437.

experiments of, 102.
Wesley's use of water, 24.
Wet friction, cold. 308.
Wet girdle. 829. 849.

contraindications. 834.

hypnotic effect. 833.

method. 830.

physiological effects. 830.

precautions and contraindica
tions. 834.

requisites. 830.

sedative effects. 264.

therapeutic applications. 831.
Wet-hand rubbing. 627. 1 103.

contraindications. 633.

method. 627.

physiological etTects. 630.

therapeutic applications. 630.
Wet -sheet pack. 600.

alterative effects of, 2'8.

antipyretic effects of. 284, 003.

in China, 21.

contraindication>>, (313.

cooling. 304.

cooling stage, 606.

effects of. 611.

eliminative effects of. 604.

heating effects of. 604.

Kussmaul on, 602.

Lucas. 600.

method. 6co.

INDEX.

1J93

Wet-shect pack, neutral, 264.
• neutral stage, 607.

physiological effects, 604.

Priessnitz, 600, 606.

Rendu on. 602, 603.

requisites, 600.

Schiiller's experiments, 610.

sedative effects, 265.

Dr. Strasser of Vienna on, 600.

superheating stage, 607.

sweating stage. 607.

therapeutic application. 609.

used by jockeys, 28.

used by John Sinclair. 29.

Wintcrnitz on, 284, 600.
Wet-sheet rub. 203. 610, 653. 660. 837,
1103.

contraindications, 663.

method. 653.

physiological effects, 658.

requisites, 653.

salt, 661.

therapeutic applications, 659.
Wet-towel rub, 307.
Weyrich. 166.

on friction. 578, 672-
Whooping-cough, 647. 866. 102 1.
Wile, toxins in urine of typhoid

fever, 575.
Wilson. J. C. 285.

Wintemitz. 108. 120. 126, 154, 156. 164.
166, 177, 209. 313. 429, 862.

abdominal pack, 849. 850.

on antipyretics, 287.

calorimeter of, 89.
on cold applications, 935.
Wintemitz, cold to artery, 791.
cold cardiac compress, 870.
on cold sitz, 766.
on cooling compress, 781.
on coling pack, 603.
effect of cold bath on corpuscles,

582.
on electric-light bath, 710, 714.

715..

experiments on rate of heating.
826.

on friction. 673.

heat elimination in fever. 583.

hot and cold abdominal pack. 849.

hydriatic treatment of fevers, 592.

on ice-bags, 787.

on leucocylosis, 971.

on prolonged cold sitz, 76s.

on psychrophore. 913.

reflex relationships, 937.

on sunstroke. 633.

on water-drinking, 927.

on wet-sheet pack. 284. 600.
Wonte. enema in colic, 897.
Woolsey on reflex relations, 734.
Wounds. 761. 790.

bleeding from, yyy.

inflamed, 775.

painful. 268.
Wright, Dr., 519.
Writer's cramp, 456, 1063.
Yellow fever. 616, 624, 647, loi i.
Ziemssen, 303.

%

d