Chapter III: Part 3

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

Tem. 53°. Tem. 212°.
2 qts. added to 1 qt. equals 3 qts. at 106°
2½ „ „ 1 „ „ 3½ „ 98°
3 „ „ 1 „ „ 4 „ 93°
4 „ „ 1 „ „ 5 „ 85°
5 „ „ 1 „ „ 6 „ 80°
6 „ „ 1 „ „ 7 „ 76°
8 „ „ 1 „ „ 9 „ 71°

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

RULES FOR BATHING.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

GENERAL BATHS.

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

SWIMMING.

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

PLUNGE BATH.

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

SPONGE BATH.

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

The temperature of the bath should not be above 95°, and 90° is generally better. Most people can habitually employ a temperature of 75° or 80° without injury. The use of a much lower temperature is not commonly advisable, and is often productive of great injury.

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

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

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

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

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

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

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

RUBBING WET-SHEET.

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

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

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

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

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

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

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

WET-SHEET PACK.

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

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

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

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

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

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

SHOWER PACK.

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

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

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

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

DRY SHEET PACK.

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

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

FULL BATH.

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

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

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

HALF BATH.

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

SHALLOW BATH.

Of this bath there are two varieties; _sitting shallow_ and _standing shallow_.

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

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

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

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

AFFUSION.

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

PAIL DOUCHE.

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

CATARACT DOUCHE.

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

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

HOSE DOUCHE.

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

SHOWER BATH.

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

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

SPRAY BATH.

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

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

LOCAL BATHS.

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

SITZ BATH.

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

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

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

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

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

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

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

LEG BATH.

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

FOOT BATH.

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

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

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

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

HALF PACK.

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

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

CHEST PACK.

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

LEG PACK.

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

CHEST WRAPPER.

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

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

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

WET GIRDLE.

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

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

ASCENDING DOUCHE.

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

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

DROP BATH.

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

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

ARM BATH.

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

HEAD BATH.

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