•A 
 
 Class kM*// 
 
 Book. A 3/ 
 
 Copyright^ 
 
 COPYRIGHT DEPOSIT. 
 
RATIONAL 
 
 HYDROTHERAPY 
 
 A MANUAL OF 
 
 The Physiological and Therapeutic Effects 
 of Hydriatic Procedures, and the Tech- 
 nique of Their Application in the 
 Treatment of Disease 
 
 By J. H. KELLOGG, M.D. 
 
 Member of the British Gynecological Society ; the International Periodical Congress of Gynecology 
 
 and Obstetrics ; the British and American Associations for the Advancement of Science ; 
 
 the Soclete d' Hygiene of France ; the American Society of Microscopists ; the 
 
 American Medical Association; Superintendent of the Battle Creek 
 
 (Mich.) Sanitarium ; Authorof the " Art of Massage ; " etc., etc. 
 
 WITH TWO HUNDRED NINETY-THREE ILLUSTRATIONS 
 NINETEEN IN COLORS 
 
 Third Revised Edition 
 
 PHILADELPHIA 
 
 F. A. DAVIS COMPANY, PUBLISHERS 
 1906 
 
LIBRARY cf CONGRESS 
 Two Copies Received 
 
 MAY 2 1906 
 
 (] Copyright Entry 
 
 »S Ct XXc. No 
 
 56LASS Ct 
 
 ^ 
 
 ^v 
 
 ** 
 
 *? 
 
 : 
 
 Entered according to Act of Congress 1900, 190a, and 1906 
 
 by 
 
 J. H. KELLOGG, M.D. 
 
 In the office of the Librarian of Congress, Washington, D. C. 
 
 Also entered at Stationers' Hall, London, England 
 
 ALL RIGHTS RESERVED 
 
TO HIS FRIEND, 
 
 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. 
 
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. 
 
 For years excellent scientific treatises on hydrotherapy 
 have existed in the French and German languages, but for 
 nearly half 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 authors 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. 
 
 v 
 
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 within 
 the last twenty-five years, during which time, as superin- 
 tendent of a large medical establishment, he has had oppor- 
 tunity 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 resume of the physical, 
 anatomical, and physiological facts which are especially re- 
 lated to the subject; second, a study of the physiological 
 effects of thermic applications; third, a description of the 
 technique of all useful hydriatic procedures; and, fourth, a 
 section on hydriatic prescription making, in which is pre- 
 sented 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 in which the rational 
 hydriatic treatment of individual diseases will be more fully 
 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 
 therapeutic value. Of those procedures which are the out- 
 growth 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, a number of forms of hot and cold compresses 
 and packs, and the simultaneous hot and cold douche. 
 
 If the number of procedures presented seems large, it 
 should be remembered that they comprise three complete 
 sets of hydriatic applications, viz. : the bath (full bath, shal- 
 low bath, sitz, foot, and other baths), the douche (jet, spray, 
 fan, and other forms of douche in general and local applica- 
 
PREFACE. Vll 
 
 tion), and the wet cloth (wet sheet pack, rubbing wet sheet, 
 wet girdle, and various other local and general applications 
 of moistened cloths), besides a variety of procedures which 
 a strict classification would place under the head of thermo- 
 therapy, phototherapy, and massotherapy. 
 
 Some eighteen years ago (1883) the author equipped a 
 laboratory and began the systematic study of the physio- 
 logical effects of water. Many hundreds of experimental 
 observations have been made by the aid of the calorimeter, 
 the plethysmography the ergograph, and various other in- 
 struments adapted to the purpose. The results of some of 
 these observations are reported in this work for the purpose 
 of presenting 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 comprehen- 
 sive view of scientific hydrotherapy in its varied physiolog- 
 ical and therapeutic aspects. 
 
 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 of 1890. Similar courses have been 
 given 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 use by the medical students and nurses, as well 
 as practitioners who desire to obtain a knowledge of the 
 foundation 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 com- 
 pletion of the work until an opportunity was afforded by a 
 vacation trip to Mexico in the winter of 1899-1900. 
 
 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 
 
Vlll PREFACE. 
 
 externally or internally, and at such temperatures as may 
 be required, is an agent which more fully than almost any 
 other co-operates with the healing powers of the body in re- 
 sisting 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 
 employed in connection with the use of electricity, massage, 
 and medical gymnastics. Rational diet is as essential in the 
 treatment of the majority of cases of acute and chronic dis- 
 ease as is water. In the treatment of chronic disorders the 
 regulation of exercise, dress, and of other habits of life is 
 also a matter of paramount importance; also the disuse of 
 tea, coffee, tobacco, and alcoholic beverages, which are often 
 found to sustain a very direct causative relation to the pa- 
 tient's maladies and are without doubt responsible for many 
 failures in which the fault has been unjustly charged to the 
 inefficiency 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 "Traite de Physiologie/' 
 by Morat and Doyon, and the "Traite de Physiologie Com- 
 paree des Animaux," by Colin. In addition, the works, of 
 Winternitz, Bell, Currie, Fleury, Beni-Barde, Bottey, and 
 numerous other French and German authors, besides a great 
 mass of periodical literature, and many hundreds of mono- 
 graphs which have been accumulated during the last thirty 
 years have been studied and consulted. 
 
 A most earnest effort has been made to exclude from this 
 work every procedure and every method for which a thor- 
 oughly scientific and physiological foundation could not be 
 presented. The author dares not, however, entertain the 
 hope that his work will be found altogether faultless, and 
 
PREFACE. IX 
 
 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 
 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 med- 
 ical classes, and for supervising and personally conducting 
 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 
 obligations to my friend, Alois Strasser, M.D., assistant Pro- 
 fessor in the Medical Department of the Royal and Imperial 
 University 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. Win- 
 ternitz, Professor of Nervous Diseases in the Medical De- 
 partment 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 modern rational hydrotherapy is 
 based, and to whom I am proud to have permission to dedi- 
 cate this volume. 
 
 J. H. Kellogg. 
 
PREFACE TO THE THIRD EDITION. 
 
 THROUGH the courtesy of the publishers the author 
 has been permitted to make a considerable number of 
 important additions to the text of this, the third edi- 
 tion of this work, as well as a few corrections which had been 
 previously overlooked. 
 
 The favor with which this work has been received has far 
 exceeded the most sanguine expectations of both author 
 and publishers. The interest in physiologic medicine is rap- 
 idly growing in the profession. The great success of the 
 open air treatment in tuberculosis has established the im- 
 portant principle that those curative agents are of greatest 
 worth which build up the vital resistance of the organism. 
 This places rational applications of water, as well as pure air 
 and all other natural agents, at the head of the list of cura- 
 tive agents and methods. 
 
 J. H. K. 
 
CONTENTS. 
 
 PART ONE. 
 
 Page. 
 
 Historical, • . . . .... • 21 
 
 Hydrotherapy among the Egyptians, Chinese, and Other An- 
 cient Nations (21) — Hippocrates on the Use of Water (22) — 
 The Medical Use of the Bath by the Romans and Arabs (23) — 
 The Popular Use of Water 150 Years Ago (24) — Cullen's Use 
 of Water in Fevers (27) — Hydrotherapy in Europe (28) — Hy- 
 drotherapy in England (29) — The Work of Currie and Jackson 
 (30) — Hydrotherapy in America (32) — The Hydropathy of 
 Priessnitz (35) — Scientific Hydrotherapy (37). 
 
 The Physics of Water, Air, Heat, and Light in Relation 
 
 to Hydrotherapy, 38 
 
 The Specific Heat of Water (38) — The Solvent Properties of 
 Water (41) — The Atmosphere (42) — Heat (44) — Thermome- 
 ter Scales and Heat Units (46) — Medical Thermometry (48) — 
 Mode of Determining and Regulating the Temperature of Water 
 without a Thermometer (49) — An Emergency Thermometer 
 (50) — Calorimetry (51). 
 
 Anatomy and Physiology in Relation to Hydrotherapy, 53 
 
 Physiology the Basis of Hydrotherapy (53) — The Circulation 
 (54) — Circulatory Systems (55) — The Mechanism of the Cir- 
 culation (56) — The Blood Current (59) — The Pulse (60) — 
 The Skin and Its Functions (62) — The Sweat (63) — Condi- 
 tions that Control the Secretion of Sweat (64) — Toxins of the 
 Sweat (65) — The Sebaceous Glands (66) — Absorption by the 
 Skin (67) — Cutaneous Respiration (67) — Nervous Functions 
 of the Skin (67) — The Tactile Sense (68) — The Temperature 
 Sense (69) — Vasomotor and Secretory Nerves (71) — General 
 View of the Nervous System as Related to Hydrotherapy (71) — 
 The Superficial Reflexes (73) — The Vasomotor Centers (73) — 
 The Visceral Motor Nerves (75) — The Sympathetic Nervous 
 System (75) — The Splanchnics (75) — Functions of the Sym- 
 
 xi 
 
Xll 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) — Water-bath Calorimeter (87) — The Author's 
 Fever Calorimeter (88) — The Fever Calorimeter of Winternitz 
 (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 
 
 Applications 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) — Primary and Secondary Ef- 
 fects of Cold (100) — Effects of Peripheral Irritation (102) — 
 The Effects of Cold upon the Skin (104) — 1. 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 r (io6) — The Effects of Cold upon the Circulation (107) — 
 The Effects of Cold upon Respiration (no) — Respiratory Move- 
 ment (no) — C0 2 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 Relation 
 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 
 
CONTENTS. xiii 
 
 Change (122) — The Effects of Cold upon Excretion (124) — 
 The Effects of Cold Applications upon Temperature (125) — 
 Prolonged Cold and Suppressed Reaction (127) — The Effects 
 of Local Cold Applications upon the Body Temperature (127) — 
 The Effects of Cold upon the Thermo- Electrical Currents of the 
 Tissues (129) — The Phenomena and Rationale of Reaction (129) 
 
 — Suppression of Reaction (129) — Definition of Reaction (130) 
 
 — The Reaction of Cold (130) — Second Reaction (132) — 
 Incomplete Reaction (132) — Conditions That Favor Reaction 
 (133) — Conditions that Discourage Reaction (134) — Thermic 
 Reaction (135) — Modifications of Thermic Reaction (136) — 
 Counterbalancing Reaction (138) — Thermic Reaction a Useful 
 Indicator (139) — Thermic Reaction and Metabolism (140) — The 
 Physiological Effects of Heat (141) — Heat a Vital Stimulant 
 (142) — The Effects of Heat upon the Skin (142) — 1. Dilatation 
 of the Capillary Vessels (142) — 2. Increase of Cutaneous 
 Secretion and Respiration (144) — 3. Increased Loss of 
 Heat by the Skin (145) — 4. Decrease of Tactile Sensibility 
 (145) — 5. Preparation of the Skin for the Application of 
 Cold (146) — The Effects of Heat upon the Circulation (146) 
 
 — Increased Activity of the Heart (147) — The Effects of 
 Heat upon the Respiration (149) — The Effects of Heat upon 
 the Muscles (150) — Lessened Irritability of the Voluntary 
 Muscles (150) — Increased Irritability of Involuntary Mus- 
 cles (152) — The Effects of Heat upon the Nervous System 
 (153) — Heat Stimulates Protoplasmic Activity (153) — Reflex 
 Effects Produced by Hot Applications (154) — The Effects of 
 Heat upon the Blood (156) — The Effects of Heat upon Nutri' 
 Hon (156) — The Effects of Heat upon the Stomach, Liver, and 
 Other Digestive Organs (158) — The Effects of Heat upon Body 
 Temperature and Heat Production (158) — Reaction Following 
 an Application of Heat (159) — The Neutral Bath (160) — The 
 Effects of Associated Hot and Cold Applications to the Skin (161) 
 
 — The Scotch Douche (161) — General Vital Reactions Result- 
 ing from Hydric Procedures (162) — Summary of Organic 
 Changes Produced by Heat and Cold (163). 
 
 The Physiological Effects of Friction or Mechanical Irri- 
 tation of the Skin, .164 
 
 Friction (164) — Physiological Effects (164) — Dermographism 
 (167). 
 
 The Physiological Effects of Light, . . . . 168 
 
XIV CONTENTS. 
 
 ' PART TWO. 
 The General Principles of Hydriatics, . . . i8f 
 
 Summary of the ^Physiological Effects of Cold Applications (181) 
 
 — General Effects (181)— Effects upon the Skin (181) — 
 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) — 1. Excitant {Action) Effects (194) — A. Primary 
 Excitant Effects (194) — When to Employ Excitant Measures 
 (196) — Contraindications (197) — Hemostatic Effects (197) — 
 Indirect Hemostatic Effects (198) — Hydriatic Heart Tonics 
 (200) — Uterine Excitation — Emmenagogic Effects (206) — 
 Vesical Excitation (206J — Intestinal Excitation (206) — B. 
 Seco7idary Excitant [Reaction) Effects (207) — Restorative 
 Effects (208) — Tonic Effects (209) — Cold Water vs. Medi- 
 cinal Tonics (210) — 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 Respecting Cold Appli- 
 cations (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 Hypo- 
 chondria and Rheumatism (221) — Calorific Effects (222) 
 
 — Sudorific Effects (223) — Importance of Attention to the 
 
CONTENTS. XV 
 
 Skin in Chronic Diseases (224) — Neglect of Heating Proce» 
 dures by Hydrotherapeutists (225) — Alterative or Spoliative 
 Effects (227) — Hot Baths Must Be Used Carefully in' Dropsy 
 (228) — The Hot Bath in Bright's Disease (229) — The Sweat- 
 ing Bath in Dropsy (231) — The Cold Bath in Renal Disease 
 (233) — The Sweating Bath in Icterus (234) — Surgical Uses of 
 the Sweating Bath (234) — Depurative or Eliminative Effects 
 (235) — Eliminative Baths in Toxemia (236) — Expectorant 
 Effects (237) — Diuretic Effects (238) — Cholagogic Effects 
 (239) — Peptogenic Effects (239) — Emmenagogic Effects (240) 
 
 — Revulsive and Derivative Effects (241) — Fluxion (242) — 
 Revulsive Methods for Combating Superficial Anemia (242) 
 
 — Methods Adapted to Anemia of Deep-seated Organs (243) — 
 Hydriatic 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 Douche (252) 
 
 — The Hot and Cold Trunk Pack (252) — General Revul- 
 sive Effects (253) — Derivative Effects (254) — Resolvent Effects 
 (257) — Alterative Effects (257) — Calorific Effects (258) — 
 C. Sedative Effects (260) — Sedatives of the Circulatory Sys- 
 tem (262) — Sedative Applications Useful Only When Well 
 Borne (263) — Nerve Sedative Effects (264) — Local Anal- 
 gesic Effects (265) — Anesthetic Effects (270) — Antispas- 
 modic Effects (270) — Hemostatic Effects (271) — Antiphlogistic 
 Effects (272) — General Antiphlogistic Effects (280) — Use of 
 Cold in Pneumonia, Pleurisy, and Other Acute Disorders (281) 
 
 — Antithermic Effects (283) — Antipyretic Effects (287) — 
 Effects of Cold on the Heart in Typhoid Fever (288) • — Antipy- 
 retic Effects of Hot Applications (288) — Relation of Heat Pro- 
 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 (291) — 
 Symptoms Indicating Decreased Heat Elimination (291) — 
 Principles That Govern the Application of Hydriatic Measures 
 for the Reduction of Temperature in Fevers (293) — Methods 
 That May Be Efficiently Employed in the Various Morbid Con- 
 ditions Accompanied by a Rise in Temperature (295) — 1. 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 (302) 
 
 — 5. The Graduated Bath (303) — 6. The Cooling Wet-Sheet 
 
xvi CONTENTS. 
 
 Pack (304) — 7. The Cold Shower Pack (305) — 8. The Cold 
 Compress (306) — g. 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) — 1. 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) 
 — 11. Old Age (336) — 12. Late or Neglected Cases (340) — 
 Secretory Sedative Effects (342). 
 
 General Rules, Principles, and Suggestions Relating to 
 
 the Practical Employment of Hydrotherapy, , 343 
 
 General Directions for the Use of the 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 Hydriatic 
 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 Hydri- 
 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) — The Untoward Effects of Hydrotherapy (382) — Head- 
 ache (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 
 ( 39 o)— The Cold Bath for Adults (390)— The Cold Bath for 
 Women (391) — The Cold Bath in Old Age (392) — The Sweat- 
 ing Process (393) — The Neutral Bath (395) — Precautions (396). 
 
 Hydriatic Institutions and Their Equipment, and the 
 
 General Management of Cases, . . . 397 
 
 The Average Temperature of Baths (422). 
 
 PART THREE. 
 
 The Technique of Hydrotherapy, . . . . . 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 (457) — 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 Circle Douche (482) — The Fan Douche 
 (483) — -The Filiform Douche (485) — The Fog Douche (486) 
 
 — The Massage Douche (486) — Localized Douches (491) — 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 
 Muscle 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 
 Bath (526) —The Cool or Cold Full Bath (527) — The Cold Full 
 Bath as a Hygienic Measure (531) — The Cold Bath an Anti- 
 
XVIII CONTENTS. 
 
 dote for Alcoholic Intoxication (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 Wet-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 Arc- 
 Light Bath (711) — The Sun Bath, or Insolation (722) — Local or 
 Partial Hydriatic Measures (724) — 1. Reflex Relations (725) — 
 2. Internal Reaction (725) — 3. Reflex Action (728) — 4. Fluxion 
 (729) — Cutaneous Areas Which May Be Utilized for Derivative 
 Effects (733) — Special Indications and Precautions Respecting 
 Localized Applications (751) — The Cold Foot Bath (753) —The 
 Shallow Foot Bath (755) — The Running or Flowing Foot Bath 
 (755) — Th e 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 
 ( 7 6i)_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 Local Pack (824)— The Wet Girdle (829) — The 
 Abdominal Heating Compress (835) — The Dry Abdominal Band- 
 age (838) — The Head Pack (839) — The Spinal Pack (839) — The 
 
CONTENTS. XIX 
 
 Hot and Cold Compress (840) — The Hot and Cold Head Com- 
 press (843) — The Hot and Cold Lung Compress (844) — The 
 Hot and Cold Renal Compress (846) — The Hot and Cold Gas- 
 tro- Hepatic Compress (846) — The Hot and Cold Intestinal 
 Compress (847) — The Hot and Cold Pelvic Compress (847) — 
 The Hot and Cold Heating Compress or Pack (847) — The Hot 
 and Cold Chest Pack (849) — The Hot and Cold Abdominal 
 Pack (849) — The Hot and Cold Lumbar Pack (851) — The 
 Hot and Cold Spinal Pack (851) — The Hot and Cold Pelvic 
 Pack (852) — Special Forms of Compress (853) — The Cephalic 
 Compress (853) — The Cold Spinal Compress (856) — The Chest 
 Pack (857) — The Square Chest Pack (858)— The Triangular 
 Chest Pack (859) — The Towel Chest Pack (860)— The Half 
 Chest Compress (861)— The Hot Chest Pack (864)— The 
 Throat Compress (865)— The Neck Compress (866) — The 
 Precordial or Cardiac Compress (867) — The Joint Compress 
 (872)— The Cotton Poultice (872) — The Hip Pack (873)— The 
 Pelvic Pack (873)-^ The Leg Pack (879) — The Foot Pack (880) 
 
 — The Perineal Compress (881) — Irrigation (881) — Irrigation 
 of The Ear (881) — Nasal Irrigation (882) — Post-Nasal Irriga- 
 tion (883) — Irrigation of the Eye (883) — Irrigation of the 
 Throat (883) — Irrigation of the Stomach, or Gastric Lavage, 
 (884) — The Water Emetic (890) — Irrigation of the Colon — 
 the Enema (891) — The Coloclyster, or Enteroclyster (897) — 
 The Graduated Enema (901) — Rectal Lavage or Irrigation 
 (902) — Irrigation of the Bladder (903) — Irrigation of the 
 Urethra (907) — Vaginal Irrigation (908) — Intra-uterine Irri- 
 gation (912) — Means of Making Hot, Cold, and Alternate Ap- 
 plications to the Mucous Passages (913) — Steam Inhalation 
 (915) — The Steam Jet (919) — Water Drinking (920) — Hot 
 Water Drinking (930) — Electricity as a Co?nfilement to Hydro- 
 therapy in the Treatment of Chronic Disease (934) — The Electro- 
 hydric or Electro-thermal Bath (945) — Electro-vapor Bath (947) 
 
 — Thermo-electric Bath (948) — Electro-Chemical Bath (948) — 
 Massage with Hydrotherapy (949) — Friction (950) — Percussion 
 (951) — General Massage (951) — Miscellaneous Baths (954) — 
 Emollient Baths (954) — Alkaline Baths (954) — Saline Baths 
 (955) — Pine-needle Bath (955) — Mustard Bath (956) — Alcohol 
 Sponge Bath (956) — The Sulphur Bath (956) — The Carbon 
 Dioxide Bath (956) — The Air Bath (959) — The Outdoor Bath 
 (960) — The Sand Bath (962) — The Indoor Air Bath (962)—, 
 The Air Douche or Fan Bath (963). 
 
XX CONTENTS. 
 
 PART FOUR. 
 Hydriatic Prescription Making 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 
 (97 8 ) — Hydriatic Incompatibilities (978) — The Adaptation of 
 Hydriatic Prescriptions to Individual Diseases (979) — Typhoid 
 Fever (971) — Malarial Fever, Remittent. Intermittent (990) 
 
 — Scarlet Fever (994) — Measles (996) — Erysipelas (997) — 
 Smallpox (998) — Cerebrospinal Meningitis (999) — Mumps 
 (1000) — Diphtheria and Tonsilitis (1001) — Lobar Pneu- 
 monia (1003) — Acute Articular Rheumatism (1006) — Chronic 
 Rheumatism (1009) — Typhus Fever (1010) — Yellow Fever 
 (1011) — Influenza, La Grippe (1012) — Cholera (1014) — Dengue, 
 Breakbone Fever (1015) — Plague (1016) — Complications 
 Common to Acute Febrile Disorders (1017) — 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- 
 
CONTENTS. 
 
 XXI 
 
 rhosis of the Liver (1044) — Renal Colic (1045) — Acute Nephritis 
 (1045) — Chronic Nephritis, Bright's Disease (1046) — Cystitis 
 and Irritable Bladder (1046) — Incontinence of Urine (1047) — 
 Nocturnal Incontinence in Children (1047) — Peritonitis (1048) 
 
 — Neuritis (1048) — Multiple Neuritis (1049) — Neuralgia (1050) 
 
 — Acute Myelitis (1051) — Chronic Myelitis (1052) — Spinal 
 Sclerosis (1053) — Locomotor Ataxia (1054) — Cerebral Apo- 
 plexy (1055) — Epilepsy (1056) — Chorea (1056) — Hysteria (1057) 
 
 — Neurasthenia (1059) — Migraine (1062) — Infantile Convul- 
 sions (1063) — Writer's Cramp (1063) — Melancholia (1064) — 
 Mania (1064) — Confusional, Puerperal; Post-febrile, Post- 
 operative, Toxic Insanities (1065) — General Paresis (1066) — 
 Headache (1066) — Thermic Fever, Heat Stroke, Sun Stroke, 
 Heat Exhaustion (1069) — Insomnia (1070) — Pruritis (1071) 
 
 — Nasal Catarrh (1071) — Pharyngitis, Tonsilitis (1072) — 
 Laryngitis (1073) — Croup (1074) — Acute Bronchitis (1075) 
 
 — Chronic Bronchitis (1075) — Pulmonary Congestion (1076) 
 
 — Broncho-pneumonia (1077) — Pleurisy (1077) — Nocturnal 
 Asthma (1078) — Pericarditis, Endocarditis (1078) — Organic 
 Cardiac Diseases, Valvular Disease of the Heart (1079) — 
 Functional Cardiac Diseases (1081) — Chlorosis (1082) — 
 Anemia (1083) — Pernicious Anemia (1084) — General Dropsy, 
 Anasarca, Maleolar Edema (1084) — Exophthalmic Goiter 
 (1084) — Myxedema (1085) — Arthritis Deformans, Rheumatic 
 Gout (1085) — Pelvic Pain (1087) — Dysmenorrhea (1087) — 
 Metrorrhagia and Menorrhagia (1088) — Amenorrhea (1089) — 
 Pelvic Peritonitis, Cellulitis (1089) — Chronic Metritis and 
 Pelvic Congestion (1090) — Ovaritis and Salpingitis (1091) — 
 Sterility in Women (1092) — Prostatitis (1092) — Acute Orchitis 
 (1092) — Spermatorrhea (1093) — Sexual Impotence (1093) — 
 Priapism (1093) — Irritable Rectum (1094) — Hemorrhoids 
 (1094) — Syphilis (1095) — Inflammations of the Eye (1096) — 
 Skin Disorders (1096) — Drug Habits (1098) — Applications of 
 Hydrotherapy in Surgical Cases (1100) — Graduated Scheme 
 for Tonic Cold Applications (1103) — Aseptic Dietary (1103). 
 
 Summary of Experimental Work .... 1107 
 
 Hydriatic Measures for Regulating Blood Pressure . 1135 
 
 Hydriatic Measures for Increasing Cardiac Energy (1140) — 
 Methods by which the Vessel Tone may be Increased and Dimin- 
 ished (1 141) — Measures which Increase the Activity of the 
 
XXII CONTENTS. 
 
 Peripheral Heart (1142) — Measures by which Blood-volume may 
 be Increased (1142) — Measures by which Blood-volume may be 
 Reduced (1 145) — Effects of Baths upon the Viscosity of the Blood 
 (1145) — Hydriatic Measures Adapted to Primary Low-pressure 
 Cases (1 147) — Hydriatic Measures Adapted to Cachectic Disorders 
 (1148) — The Hydriatic Treatment of Cases of Chronic Cardio- 
 vascular Disease — Arteriosclerosis (1148) — Hydriatic Measures 
 Adapted to Cases of Secondary Low Tension (11 52). 
 
 Bibliography 1159 
 
 Index 1 1 71 
 
LIST OF ILLUSTRATIONS. 
 
 Fig. Page 
 
 i. Emergency Thermometer 48 
 
 2. Water Calorimeter (Dulong) 48 
 
 3. Diagram of Circulatory System (colored) 48 
 
 4. Sphygmograph (Dudgeon) 48 
 
 5. Sphygmograph (Granville) 48 
 
 6. Diagram of the Pulse (Waller) 48 
 
 7. Pulse in Different Parts of the Arterial System 48 
 
 8. Sphygmographic Tracing of Normal Pulse 48 
 
 9. Sphygmographic Tracing of Pulse of a Man Aged Seventy- 
 
 four Years 48 
 
 10. Pulse of Aortic Regurgitation 53 
 
 11. Sphygmographic Tracing of a Hard (High-Tension) Pulse . 53 
 
 12. Diagrams of Pulse (Landois & Stirling) 53 
 
 13. Dicrotic Pulse 53 
 
 14. Sphygmographic Tracing of a Soft (Low-Tension) Pulse . . 53 
 
 15 (a). Irregular Pulse 60 
 
 15 (£). Irregular Pulse of Tobacco User (Waller) 60 
 
 16. Intermittent Pulse 60 
 
 17. Intermittent Pulse , 60 
 
 18. Vertical Section of the Skin 65 
 
 19 (a). Hot Spots 60 
 
 19 (<£). Cold Spots . . ; 60 
 
 20. Sympathetic Nervous System (Bock) 75 
 
 21. Fever Calorimeter (Kellogg) 85 
 
 22. Fever Calorimeter (Winternitz) 85 
 
 23. Fever Calorimeter of Winternitz (under side) 85 
 
 24. Calorimeter of D'Arsonval 92 
 
 25. Pneograph (Kellogg) 92 
 
 26. Pneographic Tracing 92 
 
 27 (a). Normal Fatigue Curve of Man Aged Twenty-four Years 150 
 
 27 (£). Fatigue Curve of Same Subject after a Hot Bath ... 150 
 
 28. Water- Cooling Apparatus 40 l 
 
 29. Compression-Tank Douche Apparatus 401 
 
 30. Bath Slipper 4 01 
 
 31. General Douche Apparatus (Kellogg) 416 
 
 zziii 
 
XXIV LIST OF ILLUSTRATIONS. 
 
 Fig. Page 
 
 32. Diagram of Author's Douche Apparatus 416 
 
 33. The Douche — Horizontal Jet 433 
 
 34. Broken Horizontal Jet 433 
 
 35. Diagram of Author's Percussion Douche Nozzle 433 
 
 36. Percussion Douche 465 
 
 37. Rain Douche .' 465 
 
 38. Combined Rain Douche, Horizontal Jet, and Multiple 
 
 Douche 468 
 
 39. Combined Douche Apparatus and Bath Tub 477 
 
 40. Horizontal Rain Douche or Spray 477 
 
 41. Spray Nozzle 480 
 
 42. Ascending Douche 480 
 
 43. Caliper Douche 482 
 
 44. Collar Douche 482 
 
 45. Fan Douche 484 
 
 46. Fog Douche 493 
 
 47. Massage Douche 493 
 
 48. Cephalic Douche 495 
 
 49. Dorsal Douche 495 
 
 50. Lumbar Douche 496 
 
 51. Abdominal Douche 496 
 
 52. Plantar Douche Apparatus 501 
 
 53. Hepatic Douche 501 
 
 54. Splenic Douche 508 
 
 55. Normal Fatigue Curve of Man Aged Twenty-four Years . . 513 
 
 56. Fatigue Curve of Same Subject after a Cold Douche . . . . 513 
 
 57. Vapor Douche 508 
 
 58. Affusion .....517 
 
 59. Local Affusion 517 
 
 60. Affusion Pail 524 
 
 61. Plunge Bath 524 
 
 62. Immersion Bath 528 
 
 63. Improvised Immersion Bath 528 
 
 64 (a). Japanese Bath Tub Containing Heating Oven .... 545 
 
 64 (£). Japanese Bath Tub with External Heating Chamber . . 545 
 
 65. Bathing at Leukerbad, Switzerland 545 
 
 66. Continuous Bath 556 
 
 67. Outline of Dilated Heart (a) before Treatment, (b) after 
 
 Treatment 566 
 
 68. Outline of Dilated Heart (a) before and (b) after Efferves- 
 
 cent Bath 566 
 
LIST OF ILLUSTRATIONS. XXV 
 
 Fig. Page 
 
 69. Outline of Dilated Heart (a) before and (fr) after Treatment 
 
 by Effervescent Bath 566 
 
 70. Surge Bath 571 
 
 71. Brand Bath 571 
 
 72 (a). Shallow Bath — First step 597 
 
 72 (6). Shallow Bath — Second step 597 
 
 73 (a). Standing Shallow — First step 598 
 
 73 (b). Standing Shallow 598 
 
 74. Wet-sheet Pack — First step 603 
 
 75. Wet-sheet Pack — Second step 603 
 
 76. Wet-sheet Pack — Third step 603 
 
 77. Wet-sheet Pack — Fourth step 603 
 
 78. Wet-sheet Pack — Fifth step . . . 604 
 
 79. Wet-sheet Pack — Sixth step 604 
 
 80. Wet-sheet Pack — Seventh step 604 
 
 81. Wet-sheet Pack — Eighth step, application completed . . . 604 
 
 82. Method of Protecting Shoulders of Feeble Patients . . . . 614 
 
 83. Shower Pack 614 
 
 84. Shower Pack 614 
 
 85. Half Pack 614 
 
 86. Hot-blanket Pack 619 
 
 87. Wringing Blanket for Hot Pack 619 
 
 88. Evaporating Wet Sheet 619 
 
 89. Evaporating Sheet — Employing Electric Fan 619 
 
 90. Wet-hand Rub 628 
 
 91. Wet-hand Rub — Protection of Hair and Ears 628 
 
 92. Wet-hand Rub — Drying Arm 628 
 
 93. Sponge Bath 628 
 
 94. Sponge Bath in Bed 637 
 
 95. Salt Glow 637 
 
 96. Cold Mitten Friction 637 
 
 97. Friction Mitt 637 
 
 98. Cold Mitten Friction to Arm 637 
 
 99. Cold Towel Rub to Arm 648 
 
 100. Cold Towel Rub to Arm — Patient Holding Towel .... 648 
 
 1 01. Cold Towel Rub to Chest and Abdomen 648 
 
 102. Cold Towel Rub to Leg 1 648 
 
 103. Cold Towel Rub to Back — Patient Holding Towel in Place 650 
 
 104. Cold Towel Rub 650 
 
 105. Cold Towel Rub to Feet 650 
 
 106. Drying Patient after Cold Towel Rub 650 
 
XXVI LIST OF ILLUSTRATIONS. 
 
 Fig. Page 
 
 107. Drying Patient after Cold Towel Rub 650 
 
 108. Wet-sheet Rub — Sheet Ready for Wetting 654 
 
 109. Wet-sheet Rub — Wringing Sheet 654 
 
 no. Wet-sheet Rub — Applying Sheet 654 
 
 hi. Wet-sheet Rub — Applying the Sheet — Second step . ... 654 
 
 112. Wet-sheet Rub 654 
 
 113. Friction of Spine 662 
 
 114. Centripetal Friction 662 
 
 115. Circular Friction 662 
 
 116. Spiral Friction 662 
 
 117. Rotary Friction 667 
 
 118. Friction — Emptying Veins of Forearm 667 
 
 119. Friction — Emptying Veins of Forearm 667 
 
 120. Friction — Emptying Veins of Upper Arm 667 
 
 [21. Friction— Emptying Veins of Leg 667 
 
 122. Cutaneous Areas which are Seat of Reflex Pain (Dana) . . 674 
 
 123. Cutaneous Areas which are Seat of Reflex Pain (Dana) . . 674 
 
 124 (a). Percussion — Tapping 679 
 
 124 (^). Percussion — Clapping 679 
 
 124 (<r). Percussion — Hacking 679 
 
 124 (</). Percussion — Beating 679 
 
 125. Dry Shampoo with Flesh Brush 682 
 
 126. The Hair Glove 682 
 
 127. Hot-air Bath 687 
 
 128. Hot-air Bath in Bed 687 
 
 129. Local Hot-air Bath Applied to Knee Joint 687 
 
 130. Turkish Bath — Shampooing 692 
 
 131 (a). Vapor Bath 692 
 
 131 (b). Vapor Bath in Bed 692 
 
 132. Portable Vapor Bath 701 
 
 133. Electric-light Bath 705 
 
 134. Horizontal Electric-light Bath 701 
 
 135. Electric-light Bath for Spine 707 
 
 136. Electric-light Bath for Trunk 707 
 
 137. The Photophore • 707 
 
 138. Electric-light Bath for Joints 707 
 
 139. Electric-light Bath and Cold Douche Combined 709 
 
 140. Arc-light Bath (Kellogg) 709 
 
 141. Finsen's Apparatus for Phototherapy 716 
 
 142. Lens-bottle for Filtering Out Heat Rays 716 
 
 143. Cooling Compressor 716 
 
LIST OF ILLUSTRATIONS. XXVU 
 
 Fig. Page 
 
 144. Case of Lupus before Treatment (Finsen) 718 
 
 145. Case of Lupus after Treatment (Finsen) 718 
 
 146. Sun Bath 718 
 
 147. Cutaneous Areas Reflexly Associated with Internal Parts . 720 
 
 148. Cutaneous Areas Reflexly Associated with Internal Parts . 720 
 
 149. Diagram Showing Collaterally Related Vascular Areas, Skin 
 
 Overlying Muscle (colored) 727 
 
 150. Hyperemia of Skin, with Collateral Anemia of Underlying 
 
 Muscle, Produced by Hot Applications (colored) ... 727 
 
 151. Anemia of the Skin, with Collateral Hyperemia of Under- 
 
 lying Muscle, Produced by a Cold Application (colored) 727 
 
 152. Co-operation of Reflex and Fluxion Effects (colored) . . . 730 
 (a) Renal Congestion. (J?) Ice-bag to Lower Sternum 
 
 with Fomentation to Loins — Congestion Relieved . 730 
 
 153. Diagrams Showing Co-operation of Reflex and Fluxion 
 
 Effects in Pelvic Inflammation (colored) 737 
 
 (a) Before Application. (6) During and after Application 
 of Ice-bag to Hypogastrium, with Hot Hip and Leg 
 Pack — Uterine Vessels Contracted, Vessels of Legs 
 
 Congested 737 
 
 154 (a). Diagrammatic Illustration of Gastric Congestion (col- 
 ored) 740 
 
 154 (J?). Diagrammatic Illustration of the Effect of Cold Applied 
 
 to the Cutaneous Area Reflexly Connected with the 
 Stomach in Cases of Gastric Congestion or Inflam- 
 mation (colored) 740 
 
 155 (a). Diagram Representing Visceral Congestion (colored) . 744 
 155 (fr). Diagrammatic Illustration of the Effect of the Hot and 
 
 Cold Trunk Pack in Relieving Visceral Congestion 
 
 (colored) 744 
 
 156. Cold Foot Bath 757 
 
 157. Leg Bath 757 
 
 158. Arm Bath 757 
 
 159. Elbow Bath 757 
 
 160. Partial Continuous Bath (Langenbeck) 764 
 
 161. Partial Continuous Bath (Langenbeck) 764 
 
 162. Sitz Bath 764 
 
 163. Cold Rubbing Sitz 764 
 
 164. Ice Cap 772 
 
 165. Aluminum Cooling Coil to the Head 772 
 
 166. Irrigating Bag to the Head 772 
 
XXV111 LIST OF ILLUSTRATIONS. 
 
 Fig. Page 
 
 167. Very Cold Compress and Ice Bag to the Head . . . . . . 772 
 
 168. Diagrams Illustrating Superficial Fluxion Effects from Hot 
 
 and Cold Applications (a) and (&) Cold Compress (V) 
 
 and (d) Fomentation (colored) 784 
 
 169. Diagrams Showing (a) Pulmonary Congestion (b) Bene- 
 
 ficial Effects of Cold Chest Compress (colored) .... 784 
 
 170. Aluminum Cooling Coil 788 
 
 171. Evaporating Cephalic Compress 788 
 
 172. Irrigating Compress . . 788 
 
 173. Proximal Compress 792 
 
 174. Fomentation to Chest 792 
 
 175. Wringing Fomentation Cloth in a Towel 792 
 
 176. Wringing Fomentation Cloth 792 
 
 177. Hollow Cone for Acne 812 
 
 178. Hot-water Bag 812 
 
 179. Application of Siphon Bag to Spine 812 
 
 180 (a). Alternate Applications to Spine 812 
 
 180 (<£). Alternate Applications to the Head 822 
 
 181. Abdominal Heating Compress — Unprotected 822 
 
 182. Abdominal Heating Compress — Protected with Mackintosh 822 
 
 183. Wet Girdle 827 
 
 184. Hot and Cold Head Compress 827 
 
 185. Hot and Cold Renal Compress 827 
 
 186. Hot and Cold Chest Pack 849 
 
 187. Hot and Cold Abdominal or Trunk Pack 849 
 
 188. Cold Cephalic Compress . . . 849 
 
 189. Roller Chest Pack— First step 855 
 
 190. Roller Chest Pack — Second step 855 
 
 191. Roller Chest Pack — Complete 855 
 
 192. Roller Chest Pack — Complete 855 
 
 193. Square Chest Pack — First step 858 
 
 194. Square Chest Pack — Second step 858 
 
 195. Square Chest Pack — Third step 858 
 
 196. Square Chest Pack — Fourth step 858 
 
 197. Square Chest Pack — Complete 864 
 
 198. Triangular Chest Pack — Ready for Application 864 
 
 199. Triangular Chest Pack — Complete 864 
 
 200. Towel Chest Pack 864 
 
 201. Half Chest Compress 864 
 
 202. Half Chest Compress — Applied 864 
 
 203. Compresses for Throat 864 
 
LIST OF ILLUSTRATIONS. XXIX 
 
 Fig. Page 
 
 204. Throat Compress — First step 864 
 
 205. Throat Compress — Second step 864 
 
 206. Neck Compress 864 
 
 207. Sphygmographic Tracings Showing Effects of the Cold Car- 
 
 diac Compress, (a) Before Application, (a) After Ap- 
 plication 868 
 
 208. Joint Compress 868 
 
 209. Cotton Poultice 868 
 
 210. Hip Pack 877 
 
 211. Pelvic Pack — First step 877 
 
 212. Pelvic Pack — Second step 877 
 
 213. Pelvic Pack — Third step 877 
 
 214. Leg Pack 881 
 
 215. Foot Pack 881 
 
 216. Irrigation of Ear 881 
 
 217. Irrigation of Eye 881 
 
 218. Gastric Lavage 884 
 
 219. Gastric Lavage — Emptying the Stomach 884 
 
 220. Gastric Lavage — Withdrawing Tube 884 
 
 221. Gastric Irrigator 884 
 
 222. Enema Apparatus — Metal Fountain 893 
 
 223. Enema Apparatus — Siphon Bag 893 
 
 224. Bulb Syringe 893 
 
 225. Knee-chest Position for Coloclyster . 893 
 
 226. Rectal Irrigator (Kellogg) 903 
 
 227. Instrument for Cooling Prostate 903 
 
 228. Instrument for Bladder Irrigation 903 
 
 229. Irrigator for Urethra and Bladder 906 
 
 230. Urethral Irrigator, Hydrophore of Schutz 906 
 
 231. Marble-covered Couch for Vaginal Irrigation 906 
 
 232. Psychrophore (Winternitz) 912 
 
 233. Hollow Sound for Making Thermic Applications to Uterus 
 
 (Kellogg) 912 
 
 234. Hollow Cylinder for Making Thermic Applications to 
 
 Vagina (Kellogg) 912 
 
 235. Hollow Cylinder for Making Thermic Applications to Rec- 
 
 tum (Kellogg) 912 
 
 236. Steam Inhaler 920 
 
 237. Steam Face Bath Alternating with Cold Blast 920 
 
 238. Steam-jet and Nozzle for Hemostasis (Kellogg) 920 
 
 239. Gaertner's Tonometer 930 
 
XXX LIST OF ILLUSTRATIONS. 
 
 Fig. Page 
 
 240. Gaertner's Tonometer 930 
 
 241. Electrohydric Bath 945 
 
 242. Carbonic Acid Douche 945 
 
 243. Ombrophore (Winternitz) 945 
 
 244. Outdoor Gymnasium — Swimming Bath 960 
 
 245. Outdoor Gymnasium — Wood Chopping 960 
 
 246. Air Bath 962 
 
 247. Air Bath 962 
 
 248. A Corner in the Battle Creek Sanitarium Laboratory of 
 
 Experimental Hydrotherapy 1107 
 
 249. (Exp. 16.) Plethysmography Tracing Showing Shrinkage 
 
 of Blood-vessels in Hand Produced by Ice Applied to 
 Opposite Hand mi 
 
 250. (Exp. 17.) Sphygmographic Tracing Showing Contraction 
 
 of Vessels of Arm Produced by Applications of Ice to 
 
 Axilla 1111 
 
 25 t. (Exp. 18.) Sphygmographic Tracing of Radial Pulse, 
 Showing Contraction of the Vessels of the Forearm Re- 
 sulting from Application of Ice to Bend of Elbow . . . 1 1 1 1 
 
 252. (Exp. 19.) Plethysmographic Tracing Showing Diminu- 
 
 tion in Volume of Forearm Resulting from Application 
 
 of Ice to Elbow 11 11 
 
 253. (Exp. 44.) Universal Dynamometer* (Kellogg) .... 11 14 
 
 254. (Exp. 44.) Physical Chart Showing the Effect of a Gen- 
 
 eral Hot Bath in Diminishing Muscular Capacity . . . 11 18 
 
 255. (Exp. 45.) Mosso's Ergograph 11 14 
 
 256. (Exp. 45.) Ergogram Obtained by Means of Mosso's 
 
 Ergograph, Showing Normal Fatigue Curve of a Young 
 Man, R. A. S '. . 11 23 
 
 257. (Exp. 45.) Ergogram Showing Fatigue Curve of R. A. S. 
 
 after a Spray at 1 1 3 for Fifteen Minutes 11 23 
 
 258. (Exp. 45.) Ergogram Showing Fatigue Curve of R. A. S. 
 
 after a Cold Spray Following a Hot Bath 1123 
 
 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 6o° for One 
 Minute 11 25 
 
 * This instrument is in use in the leading gymnasiums of the United States and 
 in 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. 
 
LIST OF ILLUSTRATIONS. XXXI 
 
 Fig. Page 
 
 261. (Exp. 54.) Normal Fatigue Curve of a Young Man Who 
 
 Was the Subject of Experiment 1127 
 
 262. (Exp. 54.) Fatigue Curve Obtained from the Same Subject 
 
 as the Preceding after a Douche at 55 for Fifteen Seconds 1127 
 
 263. (Exp. 54.) Fatigue Curve Obtained from the Same Sub- 
 
 ject after a Douche at 115 for Five Minutes . . . . . 1127 
 
 264. (Exp. 55) Normal Fatigue Curve of A. E. L 11 28 
 
 265. (Exp. 55.) Fatigue Curve of A. E. L. after a General 
 
 Douche at 6o° for Three Minutes 1128 
 
 266. (Exp. 56a.) Normal Fatigue Curve of A. E. L 1130 
 
 267. (Exp. 56a.) Fatigue Curve of A. E. L. after a General 
 
 Douche at 5 6° for Fifteen Seconds 11 30 
 
 268. (Exp. 56a.) Fatigue Curve of A. E. L. after a General 
 
 Douche at 112 for Fifteen Minutes 1130 
 
 269. (Exp. 56b.) Normal Fatigue Curve of a Young Man, the 
 
 Subject of the Experiment 11 25 
 
 270. (Exp. 56b.) Fatigue Curve Obtained from the Same Sub- 
 
 ject after an Immersion Bath at 104 for Twenty Minutes 1 1 25 
 
 271. (Exp. 58.) Normal Fatigue Curve of A. E. L 1132 
 
 272. (Exp. 58.) Fatigue Curve of A. E. L. after General Hori- 
 
 zontal Jet at 55 for Fifteen Seconds 1132 
 
 273. (Exp. 58.) Fatigue Curve of A. E. L. after Neutral Im- 
 
 mersion Bath 1 132 
 
 274. (Exp. 59.) Normal Fatigue Curve of W. P. L 1134 
 
 275. (Exp. 59.) Ergogram of W. P. L. after Shallow Bath at 
 
 65 for Two Minutes 1134 
 
 276. (Exp. 60.) Normal Fatigue Curve of W. P. L 1134 
 
 277. (Exp. 60.) Fatigue Curve of W. P. L. after a Wet-sheet 
 
 Pack at 6o° for Twenty Minutes . . . . . . . . . . 1134 
 
 278. Diagram of the Circulation 1 1 35 
 
RATIONAL HYDROTHERAPY. 
 
 VwA ©tie. 
 
 HISTORICAL. 
 
 WATER is without doubt the most ancient of all reme- 
 dial agents for disease. This fact is evidenced by 
 the frequent reference to its use in the earliest med- 
 ical literature, as well as by the habits and customs of the 
 most ancient peoples as brought to light more fully within 
 recent years by the study of the old Assyrian and Egyptian 
 records. The reason for this is clearly to be found in the fact 
 that water is a means not only usually found ready at hand, 
 but one which adapts itself to almost every imaginable patho- 
 logical condition in a remarkable manner, thus 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 various 
 exigencies and indications arising from accident and disease. 
 The ancient Egyptians, Hebrews, Greeks, Per- 
 
 .. py sians, and Hindus all employed water in the 
 among the ' r J 
 
 Egyptians, treatment of disease, as do the representatives 
 
 Chinese, and of these peoples at the present time. 
 
 Other Ancient According to a Chinese record dating back 
 
 Nations. . •; ... 
 
 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- 
 ipi ? oc rf es 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 
 
 bath, as a reward for which his statue was ordered to be 
 erected in the temple of Esculapius ; but a lack of discrimi- 
 nation in the use of this powerful agent led to his downfall. 
 Being called upon to treat the emperor's nephew, Mar- 
 cellus, a popular favorite, he adopted the measures which 
 had resulted so admirably in the cure of the athletic old 
 soldier, but they proved too powerful for the effeminate 
 youth, and he was prostrated to such a degree that he 
 died soon after at Naples, where he had gone to receive 
 treatment at the hot baths of Baiae. This enthusiastic apos- 
 tle of 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 
 given the aged prelate, entirely unaccustomed to such heroic 
 treatment, occasioned such an exacerbation of his sufferings 
 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 
 succeeded 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 stupid 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 
 
 Use of the Bath . r jf 
 
 by the Romans R° me during five centuries. Celsus and other 
 
 and Arabs. 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 of 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 
 
 T. heP tf °P" Ia / from a small work entitled, -Primitive 
 Use of Water ' 
 
 150 Years Ago, Physick, " by John Wesley, M. A., the founder 
 
 of the Methodist Church, published in 1747, 
 
 which afford ample evidence of the existence at that period 
 
HISTORICAL. 25 
 
 among the common people of a very considerable amount of 
 knowledge respecting the use of water in a variety of ail- 
 ments, as well as for the preservation of health, since the 
 remedies recommended in Weslev's work were all such as he 
 found in successful use among the people. 
 
 For ague or intermittent fever, * ' go into the cold bath 
 just before the cold fit " (this method is still in use in 
 Germany and France); or, " drink a quart of cold water just 
 before the cold fit, and then go to bed and sweat." 
 
 For a tertian ague, it is recommended to "use light and 
 sparing diet on the day between," "or use the cold bath 
 (unless you are of advanced age or extremely weak [a wise 
 precaution, showing no little experience]). But when you use 
 this, on any 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 
 stomach ; 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 fit begins, go to bed, and continue a 
 large sweat by [drinking] lemonade for six or eight hours. 
 This usually cures in three or four times. If it does not, usei 
 the cold bath between the fits." The writer found this 
 method in use 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 apoplexy, ' ' to prevent, use the cold bath, and drink 
 only water." 
 
 For asthma, "take a pint of cold water every morning, 
 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 dry or convulsive asthma, ' ' 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." 
 
 1 ' 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 burn 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." 
 
 "To 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, i * 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, i ' 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 stone, to prevent its occurrence, " drink a pint of 
 warm water daily just before dinner." 
 
 For 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 
 you 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. 
 
 Cullen made some very practical observations 
 Cullen's Use respecting the therapeutic uses of water. In 
 of Water in n * s 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 
 
 in Europe. n 
 
 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 : — 
 
 4 ' Dip the rider's shirt in cold water ; and after it is put 
 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. 29 
 
 simply a revival of these rude practices of ignorant English 
 peasants a century and a half ago. 
 
 Sir John Sinclair, in his "Code of Health and Longevity," 
 gives an account of an English nobleman, born in the year 
 1 700, who for a great part of his life was accustomed, imme- 
 diately on arising in the morning, to wrap himself in a sheet 
 just dipped in cold water — a wet-sheet pack. 
 
 In the fifteenth century, Savonarola, an Italian physician, 
 made a systematic use of the cold bath, and Barizzi employed 
 the cold vaginal douche in uterine affections. Cold affusions 
 and general douches were employed by Baccio in Italy, while 
 leading Spanish and German physicians recommended cold 
 applications for insomnia. 
 
 Septala, in the seventeenth century, employed the cold 
 douche for the relief of headache and sunstroke. 
 
 Herman, a Belgic physician, resorted to the use of cold 
 water at the same period for the relief of constipation, 
 migraine, paralysis, and mania, — maladies in the treatment 
 of which cold water still holds its own against all other 
 single remedies. 
 
 Sir John Floyer, in 1697, published a history 
 Hydrotherapy of cold bathing in which he directed that the 
 in England. , . , , , _ . 
 
 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 Priessnitz, 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 
 Magnum," in 1723, in which he demonstrated the value of 
 water-drinking as a means of treatment in scarlet fever, 
 smallpox, and measles. He cured ague by having the patient 
 drink large quantities of cold water while wrapped in blan- 
 kets, 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, 
 The Work of in the latter t of the last century ma( j e a 
 Currie and 
 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- 
 
HISTORICAL. 31 
 
 gested that after immersion the patiejnt should be exposed to 
 the air, so that the body might be cooled by evaporation. 
 He recommended as a principle of the utmost importance for 
 regulating the use of water, that it might be safely used ' ' when 
 there is no sense of chilliness present, when the heat of the 
 surface is steadily above what is natural, and when there is 
 no general or profuse perspiration." He observed that a cold 
 pour could be used more safely than cold sponging, for the 
 reason that it is "an energetic remedy," and "the system 
 often accommodates itself to a cold which is general and 
 stimulating, but shrinks from a cold which is slow and 
 successive." 
 
 He also warned against fatigue occasioned by too much 
 bathing, and recommended that after the bath the patient 
 should be dried "hastily with towels," and recommended 
 that when too severe effects had been obtained, causing too 
 great depression, the extremities should be rubbed, and • ' a 
 bladder of hot water applied to the stomach. " 
 
 Currie also noted the evil effects of reaction in fever, and 
 taught that short cold 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 
 from the use of hot applications immediately after cold in such 
 cases. He made use of the "wet blanket," or pack, in fevers, 
 and observed that it relieved delirium. He also applied cold 
 to the feet in hemorrhage of the lungs, and in a case of pul- 
 monary hemorrhage 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 febrile disorders, was lost 
 sight of, and it was not until the attention of the whole 
 civilized world was attracted by the fame of an uneducated 
 and blundering, but still successful, cold-water empiric, that 
 the profession began to give this agent the serious attention 
 that was its due ; for the modern 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, 
 
 i^AmerkT^ ° f Philadel P hia > 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 suggested, 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 
 
 experiments conducted by Henry Wilson Lockette, of Virginia. 
 These experiments were published by him in the year 1801 in 
 "An Inaugural Dissertation on the Warm Bath, presented 
 to the Trustees of the 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 effects upon the pulse and general functions, of 
 baths of different duration at varying temperatures. Among 
 the observations that he made, were the following : — 
 
 1. That a foot bath at no° F. increased the pulse from 76 
 to 92 beats a minute, the redness of the legs 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 iOO° 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 
 ioo° 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 83 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, and "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 yy beats. At the end of thirty minutes the pulse-rate 
 was /6. 
 
 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- 
 athy flourished to a considerable extent. Many institutions 
 devoted to the carrying out of these measures were estab- 
 lished in different parts of the United States, and scientific 
 hydrotherapy was ably advocated by Dr. John Bell, of Phila- 
 delphia, whose work on "Baths" has, up to recent times, 
 remained the most complete and able treatise on the subject 
 in the English language. 
 
 When seventeen years of age, Priessnitz met 
 e with an accident whereby he received numer- 
 
 Priessnitz. ous Dru i ses an( l 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 he 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 was in a short time completely cured. 
 Hearing of this remarkable cure without the use of drugs or 
 the application of any of the ordinary salves or lotions, many 
 wounded persons, and later people suffering from chronic 
 diseases, came to Priessnitz for relief, and soon his whole 
 time was occupied with their care. Priessnitz was not a 
 quack, for he made no great pretensions. He did not claim 
 special knowledge or skill. He made no pretensions to the 
 possession of any secret method or process. His work was 
 done frankly, honestly, and openly. He was a man of few 
 words, of serious, dignified character, an enthusiastic student 
 of nature. He labored patiently and earnestly for the de- 
 velopment of the great principles which he recognized. He 
 commanded the respect of his countrymen, even of members 
 of the profession. He was granted a diploma by the Austrian 
 government after an official investigation of his work and 
 methods. The French government sent the head of the 
 medical department of the army to study his methods, and by 
 this means hydrotherapy was introduced into the military 
 service of France nearly a century ago. The governments of 
 other countries did likewise. Thus the principles and methods 
 developed by this nature-taught physician were rapidly 
 diffused. 
 
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 time, 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 least 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 
 
 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, "Traite Pratique 
 et Raisonne d'Hydrotherapie." 
 
 Liebermeister, Brand, and Ziemssen in Ger- 
 Scientific many, and above all, Winternitz, of Vienna, 
 
 y ro erapy. rey — n ^ an j y s p U pii s 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 Jiirgensen, Rosbach, Bouchard, Delmas, Robin, Beni- 
 Barde, Strasser, 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 charlatans, and is now recognized by eminent medical 
 men as one of the most potent of all remedial agents. 
 
 Hartshorne, of Philadelphia, published in 1847 a sugg 68- 
 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 Winternitz as a part of Ziemssen's therapeutics in 1883. 
 
 The work of Winternitz 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 
 hydrotherapeutics made by this eminent pioneer in this line 
 of medical research, which Dr. Winternitz, at the author's 
 request, has kindly furnished him. 
 
 It is but just also to call attention to the indefatigable 
 labors of Dr. Baruch, of New York, in calling the attention 
 of the profession to the great value of water in the treatment 
 of both chronic and acute disorders. 
 
THE PHYSICS OF WATER, AIR, HEAT, AND UGH! 
 IN RELATION TO HYDROTHERAPY. 
 
 Ill OFFMAN, whose authority commands universal respect, 
 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 solid to a liquid 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 of Water than any 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 all 
 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 io° will raise the tem- 
 
 38 
 
THE PHYSICS OF WATER, AIR, HEAT, AND LIGHT, 39 
 
 perature of one pound of iron or copper from zero to nearly io°. 
 A quantity of water equaling the body in weight, losing i° 
 of temperature through contact with the body in a full bath, 
 will raise the temperature of the body a little more than i°, 
 taking no account of any change in heat production or heat 
 elimination. 
 
 In the solidifying and freezing of water a large amount of 
 heat is rendered latent, as shown by the fact that a pound 
 of ice in melting absorbs, without any elevation of tem- 
 perature, heat enough to raise one pound of water 142 in 
 temperature, the temperature of the water from the melting 
 ice remaining at 3 2° or slightly above it until all the ice is 
 melted. 
 
 Water, in passing from the liquid to the gaseous state, 
 likewise absorbs a considerable amount of heat. The amount 
 depends somewhat upon the pressure, but may be reck- 
 oned at about 950 heat units, or the amount required to 
 raise 950 pounds of water i° in temperature. The total 
 amount of heat required to raise a pound of water from the 
 ordinary temperature to that of steam is about 1,130 heat 
 units. This heat reappears when the steam is condensed 
 at the ordinary temperature. 
 
 In hydrotherapy, water is most commonly used in its liq- 
 uid state, but it is also employed in the form of ice, and in 
 the form of steam, though as steam, water is never applied 
 directly to the body. When steam is utilized, as in the 
 Russian or vapor bath, the body is not actually exposed to 
 steam, but to the fog or mist formed by the condensation of 
 the steam through contact with the atmosphere. In a vapor 
 or Russian bath the patient is not heated by the steam, but 
 by the hot air and the suspended particles of warm water 
 which come in contact with the body. As the steam enters 
 the air of the apartment from the steam-pipe or other source, 
 it is at once condensed into a mist, giving up to the air the 
 ten or eleven hundred heat units which it contains, and thus 
 heating the air. A pound of steam is capable of raising from 
 
40 
 
 RATIONAL HYDROTHERAPY. 
 
 the ordinary temperature to 130 eighty-seven pounds oi 
 air, or 1,100 cubic feet of air, the amount contained in an 
 apartment 10 x 10 x 11 feet in size. One pound of steam 
 applied to the body would be capable of raising the tem- 
 perature of a man weighing 15c 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 3 2° 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. 41 
 
 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- 12 
 
 The Solvent versa i solvent. In the body it is the medium 
 Properties of J 
 
 Water. by which 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 also 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 1-1 
 the surface of the body but for its interior as well, is apparent. 
 This is, indeed, 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 enter oclyster), the gastric tube, and by 
 subdermic 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 3 2° 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 
 docs 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 WATER, AIR, HEAT, AND LIGHT. 43 
 
 ture left on the skin after leaving the bath-room, giving 
 rise to chilliness, 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 particularly 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 3 2 . 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 13 , 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 OF WATER, AIR, HEAT, AND LIGHT. 45 
 
 Various sources of heat may be utilized in making thermic 25 
 applications to the human body for therapeutic purposes. 
 While water is generally the most convenient agent, there are 
 conditions to which it is not adapted, and in which other 
 means may be more advantageously employed. Heated air, 
 the vapor of water, or rather the fog resulting from the con- 
 densation of steam in air at a temperature near that of the 
 body, the sun's rays, and lastly the electric ray may all be 
 utilized. The use of hot air in the form of the Turkish bath 
 dates from remote antiquity, and the hot-air bath 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 rays, which the electric ray closely resembles in 26 
 its action as a thermic agent, have been utilized in the treat- 
 ment of the sick from the most ancient times. The amount 
 of heat received hourly upon each square foot of the earth's 
 surface is about equivalent to that produced by the burning of 
 a sufficient amount of coal to produce one fourth of a horse- 
 power of mechanical energy. The physical 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 rays 27 
 of radiant energy received from a luminous source penetrate 
 the skin and the tissues to a great depth, in fact, reaching 
 without doubt, the very innermost portions of the body. 
 
 When electricity meets with resistance, as in passing over 28 
 a poor conductor, it is converted into heat. The same prin- 
 ciple holds in relation to light. When light passes through a 
 perfectly transparent medium, no heat phenomena are mani- 
 fested. Very little heat accumulates in pure white glass 
 when the sun's rays 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 
 Thermometer , , , ... . , , 
 
 s . . range from freezing to boiling into one nun- 
 
 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 
 itHfi or 5~9ths, degree centigrade; while one degree centigrade 
 equals ff$, or 9~5ths, degree Fahrenheit. 
 
 31 To find the number of degrees Fahrenheit which a given 
 number of degrees centigrade 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 -g = = — = 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 5~9ths, or what 
 is the same thing, divide by two and add one ninth. 
 
THE PHYSICS OF WATER, AIR, HEAT, AND LIGHT. \J 
 
 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 -| = ** * 5 = 40 ; or, 
 
 72 -5- 2 = 36 + 4 (36 -=- 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 
 must 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 modern French system there are the greater and 36 
 the lesser calorie. The greater calorie 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. 
 
48 RATIONAL HYDROTHERAPY. 
 
 38 To convert kilogram centigrade calories into pound 
 Fahrenheit units, it must be remembered that the kilogram 
 equals 2.2 pounds, and the centigrade degree i.8 Fahren- 
 heit degrees ; hence the converting factor will be f§X -}§=■§£, 
 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 (1 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 || = 101.01 ; or, 
 400 -r- 4 = 1 00 ; 1 00 -|- 1 (one per cent, of 1 00) =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 6o° 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 : — 
 

 
 
 
 : 
 
 - 
 
 'j. - 
 
 
 
 
 
 
 Wig. i. AN EMERGENCY 
 THERMOMETER 
 (P- 50). 
 
 Fig. 2o WATER CALORIMETER (p. 52). (Dulong) 
 
 F.-g. 3. DIAGRAM OF THE CIRCULATORY SYSTEM (p. 56).. 
 
fmm 
 
 Fig. 4. SPHYGMOGRAPH (p. 60). Fig. 5- SPHYGMOGRAPH (p. 60). (Granville) 
 (Dudgeon) 
 
 i Primary 
 
 ! Dicrotic i 
 
 Tidal 
 
 •Dicrotic 
 
 :i -Post-dicrotic 
 
 iPrimarv 
 i iTidal 
 
 i i 
 
 
 ^5 
 
 
 
 
 .V L\X^ JBWwBm 
 
 ^^W 
 
 Fig. 6. DIAGRAMS OF THE PULSE (p. 60). (Waller) 
 
 ~- j IH^EII^^H 
 
 WfSk 
 
 
 
 
 ^*^l 
 
 
 
 
 
 
 
 C/3 
 
 W^M 
 
 
 
 (■ H^&H 
 
 -- n 
 
 
 
 = EH 
 
 •< B5H 
 
 Heart 
 
 
 ^ 
 
 ■H 
 
 
 
 - Ml 
 
 s B2 
 
 
 
 - MB 
 
 c K&i 
 
 
 
 
 
 " ■■59 
 
 KB 
 
 ac lava 
 
 Carotid 
 
 
 2 
 
 Kfl 
 
 Femoral 
 
 
 o 
 
 *» IKM 
 
 
 
 - 
 
 ^2 
 
 
 
 ■B 
 
 H 
 
 
 
 Rfl 
 
 
 
 
 
 
 HiVjflB 
 
 Radial 
 
 
 
 ^■i 
 
 
 
 2 ^R^^^H 
 
 ^K^^S^H 
 
 |Pj| 
 
 
 
 ^HIS^h 
 
 
 Anti tibial 
 
 
 ~ : 1 w 
 
 2 M 
 
 
 
 S3 
 
 B^l 
 
 Foot 
 
 
 ■si 
 
 t) '^^^HEmI 
 
 (plethysm) 
 
 
 ~ 
 
 c Rfl 
 
 
 
 El 
 
 V^fl 
 
 Time in 
 
 
 
 
 T '„ seconds 
 
 I 
 
 Fig. 7. PULSE IN DIFFERENT PARTS OF 
 THE ARTERIAL SYSTEM (p. 60). 
 
THE PHYSICS OF WATER, AIR, HEAT, AND LIGHT. 
 
 49 
 
 Mode of Deter- 
 mining and 
 Regulating the 
 Temperature of 
 Water without 
 a Thermometer. 
 
 The hand gives unreliable information respect- 43 
 ing the temperature of water, but a more ac- 
 curate judgment may be formed by plunging 
 the whole arm to the elbow into the water, as 
 the arm is usually protected by the clothing, 
 and hence its temperature is more equable. 
 When the temperature of the water is so 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 
 gives the quantities to be mixed for different temperatures : — 
 
 45 
 
 'emp. 53 F. 
 
 Temp 
 
 . 212 
 
 F> 
 
 
 
 
 
 2 qts. 
 
 added 
 
 to 
 
 I 
 
 qt. 
 
 equals 
 
 3 
 
 qts. 
 
 at 
 
 106 F 
 
 1% " 
 
 " 
 
 11 
 
 I 
 
 i 1 
 
 « t 
 
 1% 
 
 < c 
 
 tt 
 
 98 " 
 
 3 
 
 (i 
 
 c t 
 
 I 
 
 11 
 
 ii 
 
 4 
 
 ii 
 
 tt 
 
 93°" 
 
 4 " 
 
 ii 
 
 ( < 
 
 I 
 
 it 
 
 it 
 
 5 
 
 tt 
 
 tt 
 
 85 o ti 
 
 5 " 
 
 (i 
 
 «« 
 
 I 
 
 11 
 
 ii 
 
 6 
 
 tt 
 
 tt 
 
 8o° » 
 
 6 " 
 
 11 
 
 ll 
 
 I 
 
 it 
 
 ii 
 
 7 
 
 tt 
 
 tt 
 
 76 " 
 
 8 
 
 11 
 
 (6 
 
 I 
 
 11 
 
 ii 
 
 9 
 
 ti 
 
 ii 
 
 71 " 
 
50 RATIONAL HYDROTHERAPY. 
 
 4:6 When larger quantities are needed, it is only necessary to 
 multiply each of the combining quantities by the same num- 
 ber. 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 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 (ioo G C). The result would be obtained 
 thus : io + 2 — 12; 200 -5- 12 = 16. 6° C, or 62° F. 
 
 48 In Fig. 1 will be seen a simple thermometer 
 
 An Emergency wn i c h may be successfully used in regulating 
 
 Thermometer, , J . . . J . ., ft . to 
 
 the temperature 01 baths, and 11 necessary, in 
 
 determining whether or not the patient's temperature is above 
 
 normal, and approximately to what degree. The instrument 
 
THE PHYSICS OF WATER, AIR, HEAT, AND LIGHT. 5 1 
 
 consists simply of a small, thin-walled bottle, the mouth of 
 which is closed with a cork, through which passes a tube 
 having an opening of about one sixteenth of an inch. The 
 tube should be about ten inches in length. In the bottom 
 of the bottle should be placed about half an inch of a colored 
 solution. Some aniline color dissolved in water or alcohol 
 answers the purpose well. The tube should be passed through 
 the cork to such a distance that when the cork is inserted in 
 the mouth of the bottle, by pressing the cork in a little the 
 fluid will be made to rise in the tube, and by a little manage- 
 ment the liquid may be made to stand in the tube just at the 
 top of the cork. Grasping the bottle in the hand, the air in 
 the tube will be warmed and, expanding, will force the liquid 
 farther up the tube. It is only necessary to place a foot rule 
 behind the tube, letting the lower end rest upon the cork, 
 and we have a very delicate thermometer with a scale which 
 will answer a very practical purpose in the absence of a bet- 
 ter instrument. The normal point is determined by applying 
 the instrument to the axilla of a healthy person. 
 
 In the use of the clinical thermometer the temperature of 49 
 the patient should be taken in the rectum, if possible, unless 
 enemas are being administered for cooling or nutritive pur- 
 poses. If the temperature is taken in the mouth or the 
 axilla, great care must be used to see that the lips are kept 
 tightly closed or the arm in contact with the body. 
 
 Currie noted the fact that temperature observations made 50 
 by placing the thermometer in the mouth are sometimes 
 rendered inaccurate when cold applications are administered, 
 by the chattering of the teeth and consequent separation of 
 the lips, admitting air. 
 
 In the technical study of hydrotherapy it is 51 
 a onme ry. absolutely necessary to take into consideration 
 not only the indications of the thermometer, or the tempera- 
 ture of the body as a mass, but it is of even greater impor- 
 tance to know what are the capabilities and the conditions of 
 the body as a generator of heat. Information of this sort is 
 
52 RATIONAL HYDROTHERAPY. 
 
 not afforded by the thermometer alone. The data required 
 must be obtained by means of the calorimeter. This instru- 
 ment determines the number of heat units which escape from 
 the body in a given time, and thus, as the temperature of the 
 body remains practically uniform, the amount of heat actually 
 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 heat loss 
 from the surface of the body. The chief means by which 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 purposes 
 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 author 
 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 necessary to satisfy the demands of savage modesty. 
 
Fig. io. PULSE OF AORTIC REGURGITATION (p. 61). 
 
 Fig ii. SPHYGMOGRAPHIC TRACING OF A HARD (High-tension) PULSE (p. 61). 
 
 Fig 12. DIAGRAMS OF PULSE. 
 Tension and Hard Pulse; 
 
 Pulse and Hyperdicrotic (p. 61 
 
 i, Normal; 2, Low Tension and Soft Pulse; 3, High 
 4, Soft Pulse fully Dicrotic; 5, Very Soft 
 
 (Landois & Stirling). 
 
 Fig. 13. DICROTIC PULSE (p. 61). (Author's Collection) 
 
 Fig. 14. SPHYGMOGRAPHIC TRACING OF A SOFT (Low tension) PULSE (p 61). 
 
ANATOMY AND PHYSIOLOGY IN RELATION 
 TO HYDROTHERAPY. 
 
 THERE is no remedial agent the scientific use of which 52 
 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 
 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 
 this simple and versatile therapeutic agent, have unwisely 
 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 
 
 :*_ y ^'° •° Sy c human body, its normal functions, and the 
 
 the Basis of ... . 
 
 Hydrotherapy, 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- 
 able, but even in those that are incurable, it is marvelous to 
 note the wonderful degree to which pain and various other 
 symptoms may be mitigated by accurately adapted hydri- 
 atic prescriptions. 
 
 53 
 
54 RATIONAL HYDROTHERAPY. 
 
 54 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-medullated 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: (1) The vasoconstrictors, corresponding to the accel- 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 55 
 
 erator 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 the 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 
 synchronously with the heart, but makes a cycle about once 
 a minute. Its circulation is independent of blood pressure. 1 
 
 There are four so-called systems of circula- 63 
 Circulatory ... 
 
 Systems. tlon: ~ 
 
 I. The systemic circulation, consisting of 
 
 the arteries, capillaries, and veins, by which the blood is 
 
 propelled from the left side of the heart to the periphery, and 
 
 is brought back to the right side of the heart. 
 
 2. The pulmonary circulation, by which the impure blood 64 
 
 sent out from the right side of the heart passes through the 
 
 lungs, and is returned to the left side of the heart, to be again 
 
 distributed throughout the body. 
 
$6 RATIONAL HYDROTHERAPY. 
 
 65 3- The lymphatic circulation, by which the lymph that 
 escapes from the blood-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, pancreas, 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- 
 companying 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 
 pulmonary 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 f the 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- 
 tain a certain pressure, or tension, within the vessels, this be- 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. $? 
 
 ing one of the means by which the various processes of secretion 
 and other forms of metabolism are maintained and regulated. 
 
 Blood pressure results chiefly from the force of the heart- 69 
 beat, and the peripheral resistance at the distal end of the 
 vascular loop in the small arteries, venules, and capillaries, 
 through the narrowing of these parts by the contraction of 
 their muscular walls under the influence of nerve impulses 
 excited by various conditions and agents. In the light of 
 present knowledge it is not, however, possible to regard the 
 heart as the only source of energy in the circulation of the 
 blood. For more than a score of years physiological facts 
 have been coming to light which point with much certainty to 
 the muscular coats of the smaller vessels, the arterioles, pos- 
 sibly the venules, and very probably also the capillaries, as a 
 source of propulsive energy in maintaining the movement of 
 the blood. Schiff showed long ago that there is a rhythmical 
 contraction of the muscles in the arteries in mammals as 
 well as in amphibians, the latter fact having long been recog- 
 nized. Strieker observed the contraction of the capillaries, 
 and Severini considered the contractility of the capillaries, at 
 'east of their nuclei, as of great importance in " influencing 
 the blood stream." Roy and Graham Brown have also 
 shown that the capillaries are contractile. 3 The writer has 
 so long been thoroughly convinced of this fact, that in 1879, 
 in describing the forces of the circulation in a popular work 
 on Physiology and Hygiene, he remarked : ' ' The contrac- 
 tion of the heart, which gives the blood a propulsive impulse, 
 is followed up by the contraction of the arteries. The small 
 arteries are supposed to be specially active in assisting the 
 circulation. Some observers claim that the small arteries, or 
 arterioles, keep up a constant peristaltic action, by means of 
 which the blood is urged forward." 
 
 It may be said in short that, in addition to the heart 70 
 proper, the body is provided with what might be termed a 
 peripheral heart, which serves several important purposes : 
 (1) The regulation of the local nutritive and secretory proc- 
 
58 RATIONAL HYDROTHERAPY. 
 
 esses ; (2) to a certain extent the control of the heart's 
 action by maintaining just the right degree of tension or in- 
 travascular pressure through the narrowing of the arterial 
 outlet ; (3) an active rhythmical contraction which acts like a 
 combined suction- and force-pump at the periphery of the 
 circulatory system, relieving the heart of a part of its burden, 
 while at the same time aiding in maintaining the proper 
 standard of blood pressure. 
 
 71 This action of the small vessels is of course not confined 
 to the exterior of the body, but is doubtless present in the 
 blood-vessels in all parts of the body, especially in the mus- 
 cles. That an action of this sort is also maintained in the 
 skin is altogether probable, as it has been observed in the ear 
 of the rabbit. The capillaries of the skin are for the most 
 part arranged in simple loops, which would favor a propul- 
 sive action of this sort. It is true, the arterioles of the skin 
 have little muscular tissue in their walls ; however, this lack 
 is to a large degree compensated for by the peculiar arrange- 
 ment of the yellow elastic tissue which surrounds the vessels 
 and by the obliquely placed involuntary muscle fibers, both 
 of which favor contraction of the vessels if they do not aid 
 in the automatic or rhythmical action above referred to. 
 
 72 The rich vascular area of the muscles, which is capable of 
 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 skin 
 responds to vascular stimuli, both those which excite the vaso- 
 dilators and those which bring the vasoconstrictors into 
 activity, shows very clearly that there is in the skin an 
 enormous body of muscular structure connected with the 
 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 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 59 
 
 accelerates the movement of the blood through the heart to a 
 marked degree. This influence is especially helpful to the 
 portal circulation, and to the venous circulation of the brain. 
 
 The rhythmical contractility of the spleen, already referred 74 
 to, constitutes it a sort of heart for the portal circulation. 
 When the spleen is contracted, the liver is slightly enlarged, 
 showing an increase of tension in the portal circulation which 
 must accelerate the movement in this portion of the venous 
 system, hedged in as it is at each end by a capillary network. 
 
 The pumping action of the spleen is doubtless service- 75 
 able as a means of regulating the blood flow through the 
 liver and in maintaining the necessary pressure to secure 
 the highest degree of functional activity of this large and 
 important gland. 
 
 When the blood leaves the heart, its move- 76 
 ment is at the rate of several feet per sec- 
 ond, while in the capillaries the rate of move- 
 ment is reduced to one inch in two minutes. The rapidity of 
 movement of the blood in the vessels is constantly changing 
 with the changes in the relative conditions of the heart and 
 the contractile walls of the small vessels. The following 
 table from Waller represents the several modifications which 
 may occur, and the conditions which give rise to them. The 
 table is so nearly self-explanatory that it is only necessary to 
 add that in some conditions the blood pressure and the blood 
 flow may be neither increased nor diminished, but normal. 3 
 
 The Blood 
 Current. 
 
 Case. 
 
 Heart. 
 
 Arterioles. 
 
 Blood 
 Pressure.* 
 
 Blood 
 Flow* 
 
 I 
 
 2 
 
 Force constant 
 
 Force constant 
 
 Resistance increased. . . 
 Resistance diminished.. 
 
 + 
 
 + 
 
 3 
 
 4 
 
 Force increased .... 
 Force diminished. . . 
 
 Resistance constant. . . . 
 Resistance constant. ... 
 
 + 
 
 + 
 
 5 
 6 
 
 Force increased .... 
 Force diminished. . . 
 
 Resistance diminished.. 
 Resistance increased. . . 
 
 - + 
 
 + + 
 
 7 
 
 8 
 
 Force increased .... 
 Force diminished. . . 
 
 Resistance increased. . . 
 Resistance diminished. . 
 
 + + 
 
 + — 
 - + 
 
 * The plus sign (+) indicates increase; the negative sign (— ), decrease. 
 
60 RATIONAL HYDROTHERAPY. 
 
 77 A very good 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 difficult 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. 
 
 81 After the dicrotic wave there is usually one, sometimes 
 several, small waves, which are commonly due to oscillations 
 
Fig. 15 (a). IRREGULAR PULSE (p. 62). 
 
 ig. 15 (Jbj. IRREGULAR PULSE OF TOBACCO USER (p. 62;. (Waller) 
 
 Fig. 16. INTERMITTENT PULSE (p. 62). 
 
 Fig. 17. INTERMITTENT PULSE (p. 62). 
 
 
 h 
 
 
 \\v///-.:i#I 
 
 ililii ":'.V: ':":Y\ : ; ;J 
 
 : :: J^H ::«::"•• 
 
 i 9 
 
 •will; Villi 
 
 P 
 lli„ 
 
 1 n 
 
 ..... ..'.*. ..,11,1 ii 
 
 ::i|l::::::::l:::P'l 
 
 Fig. 19 (a). HOT SPOTS (p. 69). 
 
 Fig. 19 (b). COLD SPOTS (p. 69), 
 
ANATOMY AND PHYSIOLOGYIN RELATION TO HYDROTHERAPY. 6 1 
 
 of the instrument. The three points of importance to be 
 observed in the curve are the primary, the tidal, and the 
 dicrotic waves. 
 
 The primary wave marks the expansion of the artery 82 
 under the impulse of the wave of blood from the heart. It 
 measures in a general way the force and amplitude of the car- 
 diac impulse; the tidal wave, extending from the apex to the 
 " aortic notch," represents the sustained^ propulsion of the 
 blood resulting from the energy stored up in stretching the 
 arteries. As the stretched arteries contract, the pressure or 
 tension is more or less maintained, according to the degree 
 of elasticity in the vessel walls. With a rigid, atheromatous 
 artery, 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. g). In aortic 
 regurgitation, the fall is equally marked (water-hammer pulse) 
 because of the sudden emptying of the artery into the ventri- 
 cle (Fig. io). In the high-tension pulse (Fig. n), there is a 
 slower and more gradual decline after the tidal wave, which is 
 very well marked (Fig. 12). To the finger, the pulse of old 
 age and of regurgitation feels "empty" between the beats. 
 The pulse of high tension feels "full." 
 
 The dicrotic wave is little marked in high tension, but in 84 
 low tension is so marked that the low-tension pulse of high 
 fever is often termed the dicrotic pulse. In such a case the 
 dicrotic wave is so much exaggerated that it may be easily 
 felt under the finger (Fig. 13). 
 
 In the low-tension pulse the tidal wave, if present, will 85 
 fall below a line drawn from the apex to the bottom of the 
 aortic notch (Fig. 14). In the high-tension pulse the tidal 
 wave is marked, and rises above the line described. The high- 
 tension pulse is hard to the touch ; the low-tension is soft. 
 
 A frequent pulse is one in which the number of beats per 86 
 minute is abnormally great. In fever the pulse-rate increases 
 ten beats (approximately) for every degree Fahrenheit rise of 
 temperature. 
 
62 RATIONAL HYDROTHERAPY. 
 
 87 A quick, or short, pulse is one in which the beat itself 
 seems very sharp and quick beneath the finger. These terms 
 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 pulse. 
 These terms are not needed, as the long pulse is always a 
 hard, or high-tension, pulse. 
 
 S9 In the irregular pulse, the beats do not occur with 
 
 rhythmical succession, but the intervals are irregular (Fig. 15). 
 
 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 
 
 19.6 square feet. 
 
 The sweat-glands are, in man, present almost 95 
 The Sweat. & . . ' v , 
 
 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.: (1) 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 ; 
 (3) 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 \QQ 
 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, 
 sweating is confined to the soles of the feet. Apes sweat in 
 the 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 
 
 Conditions following agents and conditions : — 
 
 the Secretion Im I ncrease d 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 .7° 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 ; 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 65 
 
 but sweating may occur with a pale skin, — the result of fear, 
 pain, collapse, shock, or the death-agony. 
 
 Stimulation of a motor nerve causes sweating of the skin 
 over the muscles supplied by the nerve, and of the same area 
 of the opposite side of the 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, 
 and soles, and sometimes of only one side of the face. 
 
 10. Profuse perspiration occurs as a symptom in certain 
 diseases, as intermittent malarial fever, phthisis, and acute 
 rheumatism. 
 
 11. The appearance of sensible perspiration is encouraged 
 by a moist, warm atmosphere, in consequence of the lessened 
 rapidity of evaporation. 
 
 Perspiration is decreased by — 102 
 
 1. Cold. 
 
 2. A profuse watery discharge from the kidneys or bow- 
 els. The skin and the kidneys seem to act reciprocally. 
 When the secretion of one organ is increased, that of the 
 other is decreased. In warm weather the volume of urine is 
 usually diminished ; in cold weather, increased. The opposite 
 is true of the cutaneous secretion. 
 
 3. Certain drugs, as atropia. 
 
 4. Certain forms of disease, as in some cases of paralysis, 
 in diabetes, cancer, and many cases of chronic dyspepsia. 
 
 Perspiration is one of the most important means by 103 
 
 which the danger of excessive accumulation of heat within 
 
 the body is averted. When the skin fails to perform this 
 
 important function, as it not infrequently does in fever, the 
 
 body temperature often rises to a most dangerous degree. 
 
 Not only uric acid and urea, but more subtle 104 
 Toxins of the , . J c . .. ' 
 
 Sweat a potent poisons are found in the sweat, as 
 
 ' shown by the investigations of Bouchard. Per- 
 haps most important of these is a peculiar substance which 
 manifests its properties by inducing a fall of temperature. 
 5 
 
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 ether 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 with both the coarse and the fine hairs of the 
 
 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. 67 
 
 The skin absorbs substances in watery solu- 109 
 . s *\ y 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 
 Respiration 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 C0 2 is eliminated through this channel. In 
 frogs and some other closely related animals the skin elimi- 
 nates from two thirds to three fourths of the total amount of 
 C0 2 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 11,000 
 square feet. Cutaneous respiration is most increased (1) 
 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. 4 
 
 The skin is without doubt one of the most 112 
 
 Nervous important and interesting of all the sense or- 
 
 Functions of r . . . . , . , 
 
 the Skin. g ans > being provided with a greater variety of 
 
 nerves than any other portion of the body. 
 
 The nerves which supply the skin are the following : — 
 
 1. 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 temperature 
 sense, which terminate in the skin in the so-called hot spots 
 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 are 
 connected with corresponding nerve centers. 
 
 113 In making thermic applications to the skin, the effects 
 upon each one of these several sets of nerves must be taken 
 into consideration. It is evident that those areas of the 
 skin which possess the richest nerve supply must be most 
 profoundly affected by hydriatic applications, and most ca- 
 pable of producing reflex effects through their connection 
 with the internal viscera by means of their centers of origin. 
 
 114 The acuteness of the pressure sense in different 
 s parts of the body is in the following order, 
 
 beginning with the most sensitive : The fore- 
 head, lips, cheeks, and temples, the back of the fingers and 
 forearm, the anterior surface of the leg and thigh, the back 
 of the feet, the toes, the soles of the feet, and the posterior 
 surface of the leg and thigh. The extreme delicacy of the 
 pressure sense is shown by the fact that vibrations may be 
 felt when exceeding the rate of 1,500 per second. This fact 
 emphasizes the importance of giving careful attention to the 
 exact regulation of pressure as well as temperature in hydro- 
 therapeutic applications, a matter which has generally re- 
 ceived less consideration than is necessary for accurate and 
 reliable results. 
 
 115 The nerves of touch are connected with the motor centers 
 controlling the muscles of the corresponding part. Rumpf 
 has shown that increased sensibility of one part, whether pro- 
 duced by an application of heat or otherwise, is accompanied 
 by a lessening of sensibility in the corresponding region of 
 the opposite side. 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 69 
 
 This is one of the most interesting of the func- 116 
 empera= t j ons f foe 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 
 there are two kinds, — hot spots and cold spots. These are 
 arranged in curved lines or chains, starting from the hair 
 roots, near which temperature spots are always to be found 
 (Fig. 19). 
 
 Menthol excites the cold spots, and so produces a sensa- 118 
 tion of cold. C0 2 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 recognizes heat only, and not cold. 120 
 
 The acuteness of the thermal sense differs in different 121 
 portions of the body, and in the following order, the most 
 sensitive being named first : Tip of finger, eyelids, cheeks, 
 lips, 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 degree of acuteness. 
 
 The more acute areas recognize a difference in tempera- 122 
 ture of less than . i° F. Regions situated in the median line, 
 as the nose, are least sensitive. 
 
 The temperature is estimated higher when a large surface 123 
 is exposed. Water at 85 feels warmer if the whole hand is 
 immersed than water at 90 in which the finger alone is 
 dipped ; but sudden immersion of the whole body in cold 
 water produces a less unpleasant effect than when the body 
 is introduced gradually. 
 
 Cold bodies feel heavier than warm ones. The pressure 124 
 of a stream of water, as in a horizontal jet douche, feels 
 greater when cold than when warm. 
 
70 RATIONAL HYDROTHERAPY. 
 
 ^ 
 
 125 The skin is more 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 or 
 cooler than poor conductors at the same temperature. It is 
 doubtless for this reason that hot or cold water makes a 
 very much stronger impression than air of the same tem- 
 perature. 
 
 129 The temperature sense is most delicate at temperatures 
 near or a little below that of the blood (8o° to 90 F.). It 
 is less delicate at temperatures below 8o° and above the 
 temperature of the body. Impressions of pain only are made 
 by a temperature of ijo° or above. 
 
 130 Rapid variations of extremes of temperature produce more 
 marked effects than gradual changes. The strongest impres- 
 sions are made by alternations of very hot and very cold 
 applications. 
 
 131 The sensibility of the temperature sense improves with 
 practice and with diminution of the blood supply. Venous 
 congestion of the skin diminishes the temperature sense. 
 
 132 Fatigue of the temperature sense develops quickly; hence 
 marked tolerance within quite wide limits is quickly estab- 
 lished. 
 
 133 The nerves of the temperature sense are associated with 
 the heat-generating and heat-regulating centers of the brain 
 and spinal cord. 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 7 1 
 
 The blood-vessels are supplied with both con- 134 
 and Secretory stricting and dilating nerves, which arise from 
 Nerves. different centers, located at various levels in 
 
 the spinal cord. It is through impressions 
 made upon these nerves either singly or in succession that 
 some of the most important effects in hydrotherapy are pro- 
 duced. The relation of the principal vasomotor centers to 
 the principal surface areas and to the viscera of the chest and 
 abdomen, is briefly stated elsewhere (153-166). 
 
 Each one of the several million sweat-glands and seba- 135 
 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. 
 
 • 
 
 GENERAL VIEW OF THE NERVOUS SYSTEn AS RELATED TO 
 HYDROTHERAPY. 
 
 The skin, as has been aptly remarked, is a harp of a thou- 136 
 sand strings, upon which one who is a master of the necessary 
 means may play in such a manner as to produce almost any 
 desired physiological or therapeutic effect. The skin is the 
 keyboard, and the nerves and nerve centers are the internal 
 mechanism. 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 rules of musical harmony and technique 
 to the pianist. 
 
 It is necessary to understand not only the relation of the 137 
 nerve endings in the skin with the nerve centers in the 
 brain and spinal cord, but also through them the relation 
 of the skin with the internal viscera supplied with nerves 
 from the same or associated centers, and hence in special 
 reflex relation. 
 
 Applications to the skin are sometimes made for the pur- 138 
 pose of influencing the nervous system as a whole, but not 
 infrequently it is desirable that the application should be lim- 
 ited in its effect to some single internal region. 
 
*]2 RATIONAL HYDROTHERAPY. 
 
 139 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. 
 
 14:1 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 vertebras. 
 
 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. 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 73 
 
 As hydrotherapeutic applications are capable 142 
 
 Re«exes erfidal ° f excitin S each and a11 the classes of reflexes 
 that may be set up by stimulation of the cuta- 
 neous nerves, it is useful to bear in mind the location of the 
 several reflex areas, and their relation to the spinal centers. 
 
 The scapular reflex area (the skin between the shoulder- 143 
 blades), in relation with the first to the fourth dorsal ganglion. 
 
 The epigastric reflex area (the skin overlying the lower 144 
 lateral portion of the chest), in relation with the fifth to the 
 seventh dorsal ganglion. 
 
 The abdominal reflex area (the skin lying along the bor- 145 
 dors of the recti muscles), in relation with the eighth to the 
 twelfth dorsal center. 
 
 The gluteal reflex area 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 
 thigh), in relation with the fourth and fifth lumbar ganglia. 
 
 The plantar reflex area (the soles of the feet), in relation 148 
 with 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 in mind, especially in cases, of organic 
 disease of the spine. 
 
 The controlling vasomotor centers, both con- 149 
 e asomo or s t r icting 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 
 erate, on the vasodilator fibers. 
 
 The veins and the lymph-vessels are also supplied with 151 
 vasomotor nerves ; and though at the present time nothing 
 more is known of these nerves than that they exist, it is rea- 
 sonable to suppose that they obey the same general laws as 
 those connected with the small arteries. 
 
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. 
 
Fig. 20. SYMPATHETIC NERVOUS SYSTEM (p. 75). 
 
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 
 The Visceral 
 
 Motor Nerves. ments 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 sympathetic nervous system (Fig. 20) con- 167 
 The Sympa= s j sts f three distinct sets of ganglia ; namely: — 
 Svstem I ' ^ e lateral, or vertebral, ganglia, con- 
 
 sisting of a series of ganglia arranged along on 
 either side of the anterior surface of the vertebral column, 
 distributed as follows : three cervical, twelve dorsal, four 
 lumbar, five sacral, one coccygeal. These two chains of 
 ganglia form an ellipse, the ends being joined at both top 
 and bottom in a single ganglion. 
 
 2. The prevertebral ganglia, ox gangli at ed plexuses, con- 
 sisting of the cardiac, solar, and hypogastric plexuses, or the 168 
 thoracic, abdominal, and pelvic prevertebral ganglia, and the 
 umbilical 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, 
 Meissner's plexus. The latter controls both the intestinal 
 glands and the involuntary muscular fibers of the villi. 
 
 The vertebral ganglia are connected with the 170 
 Soianchni s 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 
 

 y6 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 L , , A . . . 
 
 Svmoathetic afterward used in some way in 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. 77 
 
 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. 5 
 
 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 difficult 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 
 
 ources o foods, which, as has been shown by careful 
 
 Animal Heat. ' ' J 
 
 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 68o pounds 
 of water one degree in temperature ; an ounce of fat produces 
 eighty per cent, more heat, or sufficient to raise 1,200 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, C0 2 is excreted. Heat is the result of the tearing 
 
yS ■ 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. 6 
 
 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 
 170 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 
 Coldblooded the medium in which they exist, or maintain 
 R1 . . = ' but a 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 ioo° ; birds, from 
 107 to 111°. 
 
 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 
 The Normal -^^ ^ e n0 rmal temperature of man is gener- 
 in Han. a ^ 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 
 Surface Tr ■ . . -, . . 
 
 Temperatures. Kunkel found the temperature 01 various parts 
 
 of the body surface to be as follows : — 
 
 Centigrade. Fahrenheit. 
 
 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° 92.48° 
 
 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. 
 

 80 RATIONAL HYDROTHERAPY. 
 
 191 Internal Davy and others give the following as the tern- 
 Temperatures, peratures found in various internal parts : — 
 
 Brain 104 F. 
 
 Left ventricle 107 F. 
 
 Right ventricle 106 F. 
 
 Liver 106. 5 F. 
 
 Rectum ioo° 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 tenor twelve degrees below the internal (Senator). 
 
 193 The temperature varies with age ; that of the infant 01 
 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 rate of heat 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 8 I 
 
 production 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 
 mouse 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. 
 
 Conditions that There are various conditions that profoundly 198 
 Increase Heat affect the process of heat production, each of 
 Production, and which must be recognized and remembered 
 
 _ e _ en en ^ y in dealing with febrile cases. These condi- 
 to Temperature ° 
 
 Rise. 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 
 during 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 less. 
 
 2. Muscular Activity. — The temperature of an oarsman 200 
 was found to be 104 after rowing one and one-fourth miles 
 (Experiment 1). Heat production is increased by exercise, 
 according to Helmholtz, from 7.5 to 18. 1 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 
 duction is increased thirty-five or forty per cent, during 
 digestion. The body temperature often rises half a degree. 
 
 6 
 
82 RATIONAL HYDROTHERAPY. 
 
 The contents of 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 6o° F. , although temperatures between 
 6o° and yo° 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 JJ° 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 produc- 
 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- 
 Conditions that Auction : — 
 
 206 Production. 3C * F ast ing. — 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 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 83 
 
 usually higher at night than in the morning. The morning 
 temperature is higher in a person who works at night and 
 sleeps during the day. In hibernation the heat production is 
 diminished to such an extent that the absorption of oxygen is 
 less than one fortieth as much as during normal activity, and 
 the elimination of C0 2 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 
 heat units per minute as compared with 7. 5. 
 
 3. Short applications of heat lessen heat production 208 
 while increasing heat elimination, and thereby cause a decline 
 in the body temperature. 
 
 HEAT REGULATION. 
 
 Modern researches upon this subject apparently demon- 209 
 strate that the heat-producing and heat-regulating mechanism 
 of the body consists of three elements, — thermogenic centers, 
 thermogenic nerves, and thermogenic tissues. 
 
 Of the thermogenic centers there are three classes : — 
 
 1. The automatic centers, located in the spinal cord, which 210 
 have immediate charge of the thermogenic tissues, and 
 under the control of which the process of heat production 
 
 is carried on. 
 
 2. Accelerator centers, located in the brain, which in- 211 
 crease heat production by stimulating the automatic centers. 
 
 3. Inhibitory centers, also located in the brain, which 212 
 restrain the action of the automatic centers. 
 
 The automatic centers appear to be entirely uninfluenced 213 
 by the various forms of stimuli which influence the body 
 temperature, while the regulating centers in the brain are 
 extremely sensitive to such stimuli. 
 
 The inhibitory thermogenic centers of the 214 
 The Mechanism Dram appear to rule in a remarkable manner 
 Regulation a g rou P °f important functions which are 
 
 utilized in heat dissipation when it is neces- 
 sary to combat 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. 
 
 215 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 a 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. 
 
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ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 85 
 
 One seventh of the total heat loss by the skin is due to 218 
 evaporation. 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 
 various means the amount of perspiration may be increased 
 to two or three pounds an hour. 
 
 The increase of respiratory activity increases heat loss, 219 
 not only by the increased amount of the air that is warmed, 
 but by the evaporation of water from the two thousand 
 square feet of surface presented by the pulmonary mucous 
 membrane. 
 
 In like manner the thermogenic centers control a number 220 
 of mechanisms by which heat production is increased and 
 heat loss lessened. When cold is applied to the surface, or 
 when the temperature of the blood is lowered, the accelera- 
 tor thermogenic center is excited, and as the result — 
 
 i. The automatic thermogenic centers of the spinal cord 
 are excited to increased heat production. 
 
 2. The heart's action is slowed. 
 
 3. The surface vessels contract. 
 
 4. Perspiration 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 221 
 excited by the accelerator center of the brain, and stimulate 
 the thermogenic tissues to increased activity, thus increasing 
 heat production ; the decreased activity of the heart lessens 
 the rate at which the blood is sent to the surface ; the con- 
 tracted vessels of the skin diminish the area of blood exposed 
 to cooling influences, thereby lessening evaporation and heat 
 loss ; the contraction of the erector pili, by increasing the 
 firmness of the skin, decreases its conductivity ; the diminished 
 respiratory movement lessens the amount of air heated by the 
 
86 RATIONAL HYDROTHERAPY. 
 
 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. 
 
 222 It is interesting to note that the functions of 
 Heat Production h eat production and heat dissipation are recip- 
 Dissipation rocal. If heat dissipation is suddenly increased 
 Associated. 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. 
 
 223 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 
 1,500 pound Fahrenheit heat units. At the normal rate of 
 heat production — seven heat units per minute — there should 
 have been produced within one hour 420 units of heat. Sub- 
 tracting this from 1 , 500, we have a net loss of 1 , 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 
 
 thus preventing the fall of temperature. 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 8/ 
 
 The special thermogenic tissues are found in the muscles, 224 
 in which heat production is constantly taking place through 
 the connection of these tissues with the automatic centers of 
 the spine 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 
 energy. The muscles are the chief seat of heat production. 
 They store up glycogen for heat and work. 
 
 ■ . In the clinical study of the phenomena of 225 
 
 Water=Bath . 
 
 Calorimeter. animal heat there has long been need for a 
 
 calorimeter which could be used at the bed- 
 side. Several years ago (1890), while engaged in instructing 
 a 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 tem- 
 perature, in quantity sufficient to immerse the patient, all but 
 the head. The water should be carefully weighed, and its 
 temperature accurately determined. This may be fixed at a 
 convenient point. It must be some degrees below the body 
 temperature, and should not be too far removed from the 
 room temperature. The temperature of the room should 
 be about yo° to 8o u F. , and as constant as possible. 
 
 After placing the water in the tub, it should be thoroughly 
 stirred for fifteen minutes with a wooden paddle having a 
 thermometer 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 
 that the body of a person placed in the bath will give off 
 heat 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- 
 logical conditions. This is a very practical and accurate 
 method (Exp. 3, 4, 5). 
 
 * Since writing the above, the author has learned that Liebermeister employed the same 
 simple calorimeter thirty years ago. 
 
88 RATIONAL HYDROTHERAPY. 
 
 227 The Author's The author has recently (1899) devised a con- 
 Fever Calo= venient instrument for determining quickly and 
 approximately the rate of heat elimination in 
 a patient under examination as compared with a normal 
 individual. The instrument may be briefly described as 
 follows : — 
 
 It consists of two parts (Fig. 21, a and b) ; first, a glass 
 cylinder one inch in length, and of such diameter as to give 
 its bottom an area of three square inches, making its cubic 
 capacity three cubic inches. This cylinder is protected by a 
 solid wooden case an inch in thickness, which may be readily 
 removed. It is connected with a small bottle 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 of the surface. 
 
 In the use of this calorimeter, the temperature of the sur- 
 face is taken at the same time by a surface thermometer. 
 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 defi- 
 nite area of the skin — three square inches. By means of 
 the data thus obtained and the use of the formula given else- 
 where (page 316) for determining the skin area of a body of 
 given weight, a numerical basis is found for comparison of the 
 amount of heat loss by a person who is in a febrile state as 
 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 temperature 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 89 
 
 This instrument (Fig. 22) consists of two ther- 228 
 
 The Fever mometers placed in a chamber with thick 
 
 Calorimeter of , „ , , f . . 
 
 Winternitz. wooden walls, about lour inches square on 
 
 the inside. The chamber is open on one side, 
 and one of the thermometers rests upon the skin when the 
 instrument is in position with the open side next the skin. 
 The other thermometer determines the temperature of the air 
 in the chamber. With this instrument Winternitz has made 
 a series of most interesting observations respecting the influ- 
 ence of friction and other measures upon heat elimination. 
 This instrument, of which the writer learned on a recent visit 
 to Vienna and Kaltenleutgeben (summer of 1899), is of great 
 use, and ' renders invaluable service in the prosecution of 
 physiological researches respecting heat elimination (Fig. 23). 
 
 D' Arsonval, of Paris, has devised a convenient 229 
 Calorimeter. and P ortable calorimeter (Fig. 24), which, while 
 
 less exact than the water-bath calorimeter, is 
 so convenient 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- 
 ter, 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. It is also easy to estimate the 
 volume of the air that has passed through the cylinder in 
 a given time. The greater the amount of heat elimination, 
 
90 RATIONAL HYDROTHERAPY. 
 
 the more rapid will be the movement of the anemometer, and 
 in a given time the greater the amount of heat eliminated. 
 
 This instrument is a convenient and interesting one, but 
 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. 
 
 230 Fever is due to the disturbance of the heat-regulat- 
 Fever. . 
 
 ing centers. Such disturbances may result from three 
 
 classes of causes ; viz., (i) toxic substances, (2) nervous im- 
 pressions, (3) changes in the temperature of the blood. Fever 
 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 
 is, 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 15 
 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. 
 
 231 In 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. 
 
 232 A warm atmosphere in febrile conditions tends 
 Influence of a far more than in health to cause rise of tern- 
 Warm Atmos= perature, both by decreasing heat elimination 
 phere upon _ , . , , TT . 
 Heat Production. an( ^ °y increasing heat production. Under 
 
 normal conditions an atmospheric temperature 
 continuously above 6o° F., as elsewhere remarked, tends to 
 
ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 9 1 
 
 increase heat production, and at a temperature of 104° F. 
 heat production is increased to more than three times the 
 normal amount. In health this increase of heat production 
 is of course very largely balanced by increased heat elimi- 
 nation; but in fever this balance is not maintained. The skin 
 in fever is commonly dry under conditions which in health 
 would induce profuse perspiration. Hence heat elimination 
 is greatly diminished. Fortunately, heat production is in- 
 creased 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 
 temperature below 6o° F. , increases heat production in fever, 
 but to a less degree than in health. The neutral temperature 
 for air is from 58° to 68°, 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, will affect the 
 temperature by increasing heat production, sometimes to a 
 very unusual degree, and may even cause relapse when a 
 patient is just convalescing from a fever. 
 
 Although the body is at rest in bed, there is usually in 234: 
 fever great activity in the thermogenic tissues. The pre- 
 dominating feature in fever is increased heat production. 
 
 For each degree centigrade (i.8° F.) elevation 235 
 
 Relation of { body temperature there is ordinarily an 
 
 Heat Production . r . - M . . . 
 
 to Temperature. mcrease °* neat production of six per cent., 
 
 according to Liebermeister, or 3.3 per cent. 
 for each degree Fanrenheit. The following table represents 
 the percentage increase for each degree Fahrenheit within 
 the ordinary range of fever temperatures : — 
 
92 
 
 RATIONAL HYDROTHERAPY. 
 
 Percentage Increase of Heat Production 
 Temperature, above Normal. 
 
 98.6 F o 
 
 ioo° F 4.6 
 
 101 F 8.0 
 
 102 F 11. 3 
 
 103 F 14.7 
 
 104 F ..'. 18.0 
 
 105 F. 21.3 
 
 106 F, . . 24. 7 
 
 107 F 28.0 
 
 236 „ J . JM jm m Heat dissipation is generally increased in 
 Modifications of r G J • 
 
 the Thermic fever, but in less, proportion than heat pro- 
 Functions duction. When the skin is red 'and moist, 
 Which Cause heat 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. 7 
 
 The following table shows the various relative conditions 
 that may result in increase or decrease of the body tem- 
 perature : — 
 
 237 CONDITIONS UNDER WHICH RISE OF BODY TEMPERATURE MAY OCCUR. 
 
 i. 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 TEMPERATURE 
 MAY OCCUR. 
 
 i. 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.) 
 
Fig. 24. CALORIMETER OF D'ARSONVAL (p. 89;. 
 
 Fig. 25. PNEOGRAPH (p. no). (Kellogg} 
 

ANATOMY AND PHYSIOLOGY IN RELATION TO HYDROTHERAPY. 93 - 
 
 The temperature may be reduced in fever 238 
 
 co o ° ea either by diminishing heat production or in- 
 Functions. J .... . , ■ 
 
 creasing heat elimination, or by both means 
 
 combined ; and therapeutic applications may be made in 
 
 such a manner as to influence either of these processes, 
 
 or both of them. 
 
 It may not be out of place just here to mention the leading 
 physiological means by which fever may be controlled ; viz. , 
 rest, fasting, water drinking, regulation of air temperature, 
 hydrotherapy. 
 
 A careful study of the influence of cutaneous irritation, 239 
 thermic applications, and changes in the condition of the 
 blood-vessels of the skin has been made by Pospischil. The 
 following are some of the interesting results obtained: — 
 
 Short, cold shower baths increased heat elimination to the 240 
 amount of from twenty-five to sixty-six per cent., according 
 as the patient rested or exercised after the application; cold, 
 wet rubbing caused increased heat elimination to the extent of 
 eighty per cent. ; mechanical irritation or friction produced a 
 still greater heat loss, — ninety-five per cent.; agents produ- 
 cing a " goose flesh" appearance of the skin were found to 
 diminish heat elimination more than forty-four per cent. ; 
 weak 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 influ- 241 
 enced by various antipyretic drugs, but the effect thus 
 produced 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 
 of the body and the activity of the reparative processes by 
 which the remedial forces of the system seek to effect a cure. 
 It is encouraging to note that the pernicious effects of fever- 
 controlling drugs of all kinds are being recognized by phy- 
 sicians at the present time, and that reliance is being placed 
 on those physiological antipyretic measures whereby the end 
 
94 RATIONAL HYDROTHERAPY. 
 
 sought 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 Maragliano have shown 
 that quinine, antipyrine, thallin, and salicylic acid 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 fevei 
 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 surgical wounds, nervous impressions, etc. 
 
 The temperature may rise four or five deerees 
 Heat Production * , / & . 
 
 after Death. after 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 elsewhere remarked, Currie was the first to observe 242 
 and study the physiological and therapeutic uses of 
 water in a thoroughly scientific way, he having the 
 advantage over his predecessors in possessing a thermome- 
 ter, the invention of John Hunter, whereby the temperature 
 of the animal body might be accurately ascertained. 
 
 Soon after (1801), Henry Wilson Lockette, of Virginia, 243 
 published a report of important observations and experiments. 
 
 Next, Fleury, in France, conducted an extensive series of 244 
 researches as to the effects of water upon internal and exter- 
 nal temperatures, making a special study of its tonic effects. 
 His labors placed the use of the cold douche upon a scientific 
 basis. 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 
 such," Raige Delorme wrote less than ten years later, 
 " Thanks to L. Fleury, hydrotherapeutic medical practice 
 must take its place in rational therapeutics." 
 
 Dr. John Bell, of Philadelphia, published in 1850 his re- 245 
 markable work on " Baths." 
 
 Schiiller published in 1874 the results of a remarkable 246 
 series of experiments made upon trephined rabbits, in which 
 he demonstrated the effects upon the internal circulation of 
 thermic and mechanical applications to the surface. 
 
 Vinaj, in 1892, reported experiments upon a man whose 247 
 brain had been exposed by an accident, which confirmed the 
 observations of Schiiller on trephined rabbits, respecting the 
 influence upon the brain and circulation of thermic applica- 
 
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 of 
 the viscera. 
 
 248 The physiological effects of water are due to those quali- 
 ties which enable it to be used — 
 
 i. As a nutrient, entering into the composition of every 
 structure, and serving a useful purpose in nearly every func- 
 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 con- 
 tact and by evaporation. 
 
 3. As a means of communicating heat to the body. 
 
 4. As a means of producing certain mechanical or percu- 
 tient effects. 
 
 249 Similar effects may be obtained by other agents which are 
 capable of impressing the system in like manner, as, for 
 example, hot and cold 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. 
 
 250 A very large proportion of the applications of 
 
 The General wa ter made to the surface of the body depend 
 Effects of , . __ . . , J , l , . 
 
 Thermic Irrita= * or their erhciency upon the fact that the skin 
 
 tion upon the is reflexly connected with the interior of the 
 Circulation. 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 PHYSIOLOGICAL EFFECTS OF WATER. 97 
 
 in the internal vascular area associated with it. The inten- 
 sity of the effect produced in the internal area, is, however, 
 generally less intense than that produced upon the surface, 
 although this is by no means always the case. 
 
 It must be remembered, however, that in addition to the 252 
 reflex effect produced, there is also produced a mechanical 
 effect, which is commonly the reverse of the reflex effect. 
 The real effect is the sum of these two effects, and depends 
 upon the relative intensity of the two actions. The effects 
 of external applications of water may thus be simply divided 
 into two classes, — reflex and mechanical. 
 
 Any sort of irritation of the cutaneous nerves which gives 253 
 rise to contraction of the blood-vessels of the surface, whether 
 cold, heat, friction, percussion, pinching, or mechanical irri- 
 tation, likewise causes contraction of the small blood-vessels 
 of the interior of the body, stimulating the accelerator nerves 
 of both the blood-vessels (vasoconstrictors) and the heart. 
 
 The duration of the reflex effect depends upon the inten- 254 
 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- 
 rior 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 255 
 small, the reflex effect may be confined to the internal area 
 in sympathetic relation therewith (349), and will 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 
 
9§ 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 Schiiller and 
 Vinaj, affords us a rational basis for the explanation of nearly 
 all the phenomena resulting from hydriatic procedures. 8 
 
 THE PHYSIOLOGICAL EFFECTS OF COLD. 
 
 257 Cold is a vital depressant. Under all circum- 
 
 Cold a stances and in all modes of application this is 
 
 Sedative or an . . , . «« 
 
 Excitant? lts P nmar y an ^ 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 The life processes of warm-blooded animals 
 Hibernation. . ,- , - _ , ... 
 
 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 WATER. 99 
 
 tissue takes place, so that the animal may pass several weeks 
 without eating or drinking. 
 
 In fishes, whose temperature is generally only a degree or 260 
 two above the water in which they live, the temperature may 
 be reduced so low that actual freezing takes place, when 
 there seems to be complete suspension of vital activity, but 
 not actual death, the animal living in this condition for weeks 
 and even months. 9 
 
 The depressing influence of cold upon vital activity is 261 
 
 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 of ice to the 
 
 affected parts. The activity of the perspiratory 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. 
 
 In the study of the physiological effects of 262 
 Hydriatric * v J 8 
 
 Measures water at different temperatures upon the 
 
 Consist various structures and organs of the body, 
 
 Chiefly of ^ ^he fact must be kept in mind that as em- 
 cations 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, 
 
100 RATIONAL HYDROTHERAPY. 
 
 however, in the study of the physiological effects of water, as 
 well as in directing its therapeutic application, it is necessary 
 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 
 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 8o° 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 - n an y f orm> whether internally or externally, 
 
 fects of Cold. t ^ le fi rst e ^ ect i s 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. IOI 
 
 continued for a long time, this vital depression continues 
 likewise, and is maintained for a time after withdrawal of the 
 application. The longer the application, the longer the de- 
 pression that follows. Sooner or later, however, the parts 
 return to their normal condition ; and if the depression has 
 not been so great and so prolonged as vitally to damage the 
 parts, in the return to normal activity the pendulum swings, 
 so to speak, beyond the normal line, so that for a time a 
 higher degree of vital activity is maintained than before the 
 application. This increased physiological activity is termed 
 reaction; or as the writer will undertake to show later (435), 
 tonic reaction. 
 
 When the cold application is a short one, the reaction 269 
 follows quickly, and is as much more intense as the applica- 
 tion made is energetic ; that is, low in temperature 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 applications 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 
 either spontaneous or increased by a current of air. All these 
 means are employed in hydrotherapy. The same principles 
 apply, however, whatever the mode of application. 
 
 In discussing the physiological effects of cold applications, 272 
 Currie very well says (" Medical Reports," page 68) that it is 
 " not the cold that stimulates, but the sensations which the 
 cold produces." This may at first seem like a distinction 
 without a difference, yet it seems to the writer that Currie 
 was right. The intrinsic effect of cold is depressant, while 
 that of heat is stimulant. Nevertheless, a recognition of the 
 thermic impressions made upon the temperature nerves of 
 the 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 
 
102 RATIONAL HYDROTHERAPY. 
 
 effects that the effects which are actually apparent are those 
 of excitation instead of sedation. 
 
 273 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 rallying 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- 
 
 Effects of mals reported by Wertheimer, in 1893, showed 
 
 Peripheral , / \ „ , . ' , 
 
 Irritation. tnat tne g enera l 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 PHYSIOLOGICAL EFFECTS OF WATER. IO3 
 
 Naumann, operating upon frogs, detached all portions of 276 
 one of the hind legs with the exception of the sciatic nerve, 
 and then applied cold and irritating substances to the skin of 
 the separated leg, and noted with the microscope the effects 
 upon the mesenteric circulation. He observed that gentle 
 irritation of the skin of the leg produced contraction of the 
 vessels and quickened heart action, while strong irritation 
 produced dilatation and slowed heart action from excitation 
 of the vagus, the inhibitory nerve of the heart, and of the 
 vasodilators, the inhibitory nerves of the vessels. These 
 effects are general in the body. 10 
 
 Schuller * found that the application of cold water to a 277 
 nerve trunk caused contraction of the vessels of the brain ; 
 while 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 278 
 and full baths were found to produce opposite effects. A 
 warm bath produced dilatation of the surface vessels, but 
 contraction of the vessels of the brain ; while a cold bath 
 produced contraction of the vessels of the skin, with dilatation 
 of the cerebral vessels. 
 
 These observations show clearly that two classes of effects 279 
 are produced in applications of water to the surface ; viz. , 
 (i) reflex^ (2) mechanical, or derivative. 
 
 Doubtless both of these effects are always produced. 280 
 When the application is general, the mechanical effect is 
 dominant ; when the area involved is limited, the reflex 
 effect 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 
 the body is termed retrostasis. Marked retrostasis is pro- 
 duced only when the cold application is made simultaneously 
 to a very large cutaneous area. 
 
 *Archiv fiir Klinische Medicin % Vol. 14, 1874, Leipsic, page 566. 
 
 
J 04 RATIONAL HYDROTHERAPY. 
 
 281 The effects of general warm (99°-ioo° F.) and cold (52 ) 
 applications were observed to be transient, lasting not more 
 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 o to 6 ^ pro d U ces pallor and coldness 
 
 B!ood=Vessels. °* ^ e s ^ n ' ^ ue to tne contraction of the small 
 
 vessels (Exp. 8). 11 
 
 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). 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. 105 
 
 Percussion, or slapping, and friction have much the same 286 
 effect on the small vessels as cold water, causing first excita- 
 tion of the vasoconstrictors, and later the reverse (Exp. 9). 
 
 The almost instant suspension of the glandular 287 
 
 2. Decrease or action of the skin as the result of the action 
 Suspension of of cqM [s QYQn mQre remarkable than the exci _ 
 Perspiration. 
 
 tation of these glands by the application of 
 
 heat (Exp. 10). It is evidently a purely reflex phenomenon, 
 as suspension of sweating takes place before the application 
 of cold has continued long enough to occasion a lowering of 
 the general temperature of the blood, the cessation of the 
 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 
 of the glands. 
 
 It is noteworthy that suspension of the action of the sweat- 
 glands of the entire skin surface may be brought about by a 
 cold application to a very small area, as the feet, the shoul- 
 ders, and in some cases the hands or other equally limited 
 surfaces, — evidently a reflex effect. 
 
 This sudden checking of perspiration as the result of cold 288 
 applications is injurious or dangerous only when the body is in 
 a state of fatigue, or when the perspiratory activity is the 
 result of an effort on the part of the system to antagonize a - 
 febrile movement, as in the sweating stage of malarial fever, 
 in sweating sickness, etc. 
 
 With the occurrence of reaction, the action of the sweat- 289 
 glands is resumed, and may be greatly increased. 
 
 Cold applications, by causing contraction of 290 
 
 3. Decreased the small vesse i s lessen the amount f blood 
 Heat Elimlna- ' . , 
 tion and circulating through the skin, and thus diminish 
 
 Increased Heat heat elimination, during the application. At 
 Production. ^e same time, the reflex effect upon the 
 
 centers controlling heat production stimulates the develop- 
 ment of animal heat in the body. 
 
106 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 m _ ^ Applications of a temperature below 92 to 
 Tactile ^8° lessen the acuteness of the tactile sense 
 Sensibility. (Exp. 1 1). 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 EFFECTS 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 OF COLD UPON THE CIRCULATION. 
 
 Cold slows 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 upon 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 pneumogastric, whereby the heart's 
 movements are slowed. It should be remembered also that 
 in the reaction following a short cold application the increased 
 activity of the small vessels aids the heart, while by the con- 
 tinuous contraction during a cold general 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 heart, while prolonged appli- 
 cations slow its action (Exp. 12, 13, 14, 15) (Roehrig). 
 
 A short, 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 (6o° to 8o° 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 ganglia in the vessel 
 
108 RATIONAL HYDROTHERAPY. 
 
 walls. Some of the most important of the effects of local 
 cold applications are the following : — 
 
 303 Plethysmographic experiments made by Franck 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. 16). 12 
 
 304 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 (Winternitz), showing a contrac- 
 tion of the distal portion of the radial artery. 
 
 305 A compensatory effect is sometimes observed. Winternitz 
 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 the hypothenar region are at the same time paralyzed. 
 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, while 
 the opposite ear becomes pale. 
 
 307 Cold applications made across the trunk of an artery cause 
 contraction in its distal portions. An ice-bag applied to the 
 axilla lessens the circulation in the arm (Exp. 17). 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). 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. 109 
 
 An ice-bag applied over the heart continuously for several 308 
 hours diminishes its activity and lessens rate of blood move- 
 ment through the body. 
 
 A sliort, cold application over the heart acts as a tonic to 309 
 the heart, increasing its force and raising arterial tension. 
 
 A short general cold application is a powerful heart tonic, 310 
 increasing greatly the force and efficiency of the heart in 
 appropriate cases. Direct application of cold, as by cold 
 water dripped upon the exposed part or a cold fluid passed 
 through it, slows and weakens it. 
 
 A prolonged cold application slows the heart's action, 311 
 increasing arterial tension (Exp. 20). 
 
 Winternitz noted that cold applications to a limited sur- 312 
 face of the skin increased the pulse-rate for three minutes, 
 after which it gradually diminished in frequency. 
 
 The influence of cold upon the mucous membrane is essen- 313 
 tially the same as that upon the skin, except that the mucous 
 membrane is somewhat less sensitive to thermic impressions, 
 having a smaller number of sensory nerve fibers. The 
 mucous membrane is, however, richly supplied with vaso- 
 motor and sympathetic fibers, through which decided reflex 
 effects may be produced. 
 
 A quantity of cold water taken into the stomach produces 314 
 more marked effects than water applied to an equal area of 
 the skin. The general temperature may be lowered by this 
 means, and the heart's action may be slowed. Cold water 
 drinking may lessen the pulse-rate ten to fifteen beats per 
 minute (Exp. 21). Cold water drinking produces the same 
 effects upon the visceral vessels and the blood pressure as 
 do cold applications to the skin, though in less degree. The 
 quantity of water is also an important factor. 
 
 Even more marked effects may be readily produced by the 315 
 cool enema, which, together with water drinking, is one of 
 the most efficient means of combating fever. The writer has 
 often seen the general temperature fall one or two degrees in 
 a fever case as the result of an enema administered at 8o°. 
 
IIO 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, Richter, 
 Johnson, and others seem to indicate no regularity in the 
 effects 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 the douche the effect is to pro duce at first 
 flovement. , - . 
 
 short, gasping 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). 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. I I I 
 
 This property of cold water must be borne in mind in the 320 
 treatment of asthmatics, 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 
 pulmonary vessels being made to contract suddenly by the 
 powerful excitation of the vasoconstrictor centers of the cord, 
 the area of blood presented for gaseous interchange in the 
 pulmonary mucous membrane is very greatly diminished, 
 while at the same time the demand for oxygen and for the 
 elimination of C0 2 is increased, thus producing the painful 
 sensation experienced in suffocation. 
 
 This sensation of suffocation ordinarily disappears at once 321 
 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 of the expired air shows that 322 
 Elimination an mcrease d amount of oxygen is absorbed 
 
 and an increased amount of C0 2 is exhaled 
 under the influence of cold applications. 
 
 Crawford showed more than a century ago (i 78 1) that 323 
 cold increases the difference in color between arterial and 
 venous blood, the result of increased oxidation. 
 
 The oxidation of organic waste substances which takes 324 
 place in the lungs is doubtless also increased, as is the 
 oxidation of sugar in the blood of the general circulation. 
 
 Liebig observed more than half a century ago that cold 325 
 air, cold water, and exercise, habitually employed, are the 
 most powerful of all means of stimulating tissue activity. 
 
 THE EFFECTS OF COLD UPON THE MUSCLES. 
 
 Prolonged applications of water at a low tern- 326 
 
 The Muscular perature decrease muscular irritability and 
 Sense. . 
 
 Muscular muscular energy. This is shown in the stiff- 
 
 Irritability, 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 
 few seconds, augments muscular energy and tone to a very 
 
112 RATIONAL HYDROTHERAPY. 
 
 remarkable degree. The exaggerated tonicity thus induced 
 is the cause of shivering. The cold bath, if short (i to 2 sees.) 
 and given with much pressure (25 to 35 lbs.), is a powerful 
 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. 13 
 
 328 It is a curious and interesting fact that while 
 The cold lessens the irritability of the voluntary 
 Muscles 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 evacuation 
 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 cold 
 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. I I 3 
 
 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 
 for 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 
 of the influence of heat and cold upon the ameba and the white 
 blood-corpuscle shows that the influence of heat is to cause 
 increased activity of the cell, with extension of protoplasmic 
 processes, or arms, while cold diminishes its activity, causing 
 retraction of its processes. We may thus justly conclude that 
 when cold applications are made in such a manner as to influ- 
 ence the nervous system directly, similar effects are produced. 
 It is held, 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 
 nervous system by breaking contact at the points at which * 
 connection 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 dendrites, and an increased number 
 of contacts with other neurons by means of the neuraxons 
 with their collateral branches, end-tufts, and innumerable 
 gemmules, or contact globules. 
 8 
 
114 RATIONAL HYDROTHERAPY. 
 
 335 With these facts in mind, it is not difficult to understand 
 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 to a nerve mav diminish the rate of transmis- 
 
 and Mental , . 
 
 Activitv slon nervous impulses over it to one sixth 
 
 the normal rate (Exp. 25). After such 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 distributed 
 
 becomes the seat of pain, sometimes very intense in character, 
 
 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 Schiiller showed (1874) by experiments upon trephined 
 rabbits the following interesting facts in relation to the effects 
 of thermic applications upon the brain : — 
 
 340 1. Water at neutral temperature (92°-95° F.) applied 
 directly to the brain produced no effect. 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. I I 5 
 
 2. Ice applied to the brain coverings caused contraction 341 
 of both 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 
 chilliness and shivering. 
 
 4. A cold compress applied to the spine or abdomen, or a 343 
 cold full bath caused instant dilatation of the cerebral vessels, 
 lasting from 3 to 10 minutes, then giving place to con- 
 traction. 
 
 5. Hot compresses or a hot full bath caused contrac- 344 
 tion of the cerebral vessels, later followed by dilatation. 
 
 6. Cold and warm applications applied to a nerve trunk 345 
 produced an effect exactly opposite to that produced by the 
 same 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- 
 questionably the same effects, which are evidently reflex in 
 character, occur when the sensory nerves of the skin are in- 
 fluenced by thermic applications, but they are overwhelmed 
 and quickly wiped out by the mechanical dilatation of the 
 cerebral vessels, resulting from the elevation of blood pres- 
 sure 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 
 duration caused, first, dilatation, then contraction, of the cere- 
 bral vessels, 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 
 firmed by observations made upon a man whose brain had 
 been exposed by accident, laid the foundation for a scientific 
 therapy of the brain, which has received far less attention than 
 
Il6 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 an 
 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 and 
 repair. 
 
 REFLEX EFFECTS OF COLD APPLICATIONS. 
 
 349 Edwards showed that immersion of one hand in cold 
 water causes a lowering of temperature in the other hand. 
 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 effects. 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 PHYSIOLOGICAL EFFECTS OF WATER. 117 
 
 c s 1 c** * * In accordance with the facts just mentioned, 350 
 Special Effects of J ' 
 
 Applications to it becomes apparent that to produce reflex 
 Huscular Reflex effects in the muscles we have but to make 
 Areas. QQ ^ a ppii ca ti ns to those areas the stimula- 
 
 tion of which is capable of developing muscular contraction. 
 These areas, as elsewhere pointed out, are : — 
 
 The inter- scapular (space between the shoulder-blades). 
 
 The epigastric (the sides of the chest at about the level of 
 the fourth rib). 
 
 The abdominal (the borders of the recti muscles). 
 
 The cremasteric (the inner and upper surface of the thigh). 
 
 The plantar (the sole of the foot). 
 
 By gentle irritation of the skin of these several areas, the 351 
 greater portion of the several muscular groups may be brought 
 into 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 
 it is desirable to stimulate the nutrition of the muscles, as in 
 general muscular weakness, paresis or paralysis, progressive 
 muscular atrophy, and other maladies in which there is wast- 
 ing of the muscular structures. Although muscular action 
 may not be induced, the nutritive processes in the muscles are 
 influenced favorably by applications made to these reflex 
 areas. Most important of all is the plantar surface. 
 
 An application of a jet of either cold or very hot water to 352 
 the abdomen causes instant and vigorous contraction of the 
 abdominal muscle, and is likewise a most valuable means of 
 exciting intestinal peristalsis. 
 
 Cold applications to the face and neck, short 353 
 Special Skin and intense, cause dilatation of the cerebral 
 Areas in Reflex k 
 
 Relation with K . 
 
 the Internal A prolonged contraction of the cerebral o54: 
 
 Viscera. vessels is produced if the application is greatly 
 
 lengthened, and vertigo and even uncon- 
 sciousness may result. This is true, however, only of very 
 vigorous applications, as the long cold ''head pour." 
 
I I 8 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, w T ith 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 
 slows 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. II9 
 
 A very cold and very short douche (2 to 4 sees.), with 365 
 strong pressure (25 to 30 lbs.), to the lumbar region, pro- 
 duces dilatation of the uterine vessels. This measure is ac- 
 cordingly useful in amenorrhea. 
 
 Prolonged cold applications to the breasts and the inner 366 
 surface of the thighs produce contraction of both the vessels 
 and the muscles of the uterus. 
 
 Brown-Sequard showed that the application of an ice- 367 
 bag to the lumbar region causes contraction of the renal 
 arterioles. 
 
 Rossback by experiments on a cat with trachea exposed 367J 
 and opened showed that the application of ice to the abdomen 
 causes contraction of the vessels of the mucous membrane. 
 
 A short, cold douche applied to the lower portion of the 368 
 sternum stimulates the kidneys, increasing the flow of urine-. 
 
 A short, cold douche, with strong pressure, over the liver, 369 
 stomach, spleen, or bowels, produces dilatation of the blood- 
 vessels, with increased activity in these organs. 
 
 Contraction of the small vessels may be produced in the 370 
 liver, spleen, stomach, bowels, and other internal viscera by 
 prolonged cold applications of moderate intensity (60 ° to 
 75 F.) to the skin overlying these organs. 
 
 Cold application to a reflex area often give rise to a sense 371 
 of constriction in the parts reflexly connected. When a cold 
 douche is applied to the feet, a strong sensation of constric- 
 tion 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 
 Methods for caused either to dilate or contract by cold 
 
 Reflexly in= applications to the skin, according: as the 
 
 f!uencmgthe!n= .. , ' . & 
 
 ternal Viscera application is short and intense (1 to 4 sees., 
 
 temp. 40 to 6o° F., pressure 25 to 35 lbs.) 
 (dilatation), or long and moderate (contraction), by the fol- 
 lowing methods : — 
 
 The brain, by applications to the head, neck, face, hands, 373 
 and feet. 
 
120 RATIONAL HYDROTHERAPY. 
 
 374 The nasal mucous membrane, by applications to the neck, 
 face, upper dorsal spine, hands, and feet. 
 
 375 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. 
 
 379 The liver, by applications to the lower right chest. 
 
 380 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. (See fur- 
 ther respecting reflex effects, pages 724 to 751.) 
 
 THE EFFECTS OF COLD UPON THE BLOOD. 
 
 383 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. 11 15 16 
 
 384 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. I 2 I 
 
 into the circulation. 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 corpuscles 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- 386 
 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'Arsonval 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 {Deutch. Med.-Zeit., 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 before 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 the 
 region of the stomach, increases the amount of hydrochloric 
 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. 
 
 395 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. 1 23 
 
 General cold applications, especially the cold douche, 396 
 increase the production of HC1, 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 1890, 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 
 hours. 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. 17 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. 
 
 4-00 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 
 temporarily 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. 18 
 
 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. 12$ 
 
 Short general cold applications increase the elimination 
 of CO 2 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 C0 2 elimination. 
 
 Cold applications which give rise to increased heat produc- 403 
 tion and a corresponding increase of C0 2 do not give rise to 
 an increase in urea unless they affect 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 
 influence of cold in increasing renal efficiency. 
 
 THE EFFECTS OF COLD APPLICATIONS UPON TEMPERATURE. 
 
 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. i°, 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. 
 
126 RATIONAL HYDROTHERAPY. 
 
 ±07 J. Lefevre has shown that the rate of heat loss when the 
 
 body is exposed to cold air or cold water does not decrease 
 as the temperature is lowered, but increases out of propor- 
 tion to the temperature lowering. 
 
 4-08 Fleury observed a lowering of seven degrees in tempera- 
 
 ture in a man by immersion in a bath at 50 F. for 25 
 minutes. iy 
 
 ±09 Jurgensen observed a reduction of 6.5° in temperature as 
 
 the result of a cold bath. 
 
 ±10 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°. 
 
 ±11 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 applications 
 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. 
 
 4 13 Fleury was the first to note that the body temperature 
 sometimes does not begin to fall until some minutes after 
 the subject has been removed from the bath. 
 
 ±1± 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 increase of more than 44 per cent. 
 
 ±15 It must be remembered, however, that by very vigorous 
 
 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. \2J 
 
 The necessity for the prolonged application of cold grows 416 
 out of the fact that when a cold application is made, the 
 forces of the body instantly rally to resist its influence, heat 
 production being increased and heat elimination diminished. 
 The system thus endeavors to maintain the normal tempera- 
 ture. 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. 20 
 
 When a cold application is considerably 417 
 ' . prolonged, the tendency to reaction is, to a 
 
 Reaction. large extent, suppressed, as a result of the 
 
 exhaustion of the nerve centers involved, the 
 lessening of the sensibility of the sensory nerves concerned in 
 the reflex movement upon which reaction depends, as well as 
 by the exhaustion of the powers of calorification. Thus the 
 system gradually loses its power to resist the depressing 
 effects of cold, 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 
 The Effects of that of the body always lower the temperature 
 Local CoJd f th e p ar {- f- wn i c h the application is made. 
 
 uoon the Bod Circumscribed local applications of cold 420 
 
 Temperature. 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 of large cold compresses to the trunk, except in case of 
 
128 RATIONAL HYDROTHERAPY. 
 
 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- 
 eter. 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=ELECTRICAL 
 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 
 Suppression u , „ , . . 
 
 of Reaction 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 perspiration, 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 applications, 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 • i , 
 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. 
 
 435 We have here to consider only the reaction 
 of Cold following short cold applications, the reaction 
 
 of heat being left for consideration elsewhere 
 (578). 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 reaction, 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. 
 
 131 
 
 3. The remote effects, 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 
 follows : — 
 
 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 
 roughness of the skin. 
 
 4. 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, 
 deep, gasping respiration. 
 
 8. Cooling of the skin. 
 
 9. In most cases slight rise of 
 internal temperature. 
 
 10. Perspiration checked. 
 
 REACTION. 
 
 1. Dilatation of the small blood- 
 vessels of the surface, with con- 
 traction of internal vessels. 
 
 2. Redness of the skin. 
 
 3. Skin soft, smooth, and sup- 
 ple. 
 
 4. Sensation of warmth. 
 
 5. A sensation of comfort and 
 well-being. 
 
 6. Slowing of the pulse, with 
 increased tension. 
 
 7. Respiration free, slower, and 
 deeper. 
 
 8. Heating of the skin. 
 
 9. Fall 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 4-38 
 short duration, the phenomena of reaction begin immediately 
 when the application ceases. 
 
132 RATIONAL HYDROTHERAPY. 
 
 4:39 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 
 
 occur in 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 ; and 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 
 P .. 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 the energies of the body, by which it is 
 naturally able to combat the disturbance created by the 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. 1 33 
 
 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 
 Conditions that ., ., , , ,. ,. , 
 
 Favor Reaction. lf the cold a PP llcatlon 1S 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 Reaction^ to be 445 
 Employed before the Bath : — 
 
 (1) Warm clothing. 
 
 (2) Exposure to the air of a warm room. 
 
 (3) A hot bath of some sort. 
 
 (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 skin 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 : — 
 
 (1) A very low temperature; the lower the temperature 
 the more prompt the reaction. 
 
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: — 
 
 (1) 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 
 off his shoes 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 taction and contraindi- 
 Discourage 
 
 Reaction. ca -te 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 1 . 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 
 
 10. An immediately preceding or impending chill. 458 
 
 11. Extreme aversion to cold applications. 459 
 
 As the previous observations relate chiefly 460 
 Thermic . f • . , 
 
 Reaction. to tnat P ortlon °* the phenomena 01 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. 
 
 Thermic 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 10 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 : — 
 
 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 xx' 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 instant 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. 
 
 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 (8o° 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 PHYSIOLOGICAL EFFECTS OF WATER. 1 37 
 
 I 
 % 
 
 Diagram representing the vital movement following a warm or tepid bath. 
 
 In this diagram, xx f represents the normal temperature, 
 98. 6° F. The line ab represents the action whereby the 
 body 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 
 perature 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 C0 2 , as shown by Winternitz. 
 
 4 71 Curiously enough, the influences which give 
 Counterbalan- . t . . -, « , 
 
 , ^ .. rise to an increase 01 internal neat are antago- 
 cing Reaction. b 
 
 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. 
 472 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. 1 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: — 
 
 i. Cooling of the skin by conduction and evaporation. 474 
 
 2. Cooling of the skin and of the viscera by reflex refrig- 475 
 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 
 nally through reflex stimulation of the thermogenic centers. 
 
 The thermic reaction is a useful indicator both 478 
 
 n .. IT of the extent to which the bodily functions 
 Reaction a Use= J 
 
 ful Indicator. may 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. 
 
140 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 his 
 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. 
 4-81 < It is through thermic reaction that the cold 
 
 tion and kath P r0 ^ uces ^ ts 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 
 CO 2 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 PHYSIOLOGICAL EFFECTS OF HEAT. 
 
 Heat may be applied to the body for therapeutic purposes 482 
 m 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 180° 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 116.6 , 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 every 
 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- 
 Heat a f u j Q f a jj v - ta j excitants. The heat of the 
 Stimulant. sun * s ^ e 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 remark- 
 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 The effect of moderate heat, that is, water 
 the Capillary applied at a temperature of from ioo° to 104 
 Vessels. p ^ j s to p roc luce 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 temperament 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 495 
 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 (no° 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 
 bulbs. 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 ioo° 
 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 500 
 vasoconstrictors renders very hot water useful as a means of 
 
 *" Medical Reports," 4th ed., pp. 99-101. 
 
144 RATIONAL HYDROTHERAPY. 
 
 checking hemorrhage, and in capillary oozing from surgical 
 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 160 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 sur- 
 
 .. . face 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 no° 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. 
 
 504 These facts strongly 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 C0 3 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 507 
 Loss of Heat increases the loss of bodily heat by the skin in 
 by the Skin. several ways : — 
 
 (i) By dilating the surface vessels, thus 508 
 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 f rom 9 ^o tQ gS o or th norma i temperature 
 Tactile Sensi- , - * J , ' ,. , F n 
 
 bHity. ot 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 
 
I46 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 heat is 
 practically the same as that from intense cold. 
 
 510 The thermic impression made by an applica- 
 5. Preparation ^ion Q f an y sort depends primarily upon the 
 of the Skin for - . r . . . . 
 
 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 value 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. 
 
 511 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. 
 
 512 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 WATER. 1 47 
 
 in the body. The portal area is excited and filled by digestive 
 activity; the muscles, by vigorous exercise; and the skin, by 
 percussion, friction, reaction from cold and heat, especially 
 the latter. 
 
 It is impossible for each of these vascular areas to be 513 
 excited to full activity or completely filled with blood at the 
 same time. When one of these areas is in a state of con- 
 gestion, the others must be in a condition of more or less 
 marked anemia. This explains the pallor often occasioned by 
 excessively violent exercise, and the pallor and giddiness 
 which sometimes follow almost immediately upon the taking 
 of food in certain forms of indigestion, also the faintness which 
 not infrequently overcomes a person subjected suddenly to a 
 high degree of heat in a vapor bath while sitting in an up- 
 right position. A bath at 102 F. produces venous conges- 
 tion of the brain for the first three or four minutes, then 
 cerebral anemia, which continues for some time after the 
 bath, notwithstanding marked acceleration of the pulse. The 
 same effect upon the cerebral circulation, though less pro- 
 nounced, may be obtained by a foot or leg bath at from 104 
 to 108 F. 23 
 
 The effect of a general application of heat is to 514: 
 Activitv of produce at once a notable increase in the force 
 
 the Heart. with temporary slowing of the heart's action 
 
 (Exp. 42). This diminishes, however, as soon 
 as free perspiration begins, owing to the lessening of the arte- 
 rial tension by the dilatation of the cutaneous vessels, and the 
 tolerance established through fatigue of the temperature 
 sense. The final effect of a hot application is to lower arte- 
 rial tension while quickening the pulse. 28 
 
 The first effect of a very hot application to the skin, as 515 
 already remarked (496), is to stimulate the vasoconstrictors, 
 which results in contraction of the small blood-vessels of the 
 surface; and this, together with the reflex stimulus received 
 by the heart from the periphery, accounts for the sudden 
 increase in the force and tension of the pulse. This effect 
 
I48 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. 
 
 517 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. 
 
 518 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 PHYSIOLOGICAL EFFECTS OF WATER. 1 49 
 
 induce, at first, a protective contraction of the surface ves- 
 sels (497). This compensatory arrangement is continually 
 brought into activity in the practice of hydrotherapy. 
 
 Various physiologists have noted that when a limited por- 520 
 tion of the body is warmed, a reduction of temperature takes 
 place in contiguous parts. This effect is purely a mechanical 
 one. The overfilling of the blood-vessels of one portion of 
 the area supplied by a single arterial trunk naturally results 
 in robbing another portion of the same area, the vessels of 
 which are not distended. 
 
 THE EFFECTS OF HEAT UPON THE RESPIRATION. 
 
 General applications of heat increase the rate and facility 521 
 of the respiratory movements. This is true, however, only of 
 moist heat, so called, as dry heat, or rather the inhalation 
 of dry hot air, produces the opposite effect, through its exci- 
 ting influence upon the small air-tubes. Excessive dryness of 
 the air also hinders the gaseous exchanges in the lungs, while 
 moderate dryness 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 C0 2 elimination. 
 
 Nothing so quickly relieves an asthmatic patient as a hot 522 
 full bath or a vapor or electric-light bath ; but an examina- 
 tion of the products of respiration shows a decided decrease 
 in the amount of C0 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 525 
 of the blood excite the heat-controlling centers, and bring into 
 
150 RATIONAL HYDROTHERAPY. 
 
 play the processes of heat dissipation, which include an increase 
 of lung activity, as well as of skin perspiration and respiration. 
 This fact explains the rapid respiration in high fever. 
 
 526 The influence of the hot bath upon respiration is in some 
 respects quite similar to the effects of cold. With quite high 
 temperatures (iio° to 112 F.) a sense of constriction is felt 
 when the body is immersed to the head in the full bath ; the 
 abdominal walls are contracted. The effect is most marked 
 if the application is made by the aid of a douche with con- 
 siderable pressure. 
 
 THE EFFECTS OF HEAT UPON THE MUSCLES. 
 
 527 Prolonged applications of heat, that is temperatures above 
 ioo°, diminish muscular excitability and capacity for muscular 
 work to a notable extent. Maggiori and Vinaj have demon- 
 strated this very clearly by an extended series of experiments. 
 In one instance the muscular capacity, as shown by the 
 results obtained by means of Mosso's ergograph, was dimin- 
 ished 8.043 kilogrammeters. It is this weakening of the mus- 
 cles which gives rise to the very sensible enervating effects of 
 a long hot bath. The writer has noted results in accord with 
 those of these investigators (Fig. 27, A and B). 
 
 528 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 energy of the body 
 should by this means be so greatly reduced within so short a 
 time. It can not be supposed that the actual store of force-pro- 
 ducing material in the muscles or nerve centers is exhausted 
 by the bath ; hence we must conclude that the results observed 
 are due simply to lessened muscular excitability. 
 
 529 Muscular irritability lessens very rapidly under 
 Lessened Irri- the i n fl uence of a water bath at a temperature 
 tabihty of the - n r 
 Voluntary °* 1 2 ° ^ • an( ^ above, and even at somewhat 
 Muscles. lower temperatures it is decidedly lessened. 
 
 This phenomenon may be observed very 
 readily in cold-blooded animals, in which a temperature of 
 
Fig. 27 (a). Normal Fatigue Curve of Man Aged Twenty-four Years. Total work, 8.088 kgm. 
 
 Fig. 27 (b). Fatigue Curve of the Same Subject after a Hot Bath. Total work, 5.152 kgm. 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. I 5 I 
 
 a few degrees above that of the medium in which the animal 
 lives, produces almost complete paralysis, and a few degrees 
 higher at once gives rise to absolute muscular inactivity, 
 through heat-stiffening of the muscles. Very prolonged hot 
 applications at temperatures not much above the normal 
 body temperature similarly give rise to muscular weakness in 
 
 24 
 
 man. 
 
 Notwithstanding these facts, experience shows that very 530 
 short hot applications are the best of all means for recovering 
 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 
 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 
 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 
 centers. The good results are rendered much more decided 
 and lasting if the hot application is succeeded by a short cold 
 application, such as a broken cold horizontal jet to the spine 
 for 3 or 4 seconds, or a rubbing wet sheet, or a cold fric- 
 tion bath. 
 
 It is worth while to note in this connection that the 531 
 exhausting effects of a hot bath may be readily neutralized 
 by 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 energy in either the muscles or the nerve 
 centers, but is a purely nervous phenomenon, expressing the 
 peculiar 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 
 author has demonstrated frequently by clinical experience as 
 well as by laboratory experiment (Exp. 45). 
 
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 io° 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 suffering 
 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- of the smooth, or non-striated, muscles. This 
 tability of Invol- . . . . . '. . ,. 
 untary Muscles. 1S 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. 
 
 537 Hot rectal irrigation is one of the best means of combat- 
 ing chronic congestion and enlargement of the prostate. 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. 1 53 
 
 A large hot enema or coloclyster will not infrequently 538 
 relieve constipation when other means are ineffectual, by 
 stimulating the involuntary muscular fibers of the intestines. 
 
 THE EFFECTS OF HEAT UPON THE NERVOUS SYSTEM. 
 
 Heat may excite or exhaust the nervous system according 539 
 to the mode of application. An application may be at first 
 excitant, then depressant. The effect of a neutral bath (92 
 to 95 F.) is to diminish nervous irritability, thus producing 
 a true sedative effect. This result is obtained through the 
 protective influence of a neutral medium. The body immersed 
 in water near its own temperature is almost entirely shut 
 away from a variety of perturbing influences which con- 
 tinually play upon the nerve centers through the sensory 
 impulses transmitted from the periphery. As a result, oppor- 
 tunity is afforded for the accumulation of nervous energy in 
 the cerebro-spinal centers. To obtain a sedative effect, the 
 bath must be considerably prolonged (from 30 minutes to an 
 hour and a half). 
 
 Baths of a high temperature (ioo° F. and upwards) pro- 540 
 
 duce, first, very exciting effects, manifested by nervousness, 
 
 headache, etc. ; later, symptoms of exhaustion appear. 
 
 This is the fundamental fact upon which the 541 
 
 Heat physiological phenomenon developed by its 
 
 lmu a es application is based. Heat is indeed one of 
 
 Protoplasmic rr 
 
 Activity. tne m ost powerful of all physiological stimuli. 
 
 Both the excitant and the exhaustive effects 
 
 of hot applications are explainable by this single fact. The 
 
 excitant effects are due to the direct influence of heat upon 
 
 the nerve filaments and other tissues ; while the exhausting 
 
 effects are due to the fact that while the protoplasmic or 
 
 vital activities of the body are excited by certain forms of hot 
 
 applications, thus giving rise to an accumulation of tissue 
 
 wastes or excrementitious elements, the oxidation of these 
 
 wastes is diminished by the effort of the body to prevent 
 
 excessive accumulation of heat through inhibition of the auto- 
 
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 possess 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 
 Produced b Hot a PP nca -ti° ns 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 1 5 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 1. The face and the back of the neck, which are in rela- 
 tion with the brain. 
 
 546 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. 1 55 
 
 3. The hands and feet, which are associated with the 547 
 brain, the mucous 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 
 kidneys. 
 
 7. The lower lumbar region, with the uterus and the 551 
 lower extremities. 
 
 8. The internal surface of the thighs, with the uterus. 552 
 
 9. The plantar region, with the uterus. 553 
 
 10. The feet, with the kidneys. 554 
 
 11. 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 557 
 simultaneously the vasoconstrictors of the area to which the 
 application is made, and those of the internal region which is 
 in reflex relation with it, as just designated. The explanation 
 of these interesting relations will be found in a study of the 
 anatomical relations of the vasomotor centers of the spine 
 and other special ganglia with the areas innervated by them. 
 
 The reflex effects of these localized applications at a high 558 
 temperature are of great service in hydrotherapy ; for ex- 
 ample, cerebral congestion may be relieved by the hot foot 
 bath, which, as Mosso proved by experiments on a man a 
 portion of whose skull had been removed, is capable of pro- 
 ducing even cerebral anemia. The temperature should be 
 from 105 to no° F. A hot full bath at 102 F. is often 
 most effective in relieving cerebral hyperemia. Bathing the 
 face with very hot water is a most effective means of checking 
 nosebleed. Hot sponging of the head and neck often gives 
 complete relief in insomnia from cerebral congestion. 
 
 Splenic and hepatic congestion, the usual accompaniment 559 
 of malarial 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 ioo° F.) causes dilata- 
 tion of the uterine vessels. Relief from congestive headache 
 is obtained by very hot sponging of the back of the neck. 
 
 560 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. 
 
 THE EFFECTS OF HEAT UPON THE BLOOD. 
 
 561 Winternitz and many other observers have pointed 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. 
 
 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 re- 
 markable fact that, while there is a marked increase in the 
 number of leucocytes in the circumscribed part subjected to 
 the influence of heat, there is a decided decrease in the num- 
 ber of red cells, while Henocque has observed an increase 
 in the rate of reduction of oxyhemoglobin. 25 These effects 
 in part at least explain the mottled appearance of the skin 
 induced by hot applications. 
 
 563 Strasser showed {Deutsche med-Zeit. y 1896) that general 
 hot applications diminish the alkalinity of the blood by in- 
 creasing the amount of acid phosphate, often to the extent 
 of double the normal quantity. 
 
 THE EFFECTS OF HEAT UPON NUTRITION. 
 
 564 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 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. I 57 
 
 these cells respond to the very slightest increase of tempera- 
 ture. When heat is applied to the surface of the body, not 
 only the skin, but the entire body is to some degree excited 
 thereby, both through the transmission of heat by the con- 
 ductivity of the tissues to the internal parts, and its transpor- 
 tation by the blood current from the skin to the viscera. The 
 result is an increase of the activity of the cell life of the body 
 so far as is possible without increased absorption of oxygen. 
 Oxidation is diminished, as is indicated by the diminished 
 absorption of oxygen and exhalation of C0 2 . But the 
 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 565 
 as to produce an increase of sugar in the blood, and may even 
 give rise to its appearance in the urine. It is for this reason 
 that hot baths must be used with great discretion in diabetes 
 and in all other maladies characterized by deficient oxidation. 
 
 That heat stimulates vital activity is clearly shown by its 566 
 influence upon the skin. A patient who has worn the moist 
 abdominal bandage for some time, or has been subjected to 
 the daily application of fomentations to some portion of the 
 body for a few weeks, will present a mottled appearance of 
 the skin of the part to which the application has been made, 
 — a very striking illustration of the stimulating effects of heat 
 upon the pigment cells. The heat from the direct rays of the 
 sun produces a similar effect, giving rise to freckles, and 
 deepening the color of the complexion often to a remarkable 
 degree. The same effects are likewise produced by the 
 electric light, and even by the newly discovered X-ray. The 
 stimulating effect of the electric light upon the growth of 
 plants and the ripening of fruits affords further evidence that 
 heat and light act powerfully in stimulating vital activity. 
 
 Elevation of the body temperature above normal increases 567 
 the oxidation of nitrogen. This is shown by the increase of 
 urea and other proteid wastes, and accounts for the rapid 
 wasting of the muscles during febrile disease under the influ- 
 ence of high temperature. 
 
I58 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. 
 
 o69 The hot douche over the stomach and spine opposite 
 
 diminish the secretion of HC1 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 flow 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 i.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 encour- 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. 1 59 
 
 aged, as shown by increased perspiration, relaxation of the 
 surface vessels, and increased activity of the heart. This is 
 the atonic reaction of heat. 
 
 Prolonged applications of heat always give rise to increase 574 
 of temperature, both by diminishing heat elimination and by 
 increasing heat production. Heat stimulates vital activity ; 
 indeed, there is perhaps no other agent capable of exerting so 
 remarkable 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 life in a few minutes. 
 
 Even warm air increases heat production to a most remark- 575 
 able degree. An external temperature a few degrees above 
 the body temperature may increase heat production more than 
 300 per cent. This fact is illustrated by the prevalence of 
 heat-stroke, or thermic fever, during a period of hot weather, 
 especially 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 
 vation of i° F. in body temperature, and a further elevation 
 of i° takes 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 true that the reaction 578 
 effects resulting from cold are to be preferred to those from 
 hot applications : nevertheless, the peculiar effects obtainable 
 from heat will sometimes be found better suited to the case 
 in hand than those arising from cold. Indeed, not infre- 
 quently 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 : — 
 
 ACTION. 
 
 i. Brief contraction, then dila- 
 tation of the 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, C0 2 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. 
 
 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 produc- 
 tion. 
 
 9. 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 A bath which is absolutel y neutral is practi- 
 
 Bath. cally 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 
 
THE PHYSIOLOGICAL EFFECTS OF WATER. l6l 
 
 body temperature, while a bath a few degrees below the 
 temperature of the body excites the temperature sense, and 
 thus gives rise to increased heat production and other reflex 
 effects. 
 
 The vital perturbations set up by the warm bath, how- 581 
 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, bul by 
 the protection afforded by the medium of water so employed 
 as to be absolutely unirritating, without percussion, and of 
 such 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 other disturbing influences. 
 
 As the result of this protection, the nerve centers, being 
 completely at rest, are afforded an opportunity to accumulate 
 a store of energy, 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 
 nutritive processes, and the accumulation of force-producing 
 material in the nerve cells. The irritability of the cutaneous 
 nerves is perhaps lessened by the imbibition of water. 
 
 THE EFFECTS OF ALTERNATE HOT AND COLD APPLICA- 
 TIONS TO THE SKIN. 
 
 M „ M „ In this form of application the skin is first 582 
 
 The Scotch , , , \ r , 
 
 . 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 
 therefore a most efficient means of stimulating nutritive 
 changes, obtaining derivative effects, etc., and that without 
 creating thermic disturbances of any kind in the body. 
 
I 62 RATIONAL HYDROTHERAPY. 
 
 583 Pfluger found that a short hot bath following a cold bath 
 increased the reduction of temperature. 26 
 
 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, 
 
 GENERAL VITAL REACTIONS RESULTING FROM 
 HYDRIATIC 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 effects of 
 this form of stimulation in the light of modern 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. 
 
 586 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 system 
 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 
 
THE PHYSIOLOGICAL EFFECTS OF HEAT. 1 63 
 
 calorification is, in a certain sense, to touch the springs of 
 existence ; and disturbance of the heat-making functions of 
 the body produces a corresponding disturbance in the most 
 important functions of the system. It is to create the neces- 
 sity for repair, and to impress directly and profoundly the 
 general nervous system." 
 
 SUMMARY OF ORGANIC CHANGES PRODUCED BY HEAT 
 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 
 md diminished 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 
 albumin. 
 
 7. No disturbance of metabolism occurs as the result of 
 baths at neutral temperatures, or while the body temperature 
 remains normal. 
 
 8. Strasser showed increased alkalinity of the blood after 
 cold baths, and diminution after hot baths. 
 
 9. Jardet has shown that the acidity of the urine is 
 decreased by warm baths, and may even become alkaline. 
 
 In 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 in the general body temperature. 
 
 The primary effect of cold applications is to increase C0 2 
 production. In the reaction period there is elevation of tem- 
 perature, which, if sufficiently pronounced, is accompanied 
 by an increased oxidation of albumin. 
 
THE PHYSIOLOGICAL EFFECTS OF FRICTION 
 OR MECHANICAL IRRITATION OF THE SKIN. 
 
 M 
 
 ° I\ /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. 
 
 591 . This 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, 
 4 'light," "energetic," and " very vigorous. " Briefly sum- 
 marized, their effects may be described as follows : — 
 
 592 1. Light Friction. — Light centripetal friction applied to 
 the surface accelerates the circulation, causing rise of blood 
 
 164 
 
PHYSIOLOGICAL EFFECTS OF FRICTION. 1 65 
 
 pressure, 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, 
 due to a small increase of heat production and a slight dimi- 
 nution of heat elimination. 
 
 2. Energetic 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 
 several tenths of a degree. 
 
 3. Very vigorous friction, or violent irritation of the 594 
 skin, produces almost instant and very marked dilatation of 
 
 the cutaneous vessels, the preliminary period of contraction 
 being so brief as be practically imperceptible. 
 
 The heart's action is slowed, as is also the respiration. 
 
 Heat elimination is increased nearly fifty per cent (Win- 
 ternitz, Pospischil), and the temperature may fall as much 
 as i° or 2° F. (Mantegazza). 
 
 Examination of the products of respiration show marked 
 increase of C0 2 (Pfliiger), which would indicate increased 
 heat production, notwithstanding the lowered temperature, 
 showing that the increase of heat elimination is much greater 
 in proportion than that of heat production. 
 
 There is, also, according to Pfliiger, a marked increase in 
 the production of urea, showing that there is a general in- 
 crease of catabolism, since both nitrogenous and carbona- 
 ceous wastes are augmented. 
 
 Very violent friction or irritation produces marked weak- 
 ness of the heart, dyspnea, and in rabbits, albumin in the 
 urine (Walkenstein), in which again we see an effect identical 
 with that which 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 Winternitz have shown that by the 
 application of friction to the skin, the amount of moisture 
 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 Winternitz, 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). 
 
PHYSIOLOGICAL EFFECTS OF FRICTION. 1 67 
 
 The phenomenon to which the term "dermo- 595 
 Dermographism. , . ... .. , . . , ... , 
 
 graphism is applied is closely allied to urtica- 
 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 
 produces but a very slight effect, merely a temporary pallor, 
 quickly followed by a barely perceptible redness of the skin. 
 In certain persons, however, a simple stroke with the finger 
 tip produces a raised white or rose-colored area correspond- 
 ing to the surface touched. 
 
 Dermographism indicates a disordered state of the vaso- 
 motor nerves or nerve centers. These structures are affected 
 by some poisonous substance, received from without or pro- 
 duced in the alimentary canal, and in such a manner that the 
 vessels have lost their tone, or are unable to maintain their 
 normal equilibrium. Demographism also affords information 
 respecting the condition of the nervous system in general. It 
 indicates that there exists in the body of the patient some 
 toxic agent against which the nervous system has ceased to 
 be able to defend itself. 
 
 This curious symptom is most often present in certain 
 forms of neurasthenia, especially gastric neurasthenia, in hys- 
 teria, diabetes, rheumatism, stomach dilatation, and gastro- 
 intestinal fermentations. * 
 
 This test is one of the means whereby the physician may 
 judge of the susceptibility of his patient to hydric applica- 
 tions. The test should be applied to each patient received 
 for treatment as a means of determining his power of reac- 
 tion to mechanical stimulation. Persistent spasm of the ves- 
 sels, as shown by pallor remaining for some minutes, indicates 
 an abnormal irritability of the vasomotor nerves or of the 
 visceral ganglia of the small vessels. A quickly appearing 
 and prolonged redness indicates that the vessels lose their 
 tone with abnormal readiness. All these facts should be 
 noted and considered in the hydriatic treatment of invalids. 
 
 *"EUide sur le Demographisme," T. Barthelemy, Paris. 
 
THE PHYSIOLOGICAL EFFECTS OF LIGHT. 
 
 T 
 
 596 r | ^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., heat rays, luminous rays, 
 and actinic, or chemical, rays. The whole gamut of light 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 
 1 68 
 
PHYSIOLOGICAL EFFECTS OF LIGHT. 1 69 
 
 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 energy. 
 
 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 
 11 sunburn." 
 
 Within the last few years numerous experiments have 59 1 
 been made by Arloing, d'Arsonval, Geisler, and others, for 
 
I/O 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 bacillus 
 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. \J\ 
 
 in England, Lindholm of Norway, and Finsen of Copenhagen, 
 is the noxious influence of the actinic ray in smallpox. It 
 has been found that if the chemical rays are excluded by 
 hanging thick red curtains before the windows of the sick- 
 room during the suppurative stage of the eruption and the con- 
 sequent secondary fever, ulceration may be almost uniformly 
 averted. Finsen has within the last half dozen years under- 
 taken an extensive series of observations for the purpose 
 of studying more accurately the physiological effect of the 
 actinic ray, making numerous experiments upon flies, worms, 
 embryos, and other forms of animal life. These experiments 
 have demonstrated very clearly that the chemical ray is an 
 excitant of the nervous system; and that under ordinary cir- 
 cumstances 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 emphasized, as this has long been well known and appre- 
 ciated; but the fact that the actinic ray is a direct stimulant 
 of the functions of animal and vegetable life, and thus a 
 means of supporting vital energy in all its forms, is a discovery 
 of the highest importance, and one which will doubtless 
 prove of great utility in the future. To the chemical rays 
 rather than to the thermic rays must in all probability be 
 attributed the greater part of the wonderful results which 
 have long been recognized as following the proper employ- 
 ment of the sun bath, or so-called insolation. 
 
 Upon the discovery of the electric light and practical 599 
 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 
 Win. Siemens, published in March, 1880, contained a detailed 
 account of experiments made for the purpose of determining 
 the influence of the electric light upon vegetation, with the 
 following 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 
 
PHYSIOLOGICAL EFFECTS OF LIGHT. 1 73 
 
 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 
 clearly — 
 
 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 Electrique, " gives an interesting 
 account of the results of exposure to a powerful electric 
 light, 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 suffering much during 
 the entire night. An interesting fact noted was that while the 
 
174 RATIONAL HYDROTHERAPY. 
 
 whole conjunctiva covering the ball of the eye was intensely 
 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 large scales, 
 as after scarlet fever. The pigmentation of the skin remained 
 for some time after the acute symptoms had disappeared. 
 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 
 hours after the exposure. 
 
 This experiment proves very 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. 
 600 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,ooo° 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, or insola- 
 
PHYSIOLOGICAL EFFECTS OF LIGHT. 1 75 
 
 tion, very frequently in the treatment of chronic maladies 
 of all sorts. The natives of the South Sea Islands and 
 other primitive peoples still utilize this powerful agent in 
 the treatment of the sick. The natives of the terre caliente 
 of Mexico have long practiced exposure to the sunlight on the 
 sea-beach, partially covered with sand, as a means of treat- 
 ment for syphilis, the patients thus treated being made to 
 drink large quantities of infusions of leaves of various sorts 
 while exposed to the sun. The natives of Haiti are said by 
 M. Delow to employ similar practices. 
 
 All physicians place the highest value upon exposure to 
 the sun by an out-of-door life as a means of stimulating the 
 nutritive processes of the body in many chronic disorders, as 
 anemia, chlorosis, 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 
 must be very largely attributed to the actinic ray, although a 
 share of it must be attributed to the calorific effect of the 
 sun's rays. But though its value has been so long and so 
 generally recognized, the various practical difficulties in the 
 way of utilizing 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 little use has thus far been made of this powerful agent, 
 even in institutions largely devoted to the use of physiological 
 measures. 
 
 The author has made more or less use of the sun bath 601 
 during the twenty-five years in which he has been engaged in 
 institutional medical work, but the difficulties encountered, 
 long ago led him to the study of the electric light as a substi- 
 tute for sunlight. The most definite and practical experi- 
 ments along this line were begun by him about ten years ago. 
 In a paper read before the American Electrotherapeutic 
 Association at its meeting in New York City, in September, 
 1894, he presented a description of a new method of apply- 
 
176 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 C0 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 C0 2 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- 
 hght bath in 189 1, when the author made his first experi- 
 ments upon this subject, he found the internal temperature 
 was raised by the bath i.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. 1 77 
 
 readily permit the transmission of the radiant energy of the 
 electric light, which, entering the body as light, 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, like 
 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 
 favor 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 as for the separate parts thereof, various-shaped cabinets 
 which are supplied with mirrors internally and a great number 
 of electric lights. 
 
 11 It has been undoubtedly demonstrated that radiant heat 
 penetrates the tissues much better than conducted heat, and 
 12 
 
1^8 RATIONAL HYDROTHERAPY. 
 
 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: — 
 
 " The giving off of the C0 2 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 temperature, 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 account 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 gout, 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. Lehmann reports regarding 
 psoriasis. 
 
 "As we now possess a thermic method in the electric- 
 light bath by means of which we are able to measure the 
 exact dose, and knowing the powerful influence on cell life 
 and the entire organism, we believe this method of thermic 
 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 
 light 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 
 not simply the soft part. Light penetrates the body in the 
 same manner as it penetrates any other transparent or trans- 
 lucent 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 light 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. 
 
l80 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 fire 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. 
 
Vnxi Tiwrr. 
 
 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 OF THE PHYSIOLOGICAL EFFECTS OF 
 COLD APPLICATIONS. 
 
 i. Cold is primarily depressant or sedative in 606 
 General 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, quickly 
 followed, however, by active dilatation, the internal dilata- 
 tion occurring almost instantaneously, the external later. 
 
 4. A prolonged moderately cold application to the skin 
 (6 5 to 8o°) causes prolonged contraction of the vessels of 
 the internal part in reflex relation therewith (274). 
 Effects upon *• 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 
 
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. 
 
 1. General cold applications first quicken, then 
 . e £. s u ^°" slow the heart-beat, increase tension, and cause 
 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, 4?21). 
 
 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 portion 
 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). 
 
 1. A general cold douche causes quick, gasp- 
 Effects upon b . ^ & r 
 Respiration. m S 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 s in the expired air is correspond- 
 ingly increased (322). 
 
 4. An atmospheric temperature of 40 F., or below, 
 
 causes increase of heat production and C0 2 elimination 
 
 when the body is so exposed as to cause shivering. 
 
 1. Prolonged cold applications decrease mus- 
 Effects upon . . ° J r /0 r»~\ 
 
 the Muscles. cular irritability and energy (327). 
 
 2. A short cold application, general or local, 
 
 increases the excitability and capacity of striated muscles. 
 
THE GENERAL PRINCIPLES OF HYDRIATICS. 1 83 
 
 3. 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 of the back or the feet, may cause general pallor, goose- 
 flesh appearance, and shivering (330). 
 
 1. Cold applied to a nerve trunk paralyzes 
 
 ttXTs" the p arts su p? lied b y * < 335 )- 
 
 System. 2 - Cold diminishes the rate of transmission 
 
 of nerve impulses (336). 
 
 3. Prolonged very cold applications to the head diminish 
 
 mental activity, and may produce unconsciousness, while 
 
 short applications are in a high degree excitant to the brain 
 
 (338). 
 
 1. Short, very cold applications, with high 
 Reflex Effect . „ r ,., ' * 
 
 of Cold AddH- pressure, to a reflex area, cause vasodilata- 
 
 cations. tion in the related viscera (372). 
 
 2. Prolonged non-percutient cold applica- 
 tions produce internal vasoconstriction (372). 
 
 3. Short applications to the face and neck stimulate the 
 circulation and activity of the brain (373). 
 
 4. A short, very cold douche to the chest first excites, 
 then slows, the pulse (355). 
 
 5. Prolonged immersion of the hands in cold water causes 
 contraction of the vessels of the brain and of the nasal 
 mucous membrane (356). 
 
 6. Short, very cold applications to the hands cause con- 
 traction of the uterine muscles (358). 
 
 7. A short, very cold douche to the feet, with strong pres- 
 sure, dilates the vessels of the uterus (359). 
 
 8. Immersion of the legs in cold water causes contrac- 
 tion of the vessels of the lungs and the kidneys. 
 
 9. Short cold applications to the mammae give rise to vig- 
 orous contraction of the muscles of the uterus. This simple 
 measure is much utilized for 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). 
 
 ii. Prolonged applications of cold to the upper dorsal 
 region cause contraction of the vessels of the nasal mucous 
 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). 
 
 1. The reaction following cold applications in- 
 creases the number of corpuscles in 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). 
 
 1. General cold applications increase absorp- 
 
 Effects upon t j on f rom t h e alimentary canal (389). 
 
 Secret^onTand 2 * Snort general and more prolonged local 
 
 Nutrition. cold applications increase the activity of the 
 
 glands of the stomach, liver, kidneys, and 
 other secreting viscera (390). 
 
THE GENERAL PRINCIPLES OF HYDRIATICS. 1 85 
 
 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. 
 
 1. General cold applications diminish the tern- 
 Effects upon perature of the skin and the general tempera- 
 Animal Heat . 
 and Tempera- 
 ture. 2. A cold spray to the soles of the feet 
 
 produces slight lowering of the general tem- 
 perature (424). 
 
 3. Cold applications to the head lower the temperature 
 by depressing the thermogenic centers. 
 
 4. Cold applications to the surface increase the thermo- 
 electrical 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 temperature of the skin and of the blood. 
 
 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, 
 Effects. 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). 
 
1 86 RATIONAL HYDROTHERAPY. 
 
 2. The secondary effect of heat is depressant through 
 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 . 
 
 1. 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 no° 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 has been pro- 
 longed (498). 
 
 5. Increased perspiratory and respiratory activity (503). 
 
 6. Increase of tactile sensibility at 98°, decrease at n 3°, 
 extinction at 130 . 
 
 7. Increased heat elimination from the skin (a) through 
 dilatation of the surface vessels, (b) increase of the flow of 
 blood through the skin, (c) increased evaporation of moisture 
 from the surface, and (d) increased conductivity of the skin 
 (508). 
 
 8. Heat prepares the skin for cold applications (510). 
 
 1. A general application of heat first slows, 
 Effects upon 8 . *^ . ' 
 
 the Circulation. t ^ ien <l ulc kens the pulse. Pulse rate and tension 
 
 diminish when free perspiration begins (514). 
 2. Very hot applications (11 5° 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. 
 Effects *• A general application of moist heat (air or 
 
 upon Respira= vapor) increases the rate and ease of respira- 
 tion - 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 6o° to yo° F. increases 
 CO 2 elimination, while a temperature below 40 F. also 
 decidedly increases C0 2 elimination. 
 
 1. Short hot applications (98 to 104 F.) 
 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 (536). 
 
 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. 
 
 1. Very hot baths produce various nervous 
 Effects upon ,. , , , , 
 
 . N v disturbances, as sleeplessness, nervousness, 
 
 System. headache, and other symptoms of nervous 
 
 excitation and exhaustion (540). 
 
 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). 
 
1 88 
 
 RATIONAL HYDROTHERAPY. 
 
 Effects upon 
 the Blood. 
 
 Effects upon 
 
 General 
 
 Nutrition. 
 
 Effects upon 
 the Stomach, 
 Liver, and 
 Other Abdom= 
 inal Organs. 
 
 Heat, unless followed by cold, decreases the 
 red and increases the white cells. 
 At very high temperatures heat is a powerful 
 vital stimulant or excitant. It increases C0 2 
 production and the oxidation 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 
 HC1, 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. 
 
 5. Large fomentations over internal parts lessen their 
 blood supply and functional activity. 
 
 1. 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 6o° to 
 
 Effects of Hot 
 Applications 
 upon Heat 
 Production and 
 Body Tempera= 
 ture. 
 
 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). 
 
 COMPARATIVE SUMMARY OF THE CHIEF EFFECTS OF COLD 
 
 AND HEAT. 
 
 COLD. 
 
 General. 
 Primary, depressant. 
 Short, excitant by tonic reaction. 
 Prolonged, depressant. 
 
 Special. 
 Skin: Action, diminished activity. 
 Reaction, increased activity. 
 Diminished sensibility. 
 
 HEAT. 
 
 General. 
 Primary, 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. 
 
 I89 
 
 Heart: First quickened, then 
 slowed. 
 
 Increased force. 
 Vessels: Action, contraction. 
 
 Reaction, dilatation. 
 
 Increased tone and activity. 
 
 Local anemia, collateral hyper- 
 emia. 
 
 With reaction, local hyperemia, 
 collateral anemia. 
 
 Short, reflex dilatation of vis- 
 ceral vessels. 
 
 Nerves: Benumbs and paralyzes. 
 
 Excites by tonic reaction. 
 Muscles: Short, increased excita- 
 bility and capacity. 
 Prolonged, lessened excitability 
 and capacity. 
 Lungs: Slows and deepens respi- 
 ration. 
 Increased amount of respired air. 
 Increased C0 2 . 
 Increased respiratory quotient. 
 
 Stomach: Increased HC1 and mo- 
 tor activity. 
 Kid7ieys: Congests and excites. 
 
 Animal Heat: Short, increased 
 heat production. 
 Prolonged, diminished heat pro- 
 duction. 
 
 Blood: Increased blood count, es- 
 pecially leucocytes. 
 
 Metabolism: Increased C0 2 . 
 
 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. 
 Short, reflex fluxion and deriva- 
 tive effects. 
 Nerves: Excites. 
 
 Depresses by atonic reaction. 
 Muscles: Short, lessening fatigue 
 effects. 
 Prolonged, diminished capacity 
 and excitability. 
 Lungs: Quickens and facilitates 
 respiration. 
 Diminished am't of respired air. 
 Decreased C0 2 . 
 Diminished respiratory quo- 
 tient. 
 Stomach: Decreased HC1 and mo- 
 tor activity. 
 Kidneys: renders anemic and less- 
 ens activity. 
 Anmial Heat: Short, diminished 
 heat production. 
 Prolonged, increased heat pro- 
 duction. 
 Blood: Decrease in number of red 
 cells, increase in number of 
 leucocytes. 
 Metabolism: Decreased C0 2 . 
 Increased urea and 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 r | ^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 
 are 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 peculiarities 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 comprehensive classification of the effects 
 which may be expected from definite and exact hydric 
 applications under clearly and accurately defined conditions. 
 
 609 From a careful study of the physiological effects of water, 
 it is evident that, in general, two classes of effects are pro- 
 duced. These are excitation and depression. This naturally 
 
 190 
 
THERAPEUTIC EFFECTS. 191 
 
 leads to a simple grouping of therapeutic applications of 
 water into two general classes : (1) Excitant; (2) Sedative. 
 
 These two groups of effects may be almost indefinitely 610 
 subdivided, but the leading and essential subdivisions the 
 author believes will be found included in the following table, 
 which is offered as an attempt at a scientific classification of 
 the 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. 
 
 a. Hemostatic \ P"j ect \ a 
 
 } Indirect or Reflex. 
 
 b. Cardiac. 
 
 c. Uterine. 
 
 d. Vesical. 
 
 e. Peristaltic. 
 
 B. Secondary Excitant Effects. 
 
 1. General. 
 
 a. Restorative. 
 
 b. Tonic. 
 
 c. Calorific. 
 
 2. Local. 
 
 a Sudorific \ W S P oliative or Reducing. 
 
 a. budonnc j {b) Eliminative 
 
 b. Expectorant. 
 
 c. Diuretic. 
 
 d. Cholagogic. 
 
 e. Peptogenic. 
 /. Emmenagogic 
 g. Revulsive. 
 
 k. Derivative. 
 
 i. Resolutive. 
 
 /. Alterative. 
 
 k* Calorific. 
 
192 RATIONAL HYDROTHERAPY. 
 
 II. Sedative Effects. 
 i. Circulatory. 
 
 a. Antiphlogistic. 
 
 (a) Vascular. 
 
 (b) Cardiac. 
 
 b. Hemostatic. 
 
 2. Nervous. 
 
 a. Hypnotic. 
 
 b. 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 1. The primary effect {action) of an applica- 
 
 Kesp c s ti on f ] iea t i s excitant. 
 
 Applications. J 
 
 2. The secondary effect (reaction) of an 
 
 application of heat is depressant, sedative, atonic. 
 
 3. The actual effect of an 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 prolonged 
 applicatioyi of heat is moderately excitant during the appli- 
 cation; after the application, decidedly depressant effects 
 appear, resulting from a lessening of thermic and other tissue 
 activities through atonic reaction. 
 
 (c) The effect of a prolonged application of heat at a 
 high temperature is both excitant and exhausting or depress- 
 
THERAPEUTIC EFFECTS. 1 93 
 
 ant, the excitation resulting from the elevation of the tem- 
 perature of the body, the depression being due to the exhaus- 
 tion of nervous energy. Practically, cold contracts while 
 heat dilates the vessels at the moment of application. 
 
 1. Cold is intrinsically sedative, but prac- 613 
 Respecting tically the primary effect {action) of a cold 
 
 applications. application is excitant. 
 
 2. The secondary effect {reaction) is invig- 
 orating, restorative, tonic. 
 
 3. The actual effect of an application of cold depends 
 upon the method of making the application, the temperature, 
 the susceptibility and condition of the patient, and many 
 other factors. In general, it may be said that — 
 
 (a) A short application of intense cold is excitant, and, 
 if repeated daily, tonic. 
 
 (b) A more prolonged application at a moderately low 
 temperature is less excitant and less tonic. 
 
 (c) A prolonged cold application is first excitant, then 
 sedative, the depressant effects resulting from the exhaustion 
 of the nerve centers from prolonged excitation and the lower- 
 ing of the temperature of the body. 
 
 1. A neutral bath (92 to 95 F.) produces 614 
 
 Respecting no reac ti n, circulatory or thermic, but sup- 
 
 Neutral and _ ...-., . , 
 
 Intermediate presses reflex activity by lessening the sensi- 
 
 Applications. bility of the cutaneous nerves ; consequently 
 the effect is calmative. A neutral bath is also 
 restorative by checking or abolishing the loss of energy and 
 encouraging cutaneous and renal activity. 
 
 2. Baths at intermediate temperatures produce viixed 
 effects, the dominant effects being those of the class most 
 nearly approached, cold, neutral, or hot. 
 
 The characteristic effects of baths, either hot or cold, 
 may be intensified by the mechanical effects of percussion, — 
 as by means of the douche in various forms, — by friction 
 with the hand, towel, sheet, or by other suitable means. 
 
 The effects of baths may also be intensified by various 
 
194 RATIONAL HYDROTHERAPY. 
 
 means which favor or delay reaction, applied before, during, 
 or after the bath, such as exercise, artificial heat, etc. (44?3^ 
 
 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 EFFECTS. 
 
 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 1 or 2 min.). As a ruJe, 
 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 application are much more excitant 
 than cold or cool applications. Likewise very hot applica- 
 tions are 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 1. General Primary Excitant Effects. — General applica- 
 
 tions are usually employed for general excitant effects, the most 
 important of which are the very hot douche — shower, spray, 
 
THERAPEUTIC EFFECTS. 1 95 
 
 or jet — temperature no -i30°F., continued from 15 sec- 
 onds to 4 minutes; very hot affusion iio°-ii5° F., from 30 
 seconds to 5 minutes; hot-blanket pack, I05°-II2°F. ; hot- 
 water drinking; general alternate hot and cold sponging; full 
 bath, io5°-iio° F. , 5 to 10 minutes; hot enema, hot sitz 
 bath. Hot applications to the head and spine, and very hot 
 applications over the heart are powerfully excitant. 
 
 The effect of alternate hot and cold applications is con= 
 tinuaWy to renew the exciting effect of the heat; the cold 
 application should be long enough to remove the heat ab- 
 sorbed by the skin from the hot application, but not long 
 enough to produce lowering of the general temperature, as 
 announced by chill, shivering, or any other indication of 
 thermic reaction. As a rule, in alternate applications the 
 applications should be made of equal length, — about fifteen 
 seconds each, — but the time during which the heat is applied 
 may often be increased with advantage (638). 
 
 Alternate hot and cold applications are the exciting appli- 
 cations par excellence, for the following reasons: — 
 
 (a) For primary excitant effects it is desirable to arouse 
 the nerve centers without exhausting them by decided reac- 
 tion effects, and to suppress atonic thermic reaction by mak- 
 ing the hot application very short, and following it by a short 
 cold application. 
 
 (b) If a cold application is prolonged, the effect is to 
 abstract heat from the skin and from the blood, and thus 
 either directly lower the vigor of the patient or provoke an 
 undesirable thermic reaction whereby the weakened resources 
 of the body will be still further exhausted. 
 
 (c) By a short application of heat, immediately followed by 
 an application of cold of equal length, the heat impression is 
 made of only sufficient intensity and length to produce the 
 desired nervous impression, any further effect being prevented 
 by the neutralizing influence of the succeeding cold appli- 
 cation, which restores the normal temperature of the skin, 
 and thus prepares it for the new excitant impression to be 
 
196 RATIONAL HYDROTHERAPY. 
 
 produced by the succeeding hot application. This renders 
 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 rays 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- 
 
 _ mjL ^ ternate applications of heat and cold are 
 ploy Excitant . r . 
 
 ., indicated in cases ot extreme exhaustion, 
 
 Measures. 
 
 collapse, surgical shock, collapse under anes- 
 thesia, drowning, suffocation, and syncope from hemorrhage, 
 fright, or any similar cause. 
 
THERAPEUTIC EFFECTS. 1 97 
 
 The excitant effect of cold may be occasionally used with 
 advantage in cases of collapse or asphyxia. The reaction 
 must be quick 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 douche 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 
 Contra- , , , , ,1 
 
 . .. ^ the hot douche, great care must be taken 
 
 indications. . 
 
 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 
 skin. 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, 
 and infancy (below seven years), also in cases of previous 
 injury 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 
 Hemostatic . , J . , . , , . , , . , . 
 
 Effects. ma y ® e 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 (1422). 
 
 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 cold 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 course, 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 ^ u ^- e a m ost excellent measure for checking 
 
 Hemostatic 111 ™ , 1 1 , 
 
 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 
 are especially effective. The application of ice to the nos- 
 trils also contracts the pulmonary vessels (Brown-Sequard). 
 
 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. 
 
THERAPEUTIC EFFECTS. 1 99 
 
 In hemorrhage from the uterus, short, very hot fomenta- 
 tions (1328) or the hot douche (1024) may be applied to the 
 thighs and spine, and an ice-bag (1314) placed over the lower 
 abdomen, while a hot vaginal douche is administered. 
 
 Among the most useful measures of this sort are a very 
 short hot douche to the lumbar region, the inner surfaces 
 of the thighs, and the soles of the feet, to combat uterine 
 hemorrhage. Prolonged cold applications (55°-70°) to the 
 same surfaces produce like effects. These applications may 
 be made either with or without a simultaneous use of the hot 
 uterine or vaginal douche, according to the severity of the 
 case. It should be stated, however, that cold applications 
 can not be used in cases of menorrhagia, without the utmost 
 care and discretion, at the beginning of a catamenial period, 
 on account of the danger of producing hematoma or hema- 
 tosalpinx, through the sudden checking of the outflow of 
 blood. On this account, less violent measures should be 
 employed during the first twenty-four or thirty-six hours, 
 the application of cold water being reserved to a later period. 
 The hot vaginal douche, and even the astringent douche, 
 may be employed with greater safety during the first day in 
 menorrhagia. The danger of producing hematoma is, in the 
 author's opinion, very small after the first day. 
 
 A case which came under the author's observation in prac- 
 tice some twenty years ago illustrates very well the value of 
 cold applications of this sort: A girl about fifteen years of 
 age had suffered for nearly a year with most extreme menor- 
 rhagia, until she had become exsanguinated to a very remarka- 
 ble extent, and was frequently in a state bordering on collapse. 
 The attending physician had employed every sort of medicinal 
 and many non- medicinal means for checking the hemorrhage, 
 but without avail. Packing the uterus had not been tried, 
 but tamponment of the vagina with alum and other astringents 
 had been thoroughly employed, yet without material results. 
 The patient was placed at once in a sitz bath of about 50 F. 
 for fifteen minutes, the feet being placed in cold water at the 
 
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 1 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 
 620 HeartVonics 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. 201 
 
 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 like 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 (6o° 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 rilled, 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 
 the 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 
 wet sheet, and the wet-sheet pack are all excellent means for 
 this purpose. In cases of extreme cardiac weakness with 
 degeneration 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- 
 ment 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, hemorrhage, and 
 visceral congestions. 
 
 The very short 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 cen- 
 tral heart and the peripheral heart. Cold applications to the 
 gastric and rectal mucous membranes stimulate the heart 
 and the pulmonary circulation. 
 
 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 160, 
 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 160 to ioo, 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 the 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- 
 
206 RATIONAL HYDROTHERAPY. 
 
 cations aid in the removal of the disturbing poisons. No 
 condition requiring the use of a heart tonic or stimulant can 
 be named in which a hydriatic application of some sort will 
 not answer the indication far more efficiently than any drug 
 known to the pharmacopeia. 
 
 621 Cold applications over the abdominal surface, 
 tion— E XC en"« especially over the lower abdomen, short and 
 gogic Effects. sudden cold applications to the mammary 
 
 glands, the hot vaginal douche, and also alter- 
 nate hot and cold applications applied to the breasts and 
 lower abdomen, are efficient in stimulating uterine contrac- 
 tions in cases of delayed labor. 
 
 In cases of amenorrhea, the short cold douche to the 
 lumbar region is a measure of very great efficiency. It oper- 
 ates by stimulating the circulation of the ovaries and the 
 uterus, and, by improving the nutrition of the parts, restores 
 the suspended function. 
 
 622 A cold douche to the feet and over the blad- 
 F Jt ., der is a powerful means of exciting vesical 
 
 contractions, and, used judicially, is applicable 
 in many cases of motor insufficiency of the bladder. This 
 remedy should, of course, be withheld in cases of retention 
 of urine from obstruction. 
 
 623 The hot enema, the cold enema, the grad- 
 
 n es ina uated enema, cold and alternating douches, 
 
 Excitation. . C) 
 
 and other applications over the loins and the 
 
 entire abdomen, especially about the umbilicus, are meas- 
 ures which are highly efficient in exciting intestinal activity 
 through the impressions made upon the sympathetic centers 
 and splanchnic nerves. 
 
 The hot and cold rectal douche (14-10) is an excellent 
 means of arousing nervous activity in semiparalyzed condi- 
 tions of the rectum, often so prolific a cause of constipation 
 in cases where the bowels have become inactive through neg- 
 lect to attend regularly to their daily evacuation. 
 
 There is no means by which gastric motility can be so 
 efficiently excited as by cold applications made to the epigas- 
 
THERAPEUTIC EFFECTS. 2C»7 
 
 trium or the dorsal spine. Sipping half a glass of cold water 
 or the application of an ice-bag to the epigastrium for half 
 an hour before eating powerfully stimulates gastric motility 
 in atonic states. 
 
 B. SECONDARY EXCITANT (Reaction) EFFECTS. 
 
 Secondary excitant effects are altogether derived from 624 
 cold applications, as the reaction effects of hot applications 
 are atonic or sedative. Heat may, in many cases, be ad- 
 vantageously used in connection with cold, in the production 
 of excitant effects by reaction, as in the alternate douche 
 (1044) and other alternate applications. The use of heat 
 is not merely to renew or intensify the effect of the cold 
 application by a preparation of the tissues which are to 
 receive it, an important service, but to produce its own spe- 
 cific excitation, in accordance with principles elsewhere ex- 
 plained (492). 
 
 Secondary excitant effects may be either (a) general or 
 (b) local, according to the form of the application. 
 
 I. General Secondary Excitant Effects. — The general ex- 625 
 citant effects of cold water occupy an important place in the 
 hydriatic armamentarium. Indeed, there is no therapeutic 
 measure known to modern medical science which is capable 
 of producing more powerful general excitation of the entire 
 system than a scientific application of cold water. A short 
 application of very cold water is excitant, in whatever man- 
 ner it is applied. When, to the influence of a low tem- 
 perature, is added the percussion effect obtained by the 
 douche with considerable pressure, the excitation resulting is 
 of a most intense character, and is capable of arousing to 
 action every nerve fiber and every cell, and awakening every 
 form of activity in the entire body. 
 
 In the practical therapeutic employment of water, two 
 important general excitant effects, quite similar, but differing 
 in use, are especially recognized. These two classes of effects 
 may be distinguished as (a) Restorative, and {b) Tonic, 
 
208 RATIONAL HYDROTHERAPY. 
 
 626 A single short application of cold water in the 
 
 Effects form of a douche, affusion, rubbing 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 no°) 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. 
 
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 
 
 Cold Water universally toxic in character. Whatever 
 
 vs. Medicinal . 
 
 Tonics. tonic 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 other 
 
THERAPEUTIC EFFECTS. 211 
 
 words, a medicinal tonic or stimulant aggravates the very 
 
 condition it is intended to cure. 
 
 The establishment in modern times of labo- 629 
 Nervous 
 Energy ratories for psychological and neurological 
 
 research has been the means of throwing 
 much light upon the nature of mental and nervous activity. 
 Nervous energy no longer means, as formerly, an intangible, 
 mysterious something, but, as has now been clearly demon- 
 strated, is immediately and definitely connected with material 
 elements found in the interior of the nerve cell. For exam- 
 ple, a nerve cell, when in a state of rest, shows a large 
 number of grayish granules, which have been shown to be 
 intimately connected with the storage of energy ; so that 
 when the granules are abundant, the cell is like a fully 
 charged battery, ready to discharge under the influence of the 
 right sort of stimulus the maximum of energy which it is 
 capable of exhibiting. On the other hand, when the cell is 
 fatigued, as after prolonged, energetic work, the granules are 
 found to be very few and small, and the cells shrunken 
 and pale. 
 
 With these facts in mind, it is easy to understand why 
 such disappointing results have followed the use of strych- 
 nia and a very large number of medicinal agents, so-called 
 nerve tonics, since it is evidently impossible that these 
 drugs should in any way increase the store of energy in the 
 cell; and the most that can be expected of them is the 
 excitement of the cell to activity when it has become 
 exhausted to such a degree that a sense of fatigue supervenes 
 as a warning that the store of nervous energy is reduced to a 
 point where any further demand upon it is dangerous, and 
 that rest is imperatively demanded. 
 
 The only way that the energy granules of a cell can be 
 augmented is by the assimilation of food from the blood, and 
 the development of energy-containing particles. Cold water 
 surpasses all other agents in its power to promote the normal 
 energy-storing processes. Cold applications also facilitate to 
 
212 RATIONAL HYDROTHERAPY. 
 
 a very remarkable degree the discharge of nervous energy 
 when a sufficient store exists, though sometimes it may not 
 be available because its useful application is hindered by 
 the influence of retained excretions or nerve-benumbing 
 toxins generated within the tissues or absorbed from the 
 alimentary canal. This effect of water is readily apparent in 
 the influence of the cold bath upon muscular energy, to which 
 attention is called elsewhere (327), and also in the sensation 
 of well-being, buoyancy, and readiness for exertion which 
 results from the application of cold water. 
 
 The tonic effects of cold water are unquestionably to a 
 large degree due to the influence of cold impressions acting 
 through the nerves of the skin upon the sympathetic nerve 
 centers. The great sympathetic nerve controls the blood- 
 vessels, glands, heart, the functions of secretion and excre- 
 tion, and, in fact, all the vital functions of the body. The 
 awakening of the sympathetic to renewed activity, or a bal- 
 ancing of its action, is what is specially needed by the great 
 majority of chronic invalids. The functions of the brain and 
 spinal cord, and through them all forms of nervous activity, 
 are to a remarkable extent influenced by the sympathetic. 
 The sensation of well-being which accompanies the reaction 
 following a general cold application is largely due to the in- 
 creased activity of the cerebral circulation, brought about 
 through the stimulation of the sympathetic. By its power 
 to influence the sympathetic, hydrotherapy is capable of 
 controlling, restraining, reorganizing, balancing, all the proc- 
 esses of organic life, and through them modifying the func- 
 tions of animal life to a marvelous degree. 
 630 Cold water is a physiological tonic, and has 
 
 ph , . , - the advantage over medicinal tonics of all 
 Tonic. sorts, in that it awakens nervous activity 
 
 without the imposition of any extra burden 
 upon any vital organ, and without hampering the activity of 
 any function. The cold bath employed in such a manner as 
 to produce tonic effects accomplishes its results by increasing 
 
THERAPEUTIC EFFECTS. 213 
 
 vital resistance to the causes of pathological processes, by 
 making the wheels of life run more smoothly, by lifting the 
 whole vital economy to a higher level. The impression made 
 upon that harp of a million strings, the skin, with its vast 
 network of sensory, motor, sympathetic, vasomotor, and ther- 
 mic nerves, arouses every nerve center, every sympathetic 
 ganglion, every sensory and motor filament in the entire body 
 to heightened life and activity. Every blood-vessel throbs 
 and every cell quivers with a new life ; the whole body thrills 
 with quickened impulses, the whole being is translated into a 
 new state of existence. 
 
 A person who has never experienced the glow of exhilara- 
 tion, the invigoration and buoyancy of body and mind, which 
 accompany the state of reaction from a short, general cold 
 application, can not well appreciate the value or significance 
 of the cold bath as a physiological stimulant. It is not too 
 much to say that it is of all measures known to man, the most 
 valuable as a means of arousing to activity the flagging ener- 
 gies of the body, and lifting the enervated invalid out of the 
 morasses and quagmires of chronic disease. 
 
 The reaction produced by tonic applications 631 
 Tonic Effects fills the skin with blood ; and if it is daily 
 Bath Due to repeated, the blood is finally fixed in the skin, 
 Repetition. thus permanently increasing its vascular activ- 
 
 ity, and relieving internal congestion. 
 
 The hidebound animal suffers from visceral congestion 
 because of the deficient amount of blood in the skin and the 
 excessive massing of blood in the internal organs. 
 
 In the employment of the cold bath as a tonic, there are 
 a few principles which it is important to keep constantly in 
 mind. Especially must it be remembered that the cold bath is, 
 like other tonic agents, a two-edged sword, — it is capable of 
 acting in opposite ways. The cold bath may be used in such 
 a manner as still further to weaken and debilitate the patient 
 who is already nervously exhausted. Indeed, it is so easy to 
 produce such a result that it is not improper to say that no 
 
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 effects 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 jet, the spinal douche, the circle douche, 
 the pail douche or affusion, the wet-sheet rub, the towel rub, 
 
THERAPEUTIC EFFECTS. 21 5 
 
 cold friction, the wet-hand rub, the plunge or swimming 
 bath, the sitz bath, the full or immersion bath, the Scotch 
 douche, the alternate douche, the percussion douche, and 
 various modifications of these baths may be employed in 
 such a way as to Droduce tonic effects varying in degree 
 according to the method of application, the temperature, 
 the length of the bath, and the conditions under which the 
 application is made. 
 
 As tonic effects are obtained almost altogether from the 
 use of cold water, great care must be taken to observe the 
 general directions and precautions given elsewhere with 
 reference to the use of the cold bath (767). 
 
 Tonic measures are applicable in nearly all 638 
 Indications forms of disease. Although tonic baths can 
 
 Applications. not a l wa Y s De employed at the outset of a 
 course of treatment, it should be the constant 
 aim to prepare the patient for them; and after the beginning 
 with tonic measures, there should be a progressive training in 
 the direction of more and more vigorous applications. 
 
 Tonic measures are especially indicated in cases of anemia, 
 all forms of nervous exhaustion, or neurasthenia, hysteria, in 
 the numerous varieties of dyspepsia in which enteroptosis and 
 consequent irritation of the sympathetic nerve gives rise to 
 general nervous irritability and exhaustion, in chronic ine- 
 briety, in many cases of insomnia, in obesity, in exophthal- 
 mic goiter, in convalescence from fevers, and most other 
 chronic morbid conditions. 
 
 Tonic applications are also indicated in cases of irritable 
 weakness, such as delirium tremens; in the extreme nervous- 
 ness and agitation which often accompanies fevers of grave 
 type, as typhoid and typhus; in chlorosis; in many reflex 
 neuralgias growing out of irritation of the abdominal sympa- 
 thetic; in insomnia; and in cases under treatment for the cure 
 of the alcohol, chloral, opium, or other drug habit. 
 
 In depressed conditions of the nervous system, such as 
 hypochondria, nervous dyspepsia, many cases of melancholia, 
 
2l6 RATIONAL HYDROTHERAPY. 
 
 and general nervous exhaustion, without excessive excitability, 
 very exciting applications may be employed, such as the 
 different forms of the douche, — jet, percussion, spray, and 
 rain, — in which the excitant effects of cold are supplemented 
 by percussion effects. The rubbing shallow bath, cold fric- 
 tion, the wet-sheet rub, the cold-towel rub (wrung as dry as 
 possible), the salt glow, and the shallow bath are also valu- 
 able. In very weak persons, simple dry friction may be em- 
 ployed for a few days at the beginning of the treatment, 
 or a short hot bath may be administered just before the cold 
 water applications are made. 
 
 There is no class of cases in which the tonic effects of cold 
 water are of greater importance than in the treatment of acute 
 infectious febrile disorders. Tonic hydriatic applications build 
 up the bodily resistance as no other measures can do. 
 634 A few words may be useful in relation to the 
 
 Suggestions and adaptation of tonic measures to the various 
 Respecting Cold c ^ asses °* invalids that require tonic treat- 
 Applications, ment. 
 
 Extremely feeble persons are in the great- 
 est need of tonic treatment, and yet have the least tolerance 
 for cold water ; hence in the beginning the very gentlest 
 measures must be employed, such as the cold wet-hand rub, 
 cold friction, the salt glow, alternate hot and cold applica- 
 tions to the spine, and similar means. 
 
 In many cases it is necessary at first to confine the appli- 
 cation to small areas, passing from one part of the body 
 to another in rapid succession, as first a hand, then an arm, 
 a foot, a leg, the chest, the upper portion of the back, the 
 lower portion of the back, etc. , carefully drying, rubbing, and 
 covering each part before proceeding to the next. It is best 
 to make the application symmetrical ; that is, if the right 
 hand and arm are first treated, the next parts to be treated 
 should be the left hand and arm. This brings into action 
 adjacent and related nerve centers practically simultaneously, 
 and so secures the maximum effect. 
 
THERAPEUTIC EFFECTS. 2\J 
 
 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 
 heat 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 
 well as for good, and that an application which, if wisely 
 managed, may produce powerful tonic effects, may, from 
 lack of care or judgment, become equally depressing and 
 highly 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 
 The Cold . , . _, . 
 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 yo° F. , very short (4 or 6 sees.), or if at a more mod- 
 erate temperature, as from 75 to 8o°, for 10 to 20 seconds. 
 
 637 For very feeble and anemic patients the Scotch 
 B . |n douche generally secures the best effects, as 
 Anemia. in such cases the heat-producing powers are 
 
 weak. This is especially true with patients 
 who are 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 8o° 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 (5 5° to 6o° from 1 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 
 heat 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 (iio°-I20°) 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 jo° or 6o°. 
 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 Schiiller, 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 salutary 
 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 8o°), 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 
 
 C rebral °* ^ e vasoconst rictors, 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 cerebral 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 
 
THERAPEUTIC EFFECTS. 221 
 
 friction), whereby the cerebral vessels may be brought reflexly 
 into a state of vigorous contraction. This effect is, of course, 
 transient, but the nutritive changes set up, and especially the 
 stimulation of the flow of lymph in the ventricles and lymph 
 channels of the brain, when repeated by daily applications 
 of measures of the sort suggested, produce most happy re- 
 sults. These partial tonic applications must be accompanied 
 by short and very moderate general applications. In cases 
 where considerable irritability exists in connection with the 
 cerebral congestion, the cold douche should not be employed, 
 but warm and neutral baths, the shallow bath, wet-sheet rub, 
 rubbing sitz, or tonic wet-sheet pack must be used. 
 
 In passive cerebral congestion, and especially in the con- 
 gestion of the brain which frequently accompanies anemic 
 conditions, these mild tonic measures are of the very greatest 
 value, and will produce most happy results when carefully 
 managed. 
 
 In hypochondria, tonic measures are of the 640 
 ® . OI Vf - highest importance, and are generally well 
 chondria and tolerated. It is necessary, however, to pre- 
 Rheumatism. cede the cold application by a short hot bath 
 carried to the extent of perspiration, so as to 
 secure the elimination of the poisons to which the depression 
 is due. 
 
 Rheumatics can comfortably and safely receive cold appli- 
 cations only after a heating bath of some sort. The cold 
 application must be very moderate in degree, and the painful 
 joints must be avoided. These observations apply also to 
 cases of painful gout, and to cases of neuralgia in which 
 large nerve trunks or extensive areas are involved, as in sci- 
 atica, spinal irritation, and myalgia involving many groups 
 of muscles. 
 
 In persons suffering from cardiac disease with deficient 
 compensation, in arteriosclerosis, in apepsia, in hypopepsia, 
 in acute mania, in advanced cases of consumption, especially 
 those in which pulmonary hemorrhage is a marked symptom, 
 
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 very 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 fifty 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- 
 Fff V \ C panied by general thermic or calorific effects. 
 
 It is necessary, however, in some cases, to 
 secure strong 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 affusion, 
 and especially the wet-sheet pack prolonged to beginning 
 perspiration, are most efficient calorific measures 
 641 2. Local Secondary (Reaction) Excitant Effects — Appli- 
 
 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 
 
 of organs in the body. The chief local effects, however, 
 to which it is here desirable to call attention, are the fol- 
 lowing : Sudorific, expectorant, cholagogic, peptogenic, em- 
 menagogic, hemostatic, revulsive, derivative, resolutive, alter- 
 ative, and calorific. We will briefly consider each of these 
 local excitant effects, which, as previously intimated, are for 
 the most part to be obtained by applications of cold water, 
 either by itself or in connection with heat. 
 
 Sudorific effects, or stimulation of the perspir- 648 
 
 Sudorific atorv function, are obtained by various means 
 
 Effects 
 
 which are capable of raising the body tem- 
 perature. Bouchard has shown that an elevation of the 
 temperature of the blood .7° F. is sufficient to induce gen- 
 eral sensible perspiration by stimulation of the sweat centers. 
 
 Local perspiration may be induced by circumscribed hot 
 applications or by retention of the natural heat of the part 
 by warm or impervious coverings. 
 
 The measures which may be most conveniently employed 
 for the production of active perspiration are, the electric-light 
 bath, the Turkish bath, the Russian bath, the hot-air bath, 
 the vapor bath, the hot full bath, the wet-sheet pack, the 
 dry pack, the hot douche, the vapor douche, the hot blanket 
 pack, the hot sitz bath, hot water drinking, the hot enema, 
 hot fomentations to the spine, and the sun bath. Any one 
 of these measures may be found the most convenient and 
 serviceable in individual cases, and under special conditions. 
 
 The electric-light bath is without doubt the most efficient 
 and satisfactory of all modes of inducing perspiration, as it 
 produces such powerful stimulation of the perspiratory glands 
 and other structures of the skin as to cause the perspiration 
 to appear in a remarkably short space of time, thus avoiding 
 the necessity of subjecting the body to the exhausting effect 
 of prolonged exposure to heat. Profuse perspiration gener- 
 ally appears in the electric-light bath in from three to five 
 minutes, and often when the temperature of the air surround- 
 ing the patient is not above 85 F. Winternitz has noted a 
 
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 
 
 Attention to / the area of the perspiratory ducts being more 
 
 the Skin in \ . , , , x . 
 
 Chronic tnan e l even 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 off each hour from an ounce to an ounce 
 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 ptomain 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, but 
 
THERAPEUTIC EFFECTS. 22 5 
 
 a cause of the perpetuation of this condition. This appear- 
 ance of the skin is due to the accumulation of effete matters 
 in it, and to its impaired nutrition, which state exists not 
 only in the skin, but in the entire body. Hence the correct- 
 ness of the observations of the empirical but not infrequently 
 very sagacious practitioners of the cold-water cure in the 
 early part of the present century, which led them to rely so 
 largely upon the state of the skin as a perfect index to the 
 patient's general vital condition, and as a test of his progress 
 toward recovery. 
 
 As previously stated, it is practically impossible to effect 
 a permanent cure in a large number of chronic disorders with- 
 out first restoring the skin to a normal state. Diseased con- 
 ditions of the skin are common among the civilized races 
 because of the disease-producing influence of clothing and 
 the neglect of the daily bath. 
 
 Sweating baths are of the highest value as a means of 
 ridding the skin of its accumulated impurities, opening up the 
 obstructed lymph channels and spaces, thereby encouraging 
 the circulation of the nutritive fluids and the development of 
 normal nerve and gland structures, unloading obstructed seba- 
 ceous follicles of their hardened contents, as well as arousing 
 to activity the nerve ganglia and the secreting cells of the 
 internal organs, through the reflex movements set up by the 
 cutaneous sensory impressions made. 
 
 A diseased state of the skin is always connected with a 644 
 congested or otherwise disordered condition of important 
 internal viscera, and the restoration of the skin to activity is 
 the most important means of relief from visceral congestion 
 and other functional disturbances. 
 
 The value of heating measures as therapeutic 
 Neglect of Heat- means has not generally been sufficiently ap- 
 ing Procedures p rec i ate( i by those who have undertaken to 
 by Hydro- * / . 
 
 therapeutists. employ water in a scientific manner. Indeed, 
 
 many hydrotherapeutists, as Fleury and his 
 followers, have held that scientific hydrotherapy is confined 
 to the use of cold water exclusively. On the other hand, 
 i5 
 
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 pro- 
 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 rilled with 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. 
 
THERAPEUTIC EFFECTS. 227 
 
 The cold bath in some form should be universally em- 
 ployed after sweating baths, except when contraindicated, as 
 in Bright's disease, rheumatism, neuralgia, and cases in which 
 the sedative effect of heat is desirable. 
 
 Sweating baths may be employed advanta- 645 
 Alterative or geously for the purpose of reducing the weight, 
 Effects. or to remove serous deposits in the tissues, as 
 
 in anasarca, or in the abdominal or pleural 
 cavities, and also as a hygienic or prophylactic measure for 
 the purpose of atoning, to some degree, for the neglect of 
 active muscular exercise. It is perhaps most valuable as a 
 hydriatic means in the rational treatment of obesity. It must 
 be remembered, however, that the sweating produced by 
 heat is by no means so efficient in reducing flesh as that 
 induced by exercise. It is by a combination of the two 
 means that the most pronounced effects obtainable may be 
 realized. 
 
 In cases of obesity there is great danger of overheating 64G 
 the blood in consequence of the obstacle to heat elimination 
 presented by the thick layer of non-conducting fat. There- 
 fore, hot applications for the reduction of flesh should never 
 be too greatly prolonged, and the bath should always be 
 finished off by a vigorous cold application. 
 
 The sudden removal from the blood of a large quantity of 
 serum has to some degree the same effect as bleeding from a 
 vein, weakening the heart's action by lessening the volume 
 of the blood, and thus exposing the patient to risk from car- 
 diac failure, a tendency to which is not infrequently present 
 in cases of extreme obesity, either from actual fatty degen- 
 eration or from accumulation of fat about the heart or be- 
 neath the serous lining of the chest and the mediastinum. 
 
 A short general cold application following an application 
 of heat for the purpose of producing perspiration to reduce 
 weight in obesity has the effect to restore and increase the 
 disposition for muscular effort, in addition to the tonic effect 
 upon the general nervous system, thus enabling the patient 
 
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 f 
 a cold horizontal douche, or an affusion being best employed 
 for this purpose. The temperature should be from 50 to 
 6o° 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 f dropsy, great care must be exercised, espe- 
 c US f 11 * SC cially in cases of cardiac disease. The appear- 
 Dropsy. ance 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 
 the 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 obes- 
 
THERAPEUTIC EFFECTS. 229 
 
 ity, sweating baths, even when quite prolonged, are often 
 borne without inconvenience and with decided benefit. The 
 same is true of cases in which edema of the legs is associated 
 with chlorosis, provided that marked cardiac weakness from 
 fatty degeneration or other cause is not also present. 
 
 A cold application following a hot bath in dropsy due to 649 
 cardiac disease is especially important as a means of increas- 
 ing the tone of both the blood-vessels and the heart; but it 
 must be remembered that a severe cold application to the 
 surface brings, for the moment, a very great strain upon the 
 heart during the primary contraction of the small vessels 
 which is induced throughout the entire body; hence the 
 application must be managed with great care, and extreme 
 temperatures should not be employed. 
 
 A douche at 75 or 8o° is better suited to these cases 
 than lower temperatures. The application should be made 
 first to the feet and legs, then to the arms and back, and 
 lastly to the chest. It is well to mitigate the shock to the 
 lungs and heart by dipping the hand or a towel in cold water 
 and applying to the face, neck, and chest before making a 
 general cold application. In cases of well-marked cardiac 
 insufficiency the douche must be altogether avoided, and such 
 milder measures as the rubbing shallow bath and cold fric- 
 tion employed instead. 
 
 The hot bath is also an invaluable measure in 650 
 The Hot Bath certain cases of dropsy of renal origin. It is 
 Disease °^ s P ec i a ^ vame m acute dropsy due to the 
 
 nephritis sometimes encountered as a com- 
 plication in scarlet fever, smallpox, diphtheria, and in the 
 puerperal or pre-puerperal state. In these cases it proves 
 beneficial chiefly by drawing a large quantity of blood to the 
 surface, and thus relieving the congestion of the inflamed 
 organs. It is, of course, also of some service by the elimi- 
 nation of toxins through the sudoriparous glands, but the 
 amount of urea and other toxins thus carried off, even 
 during the most profuse perspiration, is comparatively small. 
 
230 RATIONAL HYDROTHERAPY. 
 
 The hot-blanket pack is a most serviceable measure in 
 cases of this sort. The author has employed this very con- 
 venient mode of inducing perspiration in numerous cases, and 
 with most excellent results. The hot-blanket pack js admi- 
 rably adapted for use in cases of acute nephritis in children. 
 •Care must be taken to keep the head moistened with cool 
 water during the application, but it should not be cooled to 
 such a degree as to antagonize the effect of the pack. 
 
 In the dropsy of chronic nephritis the hot bath is less 
 serviceable, in consequence of the organic nature of the affec- 
 tion, which leads to the almost certain reappearance of drop- 
 sical symptoms after they may have been removed. In these 
 cases there is also great constitutional weakness as a result of 
 the disease, so that the system is poorly prepared to endure 
 the depressing effect of the hot bath. 
 651 The hot bath also has the effect of leaving the patient in 
 
 a condition of diminished resistance to colds, which is one of 
 the most serious dangers to the chronic sufferer from Bright's 
 disease. On this account, some eminent authorities wholly 
 forbid the use of hot baths in this class of cases. In the 
 author's experience, however, the hot bath has been found 
 invaluable in these cases, in one special condition ; namely, 
 when the sufferer from chronic nephritis has suddenly become 
 dropsical through an exacerbation of the disease, as the result 
 of exposure to cold, or through some departure from the 
 required diet or regimen, or other similar cause. Under these 
 circumstances, the hot bath may be employed with advan- 
 tage, and, if properly managed, without injury ; but the appli- 
 cation must be short (10 to 20 min.) and it must be admin- 
 istered so as to give the patient as little fatigue as possible, 
 never so hot nor so long as to be weakening or exhausting. 
 The heart may be protected by a cold compress (1383). 
 
 In most chronic cases of renal disease, the neutral bath 
 at a temperature of 92 to 95 F., and especially the effer- 
 vescent bath (1139), has proved more serviceable than the 
 sweating bath, as it produces stimulation of the skin circula- 
 
THERAPEUTIC EFFECTS. 23 I 
 
 tion without inducing depressing effects. The well-known 
 effect of the neutral bath in exciting renal activity is also here 
 made serviceable. 
 
 The electric-light bath is far superior to any other form of 652 
 sweating bath for cases of Bright's disease, for the reason 
 that the skin may be excited to a high degree of activity by 
 a very short application and without exposing the patient to 
 the risk involved in the breathing of highly heated air or a 
 hot atmosphere saturated with moisture, as in the Turkish 
 or the Russian bath. During the last seven years the author 
 has employed this bath in a very large number of cases, and 
 without witnessing any untoward effects, but with advantages 
 not afforded by other methods of applying heat. One great 
 advantage of this bath is that the medium about the patient 
 is not overheated. The air may be readily maintained at a 
 temperature of 85 to 90 , so that heat elimination may go 
 on normally, which can not be the case in any other form of 
 hot bath. 
 
 In the hot immersion bath, heat elimination, except 
 through the lungs, is entirely suspended. In the Russian 
 bath, heat elimination from both the skin and the lungs is 
 almost wholly interrupted. In the Turkish bath, heat elimi- 
 nation takes place by evaporation only, both the skin and the 
 mucous membrane receiving heat by conduction from the 
 highly heated atmosphere surrounding the body. 
 
 Another advantage of the electric-light bath is that heat 
 is produced in the depth ot the tissues as well as at the sur- 
 face, through the resistance encountered by the rays of light 
 in passing through the numerous layers of tissue which it 
 penetrates, reaching, with some degree of intensity at least, 
 the innermost recesses of the body. 
 
 In dropsy due to anemia, sweating baths may 653 
 
 The Sweating be employed if carefully administered, but 
 Bath in ■ * J ' / ' 
 
 Dropsy. tne Y should be very short, owing to the 
 
 extreme degree of cardiac weakness usually 
 
 present in these cases, and the general vital and nervous 
 
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 Winternitz 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. 
 654 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 
 
THERAPEUTIC EFFECTS. 233 
 
 strong and vigorous, the wet-sheet rub or the rubbing shallow 
 bath, in all cases followed by vigorous dry friction, are meas- 
 ures to be preferred to the cold douche, the cold immersion, 
 or other stronger measures of treatment. 
 
 In cases of dropsy with renal disease also, 655 
 The Cold Bath cold app ii ca tions must be administered with 
 in Renal , T r , ,. 
 
 Disease. the ver y greatest care. It the application of 
 
 cold be so intense as to produce the slightest 
 indications of chill, it will be accompanied by congestion of all 
 the viscera, and consequently increased activity of the renal 
 disease. The cold douche and similar percutient applications 
 must be entirely avoided. The cooling off after a hot bath 
 must also be managed with great care. The best method of 
 doing this is to wrap the patient in blankets after the hot 
 bath, and cool the skin by cool or tepid sponging of limited 
 portions of the surface, taking first one arm or leg, then the 
 other, and thus proceeding to extend the cooling to various 
 parts of the body until the whole surface has been treated. 
 It is sometimes necessary to go over the whole surface two or 
 three times to complete the cooling in a satisfactory manner. 
 The covering should be at the same time gradually with- 
 drawn. If too strongly sedative effects are produced by the 
 bath managed in this way, a tonic effect may be secured by 
 supplementing the bath, after the general surface has been 
 cooled and dried, by cold friction. 
 
 To avoid the possibility of taking cold, the patient must 
 not be allowed to dress nor to leave the treatment-room until 
 the surface has thoroughly cooled and the pulse returned 
 to its normal rate. The skin must be not only superficially 
 dry, but thoroughly dried out by the evaporation of the 
 absorbed moisture, as will be indicated by its condition of 
 smoothness and firmness. By reason of the great liability to 
 chilling after a warm bath, it is preferable in cases of renal 
 disease that the patient should be confined to his room for 
 several hours after treatment. It is better, on this account, 
 to administer the treatment in the evening, so that the patient 
 
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 regard 
 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 The 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 as a m eans 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 
 Depuratiye or five measure is perhaps not so great as it has 
 " . 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 
 circumstances, carried off through the skin, is evidenced by 
 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. 
 G59 The eliminative effects of the sweating bath 
 
 BattskT^ 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 (1216), 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 high 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 of 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. 2 37 
 
 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 
 
 c ,, . skin in its structure and functions. Thus, 
 
 Effects. ' 
 
 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 
 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 of 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 mucous membrane. In a febrile 
 state, or 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 up 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 quantity as to produce a chill. 
 661 The cold douche applied over the lower por- 
 
 lure ic ^. Qn o ^ ^ e sternum has long been recognized 
 
 as a means of stimulating the kidneys to ac- 
 tivity. A short cold douche to the loins is effective in the 
 same way. 27 
 
 The heating trunk pack is also a very efficient method 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 
 
THERAPEUTIC EFFECTS. 239 
 
 being wrung as dry as possible out of very cold water and 
 well covered. The pack may be allowed to remain in place 
 for two or three hours, or until dry. It may be renewed every 
 hour or two in cases in which active diuresis is required. 
 
 Fomentations to the lumbar region may be advantageously 
 employed in cases of renal insufficiency, and for the purpose 
 of obtaining revulsive effects in cases of pain in the kidneys. 
 
 The cold hepatic douche is certainly one of 662 
 Effects. ^ e most effective means of stimulating the 
 
 liver. Both the circulation and the functional 
 activity of the liver may be profoundly influenced by the 
 application of cold water by means of the horizontal jet, 
 with considerable pressure, over the lower portion of the 
 right chest and the epigastrium. The alternating douche 
 is a more agreeable and in most cases an equally exciting 
 measure. Where congestion or pain is present, the hot 
 or Scotch fan douche, without pressure, may be substituted 
 for the cold or the alternate douche (1044), or if the douche 
 can not be conveniently administered because of the feeble- 
 ness of the patient, or for any other reason, the fomentation 
 may be substituted. The effect of the fomentation will be 
 prolonged and intensified if followed by the heating compress. 
 
 In painful affections of the liver, fomentations repeated 
 every two or three hours, with the heating compress applied 
 during the interim, may be commended as a most efficient 
 means of relieving pain and restoring the organ to its normal 
 state. The hot douche and fomentation followed by the wet 
 girdle, are of the highest value in cases of infectious jaun- 
 dice, gall-stones, and in all acute congestions and inflamma- 
 tions of the liver. 
 
 The cold douche (50 to 70° F.) applied over 663 
 Peptogenic . KD ' J w 
 
 Effects tne re g lon 01 the stomach by means of the 
 
 horizontal jet with considerable pressure (20 
 to 30 lbs.), is the most efficient means of stimulating the pro- 
 duction of an abundant quantity of gastric juice of efficient 
 quality. This is the measure par excellence to be employed 
 
24-0 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. 
 
 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 improved 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. 
 The constricted gastric vessels are thus relaxed and the ane- 
 mic stomach provided with an abundant blood supply. 
 
 065 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 gastorrhea, it is necessary to employ 
 measures of a character opposite to those used for pepto- 
 genic 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 heating trunk pack (1367 ), applied 
 just before eating and retained for an hour or two afterward, 
 are most excellent means for relieving gastric irritability and 
 combating painful hyperpepsia. 
 
 666 Of all methods whereby the menstrual func- 
 
 mmenagogic ^ on ma ^ ^ e stimulated, hydric measures are 
 both the safest and 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 jo° F. ; time, 2 to 10 sees.; 
 pressure, 20 to 40 lbs.). 
 
 The prolonged hot foot bath (temperature, ioo° to 104 
 F.), the hot sitz (temperature, ioo° to 104 F.), 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, uo°, 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 
 Revulsive and stitute one of its most interesting and valuable 
 Effects 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, 
 as in cases of passive congestion without pain (673). 
 
 When this circulatory reaction is produced in an area 668 
 of 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 
 away from the inflamed or congested part, thus affording 
 relief from urgent symptoms by producing a local hyperemia 
 of the skin and a collateral anemia of the affected part. By 
 continuous cold applications, local anemia and collateral hy- 
 peremia may be produced. 
 16 
 
242 RATIONAL HYDROTHERAPY. 
 
 669 . Fluxion, or movement of the blood, is one oi 
 
 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. 
 
 670 Some of the measures most useful for this pur- 
 Methods pcse 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. w --q ^ e mcreasec | . k u t 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 c to 6o°, duration 4 to 10 seconds, 
 is most efficient. 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, of 
 
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, 6o D to 70° F. ; 
 the shallow bath, 70 to 75 ; the wet-sheet rub, 6o°. 
 
 The hot and cold compress is a powerful revulsive meas- 
 ure ; the heating compress, preceded by a fomentation or 
 rubbing 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 i04°to 106 , prolonged from 
 1 5 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 
 104 produces paralysis of the small vessels, with turgescence 
 from slowed movement of the blood. What is desired is not 
 paralysis and congestion, but activity of the vessels. In ane- 
 mia there is intense tonic spasm, which is ordinarily overcome 
 by the relaxing effect of heat; but if the heat is at too high a 
 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 
 
 Methods f special service, especially when many of 
 
 Adapted to Ane= ., , , 1 . ,, , ., 
 
 miaof DeeD- large viscera are involved in the morbid 
 
 Seated Organs, 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 
 
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 enteroptosis, nephroptosis, gastroptosis, 
 and atony of the pelvic viscera, general cold applications, 
 such as the douche at 8o c for 30 to 60 seconds, the shallow 
 bath at 8o c to 85° for 5 to 6 minutes, the tonic half-pack, 
 cold friction, and the wet-sheet rub, are means possessed of 
 wonderful curative power. Very low and very high tempera- 
 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 retrostasis, if exces- 
 sive, may be 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 
 
 will be obtained from the measures named, supplemented by 
 vaginal irrigation at iio° for 10 minutes and 8o° for 1 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- 672 
 
 riydnatic duodenal catarrh, intestinal catarrh, infectious 
 
 Measures for . • 
 
 Relief of Deep jaundice, splenic and hepatic congestion, con- 
 Congestions, 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 
 morbid 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 
 irritation coexist. 
 
 In deep passive congestions, alternate hot and cold conx- 
 presses may be applied to the related cutaneous area, fol- 
 lowed 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. 
 
24^ RATIONAL HYDROTHERAPY. 
 
 In the treatment of acute inflammation, whether near the 
 surface (but not involving the skin) or affecting a deeply 
 seated viscus, great care must be observed to avoid such pro- 
 cedures as may cause increased fluxion 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 6o°, 
 changed every half hour or every hour, succeeds better than 
 very cold applications, maintaining after fluxion through 
 reaction, while to a degree reflexly affecting the inflamed 
 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 each 
 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 of 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 
 of 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 ( 1 1 5° to 130°), and the high temperature must 
 be maintained by frequent renewal of the application. The 
 surface 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 blood 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. 
 
 For purely revulsive effects, we seek to obtain 673 
 Revulsive results very different from those which follow 
 
 Effects. a short cold application, but we depend upon 
 
 the same reflex activities and the same exciting 
 measures 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. * 8 
 
 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- 
 tempts to employ water for revulsive effects. The physician 
 or attendant who knows how to apply, under varied circum- 
 
 i 
 
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 io° 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 heat 
 give rise to excitation of the cerebral and spinal centers, 
 which interferes with the application, and produces untoward 
 effects. 
 
 675 Revulsive effects are also obtainable by the application of 
 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- 
 ficient 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 
 may be 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 
 blood 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. 
 
25O 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. 
 677 # 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 1 1 5 to 130 F., 
 though a temperature of from 1 io° 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 6o° 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. 25 I 
 
 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 
 minutes' 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 applications which can be made is the revulsive 
 Scotch 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. 29 
 
 Revulsion is perhaps most valuable as a means 678 
 
 Revulsion as of relieving pain. When analgesic effects are 
 an Analgesic ° r ° 
 
 Measure. desired, the greatest care must be taken to 
 
 avoid all thermic reaction, by the methods 
 which have been already explained. The Scotch douche 
 has been used with great success in hundreds of cases of 
 sciatic neuralgia, to the relief of which it seems to be espe- 
 cially adapted. 
 
2 52 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 very 
 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 
 
 Effects of the . _ ? ' . . ,„,--. 
 
 ' Scotch Douche. °* * acla * 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 awa}' 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 
 
 sociated 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 
 Genera Revu - ^ eous jy em pl yed in such disorders as cholera, 
 chronic rheumatism when the joints are uni- 
 versally 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 
 rule 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 
 time 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 
 with 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 
 hot application. In this manner both an excellent circulatory 
 reaction and simultaneously a calorific effect may be obtained. 
 
 The hot immersion bath may sometimes be used with 
 advantage as a revulsive measure for the relief of visceral 
 congestion, 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 of 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 
 
 „„, , essentially from revulsive effects, except that 
 
 Effects. - . . 
 
 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 blood can be drawn 
 
THERAPEUTIC EFFECTS. 255 
 
 into a part distant from the congested part to be relieved 
 may be utilized for this purpose. The most generally useful 
 procedures are the following : The hot leg bath; hot sitz; 
 short cold sitz; rubbing sitz; leg pack; half pack; hot, cold,, 
 or alternate douche to legs or arms, as may be indicated; 
 cold friction; rubbing shallow pelvic pack; heating abdomi- 
 nal compress. General derivative effects may often be ad- 
 vantageously procured by the wet-sheet pack, the rubbing 
 wet sheet, and general cold friction. Derivative measures 
 are of the greatest possible service in the treatment of insom- 
 nia, pulmonary 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, 
 a short cold douche to the feet powerfully stimulates the circu- 
 lation of the brain, and the short cold douche to the lumbar 
 region and feet is an excellent means of combating amenorrhea. 
 
 In this connection may be properly mentioned an impor- 
 tant application of the principle of derivation which may be 
 utilized by one skilled in hydriatry to most excellent advan- 
 tage in the use of the cold douche and many other general 
 cold applications. 
 
 It will be recalled that the contraction of the surface ves- 
 sels set up by the application of cold water is accompanied by a 
 similar but more brief contraction of that particular vascular 
 area which is in reflex nervous relation with the area operated 
 upon. An application made to the entire surface of the 
 body causes a momentary contraction of the peripheral ves- 
 sels throughout the entire body, raising the blood pressure 
 and forcing the surplus blood into the large venous channels, 
 especially those of the portal circulation and the associated 
 viscera, — the spleen, the liver, the stomach, the pancreas, 
 and the intestines. Reaction and dilatation quickly follow if 
 the cold application is a short one, — more quickly, in fact, 
 in internal parts than at the surface, for the reason that 
 the internal tissues are surrounded by heated organs, and are 
 
256 RATIONAL HYDROTHERAPY. 
 
 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 the 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 
 may be 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. 2 57 
 
 hydriatist must have in mind all these interesting and impor- 
 tant principles of protection and adaptation, and the facilities 
 for 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 
 Resolvent 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 
 being as follows: Heat, 60 seconds, cold, 15 seconds; or heat, 
 2 minutes, cold, 1 5 seconds. By this means strongly resolv- 
 ent effects may be obtained, while at the same time pain is 
 mitigated if not wholly relieved. 
 
 The multiple reflex activities set up in the 686 
 Alterative 
 
 Effects 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 
 
2 58 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 special 
 douches which have been elsewhere described, — the hepatic 
 douche, the splenic douche, etc. 
 
 The general alterative effects of water are the most effi- 
 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 and 
 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- 
 
 c«° r I !C 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 wrung 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 
 
 The heating compress managed thus not only stimulates heat 
 production, but diminishes the local elimination of heat, and 
 is thus very appropriately named. 
 
 Cold friction of a part, either with the hand or with the 
 friction mitt, is an efficient means of stimulating local heat 
 production. 
 
 Immersion of a part in cold water for a short time (15 
 sees, to 3 min.) is a successful calorific measure if accom- 
 panied by constant and vigorous friction. 
 
 Prolonged hot applications, as the hot bag or the fomen- 
 tation, are important means not only of accumulating heat, 
 but of stimulating local heat production. The local hot 
 air, vapor, or electric-light bath are also invaluable means 
 of local calorification. The special apparatus required for 
 this purpose are described elsewhere in this work (1250). 
 
 In the use of the local electric-light bath for purely 
 calorific effects, lamps with red globes or covered with red 
 screens may be used instead of the ordinary clear-glass globe 
 so as to exclude the chemical rays; but this is scarcely neces- 
 sary, as the actinic effects of the incandescent ray is very 
 feeble. (It may perhaps be questioned whether hot applica- 
 tions are not direct or primary rather than secondary exci- 
 tants of thermic action. This is a matter for further study.) 
 
 Applications capable of producing local calorific effects are 688 
 indicated in all cases in which it is desired to quicken the 
 functional activities of a part. Heat production is so inti- 
 mately associated with all other forms of vital activity that it 
 may be considered as a good measure of vital action in 
 general. A subnormal temperature means vital depression, 
 whether general or local. By increasing the calorification of 
 a part, we at the same time increase its activities in all direc- 
 tions, — glandular, nervous, catalytic, etc. Calorific measures 
 are thus applicable in all cases in which there is need of 
 increased local activity of any kind. They are very gen- 
 erally useful, and form the basis of many of the most impor- 
 tant of the various therapeutic uses of hydric procedures. 
 
 j 
 
260 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 ,. U1 . .. \ (a) Vascular. 
 
 1. Sedative of the < «■ Antiphlogistic -j ^ ^.^ 
 
 circulatory system. \ £. Hemostatic. 
 
 " a. Hypnotic. 
 b. Calmative. 
 
 2. Sedative of the nervous system. ^ c. Antispasmodic. 
 
 d. Analgesic. 
 ^ e. Anesthetic. 
 ( 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 cold applications : — 
 
 (a) By restoring nerve tone through the use of tonic 
 applications systematically employed for the necessary length 
 of time (remote effect); and — 
 
 {b) By the prolonged application of water at some tem- 
 perature below 92 (immediate effect). Water at a tempera- 
 ture 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. 
 
 (b) By prolonged applications of water at a neutral tem- 
 perature, from 92 to gy° 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 
 
 th C" 1 to *k e skin, is to 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 reaction 
 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 — 
 
 i . 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- 
 per. 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 cold is sedative, 
 while that of heat 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 
 
 Sedative baths are beneficial only when well 
 
 e a ye borne. Weakness after the bath, secondary 
 
 Applications J 
 
 Useful only chill, headache, and nervousness are evidences 
 
 when Well 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 
 intense or prolonged, or that the concluding cold applica- 
 tion was not employed for a sufficient length of time to 
 obliterate 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- 
 tives, — hypnotics, heart sedatives, and pain sedatives or 
 anodynes, — those of a medicinal character are all powerful 
 toxic agents. Bromide of potash, chloral, sulphonal, paral- 
 dehyde, and all the rest of the long list of hypnotics are each 
 and all productive of most pernicious effects when employed 
 for any considerable length of time, and often untoward 
 effects follow immediately upon their use. 
 
 In a recent discussion of this subject in the British 
 Medical Journal, 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- 
 able evidence that all hypnotic drugs are poisons, and capa- 
 ble of doing great mischief if habitually used. The neutral 
 bath at bedtime is worth more as a genuine and efficient 
 hypnotic 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 drug sedative which can be used for any considerable 
 length of time that will not produce injurious effects. 
 
 W T ater, on the other hand, may be made to produce 
 prompt and highly sedative effects without leaving behind any 
 damaging influence. 
 
 By cold applications the pulse rate may be reduced from 692 
 150 to 100 beats per minute, and the volume of blood in a 
 part reduced 20 tii les. 
 
264 RATIONAL HYDROTHERAPY. 
 
 693 Those measures which are sedative to the cir- 
 
 Sedati 'e 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- 
 tive, 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 jo° 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, are 
 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 
 valuable 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 
 insomnia, when spinal irritation is a marked symptom. 
 
 For local quieting effects the neutral rain §9^ 
 Local Analgesic douch from 5 to I 5 minutes, with little pres- 
 Effects. . 
 
 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 15 minutes, will usu- 
 ally be found highly useful. The heating compress also proves 
 highly 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 (6o° 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 (6o°) 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 very 
 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 (i40°to 160 ). 
 
 In chronic cases and in deep-seated acute inflammations 
 the heating compress renewed every half hour (6o°) with 
 fomentations for i 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 
 
 times a day. The quantity of water introduced at once should 
 not be more than one or two pints after the bowels have been 
 emptied, as the application 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 
 fountain, and lowering the end, the water may be allowed to 
 escape into a suitable vessel, as directed for the cold enema. 
 
 The 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 preferable to the enema. 
 
 The pain of hemorrhoids and rectal ulcer generally yields 
 to fomentations applied over the inflamed region. A very hot 
 sitz bath is also effective in cases of this sort. The water 
 need not be more than two or three inches deep, but should 
 be as hot as can be borne, the temperature being gradually 
 raised, after the patient enters the bath, to 115 or 120 F. 
 The pain of inflamed hemorrhoids is sometimes best relieved 
 by an alternation of heat and cold. In cases in which there 
 is great pain at stool, relief is often experienced by sitting 
 over a pail or slop-jar half filled with boiling water while 
 moving the bowels. The hot steam relaxes the muscles, and 
 exercises a powerful analgesic effect upon the painful tissues. 
 
 A short, very hot sitz bath (11 2 to 120 ) is a most ex- 
 cellent means of relieving chronic pelvic pain. The dura- 
 tion should be from 3 to 5 minutes, and it should be in- 
 stantly followed by a dash of cold water upon the hips or 
 rapid cold friction of the parts. This is a most excellent and 
 serviceable analgesic measure, and may be advantageously 
 employed in chronic ovarian and uterine pains, painful affec- 
 tions of the rectum, and chronic inflammation of the prostate. 
 
 The pain of sciatica and other forms of neuralgia is best 
 relieved by either revulsive applications, which may consist 
 of very hot fomentations continued for 15 or 20 minutes, 
 
268 RATIONAL HYDROTHERAPY. 
 
 followed by a well wrung, 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 
 130 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 6o°), broken when 
 the skin is sensitive, or the fan douche, continued from 6 to 
 10 seconds. 
 
 The prolonged leg pack following a fomentation (1328) 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, 6o° to jo° 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 1 5 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 efficacious, 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. 
 
 Painful 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; these should be wrung out of 
 very hot water and applied to the eye, covered, and changed 
 every 1 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 
 hyperemia 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. 
 
27O RATIONAL HYDROTHERAPY. 
 
 695 It is unnecessary to do more than call atten- 
 
 " es tion to the well-known anesthetic effects of 
 
 Effects. 
 
 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 rhigolene spray, the skin and subjacent parts may be so 
 benumbed as to render minor operations painless. 
 
 696 For true antispasmodic effects we are obliged 
 Antispasmodic . 1 ■ « ,. .. £ , 
 
 Eff to rely wholly upon applications of such a 
 
 temperature that the exciting effects of both 
 heat and cold are 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 15 minutes to an hour or 
 more. This is a sovereign remedy for hysteria, and will 
 usually avert a threatened attack if 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 J to 97°, duration 1 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. 2J\ 
 
 The sedative influence of cold may be 69' 
 Hemostatic employed as an efficient means of checking 
 
 hemorrhage, as in the application of ice to a 
 wound to check capillary oozing, plugging the nostrils with 
 ice in epistaxis, the ice-cap in apoplexy, swallowing ice pills 
 in hemorrhage from the stomach, the application of the ice 
 pack to the loins in hemorrhage from the kidneys, the ice- 
 bag or compress over the abdomen in case of hemorrhage 
 from the bowels, and the application of ice-cold compresses 
 to the 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 sought. Hence the appli- 
 cations must be absolutely continuous. If compresses are 
 employed, a freshly cooled compress must be ready for 
 instant application when the warm one is removed. 
 
 Very hot as well as very cold applications of water are 
 effective means of controlling hemorrhage. A sponge or nap- 
 kin saturated with water at a temperature of 140° to 160° F. 
 is a most efficient means of checking capillary oozing. This 
 means of controlling hemorrhage is very generally used in 
 operations involving the peritoneal cavity, and is not infre- 
 quently of very great service in shortening the time required 
 for the completion of an operation by facilitating the prepa- 
 ration of wounds for closing. The application of water at a 
 temperature of from 125 to 130 F. to the interior of the 
 uterus will almost instantaneously control uterine hem- 
 orrhage. The application must not be longer than 4 or 5 min- 
 utes, for, as shown by Runge, prolonged very hot applications 
 produce paralysis of the uterine vessels, with stasis. Cold 
 applications following hot often produce the best results. 
 
 Heat may also be applied to the uterine cavity by means 
 of a hollow metal sound (14-16), through which a stream of 
 hot water is allowed to flow. The author has made use in 
 this way of boiling water with advantage. Ice may be 
 applied with the same instrument. 
 
2 72 RATIONAL HYDROTHERAPY. 
 
 698 Under this head are included applications 
 
 Antiphlogistic w hich have for their purpose to suppress or 
 Effects. . 
 
 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- 
 turb an; es. 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: — 
 
 i. 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 cr remote, causing congestion by retrostasis. 
 
 5. An atonic or paretic state of the vaso constrictors of 
 the affected part, as in solar erythema, erysipelas, and other 
 inflammations. 
 
 6. Overstimulation of the vasodilators through visceral 
 irritation or some other reflex influence, as in cerebral conges- 
 tion due 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 
 
 i suggested: — 
 
THERAPEUTIC EFFECTS. 273 
 
 1. Improve the heart tone by a cold compress to the pre- 
 cordium for half an hour three times a day. Energize the 
 peripheral heart and dilate the surface vessels by the neutral 
 bath with friction, the effervescent bath, cold friction, and 
 the rubbing wet sheet. 
 
 2. Stimulate the circulation of the liver by the broken 
 douche to the lower half of the chest (6o°), the alternate 
 hepatic cjpuche (ioo° to 6o°), and the heating compress, and 
 drain off a portion of the portal blood into the lower extremi- 
 ties by means of the warm leg bath, the heating leg pack, or 
 the Scotch douche to the legs. 
 
 3. In this class of cases, hydrotherapy offers small assist- 
 ance in a curative way, but great relief may often be secured 
 through the use of very simple measures, such as increasing 
 the tone of the congested parts by means of cool compresses, 
 thus enabling them better to resist the disturbing cause. 
 Constipation, if present, must be combated by special means. 
 
 4. Spasm of the vessels of the feet and legs, causing con- 
 gestive headaches, may be relieved by the Scotch douche, 
 the prolonged hot leg or foot bath, and the heating pack 
 to the legs. Fomentations to the abdomen, followed by 
 the heating abdominal compress, will remove the cause of the 
 vascular spasm of the legs by relieving the irritation of the 
 sympathetic ganglia in which the disturbing reflex influence 
 originates. 
 
 5. Prolonged cold compresses (6o° to 70 ), alternate hot 
 and cold applications, or very hot compresses or douches, are 
 measures by which the vascular tone of the affected part may 
 be raised, and the stagnated blood moved on to make room 
 for an influx of pure blood with its supply of normal nutrient 
 and healing properties. 
 
 In changing the hot and cold compresses, great care must 
 
 be taken to avoid the slightest delay, as the occurrence of 
 
 reaction between the applications will destroy the effect 
 
 obtained by the cold application and cause a return of the 
 
 pain and swelling. A freshly cooled compress should be 
 18 
 
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 greatest 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 io c , 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 
 should be moistened as often as necessary, and should never 
 be allowed to become dry. An ice poultice may be applied to 
 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 6o° to the affected part. If a very cold application 
 is made, it must be removed at short intervals, particularly in 
 
276 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 6o° 
 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. 2?7 
 
 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 trunk, 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 (ioo° to 104 ), retained for a few 
 minutes, 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 
 rubbing 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 
 
278 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 affected part. It is necessary 
 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 application 
 
THERAPEUTIC EFFECTS. 2^9 
 
 may sometimes produce better effects than continuous cold in 
 the hydriatic management of deeply seated congestions or 
 inflammations. 
 
 In the use of cold, care must be taken to avoid producing 
 a harmful collateral hyperemia in cases of deeply seated 
 inflammation by prolonged cold application to the surface 
 (672). 
 
 To obtain the atonic antiphlogistic effects of heat (64?2), 
 fomentations, the cotton poultice, the hot-water bag, hot irri- 
 gation, and hot immersion are the chief measures. The neu- 
 tral pour or irrigation and neutral immersion are also highly 
 useful. Fonssagrives maintains that the relief obtained 
 by 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- 
 tact with 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 
 be sustained by our present notions respecting the part played 
 by toxins of bacterial origin in provoking and maintaining local 
 congestive and inflammatory processes. The dilution and 
 hastened removal of these poisons must certainly tend to 
 lessen the intensity of the morbid changes set up by them, 
 and to aid the tissues in their efforts to combat the disturbing 
 elements present, whatever they may be. 
 
 Recent observations have developed the interesting fact 
 that nervous irritability is notably lessened, when a nerve is 
 made to take up a quantity of water. This may be the true 
 explanation of the relief always afforded by warm com- 
 presses, the neutral bath, and many other sedative hydriatic 
 procedures. 
 
 It seems reasonable, also, that dilution of the blood may 
 serve to lessen the activity of morbid processes in a congested 
 or inflamed part, by diminishing the proportion of blood cells 
 present and diluting the blood serum. 
 
 The employment of the hot foot bath for the relief and 
 
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 General For general antiphlogistic effects, that is, 
 
 Antiphlogistic f or su J3d u i n g 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 I 
 
 blanket, and dried by allowing the moisture upon the surface 
 to be absorbed by the sheet, without any friction whatever. 
 He should remain quiet for 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 
 Use of Cold in by exudate, as in pneumonia the frequently 
 Preu^^and renewed heating compress (1284, 1318) 
 Other Acute should be employed during the early stages 
 Disorders. 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- 
 riods 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: — 
 
252 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 face and top of 
 head; the short cold douche to the hands, arms, feet, and 
 legs; leg or hip bath at 105 to no° 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, 1 or 2 minutes, at 6o° to 70 . 
 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. 
 
 702 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 6o° 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 morbid 
 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 
 
 affords relief from pain, and controls inflammatory processes 
 in a wonderful manner. 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- 
 tion effects, dilating the vessels; but cold and cool applica- 
 tions induce a sustained contraction. 
 
 When a procedure is such as to abstract heat, 703 
 Effects ^ * s antithermic. When it not only abstracts 
 
 heat but lessens heat production, it is anti- 
 pyretic. The effects of antithermic applications are often 
 defeated by imperfect methods. A passive cold application, 
 as a cold immersion bath, stimulates heat production to a 
 greater extent than heat elimination, so that the tempera- 
 ture 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 
 mind is so to manage the antithermic measures employed as 
 to avoid the thermic reflex; that is, the automatic increase of 
 heat production. The method of accomplishing this was 
 pointed out by Winternitz more than twenty years ago, but 
 has been too little appreciated, unfortunately, by those who 
 have undertaken to use water in fevers. The method is 
 simple: it consists in maintaining dilatation of the cutaneous 
 vessels and active movement of blood through the periphery 
 by means of friction. Thus accumulation of blood in the mus- 
 cles and the thermic reflex set up by cooling of the nerves in 
 the skin, which cause increased heat production, are prevented. 
 
 Whatever measure is employed it should be long enough 
 in duration to produce a decided effect upon the patient's 
 temperature. A single wet-sheet pack, for example, would 
 certainly increase heat production, and elevation of tempera- 
 ture (719). A short cold bath has the same effect. 
 
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. 
 
THERAPEUTIC EFFECTS. 285 
 
 The antithermic or refrigerant effects of water are among 
 the most important and valuable therapeutic uses to which 
 this agent can be put. It has been recognized from the 
 earliest ages, certainly since the time of Hippocrates, that 
 the application of water at a temperature below that of the 
 body is a most perfect means of antagonizing the elevation 
 of temperature which occurs in connection with fevers of 
 all classes. 
 
 From the time the value of water as an antipyretic was 
 brought to the notice of the profession by Currie and Jackson 
 in the latter part of the last century, up to the present time, 
 no one has undertaken to deny that the death-rate has been 
 uniformly lessened to a very marked degree whenever hydri- 
 atic measures have been systematically and intelligently used 
 for reducing febrile activity, from whatever cause. A long 
 list of eminent physicians, both English and Continental, as 
 well as American, have given their adherence unreservedly to 
 the use of water as the most valuable means known for this 
 purpose. 
 
 In the treatment of a long series of cases of typhoid fever 
 by the cold bath in the New York Hospital, the mortality was 
 reduced to 7. 5 per cent. The rate of mortality in over thir- 
 teen hundred cases previously treated by the usual method was 
 from twenty to thirty per cent. 
 
 The author and his colleagues of the Battle Creek Sani- 
 tarium are able to report over two hundred cases of typhoid 
 fever treated by these methods with a mortality of less than 
 four per cent. In one series of thirty-six successive cases, all 
 the patients recovered, although in several instances the symp- 
 toms were very grave, owing to delay in beginning treatment. 
 The measures chiefly relied upon were water-drinking, the 
 enema, and the cooling pack. No medicinal antipyretics 
 were employed. 
 
 J. C. Wilson, a few years ago, reported sixty-four cases of 
 typhoid fever treated in the German hospital, Philadelphia, 
 Pa. , without a single death. In one hundred and eight cases 
 
286 RATIONAL HYDROTHERAPY. 
 
 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 various applications of water, used at a teixh 
 perature lower than that of the body, may be utilized 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 application, 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 (88° 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 sufficient 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 tem- 
 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. 
 
THERAPEUTIC EFFECTS. 287 
 
 The antipyretic effects of cold water are 704 
 Antipyretic , . , , , ■ , 
 
 obtained by the systematic employment 01 
 
 antithermic measures. There has within the 
 last few years been a very strong reaction against the use of 
 antipyretic drugs, and in favor of this truly physiological and 
 rational remedy, and at the present time no respectable 
 medical authority disputes the extreme value of water as an 
 antipyretic measure. Modern observations have demonstrated 
 that the danger from elevation of temperature is not so great 
 as was formerly supposed, that in fact the rise in the body 
 temperature accompanying febrile activity is really a part of 
 the remedial effort put forth by the system in combating the 
 morbid process to which the rise of temperature is due; and 
 it has been clearly shown by Winternitz, and by many 
 others, that the mere lowering of the body temperature by 
 means of antipyretic drugs is not only not in any way 
 beneficial to the patient, bat, on the contrary, is decidedly 
 detrimental, since the system is thus compelled to struggle 
 not only with the toxins which are produced in connection 
 with the special morbid processes present, but with the toxic 
 drug introduced with therapeutic intent. 
 
 In visiting the fever ward of a large city hospital some 
 years ago, the author was particularly struck by the fact that 
 patients whose temperature was normal as the result of the 
 administration of large doses of antipyrin, had the expres- 
 sion of persons in a state of collapse or extreme shock, the 
 evident result of the combined influence of the bacterial 
 toxins and the toxic effect of the antipyretic drug. 30 
 
 In the reduction of temperature by means of hydriatic 
 measures, not only is no toxic substance introduced into the 
 body, but the cold applications, which lessen to some degree 
 the pathological thermogenic processes which are in opera- 
 tion, at the same time act as a true tonic to the reparative 
 forces of the body, and stimulate the elimination of the toxic 
 substances to which the special symptoms characteristic of 
 the disease are due. 
 
2 88 RATIONAL HYDROTHERAPY. 
 
 Indeed, as the result of the antipyretic applica- 
 Effects of Cold , ' . , AJ . . . *\ . 
 
 on the Heart tlon °* 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, but 
 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, cold 
 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 circulation, 
 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 
 
 producing a marked lowering of temperature in a well person 
 
 may have a decided effect in the febrile state. 
 
 A general rise of the body temperature may 706 
 
 Relation of result (a) from increased heat production, (b) 
 
 Heat Produc- from diminished heat elimination, or (c) both 
 
 tion and Heat i ncrea sed heat production and diminished heat 
 
 Elimination r 
 
 to Antipy- elimination may be present, or still other dis- 
 
 retic Methods, turbances of the thermogenic or thermotaxic 
 
 functions may exist (237). 
 
 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 before 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 
 
 great 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, 
 
 viterference 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 EHmina= ^e evaporation of water from the surface, the 
 tion by Evap= _. , . ' , 
 
 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 160 pounds, this would be equivalent to a fall of six 
 degrees in temperature. The normal rate of heat produc- 
 tion is about 1.8 calories, 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, we 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 oe 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 (Weyrich). Hence 
 the value of this measure 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. 
 
THERAPEUTIC EFFECTS. 2CjI 
 
 it, as by lessening the conducting power of the skin, by 
 decreasing the blood supply, and by checking perspiration. 
 It is consequently evident that to give a general cold bath in 
 a case in which the surface is pale, cold, and dry, — in other 
 words, when there is a decided diminution in heat elimina- 
 tion, — 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, 
 a very 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- 
 eliminating power of the skin. Indeed, it is more than 
 probable that this result might occur in quite a large pro- 
 portion of cases ; so that the danger from the application of 
 cold water in a manner theoretically wrong would not always 
 be so great as might at first seem; nevertheless, it is far 
 better to recognize the exact condition present, and to select 
 the most appropriate measures for meeting existing indications. 
 The physician who depends upon the reserve forces of the 
 body and the versatile powers of nature to avert the conse- 
 quences of his blundering methods in the therapeutic uses of 
 water, can hardly be regarded as a scientific hydriatrist. 
 
 In cases presenting an abnormally high tern- 708 
 Indications of a perature, the following symptoms may be 
 Condition of regarded as indicating that the elevation of 
 Production. temperature is the result of increased heat 
 
 production : — 
 i. A flushed face, with full pulse. 
 
 2. A warm, moist skin. 
 
 3. A hot, dry skin. 
 
 The following symptoms accompanying an 709 
 Symptoms elevation of temperature may be regarded as 
 
 n lca ! n ^ f" indicating that the rise in temperature is, at 
 Elimination. the moment at least, associated with decreased 
 
 heat elimination : — 
 
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 elimination. 
 
 Increase of both heat production and heat elimination, but 
 with excessive increase of heat production, is a condition 
 present in sthenic fevers and inflammations. In this condi- 
 tion the skin may be either 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 
 
 collapse shall have reached so serious a stage as to render 
 
 recovery impossible. 
 
 i. A general cold application increases both 710 
 
 Principles that heat pro( iuction and heat elimination. Which 
 Govern the . , „ ... , . 
 
 Application of °* tnese enects is dominant depends upon the 
 
 Hydriatic Meas= duration and intensity of the bath. 
 ures for the 2 . A general cold application, if very brief, 
 
 Temnerature causes no perceptible loss of heat, and may 
 in Fevers. occasion, by thermic reaction, a slight tem- 
 
 porary rise of temperature. 
 
 3. A prolonged cold application lowers the temperature 
 by 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 (J 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 mechanical 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 
 
 reaction must be wholly suppressed, or as nearly so as pos- 
 sible; in others a moderate amount of thermic reaction will 
 prove beneficial. In threatened collapse, thermic reaction 
 must be encouraged. 
 
 Of the various measures which may be em- 711 
 Methods that ployed for the reduction of temperature, the 
 
 May be Effi= following: may be mentioned as having; been 
 ciently Em= , . 5 \ .. . . ,_ , , 
 
 ployed in the tested in actual clinical experience, not only by 
 
 Various Morbid the author, but by numerous able clinicians. 
 
 Conditions ^11 have been found useful and efficient, some 
 
 bv a Rise in being best adapted to one particular set of cir- 
 
 Temperature. cumstances, others to other conditions, but 
 
 each having its particular utility ; for rational 
 
 hydrotherapy gives no countenance to routine methods, and 
 
 recognizes no panacea : — 
 
 1. The Cold or Tepid Affusion. — This method, first em- 
 ployed by Hippocrates, and in recent times revived by Currie 
 and Jackson, is efficient in lowering temperature. The mor- 
 tality rate in scarlet and typhoid fevers is reduced by its 
 use from thirty or forty per cent, to almost nothing. The 
 patient simply sits in a large tub, while several pails of 
 water at the ordinary temperature, or about 70 F. , are 
 poured over him, this procedure being repeated as often 
 as the temperature reaches 102 F. 
 
 Currie observed that the warm affusion (87 to 97 F.) 
 is more effective in reducing temperature than the cold, 
 offering in proof the following excellent reasons, which are 
 certainly highly creditable to the sagacity and medical knowl- 
 edge of this pioneer of rational hydrotherapy, considering the 
 fact that his observations were made more than a hundred 
 years ago : — 
 
 "I find that, in many cases at least, the heat of the 
 living body is lowered as speedily by the affusion of tepid 
 water as by the affusion of water that is cold. If I mistake 
 not, in some cases the heat is lowered more speedily by the 
 tepid water." 
 
296 RATIONAL HYDROTHERAPY. 
 
 The principal 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: 
 fi 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 Immersion Bath (1112). — 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, 
 
 * "Medical Reports on the Effects of Water, Cold and Warm," by James 
 Currie, Vol. I, pp. 64, 65. 
 
THERAPEUTIC EFFECTS. 2QJ 
 
 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 
 there is a slight rise immediately after the bath. This 
 is especially true at the beginning of a fever. Later the 
 effect is greater. 
 
 The question of the use of alcohol in connec- 
 
 Therapeutic t - Qn w fth the cold bath is one which is deserv- 
 
 Substitutes 
 
 for Alcohol. in S °* more than mere passing 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 
 always 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 
 
 usual condition in slowed circulation, the blood current is 
 slow 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 C0 2 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. 713 
 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 C0 2 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 circulatory 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 
 excitory 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 medullated and of spinal origin, while the accelerators 
 of the heart and the vasoconstrictors of the arteries are non- 
 medullated. 
 
 Winternitz 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 of the peripheral circulation in the skin, 
 muscles, and elsewhere. Alcohol paralyzes the vasoconstric- 
 tors, and so dilates the small vessels and lessens the repist- 
 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. 301 
 
 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 skin 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 (1132). 
 
 The late Professor Dujardin-Beaumetz, 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, but 
 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 88° to 92 is 
 highly 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 without difficulty by a feeble 
 typhoid 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 8o° or 85 makes upon the hot skin of a 
 nervous fever patient an impression very little different from 
 that 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 Bath. — Ziemssen first, and later Glen- 718 
 ard, recommended in high terms the so-called graduated bath, 
 in which the patient is placed in an immersion bath, the 
 
 * " L' Hygiene Therapeutique," by Dujardin-Beaumetz, Paris, 
 
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 yo° 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 101 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. 
 20 
 
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 
 very 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 8o° 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 very 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. $OJ 
 
 9. The Cold Sponge Bath (120^). — 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 dry. 
 
 10. The Wet-Towel Rub (1213).— The cold towel bath 723 
 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 for more vigorous applica- 
 tions, such as the cooling pack and the graduated bath. 
 
 '24 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. 
 
 25 12. The Cold Evaporating Sheet (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- 
 pose 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. 
 Repeat 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. 
 
310 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 antipyretic effect 
 desired, also reflexly 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 15. 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 (1 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. Fomentation to the Spine (1328). — It would perhaps 729 
 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. Fomentation 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 18. 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 8o° 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 very 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 
 induces lessened heat production, without communicating 
 a sufficient amount of heat to the body to cause a rise of 
 temperature. 
 
 19. Cold Applications to the Head, Spine, Heart, and 732 
 Abdomen. — The 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 
 must 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 
 ice-bag 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 Cold-Air Bath. — The temperature of the air 733 
 in the sick-room has a most decided influence upon the body 
 
3 14 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 5 8° F. cause increase of heat production, air at 
 a temperature above 6o° has a like tendency. Air is practi- 
 cally neutral between 6o° 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 
 101 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 
 
THERAPEUTIC EFFECTS. 315 
 
 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 5 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 120 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 beneficial 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 cooling by contact with air or radia- 
 tion of heat toward masses of lower temperature. The ex- 
 periments of Peclet show that the body cools by radiation at 
 the rate of about one heat unit for each square foot of ex- 
 posed skin surface per hour for each degree of difference 
 
316 RATIONAL HYDROTHERAPY. 
 
 between the temperature 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 one-half 
 heat unit per hour for each square foot of skin surface ex- 
 posed 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 6o°, the temperature of the air yo° , the 
 average skin temperature 95 °, and the amount of skin sur- 
 face 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 soft mattress. 
 By frequently changing the position of the patient, turning 
 first on one side and then on the other, the cooling surface 
 may be considerably 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 19.6 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 
 W represents the weight of the patient under consideration 
 and S the skin surface : — 
 
 180: Ww 19.6* :5 f 
 
 This may be simplified into the following formula : — 
 
 W 
 8 7 W=i8o S 1 *; or, = S* 
 
 2.07 
 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 130 pounds, the skin area would 
 be 15.5 square feet. Supposing the amount of surface ex- 
 posed to be two-thirds of the whole, or about ten 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 circulationo 
 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. 
 
3 I 8 RATIONAL HYDROTHERAPY. 
 
 735 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. 
 
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 water introduced may be steadily cooled until 
 it is reduced to 70° or even lower. As a rule, however, a 
 temperature of 8o° 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, 
 for 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 150 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 
 unit 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 effect 
 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 8o° 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 right 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 
 which the water is brought in contact is so small that com- 
 paratively slight effects are produced. 
 
 24. Partial Cold Applications. — When the general feb- 737 
 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 for maintenance of the parts in 
 proper position prohibits the employment of cold water to 
 the affected part, the principle of the ' ' proximal com- 
 press " (1327), so much used by Priessnitz, may be employed. 
 In head injuries, apply the ice-collar. 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 the trunk of an artery causes 
 contraction in all its branches beyond the point of application. 
 Conditions ^ s P rev i° usr y pointed out, elevation of tern- 738 
 
 Giving Rise to perature may occur in five different cases as 
 Elevation of regards the condition of the heat-regulating 
 
 Temperature. functions (2g7) _ 
 
 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 
 21 
 
322 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: (a) Per- 
 spiring skin; (b) warm, moist skin; (c) 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 many 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. 323 
 
 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 applications 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 102 for 3 or 4 minutes. Cold friction 
 may be applied with great advantage immediately after 
 the hot application in most cases. 
 
 Heat elimination may be encouraged by two general 739 
 methods: (1) 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 21 2°, 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 elimination 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 (744?) are most appropriate and 
 convenient for a case' in which there is fever, with increase 
 of both heat elimination and heat production. 
 
 The method of cooling the body by contact with cold air 
 has been elsewhere described (733). 
 
324 RATIONAL HYDROTHERAPY. 
 
 To cool the skin by evaporation it is only necessary to 
 substitute ordinary water for the perspiration which nature is 
 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 increase 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 for 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 affusion, 
 the cooling shower pack, and other cold applications may be 
 employed, provided a hot bath of some sort, as the hot- 
 blanket pack for 5 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 no°), 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 elimination, 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. 325 
 
 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 given 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 742 
 diminished heat elimination, but to a lesser degree, a hot 
 bath (5 to 10 min.) followed by a short cold bath (J 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. If 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 always indications for the application of heat and friction 
 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 sort, 
 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. 
 '43 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 sufficiently extensive 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 8o° 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 15 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 15 square feet (180: 120:: &71S* ; 5=15). 
 At the rate of 10,000 heat units' daily loss for a skin area 
 of 19.6 square feet, the normal heat loss for a skin area of 15 
 square feet would be about 7,650 heat units. But the actual 
 loss is only 5,400 (15 X 15 X 24 = 5,400), a diminution of 
 2,250 heat units,, or 30 per cent, less than the normal rate of 
 heat elimination. 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 
 normal, 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 
 therapeutic indication is for the use of such measures as will 
 increase heat elimination. In such a case, the Brand bath 
 would of course be contraindicated; the measures required 
 would be dry friction, or short hot baths followed by partial 
 cold applications with vigorous friction. The use of the fric- 
 tion mitt with water at 50 to 6o° would be especially indi- 
 cated. 
 
 Let us suppose, on the other hand, that the patient's sur- 
 face temperature is found to be high, the skin hot to the 
 hand, and ioo° by the surface thermometer. The heat loss 
 will be at the rate of 16,200 heat units per diem (45 X 15 X 24 
 = 16,200), or an increase of 112 per cent. The rectal tern-. 
 perature being above normal, it is evident that there must be 
 at least an equal percentage increase in heat production ; and 
 vigorous measures to diminish heat production and to in- 
 crease 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). 
 
 Hydriatic Applications to be Employed in Cases in which 744 
 Both Heat Production and Heat Elimination 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. 
 
 i. 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). 
 
 11. 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 (1395D- 
 
 17. 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 (1 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 
 
 8. Hot-blanket pack, followed by graduated bath (718). 
 
 9. Hot-blanket pack followed by prolonged tepid bath. 
 
 10. Hot-blanket pack followed by cold friction. 
 
 1 1. Dry friction. 
 
 12. Cold friction. 
 
 Cold applications alone are contraindicated in 746 
 Suggestions fever cases in which the skin is cold, the lips 
 
 and Cautions or s ^ n bi uej w hen goose-flesh, perspiration, 
 Respecting the 11 u n 
 
 Use of Water general shivering, or chilliness are present, 
 
 for Antipyretic and when cold applications are particularly 
 Effects. disagreeable 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 inflammation, as 
 in acute ovaritis or salpingitis, or other pelvic inflammations, 
 gastritis, nephritis, etc. The inrush of blood produced by 
 the cold application in cases of this sort increases the conges- 
 tion which already exists in the affected parts, and thus 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 efficiently lowered by controlling the 
 local inflammatory processes by appropriate measures. 
 
 Currie well recognized the importance of avoiding general 
 cold applications in cases of general fever due to some local 
 inflammatory affection, and recommended the tepid bath in 
 
330 RATIONAL HYDROTHERAPY. 
 
 these conditions, with careful avoidance of the cold affusion 
 or other applications likely 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 
 prolonged 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 tem- 
 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 108°, 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 little 
 comfort to a patient burning up with fever, but it is of no 
 
 *" Medical Reports," 4th edition, p. 204. 
 
THERAPEUTIC EFFECTS. 33 I 
 
 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 
 •occurs, with another rise having its maximum at midnight, 
 and followed again by a decline. It is evident that a bath 
 given 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 
 beneficial, 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 decline 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 
 contrary, 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 
 perature 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 after that time, in 
 the author's opinion, the temperature may easily be kept at a 
 lower point by the intelligent 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 are 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 hydrotherapeutic 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 (i04°-io6° and above) 
 and when normal or nearly normal (99°-ioo°), it is very 
 difficult to lower it; but febrile temperatures between ioo° 
 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 size, 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 safe when judiciously employed, 751 
 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, the 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 was 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- 
 
 Conditions in casionally encountered in connection with the 
 which there Is treatment of fevers, it is important to know 
 
 ?i! St H rb ! n ^ e ° f their significance and the remedies which 
 
 the Heat-Regu- 1 1 f 1 
 
 Sating Functions should be employed to combat them. 
 
 with Depres= In conditions in which there is a depres- 
 
 sion of Tern- slon Q f temperature while heat elimination is 
 oerature. 
 
 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 
 surface 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 colliquative 
 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 753 
 Contrafndica= mischief as well as much good. It is of the 
 Cold or Brand highest, importance to understand its limita- 
 Bath. tions and contraindications. The conditions 
 
 which forbid its use or which render necessary 
 the most extraordinary caution and circumspection in its 
 employment, may be briefly stated as follows : — 
 
 i . Sweating. — Under ordinary circumstances the presence 754 
 of 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 
 bath. The desired effect may be secured by means of cold 
 
336 RATIONAL HYDROTHERAPY. 
 
 friction (1209). At first, water at the ordinary temperature 
 (jo° to 75 c ) 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 of 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. 
 755 2. Goosc-FlesJi 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 6o° to yo c 
 is usually sufficiently exciting, but ice-water may be used 
 when more powerfully 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 impres- 
 sion combined with the mechanical effect, 
 
THERAPEUTIC EFFECTS. 337 
 
 3. Cyanosis. — Here again the cold bath of Brand is 756 
 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 sudden and prolonged contact of cold water with 
 
 the whole surface of the body, while the internal viscera, 
 already profoundly congested in consequence of 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 applications 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. Pronounced Cardiac Weakness. — The dicrotic pulse, 757 
 marked weakening of the first sound of the heart, and espe- 
 cially the " pendulum " action of the heart, in which the two 
 silent periods of the heart's action are equal or nearly equal, 
 
 are 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 
 22 
 
338 RATIONAL HYDROTHERAPY. 
 
 collapse, which may, by aid of this warning symptom, be 
 foreseen and prevented by general cold friction and the 
 
 758 cardiac compress often repeated. 
 
 5. Myocarditis. — 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 encountered 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 centers 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 overzealous 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. Intestinal 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 general cold bath. Fomentations, revulsive 
 applications, and the cooling compress may be applied to the 
 abdomen, but the general cold bath is decidedly contra- 
 indicated. The prolonged tepid bath (88 c )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. Pleurisy and Pneumonia. — 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. Tuberculosis. — 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. Infancy. — The immersion bath at low temperature is 763 
 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 sufficiently 
 vigorous to react to the ordinary Brand bath. The tepid 
 bath, the cooling pack, and cold friction are suitable measures 
 
 for this condition. 
 
 11. Old Age. — The 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- 
 
34° 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 conditions, 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 (reclining), 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. 
 765 12. Late or Neglected 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 are marked, 
 and not infrequently these conditions are 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. 34 1 
 
 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 imperil 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- 
 tions of the body successively, the cutaneous circulation may 
 be marvelously improved without increasing, even momen- 
 tarily, internal congestion. By increasing the movement of 
 the blood, and especially by producing a hyperemic 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 10 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 application 
 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 
 the 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 
 to 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 over the 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 energy, 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 
 effective 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. 
 
 Secretory Cold applications made in such a way as to 
 
 Sedative Effects l owe r 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 c -i04 c ). 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 766 
 two general classes: — 
 
 i. Those in which the seat 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 HYDROTHERAPY. 
 
 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. 
 
 767 i. Before beginning a course of general appli- 
 
 General cations of cold water, careful investigation 
 
 Directions for s h ou ld be made respecting the condition of 
 
 the Use of the , , r fe , 
 
 Bath> 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 when the application extends to the entire surface of 
 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 (443). If the reaction is excessive, 
 less strongly stimulating measures should be employed; that 
 is, (a) raise the temperature a few degrees; {b) 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 affusion; 
 
GENERAL RULES AND SUGGESTIONS. 345 
 
 (c) have the patient exercise less long or vigorously before 
 or after the bath; or (d) follow the cold application by a short 
 cool or tepid non-percutient application, as a wet-sheet rub 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 application, 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 
 well to diminish the shock resulting from the contact of very 
 cold water by an intermediate tepid or cool application. 
 
 3. The Duration of Applications. — The lower the tern- 768 
 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 moderate pressure is employed. The 
 duration may be from 1 or 2 minutes to 10 or 15 minutes. 
 
 Very hot applications 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 15 or 20 minutes. 
 
 The neutral bath may be continued as long as circum- 
 stances require. It may be made practically continuous for 
 several months, if care is taken to regulate the temperature 
 
769 
 
 346 RATIONAL HYDROTHERAPY. 
 
 so carefully that thermic reaction is wholly suppressed. For 
 sedative effects, from 30 minutes to 1 or 2 hours is the 
 usual time required. 
 
 4. The Temperature of Applications. — 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- 
 
 The Therapeutic . . , , , , . , . , . 
 
 Significance of l°g ica -l and pathological states is a subject 
 
 Reaction. which must be thoroughly understood by the 
 
 hydriatist. Elsewhere (429-481, 578, 579) 
 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 
 
 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 
 
 Conditions a given application depend upon — 
 
 that Control & FF - /- F 
 
 Reaction. l - -"-he met hod 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, (£) weak or strong, (c) fat or thin, (d) rested or 
 fatigued, (e) 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. 
 
 8. 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 
 
 Oscillatory observed following a cold bath, each recur- 
 
 Reaction. ° ' 
 
 rent reaction being weaker than the prece- 
 ding. These oscillations are doubtless due to the swift rush 
 
348 RATIONAL HYDROTHERAPY. 
 
 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- 
 
 ^uppression of t - there are cases in which the suppression 
 Reaction. 
 
 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, burns, wounds of various 
 sorts, and hemorrhages. The means by which reaction may 
 be diminished or increased have been fully described else- 
 where (443-459). 
 
 EXERCISE IN CONNECTION WITH HYDRIATIC APPLICATIONS. 
 
 774 From the days of the earliest cold-water cures, the impor- 
 
 tance of exercise in connection with water treatment, espe- 
 cially applications of cold water, has been fully recognized. 
 Priessnitz kept his patients sawing and chopping wood a 
 considerable part of the time when they were not occupied 
 with the multitudinous drinkings, packings, douchings, cold 
 plunges, etc., to which they were subjected under the heroic 
 regimen in vogue at Graefenberg. 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. 7)49 
 
 share of the patients who visited Priessnitz were persons of 
 robust constitution who were suffering chiefly from the 
 effects of high living, sedentary habits, and wine drinking, 
 the measures employed were for the most part successful. 
 
 Exercise not only encourages circulatory reaction, but 
 especially encourages heat elimination. It has been clearly 
 demonstrated by experience that the temperature lowering 
 which begins from five to fifteen minutes after a cold bath is 
 continued and increased by exercise, so that the maximum 
 diminution is fully half a degree greater with moderate exer- 
 cise than without it. 
 
 In persons able to take exercise, a sufficient 775 
 
 fh^Bath bef ° re amount of P n Y sical 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 description of a system of self-resistive exercises, see paper by the 
 author, in Modern Medicine for December, 1898. 
 
350 RATIONAL HYDROTHERAPY. 
 
 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, especially 
 in feeble persons, resulting in incomplete reaction and 
 depression. 
 776 Imperfect reaction after the cold bath is in 
 
 Exercise after ^ highest degree injurious, and lack of 
 the Bath. , , ° ° J ■_ 
 
 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 are cold, there is headache, not 
 infrequently diarrhea, and other evidences of internal 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, when there is 
 actively present a catarrhal affection of these parts. 
 
GENERAL RULES AND SUGGESTIONS. 35 1 
 
 As a rule, exercise should always be taken after a cold 
 bath when the patient is sufficiently strong to walk. 
 
 Reaction maybe 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 appear 
 when it is remembered that exercise favors thermic reaction, 
 and that thermic reaction means activity, not only in the 
 nerve-muscular thermogenetic apparatus, but in every cell 
 and tissue of the body, and an exaltation of function. 
 
 The application 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 
 agents, 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- 
 sulting 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 antagonized. 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. 353 
 
 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 clin- 
 ical observation. 
 
 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- 777 
 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 limb 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 reac- 
 tion 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, 778 
 H t 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 artificial heating of the skin the heat elimination and 
 23 
 
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 
 effects are really the result of either incomplete reaction after 
 the bath or a reaction accompanied by perspiration. 
 
 A THOROUGH SCIENTIFIC EXAMINATION NECESSARY AS 
 A FOUNDATION FOR A HYDRIATIC 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 
 morbid elements, but for the deter min-ation of the coefficient 
 of elimination of nitrogenous wastes. Careful note must be 
 taken of the relation of the total solids to the urea, as an in- 
 dicator of the relative activity of destructive tissue processes. 
 
 2. An examination of the blood is essential for a deter- 
 mination of the color coefficient, the blood-count, and the 
 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 
 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 
 
GENERAL RULES AND SUGGESTIONS. 355 
 
 excess of ordinary tissue poisons, or leucomains, either from 
 diminished 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 functional or 
 structural. 
 
 (1) The functional disturbances which it is especially 
 important to note are hypopepsia, apepsia, or hyperpepsia; 
 local congestion or irritation of the bowels, bladder, uterus, 
 or ovaries; irritability of heart or lungs or sympathetic 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- 
 alysis, 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- 
 
356 RATIONAL HYDROTHERAPY 
 
 illating, easily discouraged ? The treatment must be care- 
 fully planned with reference to all these considerations. 
 '80 6. It is of immense advantage to make a care- 
 
 c effi ' t, ^ s t U( ty °f 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 careful use. 
 
 (3) A high strengtli-weiglit 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. 35/ 
 
 effect a good reaction; but the cold applications must be short 
 and not too frequent. 
 
 (7) A low strength-weight coefficient with a normal height- 
 weight coefficient indicates diminished muscular and nervous 
 energy and the need of great care in the use of hydrothera- 
 peutic measures. 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 follow the hot 
 application with a short cold douche at high pressure. 
 
 (8) A low strength-weight 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 low strength-weight Coefficient with a low 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 
 short 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. 
 
 (10) 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 low 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 an}- 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. 
 gl 7. The patient's physical aptitudes or tem- 
 
 1 d d * 1 Cases P eramen ' t 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 simple test (480). 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. 359 
 
 servation. For example, he reasoned that if chilling 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 
 hydriatic measures. These powerful agencies must be regu- 
 lated with even greater nicety than medicinal agents, as 
 the difference 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. 
 
 10. Before making a prescription in any case, 782 
 Organotherapy - t - g a | SQ necessary to determine which most 
 and Sympto= . 
 
 matic Treatment rec l uires immecn ate attention — some urgent 
 to 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. 
 
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. 36 1 
 
 In French and German hydropathic estab- 783 
 Exaggeration lishments the more experienced patients often 
 under" 15 ° mS encourage novices with the remark, ' ' You 
 Treatment. 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 in 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 
 to 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 that 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 him. It is 
 only an indication that the treatment is producing a power- 
 ful effect upon the system, and that a reorganization 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 weeks, an increased frequency in the occurrence of the 
 paroxysms. This he explains by the supposition that a 
 change in the character of the blood results in the dissolving 
 out of the tissues of a larger amount of uric acid, which, being 
 brought into the circulation, irritates the nerve ends with 
 which it comes 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 
 
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 v/ith 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. 363 
 
 intuitive judgment are required so to combine local and sys- 
 temic measures with palliative and systematic treatment that 
 the 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 recognized. 
 
 There are also cases in which symptoms may be 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. 
 
 11. In the organization of a plan of treatment 781 
 
 y Kea - n a gq Ven case, it is necessary to determine 
 
 Progress Must ° J 
 
 be Slow. n °t on v tne 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. 
 
364 RATIONAL HYDROTHERAPY. 
 
 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 reorganiza- 
 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 for 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 harvest. 
 
 It may be said, however, for the encouragement of patients, 
 that in not a small proportion of cases, immediate relief is 
 experienced 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- 
 
GENERAL RULES AND SUGGESTIONS. 365 
 
 dition. The brief interval which elapses between the with- 
 drawal of symptom-obscuring remedies and the amelioration 
 of symptoms which come from the accumulation of 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. 
 
 If 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 life, how 
 to adjust diet, exercise, work, etc. , to the morbid condi- 
 tions which exist in his system, how to employ such palliative 
 means as will 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 times a day. In 
 acute disorders, applications may be repeated hourly, or many 
 times 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 realize 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 time, 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 relief from symp- 
 toms is experienced from the first. 
 
 It is very important for the permanency of the effects 
 obtained that the patient under treatment for 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 for the 
 patient, to remember that chronic disease is rarely entirely 
 cured; in fact, we may almost say that a complete cure of a 
 chronic malady never occurs. The symptoms may disappear,' 
 but the patient's constitution has been permanently weakened 
 in certain directions, so that his condition is analogous to that 
 of 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 
 of treatment, which is almost certain to be quite too limited, 
 but 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 func- 
 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 th^ 
 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 maybe 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- 785 
 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 8o°, 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, 
 \he succeeding cold application being short, or just long 
 snough to remove from the skin the surplus heat absorbed. 
 
 24. 
 
370 RATIONAL HYDROTHERAPY. 
 
 In the case of very sensitive and timid persons, treatment 
 should 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, yo° to 8o° instead 
 of 6o° to yo° 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. 37 1 
 
 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 (6o° to 8o° 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 790 
 higher temperature should be used, with stronger percussion. 
 This method is preferable to that suggested by Beni-Barde and 
 others; viz., to attempt to avoid the excitant effects of short, 
 very cold applications by increasing the duration of the appli- 
 cation, and thereby producing a slight 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 
 Diseases. 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 heart, 
 
37 2 RATIONAL HYDROTHERAPY. 
 
 all extremes of temperature should be avoided. Neutral baths 
 are indicated. The patient maybe trained to endure a douche 
 at 75 to 8 5 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 
 8 5° to 90 z F. for 5 to 10 minutes, accompanied by friction, 
 followed by the short Scotch douche at 104 for 1 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 few instances 
 been occasioned by a cold douche or exposure to excessive 
 heat in the Russian 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 fleshy persons 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 surfer from second- 
 ary chill and untoward results. 
 
 Thick-skinned persons of phlegmatic temperament readily 
 tolerate the very cold douche and a very high pressure; that 
 is, if no contraindicating symptom is present. 
 
 Cold water as a therapeutic agent is especially 794 
 Hvdrotheraov adapted to the treatment of acute maladies 
 in which fever or pain is present or in which 
 diminished activity or overactivity of special organs is a 
 fundamental condition. 
 
 It must be remembered that cold applications with per- 
 cussion should be 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 
 serviceable in cases of this sort. 
 
 Hydriatic measures may always be employed with great 
 advantage in chronic disease, the tonic effects of cold water 
 being almost universally required in the treatment of these 
 maladies. 
 
374 RATIONAL HYDROTHERAPY. 
 
 795 Surgical cases involving pain, fever, or danger of inflam- 
 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 modern 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. 
 
GENERAL 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 atrophy, and yet even in these conditions 
 marked improvement has not infrequently been effected; 
 atrophied parts have 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 chlorosis, anemia, and other cachexias. When 
 caused by disease of the heart or kidneys, hydrotherapeutic 
 applications are still highly useful, but must be employed 
 with the greatest circumspection. 
 
 Hemorrhages from the nose, stomach, lungs, or pelvic 
 viscera may be successfully combated by suitable applications 
 of water, as elsewhere explained. 
 
 In gastric disorders, hydrotherapy affords more assistance 799 
 than any other remedial agent. The cold douche in hypo- 
 pepsia 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 HC1, while the hot 
 douche diminishes the formation of this acid in cases in 
 which it is already present in excess. 
 
 The cold douche applied to the abdomen stimulates intes- 
 tinal peristalsis, and thus combats constipation. 
 
 Genito-nrinary a7id renal disorders present many condi- 800 
 tions which are in the highest degree amenable to hydriatic 
 treatment. The sitz bath, rectal irrigation, the vaginal and 
 uterine douches, the pelvic pack, the fan or jet douche, and 
 general tonic applications 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 conditions 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 applications 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 are 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, the 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 RULES AND SUGGESTIONS. 377 
 
 ative and tonic effects 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 rheumatism, obesity ', and diabetes, 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, through exposure to the influence of depressing 
 toxic agents and retained excrementitious matters, tonic 
 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 energize 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 (2 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- 805 
 
 Qradwttonf ** Cation selected > the water should h ? employed 
 
 at a moderate temperature, as 8o° to 85 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 6o° F. As the temperature is lowered, the 
 time of the application should be shortened, until at 6o° 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 8 5 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 8o° 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 8o°, 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. 
 §06 A second method of training for the cold bath 
 
 Scotch" Douche? is P reliminar V 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 8o° 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 SUGGESTIONS. 3/9 
 
 outset, but making the application so short in duration that 
 untoward effects are obviated. The preliminary heating of 
 the skin greatly diminishes 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 no°, 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 1 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. 
 
380 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 
 
 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 amenorrhea, 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 sitz 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 
 M . .. 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 lightning 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, fever, 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, 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 within 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, ar 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 
 
 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 (a) 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. 383 
 
 prolonged, administered with too much percussion, 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 modified 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- 81^ 
 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 affusion at 8o°, 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 bath. 
 
 Insomnia, nervousness, wandering pains, pal- 815 
 Insomnia, pitation, fidgets, uneasiness, and indefinable 
 
 t 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 for 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-light 
 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 manv cases of hysteria, 
 Neurasthenia . , . , . . „ , , . n 
 and Hvsteria in wnicn P am 1S 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 does 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 8o° 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. 
 T k* C Id ^ ^ e b e gi nrnn £ °f 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. 385 
 
 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. 
 
 Rheumatic pains, which not infrequently fol- 818 
 Rheumatic j ow hydrotherapeutic applications, are not due 
 
 D . * to 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 affected 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 
 Crises or Fever , , „ \ ,, , 
 
 of Reaction. 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 
 
386 RATIONAL HYDROTHERAPY 
 
 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, etc. ; 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 modern 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 
 character 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. 387 
 
 reaction. In these cases it is best to develop the reaction as 
 quickly as possible, so that the procedure shall not be 
 fatiguing. 
 
 In applications for the reduction of temperature, a cer- 822 
 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 823 
 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 a febrile 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 
 stomach, being provided with a better quality of gastric juice, 
 
GENERAL RULES AND SUGGESTIONS. 389 
 
 is better prepared to protect itself against injury from intru- 
 ding microbes. Modern investigations have shown 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 communicated 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 1,000 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 Bathing b ear the application of very cold water ; there- 
 Early Child- * ore ' ^ e louche m a H 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 jo° 
 to 8o° 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 e Ad° It a their conditions of life, their special predispo- 
 sitions and individual susceptibilities. 
 
GENERAL RULES AND SUGGESTIONS. 39 1 
 
 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, 829 
 
 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 8o°) 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 830 
 The Cold Bath , . .,. , £ , ^ u , 
 
 . .., women of civilized nations, because 01 the de- 
 
 tor women. 
 
 teriorating influences of their artificial life. 
 The harmful 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 cold bath favors the development of the menstrual 
 function in young girls, and if habitually employed, affords 
 great assistance at the menopause. A woman who has made 
 regular and persistent use of the cold bath for some years 
 preceding the "change of life" 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 cold bath should be avoided during menstruation. 
 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 
 
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 6o° to jo° 
 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 
 
 The Cold Bath , , . , A rr , , t , 
 
 . ~. . A of arteriosclerosis and allied forms of degen- 
 
 in Old Age. m ° 
 
 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 RULES AND SUGGESTIONS. 393 
 
 rub, 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 of 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 
 
 Process. 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 
 
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 SUGGESTIONS. 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- 
 culatory 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 bath at 02° to 95° is of special value for 833 
 The Neutral _ A , . 1 
 
 g ath> 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 1 5 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. 
 834 p recau tions Im 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 900 
 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 an 
 establishment furnished with all the appliances for the most 
 efficient use of water. It is not always necessary for the 
 patient to live 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 few words may not be out of place in regard to the 
 
 397 
 
39 8 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 offers 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 6o° 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 Priessnitz and his fol- 903 
 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 
 of affording an abundant supply of hot water is required. 
 Water may be conveniently heated by means of such a water- 
 heater as is commonly used in laundries; or when the bathing 
 establishment 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 
 utilized 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 somewhat lessened by 
 fastening a suitable head to the open end of the pipe, but can 
 never be entirely overcome. 
 
 Live steam is needed for the vapor bath, the Russian 904 
 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, 
 
400 RATIONAL HYDROTHERAPY. 
 
 an arrangement shown in the accompanying cut (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 fomentations. 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 
 
Fig. 28. WATER COOLING APPARATUS (p. 398) 
 
 *r 
 
 Fig. 29. COMPRESSION-TANK DOUCHE. 
 APPARATUS (p. 400). 
 
 Fig. 30. BATH SLIPPER (p. 404). 
 
HYDRIATIC INSTITUTIONS. 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 
 falls 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 7& 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 906 
 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 not 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. 
 
 26 
 
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 
 physiological 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 908 
 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 warmed. 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 discourage him. If a patient is too feeble to help 
 himself without more than ordinary assistance, the method of 
 application must be modified to suit his 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. 
 
404 RATIONAL HYDROTHERAPY. 
 
 909 It is important to remember that patients are as likely to 
 take cold in the treatment-rooms as elsewhere. The patient 
 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. If 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 short, 
 vigorous cold application followed by rubbing and a good 
 reaction. The secondary chill (441) 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 
 for 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 (774). 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, 
 
HYDRIATIC 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 exhilaration which comes with the 
 reaction following the bath is soon recognized as more than 
 ample compensation for 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, an? 
 other internal organs. 
 
406 RATIONAL HYDROTHERAPY. 
 
 913 Very cold or very hot baths should be avoided just before 
 or just after meals. The sitz 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 Schiiller's experiments* it is evident that the condi- 
 tion of the cerebral vessels should always be taken into con- 
 sideration in the arrangement of a hydriatric prescription. 
 Warm baths are contraindicated 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. 
 
 916 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 necessary 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. 
 
 * Archiv fur Klin. Med., 1874. 
 
HYDRIATIC INSTITUTIONS. 407 
 
 If the bath is one requiring rubbing, it must be faithfully 917 
 done, 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 minute may be sufficient to 
 spoil the effect of the procedure altogether. When the pa- 
 tient is able, he must be constantly encouraged to assist in 
 the rubbing, as the physical exercise thus involved is relied 
 upon as a means of assisting reaction, and is an important 
 factor in securing the good results expected of the procedure. 
 
 In procedures like the wet-sheet pack and the neutral bath, 918 
 care should be taken to secure the greatest possible degree of 
 quiet about the patient. Bright sunlight should be excluded 
 by drawing down the curtains a little. Conversation, if al- 
 lowed at all, should be suppressed. The patient should be 
 disturbed as little 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 bath, 
 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 sleeping, care 
 being taken that no untoward effects are provoked by the 
 accumulation 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 applied 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 muslin 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 sheet, 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 
 to produce irritation of the skin or to bruise or exhaust the 
 patient. Excessive friction depresses the heart. 
 
 It is necessary to exercise great 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 burns 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. 
 
 Equal 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 923 
 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 
 
4IO RATIONAL HYDROTHERAPY. 
 
 sciatica and in chronic joint disease. Oiling of the skin is 
 also essential as a protection against taking cold for patients 
 who are under hydriatic treatment, especially during the 
 cold season of the year. A little refined vaseline or cacao 
 butter should be applied daily or every other day, after dry- 
 ing the patient. 
 
 924 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 : — 
 
 926 Loss of Flesh. — 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 grams (1% oz.) for each millimeter (one twenty-fifth 
 of an inch) of height, as the author has elsewhere pointed 
 out),* a loss of flesh probably indicates overtreatment or 
 
 *"A New Dynamometer for Use in Anthropometry," read before the American 
 Association for the Advancement of Physical Culture, 1893. 
 
 
HYDRIATIC INSTITUTIONS 4II 
 
 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 
 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 ciearly 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 
 unduly. 
 
 A very common cause of the loss of flesh referred to is the 928 
 excessive employment of heating measures. When this is the 
 case, these should be at once suspended, and short cold appli- 
 cations at 6o° to 65 , duration 4 to 10 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 tem- 
 peratures, as by neutral baths, the neutral pack, or the rain 
 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 
 in 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- 
 erly trained to the employment of such powerful measures. 
 
 930 Loss of Appetite. — 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. 
 
 931 Loss of Strength. — 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 energize 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 
 
HYDRIATIC INSTITUTIONS. 413 
 
 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 furnishes 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, strength-height, and respiratory- 
 height and -weight coefficients are especially valuable. The 
 significance of these coefficients and their use in hydriatic 
 prescriptions has been dwelt upon elsewhere (780). 
 
 The blood-count and the percentage of hemoglobin may 932 
 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 
 for 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 excessive amount of urea or a trace 933 
 of albumin or sugar maybe an indication that the procedures 
 
 * "Physical Coefficients," Modern Medicine Pub. Co., Battle Creek, Mich. 
 
414 RATIONAL HYDROTHERAPY. 
 
 employed are too intense. 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 may be prepared by the aid of this schedule 
 shows instantly what is the effect of the treatment upon the 
 general metabolism, and also reveals any untoward effects 
 upon the kidneys. 
 
 934 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. 
 
 935 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 Dyspnea 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 (io to 15 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. 
 
 Vertigo and fainting are symptoms likely to occur in con- 
 nection with hot applications 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. 
 933 Sleeplessness 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 
 
TO RAIN DOUCHE 
 
 Fig. 32. DIAGRAM OF AUTHOR'S DOUCHE APPARATUS (p. 427). 
 
HYDRIATIC INSTITUTIONS. 41/ 
 
 a time, such quieting means as the tonic pack, the 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- 
 tal pains in persons who have been subject to those difficulties. 
 Pain is very likely to result from cold applications which have 
 not been followed by complete and thorough reaction. 
 
 Headache is one of the most common results of misman- 940 
 aged or too intense hydriatic procedures. * ' The hydropathic 
 headache" is a well-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 in operation most fully the 
 forces necessary for perfectly balancing the circulation, increas- 
 ing heat production, and energizing 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 
 
 27 
 
41 8 RATIONAL HYDROTHERAPY, 
 
 between, as, for example, 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, if 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. 
 
 942 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 
 ioo° F. at the beginning, being rapidly raised until a tem- 
 perature as high as the patient can endure is reached — io8° 
 to i io°. 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 be brief. If a douche apparatus is 
 not convenient, the patient may be put into a hot immersion 
 bath at ioo°, 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 
 8o°) 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 Excessive reaction^ 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 very likely to occur when the cold 
 application is not employed for a sufficient length of time to 
 
HYDRIATIC INSTITUTIONS. 419 
 
 allay the exciting effects of the heat, and develop the tonic- 
 sedative influence of cold. Excessive reaction calls for a 
 reapplication of cold at moderate temperature (65 to 8o°), 
 with little pressure. 
 
 Eruptions of the skin indicate excessive cutaneous excita- 944 
 tion, and interdict the use of the sweating pack and similar 
 procedures. In some instances the vapor bath or the electric- 
 light bath must be substituted for more exciting sweating 
 procedures, or 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- 945 
 therapy may be employed as a sort of diagnostic " reagent " 
 to determine, in doubtful cases, whether or not syphilitic 
 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 voluntary or involuntary 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 being substituted. 
 
 948 At the beginning of treatment, patients sometimes com- 
 plain of a slight or even decided exacerbation 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. Recovery 
 from disease is a thing which requires time, like the growth of 
 a plant. Good judgment and good sense are necessary for 
 interpreting the meaning of an exacerbation of the symptoms 
 in a case under hydriatic treatment, whether they are what 
 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 obstruction 950 
 in the attempt to discharge a collection of gall-stones or a 
 similar recurrence of renal 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 headache, 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 with 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 
 possibility of impending collapse. This test should be fre- 
 quently applied in cases of typhoid fever or other grave febrile 
 disorders, and may be 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 8o°, 75°; 
 hot, 104 to 122°, 113°. 
 
 Plunge : cold, 50 to 70 , 60°. 
 
 Immersion : cold, 50 to 70 , 60° ; cool, 70 to 8o°, 
 75°; hot, ioo to 106 , 102°; very hot, 104 to 115 , 
 108°; neutral, 92 to 97 , 95°. 
 
 Brand bath : 70° F. 
 
 Shallow : cold, 55 to 6 5 , 60°; cool, 70 to 8o°, 75°. 
 
 Cold wet-sheet pack : 60° F. 
 
 Hot-blanket pack : 130° F. 
 
 Sponge bath: 6o° 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°. 
 
 Hoi-air bath : no° to 180 , 160°. 
 
 Local hot-air bath : 200 to 300 , 250°. 
 
 Turkish bath : 140 to 250 , 180°. 
 
 Russian bath : no° to 140 , 125°. 
 
 Vapor bath : no° to 140 , 130°. 
 
 Footbath: 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°. 
 
Vntl Tlprjeje* 
 
 THE TECHNIQUE OF HYDROTHERAPY. 
 
 THE modes in which water may be applied to 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 hydrotherapeutic measures 
 may be divided into two general classes : — 
 
 i. Applications in which thermic effects alone are pro- 1000 
 duced. 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 
 external. 
 
 2. Applications in which thermic impressions are supple- 1001 
 mented by mechanical effects, either (a) by giving more or less 
 vigorous movement to the mass of water brought in contact 
 with the skin, or (b) by manual manipulations, such as rub- 
 bing or friction, and percussion. In this class are included 
 
 [423] 
 
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. 425 
 
 eral, it may be said that the therapeutic applications which 
 have been indicated for individual procedures are those to 
 which the measure in question most conveniently or aptly 
 lends itself, and those 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 of 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, a few towels, a pail, and an ample supply of hot and 
 cold water, provided the requisite experience 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 employment of the douche, three factors are active : 
 (i) Temperature, (2) Pressure, (3) Mass. 
 
 The range of temperatures employed in douches is from 
 45 to 1 2 5 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 effect 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 be 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 is 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 tem- 
 perature desired, and in rapid alternation if required. 
 
THE TECHNIQUE OF HYDROTHERAPY. 427 
 
 The author has devised and used for a number of years 1004 
 (1899) a very convenient apparatus, the general form of 
 construction of which may be seen in the accompanying cuts 
 (Figs. 31, 32). With this apparatus it is possible to ad- 
 minister the douche 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 different 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. 
 
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 iris 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 i.8° in a distance of 3^ meters (11 y 2 ft.). In giving a 
 hot douche under the same conditions, the loss of temperature 
 was 4%°. 
 1005 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, fan, broken jet, vertical rain 
 or shower, horizontal rain or spray, jiliform, percussion, 
 circle, multiple circle or needle bath, Scotch, alternate, 
 massage douche, irrigation. 
 
 Special applications of the douche to particu- 
 Localized j ar p ar ^- s f the body are described under the 
 
 following names : Cephalic, dorsal, lumbar, 
 thoracic, epigastric, hypogastric, abdominal, plantar, peri- 
 neal, anah 
 
 A number of special applications of the douche 
 
 Visceral are described and designated by the names of 
 
 Douches. , ° , . . , 
 
 the organs or internal 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, pulmonary, cardiac, gastric, enteric, hepatic, splenic % 
 renal, geni to-urinary, articular, muscular. 
 
 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 applications of irrigation are to the nose, 
 eye, ear, stomach, rectum, colon (coloclyster), bladder, ure- 
 thra, and vagina. 
 
 Physiological Effects — The douche, combining as it does 1006 
 both thermal 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 (1) 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 Schuller'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 
 the 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 (1882), "The 
 vis a tergo of the blood by the normal rhythmical contraction 
 of the vessels so like peristaltic action, prevents a retrograde 
 movement." Ludwig has shown that the movement of 
 
 Arch, fur Klin. Med. t 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. 43 1 
 
 The warm and the neutral 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 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 non-percutient hydriatic measures, 
 temperature 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., volume and 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 
 
 *Couette, "Etude Experimentale sur 1' Action Thermique de l'Eau Froide 
 en Applications Hydrotherapeutiques. " 
 
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 and 
 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 (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- 
 
Fig. 33. DOUCHE — Horizontal Jet (p. 433). 
 
 Fig. 35. Diagram 
 of Author's 
 Percussion 
 Douche 
 Nozzle. 
 
 Fig. 34. DOUCHE — Broken Horizontal Jet (p. 434)0 
 
THE TECHNIQUE OF HYDROTHERAPY. 433 
 
 lar form of douche, the horizontal jet is the form of procedure 
 referred to. 
 
 The jet douche consists of a single stream, varying in 
 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 
 of 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 finger 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- 
 
 *Lemarchand, Annates de la SodSti d' ' Hydrologie^ 1893. 
 28 
 
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 uterus, 
 in inflammation of these organs; to inflamed or sensitive 
 points; and over painful nerves. The full jet (Fig. 33), at 
 appropriate pressure, may be used upon the back, arms, legs, 
 feet, and over the liver and spleen when not contraindicated. 
 
 The head must be very thoroughly cooled before the 
 douche, and should be protected by a cold towel 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 feet. 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 5 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 435 
 
 the general inrush of blood occurs, and thus the part is pro- 
 tected. This practical fact has led to the application of the 
 douche over the liver and stomach first after the back, and 
 before the general application, on account of the almost uni 
 versal feebleness of these organs and the need of both pro- 
 tecting and energizing 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 localized 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 heating 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 chilliness, 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 
 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- 
 cations, 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 
 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 cold douche is from 45 ° to 65 ° ; 
 of the cool douche, from 65° to 8o° ; of the tepid douche, 
 from 8o° to 92 ; of the neutral 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 1883 and also in 1889 the 
 author found the douche in great use in the hospital Salpe- 
 triere, 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 all forms of nerv- 
 ous maladies. The same may be said of the hospital 
 Charite and other great centers of scientific medicine in Paris. 
 
THE TECHNIQUE OF HYDROTHERAPY. 437 
 
 The douche 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 most 
 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 section 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 localization 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 by Schuller 
 and others. 
 
 Carefully conducted experiments made by Storoscheff, of 1012 
 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. Wertheimer, Acadetnie des Sciences, 1893, p. 44. 
 
43^ RATIONAL HYDROTHERAPY. 
 
 to both the galvanic and the faradic currents was decidedly 
 increased. 
 
 The author has undertaken some experiments for the pur- 
 pose of ascertaining whether or not the last-named effect was 
 the result of increased conductivity of the skin due to satura- 
 tion with water, or to an actual increase in the muscular 
 excitability. The details of this experiment are given else- 
 where (Exp. 54). 
 1013 The exhaustive researches of Vinaj and Maggiori have 
 shown clearly the remarkable effects of the douche upon the 
 muscles. The cold douche shows by its modification of the 
 fatigue curve an enormous increase of muscular irritability and 
 capacity for work (Exp. 55). 
 
 The hot douche produces an effect in an opposite direc- 
 tion even more pronounced, hence its great value in relieving 
 muscular spasm (Exp. 56). The Scotch douche may pro- 
 duce either increase or decrease of muscular excitability and 
 capacity, according to the way in which it is managed. 
 
 The rise of blood pressure produced by the cold douche 
 may be followed somewhat later by a diminution in pressure, 
 when the blood-vessels are well dilated by a strong circula- 
 tory reaction. This is due to the fact that the influence of 
 the douche upon the surface vessels may endure longer than 
 its effect upon the heart. This is especially true of a very 
 short and energetic application (45 to 55 , at 40 lbs. pres- 
 sure, 3 to 5 sees.). 
 
 The most powerful effects of the douche are produced at 
 from 45 to 6o°; time, 4 to 30 seconds. A good working 
 temperature is between 55 and JO°. The higher the tem- 
 perature, the longer must be the duration and the greater 
 the pressure required to produce decided tonic effects. At a 
 low temperature a transient but powerful impression is made 
 upon the skin, and through the strong reflexes produced, 
 upon the entire organism, manifested chiefly through the 
 thermic and circulatory reactions. 
 
THE TECHNIQUE OF HYDROTHERAPY. 439 
 
 When the douche is administered at a higher temperature 1014 
 (8o°), in some instances undesirable nervous phenomena are 
 produced, as headache, lassitude, and imperfect reaction. In 
 such cases it is necessary to educate the patient to the use of 
 low temperatures by very short cold or even very cold appli- 
 cations. 
 
 In the administration of a cold jet douche with strong 1015 
 pressure and an unbroken stream, it will be noted that at the 
 exact point upon which the column of water falls the skin 
 becomes instantly blanched, the color reappearing as soon as 
 the stream is allowed to fall upon some other part. Each 
 time that the water column impinges upon any point of the 
 cutaneous surface, this phenomenon is repeated. The blood- 
 vessels are not only made to contract by the thermic impres- 
 sion of cold water, but the weight of the stream of water, the 
 force of impact, compresses the tissues, and forces the blood 
 out of the vessels, leaving them free to dilate again as soon as 
 the pressure is removed. Thus the tissues are alternately 
 compressed and released ; in other words, a veritable mas- 
 sage is produced, whereby the circulation is excited and accel- 
 erated ; and the thermic effect of the douche is thus materi- 
 ally aided by the purely mechanical or percussion effects of 
 the moving water as really as if friction or percussion move- 
 ments had been executed with the hand. 
 
 When the pressure employed is sufficient to produce a de- 
 cided stinging sensation at each point of contact, a powerful 
 reflex effect is produced by stimulation of the various sets of 
 nerves which recognize temperature, pressure, pain, and tac- 
 tile impressions. When we recall that in addition to the 
 nerves mentioned, the douche, in common with other proce- 
 dures, influences the vasoconstrictors, the vasodilators, and 
 the sympathetic ganglia of the vessel walls, it is apparent 
 that this procedure excels all others as a means of awakening 
 or controlling local activity in the skin, also, through the 
 wide-spreading reflexes set up by it, of arousing or otherwise 
 impressing metabolic processes and all other vital activities. 
 
44-0 RATIONAL HYDROTHERAPY. 
 
 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 
 some 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. 
 1016 Therapeutic 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 ; 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. 44 1 
 
 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 time. 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, Beni-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 not 
 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 8o°, or even 90 in very 
 extreme cases, and being gradually lowered from day to day 
 as the patient's strength and resistance increase. The pres- 
 sure is also gradually increased, beginning with 10 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 is 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 likely to be used at all, making the application at first 
 
442 RATIONAL HYDROTHERAPY. 
 
 very brief, perhaps not more than 2 or 3 seconds, and grad- 
 ually increasing the duration from day to day. 
 
 It must be admitted that both methods may be employed, 
 and perhaps the two are 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 short, 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 rheumatism 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 Bright* s disease of the 
 kidneys, gastric ulcer, locomotor ataxia, spinal sclerosis, and 
 most organic affections of the brain and spinal cord. In these 
 cases it is preferable to begin a course of treatment with very 
 mild non-percutient measures, as the tepid fan douche (90 
 to 8o°) with little pressure (4 to 8 lbs.). 
 1018 It is in some cases necessary to employ at the beginning 
 of treatment a very much lower pressure (8 to 10 lbs.) 
 than will be readily tolerated after the patient has had the 
 benefit of a few weeks' training. Low pressures (1 to 4 lbs.) 
 are especially indicated in cases in which great hyperesthesia 
 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 rheumatism, with much pain or tenderness, to 
 the chest in intercostal neuralgia, to the abdomen in chronic 
 hyperesthesia of the solar plexus and the sympathetic gan- 
 glia, and to all parts in which much irritability is present. 
 
THE TECHNIQUE OF HYDROTHERAPY. 443 
 
 As nonpercutient 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 rubbing, 
 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 may be 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 heating 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 neurasthenia in 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 nutrition, the cold 
 douche has no equal ; and it is also unrivaled as a curative 
 agent in chronic atonic dyspepsia or hypopepsia, and in 
 most cases of chronic toxemia 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 disease } 
 
444 RATIONAL HYDROTHERAPY. 
 
 In chronic inebriety, 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 stimulation 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 : — 
 
 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 io°), he bends 
 forward while one to two gallons of water at 6o° 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 
 douche is not at hand, the patient, standing with his face 
 toward the attendant, turns half around at intervals of 1 5 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 1 or 2 minutes. 
 
 1022 A short cold douche (10 to 30 sec.) or a very hot 
 douche (iio°-I22°) of the same duration maybe advanta- 
 geously employed in cases of hysterical anesthesia. The 
 
THE TECHNIQUE OF HYDROTHERAPY. 445 
 
 douche often has the effect to transfer the anesthesia to the 
 opposite side. 
 
 The cold douche is equally useful in hysterical hyperesthe- 
 sias, though in such cases the application should be made to 
 the symmetrical part of the opposite side of the body ; as, for 
 example, 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 hysterical 
 aphonia. 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 1023 
 employment of the cold douche in all cases in which an 
 active inflammation exists, and especially in cases of inflam- 
 mation of the uterus, ovaries, kidneys, stomach, liver, blad- 
 der, or bowels. 
 
 In many cases of so-called chronic inflammation, as intes- 
 tinal catarrh, myelitis, chronic gastritis, cystitis, and general 
 neuritis, the cold douche must be avoided. The cold douche 
 is of high value, however, in cases of passive congestion of 
 the liver, stomach, spleen, and other viscera. 
 
 In acute 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, valvular disease of the heart with deficient compensa- 
 tion, cardiac insufficiency from fatty degeneration, renal 
 disease, or from any other cause when marked in degree. In 
 acute or chronic nephritis ; in painful nervous affections, as 
 sciatica, locomotor ataxia, multiple neuritis, in hyperpepsia. 
 
446 RATIONAL HYDROTHERAPY. 
 
 and in gastric ulcer; in varicose conditions of the portal or 
 mesenteric 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- 
 tures is contraindicated in eruptive disorders of the skin, and 
 in hyperesthesia and neuralgia of the skin. Heggelin has 
 pointed out the danger of pulmonary hemorrhage during the 
 cold douche in persons liable 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 DOUCHE. 
 
 1024 The temperature of the water employed may vary from 
 
 ioo° 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 betaken 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 ioo° to 102 , 
 the temperature being gradually but rapidly increased, reach- 
 ing the highest point in from 30 to 60 seconds. Too much 
 time must not be lost 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 
 should be raised as rapidly as possible without producing a 
 
THE TECHNIQUE OF HYDROTHERAPY. 447 
 
 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 1025 
 exciting procedure. Its physiological effects are very similar to 
 those of the hot immersion bath, with the addition of 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 effects 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 pain, 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- 
 
448 RATIONAL HYDROTHERAPY. 
 
 able length of time after the conclusion of the application. 
 This is not an active but 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. This 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 effects 1028 
 by excitation of the circulation of the skin, the hot douche 
 from 1 to 5 minutes at a temperature of ioo° to 125 gives 
 excellent results. Ordinarily, water at a temperature from 
 104 to no° should be employed, the duration being 3 to 5 
 minutes. 
 
 The most vigorous effects 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, 
 29 
 
450 RATIONAL HYDROTHERAPY. 
 
 The general hot douche, with very slight pressure, is 
 exceedingly useful as a means of relieving general superficial 
 pain, hyperesthesia, neuralgia, and paresthesia. It is, in 
 some cases, valuable in relieving the distressing irritation of 
 pruritis, urticaria, and jaundice. A very hot general douche 
 (no c to I22 c , i 5 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 applied 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 no° 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, 
 such 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 " con- 
 cedes nothing to the cold douche" in its value and efficiency. 
 For tonic effects the 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 
 cases of exhaustion from prolonged or violent exertion. For 
 
 ♦Lemarchand, Ann. Soc. d' Hydro?. Med., Paris, Compt. rend. 1892-93, 
 XXXVIII, 247-275. 
 
THE TECHNIQUE OF HYDROTHERAPY. 451 
 
 such a purpose the application must not be greatly pro- 
 longed, and should be administered with a considerable 
 degree of pressure (30 to 40 lbs., 5 or 20 sees.). 
 
 The general hot douche, as well as the hot-blanket pack, 
 the hot full bath, and other general hot applications, is an 
 antidote for an excessive 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 pain or conges- 
 tion, to excite physiological 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 
 Alternate Douche" (1044). 
 
 THE NEUTRAL DOUCHE. 
 
 Temperature, 92° to 97 ; duration, 2 to 30 minutes ; 1031 
 pressure, from 2 to 20 pounds, according to the effect de- 
 sired. The ordinary duration of the general neutral douche is 
 from 3 to 1 5 minutes, pressure, 5 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 
 for 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 surface vessels, and so 
 contract the vessels of 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. 
 
45 2 RATIONAL HYDROTHERAPY. 
 
 1032 Physiological Effects. — The mechanical effect upon the 
 skin causes widening of 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 
 storm of sensory impressions, as in the hot or the cold douche. 
 The physiological effects of the prolonged neutral douche are 
 essentially the same as those of the neutral immersion bath. 
 This procedure, like. 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 efficiency of the 
 application as a means of increasing the volume and move- 
 ment of blood in the skin, thus relieving 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 genito-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 fall 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. 453 
 
 douche (92° to 97 ) to the back, along either side of the spinal 
 column, is one of the most effective means of quieting reflex 
 excitability of the spinal centers. 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. Vitus 1 s dance, locomotor ataxia, the irritable spine of neu- 
 rasthenia, certain genito-urinary disorders due to irritation of 
 the genito-urinary center, as nocturnal enuresis, seminal 
 weakness, vesical irritation, some cases of vaginismus, and 
 erotomania in both sexes. 
 
 The neutral douche is very useful in general nervous irri- 
 tability as a means of relieving hyperesthesia of the skin, 
 dermalgia, 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- 1035 
 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' 
 experimentation, at intervals, an apparatus was perfected 
 which accomplishes this in an admirable manner. An air 
 current under pressure is led into a specially constructed 
 nozzle, near the orifice. This device is shown in the accom- 
 panying cut (Fig. 35). The effect of the combination of air 
 
454 RATIONAL HYDROTHERAPY. 
 
 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 mass 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 of 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 ordinar}* 7 horizontal jet produces a 
 more or less constant pressure. If means are adopted to 
 diminish this solidarity, as in the so-called broken jet, the 
 result is greatly to diminish the force with which the water is 
 projected upon the surface; but in the percussion douche, the 
 stream is broken, while 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 particles of water impinge 
 upon the skin. 
 1036 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 offers are these: — 
 1. More powerful 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 with 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 
 1 
 
THE TECHNIQUE OF HYDROTHERAPY. 455 
 
 intensified as more heat is abstracted, while the evil effects 
 of the prolonged retrostasis resulting from a nonpercutient 
 general cold application 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 fusillade, 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 with the same water pressure, thus securing better 
 reaction and more pronounced 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 energized. The tissues of the back are sup- 
 plied with nerves from 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 back 
 
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 intoxications, 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 hyperesthetic states of the sympathetic 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 5 5 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 legs in asthma, to the 
 lumbar spine in lumbago, to the thigh in sciatica, over 
 
THE TECHNIQUE 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 (no° to 
 1 25 ) 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$ 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 
 (1250). Next to this in efficiency is the Russian bath and 
 the cold rain douche in combination (1052). 
 
 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 1 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 6o°. 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 (6o°). 
 
THE TECHNIQUE OF HYDROTHERAPY. 459 
 
 For the cold application the best effects 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 65 to 50 , duration 5 to 20 seconds. In 
 cases in which very cold applications are contraindicated 
 (636, 803, 1023), higher temperatures may be employed 
 (70 to 8 5 ), and the duration must be extended from 20 to 
 60 seconds. The higher the temperature, the longer should 
 be the duration of the cooling application. It is also impor- 
 tant, when the temperature is elevated, to increase the pres- 
 ure, in order to secure good circulatory reaction. 
 
 Although the Scotch douche depends for its 
 The Graduated ~ ,. +u . ... t u . , 
 
 Scotch Douch^ effectiveness upon the transition from heat to 
 
 cold, it is not essential that this change should 
 
 be abrupt; yet the more sudden the change, and the greater 
 
 the extremes of temperature employed, the more pronounced 
 
 will be the effects. 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 of the body (ioo°). The heat of the applica- 
 tion is gradually increased until a temperature of I io° to 120 
 is reached, held at this point for 3 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 30 ; but 
 this limit may be gradually extended from day to day until a 
 difference of 40 or even 50 is reached. 
 
4^0 RATIONAL HYDROTHERAPY. 
 
 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= . , . , . , , 
 
 s-otch wa -ter possesses, in 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 ioo° 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 TECHNIQUE OF HYDROTHERAPY. 46 1 
 
 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 warm douche. This renders 
 impossible general chilliness with retrostasis and the resulting 
 general vascular and nervous disturbances connected there- 
 with, which follow general cold applications to the surface, 
 and which in sensitive persons follow 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 
 (1052), and the combined cold douche and electric-light 
 bath (1250). 
 
 Special forms of the simultaneous Scotch douche which 
 may be advantageously employed are the following : — 
 
 1 . The Dorsal Cold Douche (6j° to 8o°) Combined with 
 the Abdominal Hot Douche {106° to 123°). — 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 RATIONAL HYDROTHERAPY. 
 
 upon a stool. The pressure should be moderate, 5 to 15 
 pounds. This application may be usefully employed in cases 
 of chronic gastric catarrh, chronic intestinal catarrh, hyper- 
 esthesia of the lumbar ganglia of the abdominal sympa- 
 thetic, hepatic congestion, splenic congestion, renal congestion, 
 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 chronic pelvic con- 
 gestion, so-called metritis, ovarian congestion, chronic inflam- 
 mation of the tubes, and atonic conditions of the pelvic 
 viscera accompanied by passive congestion and pain. It is 
 contraindicated in cases in which acute inflammation or sup- 
 purative processes are present. 
 
 3. The Combined Spinal Douche and Hot Douche to the 
 Feet.- — The cold percussion douche is applied to the spine 
 simultaneously with the hot douche (no°— 122 ) to the feet 
 and legs. The fan or spray douche may be employed for the 
 hot douche to the feet. By this procedure, it is possible to 
 apply a very cold (50°-6o°) 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 of the body, and the application of the cold spray to the 
 feet and legs for two or three seconds. 
 
 4. The Symmetrical Combined Scotch Douche. — In 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 tonic measures, the symptom may be 
 made gradually to disappear. 
 
 Physiological Effects. — The physiological effects produced 1038 
 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 (1 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." 
 1089 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, Ann, de la Sqc, d' Hydro!. Med., Paris, 1893. 
 
Fig. 36. PERCUSSION DOUCHE (p. 4 54)- 
 
THE TECHNIQUE OF HYDROTHERAPY. 465 
 
 especially useful in cases in which the skin is very inactive, 
 or is relaxed, as indicated by profuse and frequent szv eatings. 
 It renders valuable service in the sweatings which are charac- 
 teristic of the climacteric period, and which are frequently 
 encountered in neurasthenic cases, 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, 1 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 training 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 paralyzed muscles. Short and very hot 
 applications are powerfully restorative in cases of muscular 
 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- 
 ation of weakened muscular structures. 
 
 The Scotch douche is of great value, not only in actual 
 paresis or 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 1 
 minute, followed by a general fan or broken jet and full jet 
 or percussion douche to the spine and legs at 6o°, 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 
 chronic "backache '." 
 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 congestion, 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" (134-1). 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 i22°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. a"* Hydro! Med., Paris. 
 
 f Glatz, "L'Hydrotherapie Tonique et Revulsive," Cong. Period, internal, d. 
 sc. m^d. Compt. rend. Geneve, 1878, page 524. 
 
THE TECHNIQUE OF HYDROTHERAPY. 467 
 
 until the skin acquires a dusky-red or cherry color. The cold 
 application is then administered for 2 to 1 5 seconds, according 
 to the temperature of the water employed, and the degree of 
 irritability of the parts. Very irritable conditions require very 
 brief cold applications. With water at 50 , 3 or 4 seconds 
 will usually be sufficient; at 6o° 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 skin during the hot 
 douche, 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 dusky-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 effect ; 
 but decided chilling 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 hydriatryis 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 finger 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 
 
Fig. 
 
 38. COMBINED RAIN DOUCHE, HORIZONTAL JET, 
 MULTIPLE CIRCLE DOUCHE (p. 473). 
 
 AND 
 
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, cerebral hyperemia, 
 chronic gastritis, chronic gastro-intestinal catarrh, chronic 
 congestion of the liver and spleen, acute and subacute ne- 
 phritis, 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- 
 
47° RATIONAL HYDROTHERAPY. 
 
 dynia, and the lightning pains of locomotor ataxia. In cases 
 in which the douche (fan) is used for the relief 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 ol 
 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 1 5 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. 47 1 
 
 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, repeating this as many times as necessary to produce 
 the effect desired. 
 
 3. Increasing the relative time of the hot application, or 
 lessening the time of the cold application, thus diminishing 
 the thermic effect. 
 
 Therapeutic Applications. — The alternate douche is to 1046 
 be employed in cases in which powerfully excitant effects are 
 desirable; that is, in cases of old exudations, enlargement of 
 the liver, the so-called ' ' liver of dyspeptics, " enlarged spleen y 
 and stiffened joints in which active inflammatory processes 
 have ceased. It may also be employed wherever increased 
 functional activity is desired, as in cases of atony of the 
 genito-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 inflammation of the nerve sheath, and in pleuritic 
 effusions and dropsical accumulations 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 rheumatism. The local alternate douche should be 
 systematically employed two or three times daily as a means 
 of preventing bed-sores in low fevers, to prevent sloughing 
 after prolonged exposure to the X-ray, in chilblains, in 
 
47 2 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 band 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 TECHNIQUE 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 upon 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 
 
4/4 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 are set up. At first, the respiratory move- 
 ments are almost suspended; the breathing is in quick, gasping 
 
THE TECHNIQUE OF HYDROTHERAPY. 475 
 
 eiforts, the heart is powerfully excited, the blood pressure is 
 raised, and all the phenomena 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 Schuller, 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 ioo° to 
 104 is applied for i to 3 minutes before the cold application. 
 
 The cool rain douche (75 to 65 ) is an excellent training 
 measure 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 hot rain douche is likewise powerfully KM 9 
 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, 100° to 1 12°. 
 
 The neutral rain douche (92 to 97 ) causes immediate 1050 
 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 (1130), but are much more quickly attained. 
 
476 RATIONAL HYDROTHERAPY. 
 
 The usual duration of the neutral shower bath is from 3 to 5 
 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 
 cold shower is practically a fixed procedure, and hence is not 
 adapted to feeble persons. The neutral 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 
 exceedingly 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-furnished private bath- 
 room is supplied with a fairly good rain douche apparatus. 
 The accompanying cut (Fig. 39) shows 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 anemic s 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 (6o° 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 
 chlorosis 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 
 1 or 2 minutes. This procedure is especially useful in phleg- 
 matic neurasthenics, sedentary persons in whom the general 
 metabolic activity is diminished, in obesity, and in all cases 
 
Fig. 40. HORIZONTAL RAIN DOUCHE OR SPRAY (p. 479). 
 
THE TECHNIQUE OF HYDROTHERAPY. 477 
 
 in which after a long sweating process a gradual and very 
 thorough 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 1 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. 
 
 1053 The neutral rain douche (93 to 96 ) is one of the most 
 effective measures which can be employed for the relief 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 posi- 
 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 
 
 THE HORIZONTAL RAIN DOUCHE OR SPRAY. 
 
 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 
 size of the perforations one millimeter (Fig. 41). 
 
 Method. — The horizontal rain douche or spray is ap- 
 plied in precisely the same manner as the horizontal jet, the 
 directions and observations relating to which need not be 
 repeated here. 
 
 Physiological Effects. — The spray douche produces effects 1056 
 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 in 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 1057 
 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. It is indicated in any case 
 in which the broken jet is applicable. The broken jet is most 
 conveniently employed in cases in which the fall 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 neuralgia with hyperesthesia of the overlying skin, swot- 
 
480 RATIONAL HYDROTHERAPY. 
 
 len, 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 (106 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. 
 
 1058 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 (6o° to 4 5°), 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 48 1 
 
 of great service in cases of hemorrhoids, constipation, and 
 uterine and rectal prolapse. 
 
 The short cold ascending douche is very useful in rectal 
 prolapse and anal insufficiency, also in flatulence due to con- 
 stipation. 
 
 The neutral 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 hot ascending douche is one of the most efficacious 
 remedies for the relief of pruritus ani and pruritus vulva. 
 When employed for this purpose, the temperature should 
 be as high as can be borne. 
 
 The alternate ascending douche is to be employed in cases 
 of vesical paresis, chronic hypertrophy of the prostate, and 
 exudates resulting from inflammation of the testicles or cord. 
 
 The revulsive (104-1) ascending douche may be used in 
 most affections of the genito-urinary organs and rectum, 
 accompanied by pain. 
 
 THE CALIPER DOUCHE. 
 
 This apparatus,* which was devised by the author, and is 1059 
 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 
 
 * Since the above was written, the author has learned that a similar device had 
 previously been made by a Chicago plumber, but so far as known, no practical use 
 was ever made of it. 
 
 31 
 
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, chro7iic 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 
 
 

 
 
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 ^i^i2L 
 
 "..? 
 
 ^BC 
 
 ^i^Hl t ^ 
 
 H&^ 
 
 Sv • : .'■:-' 
 
 
 - IB 
 
 Mt r-"« . ' ' / 
 
 I . 4 h^Bdt 
 
 V 1 
 
 Fig. 43. CALIPER DOUCHE (p. 481). 
 
 Fig. 44. CIRCLE DOUCHE (p. 432, 
 
THE TECHNIQUE OF HYDROTHERAPY. 483 
 
 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 without wetting the walls or 
 furniture of the room. It has the disadvantage, however, 
 that when utilized for general purposes, it produces too strong 
 reaction to the head, 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. 
 
 THE FAN DOUCHE. 
 
 This consists of a horizontal jet from a nozzle of such 1061 
 form that the water issues in a broad, thin stream (Fig. 45 j c 
 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. 
 
 Physiological Effects.— The weight of the thin blade of 1062 
 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 Applications. — The fan douche is generally 1063 
 employed in the same class of cases in which the rain douche 
 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 
 
484 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, painful joints, 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 Jiyperpepsia, 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 8o° to 90 (50 to 60 
 sees.) is useful in the treatment of irritable neurasthenics 
 who can ndt 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- 
 
Fig. 45. FAN DOUCHE (p. 483.), 
 
THE TECHNIQUE OF HYDROTHERAPY. 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. 
 
 THE FILIFORM DOUCHE. 
 
 This is a form of horizontal jet in which the water 1064 
 issues from an exceedingly small opening. It was devised 
 by de Laure. 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 1 to 10 minutes. 
 
 Physiological Effects. — The effects of the filiform douche 
 are those of strong counter-irritation, suggesting the effect of 
 mustard. It 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 little 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 hemicrania, diphtheritic 
 and hysterical 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. 
 
 *P. Bernard, Ann. de la Sociiti d* Hydrol., 1894, p. 147. 
 
486 RATIONAL HYDROTHERAPY. 
 
 THE FOG DOUCHE. 
 
 1065 This douche, known by the French as the douche oVeau 
 puherisee, 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. 
 
 THE 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 
 
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 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. 
 
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 
 
 such powerful 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 
 application 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 much 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 v/hich 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 hot 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 
 pressure, 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- 1069 
 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 part, 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 producing powerful derivative 
 effects. 
 
 LOCALIZED DOUCHES. 
 
 One of the most valuable uses of the douche (jet, spray, 1070 
 percussion, fan, filiform) 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 
 
49 2 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 — 
 
 i. 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. Prolonged cold applications without 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 applicatio7ts 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. 
 
Fig. 46. FOG DOUCHE (p. 486). 
 
 Fig. 47- MASSAGE DOUCHE (p. 486). 
 
THE TECHNIQUE OF HYDROTHERAPY. 493 
 
 THE CEPHALIC DOUCHE. 
 
 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 be 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 ioo° to 
 102 while 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 ears 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 1072 
 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 Applications. — The cold 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 (6o° 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 of 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 excitement, and cerebral irritation. The 
 temperature should be from 8o° 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. 
 
Fig. 48. CEPHALIC DOUCHE (p. 493). 
 
 K 
 
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. 49). 
 
 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. 
 
 Physiological 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 Applications. — The tepid douche calms excit- 
 ability of spinal origin, as in hysteria and spinal irritation, 
 hyperesthesia of the lumbar ganglia of the abdominal 
 sympathetic connected with irritation of the splancknics, 
 irritability of the bladder of spinal origin, and irritability 
 of the genito-urinary center ; and relieves incontinence in 
 children. 
 
 The cold dorsal douche should be employed in spinal ane- 
 mia, in functional locomotor ataxia, in motor insufficiency 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 DOUCHE (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 OF HYDROTHERAPY. 497 
 
 pelvic viscera or functions. It should be borne in mind that 
 a douche to this region, 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 retentio?i 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 SHOULDER 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 13 to 120 , 
 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 
 
49$ RATIONAL HYDROTHERAPY. 
 
 shoulders as well. The broken or the fan douche should be 
 employed. The full jet is likely 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 
 8o°, 6 to 10 lbs., 1 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°, 1 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 hypopepsia, apepsia, 
 gastroptosis, dilatation and atony of the stomach, and in gas- 
 tric flatulence. 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 (11 5 to 122 ) is equally 
 valuable in cases of hyperpepsia, gastrorrhea, so-called gas- 
 tric rheumatism, gastric crises, gastralgia, subacute gas- 
 
 
THE TECHNIQUE OF HYDROTHERAPY. 499 
 
 iritis, gastro-duodenitis , or gastric and duodenal catarrh, 
 infectious jaundice, and the distressing pain accompanying 
 chronic nicer 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 8o° 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 re- 
 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 1 2 5 ), and the cold application should be very cold and 
 very short, 50 to 6o°, for 6 to 12 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 HYPOGASTRIC 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 
 constipation, especially when it is due to dilatation of the 
 colon, and e7tteroptosis. 
 
 The cold abdominal douche is of service in atony of the 
 bladder, in enteroptosis due to relaxation of the abdominal 
 muscles, and in pelvic displacements due to atony, when not 
 accompanied by uterine or ovarian congestions. 
 
 y 
 
THE TECHNIQUE OF HYDROTHERAPY. 5OI 
 
 The warm or hot douche should be employed when pain 
 or irritability exists in the bladder, the uterus, the ovaries, 
 or other pelvic viscera. 
 
 The Scotch douche is most valuable for the relief of the 
 pain due to irritation of the splanchnic nerves or of the lum- 
 bar ganglia 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 results in chronic diar- 
 rhea, chronic dysentery, and enteralgia. 
 
 DOUCHE TO THE FEET. 
 
 In this application the broken jet or the spray is com- 1082 
 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 cold 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 Jiyperemia, nervous 
 asthma, palpitation of the heart of sympathetic origin, pul- 
 monary 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 douche, the headache which often follows the douche 
 (sometimes called the ''hydropathic headache") may gen- 
 erally be preventedo 
 
502 RATIONAL HYDROTHERAPY. 
 
 The cold spray douche prolonged until the skin is redv 
 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 the 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 neurasthenia, 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 vesiculae 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 utertcs 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 affections 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 
 paraplegia 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. 505 
 
 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 
 nicer and fissure, vaginismus, and spasm of the sphincter 
 muscle. 
 
 This application is contraindicated in cases of ovarian 
 neuralgia, cnteralgia, 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 of 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 differs 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, hepatic, splenic, renal, genito-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 proloiiged 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. 507 
 
 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. 
 
 THE 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 6o° 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 1 minute to the feet and spine, before the cold appli- 
 cation to these parts. 
 
 The tepid or neutral cerebrospinal douche is useful in cases 
 of spinal sclerosis, ge7ieral 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. 
 
 THE 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 hemorrhage may likewise be favorably influenced 
 by this procedure. That very cold applications to the hands 
 and feet, with strong pressure, are also capable of influencing 
 the pulmonary circulation to a marked degree, has been shown 
 by the experiments of Vasilieff. Winternitz 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 15 seconds to each part. The neutral 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 limited 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 cold 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 DOUCHE. 
 
 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 energize 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 very hot douche (11 5 to 122°) applied over the 1094 
 epigastrium and the spine opposite often gives relief in 
 
5IO 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, 
 gastroduodenitis, infectious jaundice, 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 
 enteralgia, 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. 5 I I 
 
 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 
 epigastrium. The fan douche or the broken jet at a low tem- 
 perature is employed for excitant effects. 
 
 To relieve congestion, 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 following 
 the hepatic douche, or by some other of the several means 
 elsewhere described. If considerable pain is present, the gen- 
 eral douche may be employed first, the local application fol- 
 lowing immediately. In cases of chronic enlargement of 
 the liver, the alternate douche should be employed. In 
 acute congestion of the liver accompanied by pain, the tepid 
 douche should be used. In cases of extreme pain, as in 
 gall-stones, infectious jaundice, and inflammation of the liver, 
 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 (Fig. 54). 
 
 By means of the fan douche or the broken jet an applica- 1097 
 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 effective 
 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. 
 
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 make 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 RENAL 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 congestion, which is frequently associated with chronic 
 alcaholism and malarial infectioji. It also serves a useful 
 purpose in diabetes and in some cases of Brighfs disease; 
 but when albumin is present in the urine, the Scotch douche 
 should be substituted for the cold application. 
 
 In painful affections of the kidneys, as in pain due to 
 movable 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 OF HYDROTHERAPY. 513 
 
 THE GENITOURINARY DOUCHE. 
 
 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-sacral 
 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 allowed to fall first upon 
 the feet, then upon the lumbar region, then upon the inside 
 of the thighs, and finally upon the breasts and hypogastrium. 
 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 cold 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 neitralgia, and, in men, neuralgia of 
 the testicles and spermatic cord, the very hot or the Scotch 
 douche may be employed with advantage. 
 
 THE ARTICULAR DOUCHE. 
 
 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 HYDROTHERAPY. 
 
 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 
 of the skin 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. 
 
 THE HUSCLE DOUCHE. 
 
 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 (1260). The douche 
 may accordingly be utilized with advantage in most affections 
 of the muscles. When inflammation 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. 5 I 5 
 
 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 
 hot 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 1102 
 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 nozzle. 
 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, lum- 
 bago, spinal neuralgia, and also in cases of painful joints, 
 muscular and articular 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 cold rain douche or a horizontal jet. 
 
 THE AFFUSION, PAIL DOUCHE, OR POURING BATH. 
 
 This bath (Fig. 58) resembles the douche in that the 1103 
 water falls upon the body in a stream. It at the same time 
 
5 l6 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 6o° to 105 or no°, 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 
 
Fig. 58. AFFUSION (p. 515). 
 
 Fig 59. LOCAL AFFUSION (p. 517) 
 
THE TECHNIQUE OF HYDROTHERAPY. 517 
 
 next is dashed 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 limbs 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 
 CO 2 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 neutral 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 5 19 
 
 sedative effects. The temperature should be yo° to 8o°. 
 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 bystanders, 
 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 affusion 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 
 
 1 Currie, "Medical Reports," page 64. 
 
THE TECHNIQUE OF HYDROTHERAPY. 52 1 
 
 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 C0 2 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 cr 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 of 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 ioo°, 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 6o°. 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. 
 
 1107 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. 
 
 THE COLD PLUNGE. 
 
 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 skin 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 1 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. 
 L109 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. 
 
 Therapeutic 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 consequence of its 
 percutient effects. It is a much more vigorous application 
 than the half bath, producing very powerful refrigerant 
 effects, with correspondingly strong thermic reaction 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, there 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 bath-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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 52/ 
 
 Such a tub can be made by a good carpenter in a few hours, 
 and if kept well painted inside, may be used for 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 needed. 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 1113 
 temperature as cold, neutral, hot, graduated, and alternate, 
 
 THE COOL OR COLD FULL BATH. 
 
 The temperature of this bath may be from 50 to 75 ; IH4. 
 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 
 
$28 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 (1 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. 
 1115 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. 
 
Fig. 62. IMMEFSION BATH TUB (p. 526). 
 
 
 
 
 ^t 
 
 • 
 
 ^^^^ * — ^— — ' j ■■ iwp|M|| 
 
 
 M W&n 
 
 
 
 f 
 
 i3^ (1 
 
 Hid* i ffifr 
 
 V .... 
 
 Fig. 63. IMPROVISED IMMERSION BATH (p. 526). 
 
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 all, 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 
 1 5 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 far Klin. Med. 
 
 \V Union M/dicale, 29, 1880, p. 722, 
 
 34 
 
530 RATIONAL HYDROTHERAPY. 
 
 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, 8 1 5 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 
 hypopepsia. For persons enjoying fairly good health, a dip 
 
 * Currie, "Medical Reports," 4th 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 maybe advantageously em- 1118 
 The Cold Full ployed as a measure of hygienic routine by 
 
 gieni^Measure. P ersons of fair] y 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 good effects 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 10 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-list, 
 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 effects 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 1119 
 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 
 
 * dime's " Medical Reports," 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 Barbadoes, 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 76 to 8o°. 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 found 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, where 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 JJ°, 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 ioo° 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 i° C. (i.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 yo° 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 
 
$38 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 indications are present which point to 
 the necessity for cold applications for general tonic effects, to 
 increase vital resistance, or to energize the lie art, 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 8o°. 
 
 1125 Therapeutic Applications. — The tepid bath was much 
 used by Hippocrates in the treatment of fever, and has 
 been in modern times extolled by Dujardin-Beaumetz and 
 Bouchard. 
 
THE TECHNIQUE OF HYDROTHERAPY. 539 
 
 Riess treated several hundred cases of typhoid fever with 
 the continuous 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 
 began to rise again soon after the patient was removed from the 
 bath. As soon as it reached 101 , 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 ioo° 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 1 5 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 ioo°, 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 (11 3 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 ioo° 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 useful 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 1 1 5 , sometimes 
 hotter; while Europeans living in Japan take it at 104 to 
 1 09. 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 begin- 
 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 i° 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 application; 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 the 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. 
 
 1128 Therapeutic Applications. — The hot immersion bath is 
 perhaps most useful as an eliminative or spoliative procedure. 
 The bath at 104 to 110 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 wrapped 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 110 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. 
 
Fig. 64 (a). JAPANESE BATH TUB 
 CONTAINING HEATING 
 OVEN (p. 54O. 
 
 Fig. 64 (b). JAPANESE BATH TUB 
 WITH EXTERNAL HEATING 
 CHAMBER (p. 541). 
 
 Fig. 65. BATHING AT LEUKERBAD, SWITZERLAND (p. 552). 
 
THE TECHNIQUE OF HYDROTHERAPY. 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 tem- 
 perature 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 101 to 105 ; duration half 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 em- 
 ployed in such a case, it should be of short duration, not 
 more than 3 or 4 minutes, at a temperature of 105 to no°, 
 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, re- 
 lieves 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 em- 
 ployed in chronic rheumatism 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 
 
54$ RATIONAL HYDROTHERAPY. 
 
 Laseque* 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 appli- 
 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 an efficient means of relieving renal congestion. The 
 temperature should be from 106 to no°; 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 no° 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 gall-stones 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 muscular 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&que, Arch. Gen. de Med., 1874, p. 132. 
 
THE TECHNIQUE OF HYDROTHERAPY. 547 
 
 has been inadvertently applied. It is well to remember that 
 heat is a perfect antidote for 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 typhoid 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 affusion, 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 wrapped 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 (ioo° 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 fric- 
 tion 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 myelitis; 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 bath 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 OF HYDROTHERAPY. 549 
 
 All mechanical effects should be avoided after as well as dur- 
 ing 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 15 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 or 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 (1336). 
 
 Physiological Effects — Kuhn, of Niederbronn,* first scien- 1131 
 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 physiclogical 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 role in hydriatic treatment. The reaction in this 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 adding jugs or bottles rilled 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 found still in use the system 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 1 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 paraplegia, 
 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 
 strength 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 
 
 *Currie'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 alcoJiol, opium, cocaine, and chloral habits, the sedative 
 effects of the neutral bath are 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, " Neurasthenie et Arthritisme, " 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 15 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 continued 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 vitality left to react to so heroic a measure. 
 When employed for this purpose, the temperature of the 
 bath at the beginning should be 98 , 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 
 10 minutes for infants, but should be repeated every two 
 hours, or whenever the temperature reaches ioo° 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 yo° or above 1 io° 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 104 . 
 
 Contraindications. — About the only contraindication for 1135 
 the neutral bath is the presence of some morbid condition to 
 which the application of water may be inappropriate or inju- 
 
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. 
 
 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- 
 
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 of 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 
 'ower 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 Therapeutic 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, pern- 
 phigus, burns, and. 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 
 
 Passavant, 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 ioo°, 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. 
 
$6o RATIONAL HYDROTHERAPY. 
 
 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 
 meningitis, 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. 561 
 
 results in other functional nervous disorders suggest its pos- 
 sible value in epilepsy. 
 
 Dauchez* reports complete relief from hysteria with ex- 
 tremely 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 neurasthenics, 
 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, notwithstand- 
 ing their comparative inaccessibility, and the powerful com- 
 petition 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 given (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 diseases, 
 especially in pemphigus and extensive burns. When the con- 
 tinuous 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 maceration of 
 the skin in water. 
 
 In employing the continuous bath, care should be taken 
 
 *Bull. Gen. d* Thtrap., 1884, p. 153. 
 36 
 
562 RATIONAL HYDROTHERAPY.' 
 
 to regulate the temperature with very great precision, an er- 
 ror of only two or three degrees may prevent the desired 
 effect. The continuous bath is certainly a hydriatic proced- 
 ure of great value, and one worthy of more attention than it 
 has received from the profession in this country. 
 
 THE EFFERVESCENT BATH. 
 
 1139 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 courtesy 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 hydrochloric 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: — 
 
 1. Chloride of sodium, 4 lbs. ; chloride of calcium, 8 lbs. ; 
 sodium bicarbonate, 1 / 2 lb.; to which is added commercial 
 hydrochloric acid (25 per cent.), */ 4 lb. 
 
THE TECHNIQUE OF HYDROTHERAPY. 563 
 
 2. Chloride of sodium, 8 lbs.; chloride of calcium, 12 
 lbs. ; sodium bicarbonate, 1 lb. ; commercial hydrochloric 
 acid, 1 y 2 lbs. 
 
 3. Chloride of sodium, 12 lbs.; chloride of calcium, 20 
 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 cutane- 
 ous 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. 
 
 Sodium carb. (sal-soda) 1% lbs. 
 
 Sodium bicarb % lb. 
 
 Calcium chloride 3 lbs. 
 
 Sodium chloride 2 lbs. 
 
 Sodium bisulphate 1 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 C0 2 . 
 
 The carbonic acid 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 C0 2 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 C0 2 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. 565 
 
 out the body; the skin is stimulated to increased activity, 
 thus lessening the labor of the kidneys. 
 
 Therapeutic Applications. — The increased activity of the 1143 
 surface circulation, through dilatation of the cutaneous blood- 
 vessels, produces a powerful derivative and revulsive effect 
 upon the viscera. In this respect the effervescent bath at a 
 neutral temperature accomplishes the same result as does the 
 very hot bath or the Scotch douche, and has the advantage 
 that the extreme temperature is avoided, a matter of great im- 
 portance in cases of cardiac weakness with dilatatio?i, and in 
 chronic nephritis, since in both these cases very hot and very 
 cold baths must be avoided. In weakness of the heart, hot 
 baths are contraindicated because of the harmful excitation 
 first produced and the secondary depressing effect. Cold 
 baths are equally damaging because of the increased labor 
 brought upon the heart by the contraction of the cutaneous 
 vessels before reaction appears. In cases of renal disease, 
 the diseased organs are likely to suffer serious injury from the 
 temporary congestion resulting from the contraction of the 
 surface vessels. 
 
 An ordinary water bath at a neutral temperature is inca- 
 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 instance 
 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 size 
 during 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. 6y } 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. 
 1144 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 
 
 * Blatter Klin. Woch., 1880, 17, 35, 7-9, 372, 4. Medical Record, March 11 
 1899, p. 345. 
 
A- IN 
 Fig. 67. Outline of Dilated Heart, (a) before Treatment: 
 
 (A') after Treatment (p. 566). 
 
 7 IN 
 
 Fig. 68. Outline of Dilated Heart (A) before and (A') after 
 Effervescent Bath (p. 566). 
 
 Fig. 69. 
 
 Outline of Dilated Heart (A) before and (B) after 
 Effervescent Bath (p. 566). 
 
THE TECHNIQUE OF HYDROTHERAPY. 56^ 
 
 patient should not take more than three baths in succession 
 without a day's interval. 
 
 At the beginning and before the patient's susceptibility 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 95 °). 
 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 tern- 1145 
 perature of the water employed should be from 6o° 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 6o° for 15 1146 
 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. 
 
 SEA BATHS. 
 
 The sea bath is a measure of great value from both a 1147 
 hygienic and a therapeutic standpoint. Under this head we 
 may consider the swimming bath, 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 
 
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 
 fifteen 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 15 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 lies 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 
 generally 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 50 are poured upon his head and 
 allowed to run down the back of his neck. He then lies 
 
57° RATIONAL HYDROTHERAPY. 
 
 down again, and the rubbing is repeated. At the end of five 
 minutes the affusion to the head is repeated, and the rubbing 
 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 tjie 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 10 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 rubbed. Reaction soon takes place, 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 
 
f 
 
 Fig. 70. SURGE BATH (p. 567)- 
 
 Fig. 71. BRAND BATH (p. 569)- 
 
THE TECHNIQUE OF HYDROTHERAPY. 57 1 
 
 cases. In typhoid 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, 1151 
 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 increased. 
 
 4. Activity of the kidneys, liver, and skin is increased. 
 
57 2 RATIONAL HYDROTHERAPY. 
 
 5. The amount of oxygen received and C0 2 exhaled 
 during 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 energized. 
 
 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. 
 
 (b) 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 Application. — 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 ty- 
 phoid fever and most other continued fevers may be briefly 
 stated as follows : — 
 
 1. To sustain 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. 
 
 1 1 . 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. 
 
 1. 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 l'Organisme." But a modern 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 in- 
 ward from the skin ; it relieves the congested brain of surplus 
 blood by the powerful fluxion induced, cleansing it from the 
 accumulated poisons by increased movement of fluid in the 
 lymphatics 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 575 
 
 disappearance of fetor in the breath. The bodily forces, thus 
 encouraged, are enabled to maintain the battle against the 
 invading parasites until their life period has run out, or the 
 body, by physiological 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 shown 
 
 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 11 50 
 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 
 
576 RATIONAL HYDROTHERAPY. 
 
 to the perfectly soluble form necessary for elimination, they 
 accumulate in the blood. The retained excretions and accu- 
 mulated specific poisons, as has been shown by Robin, some- 
 times augment the amount of extractives from four to twelve 
 per cent., or over three times the normal amount. In ordi- 
 nary cases of fever these substances have been shown to 
 increase more than fifty per cent. The increased oxidation 
 produced by the cold bath renders these substances soluble, 
 and thus facilitates .their elimination, while the increased 
 movement of blood brings them in contact with the organs 
 capable of further changing or removing them. That the 
 increased amount of oxygen introduced by the deeper respira- 
 tion resulting from the cold bath is utilized, is shown by the 
 fact that the respiratory quotient remains the same; that is, 
 while the amount of oxygen absorbed is three times the usual 
 quantity, the amount of C0 2 eliminated is proportionate to 
 the oxygen absorbed. 
 1157 5. The liver plays an exceedingly important role in fever 
 
 cases. It is the organ upon which, more than upon any other, 
 perhaps, depends the life of the fever patient. The liver is a 
 sentinel standing at the door of the circulation. The toxins 
 which enter the portal vein from the alimentary canal, as 
 well as those which are in circulation in the blood, when 
 brought to the liver, are held back and destroyed by it to such 
 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 hepatic 
 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 paralyz- 
 ing poisons, and local pathological processes not infrequently 
 result, as shown by the enlargement so frequent in febrile 
 
THE TECHNIQUE OF HYDROTHERAPY. 577 
 
 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 
 asa " 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 
 
5^8 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. 
 
 1159 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 KHnische Wochenschrift, 1891, page 505. 
 
THE TECHNIQUE OF HYDROTHERAPY. ^79 
 
 present in grave febrile conditions is not due alone to the 
 depressing influence of the toxins upon the cardiac centers 
 and the interference with the nutrition of the muscular struc- 
 tures of the body, but is largely, perhaps chiefly, due, as 
 shown by Romberg,* to the loss of tone in the peripheral 
 vessels and the weakening of the vasomotor centers of the 
 medulla. This is indicated by the cyanotic appearance of the 
 face, the blue lips and nails, and the general turgid appear- 
 ance of the skin. 
 
 The condition of the blood stream under these conditions 
 may be compared to that of a stream of water leaving the 
 hose of a fire-engine from which the nozzle has been removed. 
 The machinery itself may be in no way interfered with, but 
 owing to the removal of the resistance against which it has 
 been working, and which acts as a means of regulating its 
 action, the pump ''runs away," as the engineer says. The 
 wear and tear to the engine is tremendous, but its cylinders 
 do not fill with water, and the lessened quantity of water 
 pumped is raised only a few feet, and runs away with little 
 force to low levels where there is no resistance. 
 
 The same thing 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. Woch., 1 895. 
 
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 
 
 * u Kongress filr innere Medicin," Weisbaden, 1896, pp. 256, 266. 
 
THE TECHNIQUE OF HYDROTHERAPY. 58 1 
 
 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 body, 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 the improved conditions under which 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 1162 
 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- 
 
582 RATIONAL HYDROTHERAPY. 
 
 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 of 
 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. 
 1163 11. 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 circu- 
 lating in the blood of a healthy person is about 3, 100 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? Antipyrine and antipyretics of all sorts diminish the 
 
 * Johns Hopkins Hospital Bulletin, Bait., 1893, IV, 37-40. 
 
THE TECHNIQUE OF HYDROTHERAPY. 583 
 
 blood count instead of increasing it, and thus greatly lessen 
 the oxidizing power of the blood. 
 
 12. Liebermeister * has shown that heat production is 1161 
 increased in fever, while Winternitz has demonstrated that 
 heat elimination is decreased, at least in many cases. It is 
 apparent that the greatest degree of elevation of tempera- 
 ture 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 disorders serves a most useful 
 purpose in establishing immunity, 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 Maurel,t according to which 
 the white blood-corpuscles are destroyed at a temperature of 
 109 to iii° 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 patient's axillary temperature 
 reaches io5°to 106 , his life is in imminent danger. The low- 
 ering of the body temperature one or two 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 failure, and of 
 
 * Liebermeister, Deutsch. Arch., 1868, v. V, p. 2 1 7. 
 f La Semaine Medicate. 
 
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, 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 them 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 
 1 per cent. The mortality in a series of 5,000 cases, 
 
586 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 with 
 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- 
 
 The Question ve rsal custom to administer alcohol to the 
 of Alcohol . . . . ..... t . 
 
 with the Cold patient just before putting him in the cold 
 
 Bath. bath. Some practitioners, as Winternitz, 
 
 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. 
 
 I Thomas, Journal of the American Medical Association, 1896, p. 1332. 
 
THE TECHNIQUE OF 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 recognized as authori- 
 ties throughout the civilized world: — 
 
 Harnack says: ' ' It should also never be forgotten, that, even 
 in small doses, the paralyzing action of alcohol is exercised 
 most rapidly and energetically upon the tonus of the blood- 
 vessels — the importance of which tonus for the regularity of 
 the circulation and the cardiac eiiergy is well known." 
 
 Victor Horsley, an eminent English surgeon, speaks thus 
 respecting the influence of alcohol upon the heart: "Surgeons 
 of former days used alcohol extensively to combat shock, but 
 the old theories of shock have been proved erroneous, and alco- 
 hol has conseque?itly become unnecessary. It will be less a?td 
 less used in tJie future, and the discredit into which it has 
 fallen is justified. ' ' 
 
 Hermann Frye, by the use of Mosso's ergograph, showed 
 that ' ' in the unfatigued muscle, 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- 
 
 *Bouchard's " Traite de Medecine. 1 
 
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. Coffee, 
 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 shov/n 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 
 clearly 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. 
 1 1 ? 1 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 tinphilosoph- 
 ical, 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. 59 1 
 
 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 better 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 
 
592 RATIONAL HYDROTHERAPY. 
 
 effects from cold applications of water may generally be 
 avoided; but it must be considered that if the desired results 
 can be obtained by the employment of less violent measures, 
 they are certainly to be preferred. 
 
 1172 In this connection it should be mentioned that Jacques, of 
 France, reported, in 1839, 313 typhoid fever cases, with only 
 four deaths, treated by means of the cold enema, cold water 
 drinking, and the cold abdominal compress changed every 10 
 to 30 minutes, while 349 cases treated at the same period 
 by ordinary methods gave a mortality of 91 deaths,* a statis- 
 tical showing which is scarcely outdone by the most favorable 
 results reported for the Brand treatment. 
 
 Scientific therapeutics gives no countenance to routine 
 methods in the treatment of any malady, whether by the use 
 of water or medicinal agents, and the author feels certain that 
 a better acquaintance with the versatile resources of hydro- 
 therapy will lead many practitioners who have regarded cold 
 baths as almost the sole method to be employed in the treat- 
 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, "Lecons siir la Chaleur Animate,'' Paris, 1876, 
 
THE TECHNIQUE 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 6o°, and the com- 
 press should be changed about once in 40 to 60 minutes. 
 
 6. When the maximum daily temperature begins to 
 decline, the temperature of the bath should be raised to 
 84 to 88°. 
 
 7. 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 101.5 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 pro- 
 found intoxication may be interrupted with advantage by the 
 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 RATIONAL HYDROTHERAPY. 
 
 The Brand bath is likewise contraindicated in the eruptive 
 fevers, as smallpox and measles. In the author's opinion its 
 use is unwise in pneumonia, and in other disorders in which 
 intense inflammation is present in an important internal 
 organ, as in acute hepatitis, salpingitis, ovaritis, menin- 
 gitis, acute gastritis, enteritis, and especially in the various 
 forms of nephritis, 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 four 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 6o°, — 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 down in 
 the bath, so that the whole body except the head is sub- 
 merged for 5 to 10 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 
 1 to 3 minutes. For the reduction of temperature in febrile 
 cases, the temperature should be 85 to 70 , and the dura- 
 tion 6 to 15 minutes. 
 
 Care must be taken to adjust the temperature of the bath 
 
THE TECHNIQUE OF HYDROTHERAPY. 595 
 
 exactly right, for when the temperature is too high, the skin 
 is left in an anemic, pale, and relaxed condition. If 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 prolonged appli- 
 cation. 
 
 The depth of the water in the shallow bath 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 half-bath. The points in 
 which the shallow bath differs from the half-bath are chiefly, 
 (a) the longer continuance of the latter; (b) the rubbing may 
 be dispensed with unless the temperature is low; (c) 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 6o°, 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 disposition to chill, and by the aid of rubbing he is ren- 
 dered so comfortable that 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 applying the water to various parts by means 
 
$96 RATIONAL HYDROTHERAPY. 
 
 of a long towel folded lengthwise and dipped in water, one 
 end being grasped by each hand, whereby the towel may be 
 drawn back and forth in a sawing motion across the back and 
 other portions of the trunk. It may be used in this manner 
 daily as a hygienic measure with great benefit. 
 
 The standing shallow (Fig. 73) is a modification of the 
 bath in which the patient stands in a tub containing water at 
 75 to 8o°. The patient is rubbed by two attendants, one 
 on each side. The water is poured over his spine, chest, and 
 shoulders, at intervals of 1 5 or 20 seconds. In rubbing the 
 legs, the attendant's hands are constantly dipped in the water, 
 and very vigorous friction is applied, duration 1 to 3 minutes. 
 
 At the conclusion of the bath, a pailful of cold water (6o° 
 to 55 ) is poured over the patient, thus insuring good reac- 
 tion. He is then quickly dried and vigorously rubbed, after 
 which he should engage in moderate exercise until good 
 reaction is secured. 
 
 The standing shallow is a sort of transition from the drip- 
 ping sheet to the douche. The best time for giving it is in 
 the morning as the patient comes warm from the bed, unless 
 it be preceded by a hot bath. It is necessary that it should 
 be applied when the skin is well heated. 
 1175 Physiological Effects — The term "half-bath," devised by 
 Priessnitz, is really a misnomer, as in this procedure the 
 application involves the whole surface of the body. It com- 
 bines the effects of the rubbing wet sheet, the affusion, and 
 the immersion bath, producing powerfully alterative and tonic 
 effects by reason of the repeated and ever-varying thermic 
 and mechanical impressions made upon the skin. 
 
 The cold shallow bath stands next to the douche in power 
 and efficiency as a tonic hydriatic procedure. That the 
 shallow powerfully stimulates metabolism was clearly shown 
 by the experiments of Pospischil, who found the flow of 
 respiratory air to be increased nearly 300 per cent, during the 
 bath, while the respiratory quotient remained the same; viz., 
 67. The favorable influence of this bath upon the general 
 
Fig. 72 (a). SHALLOW BATH — First Step (p. 594). 
 
 ...■ 
 
 
 Fig. 72 (b). SHALLOW BATH — Second Step (p. 594)- 
 
THE TECHNIQUE OF HYDROTHERAPY. 597 
 
 condition 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 8o° to 85 , the shallow or 
 half-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 Applications — The shallow bath is one of the 1176 
 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 
 himself, together constitute a powerful combination of potent 
 factors for dilating the surface vessels, and thus antagonizing 
 the anemia of the skin present in the vast majority of chronic 
 diseases and in most infectious fevers as a result of the toxic 
 influence 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 6o°. The 
 application should be short (1 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 organic 
 affections of the spine, as chronic myelitis, meningitis with 
 exudate, and ataxia with paralysis but without marked pain. 
 The temperature of the application in such cases should be 
 70 to 8o° and the duration 6 to 10 minutes. 
 
 The shallow bath may be used not only as a principal pro- 
 
59$ 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 not 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 
 yo° 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, 
 chronic 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 
 
 of constipation in which the disorder is the result of deficient 
 intestinal secretion. This effect must of course be encour- 
 aged by the copious drinking of cool or cold water at the 
 proper hours (1426). 
 
 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 of 
 preventing threatened chill in intermittent malarial fever. 
 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 with bags or bottles filled with hot water or other 
 means of heating, and kept in bed until two hours after the 
 time of the expected chill has passed. 
 
 The hot half -bath produces powerful revulsive and anal- 1177 
 gesic effects in relieving pain. The shallow bath is seldom 
 employed except for cold applications, but the hot shallow 
 bath may be used in place of the hot sitz for the relief 
 of pelvic pain, also for the relief of sciatic and crural neu- 
 ralgia, and in some cases of rheumatic 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 flexed, as in the sitz bath, 
 and pressure upon great nerve trunks is avoided. 
 
 Contraindications. — The shallow bath is contraindicated 1178 
 in cases of chronic congestion of the heart, brain, or spinal 
 cord. With great care it may be used in pneumonia and 
 pleurisy, but it is not needed in these disorders, and may better 
 be avoided. Its use is contraindicated in fever cases compli- 
 
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 
 vienorrhagia 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- 
 gitis, prostatitis, ovaritis, and salpi7igitis, 
 
 THE WET-SHEET PACK. 
 
 1179 This extremely useful and widely applicable hydriatic 
 
 procedure, generally accredited to Priessnitz, 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 6o° 
 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. 601 
 
 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). 
 
 40 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. 77). 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. 8i) u 
 
602 RATIONAL HYDROTHERAPY. 
 
 9. 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 cooling, 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, but should be included 
 in the blanket, to avoid chilling. 
 
 Care should 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, 1 893, p. 164. 
 
vK 
 
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. 
 
 Winternitz 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 
 be increased from three to five minutes at each successive 
 renewal. The sheet need be changed only when it is shown 
 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 
 hydriatic 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. This 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. 
 
 The head should be thoroughly cooled by wetting the 
 
 scalp, face, and neck with cold water before the patient goes 
 
 into the pack, and a towel, or better, a cheese-cloth napkin, 
 
 -saturated with cold water should be placed upon the face and 
 
 * Rendu, Journal de Med. et de Chirurgie Pratiques ', 1 893, p. 209. 
 
604 RATIONAL HYDROTHERAPY. 
 
 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 10 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 TECHNIQUE OF HYDROTHERAPY. 605 
 
 physiological sleep. Later, as the heat thrown off by the 
 skin, which is greatly increased in amount by the dilatation 
 of the surface vessels, warms 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 will 
 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 characterized as follows : (i) Cooling or antipyretic, 
 (2) neutral, (3) heating, (4) sweating. These several periods 
 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 size 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 
 elevate the temperature of the entire body of a patient weigh- 
 ing 1 50 pounds three degrees, if this heat should be all 
 retained. The greater part of this thermic energy is ex- 
 
606 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 suffi- 
 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 no mechanical aids to dilatation of the 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 neutral, stage of the pack begins when the 1182 
 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 superheating, 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 ioo° to 102 . 
 
 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 fourth stage, that of excitation, or the sweating 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- 
 
608 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 TECHNIQUE OF HYDROTHERAPY. 609 
 
 The fourth, or sweating, stage may be prolonged almost 
 indefinitely by making the patient drink every half hour a 
 glassful of water, either hot or cold, or some suitable beverage 
 prepared with water and fruit-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 tonic 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 tonic pack is indicated in all forms of wasting disease, 
 as in anemia, tuberculosis, convalescence from fever, and 
 chronic toxemia connected with dyspepsia, as well as in 
 chronic disorders of the liver, and especially in the toxemia 
 of chronic malarial 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 ane7nia, chlo- 
 rosis, diabetes, nervous dyspepsia, neurasthenia, scurvy, 
 chronic gastritis, hypopepsia, constipation, and general 
 paresis. The tonic pack also renders most valuable service 
 in the intervals of intermittent and relapsing fever. 
 39 
 
SlO RATIONAL HYDROTHERAPY. 
 
 1185 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 insomnia, 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. 
 
 Schiiller'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 typhus fevers, and in 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 slumber from which he awoke refreshed and quiet. 
 
 The neutral pack is of almost equal service in the treat- 
 ment of epilepsy, chorea, and tetany. 
 
 1186 The heating 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 cerebral 
 
THE TECHNIQUE OF HYDROTHERAPY. 6 1 1 
 
 congestion, hepatic and splenic congestions from chronic 
 malarial infection, constipation accompanied by hemorrhoids, 
 abdominal dropsy, and as a means of developing the erup- 
 tion in eruptive fevers. For the last-named purpose this 
 procedure is unexcelled, producing powerful cutaneous stimu- 
 lation. 
 
 The pack is also of especial service in the early stage of 
 eruptive 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 developing 
 the eruption. Hence its value in measles, scarlet fever, and 
 smallpox. 
 
 The sweating pack, or fourth stage of the process, is a W.^% 
 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 after 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 conditions. 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 heating the skin, 
 the wet-sheet pack, continued until the skin becomes well 
 warmed, or until very gentle perspiration shows upon the 
 
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 and liver, and in 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 TECHNIQUE OF HYDROTHERAPY. 613 
 
 patients suffering from chronic indigestion have but little 
 recuperative power and small 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 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 608). 
 
 Contraindications and Precautions. — The cold wet-sheet 1188 
 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 exanthemata after 
 the eruption occurs, 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 (v*o 5 min., at 104 to 110 F.), the elec- 
 tric-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. 
 
6 14 RATIONAL HYDROTHERAPY. 
 
 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 flannel 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 lungs 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 
 
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THE TECHNIQUE OF HYDROTHERAPY. 6l$ 
 
 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 of the coverings so that he shall not be over- 
 heated, and also on the other hand equal care must be 
 observed against chill. It is generally necessary to cover the 
 legs and the 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 effect 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 COOLING PACK. 
 
 If it is desired to employ the pack as an antipyretic, it 1189 
 should be applied in the ordinary way (page 608), 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 6o° 
 to /0° should be employed. There is no advantage in using 
 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- 
 
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 6o° 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 ', erysipelas, febricula, dengue, malarial fevers, yellow 
 fever, the plague, acute bronchitis, and influenza. 
 
 THE COLD SHOWER PACK. 
 
 1190 When antipyretic effects are desired, instead of removing 
 
 -the sheet from the patient for rewetting, the same results 
 
 may be accomplished, though not quite so rapidly, by open- 
 
THE TECHNIQUE OF HYDROTHERAPY. 617 
 
 ing the 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 
 rubber 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. 84). Water may 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 6o° to 65 F. If the patient does not 
 well tolerate very cold water, a temperature of yo° to 8o°, 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 antithermic 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 
 out for the Brand bath. 
 
 THE SWEATING PACK. 
 
 When it is desired to produce powerful eliminative effects 1191 
 by means of the wet-sheet pack, the application may be made 
 in the manner already described (1179), with the exception 
 that more covers are employed, to encourage reaction, and it 
 is generally wise to place hot bags at the patient's feet and 
 sides. He should take a glassful of hot water before the 
 
6l8 RATIONAL HYDROTHERAPY. 
 
 pack, and two or three glasses while in the pack. In cases 
 in which perspiration is not easily induced, the pack may be 
 preceded by a hot bath for 3 or 4 minutes. The temperature 
 of the bath should be from 105 to no°. The patient's skin 
 should be so well heated that he will anticipate the contact 
 of the cold sheet with pleasure. There should not be the 
 slightest delay between the hot bath and the cold sheet. 
 The hot-blanket pack may be used in case of the hot bath 
 when the latter is not convenient. 
 
 When it is desirable to prolong the perspiration, the 
 patient may be removed from the wet-sheet pack after the 
 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. Rubbing 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, Bell's palsy, acute and chronic myelitis, lepto- 
 meningitis, epilepsy, neuralgia, migraine, teta7iy, 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, 
 
THE TECHNIQUE OF HYDROTHERAPY. 619 
 
 cold wet friction may be employed safely, even when more 
 vigorous measures are contraindicated. 
 
 Contraindications. — The sweating pack must be avoided 
 in eruptive disorders, in the exanthemata af^er the eruption 
 appears, in advanced cases of cardiac or Brighfs disease, 
 in anemia, feeble neurasthenics, diabetics with emaciation, 
 rheumatic gout, general cutaneous hyperesthesia, and in febrile 
 states in which accumulation of bodily heat is decidedly con- 
 traindicated. 
 
 THE DRY PACK. 
 
 In this application the patient is completely enveloped in 1192 
 dry blankets, the head only being excluded, the purpose 
 being to lessen heat elimination, and thus produce an accu- 
 mulation of bodily heat, and in some cases to induce per- 
 spiration. 
 
 Requisites. — A bed or couch with a comfortable mattress, 
 a number of dry woolen blankets, bottles or rubber bags for 
 hot water, hot sand bags, or other convenient means of 
 applying dry heat to the body. 
 
 riethod. — The pillow and several woolen blankets are 
 arranged upon the bed or couch, as directed for the wet-sheet 
 pack. The patient, divested of his clothing, lies down, and 
 the blankets are quickly applied as directed for the wet-sheet 
 pack, care being taken to tuck the edges in well about the 
 head and feet, so as to avoid the circulation of air. If the 
 patient is very feeble, very cold, or deficient in ability to 
 generate heat, several hot-water bottles or bags may be placed 
 at the feet and sides next to the first blanket, beneath the 
 other coverings. The patient should drink one or two glasses 
 of water before entering the pack, and while in the pack 
 half a glass of hot or cold water should be swallowed every 
 15 or 20 minutes. The temperature 01 the room should be 
 not less than 70 . If simply an accumulation of heat is de- 
 sired, the patient should be removed from the pack before per- 
 spiration begins. If diaphoresis is sought, the application may 
 be continued for two to five hours, or as long as necessary. 
 
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 pack 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- 
 pler introduced the methodical use of the sand bath in 1831. 
 It is still employed in Germany. The temperature of the 
 sand is from 11 8° to 122 F. 
 
 1193 Physiological Effects. — The effect of the dry pack is first 
 to secure an accumulation of heat by lessening the heat 
 elimination, and in extreme cases to augment 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 hemorrhage, 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 621 
 
 In cases of paralysis, applications of the dry pack, some- 
 times general, but more frequently local, as in paraplegia 
 and hemiplegia, may be used to great advantage. 
 
 In the absence of better means, the dry pack may be 
 used as a preparation for the cold douche and other cold pro- 
 cedures. Care must be taken, however, to make the cold 
 application instantly on the removal of the patient from the 
 pack; otherwise a slight chill will be produced, and the 
 effect will be spoiled. The dry pack may also be used with 
 advantage for li breaking up a cold," for which purpose it is 
 often very successful when applied within a few hours after 
 the exposure. In cases of collapse, arteritis, or phlebitis in 
 typhoid, in septicemia, malarial and typho-malarial fever, 
 malarial neuralgia and in obesity, the dry pack is useful. 
 
 In chronic rheumatism, when the patient is not able to 
 secure the advantages of the hot-air, vapor, Turkish, electric- 
 light, or hot immersion baths, the dry pack may be employed 
 with advantage. It may also be used in chronic rheumatism 
 for continuing the effect of the hot bath, the patient being 
 immediately after 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- 
 moting reaction after a cold bath in feeble patients. 
 
 Contraindications and Precautions. — i. In the application 1195 
 of the dry pack, the fact that heat elimination is diminished 
 should be 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 relief 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. 
 
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 heart, 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 HOT-BLANKET PACK. 
 
 The hot-blanket pack (Fig. 86) consists in 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. 
 
 Requisites. — 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 overlapping 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 wringing out blankets is 
 shown in Fig. 87. 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- 1198 
 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- 
 
 pecially 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 Bright' s disease, in the albuminuria of pregnancy, in 
 eclampsia, in convulsions of children with pallor, to induce 
 perspiration in subacute rheumatism, in chronic toxemia, in 
 infectious jaundice, in nephritis complicating typhoid, scarla- 
 tina, yellow fever, measles, and other infectious fevers, in 
 influenza, malarial and uremic coma, malarial hematuria, 
 septicemia, muscular rheumatism, dengue, 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 
 
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 in 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 EVAPORATING 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 
 4Q 
 
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. 
 
 Physiological Effects. — The evaporation of one pound of 
 water will absorb about one thousand heat units, which for 
 a patient weighing 160 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 afebrile 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 (1 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 HYDROTHERAPY, 627 
 
 excessive activity of the surface circulation, with abnormal 
 heat and no tendency to chill. Slow cooling of the skin 
 by evaporation causes a contraction of the surface vessels 
 which is not followed by reaction, and which is accordingly 
 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 RUBBING. 
 
 This procedure ( Fig. 90) consists simply in rubbing the 1201 
 cutaneous surface with the wet hand. 
 
 fieihod.— Water at 40 to 75 , with plenty of Turkish 
 towels, a Turkish sheet, and a woolen blanket, are the only 
 requisites 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 is made from the median line outward, 
 the tips of the fingers sweeping over the brow and describing 
 a sort of semicircle 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 wet 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. 91). 
 
 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 
 
628 RATIONAL HYDROTHERAPY. 
 
 towel is thrown over the chest and the surface dried quickly, 
 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 lungs 
 to increased activity, thereby promoting reaction. 
 
 The arms, first one, then the other, next receive attention. 
 The attendant grasps the patient's hand with his left hand, 
 while with the right he vigorously rubs the arm with long 
 rapid strokes reaching from the shoulders to the wrist, his 
 hand being kept cold and moistened by dipping in the basin 
 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 the 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 
 
Fig. 93. SPONGE BATH (p. 634). 
 
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 as 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 
 rubbed, and the sole percussed with energy, but not rubbed, 
 on account of the unpleasant tickling sensation induced. 
 
 Not more than 5 to 1 5 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. 
 
63O 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 lowering of blood pressure, when 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 TECHNIQUE OF HYDROTHERAPY. 63 1 
 
 in febrile cases where the patient is too feeble to endure the 
 application of the cold bath or the cooling 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 intes- 
 tinal perforation, myocarditis, nephritis, collapse, and other 
 complications. 
 
 Wet-hand rubbing with water at a temperature of 85 to 
 95 is a quieting measure of value in feverishness due to nerv- 
 ous excitability 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 stimulation 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 very 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 application should be made at first at 
 a temperature of jo° or even 8o°, 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 chilblains 
 (40° to 5o c ). 
 
 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 iEgina, A. D. 660 
 (Winternitz). 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 types of eruptive dis - 
 eases of the skin. 
 
 THE SPONGE, ABLUTION, OR TOWEL BATH. 
 
 1204 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. 
 
 flethod — The foot-bath tub should contain water at a 
 temperature of 104 to no°. 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 saturated sponge or towel. The attendant 
 then applies the saturated sponge (6o° 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. 635 
 
 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 is made when the patient is 
 reclining in essentially the same manner 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 sponging with a well-wrung 
 sponge may be sufficient. The patient having been un- 
 dressed and covered in 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 5 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 6o° 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 (50 
 to 35°), and the 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. 
 
 reduction of temperature 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 Physiological 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 
 almost any circumstances demanding the employment of 
 water as a therapeutic means. 
 
 The cold ablution or sponge bath is highly advantageous 
 in all cases in which the skin is anemic, as in chlorosis, myxe- 
 dema, anemia, cases of cardiac and renal dropsy, and in all 
 cases to which cold friction and cold towel rubbing are appli- 
 cable. Skilfully applied, 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 continued 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 6o°). 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- 
 tion, 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 nosebleeding by sponging the 
 
THE TECHNIQUE OF HYDROTHERAPY. 639 
 
 face with very hot water. When used for hemostatic effects, 
 very high temperatures must be employed, — from 140 
 upwards. 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 
 taken 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 in 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 devitalized and degen- 
 erated tissues upon the pyogenic surface, and a powerful 
 stimulation of the circulation and the nerves of the part. 
 
 The tepid sponge bath is a very grateful application in 
 feverish conditions, especially in cases in which the tempera- 
 ture is not sufficiently 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 likely 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 neutral sponge bath at a temperature of 90 to 98 
 is a quieting, sedative measure of great service in nervous 
 states accompanied by feverishness without elevation of tem- 
 perature. It is also useful in mild febricula, and in fevers in 
 which the temperature is only slightly above normal, and 
 in which the skin is flushed and dry. 
 
 Alternate sponging of the spine is a powerful excitant 
 of the cardiac and respiratory centers, and may be employed 
 with wonderful advantage in cases of opium poisoning, 
 asphyxia from coal gas, and in cases of toxemia, in which 
 the heart's action is greatly weakened. This application 
 
64O RATIONAL HYDROTHERAPY. 
 
 is also valuable for its remarkable tonic effects upon the 
 central nervous system; for the relief of headache and the 
 pains at the back of the head and neck of which neuras- 
 thenics often complain, there is no better palliative than hot 
 and cold sponging to the cervical and dorsal spine. When 
 used for such excitant and revulsive effects, 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 cold water is an 
 exceedingly valuable measure for sprains and bruises. The 
 water employed should be either very hot or very cold, or 
 revulsive hot and cold applications may be made (130 , 2 
 min. ; 6o°, 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 being 
 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. 
 1207 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 GLOW. 
 
 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 HYDROTHERAPY. 
 
 Physiological 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 a tonic 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 Brighfs 
 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. 643 
 
 another being taken in systematic order until the whole cuta- 
 neous surface has been brought 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. 97) consisting of rough material of 
 some sort, — ordinary rough linen 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 of 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. 
 
 flethod. — 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. It 
 may be employed in cases in which the shock of a cold appli- 
 cation to the whole surface 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 pro- 
 ducing undesirable effects, while improving the heart tone 
 and increasing general vital resistance. 
 
 In cases in which cold is positively contraindicated, 
 hyperemia of the skin may be induced by hot mitten friction, 
 using water at as high a temperature as possible. 
 
 With patients who have good reaction and who have had 
 proper preliminary training, the ice-rub may be employed 
 often to excellent advantage. Care must be taken that the 
 skin is warm. A piece of ice is grasped in the hand, and is 
 applied in essentially the same manner as the friction mitt. 
 The ice should be passed over the general surface very 
 rapidly, pausing slightly over the heart and points at which 
 the large vessels approach the surface, making circular move- 
 ments over the liver, spleen, bowels, and other viscera. 
 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 HYDROTHERAPY. 645 
 
 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 powerful, 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 simultaneously 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 sitz, 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 1211 
 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 HYDROTHERAPY. 
 
 cations; hence it is invaluable in neurasthenia, and especially 
 with very feeble neurasthenics who are either too weak to 
 receive the douche or too exhausted to react to this powerful 
 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 prolonged cold baths. When the skin is very 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 aged persons, children, 
 and diabetics, and in this disease when complicated by ataxic 
 and adynamic conditions ; in dicrotic pulse, stupor, subnor- 
 mal temperature, pregnancy, puerperal fever, also in chronic 
 dysentery, malarial fever, coma from any cause, whooping- 
 cough, yellow fever, plague, dengue, influenza, lithemia, 
 leprosy, emaciation, scurvy, rickets, purpura, anorexia, 
 hypopepsia, intestinal catarrh, chronic ?iephritis, hysteria^ 
 neurasthenia, Bell's palsy, migraine, chorea 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. 
 
 Contraindications. — There is scarcely any condition in 1212 
 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 1213 
 a cold wet towel spread out upon the surface. 
 
 Requisites.— A towel for the head, several linen towels 
 for the application; a sheet and a towel for drying; a pail of 
 
648 RATIONAL HYDROTHERAPY. 
 
 water at the temperature desired for the application, and a. 
 basin of water at a temperature ten degrees lower. 
 
 Method — The patient should lie in a recumbent position 
 with all his clothing removed, and wrapped in a Turkish 
 sheet and a woolen blanket, a portion of the covering being 
 laid aside so as to expose the portion to which the application 
 is to be made. The head, face, and neck are first bathed 
 with the colder water, in which one of the towels is also wet, 
 and wrapped about the head. A linen towel is then wrung 
 very dry out of the water prepared for the purpose in the 
 pail. After being quickly shaken out, it is applied smoothly 
 to the part to be treated; and with the hands applied in 
 such a manner as to cover as large 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 towel 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 by 
 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, 
 
1 
 
 *®i 
 
 j 
 
 •4/1 ~ 3HB 
 
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 prefers as more 
 practical, 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 6o° and 50 . The face, neck, 
 and head are cooled with the cooler water. 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 (6o°) 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. 10 1, 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 
 
65O RATIONAL HYDROTHERAPY 
 
 kept in place by making the friction movements with the two 
 hands simultaneously and from the center toward the ends or 
 sides. It is far better, however, that at least one end of the 
 towel should be held by the patient, so that the attendant 
 may make long strokes with strong pressure, thus increasing 
 the mechanical effect, which is an essential part of this pro- 
 cedure, especially when employed for the excellent 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 up, 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 (Fig. 105). 
 The soles are then percussed, and the ankles, instep, and toes 
 rubbed until the towel is warm. Special care must be taken 
 in drying the feet, to rub them until warm. The soles of the 
 feet are important vasomotor areas, and have extended reflex 
 relations; hence the importance of keeping the feet warm. 
 
 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 
 
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THE TECHNIQUE OF HYDROTHERAPY. 65 1 
 
 be lowered with each application until water at 55 ° or 6o° 
 may be used. Still better effects may be obtained at 50 . 
 
 The hot towel rub may be used when cold is positively 
 contraindicated. As high a temperature as possible should 
 be used (140 to 160 ). Otherwise the method is the same. 
 
 Physiological Effects. — The physiological effects of the 1214 
 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 
 temperature 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 and 
 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 inflammation, pulmonary or intestinal hemorrhage. 
 
 The intensity of the effect produced depends upon sev- 
 eral factors, especially the following: — 
 
 1. The temperature of the water employed. Little effect 
 is produced by water at a temperature above 6o°, but a tem- 
 perature of 70 to 75 may be used at the beginning in very 
 
652 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 wrung 
 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. 
 
 1215 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 advantageously 
 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 douche, and especially in 
 the treatment of anemia, chronic indigestion, neurasthenia, 
 aud a long list of maladies requiring tonic measures, including 
 tuberculosis of the lungs, glands {scrofula), skin {lupus), or 
 bones, chronic rheumatism and lithemia, diabetes, rickets, 
 purpura, hemophilia, obesity, emaciation, dyspepsia, gastric 
 ulcer, and especially in cases of cardiac 'Weakness either 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. 
 
 Contraindications. — In cases of asthma and cardiac affec- 
 tions attended by pronounced weakness of the heart or excess- 
 ive compensation, the wet towel 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 DRIPPING SHEET. 
 
 This procedure, perfected by Priessnitz, consists in a 1216 
 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 
 6o° 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. 
 
654 RATIONAL HYDROTHERAPY. 
 
 The attendants prepare the wet sheet (Fig. 108), which should 
 be wrung dry enough so it will not drip rapidly (Fig. 109). 
 
 When the sheet is ready, one assistant, holding one end 
 of the 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 
 dry sheet and steps behind to assist. The patient holds up 
 both arms, while the attendant in front places the upper left- 
 hand corner of the sheet under his right arm (Fig. no); 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 lowered. 
 The sheet is then carried around the body by the assistance 
 of the attendant who stands behind the patient, and pulls the 
 bottom around. As the sheet is brought across the back of 
 the patient, the attendant in front reaches over and seizes 
 the upper edge of the sheet just above the point of the right 
 shoulder, and pulls it first upward, then down upon the 
 patient's chest (Fig. in), 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 other the 
 trunk and arms (Fig. 112). The rubbing should be contin- 
 ued for 1 to 3 minutes, or until the sheet is everywhere thor- 
 oughly warmed. The attendant should bear in mind that 
 the patient is not to be rubbed with the sheet, but over the 
 sheet, with downward percussion strokes. The bath does 
 not depend for its effects upon irritation of the skin by the 
 friction of the sheet, but upon the thermic stimulation and 
 
THE TECHNIQUE OF HYDROTHERAPY. 655 
 
 the assistance to the cutaneous 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 
 fleshy parts. Gentle patting may 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 without 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; (3) 
 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 wrung dry, the temperature of the bath should 
 not be 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 
 hot fomentations to the feet during the application. For bed- 
 
656 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 1 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 no°) 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- 
 
7 
 
 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 yo° for the sheet, 65 for the first pail, 6o° for 
 the second pail. When higher temperatures are employed, 
 it is difficult to get good reaction, since the exciting effect 
 of cold 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 
 42 
 
658 RATIONAL HYDROTHERAPY. 
 
 6o° 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. 
 1218 Physiological Effects. — 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 TECHNIQUE OF HYDROTHERAPY. 659 
 
 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- 
 ture. 
 
 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 6o°, 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 may be 
 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. 
 fications, 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 no 
 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 
 
660 RATIONAL HYDROTHERAPY. 
 
 by hydric applications; hence the rubbing wet sheet may be 
 properly designated as a pre-eminently useful hydriatic pro- 
 cedure. If 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 6o c ) may be employed. The rubbing will be very 
 vigorous, and the duration short (1 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. 66 1 
 
 The inactive skin of dyspepsia, rheumatism, 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 various 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 infections. In conges- 
 tion of the spinal cord, in hypopepsia, apepsia, constipation, 
 dilatation of the colon and stomach, and most other functional 
 disorders of the digestive organs, the powerful derivative 
 effects of the rubbing wet 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 obesity, chronic rheu- 
 matism, gout, and diabetes. Under its influence, 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 stimu- 
 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 (6o°, 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 8 5 should be employed rather than a 
 lower temperature, so that thermic reaction may be avoided. 
 
662 RATIONAL HYDROTHERAPY. 
 
 When the skin surface is cool, the rubbing wet sheet produces 
 undesirable effects in insomnia, increasing the wakefulness by 
 exciting reflexes from the skin. 
 
 In cases of cardiac insufficiency due to valvular disease of 
 the heart, the rubbing wet sheet renders valuable service as a 
 means of stimulating the peripheral heart and fixing a consid- 
 erable amount of blood' in the skin. The dilated central 
 heart is thus relieved, its action is slowed and energized, the 
 whole circulation is improved, and the author has seen not a 
 few cases permanently helped by this means when other meas- 
 ures had failed to afford more than temporary relief. 
 
 It may be applied twice daily in cases of cardiac dropsy 
 if the patient has a fair degree of vigor. Generally it should 
 be preceded by a short heating of the skin by means of the 
 electric-light bath for 3 to 5 minutes, the vapor bath for 4 
 minutes, or a very short hot immersion bath (104 to 106 , 
 2 min.). Great care must be taken to avoid weakening the 
 heart by overheating the patient. If necessary, an ice-bag 
 may be employed over the heart during the heating process. 
 
 Gilles de la Tourette * has successfully employed the rub- 
 bing wet sheet to combat the febrile symptoms which occur 
 in 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 
 
 * Pr ogres Medical, 1890, p. 101. 
 
Fig. 113. FRICTION OF SPINE (p. 663) 
 
 Fig. 114. CENTRIPETAL FRICTION (p. 664). 
 
 Fig. us- CIRCULAR FRICTION (p. 664). 
 
 Fig. 116. SPIRAL FRICTION (p. 664). 
 
THE TECHNIQUE OF HYDROTHERAPY. 663 
 
 a considerable degree interferes with reaction; hence the pow- 
 erful influence of a low temperature, as well 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 peripheral vessels occasioned by the first 
 contact of the cold sheet with the skin. The best effects are 
 obtained by temperatures between 50 and 6o°. 
 
 Contraindications — The principal contraindications for 1220 
 the rubbing wet sheet and dripping sheet are cutaneous erup- 
 tions, extreme hyperesthesia of the skin, acute visceral inflam- 
 mation, general neuritis, severe neuralgic affections involving 
 large nerve trunks, and such extreme feebleness of the circu- 
 lation that proper reaction can not be secured. Persons who 
 can not endure temperatures below 8o° should not receive 
 this bath, as reaction will be deficient. Other measures 
 should be applied until reaction is improved, such as the cold 
 wet-hand rub, cold mitten friction, and the cold towel rub. 
 
 DRY FRICTION.* 
 
 Massage is the natural accompaniment of hydrotherapy. 1221 
 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. 
 
 * For a full description of the forms and methods of massage, see the author's 
 work, "The Art of Massage," Modern Medicine Publishing Company, Battle 
 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), applicable 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. 
 
 11 Spiral frictioji (Fig. 116), a sort of combination of the 
 preceding, executed with one hand, which progresses from 
 
THE TECHNIQUE OF HYDROTHERAPY. 66$ 
 
 the lower, or distal, to the upper, or proximal, end of the 
 part with a sort of spiral movement. 
 
 " Rotary friction (Fig. 117), 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 scapulae. In applying rotary friction, it is often 
 necessary for one hand to support the tissues while the other 
 hand is executing the movements. 
 
 "Rate of Movement. — 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 minute. 
 
 "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 the 
 thumbs, passing from below upward. 
 
 1 ' 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. 118 and 119). 
 
 " In the upper arm, special attention will be given to the 
 cephalic along the outer side, and the basilic along the inner 
 side, of the arm (Fig. 120). 
 
 11 In applying friction to the leg, the thumb should at first 
 be passed with firm pressure over the long saphe7ious, the 
 course of which is from the instep along the anterior inner por- 
 tion of the leg to the groin and the short saphenous, 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. 121). 
 
666 RATIONAL HYDROTHERAPY. 
 
 1 ' Centripetal friction is applied to the following parts in 
 the direction designated : — 
 
 "Head, from before backward, and above downward. 
 
 ' ' Neck, downward. 
 
 " Back, above shoulder-blades, circular; from shoulder- 
 blades to sacrum, down; in the region of the loins, from the 
 sides toward the spine. 
 
 1 ' Hips, circular. 
 
 ' ' Chest, from the sternum toward the axilla. 
 
 "Abdomen, upper part, from above downward and out- 
 ward; lower part, from the median line downward and outward. 
 
 "Arms and legs, from below upward. 
 
 1 4 To promote absorption, rub toward the heart (centripetal 
 friction). 
 
 4 ' For sedative and derivative effects upon the viscera and 
 nerve centers, rub downward (centrifugal friction). 
 
 1 ' Rubbing upward, or in the direction of the venous blood 
 current, increases the activity of the circulation. 
 
 1 * Rubbing downward decreases vascular activity. 
 
 "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. It 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 : — 
 
a *> 
 
 It 
 
 o < 
 
 o 
 
 i 
 
 i 
 
 as 
 
 < . 
 
 O w 
 
 '!■ 
 
 
 ■ 
 
 
 
 *;4 
 
 
 * ■ : .'*?fe?i. 
 
 
 
 
 HH 
 
 "^^^ 
 
 HB* i 
 
 . 
 
THE TECHNIQUE OF HYDROTHERAPY. 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 ringers 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 for one or two seconds in making rotary fric- 
 tion in the palm after each centripetal stroke. 
 
 " The Forearm. — With 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. 
 
 1 ' 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. 
 
 4 ' In the treatment of very feeble persons, the patient may 
 
66& RATIONAL HYDROTHERAPY. 
 
 be too much fatigued if the operator works with both hands 
 at once, thus leaving him to support his own arm. In such 
 case 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 that 
 described for the forearm. 
 
 "The Shoulder. — In applying friction to the shoulder, 
 the masseur faces the side of the patient, operating with the 
 two hands in alternation, following the surface of the joints, 
 and always taking care to work centripetally; that is, toward 
 the heart or toward the center of the body, and taking pains 
 to follow the irregularities of the surface. The under as well 
 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 TECHNIQUE OF HYDROTHERAPY. 669 
 
 rather slow strokes from knee to groin, not forgetting to give 
 the knee due attention. 
 
 " The Chest. — 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, 
 beginning 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 
 convenient, 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 
 
 il The Abdomen. — Facing 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 Neck. — 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 
 
67O 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 all 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. 
 
 il The Face. — 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, 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. 
 
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. 
 
 1 'I. Make rotary friction upon the two sides simultane- 
 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. 
 
 " 1 . 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 
 
672 RATIONAL HYDROTHERAPY. 
 
 ends of the fingers as deeply into the tissues as possible on 
 either side of the spinous 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 light 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 always necessary or advisable. In cases in which the 
 purpose is 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 hydriatic 
 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: — 
 
 1. Very light friction causes contraction of the surface 
 
 * Naumann, Prager, Viert, 1867. 
 f Rohrig, Deutsche Klinik, p. 254. 
 
THE TECHNIQUE OF HYDROTHERAPY. 6?$ 
 
 vessels, rise of blood pressure, and slight elevation of tern- 
 perature. 
 
 2. Moderate friction causes, first, contraction of the blood 
 vessels, with rise of blood pressure, then dilatation of the 
 cutaneous vessels, with increase of blood movement and fall 
 of temperature. 
 
 3. Very vigorous friction produces, almost from the very 
 beginning, extreme dilatation of the small vessels, the stage 
 of 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 i.8°F. The amount of 
 oxygen consumed as well as C0 2 is increased by friction, also 
 the 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. 
 
 In hydrotherapy the effect usually sought is that of 
 moderate friction; namely, preliminary contraction of the 
 blood-vessels, followed by dilatation. By this means, the 
 reaction which follows the cold application will be encour- 
 aged. The vigor of the application should be just sufficient 
 to 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 
 and 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 Winternitz, perspira- 
 tion may be increased more than 50 per cent. The tempera- 
 43 
 
674 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. 
 
 1225 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 HYDROTHERAPY. 675 
 
 cation of water. After cold baths, friction must always be 
 employed for 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 friction movements are some- 
 times 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 desirable, 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 immediately 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 s kitty 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 
 of 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 rate 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 increasing the loss of heat by radiation (1232). 
 
 In rubbing the patient, both in the bath and afterward, it 
 is well to keep in mind the 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 congestion. For example, in cases of cerebral 
 hyperemia, special attention must be given to rubbing the 
 legs and arms. Again, in case of pelvic pain, the lower part 
 of the back should be rubbed vigorously; for ovarian pain, 
 
/^ Decayed teetfl. 
 
 -j -/ye. -'-..Pharyngitis. 
 y.'^,'* Otitis media. 
 
 ; Neurasthenia 
 SP Ovaries? 
 
 Fig. 122. Cutaneous Areas which are the Seat Fig. 123. Cutaneous Areas which are the seat of 
 of Reflex Pain (p. 677). (Dana) Reflex Pain (p. 677). (Dana) 
 
THE TECHNIQUE OF HYDROTHERAPY. 6yj 
 
 the outer surface of the hips; for gastric pain, the dorsal 
 region of the back; for splenic pain, under the left shoulder- 
 blade; for hepatic pain, under the right shoulder-blade; in 
 neurasthenia, the back of the neck, a common seat of pain, 
 should receive especial attention; in cerebral anemia and in 
 uterine disorders, the top of the head; in constipation, the 
 abdominal surface; in hypopepsia, the epigastric region; and 
 in eye strain, the supra-orbital and temporal regions; in cer- 
 tain ovarian disorders and some forms of neurasthenia, 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- 
 ment 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 1226 
 skin is so sensitive that friction proves too exciting, giving 
 rise to insomnia, nervous irritability, 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, friction encourages the tonic reaction of cold, acting 
 
 A Clinical Study of Neuralgias. 1 
 
6yS RATIONAL HYDROTHERAPY. 
 
 in 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 
 as, (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 
 avoid 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 friction 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 by 
 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 very 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 
 little talcum powder over the surface operated upon, after 
 drying, 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 palm 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. 
 
680 RATIONAL HYDROTHERAPY. 
 
 There are cases in which light friction may be employed 
 to very great advantage as an alternative with hydriatic pro- 
 cedures, when the patient's vital forces are too much reduced 
 to allow of the daily employment of cold douches or similar 
 applications. The author has not infrequently found it advan- 
 tageous to suspend hydrotherapeutic measures for a short 
 time almost altogether, substituting dry friction with the 
 hand, a soft brush, or a linen, flannel, or Turkish cloth mitt. 
 
 In very sensitive patients, as certain neurasthenics, gentle 
 patting over the sheet must take the place of friction as a 
 means of drying the skin. 
 
 When patients are suffering from rheumatic joints, the 
 parts should not be rubbed vigorously, but strong friction 
 should be applied to each limb at a point just above the 
 affected joint and in a centripetal direction. In cases of 
 acute inflammation of any sort, the friction must be at first 
 centrifugal, 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 omission, how- 
 ever, in the greater permanence of the temperature reduction. 
 
 Friction must be avoided altogether in cases of eruptive 
 disorders of the skin, in eruptive fevers, also in cases of 
 erythema, dermalgia, and cutaneous hyperesthesias. When 
 the skin is hot, flushed, and dry, gentle friction may some- 
 times be employed, but as a rule, friction is to be avoided; 
 also when perspiration is profuse. Gentle friction or stroking 
 must be avoided when it is desirable to promote reaction; 
 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 taken 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 continu- 
 ally readjusted so as to bring new portions into contact with 
 
THE TECHNIQUE OF HYDROTHERAPY. 68 1 
 
 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- 1227 
 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 (1066). 
 
 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 
 
682 RATIONAL HYDROTHERAPY. 
 
 joint. As a rule, the hand should strike the body tra- • , 
 versely with relation to the muscles." * 
 
 Of the various forms of percussion, spatting and clapping 
 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 upon 
 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 Art of Massage," Modern Medicine Pub. Co., Battle Creek, Mich. 
 
( 
 
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 lum- 
 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 over the affected part. 
 
 Contraindications. — The contraindications are essentially 1230 
 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. 
 
 Therapeutic 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 before 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 RUBBING. 
 
 232 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 effects of oil rubbing are 
 essentially the same as those of moderate friction, except 
 
Fig. 127. HOT-AIR BATH (p. 687). 
 
 Fig. 129. LOCAL HOT-AIR BATH APPLIED 
 TO KNEE JOINT (p. 692). 
 
 8 
 
 § 
 
 Fig. 128. HOT-AIR BATH IN BED (p. 688). 
 
THE TECHNIQUE OF HYDROTHERAPY. 685 
 
 that it is a milder measure. The lubrication of the surface 
 lessens the degree of 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 which 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 water. 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 surface 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 conductivity. 
 
 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 Applications. — Lubrication of the surface 
 with oil facilitates the application of dry friction, and prevents 
 the irritation likely to result from repeated and long-contin- 
 
6S6 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 excellent 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 employed 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 687 
 
 THE HOT-AIR BATH. 
 
 This bath 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 180 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 if 
 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 8o°, 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 
 
RATIONAL HYDROTHERAPY. 
 
 of heating the skin preliminary to a cold application of some 
 sort. It may in this way precede a cold douche, a cold wet- 
 sheet pack, a cold immersion, a cold sponge, or a wet-sheet 
 rub. When used for this purpose, the bath should be con- 
 tinued just long enough to induce gentle perspiration. If 
 continued longer, a sedative effect may be produced which 
 will antagonize the tonic effect desired from the cold applica- 
 tion which follows. As a means of inducing perspiration, the 
 hot-air bath is inferior to no other measure except the elec- 
 tric-light bath. 
 
 Before the patient enters the cabinet, the hair of the 
 scalp should be thoroughly wet and the face and neck well 
 bathed with cold water. If there is a great tendency to 
 cerebral congestion during the bath, a towel saturated with 
 cold water or an ice collar may be placed about the neck. 
 
 If a regularly constructed cabinet is not available for a 
 bath, an efficient hot-air bath may be administered by very 
 simple means which can be improvised almost 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 oil 
 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 surrounding 
 both the patient and the chair by a rubber blanket ; or in the 
 absence of this, several ordinary blankets, with newspapers 
 placed between, may be substituted. 
 
 It is even possible to administer a hot-air bath in bed by 
 building over the patient a sort of canopy by means of 
 blankets spread upon hoops, as shown in the accompanying 
 cut (Fig. 128). The hot air is conducted into the space about 
 the patient by means of a metal pipe four or five inches in 
 diameter, and connected with a kerosene stove or a large 
 kerosene lamp. Care should be taken to protect the bed 
 
THE TECHNIQUE OF 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 gives 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 
 
69O RATIONAL HYDROTHERAPY. 
 
 1234 Physiological Effects — The first effect of the hot-air bath 
 is to heat the skin and the body. The heat is communicated 
 to the skin by the dry, hot air, the temperature of the succes- 
 sive layers of the skin being elevated until finally the blood- 
 vessels are reached and the temperature of the blood is raised 
 to a sufficient degree to cause perspiration. The skin be- 
 comes red through the dilatation of the surface vessels, which 
 are in a state of passive congestion. The temperature of the 
 blood is generally elevated from two to five degrees according 
 to the duration of the bath. When the bath is continued 
 for some length of time, or for a short time at high tempera- 
 ture, respiration becomes very short, difficult, and thoracic. 
 There is headache, and intense thirst, with nausea and vertigo. 
 Quickening of the pulse and respiration nearly always occur 
 in the hot-air bath. These symptoms usually disappear with 
 dilatation of the surface vessels and the beginning of perspira- 
 tion. They may be largely prevented by vigorous friction 
 of the 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), 
 
 1235 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. 
 
 69I 
 
 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 rheumatism. It is of 
 service in the toxemia of chronic dyspepsia, biliousness, etc. 
 It may be used in obesity, and with caution in certain cases 
 of Bright 's disease. 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 dilatation. 
 
 The hot-air bath may be used to excellent advantage for 
 revulsive effects in sciatica, lumbago, 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 example, 
 in sciatica a cold spray or douche would be employed over 
 the course of the nerve in the affected limb, or a towel wrung 
 out of cold water might be applied over the part, and the 
 part vigorously rubbed for 3° 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 8o° to 
 8 5 , the time, from 1 to .3 minutes, and followed by a gentle 
 spray, shower, or a graduated immersion. Beginning at 95 , 
 the temperature may be lowered to 8o° within 2 minutes, 
 with rubbing. 
 
 In extreme cases of rheumatism 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 weak- 
 ness,'m the febrile condition, 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 (1423). 
 
 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 
 

 
 Fig. 130. TURKISH BATH — Shampooing (p. 695)- 
 
 Fig. 131 (6). VAPOR BATH IN BED (p. 701). 
 

THE TECHNIQUE OF HYDROTHERAPY. 693 
 
 circumscribed portion of the body a temperature of 300 ° to 
 400 . 
 
 The Japanese administer 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. As 
 general perspiration is always induced when the application 
 is prolonged, the patient should be undressed in preparation 
 for the bath, and at its conclusion a short cold application 
 should be made to the entire surface of the body as well as 
 to the part treated. A cold mitten friction, a cold towel rub, 
 or a wet sheet rub are the best measures for this purpose. 
 Care should be taken to avoid chilling the patient. Imme- 
 diate and thorough reaction should be promoted by careful 
 drying and thorough rubbing. 
 
 Therapeutic Applications. — Remarkably excellent effects 1238 
 are certainly obtainable by the daily or frequent application 
 of the localized hot-air bath, especially in cases of rheumatic 
 joints, chronic inflammation 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 chamber, 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 
 inflammation, in general fever, and in cases in which the skin 
 of the parts is diseased. 
 
694 RATIONAL HYDROTHERAPY. 
 
 THE TURKISH BATH. 
 
 1239 This is a very old procedure, dating back to the time of 
 the Romans. The author, with thousands of others, has 
 explored in Rome and Naples the ruins of baths which were 
 in 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 
 nearly nineteen centuries is still in active operation. In this 
 bath the air is heated by means of a huge brick furnace, the 
 body of which is exposed 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 Turkish bath requires an establishment espe- 
 cially fitted up for its application, the essential features of 
 which are : dressing-rooms, a warm room, or tepidarium 
 (temperature no° 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. 
 
 .flethod. — 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. 695 
 
 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 at 
 intervals during the bath. During the first 10 or 15 min- 
 utes, the patient is frequently rubbed by the attendant 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 shampoo-room, 
 where, lying upon a slab, he is 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 : — 
 
 1. 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. 
 
696 RATIONAL HYDROTHERAPY. 
 
 The next step is shampooing the patient with soap and 
 water by the aid of a shampoo brush, a wad of horsehair 
 or fiber, the hair mitt, or a mitt of Turkish cloth especially 
 adapted to the purpose. 
 
 When the whole surface has thus been shampooed, the 
 douche is administered. It as well to begin the douche with 
 a warm shower, which should be heated to 104 to 106 . 
 When the patient's skin has become well heated, and he 
 feels a thirst for cold water, the hot water is suddenly turned 
 off and the horizontal jet, spray, or multiple circle douche 
 administered. After the shower, the patient enters the 
 plunge bath for a few seconds if he desires. The tempera- 
 ture of the plunge should not be above 70 , and better effects 
 are secured by a short plunge in water at 6o°. 
 
 In the famous Hammam Turkish Bath in Paris, the author 
 found the temperature of the water of the plunge to be 54 . 
 A temperature even lower than this is sometimes employed, 
 but is not to be recommended. 
 
 After the plunge, the patient is quickly dried, rubbed 
 vigorously, then lies for 15 or 20 minutes, lightly covered, in 
 the cooling-room. He should not leave the bathing apart- 
 ments until the pulse has returned to the normal rate, and 
 the skin is cool and perfectly dry. 
 1240 Physiological Effects. — The physiological effects of the 
 
 Turkish bath are not very different from those of the hot-air 
 bath. The body being completely surrounded with super- 
 heated air, so that the pulmonary mucous membrane as well 
 as the cutaneous surface is exposed to its influence, somewhat 
 more pronounced systemic effects are produced than by the 
 hot-air bath, especially at the beginning of the application. 
 Before perspiration begins, the heart is usually very much 
 excited. The acceleration of the pulse is in direct proportion 
 to the elevation of the temperature of the bath; the higher 
 the temperature, the more rapid the pulse. With dilatation 
 of the cutaneous vessels and beginning perspiration, the pulse 
 is slowed, and blood tension lowered. 
 
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 
 bath 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 
 
 *." Recherches Ph^siologiques sur les Bains de Vapeur SSche " (Hamman 
 Bains, Turcs). 
 
698 RATIONAL HYDROTHERAPY. 
 
 an error, however, 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 indications 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 con- 
 dition of every patient before submitting him to so vigorous 
 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 means of preparing the skin for cold applications of any 
 sort (1235). 
 124:2 Contraindications. — The Turkish bath should not be em- 
 ployed in cases of skin disease accompanied by eruptions, 
 on account of the excessive congestion of the skm 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 organic disease of the 
 heart, in Bright' s disease of the kidneys, in most pulmonary 
 affections, in cases of arteriosclerosis in which the disease has 
 reached an advanced stage, in cases in which a previous at- 
 tack of apoplexy has recently occurred, in diabetes with ema- 
 ciation, and in 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. 
 
 THE RUSSIAN BATH. 
 
 1243 In this bath the patient lies upon a slab in a small room 
 rilled 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 
 
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). The same 
 precautions should be observed at the conclusion of the bath 
 respecting the cooling of the patient, as elsewhere indicated 
 (1233). 
 
 Physiological Effects. — The effects of the Russian bath 1244 
 are essentially the same as those of the hot-air bath (1234) ; 
 but to the ordinary effects of other hot baths the Russian bath 
 adds one disagreeable feature, — the interference with the 
 respiratory process, because of the saturated condition of 
 the atmosphere of the bath. 
 
 The elimination of C0 2 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 
 
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. 
 
 1245 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 
 rheumatic 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 in febrile cases. The bath must also be interdicted 
 in cases of cardiac weakness, in most cases of advanced Bright } s 
 disease, pulmonary tuberculosis, and in arteriosclerosis, } 
 
THE TECHNIQUE OF HYDROTHERAPY. 701 
 
 THE VAPOR BATH. 
 
 The vapor bath (Fig. 131) resembles the hot-air bath 1240 
 in the mode of administration. The same sort of cabinet 
 may be used, 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 : — 
 
 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 lowered 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 
 with 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 Winternitz: A board of a size 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 
 
702 RATIONAL HYDROTHERAPY. 
 
 whole length of the tub before escaping, it gives off a large 
 quantity of steam, which, passing up through the openings 
 in the board, surrounds the patient with warm vapor. The 
 vapor is retained about the body of the patient by blankets 
 placed over the top of the tub, and tucked around the neck 
 in such a way as to protect the head from the warm vapor. 
 The intensity of the heat may be regulated by controlling the 
 flow of water. The inventor of this ingenious kind of vapor 
 bath informed the author, when on a visit to his establish- 
 ment at Kaltenleutgeben, near Vienna, that he had been 
 able to administer a good vapor bath with two gallons of 
 hot water. 
 
 Nothing could be simpler or cheaper unless it be the 
 method adopted by the New Zealanders, who, as we have 
 been informed by Mr. Maui Pomare, administer a vapor bath 
 by the following unique but effective means: Several stones 
 are laid upon a small heap of wood properly arranged ; the 
 wood being lighted, the stones are soon heated very hot. 
 They are then covered with a thick bed of green leaves, 
 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 had 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 bath 
 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). 
 
THE TECHNIQUE OF HYDROTHERAPY. 7°3 
 
 Physiological Effects — The pulse is greatly quickened, 1247 
 rising rapidly to 140 or 150 beats per minute. The heart is 
 quickly tired out by the excitatiqn 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 per cent., 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-light bath. It 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 
 
 * " Experimentelle Stuclien uber die Wirkung der heissen Luft und Dampf- 
 bader," Archiv fur Psychiatrie> Berlin, 1880, XI, 266-270. 
 
704 RATIONAL HYDROTHERAPY. 
 
 rises much more quickly in the vapor bath than in the Turk- 
 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 (1) 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. 
 1248 Therapeutic Applications.— The vapor bath is indicated in 
 the same class of cases as those for which the hotrair, 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 
 
Fig. 133. ELECTRIC-LIGHT BATH (p. 707). 
 
THE TECHNIQUE OF HYDROTHERAPY. 705 
 
 wastes, as in rheumatism or gout, and that very large class 
 of chronic cases, including a large proportion of neurasthen- 
 ics, in which the uric acid diathesis is the fundamental dys- 
 crasia which forms the general background for the varied 
 pathological pictures presented. 
 
 The vapor bath is a powerful eliminative 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 syphilis, 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 no procedure excepting the electric- 
 light bath, which by its greater power to heat the tissues, 
 stimulates still 'more actively the oxidation of the 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 cord, hys- 
 teria, hypochondria, are all favorably influenced, often with 
 remarkable rapidity, by the vapor bath. Exudates and effu- 
 sions, 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 is perhaps less effective 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 infectiotis jaundice, 
 in acute alcoholic poisoning in connection with the cold bath, 
 in tetany, in migraine and malarial neuralgia (between at- 
 45 
 
7°6 RATIONAL HYDROTHERAPY. 
 
 tacks), and as a heating procedure in connection with gen- 
 eral cold applications, such as the douche, the half v bath, and 
 the wet-sheet rub. As a heating procedure (2 to 5 min.), 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 appli- 
 
 cations, it may be made to render valuable service in various 
 partial applications as well. By suitable arrangements, the 
 application may be confined to an arm, a leg, or any circum- 
 scribed portion of the body. When thus used, a much 
 higher temperature may be employed than when the whole 
 cutaneous surface is exposed. 
 
 Therapeutic Applications. — The powerful heating effect of 
 the vapor bath renders it highly valuable as a means of reliev- 
 ing pain. It may be applied in nearly all conditions to which 
 the fomentation is applicable. The fomentation itself is in fact 
 little more than a crude form of vapor bath. As compared with 
 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 
 
Fig. 135. Electric-Light Bath for 
 Spine (p. 708). 
 
 Fig. 138. Electric-Light Bath for Joint 
 (p. 708). 
 
 Fig. 136. Electric-Light Bath for 
 Trunk (p. 708). 
 
 Fig. 137. The Photophorb (p. 7 n}. 
 
THE TECHNIQUE OF HYDROTHERAPY. yOJ 
 
 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 ulcer, 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 douche (1102), 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-LIGHT BATH. 
 
 In 1 891 the author's attention was called by a colleague, 1250 
 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 therapeutic 
 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 
 
708 RATIONAL HYDROTHERAPY. 
 
 rows of lights being filled with glass or metal mirrors to mul- 
 tiply the number of lights by reflection. The cabinet is so 
 arranged that the whole body of the patient, sitting upright, 
 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 fullest 
 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 with sixty 
 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 joints (Fig. 138), and other parts 
 (Fig. 137). These appliances are so 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 apparatus 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. 
 
 Flethod. — There are two general forms of the electric- 
 light bath; viz., the incandescent-light bath and the arc-light 
 
.m _ K) — Oy - '», _ < »> - #« — i>) < — ,-f 
 
 ^ O - ^-^v^^c^^ 
 
 ill 
 
 sz x^-. ,c sl. 
 
 "'V 
 
THE TECHNIQUE OF HYDROTHERAPY. 709 
 
 bath. Unless otherwise indicated, the term l ' 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 localized 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-light bath is superior to every other form of 
 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 5 minutes. When strongly derivative or eliminative 
 effects are required, the application may be continued for 15 
 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 HYDROTHERAPY. 
 
 ing the cold application for 10 seconds at intervals of half 
 a minute, this bath may be made very highly exciting and 
 also tonic. 
 
 The sweating electric-light bath is usually followed by a 
 shampoo and a cold douche, the finishing treatment being 
 essentially the same as that for the Turkish and the Rus- 
 sian baths. 
 
 In cases in which the purpose is simply to excite the circu- 
 lation of the skin, the daily shampoo is not required, as the 
 heating process will be terminated when active perspiration 
 begins. Feeble patients and persons not accustomed to cold 
 water may be cooled by means of the wet-hand or wet-towel 
 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. 
 
 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. Winternitz 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 711 
 
 skin and thus encouraging perspiration, is certainly incon- 
 testible. 
 
 Local application 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-joint for re- 
 solvent 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 produc- 
 ing a powerful derivative effect. This is a most excellent 
 measure in spinal neuralgia, in lumbago, and in reflex spinal 
 pains arising from irritation of the sympathetic ganglia. 
 
 The Photophore. (Fig. 137.) — This is a device for the use 
 of the incandescent electric light as a measure for local 
 heating. It consists of one of more incandescent lamps 
 surrounded by a metal reflector of convenient form and size 
 for application to small cutaneous areas, as the spine, the 
 abdomen, the chest, the shoulder, the thigh, etc. This is a 
 much more effective device than any form of hot-air appa- 
 ratus. By covering the skin with a moist cloth, the effects 
 of a fomentation may be secured. 
 
 Application 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 com- 
 press and massage, accomplishes w r onders 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, 
 vitalizing and energizing the diseased and sluggish parts, 
 and quickening the healing process. 
 
 The Arc=Light Bath. — Experiments have shown that in 1251 
 the incandescent light bath only five per cent, of the elec- 
 trical 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 factors. The electric 
 are 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 
 
712 RATIONAL HYDROTHERAPY. 
 
 cabinet consists of a quadrangular construction which permits 
 the exclusion of the head of the patient. In each corner 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 tnat 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 
 (590), 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 1 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. 
 
 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 HYDROTHERAPY. 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 
 heat, as profuse perspiration generally appears in the electric- 
 light 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 skin 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 
 efficiency as a source of radiant energy. In the Turkish bath, 
 heat is communicated to the body chiefly by convection from 
 heated air. 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 moisture 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 paper, "The Incandescent Electric-Light or Radiant-Heat Bath," read 
 before the Electro-Therapeutic Association at its fourth annual meeting, New 
 York, Sept. 25-27, 1894. 
 
714 RATIONAL HYDROTHERAPY. 
 
 of radiant energy. The electrical current of the incandescent 
 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 Einhorn 
 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. Winternitz, 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 work t 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. 
 \ Winternitz, " Fortschritte der Hydrotherapies' 
 
THE TECHNIQUE OF HYDROTHERAPY. 71 5 
 
 dosage 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 
 effete matters which accompany vigorous perspiration pro- 
 ceed with 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 Klar.* This investigator showed by calorimetric experi- 
 ment that with the body exposed in an atmosphere somewhat 
 below the body temperature, heat elimination was during the 
 first five minutes ten times the normal 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 
 of 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 : — 
 
 1 ' The electric-light bath is a new invention by Kellogg, 
 
 *Klar, Wien. Klin. Woch. % 1895, p. 180. 
 
7l6 RATIONAL HYDROTHERAPY. 
 
 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 degree. 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 Winternitz 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 1 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 
 10 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 
 
Fig. 141. FINSEN'S APPARATUS FOR PHOTOTHERAPY (p. 721). 
 
 Fig. 142. LENS-BOTTLE FOR FILTER- Fig. 143- COOLING COMPRESSOR (p. 721). 
 
 ING OUT HEAT RAYS (p. 721). 
 
THE TECHNIQUE OF HYDROTHERAPY. JIJ 
 
 have in 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 168 to 180. 
 
 Therapeutic Applications The electric-light bath has 1253 
 
 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- 
 lable, 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 application 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 character. The excessive heat- 
 ing of the skin prepares the way for the cold application, 
 
?l8 RATIONAL HYDROTHERAPY. 
 
 without at the same time so overheating and relaxing the 
 blood-vessels as to render recovery of the tone of the cuta- 
 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 perspira- 
 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, 
 iteuritis, 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 
 
Fig. 144. A Case of Lupus before 
 Treatment (p. 721). (Finsen) 
 
 Fig. 145. A Case of Lupus after Treatment 
 (p. 721). (Finsen) 
 
 Fig. 146. SUN BATH (p. 722). 
 

THE TECHNIQUE OF HYDROTHERAPY. /1 9 
 
 which has been absorbed by the skin in the previous hot 
 application. The electric-light bath having 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- 
 gestion, 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 rheumatism and all maladies dependent 
 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, 
 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 natures 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 the sweating bath is certainly 
 scarcely yet appreciated by the majority of civilized 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 RATIONAL HYDROTHERAPY. 
 
 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 his 
 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 bath, possesses 
 a hygienic value which can not be overestimated. 
 
 A local application of the electric light for 15 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. 
 
Biaitv 
 
 Bowels and Ab- 
 dominal Viscera. 
 
 Bladder, Uterus, 
 and Ovaries. 
 
 ( Genito-Urinary 
 I Organs. 
 
 Pelvic Organs, 
 Intestines, Brain 
 
 Fig. 147. CUTANEOUS AREAS REFLEXLY ASSOCIATED 
 WITH INTERNAL PARTS (pp. 117-120, 725). 
 

Braia. 
 
 Luns 
 
 Stomach. 
 
 Kidneys, Bowels. 
 
 Pelvic Viscera. 
 
 Geni to-Urinary 
 Organs, Bowels, 
 ( Brain. 
 
 Fig. 148. CUTANEOUS AREAS REFLEXLY ASSOCIATED 
 WITH INTERNAL PARTS (pp.i 17-120, 7 a 5 \ 
 
THE TECHNIQUE OF HYDROTHERAPY, 721 
 
 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 
 Finsen, 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 V 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 
 
^22 RATIONAL HYDROTHERAPY. 
 
 method in the treatment of leprosy, believing that it may be 
 found of value in dealing with this most obstinate malady, 
 at least in the tubercular form of the disease. 
 
 THE SUN BATH, OR INSOLATION (Fig. 146). 
 
 « 
 
 1254 Sunlight is one of the most powerful of all hygienic and 
 
 curative agents. As a hygienic measure it is of inestimable 
 value in the destruction of dangerous microbes, the most of 
 which are unable to resist the action of the direct rays of the 
 sun for more than a few minutes. Sunlight is thus the most 
 important of all disinfecting and sterilizing agencies. The 
 value of sunlight in the maintenance of health is well shown 
 in the dwarfed development or rapid deterioration of plants 
 deprived of its stimulating influence. In caves, mines, and 
 other places from which the light is excluded, plants, with 
 the exception of the fungi, do not grow, or if they do, very 
 quickly die, never attaining maturity. Animals also are 
 dwarfed 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 rays, 
 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 
 pf 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 malnutrition, 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 custom 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 for 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." 
 
 Suggestions 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 to 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 HYDRIATIC 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' 
 
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 gen- 
 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): — 
 
 (1) 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 
 
J 26 RATIONAL HYDROTHERAPY. 
 
 the medium of the skull, the vessels of which anastomose 
 with those of the scalp and those of the brain. 
 
 (2) The skin of the back is reflexly related to the centers 
 of the spinal cord. This is also true of the entire skin sur- 
 face of the trunk and limbs. 
 
 (3) The skin covering the neck is reflexly, through the 
 spinal cord, related to the pharynx and the larynx. 
 
 (4) The upper dorsal region, the skin of the chest in 
 front and behind, and the inner surface of the thighs, have 
 special vasomotor reflex relation with the lungs. 
 
 (5) That portion of the chest wall overlying the heart 
 (the precordia) is especially associated with the heart, — a 
 fact often of priceless service. 
 
 (6) The skin covering the lower portion of the right chest 
 is reflexly related to the liver. 
 
 (7) The skin surface of the lower left chest is associated 
 with 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- 
 
Fig. 149. Diagram showing collaterally related vascular areas, skin 
 overlying muscle (p. 731). 
 
 Fig. 150. Hyperemia of skin with collateral anemia of underlying muscle pro- 
 duced by a hot application (p. 731). 
 
 cold Compress 
 
 1 
 
 Fig. 151. Anemia of the skin with collateral hyperemia of the 
 underlying muscle produced by a cold application (p. 731). 
 
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 1258 
 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, by 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. 
 
72 8 RATIONAL HYDROTHERAPY. 
 
 (3) The graduated bath, 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 ioo° 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 before 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, 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 follow the local application with a general 
 douche or other cold application whereby general external 
 and internal reaction may be produced. 
 
 1259 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 : — 
 
 (1) 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 
 
730 RATIONAL HYDROTHERAPY. 
 
 the portal reservoir, from which, in the later moments, it is 
 distributed among the internal organs. 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 
 umbilicus is the dividing line in this compensatory action. If 
 cold is applied to one foot or hand, the effect is not, however, 
 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 73 * 
 
 Collateral Anemia and Hyperemia. — Where all the parts 1261 
 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 (1274 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 of 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. 
 
73 2 RATIONAL HYDROTHERAPY. 
 
 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 are 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 for 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 to the front; 
 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 
 
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, C0 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 first 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 establishment of both conditions (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 for Derivative 1262 
 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, I50 : — 
 
 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 HYDROTHERAPY. 
 
 face are so good conductors that the brain is quickly heated 
 by a hot application, and thus 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. 
 
 <4 (^)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. 
 
 li (d) 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 : — 
 
 i. To influence the longitudinal 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 HYDROTHERAPY. 
 
 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 region, 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 The 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, 1267 
 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: — 
 
 i. 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 ]ungs 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 
 
 rnonia, 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 1273 
 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 HYDROTHERAPY. 
 
 liver and spleen may be influenced by the same measures 
 described in relation to the stomach. The vessels of these 
 organs are connected with the cutaneous circulation through 
 the anastomosis of the phrenic arteries (right and left) with 
 the internal mammary and the intercostals. Passive conges- 
 tion of these organs is seldom of serious importance except 
 when arising from disturbance of the portal circulation. 
 Applications to relieve general portal congestion (1277) will 
 relieve hepatic and splenic congestion, since such causes as 
 tend to concentrate the blood in the portal circulation will 
 influence in like manner the liver and spleen, together with 
 the other abdominal viscera. 
 
 1276 The Intestines. — The intestines, especially the duodenum 
 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 The 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 
 
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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," 1859 
 
742 RATIONAL HYDROTHERAPY. 
 
 from the phrenic, lumbar, ilio-lumbar, lower intercostal, 
 epigastric, and 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., vol. 3) the coeliac axis and mesenteric vessels were 
 plugged, but blood in sufficient amount to supply the viscera 
 had reached the branches of these arteries through their 
 parietal communications. The anastomosis gives an anatom- 
 ical demonstration of the value of local blood-lettings and 
 of counter-irritants in inflammatory affections of certain of 
 the viscera, and also a scientific basis to the ancient prac- 
 tice of poulticing the loin and the iliac region in nephritis and 
 in inflammation about the caecum.' ' (Surgical Applied Anat- 
 omy, Page 371.) 
 
 These interesting anatomical relations, when understood 
 by the hydriatic physician, place at his disposal most power- 
 ful means of influencing the portal circulation. By warm 
 or hot applications to the rectum the veins composing the 
 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. 
 1279 Chronic portal congestion is best combated by the pro- 
 
 longed cool sitz (1308) and the wet girdle (1347). The 
 temperature of the sitz should be 8o° 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 pres- 
 sure on the systemic si'de 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 affords 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 produced by warm 
 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 (1 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 effect 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 influ- 
 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 (1281 to 1291) the practical application of the 
 foregoing principles is illustrated by means of the compress. 
 
 1281 (1) 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 (ioo° 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 C0 2 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 
 
 continuous 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 preventing 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 
 good illustration of this is seen in the case of 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 appli- 
 cations than by prolonged cold compresses. If cold com- 
 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. 
 
 1283 (3) The proximal cold compress controls local blood 
 
 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 
 
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 cutaneous circulation, an excellent derivative 
 effect is produced, the value of which is often overlooked. 
 
 (5) By alternate hot and cold applications to a limited 1281 
 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 (6) Very hot 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 sufficiently 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 reflexly 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 warm or neutral 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 must 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 
 
75° RATIONAL HYDROTHERAPY. 
 
 purpose of producing anemia in some proximate or remote 
 part, the wet towel should be protected not only by flannel, 
 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, (b) When it 
 is desired to increase the movement of blood in a refiexly 
 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 active 
 congestion of the skin and related parts, with derivative 
 effect, and at the same time a vigorous fluxion in the refiexly 
 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. 
 1290 (10) The hot and cold compress (1356) produces remark- 
 
 able effects by combining derivative and reflex effects. For 
 example, (a) a fomentation to the upper back diverts blood 
 from the bronchial vessels, while cold simultaneously applied 
 to the front of the chest contracts the same vessels by reflex 
 influence, thus intensifying the effect (1270); (J?) Cold over 
 the sternum with a fomentation over the lumbar region 
 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); (0 The pelvic 
 circulation is controlled by a cold bag over the hypogastrium 
 in conjunction with a hot pelvic pack (1272); (d) 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- 
 chlorhydria, 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. 
 
 (11) The hot and lieating pack (1365) consists in a hot 1291 
 bag or coil combined with a heating compress or partial 
 pack. The action differs from that of the hot and cold com- 
 press 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 the 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 Respecting Localized 1292 
 Applications. — Great care must always be employed in the 
 application of douches or affusions to the head. (1) 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 maybe 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 8o° 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 oondition 
 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-lying 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 6o°), 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. 
 
 (10) 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 , 1 to 5 min.) though less 1293 
 useful than the hot foot bath, is of great service in producing 
 reflex, 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 1 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 
 uterine 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 6o°, 
 1 to 3 min.). It must be repeated daily. 
 
 The prolonged cool foot bath (6o° 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 we'll 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 (n5°to 125°). 
 
THE TECHNIQUE OF HYDROTHERAPY. 755 
 
 THE SHALLOW FOOT BATH. 
 
 The shallow foot bath is a variety of the cold foot bath 1295 
 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 like 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 maintained. 
 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 HYDROTHERAPY. 
 
 are reversed ; and thus each foot is treated. The bath is pro- 
 longed until the toes are reddened by reaction. 
 
 The running foot bath may be conveniently taken in the 
 full bath tub, by allowing cold water to run with the outlet 
 partially or fully open. 
 
 Therapeutic Applications. — This bath is indicated in alii 
 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 habit- 
 ually cold feet from vasomotor spasm of the extremities. The 
 remedial effect in these cases is obtained not alone by 
 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 ganglia. 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 neuras* 
 thenics suffering from cold extremities and cerebral conges- 
 tion, producing an excellent general tonic effect. 
 
 In cases of i7isomnia due to cold feet, it is well to precede 
 the application by a hot foot bath (1 io° to 1 15 , 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. 
 
 Contraindications. — The flowing foot bath should be 
 avoided in catarrh of the bladder, irritable rectum and blad- 
 der, and other forms oi pelvic inflammation. It is also con- 
 traindicated in ovarian neuralgia, neuralgia of the bladder, 
 sciatica, and rheumatic 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 
 
Fig. 156. COLD FOOT BATH (p. 753). 
 
 Fig. 157. LEG BATH (p. 758). 
 
 Fig. 158. ARM BATH (p. 759). 
 
 Fig. 159. ELBOW BATH (p. 759). 
 
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 time 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 io° 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 (1 1 5 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. 
 Heat 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 
 
 *Wratsch, Lyon Medical, 1883, page 541. 
 
7$% RATIONAL HYDROTHERAPY. 
 
 a hot foot bath. By vaginal examination it may be readily 
 noted that 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 neuralgia 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 
 chilling of the feet, if applied soon after exposure. 
 
 The prolonged warm or hot foot bath (98 to 106 ) dilates 
 the vessels of the feet, and produces collateral anemia of the 
 pelvic viscera. A short, very hot foot bath (no° to 120 , 
 5 min.) produces the same effect. The hot foot bath (104° 
 to iio c ) 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 1 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 LEG 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 TECHNIQUE OF HYDROTHERAPY. 759 
 
 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 1300 
 a useful measure, especially in surgical 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 
 burns 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. 159) is a modification of the arm 1301 
 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 Priessnitz, is dependent upon 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. 
 
 THE HAND BATH. 
 
 1302 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 auditory 
 canal, lessening the pressure in the cerebral arteries, and nar- 
 rowing the veins of the retina. The hot hand bath produces 
 opposite phenomena. These observations explain the effect 
 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, first introduced by Langenbeck,t consists in 
 the continuous immersion of a limb in water at a neutral 
 temperature. Langenbeck 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 de Physiologie, v. 3, pp. 497-502, 
 \ Deutsche Klinik, 1855, No. 39, pp. 409-419. 
 
THE TECHNIQUE OF HYDROTHERAPY. 76 1 
 
 by him were as follows: (1) 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 for the wonder- 
 ful discovery of Lister, the partial immersion bath might have 
 remained for a long time the most 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 to a heated dis- 
 cussion upon the utility of the method, which occurred at the 
 Academy of Medicine in the winter of 1874-75, Dr. 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 circumstances 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 
 
7^2 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 rubbing 
 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 
 1 to 1 5 minutes. The duration of the cool or the tepid sitz 
 may be considerably longer (70 to 8o°, 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 sitz 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 
 
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 surface ves- 
 sels. The special advantage of the bath depends upon the 
 persistence of this dilatation, which fixes a large quantity of 
 blood in the skin. Contraction of the internal vessels 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 
 jaundice 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 poisoning, 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 (jo° to 8o°, 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 6o° 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 7 5 to 8o° (usually about 
 75 ) is preferable to a lower temperature, especially for 
 
Fig. 160. Partial Continuous Bath (p. 761). Fig. 161. Partial Continuous Batk (p. 761). 
 (Langenbeck) (Langenbeck) 
 
 Fig. 162. SITZ BATH (p. 76:). 
 
 
 l*-w 
 
 Fig. 163. COLD RUBBING SITZ (p. 767). 
 
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 no°). 
 
 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 io°. 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. 
 
j66 RATIONAL HYDROTHERAPY. 
 
 The cold sitz bath is also indicated in hemorrhage of the 
 bladder, intestines, uterus, urethra, and rectum, in hemor- 
 rhoids, chronic inflammation of the prostate, chronic 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 vessels are thus drained of blood while 
 they are at the same time reflexly contracted. 
 
 An excellent revulsive effect is produced by a dip 
 into cold water for a few seconds, following a very hot sitz 
 (ii5°to 120°), of 3 to 8 minutes' duration. It is a most 
 powerful sedative measure in painful affections of the pelvic 
 viscera. It may be very advantageously employed in cases 
 of ovarian or uterine 7ieuralgia, enteralgia, and in painful 
 affections of the bladder, rectum, and prostate. 
 
 The cold sitz, accompanied by rubbing of the whole sur- 
 face with cold water, is a powerful means of stimulating 
 cerebral activity. Winternitz has shown by plethysmographic 
 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. j6j 
 
 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 cystitis, 
 prostatitis, metritis, ovaritis, enteritis, colitis, appendicitis, 
 peritonitis, salpingitis, and so-called cellulitis ; in affections 
 of the bladder, uterus, and intestines attended by muscular 
 spasm; in vaginismus ; in enteralgia, lumbo-abdominal neu- 
 ralgia, neuralgia of the ovaries, bladder, testicles ; in coc- 
 cygodynia and sciatica; and in most painful affections of 
 the genito-urinary organs. The cold bath in any form must 
 be avoided in spermatorrhea 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 85 , gradually cooled to 
 75 , may, however, be employed with benefit. The length 
 of the bath when employed in this manner should be 15 
 to 20 minutes. 
 
 THE COLD RUBBING SITZ BATH (Fig. 163). 
 
 The patient's head having been properly cooled and pro- 1309 
 tected by a wet towel, he steps into the hot foot bath, and 
 then seats himself in the sitz 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., temperature 
 65 to 5 5 c ). 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- 
 duce decided thermic and mechanical impressions upon the 
 
 1 
 
768 RATIONAL HYDROTHERAPY. 
 
 reflex areas associated with the viscera of the pelvis and 
 lower abdomen. A most powerful and lasting circulatory 
 reaction is produced in the surface vessels, which depletes 
 the circulation of the associated internal areas by collateral 
 influence, producing a strong revulsive effect. 
 
 Therapeutic Applications — The cold rubbing sitz is a pow- 
 erfully tonic measure, influencing especially the genito-urinary 
 organs, 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 enteroptosis 
 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 
 8o° to 8 5 , 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 
 
 rnodic affections of the pelvic and abdominal viscera, as neu- 
 ralgia of the ovaries or testicles, tenesmus of the bladder or 
 rectum, and vaginismus. It may be added, however, that 
 the cold rubbing sitz 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 HOT SITZ BATH. 
 
 Temperature, 106 to 120 ; duration, 3 to 10 minutes. 1311 
 It is well to begin with a temperature of ioo°, rapidly add- 
 ing hot water until the maximum temperature is reached. 
 A hot foot bath is taken with it (no 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 bath, by dilating the branches of the external iliac, still 
 further drains the portal circulation. At temperatures 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 inflamed 
 hemorrhoids. It is likewise of great value in vaginismus, 
 spasm of the neck of the bladder, a?ial tenesmus, in uterine 
 colic, in nephritic colic, in sciatica, lumbo- abdominal neural- 
 gia, neuralgia of the ovaries, testicles, 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 
 
770 RATIONAL HYDROTHERAPY. 
 
 bath is a most powerful analgesic measure. For the best 
 effects, it should be followed by a short cold application. 
 In cases in which this bath is employed for the relief of 
 acute visceral 'congestion, great care must be exercised to 
 cool the surface of the body gradually, so as to restore the 
 tone of the vessels without producing a general and sudden 
 contraction of the surface vessels, whereby the good effects 
 of the bath may be immediately destroyed (affusion or spray, 
 8o°, 5 min. ; or 40 , 5 to 10 sees.). The slightest chilly sen- 
 sation following the bath will be accompanied by a return of 
 the unpleasant symptoms which have been removed by the 
 application. 
 1311^2 A most useful form of the sitz bath is what the author has 
 termed the revulsive sitz. The bath begins at 100 F., the 
 temperature being rapidly raised to 1 1 5 or 120°. The 
 patient remains in the bath 3 to 8 minutes, the head being 
 carefully protected by a cold compress upon the head or about 
 the neck. As the patient rises from the bath, a pailful 
 of cold water is dashed upon the hips, so as to produce 
 a tonic reaction, and fix in the 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 SITZ BATH. 
 
 1312 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 77 1 
 
 Therapeutic Applications. — The neutral sitz bath is an 
 exceedingly useful means of relieving nervous irritability and 
 congestion of the pelvic viscera. It is of great service in the 
 treatment of painful and inflammatory affections of the 
 genito-urinary organs in both men and women, in pruritis of 
 the vulva and anus, in strangulated hemorrhoids, frequent 
 urination from irritability of the bladder, spermatorrhea 
 arising from excessive irritability of the genito-urinary center, 
 — frequent losses, — neuralgia of the spermatic cord and 
 testicles, and in cases of enteroptosis accompanied by extreme 
 hyperesthesia of the lumbar ganglia of the abdominal sympa- 
 thetic, also in chronic backache from rectal and uterine dis- 
 orders or enteroptosis, and coccygodynia. 
 
 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, ovaries, 
 and tubes. This bath is especially useful as a means of relief 
 in neuralgia of the Fallopian tubes or of the testicles, in vagin- 
 ismus, pruritis of the anus and vulva, vesical and rectal 
 tenesmus, hyperesthesia of the lumbo-aortic plexus, and in 
 hyperesthesias of the genito-urinary organs'. It is indicated 
 as a sedative means in erotomania in both sexes, in 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 conditions 
 which may be present. 
 
 THE COMPRESS. 
 
 This is simply the application of water at any temperature 1313 
 by means of a cloth, a sponge, spongiopyline, or other suita- 
 ble 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 
 
7/2 RATIONAL HYDROTHERAPY. 
 
 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 is 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- 
 clusion of the treatment. 
 
 Compresses may be classified according to their tempera- 
 ture, as: (i) very cold (55 or less); (2) cool ox cooling (60 to 
 7°°); (3) warm or neutral (92 to 98 ); (4) hot (102 to 
 110 ); (5) very hot (no° to 160 ); (6) alternate (very hot 
 and very cold in alternation); (7) revulsive (short cold follow- 
 ing prolonged very hot); (8) hot and cold (simultaneous); (9) 
 hot and cold pack; (10) heating or stimulating (applied cold, 
 more or less protected, and prolonged until warmed by the 
 body heat); (11) the 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. 
 
 1314 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 use 
 of the ice cap (Fig. 164), the rubber or aluminum coil 
 (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 mixture. 
 When ice or very cold water can not be obtained, as in 
 many tropical countries, a very satisfactory substitute may 
 
THE TECHNIQUE OF HYDROTHERAPY. fjl 
 
 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 4 l ° was secured, the initial temperature of the 
 water being 7°°, 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 "CO 2 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 — 8o° 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 utilizing 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. 
 
 Schultze 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 18 F. ; at a 
 depth of two centimeters (four fifths of an inch), the lowering 
 of temperature was 3. 6° F. ; 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- 
 
 * Joffroy, "These d' Aggregation," Paris, 1878, p. 176. 
 
774 RATIONAL HYDROTHERAPY. 
 
 mometer applied to the internal surface of the chest in a case 
 of thoracentesis showed a diminution of temperature of 
 nearly y° F. A clinical thermometer placed against the 
 inner surface of the cheek while ice was pressed against the 
 outer surface showed a diminution of more than fourteen 
 degrees in temperature. A thermometer placed in the vagina 
 indicated a fall of nearly one and one-half degrees, as the 
 result of an application to the hypogastrium of a large 
 bladder filled with ice (Exp. 64, 65, 66, 67). 
 1315 Physiological Effects — These depend upon the length of 
 the application and the part to which it is applied. A short, 
 very cold compress has the effect 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 to 
 increase vital resistance, as in pneumonia. The ice-water 
 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-collar. 
 
 Prolonged cold applications (an ice-bag for I 5 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 
 parts 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 
 diminished, and thus general vital activity is lessened. 
 
 A short cold application to the head (1 to 5 min.) 
 excites cerebral activity through the reaction which follows. 
 But by rewetting 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 
 contract more vigorously, and the effect of the application is 
 more intense than if continuous, as by an ice-bag or ice- 
 compress. 
 
 Intense cold applications, especially when made to the 
 head, become very painful when prolonged. Such a degree 
 of cold is unnecessary to secure the therapeutic effect desired. 
 
 Therapeutic Applications.— The very cold compress ren- 1316 
 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 local inflammation in joints, inflamed 
 wounds, and other conditions in which powerful sedative 
 
7j6 RATIONAL HYDROTHERAPY. 
 
 effects are required. Applied to the head, it lowers the tem- 
 perature in fever, relieves delirium in febrile conditions, may 
 control excitement in acute mania, and renders invaluable 
 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 are 
 also of service in certain cases of neuralgia. Ice compresses 
 may be applied for the relief of inflamed hemorrhoids. An 
 ice-bag laid across the trunk of an artery is more effective in 
 reducing the blood supply of the part in which the artery is 
 distributed than an application made directly to the part 
 itself; and an application made to the axilla, the bend of the 
 elbow, the groin, or the bend of the knee, will control inflam- 
 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 reliev- 
 ing cerebral congestion. An ice compress over the heart 
 lowers the general temperature by cooling the blood, while 
 it energizes 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. ^J 
 
 A cold compress to the thighs, perineum, and hypogas- 
 trium in conjunction with a very hot fomentation (10 min.) 
 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 bleeding, 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 energy, 
 in health and disease alike. In case of wounds of the hand 
 or foot, the cold proximal compress may render inestimable 
 service. 
 
7?8 RATIONAL HYDROTHERAPY. 
 
 Nosebleed may be checked by the application of cloths 
 wrung out of ice-water to the face or to the upper part of the 
 spine. 
 
 An ice-bag applied over the stomach or to the spine oppo- 
 site will often check vomiting, and will relieve the excruciating 
 pain of cancer of the stomach or chronic ulcer. 
 
 An ice-bag or ice compress renders great service in cases 
 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 inflammation 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 the 
 benumbing effect of cold resulting in lessened activity of the 
 centers brought under its influence. According to him, an 
 ice-bag applied to the lower portion of the spine, will dilate 
 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 suffered from cold 
 
THE TECHNIQUE OF HYDROTHERAPY. 779 
 
 feet and legs, noted that her limbs became warm and filled 
 with 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 collar is a valuable measure in the treatment of 
 diphtheria, the application being exchanged at intervals of 
 1 5 to 20 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 appli- 
 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 is 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 asphyxia 
 from opium, chloroform, or other narcotics. The cold appli- 
 cation excites the respiratory center. 
 
 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 purposes. 
 
78O 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 minutes at inter- 
 vals of half an hour, and to make an application of very hot 
 w T ater 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 borne in mind. Examples : Inflammation of muscles and 
 joints ; deeply seated abscesses vascularly connected with the 
 cutaneous surface; parietal pleurisy or peritonitis ; inflamma- 
 tion of the structures of the eyeball. 
 
 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 COOLING COMPRESS. 
 
 1318 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 TECHNIQUE OF HYDROTHERAPY. 78 1 
 
 The temperature to be employed is 55 to 70 . For 
 sedative effects, the compress may be changed every 5 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 occur, 
 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 
 requires a compress at least one foot square. 
 
 Physiological Effects. — The cooling compress has been 1319 
 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 
 
 *Baginsky, " Lehrbuch der Kinder Krankheiten," 1896, p. 292. 
 
782 RATIONAL HYDROTHERAPY. 
 
 through loss of the influence of the skin reflexes, while the 
 blood is diverted from the collateral surface 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 guard. 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 must be prevented by a simultaneous 
 hot application to some surface where hyperemia of the skin 
 will 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 warm 
 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 continuous stimu- 
 lation of the vasoconstrictors is maintained. 
 
 It must not be forgotten that the action of the cool com- 
 press involves 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. Through 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. 783 
 
 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 management of this thera- 
 peutic force is the most severe test to which an individual's 
 knowledge of hydriatic principles and procedures can be 
 brought (1281-1291). 
 
 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 : W : : 87 : x\ i in which W represents 
 the weight of the patient, and x the skin area. Dividing the 
 result by four, the required size of a cooling compress for use 
 in reducing temperature will be: for a person weighing 180 
 lbs., 5 sq. ft. ; 120 lbs., 4 sq. ft. ; 60 lbs., 2^ sq. ft. ; for a child 
 weighing 30 lbs., i J / 2 sq. ft., or 12 x 18 inches. 
 
 In Dr. Thompson's experiments upon dogs, published in 1320 
 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 animal 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 (1314). 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 surface, are obtained 
 
7^4 RATIONAL HYDROTHERAPY. 
 
 through its influence 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 higher 
 will be the temperature. Hence passive congestion 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. 
 1321 Therapeutic Applications — The cool compress may be 
 
 employed in such a manner as to render invaluable service in 
 all forms of localized inflammatory 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. 168, 169). 
 
 The compress is exceedingly useful in typhoid 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- 
 
A. Congested skin. 
 
 B. Cutaneous vessels contracted by cold compress. 
 
 C. Diagram showing local cutaneous congestion, as in a boil. 
 
 D. Diagram showing reliei of local congestion by a fomentation which dilates the surrounding vessels. 
 
 Fig. 168. Diagrams Illustrating Superficial Fluxion Effects from Hot and Cold Applica- 
 tions (p. 784.). 
 
Fig. 169. Diagrams showing : A. Pulmonary congestion. B, Beneficial 
 
 EFFECTS OF COLD CHEST COMPRESS. (P. 784.) 
 
THE TECHNIQUE OF HYDROTHERAPY. 785 
 
 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 front chest and the affected 
 side, and changed as soon as well warmed (1284). 
 
 The cool compress is highly useful as an application in 
 cases of cardiac insufficiency, either in fevers or as the result 
 of disease of the heart. It is applicable in nearly all cases 
 except those in which 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 dermatitis, the cool compress is exceedingly valuable. 
 In inflammation of the external portio7ts of the eye, the cool- 
 ing compress is more effective than ice-cold applications, but 
 it is effective only when the inflammation 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 
 covering the eyebrow (1264) in inflammation of the lids. 1 
 
 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 (10 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 for reaction to be established (15 
 to 30 min.), the effect is somewhat different. The reflexly 
 
 50 
 
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 organ, and thus combats in the most 
 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 combating 
 hypostatic congestion of the lungs in surgical cases and pro- 
 longed helplessness from any cause, in resisting the action of 
 specific bacteria in typhoid fever, and also renders most 
 valuable service in the early stages of pneumonia. When the 
 febrile activity is very great, the compress may be renewed 
 as often as every 5 to 10 minutes. Later, when the activity 
 of the inflammatory 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 173 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 HYDROTHERAPY. 7%7 
 
 Mays, of Philadelphia, has for several years advocated 1322 
 the ice-bag to the chest in pneumonia, and the results 
 he reports * are certainly much superior to those obtained 
 by other methods in common use. For more than twenty 
 years the author has employed the cold compress or ice 
 compress in the early stages of pneumonia, exchanging it 
 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- 
 vessels of the skin, but also those of the deeper tissues under- 
 lying the area to which the application is made. This effect 
 is 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 
 and cardiac insufficiency. The continuous application of the 
 ice-bag is equally serviceable in cases of cardiac irritability 
 (1383). 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. 
 
 Contraindications. — 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 
 of 6o° to yo° is generally useml, while a lower temperature is 
 often injurious. 
 
 THE COOLING COIL. 
 
 A refrigerating method much employed in Germany is the 1323 
 
 cooling coil (Fig. 170), consisting of a flat coil of rubber 
 
 Transactions of the Philadelphia County Medical Society, 1895, p. 302. 
 
ySS 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 EVAPORATING COHPRESS (Fig. 171). 
 
 1324 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 1,000 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 upon 
 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 150 heat units in an hour; but in order that the 
 evaporating compress may accomplish its work, it must 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 Applications. — The evaporating compress is 1325 
 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- 
 tation 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 insomnia 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 IRRIGATING COMPRESS. 
 
 In this procedure a compress consisting of several thick- 1326 
 nesses of cheese-cloth or soft muslin, or a mass of absorbent 
 cotton, having first been saturated with cold water (6o°), 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. 172. The tube should 
 
790 RATIONAL HYDROTHERAPY. 
 
 be so constricted by tying a string about it or by other means 
 that the water will flow at just the proper rate to maintain 
 the temperature desired. If a fountain with a stopcock is 
 employed, the flow of water may be regulated by the cock. 
 
 The physiological effects and the therapeutic applications 
 of this procedure are the same as with the ordinary cold com- 
 press, the only difference being that by the method of irriga- 
 tion the temperature of the application may be maintained at 
 a certain point as long as desirable, and thus reaction may 
 be easily suppressed. Irrigation is especially applicable in 
 cases of wounds, burns, bruises, and other injuries in which 
 the dressing can not be readily removed without irritating 
 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 10 minutes once in two or three hours, 
 to maintain proper activity of the circulation. 
 
 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 in 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 79 1 
 
 principle on which this compress rests has a sound experi- 
 mental basis. The application of 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. Priessnitz employed the cold elbow bath for the 
 control of inflammatory processes of 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 6o° 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. 68). 
 
 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-bag 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 FOMENTATION (Fig. 174). 
 
 This is an application of a hot compress, usually a thick 1328 
 folded flannel cloth, applied a number of times in succes- 
 
79 2 RATIONAL HYDROTHERAPY. 
 
 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 larger 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. 
 
 flethod. — 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 : — 
 
 1. 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 
 
- 
 
THE TECHNIQUE OF HYDROTHERAPY. 793 
 
 that it will 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 wringing (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 be 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 
 
794 RATIONAL HYDROTHERAPY. 
 
 is required, or a thin compress is used, the renewal must be 
 made at more frequent intervals. In other cases, a sufficient 
 amount of warmth may be retained to last for eight to ten 
 minutes. If desirable or convenient, a rubber bag, a bottle 
 filled with hot water, or some other heated object, may be 
 applied between the moist cloth and the dry covering to 
 maintain the heat. 
 
 When the fomentation cloth is removed for renewal, the 
 dry wrappings should be quickly replaced and the cloth wrung 
 out of hot water and replaced as quickly as possible, so 
 that the surface will not become chilled by evaporation, and 
 the effect of the fomentation be thus neutralized. An excellent 
 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 1 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 HYDROTHERAPY. 795 
 
 ent, no harm could result from a more thorough cooling 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 thorough 
 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 head. She was almost beside herself with pain, 
 and writhed in agony as every fresh paroxysm came on. No 
 hot water being obtainable without 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 
 be 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 burn. 
 
796 RATIONAL HYDROTHERAPY. 
 
 1329 Physiological Effects. — The fomentation is a powerful ex- 
 citant measure, stimulating tissue activity, increasing metab- 
 olism or tissue change, quickening the circulation and general 
 nutritive processes, and encouraging absorption and repair. 
 The excitation of the sensory, vasomotor, and sympathetic 
 nerves produces highly important functional effects. 
 
 Fomentations, like other forms of hot applications, have 
 not only a primary or direct excitant effect, but also a sec- 
 ondary sedative effect. 
 
 When applied at a sufficiently high temperature, the fo- 
 mentation 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 
 continued at a high temperature, the vasomotor paralysis 
 produced and the turgidity of the cutaneous structures is 
 very pronounced, 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 charac- 
 ter, while cold produces active dilatation. The relaxing ef- 
 fect seems to influence the veins somewhat more than the 
 arteries, thus showing the blood stream, which, with the in- 
 creased rate of hemoglobin reduction (Henocque), accounts 
 for the dusky color produced. 
 
 When applied to a cutaneous area reflexly associated 
 with some internal part, the vessels of the latter are through 
 reflex influence relaxed simultaneously with those of the 
 surface. When the fomentation is thus employed to concen- 
 trate blood in any internal part, its size should be limited to 
 that of the reflexly associated area; otherwise the derivative 
 effect of the application may counterbalance and nullify its 
 reflex effect. 
 
 Very hot applications lessen the sensibility of the cuta- 
 neous nerves. When applied to a reflex area, an anodyne 
 effect is produced in deeply seated, painful parts through the 
 thermic nerves. 
 
 The parts brought under the influence of the high tem- 
 perature are, for the time being, excited to increased action. 
 
THE TECHNIQUE OF HYDROTHERAPY. 797 
 
 Very soon after the application is withdrawn, however, an 
 atonic thermic reaction occurs, as the result of which all 
 kinds of vital activity are lowered. An examination of the 
 blood of the part to which the fomentation has been ap- 
 plied for a short time shows a notable diminution in the 
 proportion of the hemoglobin and red cells and an increase 
 of white cells to two or three times the normal. Hot ap- 
 plications encourage migration of the white cells and thus 
 leucocytosis. The actual number of blood cells in the part 
 is, however, greatly increased because of the increased vol- 
 ume. 
 
 When the blood-vessels of the skin over a deeply seated 
 part are widely dilated and rilled 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 applies to 
 applications to the abdominal surface for the relief of visceral 
 inflammations, since there is a connection between the venous 
 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 
 
798 > RATIONAL HYDROTHERAPY. 
 
 by nature for the cure of inflammatory processes or the miti- 
 gation of their evil effects. This may explain the wonder- 
 ful benefit derived from the use of heat in a large number 
 of local inflammatory processes. Recent experiments 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 which nature renders the tissues inhospitable to 
 the microscopic parasites upon which inflammation almost 
 always depends. 
 
 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. 
 1330 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 leucocytosis, and awaken functional 
 activity. For these purposes it is best used in alternation with 
 the heating compress. Remote antiphlogistic and hemo- 
 static effects are induced by derivative applications. The ab- 
 dominal fomentation is indicated when the abdominal mus- 
 cles are contracted. This remote effect is exceedingly valu- 
 able in cases of visceral congestion and inflammation ; hence 
 the efficacy of the fomentation in relieving both pain and 
 congestion in inflammation of the liver, acute and chronic gas- 
 tritis, splenic congestion and enlargement, acute and chronic 
 intestinal catarrh, peritonitis, ovaritis, metritis, and inflammatory 
 
THE TECHNIQUE OF HYDROTHERAPY. 799 
 
 affections of the muscles and nerves, in all of which cases 
 the application is made directly over the affected 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 efficient, 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 lungs, the liver, and other internal organs, have 
 been pointed out in preceding paragraphs (1270-1276). 
 
 In case of acute inflammation involving the surface 
 structures, the fomentation may be usefully employed for 
 a short period (5 or 10 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 1331 
 for their analgesic, or pain-relieving, effects, for which they 
 certainly 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 application 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 little 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 
 a 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 magic 
 
800 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 dislocation 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 chronic pains, the pain from gall-stones, 
 renal calculi, hepatic pain, infections jaundice, and for neu- 
 ralgias 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 
 after meals is an exciting measure. 
 1332 A very short fomentation over the heart is useful in col- 
 
 lapse under anesthesia, in opium poisoning, and in cases of 
 heart failure due to other causes. The application should be 
 
THE TECHNIQUE OF HYDROTHERAPY. 80I 
 
 followed by a cold compress or an 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 eyeball, very hot applications to the 
 eye, avoiding the cheek, but extending over the brow, afford 
 great relief, and greatly facilitate recovery (1264). 
 
 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 toothache, 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 reflex 
 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 simultaneously with the fomentation to 
 the face or the side of the head. The very best effects 
 are obtainable by revulsive applications (673, 1041, 1341). 
 
 In cases of hyperesthesia 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 shoulder-blades, in the 
 back, of the neck, and various other reflex neuralgias, pares- 
 thesias, and vasomotor disturbances. 
 
 Farquharson recommends fomentations to the anal region 
 in incontinence of urine when of spinal origin, and especially 
 when due to a sort of chorea of the lumbar cord. 
 5i 
 
802 RATIONAL HYDROTHERAPY. 
 
 Fomentations to the throat are of great value in inflam- 
 matory affections of the larynx, fauces, and tonsils, through 
 the strong revulsion which they produce, diverting the blood 
 away from the internal parts to the skin. The application 
 should be continued for 15 to 20 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 relief. In true croup, it 
 aids, to some degree at least, in the loosening of the obstruct- 
 ing membrane; and in false croup, the fomentation causes 
 relaxation of the contracted air passages by relieving the irri- 
 tation which gives rise to the disease. After the fomentation, 
 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 tonsillitis, and to the chest in pneu- 
 monia and pleurisy. The application should be applied for 
 5 to 10 minutes at a temperature as high as can be borne. 
 
 In ulceratio7ts and inflammations 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 1 5 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 flannel to prevent cooling by 
 evaporation, or a neutral compress (96 to 98 ) may be applied. 
 The neutral compress must be changed every 10 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 above, 
 rather than to the cheek. 
 
 Fomentations to the spine may be applied in fever as a 
 means of stimulating the spinal centers, especially the sweat 
 
THE TECHNIQUE OF HYDROTHERAPY. 803 
 
 centers, and warming the surface, thus increasing heat 
 elimination. 
 
 Fomentations over the abdomen relieve the painful tym- 
 panitis 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 vessels of the affected 
 internal part. The atonic reaction which follows hot applica- 
 tions also aids in combating the inflammation. 
 
 In the case of pelvic and abdominal inflammations , 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 invalu- 
 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 
 be continued more than 3 to 5 minutes, and should be followed 
 by a continuous cold application. 
 
 Very hot applications (1 35° to 160 ) are exceedingly serv- 1333 
 iceable in cases of swollen internal hemorrhoids or prolapsed 
 rectum, 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 1 5 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 
 
804 RATIONAL HYDROTHERAPY. 
 
 should be applied. If the bowel, or hemorrhoids, can not be 
 reduced, the hot applications should be renewed for 10 to 15 
 minutes every hour, the cold compress being continued dur- 
 ing the intervals. 
 
 The fomentation should be employed on the same plan in 
 orchitis, acute inflammation or congestion of the ovaries, 
 uterus, and kidneys, and in prostatitis, proctitis, and vagini- 
 tis when accompanied by much pain. In inflammation of 
 the bladder the cold compress must be omitted, the parts 
 being simply kept warm. 
 
 The hot fomentation to the perineum is indicated in 
 inflammation of the prostate. 
 
 Hot applications over the hypogastrium, thighs, and the 
 vulva and perineum are likewise indicated in inflammations 
 and other painful affections of the uterus and ovaries. 
 
 Intercostal neuralgia, pleurodynia, lumbago, sciatica, 
 and other pains of similar character may generally be made 
 to vanish as if by magic under the potent influence of the 
 fomentation vigorously applied. Hemicrania, being an acute 
 toxemia, in most cases, at least, is more obstinate, but is 
 often greatly relieved. 
 
 In neuralgia and acute articular rheumatism, in which 
 the application of cold as a finishing 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 15 or 20 
 minutes, or until it has become nearly of the temperature of 
 the skin. It should then be removed, the part dried and 
 gently rubbed, then covered with a warm dry soft flannel 
 folded to several thicknesses. 
 
 The cuts on page 720 (Figs. 147, 148) show at a glance 
 the areas over which hot 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 given else- 
 where (1260-1291). 
 
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, fomentations 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 lung. 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 compress 
 (1356), is perhaps the best of all means of combating 
 passive pulmonary congestion. By means of the fomenta- 
 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 lungs 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 1 5 minutes. 
 
 In the application of heat for derivative effects upon a 
 lung, an ovary, or other viscus, 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 anemia 
 which it is desirable to establish by diversion of blood to the 
 skin, will be aided by excitation of the vasomotor centers. 
 
806 RATIONAL HYDROTHERAPY. 
 
 Very hot fomentations should be applied in the early stage 
 of boils, not only for the relief of pain, but to stimulate the 
 vital activities whereby the disease may be aborted. Fomen- 
 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 the 
 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. During 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 rheumatic 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 to protect the joints, and at evening the application, 
 made just before the patient retires for the night, may be fol- 
 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 
 
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 
 congestion. This measure is especially useful in that form of 
 congestion or hyperemia of the brain due to overwork. The 
 temperature should be 135 to 14.0 , or high enough to induce 
 slight pain at the beginning of the application. A lower 
 temperature than this has the effect to produce slight con- 
 gestion in a normal brain, or to increase the congestion 
 when the blood-vessels are overdiste7ided. The compresses 
 should be light, and should be renewed every two or three 
 minutes. Two compresses are required for applications 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 applications. 
 
 Light, very hot fomentations are exceedingly useful in 
 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 head 
 and by moderately warm applications around the neck, 
 whereby the blood supply of the brain is increased. 
 
 In cases of great loss of 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 
 application should be made especially to the neck and the 
 top of the head. Hot applications made to the face alone, 
 or 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 of urine, constipation 
 accompanied by abdominal pain and tenderness, torpid liver, 
 
808 RATIONAL HYDROTHERAPY. 
 
 and dysmenorrhea, the very hot fomentation is a remedy of 
 great value, and may be used with brilliant results. The 
 efficiency of this measure in relieving sick-headache is unri- 
 valed, the applications being made to the spine, head, neck, 
 or stomach. 
 
 When employed to relieve suppression of the urine from 
 co7igestion of the kidneys or in acute nephritis, 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 10 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 hysterogenous 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 circinatus, the applications being made 
 daily, at a temperature of 122 . When the disease affects the 
 scalp, 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 form 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 confined 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 (Fig. 177), 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 for 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, lepto- 
 meningitis, spinal irritation, acute chorea, chorea major, 
 general tic, paralysis agitans, tetany, occupation neuroses, 
 angioneurotic edema, scleroderma, muscular contraction, 
 alcoholism, 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, influenza, chronic dysentery, 
 
8lO RATIONAL HYDROTHERAPY. 
 
 miliary fever, febricula, locomotor ataxia, diabetes, chronic 
 gastritis, tuberculosis of the lymph glands, Weil's disease, 
 lithemia, increased peristalsis, gastric ulcer, cholera morbus, 
 cholera infantum, Asiatic cholera, appendicitis, torticollis, 
 ascending paralysis, BeW s palsy, Meniere 's disease, paraly- 
 sis of the circumflex nerve, myelitis, anterior poliomyelitis. 
 
 The thorough application of the fomentation two or three 
 times a day for a week or two preceding an abdominal opera- 
 tion, m 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 for any 
 reason a cold application can not be made, the patient should 
 be wiped dry with a soft towel, and covered sufficiently to 
 prevent chilling; but the covering should not be so warm as 
 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 5 to 10 
 minutes) repeated at intervals of two or three hours, cold 
 compresses being applied during the interval. In case the 
 inflammatory affection is situated in an internal viscus, the 
 application may be continued for half an hour, or even for 
 a longer period, provided there is not at the same time a con- 
 siderable general elevation of temperature. The reason 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 
 reach the diseased part, but its blood-vessels are made to con- 
 tract through the influence of the heat upon the vasomotor 
 nerves, and through the induced collateral hyperemia. 
 
 7. In some painful affections, especially when the skin is 
 in a state of hyperesthesia, the application of intense heat 
 aggravates the pain as well as other symptoms. In such 
 cases more moderate heat — neutral or even cold or heating 
 compresses — should be employed. 
 
 8. It should be remembered that if a fomentation is left in 
 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. 
 
 10. The fomentation must be avoided, or, if employed at 
 all, only with great care and for short periods (5 to 10 min- 
 utes), when the abdominal walls are relaxed and the intes- 
 tines distended with gas, since the natural effect of heat is to 
 increase these conditions. 
 
 THE HOT=WATER BAG (Fig. 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 rilled 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 when it is desirable to employ heat for a consider- 
 able time. 
 
 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 appli- 
 cation is made not to the spine, but to the back, and hence 
 should cover a sufficiently broad area to bring under the 
 influence of heat a considerable portion of the cutaneous 
 branches of the posterior spinal nerves. The results to be 
 obtained are due, not to the action of heat upon the nerve 
 centers, but to reflex and fluxion effects. 
 
 THE SIPHON HOT-WATER BAG. 
 
 1336 The siphon bag (Fig. 179) devised by the author some 
 twenty-two years ago is a convenient method for applying 
 
I 
 
THE TECHNIQUE OF HYDROTHERAPY. 813 
 
 either heat or cold continuously. It is used in precisely the 
 same manner as the cooling or heating 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 an'd completely than does the coil, and is more 
 uniformly heated. 
 
 THE THERMOPHORE. 
 
 This is a rubber bag containing a quantity of a chemical 1337 
 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. 
 
8l4 RATIONAL HYDROTHERAPY. 
 
 THE MUSTARD FOMENTATION. 
 1338 This measure consists of an ordinary fomentation in' 
 which mustard is added to the water employed in the pro- 
 portion of a tablespoonful of ground mustard to the quart 
 of water. It is not necessary to prepare a large quantity of 
 water. Boiling water into which ground mustard has been 
 thoroughly stirred in the proportion of a tablespoonful to 
 the quart, and steeped for a few minutes, should be freely 
 sprinkled upon the fomentation cloths, previously wrung out 
 as dry as possible, placed in a basin or pail. 
 
 The effect is that of a 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 COMPRESS. 
 
 1339 This is a compress at 92 to 97 , its temperature being so 
 
 nearly that of the skin that neither thermic nor circulatory 
 reaction is produced. Its effects are simply those of a poul- 
 tice. The sensibility of the cutaneous nerves is lessened by 
 the imbibition of moisture, 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 locomotor 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 hyperesthesia of the skin due to an irritable 
 condition of the abdominal sympathetic centers. It may 
 
THE TECHNIQUE OF HYDROTHERAPY. 815 
 
 replace the poultice 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 {ox painful wounds, 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 covered, and with 
 flannel only, the neutral rather than the stimulating effect is 
 obtained. The same measure renders valuable service in 
 cases of sprain, joint injury from dislocation, chronic inflam- 
 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 zoster. 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 through its nerve-quieting 
 
8l6 RATIONAL HYDROTHERAPY. 
 
 influence as a general neutral compress that the wet-sheet 
 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 
 relieving hyperesthesia of the "abdominal brain," the solar 
 plexus, and the lumbar ganglia of the sympathetic. 
 
 THE ALTERNATE COMPRESS. 
 
 134:0 This measure consists in the application of very hot and 
 very cold compresses in alternation. 
 
 riethod. — 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 duration 
 of each application respectively may be timed so as to meet 
 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 succes- 
 sive applications of heat and cold to some extent combine the 
 effects 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 817 
 
 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. 
 
 Therapeutic Applications. — The alternate compress may 
 be advantageously employed to combat the tendency to sup- 
 puration in cases of localized 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 2 
 
8l8 RATIONAL HYDROTHERAPY. 
 
 puration is threatened, may be kept in such constant move- 
 ment, contracting and dilating, that the cell-paralyzing 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 
 for 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 to paralyzed limbs, and to parts affected by 
 chilblains > also as a means of stimulating absorption in dropsy 
 of the abdomen, dropsy of the chest, and in chronic pleurisy 
 and pneumonia, 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 
 opium poisoning, profound alcohol intoxication, or poisoning 
 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 819 
 
 the heat and cold. With the alternate compress the applica- 
 tions are of equal time, or at least the cold application does 
 not exceed the hot. 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 
 are 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 
 
8 20 RATIONAL HYDROTHERAPY. 
 
 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, neither 
 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 
 increase the pain by exciting the affected nerves. This 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 
 eye, 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. 
 
 1342 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. 821 
 
 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 uncovered or pro- 
 tected by two or three thicknesses of cheese-cloth, are more 
 vigorous measures 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 10 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 10 or 
 15 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., 15 to 20 seconds each. 
 
822 RATIONAL HYDROTHERAPY. 
 
 Alternate sponging is a measure which may be con- 
 tinued 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 sufficiently 
 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 up 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 must 
 be taken to adapt the application carefully to each individual 
 case. A somewhat prolonged (5 to 8 min.) hot pour to the 
 spine, followed by a cold pour for 1 5 to 20 seconds, is a most 
 excellent means of relieving congestion of the cord. The 
 pour may be very conveniently administered with the patient 
 sitting over the edge of a full bath-tub, or upon a low 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 Applications. — The alternate process is of 
 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 efficient means of arousing the patient from 
 opium or alcohol narcosis. It is equally indicated in Prussic 
 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 drowning. The 
 application should be continued not only until the patient 
 shows evidences of returning consciousness, but for some time 
 
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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 chloroform, 
 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 COHPRESS OR LOCAL PACK (Fig. 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. 
 
 flethod. — 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- 
 tecting 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 
 compress 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 825 
 
 2. When the purpose is to control a deep-seated inflam- 
 mation by producing fluxion of the parts, the compress being 
 changed once in 30 or 40 minutes for this purpose, the com- 
 press should be covered with flannel, so as to cause prompt 
 reaction. 
 
 3. When it is desired to produce the effect of a poultice 
 by the fullest possible accumulation of heat and consequent 
 dilatation of the surface vessels, the compress should always 
 be protected, not only by several layers of flannel, but also 
 by some impervious covering, as thin mackintosh, or rubber 
 cloth, or oilcloth; or in the absence of some convenient, 
 impervious material, ordinary newspapers may be employed. 
 The efficiency of paper may be increased by saturating it 
 with oil, wax, or paraffin. This is the protected heating 
 compress proper (Fig. 182). 
 
 The rate at which the heat accumulates in the heating 
 compress depends, of course, primarily upon the degree of 
 protection; but many other factors are involved, as the tem- 
 perature of the water employed, the amount of water left in 
 the compress, the reactive powers of the patient, and the 
 condition of the cutaneous circulation in the surfaces to which 
 the application is made. 
 
 Other things being equal, very cold water produces a 
 quicker and more vigorous reaction than water of a higher 
 temperature. The more water the compress contains, the 
 longer the time required to heat it, hence the longer the 
 delay in the establishment of the reaction. If the protection 
 is but partial, evaporation may take place at such a rate as 
 to prevent accumulation of heat, the heat being dissipated by 
 the evaporation as rapidly as it is generated. If the compress 
 dries rapidly, this fact is evidence that rapid evaporation is 
 taking place; and of course the heating of the compress will 
 be much less than when it is protected by an impervious 
 covering. 
 
 Physiological Effects. — The effects of the heating com- 1345 
 press are like those of the wet-sheet pack, somewhat mixed 
 
826 RATIONAL HYDROTHERAPY. 
 
 or varied. At the beginning and for some minutes after the 
 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 produced in the related internal area. 
 When reaction takes place, however, heat begins to accumu- 
 late, and dilatation of the vessels occurs, which increases with 
 the accumulation of heat, — a characteristic which gives to 
 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 congestion 
 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 are 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 efTect 
 
THE TECHNIQUE OF HYDROTHERAPY. 827 
 
 of a well-protected compress may not be greater than that 
 of a partially protected compress with another person. This 
 fact must be constantly considered in giving directions respect- 
 ing the application of the heating compress. 
 
 In persons in whom reaction takes place very slowly after 
 the application of the compress, so that uncomfortable chilli- 
 ness and other disagreeable symptoms are experienced, the 
 surface with which the bandage is to come in contact should 
 be vigorously rubbed with the dry hand until red, or with the 
 hand or a friction mitt dipped in water at a temperature ten or 
 fifteen 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. 
 During the warming-up period, before superheating begins, 
 the effect of the heating compress is highly tonic, exciting 
 all the functions of the skin and the internal parts connected 
 with 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 
 heat is produced, including analgesic effects upon the skin and 
 associated parts, and also developing atonic thermic reac- 
 tion, and producing powerful derivative or revulsive effects. 
 
 If it is desired to emphasize the tonic effect of the appli- 
 cation, 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 
 warmly covered with blanket flannel, and the impervious 
 protection carefully applied. It may be well to remark that 
 when the greatest heat accumulation is secured by the imper- 
 vious 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 
 being maintained in the skin, a strong tonic effect is exerted 
 upon the viscera, and most powerful fluxion 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 
 
 insomnia, indigestion, constipation, bronchial catarrh, laryn- 
 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 asthma; 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 coryza, headache, vertigo, or insomnia 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 of hypopepsia. 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 HYDROTHERAPY. 829 
 
 warmed, so as to encourage energetic fluxion in the lungs, 
 the importance of which has been pointed out elsewhere. 
 
 The heating compress likewise finds useful employment as 
 an application to the trunk in acute and chronic peritonitis 
 (frequently renewed, in the acute form), amyloid infiltration 
 of the liver, amyloid kidney, acute ascending paralysis, co7i- 
 gestion of the spleen, ascites, infectiotis jaundice, icterus neo- 
 natorum, appendicitis, enteralgia, intestinal catarrh, gastric 
 ulcer, hyperorexia, Addison' s disease, chronic migraine ; to 
 the spine in locomotor 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 of treatment are capable of 
 producing more disastrous results than the heating 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 applied, 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 GIRDLE (Fig. 183). 
 
 This application is practically the same as the half-pack, 1347 
 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. 
 
83O RATIONAL HYDROTHERAPY. 
 
 This measure has been exceedingly popular in Germany 
 for at least a hundred years, and possibly a much longer 
 time, under the name of " Neptune's girdle." 
 
 Requisites.— A linen bandage usually eight or nine inches 
 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 (134-4). The girdle may be wide enough to reach 
 from the axillae to the hips, when it is termed the trunk 
 pack. In some cases also it is better to reduce the size of 
 the bandage at the start, covering only the abdominal sur- 
 face instead of passing the bandage around the whole 
 trunk. The impervious covering may be applied or omitted 
 as indicated. 
 1348 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. If the covering 
 is 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 83 1 
 
 the viscera and the structures of the abdominal wall is 
 clearly shown by the strong contraction of the abdominal 
 muscles frequently occurring in connection with visceral irri- 
 tation. 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 1349 
 is one of the most valuable of what might be termed the 
 minor hydrotherapeutic measures. Its use is applicable to all 
 cases in which there is evidence of visceral irritation or hyper- 
 esthesia of the abdominal sympathetic ganglia, a condition 
 which is almost universally present in chronic dyspepsia, con- 
 stipation, gastric and intestinal catarrh, hepatic congestion 
 and other disorders of the liver which result from chronic gas- 
 tric disorders, and in many chronic pelvic 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 secretion, and 
 thus tending to promote normal activity and to relieve chronic 
 
832 RATIONAL HYDROTHERAPY. 
 
 constipation. Applied around the upper portion of the abdo- 
 men, the bandage is useful as a means of promoting health- 
 ful activity of the stomach and liver. Its effect is power- 
 fully revulsive. It stimulates the vasomotor centers, and 
 hence relieves congestion of the liver, kidneys, and other 
 abdominal viscera. It is also of much service in ordinary 
 dyspepsia with dilatation and prolapse of the stomach. 
 
 There is no more serviceable measure in the treatment of 
 chronic indigestion in all its forms. In hyperpepsia, it should 
 be applied very cold, wrung very dry, covered just sufficiently 
 to secure good reaction, superheating being avoided by omit- 
 ting the impervious covering. This is also true in each of 
 the conditions above mentioned. 
 
 In hypopepsia y the bandage should be wrung out of water 
 at a temperature of 6o° to 70 , very dry, 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 flatulence 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 y 
 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 to 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 HYDROTHERAPY. 
 
 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 gestatioit. It may be 
 used with benefit during the entire period, and especially dur- 
 ing the later months. 
 1350 Precautions and Contraindications. — i. 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 rubbing 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 abdominal 
 supporter. 
 
 3. When worn night and day, the wet girdle frequently 
 gives rise to an eczematous, or, in some cases, herpetic 
 eruption of the skin; sometimes boils make their appearance 
 in the region covered by the bandage. These morbid proc- 
 esses are in no way desirable, and care should be taken to pre- 
 vent them. The old notion that effete 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 zinc, 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 
 
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 invalids 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 stomach, 
 in varicose conditions of the gastric veins, in Jiemorrhoids, 
 intestinal catarrh, bleeding fibroid 'of 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. 
 
8$6 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 (1347), 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 ganglia of the abdomi- 
 nal sympathetic, constipation, flatulence, gastric and intes- 
 tinal catarrh t insomnia y 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. 
 1352 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- 
 tem is a reservoir capable of containing all the blood in the 
 body. When the heating 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. 83/ 
 
 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 conditio?t 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 
 malarial 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. 
 
 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 varicose 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 may be 
 seen near the epigastrium. 
 
 It should be remarked that in these cases the abdominal 
 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 in 
 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 ABDOMINAL BANDAGE. 
 
 1353 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 night, 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 1854 
 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 
 
 SC3.1d 
 
 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. 
 
84O RATIONAL HYDROTHERAPY. 
 
 Requisites. — The requisites 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 cheese-cloth bandage one foot wide, three 
 thicknesses, and four yards long. 
 
 Method. — The towel is folded lengthwise and wrung dry 
 from water at 6o°, 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 Applications. — The spinal pack produces, 
 first, strong fluxion in the spinal 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 hyperemia 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 8o°, covered with two thick- 
 nesses of flannel only, without mackintosh, is a calmative 
 procedure of great value in spinal irritation with hyperes- 
 thesia of the spine, and in conditions in which irritability 
 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 84I 
 
 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 1 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 
 
842 RATIONAL HYDROTHERAPY. 
 
 adjusted with special relation to internal parts, as explained 
 for each special form of this procedure. 
 1357 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 
 1262-1291. 
 
 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; 
 
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 RATIONAL HYDROTHERAPY. 
 
 The author has made use of this application for many 
 years as a means of relieving certain forms of neuras- 
 thenic headache. It is exceedingly useful also in so-called 
 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- 
 cedure in the treatment of insomnia when due to cerebral 
 hyperemia. It should be avoided, however, in cases of insom- 
 nia due to excessive excitability of the cerebral cells, and is 
 of course contraindicated in insomnia due to anemia. 
 1359 The Hot and Cold Lung Compress. — A thick and very 
 hot fomentation is applied over the back, reaching from the 
 middle of the neck to the lumbar region, and extending to 
 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 made 
 simultaneously, especially hot packs, which produce decided 
 derivative effects. 
 
 This procedure is exceedingly useful in the early stages of 
 pneumonia, in broncho-pneumonia, 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 HYDROTHERAPY. 845 
 
 cold lung compress in cases in which an anesthetic is 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 surface 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 lungs, 
 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 ether anesthesia, and thus 
 combats the tendency to bronchial pneumonia, which is often 
 a greater risk in old subjects than the operation itself. 
 
 A special form of the hot and cold compress is of particu- 1360 
 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- 
 
846 RATIONAL HYDROTHERAPY. 
 
 ishes the excitability of the respiratory centers, while the 
 fomentation relaxes the spasm of the bronchioles. 
 
 1361 The Hot and Cold Renal Compress (Fig. 185) The hot 
 
 application covers the back from the middle dorsal region to 
 the coccyx. The cold application should consist of an ice- 
 bag or a cold compress covering the lower third of 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 reflex 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. 
 
 1362 The Hot and Cold Qastro= 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 cold 
 bag at least eighteen inches long is applied to the dorsal and 
 lumbar spine. Through the dilatation of the branches of the 
 internal mammary arteries and associated veins, the blood 
 is 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. 847 
 
 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 establishing collateral hyperemia of the overlying struc- 
 tures, and also by diverting the venous blood from the kidney 
 into the anastomosing muscular channels. 
 
 This procedure is of special value in chronic duodenitis 
 and colitis. 
 
 The Hot 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. 153.). 
 
 This measure is especially valuable in the treatment of 
 acute inflammations of the uterus, tubes, ovaries, and blad- 
 der, in appendicitis and pelvic peritonitis. In cases of 
 inflammation of the prostate, in proctitis, and cystitis, the 
 ice-bag 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 HEATING COMPRESS OR PACK. 
 
 This procedure differs from the hot and cold compress in 1365 
 the same way in which the ordinary heating compress differs 
 from the cold compress. In the hot and cold compress 
 the hot application is made continuous, or practically so, 
 by the frequent renewal of the compress. In the hot and 
 heating compress or pack the cold application is not re- 
 newed, 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. 
 The 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 HYDROTHERAPY. 849 
 
 3. By lowering the pressure in the veins, the arterial cir- 
 culation through the affected part is facilitated, 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 (1262-1278). 
 
 The Hot and Heating Chest Pack — The chest pack is 1366 
 applied 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 arranged, 
 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 is a good 
 plan to adjust a flannel about the neck in the manner shown 
 in Fig. 186. 
 
 The Hot and Heating Abdominal Pack (Fig. 187) .—In 1367 
 this procedure the moist bandage is placed around the trunk 
 at the level of the umbilicus in the usual manner for 
 the iimschlag, or wet girdle (1347). 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 Winternitz, 
 using instead of a coil, however, a rubber bag filled with very 
 hot water, a thermophore, or a siphon sack. 
 
 ' The first information printed in this country in relation 
 
 54 
 
85O RATIONAL HYDROTHERAPY. 
 
 to this valuable hydriatic measure was an article contributed 
 by Professor Winternitz, by request of the author, to his 
 journal, Modem Medicine* 
 
 If necessary to continue the application for a considerable 
 length of time, the hot water bag may be refilled once or 
 twice. In general, however, it is better to remove the hot 
 bag or coil at the end of the first 30 minutes, thus avoiding 
 overheating. 
 
 The hot and cold abdominal pack has rendered most 
 valuable service in a great number of cases; and so positive 
 and satisfactory have been its results in the hands of the 
 author that in his estimation it stands almost unrivaled as a 
 hydriatic procedure in the certainty with which it produces 
 the effects expected from it. This measure has proved espe- 
 cially successful in both sensory and motor disturbances of 
 the stomach, especially in cases in which the patients com- 
 plain of pain soon after eating, flatulence, eructations and 
 regurgitations of food and vomiting of bile. 
 
 In one case in which a lady had suffered four months from 
 regurgitation of bile into the stomach, being reduced to a very 
 low state, the reflux of bile was at once controlled by the 
 application of this pack. It was applied half an hour before 
 each of the two daily meals given the patient, and was 
 retained two hours, so that the process of digestion was begun 
 under the influence of the pack. During the first few 
 weeks of the treatment the difficulty returned occasionally 
 when the compress was omitted, but after a few months, the 
 patient was able to dispense with the pack, and was not 
 only entirely relieved of the distressing symptom, but had 
 gained twenty-five pounds in flesh, and was restored to health. 
 In another case a man had been for years afflicted in the same 
 manner, having frequent attacks, lasting for several weeks, 
 during which time vomiting occurred within a few minutes 
 after each meal. The patient was brought to the Battle 
 Creek Sanitarium in an extremely feeble condition. The hot 
 
 ^Modern Medicine, Vol. I, page 50. 
 
THE TECHNIQUE OF HYDROTHERAPY. 85 1 
 
 and cold abdominal compress, however, controlled the vomit- 
 ing in a few 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 application of this powerful analgesic pro- 
 cedure. By its daily application for a few weeks, cases in 
 which the ganglia 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 cases of 
 nervous headache, or migraine, which is likewise a sympa- 
 thetic nerve disorder. Obstinate vomiting, nausea, including 
 the nausea and vomiting of pregnancy, 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 hyperpepsia and in hypopepsia attended by 
 gastric irritation. 
 
 The Hot and Heating Lumbar Pack — This application 1368 
 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 square bag is used for this purpose. This 
 application is of special service as a means of combating 
 portal or renal congestion. Care must 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 Heating Spinal Pack — A half sheet, one 13^9 
 thickness, wjung out 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 
 
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 Heating Pelvic Pack. — This measure is 
 applied in the same manner as the ordinary 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 blanket and the 
 wet sheet, 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 muscular spasm, as tenesmus of the 
 bladder or rectum, and vaginismus. Painful ovarian conges- 
 tion, 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. 853 
 
 erally very readily relieved by it. Sexual erethism, irregular 
 and painful menstruation, and the heaviness and indescrib- 
 able but distressing symptoms with which so many invalid 
 women suffer, yield to this remarkably efficient measure. 
 
 SPECIAL FORHS OF COilPRESS. 
 
 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 which need to be understood, especially in 
 relation to the technique of their application. These are 
 the cephalic compress, the chest pack, the throat compress, 
 the neck compress, the joint compress, the cotton poultice, the 
 hip pack, the pelvic pack, the leg pack, the foot pack, and 
 the hot 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 CEPHALIC COilPRESS (Fig. 188). 
 
 The application is usually made to either the top or the 1371 
 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 is 
 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, 1262). A napkin moistened with ice-water 
 
854 RATIONAL HYDROTHERAPY. 
 
 and laid'upon the forehead may do more harm than good, by 
 contracting the supraorbital branch of the internal carotid, 
 and thus diverting more blood into its internal branches in 
 the cerebrum. This effect may be readily antagonized by 
 a cold application about the neck, which will contract the 
 carotids and the vertebral arteries and all their branches, and 
 thus aid the reflex action from the face and scalp in lessening 
 the volume of blood in the brain. 
 
 These contrary and undesirable effects of cold applications 
 are most likely to occur in conditions in which the vascular 
 tension is low and fluctuating. They may give rise to local 
 or circumscribed cyanosis from vascular spasm, and simul- 
 taneous collateral congestion. 
 
 In making cold applications for the relief of cerebral con- 
 gestion, special care should be given to the eyes. The com- 
 press should always cover them, and should be well pressed 
 down upon them, so as to utilize the powerful reflex relations 
 which exist between the eye and the brain through the 
 sympathetic. 
 
 The same principle governs applications to the hands and 
 feet for relief of inflammatory conditions involving deep 
 structures. An ice-bag over the trunk of the supplying artery 
 (axilla, bend of elbow, groin, popliteal space) will lessen the 
 local congestion, as well as or even better than an application 
 to the whole arm or leg; while an application to the part 
 alone might produce collateral internal congestion. 
 
 Physiological Effects. — The effects of the application of 
 cold to the head have already been considered (1072). It may 
 be mentioned further that the head compress is less exciting 
 and more sedative than the cephalic douche. Applied con- 
 tinuously, or frequently renewed, the prolonged cold head 
 compress is highly sedative, lessening the cerebral blood supply, 
 and diminishing the activity of the brain. In active conges- 
 tion, a continuous very cold application is best; in passive 
 congestion, it is better to secure vasomotor exercise and 
 fluxion of the brain by means of the repeated impressions ob- 
 tained by frequent renewals of the cold compress, allowing 
 
Fig. 189. ROLLER CHEST PACK — First Fig. 190. ROLLER CHEST PACK — Second 
 
 Step (p. 858). Step (p. 858). 
 
 Fig. 191. ROLLER CHEST PACK 
 Complete (p. 858). 
 
 Fig. 192. ROLLER CHEST PACK 
 Complete (p. 858). 
 
THE TECHNIQUE OF HYDROTHERAPY. 855 
 
 only time for the beginning of reaction effects or slight warm- 
 ing of the compress. 
 
 The short cold compress increases the cerebral blood 
 supply by reflex reaction effect. 
 
 The hot or warm cephalic compress, or fomentation to 
 the head, congests the cerebral vessels when long applied. 
 
 A short hot application acts by revulsion to diminish the 
 blood supply of the deeper parts. 
 
 Therapeutic Applications — All forms of cerebral conges- 
 tion, insomnia from cerebral hyperemia, the delirium of 
 infectious fevers, and congestive headache, require the cold 
 head compress. 
 
 The hot head compress, or fomentation to the head, excites 
 cerebral activity, and is of great service in anemia in syn- 
 cope, shock, and in collapse from any cause when associated 
 with cerebral anemia. 
 
 The short 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. This 
 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 long-continued 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 spermatorrhea 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 
 vaginismus, and in masturbation 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. 
 
856 RATIONAL HYDROTHERAPY. 
 
 In anemic headache, the ice-bag may be applied to the 
 upper part of the neck for 1 to 3 minutes. The reaction 
 following increases the supply of blood to the brain. In 
 nervous asthma, prolonged applications of the ice-bag to the 
 back of the head will be found advantageous (1360). For 
 very rapid beating of the heart, apply the ice-bag for 10 to 
 20 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 cold 
 
 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 column, 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 dorsal, 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 1 5 or 20 minutes, and the surface 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 (6o°, 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 HYDROTHERAPY. 857 
 
 dorsal region in nervous vomiting; to the lumbar region in 
 uterine and renal hemorrhage ; 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 applications of all sorts to the spine are contraindi- 
 cated in most cases of so-called spinal 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 1373 
 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 still, 
 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 patient's 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 
 
858 RATIONAL HYDROTHERAPY. 
 
 of the bandage is drawn and tucked under the transverse fold 
 crossing the chest. The transverse portion of the bandage is 
 then pulled up toward each shoulder, and fastened as snugly 
 as possible by means of safety-pins. The wet bandage should 
 be made to fit the patient tightly everywhere (Figs. 189-192). 
 
 A flannel bandage of the same width and a little greater 
 length is applied over the moist bandage in precisely the 
 same manner, care being taken to cover the wet bandage 
 completely, and to make it fit snugly at every point so as 
 wholly to exclude the air. The flannel bandage may be long 
 enough to extend several times about the chest so as to pro- 
 tect the wet bandage as thoroughly as necessary. A bandage 
 of mackintosh cut as in the square pack (Fig. 193) may be 
 placed next the wet bandage when needed. 
 1374 The Square Chest Pack.— This is one of the most con- 
 venient and perhaps on the whole the most satisfactory of all 
 the several forms of the chest pack (Figs. 193-197). 
 
 Requisites. — A rectangular linen bandage of the proper 
 length, and a woolen bandage of the same shape but larger. 
 The length of the linen bandage should be one and one-half 
 times the circumference of the patient's chest over the largest 
 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 wider and 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 859 
 
 at 6o°, 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 Triangular Chest Pack. — This is a very convenient 1375 
 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 
 
860 RATIONAL HYDROTHERAPY. 
 
 patient lies down. Now, wet the triangular linen bandage in 
 the following manner : Fold it by placing the two equal 
 angles of the triangle together, grasping the bandage with the 
 left hand at the middle of the base. Continue folding in like 
 manner until three or four inches wide, then turn the lower 
 end upward, still retaining the hold with the left hand. Dip 
 the whole in water, wring out dry so as not to drip, still 
 retaining hold with the left hand as at the beginning. After 
 the bandage is wrung dry, shake with the left hand until it is 
 completely unfolded. Spread out with the apex down, the 
 base upward, falling parallel with the base of the triangular 
 woolen bandage and one inch below it (Fig. 198). Now let 
 the patient lie down in such a position that the occiput will 
 fall just below the upper edge of the bandage. Next let the 
 attendant lay hold of one lateral angle of the wet bandage, 
 and draw over the shoulders, then the other, covering each 
 shoulder well, and carrying the tips of the bandage across 
 the chest and under the side opposite, leaving the arms out. 
 The woolen triangle is then adjusted in similar fashion, and 
 lastly the folded sheet is brought around the chest, first one 
 end and then the other, binding all together (Fig. 199). 
 When necessary to renew the compress, it may be easily 
 withdrawn after opening the woolen wrappings. 
 1376 The Towel Chest Pack. — This is the simplest and one of 
 
 the best of all the various forms of the chest compress or 
 pack. It differs from the preceding only in having two large 
 towels used in place of the linen triangle. These are wrung 
 out very dry, and then applied one over each shoulder and 
 across the chest in front and behind, care being taken to cover 
 the whole surface of the chest (Fig. 200). The outer wrap- 
 pings are then closed about the chest as in the triangular 
 pack. The wet towels must be wrung as dry as possible. 
 In applying the chest pack in either form described, it is 
 of the utmost importance that the application be made accu- 
 rately. If the compress is applied in such a way that evapora- 
 tion takes place, the parts will be chilled, producing an effect 
 
THE TECHNIQUE OF HYDROTHERAPY. 86l 
 
 the very opposite to that desired. On the other hand, 
 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 6o° or less, except for very 
 feeble patients who are not accustomed to cold, in which 
 case it may be yo° to 7 5°, 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 50 , 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. — In certain cases it may some- 1377 
 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 well 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. 201). The flannel covering is then 
 applied in the usual way, and lastly a flannel bandage of 
 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 
 the chest, 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 
 Jong enough, or two towels may be used. If necessary, a 
 
862 RATIONAL HYDROTHERAPY. 
 
 safety-pin may be applied at the top of the shoulder in such 
 a way as to attach the towel to the flannel to prevent its 
 slipping down over the shoulder. 
 
 The hot and heating chest pack (1366) and the hot and 
 cold lung compress (1359) have been fully described else- 
 where. They are important modifications of the chest com- 
 press which are of special value in the morbid conditions in 
 which they are particularly indicated. The special directions 
 for the use of the chest compress in pneumonia and other 
 pulmonary maladies are given elsewhere. 
 
 1378 Physiological Effects — There is no therapeutic agent the 
 use of which rests upon a more thoroughly sound and rational 
 basis than does the employment of the compress in pul- 
 monary affections, especially in pneumonia. 
 
 The experiments made by Winternitz and Schlikoff showed 
 that the temperature of the cavity of the chest is diminished 
 within ten minutes after the application of the cooling thoracis 
 compress. The blood-vessels of the chest are made to con- 
 tract instantly when contact with the cold compress is made. 
 The tidal air is increased more than one third in volume 
 (Exp. 71). 
 
 1379 Therapeutic Applications — The chest pack acts powen 
 fully upon the pulmonary mucous membrane. It is of great 
 value in pulmonary congestion, and has also been used with 
 considerable success in pulmonary tuberculosis. In this dis- 
 ease it controls the cough, lowers the temperature, lessens the 
 night sweats, and facilitates the healing process by aiding 
 leucocytosis. In bronchial catarrh it is of very great service, 
 relieving the congestion by bringing the blood to the surface, 
 thus relieving the cough and the expectoration. 
 
 In spasmodic asthma the application of the chest pack 
 sometimes brings on a paroxysm of difficult breathing. This 
 tendency may be largely obviated by the application of fomen- 
 tations to the chest just before the application of the cold com- 
 press. The chest pack is a very valuable measure in all cases 
 of chronic bronchitis, chronic pneumonia, and chronic pleurisy f 
 
THE TECHNIQUE OF HYDROTHERAPY. 863 
 
 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 — 5 to 
 8 minutes. 
 
 The cooling chest compress is applicable in all cases of 
 congestion and inflammation 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 given 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 5 minutes, followed by a cold compress for 15 to 20 
 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 
 f aintness are likely to occur. 
 
864 RATIONAL HYDROTHERAPY. 
 
 When considerable fever is present, as indicated by a tem- 
 perature of ioi° to 102°, the compress should be wet in cool 
 water, or water at a temperature of 6o° to 70 , and wrung 
 lightly, so that it may contain, when applied, as much water 
 as possible without 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. — 1. Every precaution must be taken to avoid 
 chilling the patient. If the towel is too wet, a feeble patient 
 may not be able to warm 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 and pneu- 
 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; 
 
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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 ear. 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 RATIONAL HYDROTHERAPY. 
 
 THE NECK COMPRESS (Fig. 206). 
 
 1382 This consists simply of a linen cloth wrung out of water 
 
 at the right temperature and wound about the neck, covered 
 with flannel or flannel and oilcloth. 
 
 For acute laryngitis the bandage should be wet in water at 
 6o° to 70 , wrung moderately dry, and covered with flannel 
 only. It should be changed just before the bandage becomes 
 dry. In cases of chronic laryngitis the bandage should be 
 wrung out of very cold water, and covered with flannel and 
 mackintosh. On removing the bandage in the morning, the 
 parts should be thoroughly rubbed with cold water, and should 
 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 larynx, 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 organs 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 in 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" are 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 867 
 
 for sore throat, should be lightly covered with flannel, and 
 changed every four hours; if for chronic catarrh of 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 cerebral ane- 
 mia, as also in pernicious 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 torticollis cured 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 be 
 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 slow 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 Cher et d' Orthod.," 1896, XX, 73, 76. 
 
$6& 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 cutaneous 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 (298-316, 620). 
 1384: Therapeutic Applications — Frequent application of cold 
 over the heart is indicated in the feeble heart of low 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 are employed, the com- 
 press or ice-bag should be removed every half hour, and the 
 
(a). Before Application (Tension Low). 
 
 (t>). After Application (Tension High). 
 Fig. 207. SPHYGMOGRAPHIC TRACINGS SHOWING THE EFFECTS OF THE 
 COLD CARDIAC COMPRESS IN RAISING THE BLOOD PRESSURE (p. 868). 
 
 M ' 
 
 Fig. 208. JOINT COMPRESS (p. 872). 
 
 i 
 
 W 
 
 Fig. 209. COTTON POULTICE (p. 872). 
 
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 chloroform 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 
 thickness of thin flannel. Every ten minutes the ice-bag; is re- 
 
87O RATIONAL HYDROTHERAPY. 
 
 moved, and the parts rubbed with dry flannel until warm and 
 reddened. A failure of the parts to react or the appearance 
 of an areolar cyanosis (a mottled bluish appearance) consti- 
 tutes a warning sign of excessively depressed nerve centers, 
 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 opinion 
 that few deaths from chloroform would ever occur if this 
 measure were uniformly resorted to. The ice-bag should 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 6o°, and changed every 15 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: — 
 
 " 1. 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. 87 1 
 
 '*2 4 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 d^ugs are employed, cold applications should be 
 applied over *he heart, for the reason that antipyrin 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 in 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 (no° for 10 min.).* 
 
 Contraindications. — The cold precordial compress is to be 1386 
 avoided in the fatty degeneration of the heart muscle which 
 occurs in the advanced stages of cardiac disease, and in dia- 
 betes 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- 
 mation, the restoration of the tonus of the vessels and tissues 
 removes the disease of the vessels thus caused. 
 
 * Thermes. Ann. Soc. Hydrol. Med., Paris, 1879-80, 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 derange- 
 ments 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 importance 
 to restore normal conditions of the circulation. 
 
 THE JOINT COMPRESS (Fig. 208). 
 
 1387 This 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 impervious 
 material. In cases of acute joint disease with pain and swell- 
 ing, a moderately wet compress should be applied, at a tem- 
 perature of 6o° 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- 
 tected by means of several coverings of flannel or a thick 
 mass of 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 
 ordinary cases. In the morning the 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. 
 
 THE 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. 
 
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, 212, 213). 
 
 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 RATIONAL HYDROTHERAPY. 
 
 down upon it, the sacrum will fall in the center of the sheet 
 each way. Fold another woolen sheet cornerwise, and lay 
 across the table with the apex pointing down and the base at 
 such a point that when the patient lies down, the upper edge 
 of the blanket will fall a couple of inches above the umbilicus 
 and a little below the sheet folded lengthwise. Now wring 
 out a cotton sheet cut or folded cornerwise in the shape of a 
 triangle a little smaller than the woolen triangle, and place 
 upon the couch with the apex down and the base an inch 
 below that of the woolen triangle. 
 
 The patient should now lie down upon the couch face up- 
 ward, and in such a position that the upper border of the wet 
 sheet will fall at about the level of the umbilicus. The legs 
 are drawn 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 in 
 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. 
 
 Four stages may be recognized :— = 
 
 I. The tonic 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, 875 
 
 2. The neutral stage, — 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 heating 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 sitz may be 
 administered for 4 or 5- minutes just before the pack, or a 
 hot hip pack for 6 to 8 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 heating 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 linen 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, his head having 
 
Sy6 RATIONAL HYDROTHERAPY. 
 
 been previously protected by cooling and the application of a 
 cold towel, lies down upon the couch, and is enveloped as 
 previously described, the dry triangular sheet being adjusted 
 so as to maintain close contact with the body at every point. 
 Then the side angles are brought up and tucked in; the apex 
 is firmly drawn up between the legs and securely fastened. 
 The cotton sheet is then adjusted in like manner, and a folded 
 woolen blanket drawn about the hips. 
 1391 Physiological Effects. — The pelvic pack is intended espe- 
 
 cially to influence the pelvic viscera, the bladder, the lower 
 colon, the rectum, the testes and prostate in men, and the 
 ovaries and uterus in women. Applied in the manner indi- 
 cated, it acts upon those surfaces which are in most intimate 
 reflex relation with the viscera of the pelvis; namely, the 
 cutaneous surfaces of the lumbar region, the lower abdomen, 
 the inner surface of the thighs, and especially the cutaneous 
 covering of the external genitals. If the sheet is simply 
 wrapped about the hips, instead of being drawn up 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 
 special conditions or susceptibility of the patient, as is the 
 case 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 
 energize 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 
 for an hour or two, or until the skin is strongly excited, a 
 powerful revulsive effect is exercised upon the viscera of the 
 pelvis. This is one of the most effective means of decon- 
 
THE TECHNIQUE OF HYDROTHERAPY. 877 
 
 gesting these organs. The application of the pelvic pack at 
 a temperature of 6o° 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, enterop- 
 tosis, sexual zveakness, 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 
 congestio?i of the pelvic viscera, as chronic colitis, chronic 
 metritis, chronic ovarian congestion, amenorrhea resulting 
 
878 RATIONAL HYDROTHERAPY. 
 
 from arrested development, excessive involution after child- 
 birth. It should be followed by a short cold application, as 
 the cold douche, cold friction, affusion, or cold rubbing sitz 
 for 20 to 30 seconds, at a temperature of 70 to 75°. The 
 length of the application and the temperature must of course 
 be suited to the particular case in hand. 
 
 The repeated pelvic pack, employing water at 6o° to 70 , 
 with a quite wet sheet, changed every 30 to 40 minutes, is a 
 measure of great efficiency in cases of acute congestion or 
 inflammation of the pelvic viscera. The blood-vessels of 
 the viscera are not only contracted, thus preventing stasis and 
 an increase of the inflammatory process, but the vital activi- 
 ties are excited and maintained by stimulating impulses con- 
 tinually received from the surface; and thus the disease process 
 is antagonized and brought to an early and successful issue. 
 This measure is of great value in non-suppurating inflamma- 
 tions of the ovaries and tubes, pelvic peritonitis, acute metri- 
 tis, vaginitis, proctitis, dysentery, prostatitis, urethritis, 
 and orchitis. By the application of water at a moderate 
 temperature to the entire cutaneous surface reflexly associated 
 with the pelvic circulation, much more pronounced effects 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 15 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 hot pelvic pack is most useful as an analgesic measure 
 in all painful affections of the pelvis. It renders the highest 
 service in cases of dysmenorrhea, ovarian neuralgia, and 
 all neuralgiac affections of the pelvic viscera, also in enter- 
 algia, sciatica, and coccygodynia. 
 
 The combined pelvic pack 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. The first form 
 named is of special service in acute pelvic inflammations; 
 the second, in cases of fever with irritable bladder. 
 
 Contraindications and Precautions. — The pelvic pack, to 
 be of real service, must be carefully adapted to the condition 
 in hand. For example, 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 applica- 
 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 use of the cool or cold pelvic 
 pack to avoid both chilliness and perspiration, else the proper 
 effect of the application will be lost. Likewise, in appli- 
 cations of the hot pelvic pack profuse perspiration is to be 
 avoided. 
 
 THE LEO PACK (Fig. 214). 
 
 Either one or both legs may be included in this procedure. 1393 
 Requisites — The same materials are needed as for the 
 
 trunk pack, though the wrappings may be smaller. 
 
 riethod, — 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 
 
880 RATIONAL HYDROTHERAPY. 
 
 6o° for the cold pack, and as hot as can be borne for the hot 
 pack. A linen sheet is used for the former, a blanket for the 
 latter. 
 
 Physiological Effects.— The leg pack is a powerful deriv- 
 ative measure. Applications made to the legs affect to a 
 marked degree the circulation in the head, throat, chest, and 
 pelvis. 
 
 Therapeutic Applications. — The leg pack may be used to 
 excellent advantage as a derivative measure in quite a large 
 class of cases, as in cerebral congestion, pulmonary 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 pack is exceedingly useful in cases of 
 neuralgia of 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 
 rheumatism confined to the knee and ankle joints, and as 
 a derivative measure. 
 
 THE FOOT PACK (Fig. 215). 
 
 1394 This resembles the leg pack, but differs from it in that 
 the feet and ankles only are involved. 
 
 The patient lies upon a cot while each foot is separately 
 wrapped in a towel wrung out of cold water, and a blanket 
 carefully folded about the feet and legs to the height of the 
 knees. The entire 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 relieving cold or sweating feet, and for 
 insomnia. The pack should be applied at night, and allowed 
 to remain in place for a few hours, or overnight. On its 
 removal, the feet should be 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 1395 
 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 6o° 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 rectal irritation, leucorrhea of the rectum> 
 acute inflammation of the prostate, chronic gleet, vaginal 
 leucorrhea, 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. 
 
 IRRIGATION. 
 
 Irrigation differs from the douche in the fact that the 1395 \ 
 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 fountain 
 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 EAR. 
 
 Fig. 216 shows an excellent method of applying the 1396 
 irrigation to the ear by means of a glass or hard-rubber de- 
 
 56 
 
882 RATIONAL HYDROTHERAPY. 
 
 vice. The water passes into the ear and out through a tube, 
 thus enabling the patient to jeceive the treatment in any 
 position, as the instrument exactly fits into the outer extremity 
 of the external canal of the ear. The temperature may be 
 from ioo J 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 inclined 
 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 
 
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 IRRIGATION. 
 
 The post-nasal douche 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. 
 
 IRRIGATION OF THE EYE (Fig. 217). 
 
 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 
 the 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 RATIONAL HYDROTHERAPY. 
 
 region. The application of very hot water by this means 
 may be recommended in cases of chronic pharyngitis with 
 tickling of the mucous membrane and. dryness of the throat, 
 irritation, hacking cough, and rawness, giving rise to fre- 
 quent clearing of the throat or a tickling cough. 
 
 IRRIGATION OF THE STOMACH, OR GASTRIC LAVAGE 
 (Figs. 218, 219, 220). 
 
 1401 This procedure does for the stomach precisely what the 
 enema or the coloclyster does for the colon. By its aid the 
 stomach may be washed out, hot or cold applications may 
 be made to it, and cleansing and medicated solutions may be 
 applied to the gastric membrane. 
 
 Method. — In the use of the stomach-tube, several points 
 require special attention: First, the tube should be of the 
 most approved pattern, of medium size, very soft and flexible, 
 and perfectly smooth. It should not be forced into the stom- 
 ach, as in the use of the old-fashioned stomach-pump, but 
 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 water. 
 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- 
 
Fig. 218. GASTRIC LAVAGE (p. 884). 
 
 Fig. 219. GASTRIC LAVAGE — Emptying 
 the Stomach (p. 884). 
 
 
 ^^^^ *tfe 
 
 W>1 
 
 4B&^ 'mm 
 
 tl 
 
 
 
 
 a m ■ 
 
 
 i 
 
 + 
 
 
 
 f 
 
 
 
 
 1 
 
 si 
 III 
 
 1 
 
 Fig. 220. GASTRIC LAVAGE — Withdraw- 
 ing Tube (p. 884). 
 
 Fig. 221. GASTRIC IRRIGATOR (p. 886). 
 
THE TECHNIQUE OF HYDROTHERAPY. 88$ 
 
 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 uo°. This measure he 
 
886 RATIONAL HYDROTHERAPY. 
 
 finds especially beneficial in so-called nervous dyspepsia and 
 gastritis. Dr. Tiirck, of Chicago, 111., has made large use of 
 this measure in gastric disorders, and places a high value 
 upon it. A return flow tube is employed for the purpose 
 (Fig. 221). 
 
 In cases of hypopepsia and apepsia the tonic circulatory 
 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 membrane, 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 reflexes connected with the stomach. 
 
 At the beginning of the treatment, the temperature of the 
 hot water should be 105 , that of the cold, 8o°. 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 1 15 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 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 nurse, while the tube 
 is introduced. A large glass funnel or fountain should be 
 in readiness, with two or three pints of water at ioo°, 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 size 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 curds 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 ptomains 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 1402 
 necessary as a means of cleansing the stomach in cases of 
 obstruction of the 'pylorus from any cause, when the closure 
 is complete or nearly so. In such cases it must be employed 
 
888 RATIONAL HYDROTHERAPY. 
 
 systematically daily, or in some instances even twice a day. 
 In chronic 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 insuffi- 
 ciency, the habitual use of the stomach-tube is sometimes 
 required, although it is not always necessary that lavage 
 should be administered daily. Complete emptying and cleans- 
 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 of 
 mucus are present, the stomach-tube must be used; but it 
 should be dispensed with as soon as possible. In cases of 
 hypopepsia, in which there is little or no irritation of the 
 mucous membrane, the use of the stomach-tube once or 
 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 advantageously 
 resorted to in gastric ulcer, though generally it is contra- 
 indicated in this condition. 
 
 In 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 HYDROTHERAPY. 889 
 
 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 chronic gastritis, water at a temperature of 105 to 120 
 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 (1383), 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 intestinal obstruction 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 fecal vomiting 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 
 obstruction. 
 
 Contraindications. — The habitual use of the stomach-tube 
 is highly detrimental to the stomach, and should be pro- 
 hibited except when made absolutely necessary by organic 
 
89O 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-tube 
 has become so very common, the author has found himself 
 under the necessity of prohibiting its use as frequently as he 
 has been called upon to recommend its employment. 
 
 The use of the stomach-tube should be carefully avoided 
 in cases of ulceration accompanied by hemorrhage, and in 
 cases of cirrhosis of the liver in which there is reason to sus- 
 pect an accompanying varicose condition of the gastric veins. 
 In hemorrhagic 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 undertaken 
 with most extraordinary precaution. 
 
 THE WATER EMETIC. 
 
 1403 Copious drinking of water at a temperature of 95 to ioo° 
 
 is an excellent 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 glasses 
 have been swallowed, another glassful to which a teaspoonful 
 of common salt has been added, should be taken. 
 
 The emetic is by no means a certain means of emptying 
 the stomach; even though there may be considerable quanti- 
 ties of liquid removed from the stomach by vomiting, it is 
 impossible to say that there is not a considerable quantity still 
 left; and in any case it is 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 89I 
 
 necessary only in cases in which the stomach-tube can not 
 be safely employed, or when the patient's fear of the stomach- 
 tube is so 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. 
 
 IRRIGATION OF THE COLON.— THE ENEMA. 
 
 This very useful procedure consists of the introduction of 1404 
 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 well known; second, the graduated 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 coloclyster, termed by the French "en- 
 teroclyster," which consists of 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 
 effects, a temperature near that of the body is proper. It is 
 generally better to introduce the water gradually, so that the 
 bowels may not be stimulated to contraction, causing the 
 fluid introduced to be discharged before a sufficient quantity 
 has been received. 
 
892 RATIONAL HYDROTHERAPY. 
 
 While the water is being introduced, the patient lies upon 
 his back, with the hips slightly elevated. If a strong desire 
 is 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 compressing 
 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 distending the colon so as to compel it to 
 receive three or four quarts 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 application 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 volume 
 of the blood by absorption. 
 
 The warm enema (98 to ioo°) 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 TECHNIQUE OF HYDROTHERAPY. 893 
 
 tation, and 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. How- 
 ever, it is far better to be a slave to the enema than to ' ' after- 
 dinner pills." 
 
 A small cold enema is usually preferable to a large warm 
 one. A pint of cold water may be 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 (8o° 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 
 
894 RATIONAL HYDROTHERAPY. 
 
 adhesions have been broken up, for the purpose of " placing" 
 the intestines, as a precaution against obstruction. The value 
 of 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 author 
 has never once been compelled to reopen the abdomen to 
 relieve obstruction, and has been able to record a mortality 
 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. 
 1405 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, hut as a 
 measure which aids in the removal of the causes of the abnor- 
 mal temperature by exciting renal and cutaneous activity. 
 
 The cold enema was employed by the De Hahns 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 150 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 (5 X 1 5 =7 5)- 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 HYDROTHERAPY. 895 
 
 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 lowered .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 5, 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 tem- 
 perature of the patient, which was between 105 and 106 , 
 and had proved refractory to every other measure, was 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 70 , and excellent 
 effects may be obtained by means of the enema at 8o°, 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 
 near that of the body, gradually but quite rapidly lowering 
 it by adding cold water in sufficient quantity to produce the 
 temperature desired. Suppose, for example, that it is desired 
 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 ioo°, and three pints rapidly added 
 at a temperature of 6o°. 
 
896 RATIONAL HYDROTHERAPY. 
 
 Stolz, 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 10 minutes, of the 
 enema at a temperature of 46°, the pulse was slowed twenty 
 to thirty beats, and the temperature as taken in the mouth 
 was lowered 3. 6°. 
 
 The cold enema has rendered great service in the treat- 
 ment of jaundice, as first shown by Krull.* The author pre- 
 fers the enema at 105 to no D , followed by the cold enema 
 (6o°). 
 
 The cold enema is most effectual as a means of relieving 
 constipation through its tonic effects upon the structures of 
 the rectum and mucous membrane. 
 1406 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 brought 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 no 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 of 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 
 
 Krull, Berliner Klin. Wock., 1877. 
 
THE TECHNIQUE 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 arter- 
 ial 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 com- 
 bined with an aseptic dietary of farinaceous gruels, fruit 
 juices, and systematic water drinking. 
 
 The hot enema (104 to 1 1 5 ) may be used with great 
 benefit for its relaxing effect upon involuntary muscular tis- 
 sue, 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 no° 
 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 1*07 
 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 
 
898 RATIONAL HYDROTHERAPY. 
 
 the patient. In the right Sims's position the water is passed 
 upward through the sigmoid flexure, and then runs along the 
 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 pseudo-membranous colitis. 
 
 Physiological Effects.— The physiological effects of irriga- 
 tion of the intestine have been carefully studied by Krull, 
 Stadelmann, and Kemp. Krull 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 1 io° 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 899 
 
 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 acute inflammation, 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 
 filling the blood-vessels and by reflex stimulation of the heart. 
 
 For most pronounced effects upon the heart and kidneys, 
 the temperature should be uo° 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 drug. 
 
 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 Schuller.* 
 
 According to M. Von Genersch t 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- 1408 
 ous relief in a class of patients, unfortunately by no means 
 small in number, who, suffering from atony and dilatation of 
 the colon y are always carrying about with them an enormous 
 accumulation of fecal matters. The patients are variously 
 classified as neurasthenics, hypochondriacs, simple dyspep- 
 
 *Arch. fur Klin. Med., 1874. 
 
 I Von Genersch, Progres Medical, 1893, p. 162. 
 
gOO RATIONAL HYDROTHERAPY. 
 
 tics, etc., and are treated for biliousness, insomnia, exhaus- 
 tion, and a multitude of ailments, all of which conditions are 
 the simple result of chronic autointoxication, and are 
 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 for a week or 
 more, showing that a single irrigation of the colon, no mat- 
 ter how thoroughgoing, is not sufficient to establish the fact 
 of its thorough cleansing. In this class of cases the coloclys- 
 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 6o° to J0° 
 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. OXH 
 
 formly excellent. Patients rarely fall 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 ioo°, the purpose being to flush the 
 portal circulation while at the same time cleansing the ali- 
 mentary canal. A much 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 depressing 
 and relaxing effect. 
 
 The coloclyster by means of the Sims's position is an 
 exceedingly useful measure in fevers. By placing the patient 
 in this position a much larger quantity of water may be intro- 
 duced, 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 GRADUATED ENEMA. 
 
 This form of intestinal irrigation is administered in the 1409 
 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 RATIONAL HYDROTHERAPY, 
 
 of warm water introduced each day is diminished by half a 
 pint, one-fourth pint of cold water being added, making the 
 total amount of the fluid one-fourth pint less each day. At 
 the end of the twelfth day the enema will consist of four 
 ounces of cold water. In the majority of cases the decrease 
 in temperature will compensate in stimulating effect for the 
 diminished quantity; so that the bowel is thus brought to a 
 more natural state, and weaned from the necessity of dis- 
 tension with warm water in order to provoke an evacuative 
 movement. The graduated enema is exceedingly useful as 
 a means of overcoming the enema habit. 
 
 RECTAL LAVAGE OR IRRIGATION. 
 
 1410 The author a number of years ago devised a hard-rubber 
 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 gradually 
 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 inflammation 
 of the prostate. Hot irrigation is also valuable as a means 
 of relieving leucorrhea, 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 (6o° to 40 , 5 to 10 min.). Repeat hourly. 
 Fig. 227 shows an instrument for dry cooling. 
 
 Alternate irrigation (6o°, 15 sees.; 1 io° 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. 
 
Fig. 227. INSTRUMENT FOR COOLING PROSTATE (p. 902). 
 
 I 
 
THE TECHNIQUE OF HYDROTHERAPY. 903 
 
 IRRIGATION OF THE BLADDER. 
 
 The instruments required for this procedure are a fountain 1411 
 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 or 
 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 instru- 
 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 
 perature of the water employed should be, for ordinary cleans- 
 ing purposes, ioo°. Water containing chloride of sodium, in 
 the proportion of one and one-half drams to the quart, 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 emptied, so as to avoid the irritation produced 
 by strong contraction of the bladder upon itself. 
 
9O4 RATIONAL HYDROTHERAPY. 
 
 By the same apparatus employed in vesical irrigation, cer- 
 tain useful mechanical effects may be brought to bear upon 
 the bladder. In cases in which the organ has become abnor- 
 mally contracted, so that the patient is continually annoyed 
 by distressing demands for micturition, the normal capacity of 
 the organ may be restored by gradual distention by means 
 of the hydrostatic pressure of the water column connected 
 with the fountain. To accomplish this, the outflow tube is 
 closed, the fountain is placed about one foot above the 
 patient, and the bladder is allowed to fill as full as possible 
 with this amount of pressure; then the fountain is slowly 
 raised until the patient experiences a very strong desire to 
 empty the bladder. The inflow is now shut off, the outlet 
 opened, and the bladder allowed to empty itself; after a rest 
 of three or four minutes, the operation is repeated. The 
 bladder should thus be filled and emptied three to six times 
 at each treatment, and the treatment should be repeated 
 daily. The temperature of the water employed should be 
 104° to 106 . 
 
 We are indebted to Daggett, of Buffalo, for a method of 
 irrigating either the bladder or the urethra, or both, which is 
 exceedingly practical, and is superior to the hydrophore. A 
 cut of the instrument employed is shown in Fig. 229. The 
 irrigator is connected with a fountain syringe containing a 
 solution of salt in the proportion of a dram to a quart, at 
 a temperature of 115 . The instrument is introduced into 
 the meatus far enough so that it can be grasped and held in 
 place. The tube is then connected with the inlet, the end 
 of the finger being held over the outlet. The fountain is 
 placed two or three feet above the patient's head, so as to give 
 moderate pressure. As the urethra is gradually distended, 
 the fluid finds its way backward, and finally enters the bladder 
 if permitted to do so. When the bladder is filled, it is only 
 necessary to pinch the tube connecting the irrigator with the 
 fountain, and allow the water to escape. By repeating the 
 operation several times, the bladder may be thoroughly 
 
THE TECHNIQUE OF HYDROTHERAPY. 905 
 
 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 
 bladder. Of course there are cases in which this 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 after proper instruction. 
 
 Physiological Effects. — The mucous membrane of the 
 bladder is exceedingly sensitive to temperatures either above 
 or below 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 (Mellez), 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 in old men suffering 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 ammoniacal 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 atony of the bladder and in 
 cases of paralysis of the organ associated with paraplegia, 
 
906 RATIONAL HYDROTHERAPY, 
 
 locomotor ataxia, and other affections 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 calculi, so-called gravel, 
 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 8o°. If this produces no unpleas- 
 ant effect, the temperature may be gradually lowered to 6o°. 
 Hot applications may likewise be employed with advantage in 
 these cases, but the temperature should not exceed 1 1 5° 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 no° 
 and 8 5 , and the highest and lowest temperatures should be 
 gradually approached. 
 
 In hemorrhage from the bladder, very hot irrigation (n8° 
 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 (uo° to 120 ) for 5 or 10 
 minutes, followed by a very gentle affusion at 8o°. 
 
 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 
 
: 
 ■ 
 
 : 
 
 
 I' 
 
 
 |j 
 
 I 
 
 1- 
 
 . 
 
 
 j 
 1 
 
 1 
 1 
 
 ( 
 
 
 
 Fig. 229. 
 
 IRRIGATOR FOR URETHRA 
 AND BLADDER (p. 904). 
 
 Fig. 230. URETHRAL IRRIGATOR, 
 HYDROPHORE OF SCHUTZ (p. 907). 
 
 Fig. 
 
 231. MARBLE-COVERED COUCH FOR VAGINAL 
 IRRIGATION (p. 909). 
 
THE TECHNIQUE OF HYDROTHERAPY. 907 
 
 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 application, 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 
 
 feel the slightest sensation of chilliness. 
 
 Irrigation of the bladder must be avoided in cases of 
 
 acute urethritis, in consequence of the danger of conveying 
 
 the infection backward into the bladder and other of the deep 
 
 passages. 
 
 IRRIGATION OF THE URETHRA. 
 
 Numerous instruments are employed for the application of 1412 
 liquids to the urethra. One of the best of these is the hydro- 
 phore 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 is 
 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 
 chronic urethritis by very hot water. He employed simply 
 a fountain syringe, consisting of a tin pail with a rubber tube 
 
908 RATIONAL HYDROTHERAPY. 
 
 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 180 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 wasequally 
 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 (no° 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 (no° to 11 8° 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. 
 
 VAGINAL 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 TECHNIQUE OF HYDROTHERAPY. 909 
 
 at various temperatures has resulted in numerous failures and 
 disappointments. 
 
 Following the example of Peasley and Emmett, who 
 were among the first to champion the vaginal douche r„s a 
 therapeutic measure in gynecological practice in this co\ntry, 
 most American practitioners make habitual use of vaginal 
 irrigation at as high a temperature as the patient can com- 
 fortably bear, or from 105 to 122 F. Fortunately, vaginal 
 irrigation at this temperature is applicable to a large propor- 
 tion of cases; but other temperatures, higher or lower, may 
 often be employed to much better advantage. The application 
 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 for 
 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 cul 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 of 
 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. 
 
9IO RATIONAL HYDROTHERAPY. 
 
 1414 Many years ago Max Runge made an exhaustive study of 
 the effects of vaginal irrigation upon the circulation and mus- 
 cular excitability of the uterus, 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 
 tetanic contractions, lasting for a full minute, which were fol- 
 lowed by rhythmical contractions and relaxations, continu- 
 ing for some time. When the cold application was continued 
 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 hour. 
 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 122 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 TECHNIQUE OF HYDROTHERAPY. 9II 
 
 the uterus. Stronger 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, 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- 
 ence 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 8o° has often produced excellent antiphlogistic 
 results in cases in which hot irrigation could not be tolerated. 
 
 Hot 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 hot irrigation, as shown 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. 
 
$12 RATIONAL HYDROTHERAPY. 
 
 If hot irrigation fails, employ cold, boiled water (65 ° to 
 55 ). If cold irrigation produces pain, employ simultane- 
 ously a hot sitz bath or hot hip or leg pack. Hot irrigation 
 is sometimes better tolerated in connection with the cool or 
 tepid sitz bath (75 ° to 85 °). Rub the surface well to pro- 
 mote reaction. 
 
 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 miscarriage. After the beginning of labor, however, very 
 hot irrigation produces prompt dilatation of the cervix. 
 
 The ordinary effects of vaginal irrigation will be in- 
 creased by employing an intermittent jet obtained by attach- 
 ing an ordinary bulb syringe to the fountain douche appara- 
 tus. Alternate irrigation is sometimes useful in relaxed 
 conditions and in promoting absorption of exudates when 
 pain and congestion are not present. Two fountains with 
 tube attachments may be employed, one containing cold (6o° 
 to 8o°), the other hot (104 to 120 ), water; or two fount- 
 ains may be joined to a single tube by a suitable connection. 
 
 The percussion vaginal douche is an effective means of 
 cleansing irrigation, and also powerfully stimulates the pelvic 
 circulation. It is administered by means of a modification 
 of the ordinary fountain douche in which the fountain is 
 closed and the air pumped in by a rubber compressor bulb, 
 a small amount of air being .mingled with the water so that 
 there is an alternate discharge of water and air expelled with 
 considerable force. 
 1415 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 
 
Fig. 232. PSYCHROPHORE (p. 913)- (Winternitz) 
 
 Fig. 233. HOLLOW SOUND FOR MAKING THERMIC APPLICATIONS TO 
 UTERUS (p. 91J). (Kellogg) 
 
 Fig. 234. HOLLOW CYLINDER FOR MAKING THERMIC APPLICATIONS TO 
 VAGINA (p. 913). (Kellogg) 
 
 Fig. 235. HOLLOW CYLINDER FOR MAKING THERMIC APPLICATIONS 
 TO RECTUM (p. 9 n). (Kellogg) 
 
THE TECHNIQUE OF HYDROTHERAPY. 913 
 
 well to add to the water common salt, one gram to ioo, or 
 10 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. 
 
 MEANS OF MAKING HOT, COLD, AND ALTERNATE APPLICA- 
 TIONS TO THE MUCOUS PASSAGES. 
 
 Fig. 232 illustrates an instrument devised by Professor 1416 
 Winternitz, known as the psychrophore, and intended for 
 making applications to the urethra when hot or cold appli- 
 cations are desirable. The author has found this measure 
 serviceable in the treatment of certain cases of extreme hyper- 
 esthesia of the urethra. Both prolonged cold applications 
 and short hot applications may be used with success. In 
 some of these cases alternate hot and cold applications 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 yS° to 8o° 
 for 5 minutes, then an application at 50 to 57 for 5 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 nocturnal enuresis. 
 
 The author a number of years ago devised a series of hol- 
 low applicators shown in the accompanying cuts (Figs. 233- 
 235), which have proved very successful for the several pur- 
 poses for which they were designed. By means of a hollow 
 uterine sound (Fig. 233) either hot, cold, or alternate appli- 
 cations may be made to the interior of the uterus with great 
 convenience. By compressing the outflow tube, the rate at 
 which the water passes through the instrument may be regu- 
 5* 
 
914 RATIONAL HYDROTHERAPY. 
 
 lated, and by the same means also the temperature. If 
 the water at the outlet is made to fall upon a thermometer, 
 the temperature of the water may be observed at every 
 moment, and may be made to rise or fall by adjustment of 
 the gauge. The author has frequently made applications to 
 the body of the uterus at 160 with excellent effect, although 
 this temperature is somewhat painful. A temperature of 140 
 is usually sufficiently high to accomplish the desired results. 
 The instrument also proves useful in cases of subinvolution, 
 vegetations, catarrh of the cervix, and flexion or relaxed uter- 
 ine walls and arrested development. 
 
 1417 In Fig. 234 is shown a hard-rubber instrument which has 
 been found very useful as a means of applying heat to the 
 pelvic viscera through the vagina, in cases in which the bed- 
 pan or douche apparatus can not be used without injurious 
 disturbance to the patient. The instrument is simply intro- 
 duced into the vagina, and a current of hot water passed 
 through it. The patient may lie in any position, and thus is 
 in nowise inconvenienced 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. 235 shows an instrument constructed on the same plan 
 as the preceding, but smaller in size, and designed for ther- 
 mic applications 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 
 
THE TECHNIQUE OF HYDROTHERAPY. QI 5 
 
 as great as the patient will bear. Very hot applications are 
 useful in cases of internal hemorrhoids, rectal catarrh, rectal 
 ulcer and fissure, enlarged prostate, and spasm of the 
 sphincter. 
 
 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. 
 
 Arzberger, to whom the credit of having first employed 
 instruments of this sort is ascribed, employs a temperature of 
 /0° to 6o°. The temperature at first may be higher (8o° 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 1419 
 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 affair, has been 
 the means of saving many lives, 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 yard 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 the vapor may be brought 
 to the face of the patient lying close to i ;k: edge of the bed; or 
 
gi6 RATIONAL HYDROTHERAPY. 
 
 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 all 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 
 inhaling apparatus must be removed, or the inhalation of pure 
 oxygen gas may be employed in connection with it. 
 1420 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 HYDROTHERAPY. 917 
 
 ditions, especially when there is thickening of the mucous 
 membrane and hypertrophy of the glandular structures, as in 
 cases of large or elongated uvula, enlarged tonsils, follicular 
 hypertrophy of the tonsils, or aderioids, 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 manage 
 the inhalation so as to confine the effect almost wholly to the 
 naso-pharynx. 
 
 The effect of the hot vapor upon the mucous membrane 
 is precisely that of circumscribed applications of heat to the 
 cutaneous surface. The tissues are excited to increased activ- 
 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 against 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-heating 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 
 
91 8 RATIONAL HYDROTHERAPY. 
 
 directly and reflexly with the diseased parts, are brought 
 under the influence of the hot application. Thus while the 
 vasomotor stimulating influence of the heat is acting upon 
 the mucous membrane of the nose and throat, this direct 
 action is greatly assisted by the strong hyperemia of the skin 
 produced, and consequent draining of collaterally associated 
 vessels of the mucous membrane. Patients experience from 
 this treatment a degree of immediate relief such as is afforded 
 by no other measure with which the author is acquainted. 
 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 not 
 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 minutes 
 each time. At the conclusion of the treatment, 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- 
 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 TECHNIQUE OF HYDROTHERAPY. 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 treatment 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. 
 
 THE 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 21 2° for controlling hemor- 
 rhage, and Pincus Kiliani, who continued the experiments 
 and observations, has clearly shown that steam has powerful 
 
920 RATIONAL HYDROTHERAPY. 
 
 styptic properties, and that it might be used advantageously 
 in operations upon the liver, kidneys, lungs, and other paren- 
 chymatous organs. Bleeding from quite large arteries is readily 
 controlled by it. Under the influence of the steam jet, the 
 parts shrivel, and acquire a cooked appearance. This action of 
 steam 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 92 1 
 
 Todano, an Italian contemporary of Hahn, 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, it ought also to be poured 
 into the stomach in large quantities when the patient's 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 we remember that the living organisms 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 Physiologiques sur Quelques Poisons Americains. " CI. Bernard, 
 Paris, 1864. 
 
92 2 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 
 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 C0 2 , Distilled 
 water charged with C0 2 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 readily 
 quenches thirst. The presence of mineral salts of any kind 
 lessens the rate of absorption. 
 1424 Schultz 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 twenty 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 Bath," Glasgow. 
 
THE TECHNIQUE OF HYDROTHERAPY. 923 
 
 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 (1.55 
 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 
 body. Thus it is evident that by increasing the .amount of 
 water introduced into the body, the movement of the vital flu- 
 ids, 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 vitalized 
 and functionally active life. 
 
 Therapeutic Applications — The effect upon the blood of 1425 
 copious water drinking suggests it as a valuable measure in 
 cases of dropsy, whether general or local in character, espe- 
 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 extent 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- 
 
924 RATIONAL HYDROTHERAPY. 
 
 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 
 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 occurred, 
 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 in lai'ge 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 925 
 
 supply of liquid so encourages its activities that it may not 
 inaptly be compared to the flowing mountain stream. 
 
 Cold Water Drinking. — Priessnitz required his patients to 1426 
 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 medicatrix natures 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 ten 
 glasses a day with advantage, when required, but not 
 infrequently three or four glasses are sufficient, 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 
 
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 encouraging 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 diabetes 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. 
 
 Wintcrnitz and numerous other observers have shown that 
 
THE TECHNIQUE OF HYDROTHERAPY. 927 
 
 when water is taken in sufficient quantities, the temperature 
 of the body may be lowered by the absorption of heat from 
 the water. Suppose, for example, a patient having a tem- 
 perature of 102 should swallow three pints of water at 6o°. 
 In acquiring the temperature of the body the water swallowed 
 will absorb 126 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 6o° to 6 5 . 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. (1.3 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. (i.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 decreased 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 
 
928 RATIONAL HYDROTHERAPY. 
 
 placed in the axilla and rectum (Exp. 73). This fact was 
 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 are 
 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 of 
 tissue poisons, the accumulation of which gives rise to the 
 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 of 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 
 liver 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 temperature of the water drunk should ordinarily be 
 about yo° F. In special cases water at 6o° and even 50 
 may be employed. Very cold water is indicated only in 
 fevers, in constipation, and in small quantities in hypopepsia. 
 
 The quantity of water taken must depend on the effect 1427 
 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 night, and as much more 
 on arising in the morning. A thirst for water is almost 
 always an indication that it may be taken with advantage, no 
 matter whether such use is in harmony with the established 
 canons of hygiene 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 Best Water. — The purest water is universally the 1428 
 best. Whatever beneficial effects 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 drug- 
 store, and if diluted to the same extent as that in which they 
 are found in the so-called natural waters, the effects obtained 
 from their use would be the same. Medical experience has 
 59 
 
930 RATIONAL HYDROTHERAPY. 
 
 shown that the best of the so-called mineral waters are those 
 which contain the least mineral ingredients. The very 
 best water is distilled water which has been well aerated. 
 Water obtained from natural sources is generally more or less 
 contaminated, that from lakes, streams, and rivers being 
 necessarily denied by the fish and other creatures which live 
 in natural bodies of water, and by surface drainage, which, 
 after every rain, washes out quantities of filth. 
 
 Water obtained from public supplies should always be 
 boiled ; indeed, this precaution is a wise one under nearly all 
 circumstances. 
 
 Hard water should always be boiled for a long time to 
 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 saline ingredients, the 
 more slowly the water is absorbed. The presence of acids 
 encourages absorption. Carbonated distilled water and diluted 
 fruit juices without sugar are the best drinks. 
 
 HOT WATER DRINKING. 
 
 1429 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 taking 
 three or four glasses at once in this way at a temperature 
 which would seem positively incredible. In one instance a 
 gentleman was found sipping a glass of water at a temperature 
 of 160 . The free use of hot water has been largely encour- 
 aged by physicians who recommend an exclusive meat diet- 
 ary, experience having] taught them that the free use of 
 meat must be accompanied by copious water drinking as a 
 means of ridding the system of the ptomains, toxins, and 
 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 
 
Fig. 239. GARTNER'S TONOMETER (p. 931). 
 
THE TECHNIQUE OF HYDROTHERAPY. 93 1 
 
 under conditions which would otherwise lead to speedy 
 exhaustion of the defenses of the body, and thus precipitate 
 some acute and perhaps fatal malady, as Bright's disease, 
 organic changes in the liver, 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 an atonic 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 hyperpepsia, and 
 likewise in gastrorrhea, as in these conditions there is an 
 excessive production of hydrochloric acid. In order to be 
 beneficial 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 Gsertner, 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. 
 
93 2 RATIONAL HYDROTHERAPY. 
 
 Hot water drinking is very useful in gastralgia, especially 
 when accompanied by vomiting. Slowly sipping hot water 
 will sometimes relieve vomiting not only in gastralgia, but in 
 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 some similar cause. 
 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 When Free Water Drinking Should Be Avoided. — In 
 
 extreme dilatation 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 rilled, so that it 
 runs over into the small intestine. 
 
 The effect of this overburdening of the stomach with liquids 
 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 
 
THE TECHNIQUE OF HYDROTHERAPY. 933 
 
 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 inclined 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 slowly 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 important 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 HYDRO- 
 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 us as a 
 legacy from the infantile days of our beneficent art, or 
 which were engrafted upon it during the ages when a]l 
 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 scientific 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 of 
 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 as 
 
THE TECHNIQUE OF HYDROTHERAPY. 935 
 
 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-all, the effort has been made so to combine them all 
 as to secure for 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, for 
 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 the 
 various physiological agents which are indicated. To under- 
 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 similarity 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 physiological effects. 
 
 The researches of Schuller, Vinaj, Winternitz, 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 HYDROTHERAPY. 
 
 Warm applications, that is, a temperature of 92 to 98 , 
 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 causes 
 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. 
 1432 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 the 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 either case a larger area under the influence of the 
 opposite pole. Knowing 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 organs, 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 unable to 
 produce electrotonic 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 electrophysics. 
 
 These and other considerations show us that in explaining 
 the effects of percutaneous applications of electricity we 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, Winternitz, 1434 
 Beni-Barde, Fleury, and other hydriatrists, have established 
 a distinct reflex relationship between the principal internal 
 organs and particular cutaneous areas, as elsewhere desig- 
 nated (372-382). 
 
93$ RATIONAL HYDROTHERAPY. 
 
 In general, the skin overlying an internal organ is reflexly 
 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 genito-urinary 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. 
 14-36 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 HYDROTHERAPY. 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 yj° 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 faradic; 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 : First, 
 increased movement of blood and accelerated functional 
 activity of an internal organ may be induced by short, vigor- 
 ous, cold applications in combination with cathodic applica- 
 tions of galvanism. The electrical application may be either 
 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 gen- 
 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 application (6o° to yo° continuing from thirty minutes to 
 several hours), combined with the simultaneous anodic appli- 
 cation of the galvanic current of moderate strength. 
 
 By the application 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, ovaries, likewise in atonic conditions of 
 the stomach and bowels, and in amenorrhea and hypopepsia. 
 
 1438 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, continued 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. 94 1 
 
 In cases of atony of the bladder, and inactivity of the 1440 
 bowels due to dilatation of the colon, the cold douche to the 
 feet and over the lumbar, umbilical, and hypogastric regions, 
 in combination with faradic 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 1441 
 acid is absent or greatly deficient in 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, for half an hour before each 
 meal. Painful congestion is relieved 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 liver (130 to 1442 
 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 1443 
 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. 
 
942 RATIONAL HYDROTHERAPY. 
 
 1445 In amenorrhea, the effects of cathodic, faradic, or sinu- 
 soidal applications to the uterus are greatly increased by short 
 cold applications to the lumbar regions, the inner surface of 
 the thighs, and the feet. 
 
 1446 In applications of electricity to paralyzed and paretic 
 muscles, the effects of the electrical application may be 
 greatly increased by the previous application of cold water in 
 the form of the orolinary cold douche, the percussion douche, 
 the Scotch douche or cold friction, or the heating compress. 
 The marked increase of muscular 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. 
 
 1447 For relief of pain in neuralgic joints, hot applications 
 followed by the sinusoidal or galvanic current, are a most 
 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 meas- 
 ures may with much advantage be employed in connection 
 with cataphoresis. The author has found this combination 
 exceedingly useful in treating many cases of this sort. 
 
 1448 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 of 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. 
 
 1449 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 943 
 
 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 15 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 1 to 5 
 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, 1451 
 or sinusoidal current, is perhaps the most powerful of all 
 hypnotic measures. The author has employed this bath with 
 success for nearly twenty-five years; and it has rendered 
 valuable service not only in relieving insomnia, but in helping 
 patients through the trying time which immediately follows 
 the withdrawal of opium, cocaine, and other drugs, in the 
 treatment of various forms of drug addiction. 
 
 The faradic, sinusoidal, static, and high frequency currents 1452 
 are all tonic in character, stimulating metabolism, arousing 
 the nerve centers, and directly exciting the brain and all 
 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 tone 
 elevated, and the nervous reflexes in full swing. 
 
944 RATIONAL HYDROTHERAPY. 
 
 1453 The refrigerant effects of the cold bath may be greatly 
 increased by the simultaneous application of a slowly alter- 
 nating sinusoidal current in such a manner as to secure vig- 
 orous contraction of the large muscular masses. Three sets 
 of electrodes should be employed : one for the arms, another 
 for the legs, and another for the back and the abdomen. The 
 contractions should be at the rate of four to six per minute. 
 The temperature should be 78 ° to 75 °. The duration of the 
 bath should be 10 to 15 minutes. The patient should be 
 rubbed during the bath so as to maintain an active cutaneous 
 circulation. 
 
 1454 The analgesic effects of water may be most advan- 
 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 author's 
 custom to administer a very hot vaginal douche just before 
 and just after the electrical treatment. A very hot sitz, 
 1 1 5 to 120 , for 3 to 5 minutes, followed immediately by 
 a dash of cold water over the hips, prevents pain and hemor- 
 rhage. 
 
 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. 
 

 
 
 1 - 2* * 
 
 
 "- ' *H i i* 
 
 i;;: 1— — """ ' ""*"""" 
 
 r W 
 
 I 
 
 Fig. 241. ELECTROHYDRIC BATH (p. 946). 
 
 Fig. 242. CARBONIC ACID DOUCHE (p. 957). 
 
 Fig. 243. OMBROPHORE (p. 958. ) 
 (Winternitz) 
 
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). 
 
 11. 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- 
 ence to Figs. 122, 123, for which the author is indebted to 
 Dana's work previously mentioned. 
 
 THE ELECTRO-HYDRIC, OR ELECTRIC-THERMAL BATH. 
 
 This bath is simply a water bath with the addition of 1457 
 electricity. The author employs the faradic, galvanic, or 
 
946 RATIONAL HYDROTHERAPY. 
 
 sinusoidal electrical currents in this way. The electricity is 
 communicated to the patient in a porcelain tub by means of 
 a stationary head plate and sliding metallic electrodes on either 
 side (Fig. 241). The electrical apparatus may be placed at the 
 head of the tub or in any other convenient place within easy 
 reach of the operator. The temperature of the bath depends 
 upon the effects desired. The temperature most commonly 
 employed is from 92 to 98 . 
 
 When tonic effects are desired, the faradic current is gen- 
 erally found preferable. The temperature of the bath may 
 be from 92 to 95 , for 5 to 6 minutes, and at the last end 
 cooled to 8o°, the patient being rubbed in the meantime to 
 prevent chilling. The strength of the current should be such 
 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 effects 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 bath 
 should be continued for 12 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 HYDROTHERAPY. 947 
 
 galvanic bath. If the bath is supplied with electricity from a 
 street-current of high tension, as a 500-volt or 1,000-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 life. 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. 
 
 Better effects are obtained from the sinusoidal current 
 than from any other thing combined with the water bath. 
 By this means the entire muscular system may be brought 
 into a condition of vigorous tension and movement without 
 the slightest discomfort to the patient. Another advantage 
 is that the temperature of the bath may be reduced much 
 lower without discomfort than in any other form of bath. 
 Almost any patient can bear 8o° for ten or twelve minutes 
 without chilling, and many patients bear a temperature of 
 75°, or even 70 without discomfort, it only being necessary 
 to make the current as strong as can be borne, or sufficiently 
 strong to secure vigorous muscular contraction, as, by this 
 means, heat production is increased, and the sense of chilli- 
 ness is obviated. The author has determined by calorimetric 
 experiments that heat production is increased by this bath at 
 least thirty per cent. The sinusoidal electric bath is indi- 
 cated in cases of diabetes, obesity, and as a s general tonic 
 alterative. 
 
 Electro-Vapor Bath. — This bath consists of a cabinet 145$ 
 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 are 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 may be directed through the 
 body in various directions by connecting the different elec- 
 trodes through the switch board. 
 
948 RATIONAL HYDROTHERAPY. 
 
 14:59 Thermo=Electric Bath. — In this bath, an application of 
 electricity is combined with a hot-air bath (1233). The 
 physiological effects are essentially the same as have been 
 elsewhere indicated in the description of the hot-air bath 
 (1234). The mechanical arrangements are essentially the 
 same as those described above for the electro-vapor bath; 
 the only difference is that provision is made for heating 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 value of the. electro-vapor bath apply equally 
 to this procedure, and need not be repeated. 
 
 1160 Electro=Chemical Bath. — This bath is simply an 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 to the water of the bath. 
 
 The bath may be rendered alkaline, 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 
 is, as has been experimentally shown, exceedingly minute, 
 and scarcely worth considering. 
 
 Certain observers claim special tonic effects from the 
 employment of an acid solution, the water of the bath being 
 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 the efferves- 
 
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 
 
950 RATIONAL HYDROTHERAPY. 
 
 may be employed either as a preparatory or a supplementary 
 measure. 
 
 All the procedures of massage may be associated with 
 hydrotherapy. Friction, percussion, and deep massage are 
 especially of service. 
 
 Friction. — Friction, as elsewhere explained (1225), is 
 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 following may serve 
 simply as illustrative examples: — 
 
 i. Friction of the skin at intervals of i 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), the cold chest compress in pneumonia (1374), ice- 
 bag to the back of the neck (1314), the ice-cap (1314), and 
 the spinal ice-bag (619, 671). Friction should be avoided 
 when the purpose of the cold application is to allay super- 
 ficial inflammation. The hot fomentation (1328) 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 (1347), 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. 
 
THE TECHNIQUE OF HYDROTHERAPY. 951 
 
 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 foot bath 
 (1296), the standing shallow (1174), 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. 
 
 i. 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. 
 
 1. The application of massage after the cold bath is espe- 
 cially useful after prolonged cold procedures such as are 
 
952 RATIONAL HYDROTHERAPY. 
 
 appropriately employed in obesity and fat diabetics, as 
 the plunge (1108), the shallow (1174), the prolonged cold 
 douche (1010), and the dripping sheet (1216). Massage fol- 
 lowing the cold bath is indispensable in cases of obesity in 
 which the patient is too weak to secure good reaction by 
 vigorous exercise after the cold bath. 
 
 2. Very vigorous massage may be applied with advantage 
 after the cold bath in cases of rheumatism, especially in cases 
 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 cases 
 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 inflam- 
 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 of 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 lies 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. 
 
954 RATIONAL HYDROTHERAPY. 
 
 MISCELLANEOUS BATHS. 
 
 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. 
 
 1462 Emollient Baths. — In certain forms of cutaneous irrita- 
 tion great relief is afforded by the employment of an emol- 
 lient bath, which consists of an ordinary full or immer- 
 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 pounds 
 of bran previously softened by soaking for fifteen minutes in 
 a sufficient quantity of water to completely saturate and cover 
 the bran; or, 1 pound of corn-starch previously made into 
 a thin smooth paste, with 1 or 2 gallons of water; or, 1 
 to 2 pounds of isinglass dissolved in 1 gallon of water. Of 
 the above, corn-starch or gelatin are to be preferred. 
 
 1463 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 proportion 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 and 
 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 
 
 
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 
 i 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 pounds; 
 magnesium chloride 1 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 1 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- 1405 
 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 pa- 
 tient's condition. The temperature may be somewhat lower 
 than when ordinary water is employed. This bath produces 
 powerful 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. 
 
956 RATIONAL HYDROTHERAPY. 
 
 1466 The Mustard Bath. — Add to the water of an ordinary full 
 
 bath 2 ounces of freshly ground mustard 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 mustard fomentation, wring a towel or a 
 cheese-cloth compress out of hot water to which ground 
 mustard has been added in proportion of \ ounce to the 
 quart. Spread this upon the part to which the applica- 
 tion is to be made, then apply the fomentation over it. 
 
 Alcohol Sponge Bath. — To 3 parts of water at the tem- 
 14-67 perature desired, add 1 part of proof spirit. The alcohol 
 sponge is useful in relieving the night-sweats of phthisis. The 
 efficiency of the evaporating sponge bath as a cooling meas- 
 ure 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 for 
 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, 
 (C0 2 ) 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 
 
 *Verrier, Precis d'Hydrotherapie Scientifique. 
 
95 8 RATIONAL HYDROTHERAPY. 
 
 with it a cylinder containing liquid carbon dioxide gas. For 
 localizing this douche, an ordinary siphon bottle with a con- 
 necting rubber tube and nozzle may be utilized in the 
 absence of any better apparatus. 
 
 Professors Winternitz and Gaertner, of Vienna, have 
 recently devised an apparatus for administering a cold shower 
 bath, which they have named the " Ombrophor " (Fig. 
 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 be 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 cell. It may likewise be used with advantage in 
 
THE TECHNIQUE OF HYDROTHERAPY. 959 
 
 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 of too powerful retrostasis. 
 
 The Air Bath. — The effect of cold air when brought in 1470 
 contact with the surface of the body is essentially the same as 
 that of 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 fact. 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 in 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 corresponding 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 neces- 
 sary by the artificial customs and conditions imposed by civi- 
 lization, in no small degree interferes with the normal functions 
 of the skin Dy overheating this organ, retaining noxious secre- 
 tions in contact with it, and depriving it of the normal stimu- 
 
 i 
 
960 RATIONAL HYDROTHERAPY. 
 
 lating effect of the actinic rays of the sun and the important 
 gymnastic exercise of the vasomotor nerves and centers and 
 the contractile tissues of the small vessels and capillaries 
 resulting from the never-ceasing storm of thermic impres- 
 sions made upon the unprotected skin by contact with the 
 ever-changing atmosphere. 
 
 The writer has for more than twenty-five years made use 
 of the air bath in connection with various hydriatic procedures 
 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 administered by 
 means of the outdoor gymnasium: A high-walled enclosure 
 provided with dressing rooms and all necessary conveniences 
 for out-of-door exercise at all seasons of the year. An out- 
 door gymnasium arranged under the writer's direction, con- 
 sists of the following: A wide walking or running track 
 extending around the outside of the enclosure, just 1-10 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 other, with an 
 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 large 
 pile of fine white beach sand for those who wish to indulge in 
 the sand bath, swinging rings, horizontal ladders, a May-pole, 
 appliances for lawn-tennis, pitching quoits, and various gym- 
 nastic games (Figs. 244, 245). 
 
 On entering the outdoor gymnasium the patient removes 
 all his ordinary clothing, and dons a thin bathing-suit or a pair 
 of trunks; shoes, stockings, and hat are discarded, for 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 worn 
 if desired, but it is better to expose the soles of the feet to 
 
THE TECHNIQUE OF HYDROTHERAPY, 96 1 
 
 contact with the earth and the grass. He imagines himself a 
 boy again, frolicking in 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 returns 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 had 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 sanitarium 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 outdoor 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 exercise. 
 
 For feebler patients, carriage riding provides a partial sort of 
 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 
 
962 RATIONAL HYDROTHERAPY. 
 
 most excellent results. The patient is as lightly covered as is 
 consistent with comfort, and the wraps should consist of white 
 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 lying 
 in the cool fresh air promotes appetite and normal metabolism 
 and greatly adds to the beneficial effects derived from other 
 therapeutic measures. 
 
 2. The Sand Bath — The sand pile, with which every out- 
 door gymnasium should be provided, affords an excellent 
 opportunity for the sand bath. Under the influence of the 
 summer sun the sand becomes intensely heated and when 
 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 direct 
 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 or 
 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 adminis- 
 tered in different ways : The patient may simply remove hie 
 clothing, and walk about the room, or sit, or lie, as his strength 
 or inclination may indicate. The best effects are obtained by 
 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 be 
 assisted by an attendant. Chilling is prevented even when 
 the temperature of the air is quite low, by vigorous rubbing of 
 the surface and the employment of active and passive move* 
 
Fig. 246. AIR BATH (p. 963). 
 
 Fig. 247. AIR BATH (p. 963). 
 
THE TECHNIQUE OF HYDROTHERAPY. 963 
 
 merits. 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 6o°. 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 body, . the surface may be 
 moistened by sprinkling or by covering it with a wet sheet, 
 
Vuxt Fxtttr* 
 
 HYDRIATIC PRESCRIPTION MAKING. 
 
 A CLEAR conception of the nature of disease is the first 
 essential in the building of a hydriatic prescription and 
 in searching for therapeutic indications. To say that 
 disease is disharmony, a morbid state, a perverted vital 
 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 maintain 
 itself in such a state. This faculty which the body possesses 
 of maintaining a physiological equilibrium, of resisting 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 same 
 processes by which it maintains itself in health. Napoleon 
 recognized this fact when once he protested against the poly- 
 pharmacy of his day, exclaiming, ' ' Life is a fortress. Why 
 throw obstacles in the way of its defense? Its own 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 not only from the recognized immediate or 
 exciting cause, but from a lessening 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 have 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. 
 964 
 
HYDRIATIC PRESCRIPTION MAKING. 965 
 
 clinical picture of typhoid fever. Cholera germs, likewise, are 
 unable to develop in the healthy alimentary canal, but only 
 obtain a permanent footing 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 Organism. — The natural meth- 1471 
 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 
 
966 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 life-battle is being fought, whereby the cells engaged 
 in the conflict are stimulated and sustained while the accumu- 
 lated poisons are burned, or are carried away by the serum 
 with which the tissues are bathed. Through the control of 
 the general blood movement and of the local blood supply, 
 hydrotherapy is capable of influencing 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. 
 
 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 organ- 
 isms, even though they may not be entirely killed. The lymph 
 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 
 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 plays 
 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: — 
 
968 RATIONAL HYDROTHERAPY. 
 
 Activities to be Encowaged. 
 
 1. General vital resistance. 
 
 a. Destruction of toxins. 
 
 b. Elimination of toxins. 
 
 c. Destruction and elimination of bacteria. 
 
 2. Oxidation. 
 
 3. The functions of the automatic and reflex centers. 
 
 4. General and local metabolic processes, blood formation, 
 glandular activity, etc. 
 
 5. Cardiac activity and general blood movement and 
 local blood supply. 
 
 6. Heat production. 
 
 7. Heat elimination. 
 
 Activities and conditions to be diminished, comb ate d y or 
 mitigated. 
 
 1. Nervous irritability. 
 
 2. Bacterial growth. 
 
 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 individual 
 
HYDRIATIC PRESCRIPTION MAKING. 969 
 
 cells. To increase the vital resistance, the energy and ac- 
 tivity of the cell must be increased. Hydrotherapy affords 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), alternate sponging of the spine (1342), the 
 alternate spinal compress (1340), cold water drinking 
 (14-26), 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, but 
 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), 
 
9/0 RATIONAL HYDROTHERAPY. 
 
 should be applied every three or four hours, unless a cold 
 bath of some other sort, such as the wet-sheet pack (1179) 
 or the Brand bath (1150), has been administered. 
 
 The principal ways in which the body resists the encroach- 
 ments of disease are, (a) destruction of toxins, (b) elimi- 
 nation of toxins, (c) destruction and elimination of bacteria. 
 
 1473 a. Procedures Which Encourage Destructio?i 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 thyroid 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 bodily 
 activities by which destruction of toxins is promoted. 
 
 147-4 $. Procedures To Encourage the Elimination 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 ioo 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 c.c. 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 off 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 
 
HYDRIATIC PRESCRIPTION MAKING. 97 1 
 
 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 (1344) frequently renewed, 
 and the alternate compress (1340), 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 (1344), the alternate com- 
 press (1340), the Scotch douche (1037), and the alternate 
 douche 1044). The elimination of bacteria by the skin and 
 kidneys is encouraged by sweating baths (1239-1250), copious 
 water drinking (1423), and especially by the vapor bath 
 (1246), 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 CO 8 (402), 
 
972 RATIONAL HYDROTHERAPY. 
 
 and it is evident that general oxidation is thereby increased 
 throughout the body. By the employment of 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 which either the oxidation 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, 
 creatin, 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 production, 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 cooling pack 
 (1189), are the measures most effective for stimulating oxida- 
 tion of fat and carbohydrates. 
 
 The hot immersion bath (1126), the heating pack (1186), 
 the dry pack (1192), the vapor (1246), hot-air (1233), and 
 Turkish baths (1239), sun bath (1254), 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 (644), 
 by a very short general cold application, to counteract the 
 depressing effects of the hot bath, and to restore the tone of 
 the skin. 
 14-77 Procedures Which Excite the Central Ganglia. — In 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 
 
HYDRIATIC PRESCRIPTION MAKING. 973 
 
 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 (1318), alternate (1340), and 
 hot and cold localized compresses (1356), are most efficient 
 means of exciting the central ganglia. 
 
 Measures Which Encourage General and Local fletabolic 1178 
 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 local, as in hypopepsia. 
 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 appli- 
 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 
 effects 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 (383-388, 390-399). 
 
 That general cold applications to the cutaneous surface 
 promote to a high degree the processes of blood formation, 
 
974 RATIONAL HYDROTHERAPY. 
 
 is well shown by the efficiency of the cold bath in combating 
 the most inveterate forms of anemia, even when all other 
 measures have failed. It is certainly safe to say that there is 
 no known remedy of such great value in promoting blood for- 
 mation as short general cold baths. The lower the tempera- 
 ture, the better, but the application must be very short. 
 The cold mitten friction (1209) and the cold towel rub 
 (1213) applied two or three times daily are especially valu- 
 able for this purpose. For patients who have been trained 
 up to its use, the cold douche (1010) is most effective of all. 
 1479 Procedures Which Increase General Blood flovement and 
 
 Local Blood Supply — By the regulation of the general move- 
 ment of the blood, all the nutritive processes of the body may 
 be influenced. Since the blood is the great healing agent 
 of the body, measures whereby the movement of the blood 
 throughout the body may be encouraged or controlled are of 
 the greatest importance in dealing with both acute and chronic 
 diseases of almost every sort. Cold applications to the sur- 
 face excite the heart, increase the blood pressure, and increase 
 the movement of the blood and lymph throughout the body. 
 All tonic measures may be used for this purpose. The cold 
 precordial compress (1383) serves a like purpose, and may 
 be employed in many cases when general cold applications 
 may be inadmissible, and also when hot applications are 
 required for some other purpose, thus antagonizing the 
 depressing effect of heat. The cold mitten friction (1209) 
 and the cold towel rub (1213) are especially useful in re- 
 enforcing the energy of the heart and encouraging the circu- 
 lation in almost all cases in which these indications are 
 present, whether in cases of fever, cardiac or renal diseases, 
 or in cases of neurasthenia with general feebleness, and in 
 chronic tuberculosis and other wasting disorders. 
 
 General hot applications at first stimulate the heart and 
 increase blood pressure, but later lower the blood pressure 
 (1025), diminish the energy of the heart, and lessen the rate 
 of the movement of the vital fluids. Hot applications are 
 
HYDRIATIC PRESCRIPTION MAKING. 975 
 
 seldom required for this purpose, though the neutral bath 
 (1130) is sometimes useful in quieting excessive activity. It 
 is important to bear this fact in mind whenever it is thought 
 necessary to employ hot baths in cases in which there is pro- 
 nounced cardiac weakness, so that excessive or prolonged 
 general hot applications may be avoided. Being thus fore- 
 warned, it is also possible to guard against cardiac failure by 
 the application of the cold precordial compress (1383) during 
 the hot application. This is very often necessary in the ad- 
 ministration of the vapor bath (1246), the electric-light bath 
 (1250), and especially the Russian (1243) and hot immersion 
 baths (1126), in cases of cardiac disease. 
 
 Cold applications first quicken and then slow the action of 
 the heart, raise the blood pressure, and increase the movement 
 of the blood and the lymph through their proper channels in 
 all parts of the body (298-316, 1256-1292). 
 
 Measures Which Increase Heat Production. — That cold 1480 
 applications to the skin promote heat production has long 
 been recognized as a thoroughly established fact (290). The 
 processes of thermogenesis, or heat production, are brought 
 into play through the impression of cold upon the thermic 
 nerves of the skin. The more intense and prolonged this 
 impression, the greater the effect in increasing heat produc- 
 tion. The most intense effects are produced by prolonging 
 the application until the temperature of the body has been 
 slightly lowered. If the application of cold is greatly pro- 
 longed or is repeated at short intervals, the thermogenetic 
 reaction fails, and the depressant effects of cold appear (417). 
 
 Measures Which Increase the Elimination of Heat. — 1181 
 Increased heat elimination is indicated in nearly all cases 
 of fever, as it has been shown by Winternitz (1164), that 
 in febrile disorders the elevation of temperature is due less 
 to increased heat production than to decreased heat elimi- 
 nation. The measures most essential are such as will main- 
 tain active cutaneous circulation, while at the same time 
 cooling the skin, This may be accomplished by vigorous 
 
976 RATIONAL HYDROTHERAPY. 
 
 rubbing in a cold immersion bath, — the so-called Brand bath 
 (1150), —by the rubbing wet sheet (1216), the wet-sheet 
 pack (1179), very short hot applications followed by short 
 cold applications to the surface, the cold friction bath (1209), 
 the cold towel rub (1213), cold water drinking (1426), cold 
 enema (1405), cold applications to the spine (1372).- In 
 certain cases the hot-blanket pack (1197), the hot evapo- 
 rating sheet (726), and various other measures, may be use- 
 fully employed (744, 745). 
 
 1182 rieasures Which Relieve Pain and Nervous Irritability. — 
 
 Nervous irritability and pain may be most successfully com- 
 bated by hydriatic applications, which are not only suc- 
 cessfully directed to the removal of the cause, but also act 
 efficiently in palliation. The measures most useful for this 
 purpose have been discussed elsewhere. See 693, 694. 
 Also 1130, 1031, 1318, 1351, 1355, 1344, 1328.' The 
 general neutral bath (1130) and the neutral douche (1031) 
 are marvelously efficient in relieving nervous irritability, and 
 inducing sleep, not only in chronic forms of insomnia, but the 
 neutral bath or pack in the delirium and vigil of acute fevers. 
 The moist abdominal bandage (1351), cool head-cap (1371), 
 and in certain cases the heating spinal compress (1355) are 
 equally useful. The hot fomentation (1328) and the heating 
 compress (1344) are as useful in relieving localized pain and 
 diminishing local irritability, whether cutaneous or visceral, 
 as are cold applications in arousing activity in sluggish parts. 
 The cold compress (1318) and the ice compress (1314) 
 are likewise useful in relieving pain in superficial parts to 
 which these applications may be made directly. 
 
 1483 fleasures Which Combat Bacterial Development. — The 
 
 development of invading bacteria in cases of infection may 
 be delayed by prolonged applications of cold, when it is 
 possible to make the application directly to the parts 
 involved. When deeper parts are affected, the growth of 
 parasites may be combated by increasing the alkalinity of the 
 blood by means of general cold applications (388), and by 
 
HYDRIATIC PRESCRIPTION MAKING. 977 
 
 the application of measures which have already been de- 
 scribed as favoring local leucocytosis, such as the frequently 
 renewed heating compress (1344), and the alternate com- 
 press (1340). These measures, by increasing the movement 
 of the blood through the affected parts, bring constantly into 
 contact with the growing bacteria fresh supplies of alexins and 
 antitoxins, whereby their growth is discouraged, while at the 
 same time the white cells are actively engaged in capturing 1484 
 and destroying the parasites. 
 
 rieans of Controlling Blood Hovement and Volume. — 
 Stasis of the blood and lymph encourages morbid processes 
 by favoring the development and the accumulation of waste 
 and toxic substances in the tissues, thus leading to perverted 
 metabolism or unhealthy tissue formation, and by weakening 
 the resistance of the cells, which become asphyxiated by the 
 accumulation of CO s and poisoned by their own excretions, 
 so that they are unfitted for combat with the invading 
 parasites. 
 
 The same measures which have been described as encourag- 
 ing leucocytosis may be successfully employed in combating 
 stasis of the blood in inflamed or congested parts. Deriva- 
 tive measures (682), the cold compress (1318) over the 
 affected viscus, Scotch douche (1037), and revulsive measures 
 (680) of all sorts are indicated. See also 1256 to 1292. 
 
 neasures Which Lessen Heat Production.— Heat produc- 1185 
 tion, which must be discouraged in febrile states, is best 
 inhibited by short hot applications to the surface, and by 
 prolonged or frequently repeated cold applications. The 
 short hot immersion bath (1126), the hot-blanket pack 
 (1197), fomentations to the spine (1328), the hot evapo- 
 rating- sheet (726), are the best means of applying heat for 
 this purpose. The graduated bath (1120), the prolonged 
 tepid bath (1123), (88°), and the cooling pack (1189) are 
 the best cold applications for diminishing heat production 
 (744). 
 
 Measures Which Lessen Heat Elimination. — It is seldom 1486 
 
 62 
 
97$ RATIONAL HYDROTHERAPY. 
 
 necessary to discourage heat elimination, except in cases of 
 syncope, in which the dry pack (1192), the hot-blanket 
 pack (1197), the hot enema (1406), and hot water drinking 
 (1429) are efficient 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 peripheral vessels. 
 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 rubbing (1201), and cold mitten 
 
 1487 friction (1209). See 752. 
 
 General fletabolic Activity Is Diminished, 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, intestinal, uterine, and vesical catarrh, overex- 
 citation of the secreting glands may be lessened by with- 
 drawing the blood from the part by various derivative meas- 
 ures (667-684, 1286-1291). 
 
 1488 Hydriatic Incompatibilities. — Wise discretion must be 
 used in the combination of procedures, lest one measure 
 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 perhaps the best test of a physician's experience 
 and skill. The following meager suggestions barely touch 
 the surface of the subject. 
 
 i. 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 accidental. 
 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. Cool 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 in 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 14-89 
 type and model for the treatment of all acute infectious fevers, al- 
 though each presents special indications to which attention will be 
 called. 
 Etiological Indications. 
 
 1. Prevent Further Introduction 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 dextrinized or predigested 
 cereals, as zwieback, granola, granuto, syrupy malt extracts. 
 Pathological Indications. 
 
 3. Combat the Local Morbid Process in the Intestine. — 
 (a) Pay thorough attention to indications especially as regards 
 
98O RATIONAL HYDROTHERAPY. 
 
 a dietary which will not furnish a favorable nutrient media for the 
 growth of the bacillus. Administer a coloclyster (1407) at 75 
 to 8o° twice daily, placing the patient in the right Simm's position 
 so as to insure a complete evacuation of the entire colon. 
 
 (£) Avoid irritating foods and drugs, especially purgation, 
 mercurials, and salines. 
 
 (V) Increase the local resistance by the cold abdominal com- 
 press (1318) 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. 
 
 (d) Relieve local congestion and pain by applying fomenta- 
 tions (1328) to the abdominal surface, or the hot trunk pack (1197) 
 for ten minutes every three hours, and by taking care to maintain 
 the activity of the cutaneous circulation by frequent rubbings and 
 proper covering in connection with the cold compress.- See that 
 the hands and feet are kept warm, if necessary by hot hand (1302). 
 or foot baths (1297), or by warm wrappings and hot-water bottles. 
 
 4. Increase and Sustain General Vital Resistance. — Em- 
 ploy the cooling pack (1189), the graduated bath (1120), the pro- 
 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 (1216) 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 (1213), 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 (1103X 
 large hot fomentations (1328), or hot sponging (1204). Appl) 
 
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 6o°) 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 (134-4), changed 
 every 15 minutes. Repeat the fomentation hourly. 
 
 9. Nose=BIeed. — 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, 1 to 6, four times daily. Mois- 
 
982 RATIONAL HYDROTHERAPY. 
 
 ten the mouth frequently with cinnamon water. Keep the tongue 
 moist by a mass of cotton placed between the teeth moistened 
 frequently with cinnamon water, made by adding ten drops of 
 cinnamon essence to half a glass of boiled water. 
 
 12. Constipation. — Copious coloclyster (1407) at 75°, twice 
 daily, followed by enema, one pint at 70 ; oil enema. 
 
 13. Diarrhea. — Copious coloclyster (1407) at 95 after 
 every evacuation of the bowels; hot enema (105 ) (1406), two or 
 three pints followed by cold (70 ) one pint. Cold abdominal 
 compress (1318) at 6o°, changing every half-hour; hot leg pack 
 (1393), if extremities are cold. An exclusive diet of fruit juices 
 for a day or two. 
 
 14. Tympanites. — Very hot fomentation (1328) for 5 min- 
 utes, followed by cold compress (1318), changing every 15 min- 
 utes. Coloclyster (1407) at 75 to empty colon. Yellow soap 
 may be added to the water, if necessary. This symptom is 
 rarely troublesome under hydriatic treatment. 
 
 15. Fever — Cooling pack (1189); graduated bath (1120); 
 prolonged tepid bath (1123) 88°; Brand Bath (1150); cold 
 towel rub (1213); cold mitten friction (1209); large cold com- 
 press (1318); cooling enema (1405); cooling bath when tempera- 
 ture rises about 101.5 . See 703-765- 
 
 a. High Temperature with Hot Dry Skin Cooling pack 
 
 (1189); graduated bath (1120); Brand bath (1150); prolonged 
 tepid bath (1123). See 744. 
 
 b. 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), 8S°, 1 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. 
 
TYPHOID FEVER. 983 
 
 18. Coma.— Cold towel rub (1213); cold mitten friction 
 (1209); prolonged neutral bath (1130); wet-sheet pack (1179); 
 cooling enema (1405) every 3 to 4 hours; alternate spinal compress 
 (1342). 
 
 Complications are due to special localized manifestations of the 
 disease, chiefly either to secondary infection of the bacillus itself or to 
 intense local action of the toxins. 
 
 19. Gastric Irritation. — Large fomentations over the stomach 
 or around the body (1328), for 20 minutes. Repeat every 3 
 hours. Cold compress (1318) at 6o°, renewing every 15 minutes, 
 during the interval; hot and cold gastric compress (1362); ice- 
 bag to epigastrium (1316); ice pills, feed by nutritive enemas. 
 
 20. Intestinal Ulcerations. — Fomentation over the abdomen 
 (1328), 5 minutes every 2 hours, followed by cold compress (1318) at 
 6o°, changing as soon as warmed ; hot foot bath (1297) or leg pack 
 (1393). 
 
 21. Intestinal Hemorrhage Withhold food till hemorrhage 
 
 ceases. Extreme quiet for 2 to 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), 75 . 
 
 22. Inflammation of Bile^Ducts — Large fomentation (1328) 
 over the right side for 15 minutes every 3 hours followed by 
 cold compress (1318) at 6o°, changing every 15 minutes during 
 the interval. Water drinking (1423); an exclusive diet of fruit 
 juices and fruit purees for 3 or 4 days; cooling enema (1405) 
 repeated every 3 hours. 
 
 23. Appendicitis. — Fomentation (1328) for 20 minutes over 
 right iliac region every 2 hours. Cold compress (1318) at 6o°, 
 renewed every 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). 
 
 25. Bronchitis, Broncho=Pneumonia, Lobar Pneumonia 
 
 Fomentation to the chest (1328) for 10 minutes every 2 or 3 
 hours, followed by cool chest compress (1321) renewing, every 
 l 5 to 3° minutes during the intervals. See 1570, 1571, 1498, 
 taking into consideration the patient's condition. 
 
984 RATIONAL HYDROTHERAPY. 
 
 26. Pulmonary Congestion Alternate compresses (1340) 
 
 to the chest for 15 minutes, renewed every 3 hours; heating 
 chest pack (1374) during the interval, at 6o°, changing once an 
 hour. Rub the chest well at each change. Hot foot bath (1297) 
 or leg pack (1393). 
 
 27. Cardiac Failure. — Cold mitten friction (1209) when- 
 ever the skin is cold or cyanotic. Avoid the Brand bath and ex- 
 treme general cold baths. Lower temperature by cold mitten 
 friction (1209), graduated bath (1120), prolonged tepid bath 
 (1123); ice-bag over heart (620, 1322) for 15 minutes at inter- 
 vals of 2 hours. (Avoid in endocarditis.) Hot fomentations 
 (1328) over the heart for y 2 minute followed by cold compress for 
 10 minutes when cold alone is not sufficiently stimulating. 
 
 28. Endocarditis — Pericarditis. — Hot fomentation (1328) 
 for 30 seconds followed by ice-bag (620> 1322) to be taken off 
 and parts rubbed till red every 15 minutes. Repeat the fomenta- 
 tion hourly, if necessary to relieve pain. 
 
 29. Myocarditis. — Fomentation (1328) 30 seconds, followed 
 by compress (1314) at 6o°, 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. meningitis. — Hot-blanket pack (1197); ice-cap (1323); 
 ice-collar (1316) ; ice-bag to spine (1372); hot immersion bath 
 (1126), 103 , 2 to 5 minutes, followed by wet-sheet pack (1179) 
 with ice-bag (1314) 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 FEVER. 985 
 
 34. Hysteria. — Hot-blanket pack (1197) followed by neutral 
 wet-sheet pack (1182); ice to head (1314) and spine (1372); 
 cooling enema (1405). 
 
 35. Neuritis. — For general neuritis, prolonged neutral bath 
 (1130) 1 to 3 hours, twice daily. Water drinking (1423), 
 copious cooling enema (1405), hot-blanket pack (1197), 15 
 minutes, followed by heating pack (1183). For local neuritis, 
 fomentation every 2 hours, with heating compress during 
 interval, or revulsive compress for 5 to 10 minutes every 
 hour or two. 
 
 36. riultiple 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 20 minutes repeated every 3 hours; continuous heating com- 
 press (1344) during interval. 
 
 39. Arthritis. — Fomentation (1328) for 15 minutes every 3 
 hours; heating compress (1344) during interval, changing hourly 
 or more often when the local temperature is high. 
 
 40. Abscess of the Muscles. — Fomentation (1328) for 10 
 minutes every 2 hours followed by continuous heating compress 
 (1344) at 6o° during the interval. Prevent general septicemia by 
 prolonged neutral baths, copious water drinking, large enemas 
 twice daily, and early opening and antiseptic treatment. 
 
 41. Suppurating Kidney Fomentation for 10 minutes over 
 
 the kidney, repeating every 2 hours; continuous heating com- 
 press (1344) during interval; revulsive compress every 3 hours 
 (1341); irrigation of bladder (1411). 
 
 42. Orchitis. — Fomentation (1328) for 20 minutes every 2 
 hours followed by the cooling compress (1318) extending over 
 the hypogastrium and inside the thighs; hot pelvic pack (1390) 
 for 15 minutes every 3 hours; hot foot bath (1297); ice- 
 bag (1372); take care to maintain vigorous surface circu- 
 lation. 
 
 43. Ovaritis. — Hot and cold pelvic compress (1364); ice-bag 
 
9^6 RATIONAL HYDROTHERAPY. 
 
 over ovary, removing for 5 minutes every half-hour, with hot leg 
 pack (1393); keep the extremities warm. 
 
 44. Pelvic Hematocele.— Hot pack to the hips (1389) and 
 legs (1393 and 1197), 10 to 20 minutes; repeat every 2 to 3 
 hours; ice-bag over tumor during intervals. After first 24 hours, 
 revulsive compress (1341) three times daily; hot rectal (1410) or 
 vaginal irrigation (1413) twice daily; fomentation (1328); hot 
 enema (1406). 
 
 45. Acute Nephritis, Albumin in Urine — Hot-blanket pack 
 (1197) continued, if possible, to vigorous perspiration; repeat 
 every hour. Ice-bag over heart (1314) during pack. Hot full- 
 bath (1126) 103 to 105 for 6 minutes, followed by neutral bath 
 (1130) 92 to 94 for 1 to 2 hours; fomentation to back (1328) for 
 20 minutes every 2 hours; heating compress (1344) applied at 6o° 
 during intervals; enema (1404) at 92 three times daily; small ice- 
 bag (1314) over lower third of sternum, remove for 5 minutes 
 every half-hour; copious water drinking (1423). 
 
 46. Scanty Urine. — Enema (1405) at 8o° every 4 hours; 
 copious water drinking (1423) from 1 to 2 pints every 4 hours, 
 employing carbonated distilled water if possible; may add fruit 
 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 (6o°) precordial compress 
 (1383), 15 minutes, 3 times daily; cold mitten friction (1209) or 
 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 
 
TYPHOID FEVER. 987 
 
 hour before eating; wet girdle (1347) worn at night; cold mitten 
 friction (1209) or cold towel rub (1213) twice daily. 
 
 51. Anemia. — Graduated tonic treatment (1625), twice 
 daily. Out-of-door life; nitrogenous diet. 
 
 52. General Weakness. — Alternate spinal sponging (1342) 
 or compresses (1340) twice daily, followed by cold mitten friction 
 (1209) or cold towel rub (1213) twice a day; massage (1221, 
 1461); manual Swedish movements. 
 
 Complications. 
 
 53. Boils, 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 carefully masseed (1221, 1461), tak- 
 ing care to avoid abrading the surface; pimples should be dressed 
 antiseptically. Hot fomentation (1328); neutral compress 
 (1339); ice-bag or ice compress (1314). 
 
 54. Ataxo=Adynamic State — Hot full-bath (1126) for 5 
 minutes followed by cold affusion (1103) for 3 minutes at 75 to 
 73 ; the affusion should be followed by vigorous rubbing. Hot 
 full-bath (1126) io 4 °to 105 followed by cold affusion (1103), 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 10 minutes 
 every 2 hours. Prolonged neutral bath (1130), 92 to 95 °, rub- 
 bing gently if inclined to chill; gradually lower temperature to 
 88°; continue for several hours. A general cold friction (1209); 
 ice-bag to the spine; fomentations to the spine (1328), or hot- 
 blanket pack (1197) followed by cold friction (1209). 
 
 55. Typhoid in Infants. — Graduated bath (1120); prolonged 
 neutral bath (1130); cooling pack (1189); continuous abdominal 
 compress (1351); cooling enema (1405). Avoid Brand bath. 
 
 56. Typhoid in Aged Persons. — Graduated bath (1120); 
 prolonged neutral bath (1130); cooling pack (1189); cooling 
 enema (1405); cold friction (1209) over heart and chest every 
 3 hours, heating compress (1344) between. Special attention 
 
RATIONAL HYDROTHERAPY. 
 
 should be given to the administration of water by the mouth and 
 by enema (1404). Avoid Brand bath. 
 
 57. Typhoid with Puerperal Fever The prolonged neutral 
 
 compress (1339); graduated bath (1120), avoiding temperatures 
 lower than 8o°. Cooling pack (1189); hot-blanket pack (1197), 
 followed by cold towel rub (1213) or cold mitten friction (1209); 
 hot pelvic pack (1390); hot enemas (1406); hot uterine irriga- 
 tion (1415); hot vaginal irrigation (1413); cold precordial com- 
 press (1383) or ice-bag (1314) over heart; fomentation (1328) 
 over abdomen 5 to 10 minutes every 2 to 3 hours; heating com- 
 press (1344) applied at 6o°, renewing every 20 minutes during the 
 intervals. 
 
 58. Typhoid with Pregnancy. — Prolonged neutral or tepid 
 bath (1130); cool enemas (1405); cold towel rubs (1213); 
 cold friction (1209). Wet-sheet pack (1179); abdominal com- 
 press (1318). Avoid Brand bath. 
 
 59. Typhoid with Erysipelas — The same measures as in 
 ordinary typhoid, adding ice-cold compress (1314) to inflamed 
 surfaces, changing every 15 minutes; fomentation (1328) for 5 
 minutes every 2 hours; after 24 hours, cooling compress (1318) to 
 the inflamed parts, changing every 20 minutes. As inflammation 
 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 (12 13). 
 
 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 (1405); 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. 
 
TYPHOID FEVER. 989 
 
 64. Typho=MaIarial Fever — Short hot immersion bath 
 (1126) or hot-blanket pack (1197) followed by short cold pail 
 douche (1 108), spray (1055), shower (1047), 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), 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, multiple 
 neuritis, spinal meningitis, arthritis, and ovaritis, 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 duration of the disease, greatly diminish its 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 (103 or 104 ), most vigorous hydriatic 
 measures should be employed at once to bring the fever under 
 control if possible. As the disease advances, milder measures, 
 such as the neutral bath (1130), the graduated bath (1120), the 
 rubbing wet sheet in bed (1216), and repeated wet towel rubbing 
 (1213) 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 (1630) 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. 
 
990 RATIONAL HYDROTHERAPY. 
 
 MALARIAL FEVER — REMITTENT. INTERMITTENT. 
 
 1 £90 Etiological Indications. 
 
 i. To Suppress Infection. — Boil drinking water, and if neces- 
 sary and possible remove to a salubrious locality. Avoid mos- 
 quito bites. 
 
 Pathological Indications. 
 
 2. Increase General Resistance. — Tonic hydriatic applica- 
 tions, especially the wet-sheet pack (1179); cold mitten friction 
 (1209); cold towel rubbing (1218); wet-sheet rub (1216); half- 
 bath (1174); cold douche (1010); cool coloclyster daily (1407); 
 copious water drinking (1423). The vigor of the applications 
 must be suited to the patient's condition (1625). Repeat two to 
 three times daily during remission or between the paroxysms. 
 
 3. Increase General Leucocytosis as a Means of Qestroy- 
 ing the Parasites. — The hot bath followed by vigorous cold 
 applications, — hot-blanket pack (1197) followed by cold towel 
 rub (1213); vapor bath (1246) or electric-light bath (1250) 
 followed by cold douche (1010) or wet-sheet rub (1216); hot- 
 blanket pack (1197) followed by cold douche (1010) or shallow 
 bath (1174); sweating bath (832, 1191) followed by wet-sheet 
 rubbing (1216). 
 
 4. Combat Hepatic and Splenic Enlargement. — Fomenta- 
 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 (1192). 
 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 Organic 
 Changes and Degenerations of the Liver, Spleen, and Other 
 Viscera. — Copious water drinking (1424) to eliminate the poi- 
 sons; cold applications 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, 70°, 
 
MALARIAL FEVER. 99 l 
 
 (1404) or coloclyster (1407) twice a day; careful feeding; easily 
 digestible foods, especially well-dextrinized cereals and fruits. 
 
 Clinical Indications. 
 
 7. The indications for the treatment of continued malarial 
 fever are almost identical with those for the treatment of typhoid. 
 The typhoid state is not infrequently present. The abdominal 
 compress (1351) is as useful in combating lesions of the liver 
 and spleen in the remittent or continued forms of malarial infec- 
 tion as in typhoid. 
 
 In the intermittent form special attention is given to suppres- 
 sion of the chill and less to the employment of antifebrile 
 measures. 
 
 8. Fever. — The temperature rises higher than in typhoid. 
 The cooling pack (1189) is especially indicated. The cooling 
 enema (1405), graduated bath (1120), rubbing wet sheet in bed 
 (1216), cold towel rubbing (1213), and cool sponging (1204) are 
 indicated. Water drinking (1423). In intermittent fever care 
 must be taken to avoid precipitating a chill by cold applications, 
 which should not be made until all tendency to rigor has disap- 
 peared. 
 
 9. Chill. — The prevention of the paroxysm, or interruption 
 of the periodicity of the disease is of the highest importance in 
 intermittent malarial fever. The best measures are the sweating 
 pack (1191), or the very hot immersion (1126) or shower 
 bath (1054), 3 to 5 minutes, followed by a very cold douche dr 
 affusion (1103), and this followed by vigorous rubbing (920), and 
 the dry sweating pack (1192). When the chill occurs, give the 
 patient hot water to drink, wrap in warm blankets, place bags 
 filled with hot water, or heated bricks, to the sides and loins. Avoid 
 hydriatic applications of all sorts. Moistening of the skin causes 
 chill by evaporation. 
 
 10. Sweating. — Wipe with a soft cloth, taking care to avoid 
 too much exposure of the body. If the sweating is greatly pro- 
 longed, sponge the surface with very hot (1206) water. Make 
 no cold applications while the patient is sweating. 
 
 11. During Interval — If intermittent, on well day admin- 
 ister a sweating bath followed by cold wet-sheet rub (1216) and 
 other vigorous tonic measures. A fomentation (1328) should 
 
992 RATIONAL HYDROTHERAPY. 
 
 be applied over stomach and liver, morning and night. The wet 
 girdle (1347), without impervious covering, should be worn con- 
 stantly and changed just before becoming dry, or three or four 
 times daily. 
 
 12. Mixed Infections: Typho=IVlaIarial Fever, Halarial Dys= 
 
 entery, and So=caIled Halarial Pneumonia Should be» treated 
 
 especially with reference to the primary or most prominent disorder. 
 See Dysentery (1530), Pneumonia (1498), Typhoid (1489). 
 
 13. Hematuria. — Continuous rest in bed; hot-blanket pack 
 (1197) for 30 to 40 minutes, followed by cold mitten friction 
 (1209), twice or more times daily, administered so as to avoid 
 chilling. The skin must be well reddened and very active cutane- 
 ous circulation maintained. Ice-bag (1314) over sternum during 
 interval; withdraw ice-bag for 5 minutes every half-hour to allow 
 reaction to occur. Fomentation (1328) to back for 15 minute? 
 every 2 hours followed by well-protected heating compress (1344) 
 Between fomentations (1328), maintain vigorous surface circula- 
 tion by hot-water bags, etc. 
 
 14. Syncope. — Hot-blanket pack (1197) for 15 minutes, fol- 
 lowed by very cold and vigorous friction (1209), and wrapping 
 in warm, dry blankets. Hot fomentation over heart 1 minute 
 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 (1423) and hot enema (1406). After the 
 bath, wrap the patient in dry blankets. 
 
 16. Malarial Enlargement of Liver and Spleen. — Alternate 
 compress (1340) or alternate douche (I044. 1 , 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 drinking (1423) ; an aseptic dietary. 
 
 1 8. 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 
 first 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, the vital 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, antiperiodic doses of quinia (5 
 to 15 grains) may 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 repeated doses of quinine is never 
 necessary in the treatment of intermittent fever when the resources 
 of hydrotherapy are effectively brought into operation. 
 
 In chronic malarial infection, which is often refractory to qui- 
 nine, hydrotherapy is marvelously successful. See "Malarial 
 Cachexia" (17). 
 
 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 measures, espe- 
 cially the cooling pack (1189); during the remission apply 
 fomentations (1328) over the liver, cold towel rubbings (1213) 
 every two or three hours, and thus build up the patient's resistance. 
 In cases which have resisted antiperiodic 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- 
 herapy alone proves insufficient, one or two small antiperiodic 
 doses of quinine may be administered with the happiest results. 
 63 
 
994 RATIONAL HYDROTHERAPY. 
 
 SCARLET FEVER. 
 1491 Pathological Indications. 
 
 i. Encourage General Resistance Hot-blanket pack 
 
 (1197), 3 to 8 minutes followed by cooling wet-sheet pack (1189). 
 (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 8o°, the 
 patient sitting in a bath tub. Cold mitten friction must be 
 avoided. 
 
 2. Eliminate Poisons. — Copious water drinking (1423), 
 two to six glasses in 24 hours. Carbonated water, fruit juice, 
 fruit purees, etc. 
 
 Clinical Indications. 
 
 3. Fever.— Cooling pack (1189), hot-blanket pack (1197), 
 followed by cold towel rub (1213) or wet-sheet rub (1216), 
 graduated bath (1120), copious water drinking (1423), cooling 
 enema (1405). 
 
 4. Delayed Eruption — Wet-sheet pack (1183) prolonged to 
 heating stage. 
 
 5. Diarrhea. — Enema (1405), 75 to 8o° after each move- 
 ment. Fomentation (1328) for 15 minutes over the abdomen every 
 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°t0 95°. Water drinking (1423); large enema 
 (1404). 
 
 8. Pharyngitis. — Fomentation (1328) to throat 10 minutes 
 every hour with ice compress (1314) during interval. Steam 
 inhalation (1419) 5 to 10 minutes every half-hour. Gargle throat 
 with very hot water hourly. Throat compress (1381) at 6o°, 
 changed every 15 minutes; protected heating compress (1344) 
 
SCARLET FEVER. 995 
 
 changed once in 3 hours. Spray throat with weak solution of 
 peroxide of hydrogen or hydrozone every hour. 
 
 9. Delirium with Insomnia and Nervous Agitation or 
 Chorea. — Ice bag (1323) to head, hot fomentations (1328) to 
 spine, followed by prolonged wet-sheet pack (1179). 
 
 10. Desquamation. — Neutral (92 to 95 °) alkaline bath daily 
 (1112, 1463), 15 minutes to 1 hour. 
 
 11. Nephritis, or Suppression of Urine — Hot-blanket pack 
 (1197) for 20 to 30 minutes followed by heating compress 
 (1344:) to the loins. Copious water drinking (1423); enema 
 (1405) 8o° to 90 , twice daily. 
 
 12. Pleurisy. — Fomentation to the chest (1328) for 15 
 minutes every 2 hours with heating compress (1344) during the 
 interval. Tight muslin bandage about chest if pain is intense. 
 
 13. Rheumatism. — Sweating pack (1191); copious water 
 drinking (1423); fomentation (1328) to joints every 3 hours 
 with heating compress (1344) during interval. 
 
 14. Pericarditis, or Endocarditis — Ice-bag (1314) or cold 
 compress (1314) over heart to be removed for 5 minutes every 
 15 to 20 minutes. 
 
 15. Enteritis. — Hot trunk pack (1197), with hotfoot bath 
 (1297) or hot leg pack (1393) for 20 minutes, followed by cold 
 abdominal compress (1318) at 60 °, to be changed every 30 min- 
 utes. Enema (1404) after each stool, at 95 °. 
 
 16. Pneumonia. — Fomentation (1328) for 15 minutes every 
 2 or 3 hours, cold compress (1344) at 6o° 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-sheet 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), very hot baths (1126), heating pack 
 (1183). 
 
996 RATIONAL HYDROTHERAPY. 
 
 After eruption is fully developed, cooling pack (1189), grad- 
 uated bath (1120), cool enema (1405), and other antipyretic 
 measures. Copious water drinking (1423) is especially important. 
 
 Give attention to throat, to prevent infection of the ears. 
 Steam inhalation (1419); irrigation (1400); heating compress 
 (1344). 
 
 If albumin appears, the blood must be kept in the skin by hot 
 packs (1197) and warm wrappings; and the cold applications 
 must be "partial," such as wet-hand rub (1201), cold mit 
 ten friction (1209), cold towel rub (1213). 
 
 Prolonged chilling of the skin must be carefully avoided. 
 
 MEASLES, 
 1492 Pathological Indications, 
 
 i. Maintain General Resistance. — Wet-sheet pack (1179); 
 graduated bath (1120). 
 
 2. Prevent Pulmonary Complications. — Fomentation to 
 chest (1328) twice a day, chest pack (1373) during interval. 
 Clinical Indications. 
 
 3. Naso=Pharyngeal Irritation. — Apply light very hot com- 
 presses (1286) to the face. Inhale steam (1419) and vapors of 
 aromatic oils and balsams. Fomentation (1328) to the throat 
 every 2 hours, heating compress (1344) during the interval, 
 changing every 15 minutes at first, less frequently later. 
 
 4. Headache. See 1554, n-15; 1562. 
 
 5. Delayed Eruption. — Hot-blanket pack (1197) 10 minutes 
 followed by heating wet-sheet pack (1183). 
 
 6. Inflammation of Middle Ear. — Ice to throat of same side 
 (1314); fomentation (1328) over ear. 
 
 7. Nephritis. See 1537. 
 
 8. Hemorrhagic Form. — Hot-blanket pack (1197) or short 
 hot immersion bath (1126) followed by heating wet-sheet pack 
 (1183). Repeat every 3 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 (1209) twice daily. 
 Moist chest pack (1373) night and day. 
 
 10. Lobar Pneumonia — Bronchopneumonia, — Fomenta- 
 tion (1328) for pain and irritable cough, repeated every 2 or 
 
ERYSIPELAS. 997 
 
 3 hours; cold compress (1344) during interval, at 6o°, chang- 
 ing every 15 to 30 minutes; hot hip and leg pack (1393) if the 
 local inflammation is severe. See Pneumonia (1498). 
 
 11. Cough — See 1570, 4-7. 
 
 12. Nosebleed. — See 1496, 4. 
 
 13. Inflammation of the Eye or Eyelids. — See 1602. 
 
 ERYSIPELAS. 
 Pathological Indications. 1493 
 
 1. General. — Cold mitten friction (1209) or towel rub (1213) 
 every 3 hours. 
 
 2. Combat Local Inflammation and Extension of the Dis= 
 ease. — Cold compress (1318) during the early stage of the dis- 
 ease, renewing before it becomes warm, later, less frequently. 
 Avoid ice-bags or ice compresses, which involve risk of sloughing; 
 Fomentations (1328) for 2 to 5 minutes every 2 hours. Ice-collar 
 (1316), when the skin of the head or face is affected. 
 Clinical Indications. 
 
 3. Fever. — Graduated bath (1120); prolonged neutral bath 
 (1130); cooling enema (1405); cooling wet-sheet pack (1189). 
 
 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. — See 1576. Fomentation 
 (1328) over heart 30 seconds, followed by precordial compress 
 (1383) at 6o°; change every half-hour. 
 
 7. Myocarditis — See 1489, 29; 1576, 5. 
 
 8. Arthritis — See 1499; 1489, 39 
 
 9. Albuminuria, Acute Nephritis See 1537. 
 
 10. Delirium. — See 1489, 17. 
 
 General flethod. — During the early stage of the disease, while 
 the surface is bright red and the inflammation extending, apply 
 cooling measures, changing every few minutes (3 to 5), as often 
 as warm. Prevent extreme depression by a fomentation (1328), 
 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), changing at intervals of 15 to 30 minutes, pro- 
 longing the interval as the fever and inflammation subside. 
 
993 RATIONAL HYDROTHERAPY. 
 
 SMALLPOX. 
 
 1494 Pathological Indications. 
 
 i. General — Spare, aseptic diet (1626); water drinking 
 (1423). See Scarlet Fever (1491, i). 
 
 Clinical Indications. 
 
 2. Lumbar Pain. — Fomentation (1328) or hot trunk pack 
 (1197) every three hours; heating pack (1183) during interval, 
 change every 30 to 40 minutes. 
 
 3. Nausea and Vomiting. — Ice-bag (1314) over stomach, 
 hot and heating trunk pack (1367). 
 
 4. Constipation. — Cold enema (1405) daily; coloclyster 
 (1407) 70 daily. 
 
 5. Diarrhea. — Enema (1404) at 95 after each movement; 
 fomentation (1328) to abdomen; cold compress (1318) to be 
 changed every hour. 
 
 6. Delayed Eruption. — Hot-blanket pack (1197) or hot 
 bath (1126) followed by sweating wet-sheet pack (1183). 
 
 7. Fever. — Graduated bath (1120); prolonged tepid bath 
 (1123); cooling wet-sheet pack (1189); cool enema (1405), 
 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 interval, 
 at 6o°, renewed every 20 minutes. 
 
 10. Pitting. — Cooling compress, using red cloth, covering 
 face completely. Red curtains to windows. 
 
 n. Headache and Delirium. — Ice-cap (1323), ice-collar 
 (1316). Hot and cold cephalic compress (1358). 
 
 12. Broncho=Pneumonia — See 1573. 
 
 13. Endocarditis. — See 1576. 
 
 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. 
 
CEREBROSPINAL MENINGITIS. 999 
 
 General Method. — Keep the temperature down, and maintain 
 activity of the skin by prolonged neutral (1130) 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 compress (1318). In 
 confluent cases, general septicemia is prevented by prolonged 
 immersion baths (1136). 
 
 CEREBROSPINAL MENINGITIS. 
 Pathological Indications. 1495 
 
 1. General. — Careful cold mitten friction two to four times 
 daily. 
 
 2. Combat Congestion of the Brain and Cord Ice-cap 
 
 (1323); ice-collar (1316); 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 (1197); 
 hot immersion bath (1126) 102 °. The head should be protected 
 by the ice-cap (1323), cooling coil, or the ice-collar (1316) 
 during all hot applications. Fomentation to the spine every 2 
 hours. Spinal ice-bag during intervals. Vigorous cutaneous cir- 
 culation must be maintained. 
 
 3. Prevent Bronchitis. — Fomentation (1328) to the chest 
 twice daily; well-protected heating compress (1374) during inter- 
 val. Keep shoulders dry and well protected while in bed. In 
 cold bath, see that water covers shoulders. The chest compress 
 must cover the shoulders. 
 
 Clinical Indications. 
 
 4. Headache. — Fomentation (1328) to the back of the neck; 
 ice compress (1314) to head and neck; hot and cold head com- 
 press (1358). 
 
 5. Pain in Back and Legs. — Fomentation (1328) to back; 
 hot hip pack (1389). Repeat every 4 hours or more often. 
 Heating compress (1344) or ice-bag (1314) during interval. 
 
 6. Vomiting. — Ice-bag (1314) over stomach; hot and heating 
 trunk pack (1367). 
 
 7. Diarrhea. — Enema (1404) at 95 ° after each movement. 
 During interval cold abdominal compress (1318) at 60 °, renewed 
 every fifteen minutes with fomentations to the abdomen 15 min- 
 utes every two hours (1328). 
 
IOOO RATIONAL HYDROTHERAPY. 
 
 8. Muscular Rigidity.— Hot-blanket pack (1197); hot 
 immersion bath (1126); hot fomentation (1328), followed by 
 well-protected heating compress (1344). 
 
 9. Hyperesthesia. — Neutral bath (1130), 94 to 96 . 
 
 10. Delirium or Mania — Prolonged wet-sheet pack (1179); 
 ice-cap (1323) and ice-collar (1316). 
 
 n. Muscular Spasm. — Hot immersion (1126) 102 ° for 15 to 
 30 minutes, with ice-cap (1323) and ice-collar (1316). Pro- 
 longed neutral bath (1130). Heating spinal compress (1355). 
 
 12. Contraindications. — Cold immersion bath, Brand bath, 
 and other general cold procedures. 
 
 General flethcd. — The object to be sought by treatment is to 
 relieve congestion of the brain and spinal cord by diverting as 
 much blood as possible into the skin, hence the skin must be kept 
 constantly warm. General cold procedures such as the cold 
 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 (1314) and 
 the application of an ice-bag (1314) over the heart. Partial cold 
 applications, as cold mitten friction (1209), should be adminis- 
 tered several times daily to maintain vital resistance, care being 
 taken to maintain surface warmth by the application of heat to the 
 spine and legs (1328, 1393) or other parts during the treatment, 
 so as to avoid retrostasis. 
 
 MUMPS. 
 1496 Pathological 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 Inflammation. — Hot-blanket pack 
 (1197) followed by heating or sweating wet-sheet pack (1187), 
 continued 1 to 2 hours. Repeat the application twice a day. 
 Fomentation (1328) over the affected parts every 2 hours for 15 
 minutes, followed by heating compress (1344) at 6o°, to be 
 changed every 10 minutes or as soon as warm; ice-bag over 
 swollen glands until active inflammation is subdued. Remove 
 ice every half hour and apply fomentation for 5 minutes. 
 
 
DIPHTHERIA AND TONSILITIS. IOOI 
 
 Clinical Indications. 
 
 3. Headache — Cool compress (1318). 
 
 4. Nose=Bleed. — Ice (1314) to back of neck; hot com- 
 press (1286) over face; ice to hands; elevate hands to vertical 
 position; 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. 
 Abdominal compress (1318) at 6o°, 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); ice pills; sipping very 
 hot water. 
 
 7. Earache. — Ice bag (1314) to neck of the same side, 
 fomentation (1328) over ear; hot ear douche (1396) if neces- 
 sary, Protect the ear with warm cotton to prevent chilling by 
 evaporation after treatment. 
 
 8. Convulsions. — Hot blanket pack (1197) or hot immer- 
 sion (105 to 108 ) (1126) with cold to head. 
 
 9. Inflammation of the Mammae — Fomentation (1328) 
 over the breast for 15 minutes every 3 hours. During interval, 
 heating compress (1344) at 6o° 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. Inflammation 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 interval, heating compress (1344) at 6o° 
 in place of ice compress, renewed every 15 minutes. 
 
 DIPHTHERIA AND TONSILITIS. 
 Pathological Indications. 1497 
 
 1. Increase and Maintain Vital Resistance. — Hot fomenta- 
 tion (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. 
 
1002 RATIONAL HYDROTHERAPY. 
 
 To Combat Local Inflammation. — Fomentation (1328) to 
 throat every 2 hours for 15 minutes; ice compress (1314) to throat 
 during interval. If inflammation becomes intense, and suppuration 
 or sloughing is threatened, the heating compress (1344) at 6o°, 
 changing every hour. Steam inhalation (1419); antiseptic 
 lotions to throat; hot-water gargle. 
 
 2. Combat General Toxemia and Resulting Degenerations 
 and Localized Inflammations. — Copious enemas (1404) twice 
 daily. Copious water drinking (1423), three to six pints daily. 
 The free use of fruit juices. Hot fomentations (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. 
 
 3. To Combat Local Inflammation. — Hot-blanket pack (1197) 
 followed by sweating wet-sheet pack (1191); repeat every 3 
 or 4 hours if necessary. Fomentation (1328) to throat every 
 2 to 3 hours for 15 minutes; ice compress (1314) to throat during 
 interval; ice pills; if inflammation becomes intense and sloughing 
 is threatened, the heating compress (1344) at 6o°, changing every 
 hour. Steam inhalation (1419); antiseptic lotions. 
 
 Clinical Indications. 
 
 4. Fever.— Hot-blanket pack (1197) followed by wet-sheet 
 pack (1179); prolonged neutral bath (1130) when rectal tem- 
 perature rises above 101 ; fomentation (1328) followed by cold 
 towel rub (1213); cold enema (1405) with simultaneous fomen- 
 tation (1328) to the back; hot enema (1406) followed by cold 
 towel rub (1213) or cold mitten friction (1209). 
 
 5. Coma or Collapse. — Hot-blanket pack (1197); colo- 
 clyster (1407) at 8o°; alternate compress or sponging to spine 
 (1342); cold mitten friction (1209); hot and cold cephalic com- 
 press (1358); in case of collapse, short hot immersion bath 
 (1126) followed by dry pack (1192); hot enema followed by 
 dry pack (1192). 
 
 6. Albuminuria, Nephritis. — See 1537. 
 
 7. Broncho-Pneumonia. — See 1573. 
 
 8. Paralysis. — Fomentation to spine (1328) with cold mitten 
 friction (1209); short hot-blanket pack (1197) or electric-light 
 bath (1250) followed by cold mitten friction (1209); hot and 
 cold friction over the affected part; applications of galvanism and 
 
LOBAR PNEUMONIA. IOO3 
 
 sinusoidal current; gymnastics, massage, and appropriate exer- 
 cise. 
 
 9. Neuritis. — Fomentation (1328) over the course of the 
 affected nerve for 15 minutes every 2 to 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 lime; fomentation to throat 15 minutes every 2 
 hours; cold or very cold compress, changed every 15 minutes 
 during the interval; hot blanket pack (1197); keep skin warm. 
 Surgical interference is often necessary. 
 
 11. Threatened Suffocation. — Put the patient in a bath (102 
 to 105 °), and pour cold water over the chest and spine. Cold 
 mitten friction. 
 
 LOBAR PNEUMONIA. 
 Etiological Indications. 1498 
 
 1. Exercise special care to prevent pulmonary congestion from 
 exposure of the shoulders or chest to chill by evaporation. Pro- 
 vide the patient with abundance of pure warm air; have a supply 
 of oxygen at hand for immediate use if required. 
 
 Pathological Indications. 
 
 2. Maintain General Vital Resistance. — Cold mitten friction 
 (1209) or cold towel rub (1213) two to four times daily, after 
 some appropriate heating procedure, as fomentation (1328) to 
 chest or back, hot-blanket pack (1197), or sweating pack (1191). 
 
 3. Combat Local Congestion of the Lungs and Invasion of 
 the Specific Bacillus. — Fomentation (1328) to the chest before 
 and behind, for 15 minutes every 3 hours. During interval, 
 apply cold compress (1318) at 6o°, changing every 15 minutes, or 
 as soon as warmed. Lengthen the period between fomentations, 
 and change the compress less frequently as temperature is lowered, 
 the pain less, and the stage of the disease more advanced. Several 
 ice-bags may be used in place of the cold compress, but the bags 
 should be removed at least every half hour, and the chest should 
 be rubbed until red and warm to maintain surface circulation 
 and skin reflexes. The skin must be kept warm. 
 
 4. Elimination of Poisons. — Sweating pack (1191) continued 
 
1004 RATIONAL HYDROTHERAPY. 
 
 for 2 to 4 hours followed by cold mitten friction (1209) carefully 
 administered. The sweating bath may be preceded by the short 
 hot bath. Copious water drinking (1423). Neutral enema twice 
 daily (1404). 
 
 Clinical Indications. 
 
 5. Cough. — Fomentations (1328) every 3 hours; heating 
 compress (1344), changing every 15 to 30 minutes during inter- 
 val. Steam inhalation (1419) 15 minutes every hour; sip- 
 ping half a glass of hot water (1429) when inclined to cough; 
 careful protection of neck and shoulders from chilling by contact 
 with wet bedclothing. Keep shoulders covered. Fig. (186.) 
 
 6. Pain in Chest. — Revulsive compress (1341) covering the 
 whole chest before and behind. 
 
 7. Exudate. — Alternate compresses (1340) for 20 minutes 
 three times a day, with continuous well-protected heating compress 
 (1344) during intervals after convalescence; for unresolved exu- 
 date, alternate fan douche (1061) or alternate spray (1055). 
 
 8. Constipation. — Daily cold enema (1405) or coloclyster 
 (1407). 
 
 9. Diarrhea Enema (1404) at 96 after each movement; cold 
 
 abdominal compress (1318), 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. Gastro=Duodenitis. — Fomentation (1328) over stomach 
 and bowels or hot trunk pack (1196) every 3 hours. Dur- 
 ing intervals, cold compress (1318) at 6o°, 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 
 arid upper spine at the end of the bath. 
 
LOBAR PNEUMONIA. IOO5 
 
 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 (1191). 
 
 18. Insomnia. — Neutral wet-sheet pack (1182). 
 
 19. Cerebral Congestion. — Hip and leg pack (1393); ice 
 head cap (1323). 
 
 20. Fever. — Prolonged neutral bath (1130); wet-sheet pack 
 (1179), cooling enema, 1405. See 1485. 
 
 21. Subnormal Temperature. See 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. 
 
1006 RATIONAL HYDROTHERAPY. 
 
 ACUTE ARTICULAR RHEUMATISM. 
 
 1499 Etiological Indications. 
 
 i. Absolute rest in bed. Abstinence from all solid food for a 
 few days, allowing only ripe fruits, fruit juices, well dextrmized 
 cereals (1630), and malted foods (1631). Avoid meats, animal 
 broths, beef tea or extracts, eggs, oysters, cheese, and all foods 
 rich in proteids. 
 
 Pathological Indications. 
 
 2. Combat Inflammatory Process in Joints. — Secure active 
 cutaneous circulation by hot-blanket pack (1197) and sweating 
 wet-sheet pack (1187); hot fomentations (1328) to the joints, 
 followed by heating compress (1344). Keep the patient sweating 
 until acute pain ceases and temperature falls. 
 
 3. Prevent Extension of the Disease to the Heart, Lungs, 
 Pleura, and Meninges by promoting activity of the skin and 
 kidneys, and building up the general vital resistance by carefully 
 administered cold applications. The hot-blanket pack (1197), hot 
 enemas (1406), hot trunk pack (1196), following each hot appli- 
 cation by cold mitten friction (1209) administered carefully to all 
 portions of the body free from local inflammation. 
 
 Clinical Indications. 
 
 4. Encourage Elimination. — The prolonged sweating bath 
 administered by means of the hot-blanket pack (1197) continued 
 for several hours, is a most valuable measure. The patient should 
 not be taken out of the pack suddenly, but gradually, cold mitten 
 friction (1209) being applied to each part until good reaction 
 occurs before uncovering another portion. After rubbing, the 
 surface should be carefully protected by flannel blankets. Free 
 water drinking; large enema twice a day (1404). 
 
 5. Pains in Joints Hot-blanket pack (1197) followed by 
 
 dry wrapping; fomentation (1328) to joints, repeated every 2 hours; 
 during the interval a well-protected heating compress (1344) 
 applied as soon as the fomentation is removed. Smear joints with 
 vaseline daily. 
 
 6. Fever. — Hot-blanket pack (1197) continued to sweating, . 
 followed by sweating wet- sheet pack (1191) prolonged for several 
 
ACUTE ARTICULAR RHEUMATISM. IOO/ 
 
 hours, is the best means of lowering the temperature. When the 
 temperature is very high, the neutral bath (1130), g2 -g^° f may 
 be employed. Ice compress to head and neck. Cold mitten fric- 
 tion (1209) or cold towel rub (1213) may be administered after 
 the sweating pack (1191) or the hot-blanket pack (1197) two to 
 three times daily. 
 
 7. Profuse Perspiration. — 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 (1120) may be adminis- 
 tered; the temperature should not be lowered below 85 °. As the 
 temperature is lowered, the patient should be rubbed with sufficient 
 vigor to prevent chill. The cool enema (1405) may also be used 
 in connection with the fomentation (1328) to the back. Be care- 
 ful not to check perspiration suddenly, nor at all until acute 
 symptoms subside. 
 
 8. In Convalescence encourage blood making by graduated 
 cold baths (1625), especially cold mitten friction. 
 
 9. Hyperpyrexia (temp. 104 to 106 ). — a. Prevent by ice-cap 
 (1323), cold mitten friction (1209) at 50 to 40 , or cold towel 
 rub (1213) at 60 ° to 50 , two or three times a day, when tem- 
 perature rises above 101.5 F. May precede cold application by 
 very hot sponging (1204). 
 
 b. Combat when temperature rises above 101.5 by mitten fric- 
 tion (1209), temperature 6o°, every two or three hours, continuing 
 -until temperature falls to 10 1°. Continue application to each part 
 until reddened, so as to prevent retrostasis (671). Graduated baths 
 (1120) (102 to 85 ) may be resorted to in obstinate cases, also 
 the cool enema (1405). In all cases apply ice-cap (1323) and 
 ice-collar (1316) to antagonize cerebral congestion and coma. 
 
 10. Endocarditis, Pericarditis. — The hot fomentation (1328) 
 (not very hot) should be applied over the heart for half a minute 
 at intervals of 1 hour. This should be followed by the ice-bag 
 (1314) or cold precordial compress (1383). 
 
 n. Pleurisy and Pneumonia. — See 1498, 1573, 1574. 
 
 12. Cerebral Rheumatism. — Ice (1314) to head; prolonged 
 neutral baths (1130), 92 ; coloclysters (1407) at 8o° three times 
 a day; ice to head and neck; cooling pack; sweating pack, 
 repeating two or three times daily. 
 
 13. To Prevent Permanent Damage of Joints. — Simple flex- 
 
1008 RATIONAL HYDROTHERAPY. 
 
 ions of the joints as soon as the fever declines; short applications 
 of alternate compress or alternate douche two to three times daily, 
 after convalescence begins, with a well-protected heating compress 
 during the interval. 
 
 14. Articular Affusions. — Alternate compress (1340) or alter- 
 nate douche (1044) three times a day, well-protected heating 
 compress (1344) during interval; galvanism to joint; cataphore- 
 sis; static electricity; massage; bandaging. 
 
 15. Nodosities. — Scotch douche (1037) or fomentations 
 (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 compress 
 (1344); massage; galvanism. 
 
 16. Arteritis and Phlebitis — Fomentation (1328) over 
 affected part every 2 or 3 hours for 20 minutes; heating compress 
 (1344) during interval, wrung very dry, and protected with mackin- 
 tosh. 
 
 17. Neuralgia. — Revulsive compress (1341) followed by dry 
 cotton poultice; renew every hour or two. 
 
 18. Neuritis. — Complete rest of part; fomentation every 2 
 to 3 hours, followed by well-protected heating compress (1344). 
 
 19. Tachycardia. — Cold precordial compress (1383) for 15 
 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), 6o°, during intervals, changed 
 every hour. 
 
 21. Gastralgia. — Hot and cold gastric compress (1362), heat 
 to epigastrium (1331), 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. 1500 
 
 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). 
 
 Pathological 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 
 
IOIO RATIONAL HYDROTHERAPY. 
 
 towel rub (1213); wet-sheet rubbing (1216); vapor bath (1246); 
 hot-air bath, especially electric-light bath (1250); Turkish bath 
 (1239); sun bath (1254). 
 
 8. Contraindications. — Very cold baths, especially immer- 
 sions. See 1010, 1103, 1174, 1201, 1209, 1213, 1216, 1217. 
 
 See also Acute Rheumatism, 1499. 
 
 TYPHUS FEVER. 
 1501 Pathological Indications. 
 
 i. General.— See 1489, 4, 5> 6. 
 
 2. Prevent Visceral Congestion and Degeneration, — Hot- 
 blanket pack (1197) followed by sweating wet-sheet pack (1187) 
 and prolonged neutral bath (1130), once or twice daily. 
 Clinical Indications. 
 
 3. Fever. — The graduated bath (1120), the prolonged tepid 
 bath (1123), and the prolonged cooling pack (1191) are 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 as 
 necessary and continue 2 hours or more if patient sleeps. Con- 
 tinuous cold to the head; ice-bag to neck and head. 
 
 5. Delirium. — Ice compress (1314) to head and neck; 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 and face; ice-collar 
 (1316); ice-cap (1323); hot and cold cephalic compress (1358); 
 wet-sheet pack (1179); hot-blanket pack (1197). 
 
 7. Pain in Legs. — Fomentation (1328) to the lower spine; 
 hot hip (1389) and leg pack (1393) followed by wet-sheet pack 
 (1179) or cold towel rub (1213). 
 
 8. Persistent Vomiting. — Ice-bag (1314) to the epigastrium; 
 hot and cold gastric compress (1362); hot and cold trunk pack 
 (1367); lavage (1401), if persistent. 
 
 9. Complications. — See 1507. 
 
 General Hethod. — 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 
 
YELLOW FEVER. IOII 
 
 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 
 
 i. Maintain Genera! 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 (1423); enemas (1404). See 1473, 1474. 
 
 Clinical 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 (1393), 
 trunk pack (1196). Fomentation over lower back (1328). 
 
 6. Delirium. — Ice-cap (1323), wet-sheet pack (1183) to 
 heating stage. 
 
 7. Cerebral Congestion. — Ice-cap (1323), or ice-collar 
 (1316); hot leg pack (1393); prolonged neutral bath (1130). 
 
 8. Gastric Irritation.— Fomentation (1328) over stomach 
 every 2 hours; during interval heating compress (1344) at 6o° 
 renewed every 20 minutes; ice-bag (1314) to epigastrium; hot 
 and cold gastric compress (1302) 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- 
 
1012 RATIONAL HYDROTHERAPY. 
 
 num; continuous abdominal heating compress (1344), chang- 
 ing every 20 or 30 minutes. Copious enema twice daily (1404). 
 
 12. Collapse — Hot-blanket pack (1197); hot enema (1406); 
 cold mitten friction (1209); cold compress over heart (620); 
 fomentation over heart (1328) for 30 seconds, cold compress 
 (1314) 10 minutes; repeat. 
 
 13. Jaundice. — Prolonged neutral bath (1130); large hot 
 enema (1406) twice daily; copious water drinking (1423); fomen- 
 tation (1328) over liver every 3 to 6 hours for fifteen minutes, 
 heating compress (1344) during the intervals. 
 
 14. Convulsions. — Short hot bath (1126) followed or 
 accompanied by cold affusion (1103) to head and spine; alter- 
 nate compress (1342) to spine; heating wet-sheet pack (1183). 
 
 15. Coma. — Alternate spinal compress (1342) or sponging 
 (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 poi- 
 son while the frequently repeated cold rubbings stimulate vital 
 resistance. The hydriatic method bids fair to rob this disease of 
 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 Pathological Indications. 
 
 1. Increase General Vital Resistance and Aid Elimination of 
 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 Head, 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, 
 1571, 1572, 1573, 1574. 
 
 5. Headache. — Hot and cold head compress (1358), 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. 
 
10 14 RATIONAL HYDROTHERAPY. 
 
 CHOLERA. 
 
 1504 Etiological Indications. 
 
 i. Prevent Further Infection — Boil drinking water, adminis- 
 tering acid fruit juices to destroy cholera germs; avoid milk, meat 
 juices, broths, which afford excellent nutrient media for the 
 comma bacillus. Also avoid all solid food till convalescence is 
 established. 
 
 Pathological Indications. 
 
 2. Increase Vital Resistance, — Hot full-bath (1126) or 
 hot-blanket pack followed by cold mitten friction (1209) or cold 
 towel rub (1213); hot-blanket pack (1197); short hot bath 
 (1126) or hot enema (1406), followed by cold friction (1209) 
 until surface is red. 
 
 3. Combat Visceral Congestion, — Hot-blanket pack (1197) 
 followed by vigorous cold rubbing with mitt (1209) or towel 
 (1213). 
 
 4. Encourage Elimination — Prolonged neutral bath (95 ° to 
 98 ) (1130); copious water drinking. 
 
 Clinical Indications. 
 
 5. Vomiting, — Lavage (1401); lavage with distilled water 
 or boiled water containing 1 part pure hydrochloric acid to 4,000 
 parts of water (10 to 12 drops pure hydrochloric acid to the quart 
 of water). 
 
 6. Diarrhea. — Large warm enema after each stool (1406), 
 at first adding soap to the water. Cold compresses to the ab- 
 domen, changed every 20 minutes. Hot enemas, 108 to no°, 
 three to four pints. Hot enema, three to four pints, containing five 
 to eight drams of tannic acid to the quart. Repeat every 2 hours. 
 
 7. Cyanosis, — Vigorous cold friction (1209); hot-blanket 
 pack, followed by cold friction; dry pack with cold over heart; 
 hot enema (no°), followed by cold friction. 
 
 8. Scanty Urine. — Hot enema (1406), frequently repeated; 
 ice-bag (1314) over lower third of sternum. Hot-blanket pack 
 (1197). 
 
 9. Collapse. — Alternate spinal sponging (1206, 1342) or com- 
 press (1340); cold friction (1209); hot enema (no°); alternate 
 compress over heart. 
 
DENGUE BREAKBONE FEVER. IOI5 
 
 10. Cramps. — Hot fomentations; short hot immersion bath 
 (1126); rubbing of limbs. 
 
 n. 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 riethod. — 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). 
 
 DENGUE, BREAKBONE FEVER. 
 Clinical 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 (1404) 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. 
 
I0l6 RATIONAL HYDROTHERAPY. 
 
 PLAGUE. 
 1506 Pathological Indications. 
 
 i. Combat Visceral Congestion and Inflammation, — Hot- 
 blanket pack (1197) for one-half hour, followed by prolonged 
 sweating wet- sheet pack (1187) i to 2 hours, repeating three 
 times daily; copious water drinking (1423); large enema 
 (1404) twice daily. 
 
 2. Stimulate Resistance, — Cold towel rub (1213) or mitten 
 friction (1209) after each hot application, and at least as often 
 as every 3 hours. 
 
 Clinical Indications. 
 
 3. Pain in the Neck and Legs Hot hip (1389) and leg 
 
 pack (1393) or fomentation (1328) to the back every 3 or 4 
 hours, followed by heating compress (1344) to the back, changing 
 hourly during the interval. 
 
 4. Pain in the Head — Fomentation (1328) to the back of 
 head for 5 minutes every 2 hours, followed by ice-cap or cold com- 
 press (1314); hot and cold head compress (1358). 
 
 5. Gastric Hemorrhage. — Hot trunk pack (1197) for 5 
 minutes, followed 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 hours 
 if necessary. 
 
 6. Intestinal Hemorrhage — Hot hip (1389) and leg pack 
 (1893) 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 blanket 
 pack (1197) for 15 minutes, followed by vigorous cold friction (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 with oil or vaseline. 
 
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. Gastritis, — Fomentation (1328) every 3 hours, followed 
 by heating compress (1344) at 6o°, to be changed every 30 
 minutes during interval. 
 
 2. Enterocolitis — 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 
 6o° 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 6o° 
 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 
 hip (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. 
 
IOl8 RATIONAL HYDROTHERAPY. 
 
 6. Laryngitis. — Steam inhalation (1419); fomentation to 
 throat (1328) every 3 hours with heating compress (134:4) during 
 interval, renewed every 15 minutes at first, later once an hour. 
 Derivative applications to legs, — hot foot baths (1297), hot leg 
 packs (1393), heating leg pack (1183). Repeat three to four 
 times daily. Fomentation (1328) for 15 minutes every 3 hours, 
 with well-protected heating compress (1344) between, changing 
 once an hour. Derivative treatment to lower extremities. Steam 
 inhalation (1419) 15 minutes every hour. 
 
 7. Broncho=Pneumonia Fomentation to chest (1328) every 
 
 2 hours, heating compress (1344) at 6o° during the interval, chang- 
 ing every 30 minutes; hot-blanket pack (1197) for 15 minutes, 
 followed by heating (1183) or sweating wet-sheet pack (1187), 
 one to three applications each 24 hours. 
 
 8. Pleurisy. — Fomentation (1328) every 15 minutes until 
 pain is relieved. Repeat every 3 hours; well-protected heat- 
 ing compress (1344) during interval. Tight bandage about 
 chest if necessary to control pain. 
 
 9. Nephritis, Albuminuria. — Hot-blanket pack (1197) for 
 30 to 60 minutes two to three times in 24 hours. Follow by 
 cold friction (1209). Protect the surface, and maintain vigor- 
 ous surface circulation. Large enema (1404) 3 times a day; 
 copious water drinking (1424); fomentation (1328) to lumbar 
 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 2 
 hours. 
 
 n. Delirium. — Ice-cap (1323); ice-collar (1316); heating 
 wet-sheet pack (1183) continued 1 to 2 hours. Prolonged tepid 
 or neutral bath (1130). 
 
 12. Paralysis. — Ice-cap (1323), ice to spine (1372); alter- 
 nate 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); hot 
 hip (1389) and leg pack (1393). Hot immersion bath (1126) 
 105 °, 5 to 8 minutes, with ice to head and neck (1314). 
 
 14. Abscess. — Fomentation (1328) for 15 minutes every 
 2 hours; heating compress (1344) at 6o° during interval. Renew 
 every 15 to 30 minutes. 
 
PULMONARY TUBERCULOSIS. IOIQ 
 
 15. Visceral Inflammation. — Large hot fomentation (1328) 
 over inflamed part for 15 minutes every 2 hours. During the 
 interval, heating compress (1344) at 6o°, 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). See 
 Typhoid Fever (1489, 5, 15, etc.). 
 
 PULMONARY TUBERCULOSIS. 
 
 Etiological Indications. 1508 
 
 1. 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 kumyss, 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 
 (1519) and Hypopepsia (1521). 
 
 6. Chill. — Rest in bed, dry pack (1192), hot water drinking 
 (1429). 
 
 7. Cough. — Fomentation (1328) to chest, followed byheating 
 chest pack (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 
 
 (1379V 
 
1020 RATIONAL HYDROTHERAPY. 
 
 9. Pulmonary Hemorrhage, Pulmonary Congestion. — Very 
 hot application to spine between shoulders. Ice to chest (1314), 
 ice to hands (1302). Hot leg pack (1393). Keep the extremi- 
 ties warm. Elevate the chest and shoulders. 
 
 10. Fever. — Neutral pack (1182), 15 to 20 minutes. Free 
 water drinking (1423). Rest in the horizontal position until the 
 daily evening temperature becomes nearly normal. 
 
 11. Night Sweats.— Very hot sponging (1204) at bedtime. 
 
 12. Hypopepsia, — Atonic Dyspepsia. — Daily general cold 
 applications (1625); ice-bag (1314) over stomach for half an hour 
 before meals. 
 
 13. Diarrhea — Enema (1404) at 95 , after each movement 
 followed by cold abdominal compress (1318) at 6o°, changing 
 every half hour. Rest in bed till checked. 
 
 14. Laryngitis. — See 1568. 
 
 15. Emaciation.— See 1516. 
 
 16. Contraindications. — Avoid general cold baths when 
 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. 
 
 1. 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. 1 02 1 
 
 Clinical Indications. 
 
 2. Revulsive (134:1) 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 COUGH. 
 
 1. Increase Vital Resistance. — Cold mitten friction (1209) 1510 
 or cold wet-hand rub (1201) 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. 1511 
 
 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 full-bath (1126), 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). Follow 
 bath by prolonged moderate exercise, or massage and manual 
 Swedish movements. Inhalation of oxygen; oxygen enema. 
 
 3. Encourage Elimination of Tissue Wastes. — In addition 
 to above, water drinking (1423); free use of fruit juices and 
 carbonated distilled water; wet girdle (1347) day and night; 
 cool coloclyster (1407) daily, if bowels are sluggish. 
 
 4. Increase Alkalinity of Blood. — Exercise; cold baths; cold 
 air bath (1470); sweating baths; fruit diet (1627). 
 
 Clinical Indications. 
 
 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. Painful Joints, not Swollen. — Revulsive compress (1341) 
 three times a day, followed by deep massage of limb above the 
 joint and light centrifugal friction (1224) of the joint; during 
 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 intervals. 
 
 8. Headache and Migraine. — See 1562, 6, 7, 8, 11, 12. 
 
 9. Neurasthenia. — See 1554. 
 
 10. Neuralgia. — See 1545. 
 
 11. Insomnia. — See 1564. 
 
 12. Iluscular Pains. — See 1513. 
 
 13. Gall=Stones.- See 1534 B. 
 
 14. Renal Colic. — See 1536. 
 
 15. Irritable Prostate. — See 1594, 2. 
 
 16. Arterio=Sclerosis. — See 1577, 8. 
 
 17. Bright's Disease. — See 1538. 
 
 18. Contraindications — Prolonged cold baths. 
 
 General Method. — Diminish the production of uric acid by 
 regulation of diet (1626); increase the destruction of uric acid 
 
GOUT. I023 
 
 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 Indications. » 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). 
 Pathological Indications. 
 
 2. Encourage Tissue Change, Especially Oxidation of Pro- 
 teid Wastes. — Prolonged sweating baths — vapor (1246), 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. 
 Clinical Indications. 
 
 4. Headache — Water drinking (1423); enema (1404); hot 
 and cold cephalic compress (1358) with hot foot (1297) or leg 
 bath (1299). 
 
 5. Migraine. — Lavage (1401); revulsive compress to seat of 
 pain (1341); hot leg (1299) or foot bath (1297); enema 
 (1404); 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 (1318) to anal region 
 and buttocks; cool enema. 
 
 8. Pruritis Ani, — -Very hot anal douche (1087). 
 
 9. Pain and Swelling of Joints, — Elevate limb; cooling com- 
 press (1318); change soon as warm. 
 
 10. fever, — Hot-blanket pack (1197) followed by prolonged 
 neutral bath ( 1130'}, 
 
1024 RATIONAL HYDROTHERAPY. 
 
 ii. Scanty Urine. — Water drinking (1423) (distilled carbon- 
 ated water) (1428); enema (1404) twice daily. See 1537. 
 
 12. Retrocedent Gout, — For coma or delirium, cold to head 
 and neck (1314); large enema (1404); hot-blanket pack (1197); 
 hot immersion (1126). 
 
 13. Cardiac Complications, Syncope. — Hot enema (1406); 
 alternate compress to spine (1342). 
 
 14. Gastrointestinal Disturbance by Retrocession. — Fo- 
 mentation (1328) over stomach; hot trunk pack (1197); hot 
 immersion (1126) or hot-blanket pack (1197) with heating 
 gastric compress (1344) during interval. 
 
 15. Contraindications. — Avoid cold baths; avoid immersion 
 of affected parts in cold water, and general cold baths. 
 
 B. Chronic Form. 
 
 16. The general measures indicated above. See also 1511. 
 
 17. Increase circulation in affected parts by hot fomentations 
 (1328) followed by dry cotton pack (1388) or heating compress 
 (1344); massage, at first derivative only; later, to joint itself. 
 
 18. Constipation. — Relaxing diet; wet girdle (1347); cold 
 water drinking (1423); abdominal massage. 
 
 19. Hepatic Congestion — Revulsive hepatic compress (1341) 
 every 3 hours; heating compress (1344) during interval. 
 
 20. Gravel, — 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, 1571. 
 
 23. Asthma. — Scotch douche to legs (1037); large enema 
 (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 (1318) 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, IO25 
 
 ACUTE MUSCULAR RHEUMATISM. 
 Pathological Indications. 1513 
 
 i. See Acute Rheumatism, 1499. 
 Clinical Indications. 
 
 2. The same as for acute articular rheumatism (14-99) 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. 
 Pathological Indications. 1514 
 
 i. 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 Oxygen — 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 Indications. 
 
 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 RATIONAL HYDROTHERAPY. 
 
 9. Boils. — Prolonged neutral baths (1130); tri-weekly soap 
 shampoo. 
 
 10. Pruritis. — Prolonged neutral baths (1130) followed by 
 cold mitten friction (1209) to sound parts of skin; neutral com- 
 press (1339). 
 
 n. Somnolence. — Copious water drinking (1423); hot 
 enema (1406), repeated every 3 or 4 hours; prolonged neutral 
 bath (1130) with cold affusion (1103), 6o°, to head and spine at 
 intervals of 15 minutes. Hot-blanket pack, 15 minutes (1197), 
 followed by cold friction (1209) and dry pack (1192). 
 
 12. Constipation, — Enema (1404) at 70 daily; wet girdle 
 (1347). See 1524. 
 
 13. Insomnia — Prolonged neutral bath (1130) at bedtime; 
 neutral pack (1182), 30 to 40 minutes; neutral spray (1057) or 
 broken douche (1031), 3 to 4 minutes at bedtime. 
 
 14. Bronchitis. — Chest pack (1373); steam inhalation 
 (1419); Scotch douche (1037) to legs. 
 
 15. Pulmonary Congestion. — See 1572. 
 
 16. Edema of Legs. — Rest in bed; cold precordial com- 
 press (1383), 15 to 30 minutes three times daily. Revulsive com- 
 press (1341) or Scotch douche (1037) to legs three times a day, 
 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 (1139). Carefully graduated exercises by the Schott 
 method. 
 
 19. Threatened Gangrene, — 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 (1112, 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 Skin. — Vapor bath (1246) or prolonged neutral bath 
 (1130), followed by oil rubbing daily (1232), or two or three 
 times a week. 
 
 26. Contraindications. — If emaciated, avoid exercise and 
 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 in 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 fleshy, must be 
 carefully avoided, and the principal reliance must be placed upon 
 short cold procedures which build up the patient'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. 
 Pathological Indications. 1515 
 
 1. Increase Oxidation of Hydrocarbons. — Moderately pro- 
 longed cold baths, especially wet-sheet pack (1179); shallow 
 bath (1174); cold rain douche (1047); dripping sheet (1217); 
 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. 
 Clinical Indications. 
 
 2. Cardiac Weakness. — Cold precordial compress (1383) 
 (except in fatty degeneration of heart) 15 to 30 minutes three 
 times daily; graduated exercises, effervescent bath (1139). 
 
 3. Bronchitis. — See 1570. 
 
 4. Albuminuria. — See Nephritis 1537. 
 
 5. Diabetes. — See 1514. 
 
 6. Rheumatic Pains. — See 1499, 5. 
 
 7. Contraindications. — Avoid prolonged hot baths unless 
 immediately followed by cold bath. 
 
1028. RATIONAL HYDROTHERAPY, 
 
 General Method. — Increase the consumption of carbon by 
 prolonged cold baths (1114) and vigorous exercise while reducing 
 the daily ration to the lowest point consistent with the mainte- 
 nance of the patient's strength. The treatment must 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, the vigor of the treatment must be diminished. 
 There should be a steady gain in muscular strength accompa- 
 nying the loss of flesh. The patient's strength should be deter- 
 mined at least weekly by the dynamometer so that his condition 
 may be exactly known. Hot baths are especially debilitating. 
 
 EMACIATION. 
 1516 Pathological Indications. 
 
 i. Rest in bed, fat- and blood-making diet (kumyss, butter- 
 milk, eggs, dextrinized cereals (1630), malted or predigested 
 cereals (1631)); graduated tonic treatment (1625). Fomenta- 
 tion (1328) over stomach twice daily followed by wet girdle 
 (1347). 
 Clinical Indications. 
 
 2. Persistent Vomiting,— See 1519, 3. 
 
 3. Gastric Ulcer Withhold food by mouth; rectal feeding; 
 
 fomentation (1328) over stomach twice daily; well-protected 
 heating compress (1344) during interval. Graduated hydriatic 
 treatment. See 1625. 
 
 4. Chronic Gastritis, — Rest in bed; abdominal fomentations 
 (1328), 2 to 3 times daily; protected heating compress (1344) 
 during interval. See 1520. 
 
 5. Intestinal Catarrh — Enema (1404) at 95 after each 
 stool. During interval heating compress (1344) at 6o°, chang- 
 ing every 30 minutes. See 1529. 
 
 6. 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 flalarial Infection.— See 1490. 
 
 12. Chronic Bronchitis. — See 1571. 
 
RACHITIS — SCURVY. 1029 
 
 13. Asthma — See 1571, 4. 
 
 14. Drug Habits — See 1612. 
 
 15. Pelvic Disease.— See 1586-1592, 1596. 
 
 16. Rachitis See 1517. 
 
 17. 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, so 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. 1517 
 
 1. Increase General Vital Resistance.; — Carefully graduated 
 hydriatic treatment (1625) applied twice daily; aseptic dietary 
 of substances rich in fats and proteids. Massage (1461); oil 
 rubbing (1232); sun baths (1254); out-of-door life. 
 
 SCURVY, PURPURA. 
 Pathological Indications. 1518 
 
 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). 
 
IO3O RATIONAL HYDROTHERAPY. 
 
 ACUTE GASTRIC CATARRH. 
 
 1519 Etiological Indications. 
 
 1. Rest. — Withhold food if necessary, administering food and 
 water by enema for several days (1404). 
 
 Pathological Indications. 
 
 2. Combat Local Inflammation. — Fomentation (1328) for 
 15 minutes over stomach and bowels every 2 hours. During 
 intervals, heating compress (1344) at 6o°, changing every 30 
 minutes. Hot foot bath (1297); hot leg pack (1393). 
 
 Clinical Indications. 
 
 3. Vomiting. — Ice-bag (1314) to epigastrium; hot and cold 
 gastric compress (1362); hot and cold trunk pack (1367); 
 ice (1372) to spine opposite stomach; careful lavage (1401) if 
 vomiting is persistent and rejected matters offensive. 
 
 4. Pain. — Revulsive compress (1341) 10 minutes every hour. 
 Heating compress (1344) during interval. 
 
 5. Fever. — Hot-blanket pack (1197) 20 minutes, followed by 
 cold half pack (1196); prolonged neutral bath (1130); cooling 
 pack (1189), following fomentation (1328) over stomach. 
 
 6. Contraindications. — Cold immersion baths and general 
 cold douche. 
 
 CHRONIC GASTRITIS. 
 
 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 HC1 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. 
 
 Pathological Indications. 
 
 3. Increase General Vital Resistance. — Graduated cold 
 
 baths (1625) twice daily. 
 
 4. Combat Local Congestion. — Gastric fomentation (1328) 
 
CHRONIC GASTRITIS. IO3I 
 
 three times daily, 15 min. ; during intervals, heating compress 
 (1344). Hot leg pack (1893) followed by heating compress 
 (1344) to legs; Scotch douche (1037) to legs; hot leg bath 
 (1299), followed by cold friction (1209) to legs. In acute exac- 
 erbations, withhold all food, rest in bed. 
 
 Clinical Indications, 
 
 5. Mucus Vomiting in Morning. — Omit the evening meal. 
 Fomentation (1328) over stomach in evening followed by heating 
 compress (1344) to be worn during the night; lavage (1401) 
 at bedtime. 
 
 6. Vomiting Soon after Eating. — Hot and cold gastric com- 
 press (1362) or trunk pack (1367) half an hour before eating, 
 to be retained 2 hours ; dry food in small quantity; rest in bed 
 after eating; ice-bag to spine after eating. 
 
 7. Gaseous Eructations. — Lavage (1401) once or twice a 
 week; dry diet of predigested cereals (1630). Cold compress 
 (1318); heating compress (1344) over stomach at 6o°, changing 
 every 4 hours. Massage for half an hour 2 hours after eating, 
 if local irritation or tenderness does not contraindicate. 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), 6o°, changed every 4 hours; large soap enema (1404) or 
 coloclyster (1407) two or three times a week, at 70 . 
 
 9. Constipation, — Graduated cold enema (1409) 70 , daily. 
 Abdominal massage; wet girdle (1347); cold douche to abdomen 
 (1081), fan (1061) or broken jet (1010), 20 seconds; cold 
 rubbing sitz (1309). 
 
 10. Hepatic Congestion. — Fomentation (1328) 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. 
 
 12. Pain in Stomach. — Revulsive compress (1341) over 
 epigastrium; repeat several times daily if necessary. Avoid acid 
 fruits, very hot foods, very cold foods, and concentrated sweets if 
 they cause pain. 
 
I O32 RATIONAL HYDROTHERAPY. 
 
 HYPOPEPSIA AND APEPSIA. 
 
 1521 Pathological Indications. 
 
 1. Increase General Vital Resistance — Graduated tonic 
 hydriatic treatment (1625) twice daily; out-of-door life; cold-air 
 bath (733,1470); swimming. 
 
 2. Increase Activity of Gastric Glands. — Cold fan douche 
 (1061) over stomach; cold percussion douche (1035) to dorsal 
 spine; general cold douche (1010) or other cold procedure 
 (1625); wet girdle (1347); external and internal galvanism of 
 stomach. Drink a third of a glass of cold water half an hour 
 before eating. 
 
 3. Increase Motility. — Cold gastric douche (1094) 3 hours 
 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. 
 
 4. Indigestion, Biliousness. — Hydrochloric acid being ab- 
 sent, flesh meats must be withheld. Aseptic diet (1626); avoid 
 fried foods, rich gravies and animal fats, which lessen the secre- 
 tion of HC1 (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, pepper, 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 Hypersecretion. 
 
 — Revulsive compress (1341) twice daily, an hour before meals; 
 continuous heating compress (1351) without mackintosh during 
 
DILATATION OF THE STOMACH. IO33 
 
 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 friction 
 (1209). Sip half a glass of hot water half hour before eating. 
 
 4. Combat Toxemia. — Sweating procedures; electric-light 
 bath (1250); sweating pack (1191); vapor bath (1246); 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 (1423). Enema (1404) daily for a week or two, 70 , 
 injecting a second portion to be retained. 
 
 5. Flatulence 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 meal. 
 
 7. Gastric Irritation with Vomiting After Eating. — Hot 
 and cold gastric compress (1362) or hot and heating trunk pack 
 (1367) applied half an hour before eating and continued for 2 
 hours. 
 
 8. Contraindications. — Cold douche over stomach, cold 
 shower, and prolonged cold baths of all sorts. 
 
 DILATATION OF THE STOMACH. 
 Etiological Indications. 1523 
 
 Aseptic diet (1626); avoid overeating, frequent eating, and 
 gas-forming foods, also drinking large quantities at once. Give . 
 very simple dry dietary of well-dextrinized (1630) or predigested 
 (1631) cereals or liquid diet, — kumyss, acid buttermilk, purees, 
 or gruels prepared from predigested cereals, nut creams or emul- 
 sions. 
 Pathological Indications. 
 
 1. Combat Gaseous Distension of Stomach. — Lavage 
 (1401) at regular intervals as required to prevent food accumu- 
 ation. Cold gastric compress (1314) without impervious cover- 
 
1034 RATIONAL HYDROTHERAPY. 
 
 ing, changed every 4 hours; cold fan douche (1061) over stomach 
 twice daily. 
 
 2. Increase General Vital Resistance, Combat Autointoxi- 
 cation. — Short sweating baths, — electric-light bath (1250); 
 sweating wet-sheet pack (1187); hot immersion (1126) 4 to 6 
 minutes, at 105 ; hot-blanket pack (1197); hot enema (1406). 
 Follow each hot bath by a tonic application (1625). 
 
 Clinical Indications. 
 
 3. Vomiting — Lavage (1401); withholding food; if persist- 
 ent, feeding by nutrient enema; ice-bag (1314) over stomach and 
 to spine opposite. 
 
 4. Pyrosis. — Hot water drinking (1429) before retiring at 
 night; fomentation (1328) over stomach at bedtime, with wet 
 girdle (1347) overnight; sipping half a glass of very hot water 
 on rising in the morning. A few ounces of orange juice or other 
 natural, unsweetened 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 cold enema (1409); colddouche 
 (1010) to abdomen; wet girdle (1347); regularity at stool. 
 See 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 (1406); 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. IO35 
 
 (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 (1625); 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. Hiccough. — 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. 
 
 1. Increase Peristaltic Activity. — Drink half a pint to a 1524 
 pint of cold water before breakfast, preferably carbonated water. 
 Increase bulk of food, with free use of fruit, especially apples, 
 oranges, and figs. Granose is especially to be commended; also 
 nut products, malted nuts, cereals, bran cakes, and figs. Small 
 cold enema (1404); graduated enema (1409); fomentation 
 (1328) 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) 
 1 to 3 minutes; cold rubbing sitz, 70 to 75 ° (1309), 5 to 20 min- 
 utes. Avoid complete emptying of colon, using small cold 
 enema 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 pledget of cotton saturated with raw linseed oil or 
 with glycerin. 
 
IO36 RATIONAL HYDROTHERAPY. 
 
 2. Increase Activity of Intestinal Glands Half a pint to 
 
 a pint of water at bedtime, to be retained overnight; abdominal 
 massage; wet girdle, without mackintosh (1347)- Boracic acid 
 powder before breakfast, introduction of absorbent cotton satur- 
 ated with oil or glycerin at night or before breakfast. 
 
 3. Remove Accumulated Fecal flatters. — Large hot enema 
 or coloclyster; neutral enema; warm soap enema; oil enema; 
 glycerin enema (one part glycerin to four water) (1404). 
 Repeat the application till bowel is thoroughly emptied, then inject 
 a pint of water at 70 to 6o° to tone the bowel. 
 
 4. Dilatation of Colon. — Graduated enema (1409); cold fan 
 douche (1061) to abdomen and spine opposite; running cold foot 
 bath (1296); cold rubbing sitz (1309); cold wet girdle, without 
 mackintosh (1347), changing every 4 hours. 
 
 5. Increase Strength of Abdominal fluscles. — Cold fan 
 douche (1061); cold plantar douche (1083); percussion 
 abdominal douche (1081); cold abdominal compress (1318); 
 renewed every 4 hours, without impervious covering; sinusoidal 
 electricity; massage; special exercises, particularly head raising 
 and legs raising while lying upon the back. 
 
 6. Enteroptosis. — Restore prolapsed bowels to position; 
 strengthen abdominal muscles as indicated above; correct sitting 
 position; abdominal supporter; replace viscera daily. See 1525. 
 
 7. Hemorrhoids. — Long cold sitz bath (1308); 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 rectum, hot irrigation (1410)- For 
 pain in the abdomen, revulsive compress (1341); Scotch 
 douche (1037); hot enema at no°, followed by small cool enema 
 (1404); revulsive sitz (1311^). 
 
 9. Relieve Spasm of Sphincter Ani fluscle — 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). 
 
ENTEROPTOSIS. IO37 
 
 Shallow cold sitz (1305); cold anal douche (108?) j alternate 
 anal douche (1046); sinusoidal electricity to rectum. 
 
 11. Contraindications. — Sweating baths sometimes induce 
 constipation (1176), also abuse of the fomentation and the 
 habitual use of the warm enema, which should be strictly avoided. 
 If 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. 
 
 General flethod. — Each case must be carefully studied with 
 reference to the leading cause or causes which are 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. 1525 
 
 1. Correct sitting and standing positions; corrective gymnastics 
 and manual Swedish movements; sinusoidal 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). 
 
 Pathological Indications. 
 
 2. Replace the Viscera Replace viscera daily by abdominal 
 
 massage, genu-pectoral position, inspiratory lifting, etc; abdominal 
 supporter; combined support of abdomen and shoulders. 
 
 3. Strengthen the Abdominal Muscles. — Cold fan douche 
 to abdomen (1061); cold plantar douche (1083; special exer- 
 cises, 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 of ab- 
 dominal muscles, preferably the slowly alternated sinusoidal cur- 
 rent; swimming; Swedish gymnastics; abdominal massage. 
 
IO38 RATIONAL HYDROTHERAPY. 
 
 Clinical Indications. 
 
 4. Abdominal Tenderness and Discomfort. — Fomentation 
 (1328) twice daily; wet girdle (1347); abdominal supporter; 
 hot enema followed by small cold enema (1404:). 
 
 5. Indigestion. — Aseptic dietary (1626); massage to empty 
 the stomach 2 hours after eating. Massage (1461) when required. 
 See Hypopepsia and Dilatation of Stomach (1521, 1523). 
 
 6. Pain between Shoulders. — Fomentation (1328) to back; 
 gastric heating compress (1344); abdominal supporter. 
 
 7. Backache. — Fomentation (1328); revulsive compress 
 (1341); alternate sponging (1206) or compress (1340); heating 
 spinal compress (1355); Scotch douche (1037); abdominal 
 supporter. 
 
 8. Neurasthenia See 1554. 
 
 9. Headache. — See 1554, n-15, 1562. 
 
 10. Hysteria. — See 1553. 
 
 11. Nervous Asthma. — Hot enema (1406); hot water drink- 
 ing (a pint or more); fomentation to abdomen (1328); fomenta- 
 tion to back; wet girdle day and night (1347); hot and cold trunk 
 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. 
 
 1526 Etiological Indications. 
 
 1. Rest in bed; rectal feeding for 2 weeks, repeating after a 
 few days if necessary; bland aseptic liquid diet (1626» 1628); 
 avoid solid food, condiments, flesh foods. 
 
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. Hemorrhage. — 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 
 
 i. 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 Regurgitations 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). 
 
IO4O RATIONAL HYDROTHERAPY. 
 
 7. Headache. — Hot and cold head compress (1358); alter- 
 nate spinal sponging (1342), cool compress if congestion is pres- 
 ent; massage to head and neck. 
 
 8. Anorexia. — Ice-bag over stomach half an hour before 
 eating; cold spinal douche (1074); cold air bath (733, 1470); 
 out-of-door life; small cold enema before breakfast, retained. 
 
 9. Abdominal Weight and Tenderness — Abdominal sup- 
 porter; hot fan douche (1063) to abdomen; hotfoot bath (1297); 
 revulsive sitz (131 1-g-); fomentation (1328) twice daily, followed 
 by heating compress (1344). 
 
 10. Excessive Peristalsis. — Hot and cold abdominal com- 
 press (1356); abdominal fomentation twice daily, followed by wet 
 girdle (1347) protected with 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 are 
 the hot and cold trunk pack (1367); fomentation (1328) over 
 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 legs. 
 See Enteroptosis (1525) and Dilatation of the Stomach (1523). 
 
 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 GASTROINTESTINAL CATARRH IN CHILDREN, 
 CHOLERA INFANTUM SUMMER DIARRHEA 
 
 1528 1. Withdraw all food; hot-blanket pack (1197) till skin is 
 
 reddened; follow by cold mitten friction (1209) or cold wet-hand 
 rubbing (1201). 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 no° 
 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 (1429) ; 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 Discourage Bacterial Growth. — 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. nucous Stools. — Large hot enema (1406) at 95 fol- 
 lowed by small cold enema (1405); cold abdominal compress 
 (1318) changed every hour. Revulsive sitz (13 11 -J-) or compress 
 to abdomen (1341); Scotch (103?) fan douche (1061) to 
 abdomen. 
 
 9. Frequent Stools. — Abdominal compress as above; prolonged 
 cool sitz (1308) 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 I 1347). 
 
IO42 RATIONAL HYDROTHERAPY. 
 
 ii. Contraindications. — Cold douche, protected heating 
 compress, prolonged fomentations. 
 
 General riethod. — Increase the general vital resistance and 
 improve gastric conditions, regulating the diet so as to render the 
 intestine an unfavorable habitat for the bacteria which constitute 
 the chief cause of this disease; remove bacteria and masses of 
 mucus and pseudomembrane by neutral enemas (1404), and follow 
 by small enemas of gallic or tannic acid solution, which destroy 
 the germs associated with this disease. 
 
 ACUTE DYSENTERY, COLITIS. 
 
 1530 i. Free water drinking (1423); an aseptic dietary; no animal 
 
 broths or meat preparations (1626). Browned rice, kumyss, 
 buttermilk, fresh ripe fruit, fruit juices, with well-dextrinized cereals 
 (1630), are proper foods. 
 
 2. To Combat Viscera! Inflammation. — Hot-blanket pack, 
 (1197) with hot hip and leg pack (1393), followed by heating 
 abdominal compress (1344), 6o°, changed every 20 to 40 minutes; 
 ice suppositories if the inflammation extends into the rectum. 
 Cold sitz (1305), 75°, 15 to 30 minutes, with hot foot bath 
 (1297). Cold irrigation of the rectum (1410). Rest in bed, 
 
 3. To Relieve Pain. — Very hot pelvic pack, with hot foot 
 bath (1297); very hot enema (1406), no°, followed by cold 
 rectal irrigation (1410); repeat hourly if required. 
 
 CHRONIC DYSENTERY, CHRONIC COLITIS. 
 
 1531 Rest in bed; aseptic dietary (1626); graduated cold baths 
 (1625) twice daily; cold rubbing sitz (1309) ; hot revulsive sitz bath 
 (1311i) 6 to 10 minutes daily, immediately preceded by a hot enema 
 (1406). 
 
 If much pain is present, revulsive sitz (1308, 1311 i) once or 
 twice a day. Moist abdominal bandage (1347) 
 
 CHOLERA MORBUS. 
 
 1532 i- Secure physiological rest of stomach and bowels by withholding 
 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). 
 
APPENDICITIS — JAUNDICE. IO43 
 
 3. Diarrhea. — Hot enema (1406) after each stool; fomenta- 
 tion (1328) over abdomen every 2 hours, duration 20 minutes 
 during interval, heating compress (1314) at 6o°, renewed every 
 30 minutes. If the temperature is above 102 , prolonged neutral 
 bath (1130) or hot-blanket pack (119?) 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), 1533 
 repeated every 6 hours; fomentation (1328) 15 minutes every hour; 
 during interval, heating compress (1344) at 6o°, 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. 
 A. Catarrhal Form. 1534 
 
 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 6o°, renewed every 30 minutes. Copious hot enema 
 (1406), no°, twice a day. After discharge of hot-water, an enema 
 of one pint water at 70 . Hot trunk pack (1196); hot immersion 
 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 (1250); 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. Itching. — Neutral saline bath (1464); hot sponging (1204). 
 
1044 RATIONAL HYDROTHERAPY. 
 
 6. Chili.— Hot water drinking (1429); dry pack (1192). 
 
 7. Gastric Catarrh. — See Chronic Gastritis 1520. 
 
 B. Biliary Colic — Gall=stone. 
 
 1. General.— Fruit diet (1627); water drinking (1423); liquid 
 aseptic dietary (1628). 
 
 2. Pain — Revulsive compress (1341) every two hours; con- 
 tinuous hot applications to hepatic region; hot coloclyster (1407), 
 or enema (1406), every 2 hours; hot immersion bath (1126). 
 
 3. Fever. — Prolonged neutral bath (1130); hot-blanket pack 
 (1197) followed by wet-sheet pack (1216); cold mitten friction 
 (1209) or cold towel rub (1213). 
 
 4. Nausea and Vomiting. — Lavage (1401) if persistent. See 
 1519, 3 
 
 5. After acute attack, administer treatment for Gastro-intesti- 
 nal Catarrh. See 1529. 
 
 CIRRHOSIS OF THE LIVER. 
 1535 Etiological Indications. 
 
 1. Avoid tea, coffee, tobacco, alcoholics, condiments. Asep- 
 tic dietary (1626). 
 
 Pathological Indications. 
 
 2. Organic Changes in Liver. — Alternate douche (1044), 
 alternate compress (1340); Scotch douche (1037); flannel-cov- 
 ered heating compress (1344). Follow local application by gen- 
 eral 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; 
 wet girdle (1347 ) ; 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, 1536 
 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 
 (1196) renewed hourly; revulsive sitz (131H)> c0 ^ 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. 1537 
 
 1. Relieve Renal Congestion. — Congest the skin by means 
 of the hot trunk pack (1196), 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. 
 
IO46 RATIONAL HYDROTHERAPY. 
 
 7. Contraindications. — Prolonged general cold applications, 
 Brand bath, cold douche, cold affusion. 
 
 General Method. — Absolute rest in bed; maintaining a warm 
 and active skin even to the extent of perspiration; an aseptic, 
 liquid dietary (1628) to encourage free diuresis, copious water 
 drinking. 
 
 CHRONIC NEPHRITIS, BRIGHT'S DISEASE. 
 
 1538 1. General. — Aseptic dietary (1626); especially avoid meats 
 and condiments; buttermilk or kumyss diet or exclusive fruit diet 
 (1627) during acute attack; tea, coffee, tobacco, and alcoholic 
 liquors to be strictly avoided. 
 
 2. Maintain activity of skin by warm woolen clothing, dry 
 friction (1221), applied daily; cold mitten friction (1209) fol- 
 lowed by dry friction (1221); oil rubbing (1232). Carefull) 
 graduated cold applications (1625). Electric-light bath (1250) 
 followed by cold towel rub (1213). Sweating bath (1197) twice 
 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 by 
 cold mitten friction (1209) or cold towel rub (1213), water 
 drinking (1423), one to two pints twice daily; effervescent 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), perfect 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 1. Inflammation. — Copious water drinking (1423), revulsive 
 sitz (131H) twice a day; hot leg packs (1393) followed by dry 
 heat to legs; neutral bath (1130) 20 to 40 minutes two or three times 
 a week; prolonged neutral sitz (1312); cold friction; cold towel 
 rub (1213); fomentation (1328) over bladder; hot bladder irriga- 
 
INCONTINENCE OF URINE. JO47 
 
 lion (1411); hot enema (1-106); 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 
 (13-14:) over perineum and genitals; revulsive sitz (131H); hot 
 rectal irrigation (1110), hot bladder douche. 
 
 3. Contraindications. — Cold sitz, cold immersion, cold 
 douche, cold foot bath. 
 
 INCONTINENCE OF URINE. 
 
 1. To Increase Energy of Bladder. — Cold plantar douche 154.0 
 (1083) 1 to 2 minutes; cold running foot bath (1296); cold per- 
 cussion douche (1035) to hips and legs, 6o° 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 ioo°, and lower tem- 
 perature i° daily to 8o°. 
 
 2. Relieve Vesical Irritation. — Revulsive sitz (1311s); hot 
 pelvic pack (1390); prolonged neutral sitz (1312) following re- 
 vulsive sitz (1311*). Neutral douche to lower spine (1031); 
 Scotch douche to feet and legs (1037); hot bladder irrigation, 
 ioo°-ii5°. 
 
 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), and proper 
 diet. 
 
 3. Diminish Acidity of Urine, by free use of fruit and 
 water drinking in the forenoon. 
 
IO48 RATIONAL HYDROTHERAPY. 
 
 PERITONITIS. 
 A. Acute Form. 
 
 1542 1. Rest in bed; fluid diet; fruit-juice without sugar; gruels of 
 dextrinized or malted cereals (1630); withhold food 2 4 to 48 hours. 
 
 2. Albumin in Urine. — Hot-blanket pack (1197) and other 
 sweating measures to maintain cutaneous activity, repeated every 
 2 to 4 hours. 
 
 3. Fever. — Hot-blanket pack (1197) followed by cold mitten 
 friction (1209); prolonged neutral bath (1130); fomentation 
 (1328) to abdomen with cooling wet-sheet pack (1189) at the 
 same time. 
 
 4. Enema (1404) at 8o°, repeating, to remove gas; add soap 
 to water if necessary to secure movement. Fomentation (1328) 
 every 2 hours for 15 to 20 minutes. During interval, heating 
 compress (1344) at 6o°, changing every 5 minutes while the 
 body temperature is elevated, less frequently as temperature falls= 
 Copious water drinking (1423); prolonged neutral bath (1130); 
 cold precordial compress (1383) or ice-bag (1314) over heart 
 for 15 minutes 2 or 3 times a day for cardiac weakness. 
 
 Prevent Obstruction — Large enema (1404) three times a day 
 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). 
 
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 
 ioo° to 8o°; 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 
 
 i. 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. 
 
IO5O RATIONAL HYDROTHERAPY. 
 
 NEURALGIA 
 1545 Pathological Indications. 
 
 1. Combat Toxemia when Present. — Sweating bath followed 
 by appropriate general cold bath (1625) three times a week; the 
 electric-light bath (1250), vapor bath (1246), sweating wet-sheet 
 pack (1191), are especially serviceable. Copious water drinking 
 (1423); aseptic dietary (1626); dry friction (1221) of skin or 
 oil rubbing daily after short sweating bath (1250), followed by 
 tonic cold application (1625). 
 
 2. Combat Anemia and General 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 application. 
 
 Clinical 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. Neuralgia 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 Neuralgia and Lumbago. — Fomentation (1328) 
 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 (1250), vapor bath 
 (1240) or sweating pack (1191) followed by dry pack (1192). 
 
 8. Neuralgia due to Chronic Neuritis. — Alternate compress 
 (1340) or douche (1044); filiform douche (1064). In sciatica, 
 Scotch douche, if persistent: nerve-stretching. 
 
 9. Neuralgic Affections of Ovaries, Uterus, Rectum, Blad- 
 der, and Coccyx. — Revulsive sitz (13113); not 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. Gastralgla. — 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 6o° during interval; graduated tonic treatment (1625). 
 
 12. Erythro Melalgia — 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 HYEL1TIS 
 Pathological Indications. 1546 
 
 1. 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, 6o°, renewed every 15 minutes. 
 
 
IO52 RATIONAL HYDROTHERAPY. 
 
 2. After Acute Stage Has Subsided. — Alternate compress 
 (1340), or alternate douche (1044) to spine three times a day. 
 
 Clinical Indications. 
 
 3. Pain and Paresthesia in Legs — Hot leg pack (1393); 
 hot foot bath (1297); hot half-bath (1174); revulsive compress 
 (1341) to spine several times daily, duration 15 to 60 minutes. 
 
 4. Girdle Sensation. — Hot trunk pack (1197) followed by 
 cold friction (1209); wet girdle, well-protected (1347); fomen- 
 tation to spine followed by heating spinal compress (1355). 
 
 5. Neuralgic Spinal Pain. — Fomentation (1328) or hot 
 sponging (1204) of spine followed by heating compress (1344). 
 
 6. Paraplegia. — Alternate compress (1340) or fan douche 
 (1061) to spine and legs; massage; galvanic, faradic, or sinusoidal 
 electrical applications. 
 
 7. Sensory Paralysis — Alternate spray (1044, 1055); alter- 
 nate sponging (1204); alternate compress (1340); percussion 
 douche (1035) twice daily. Static or faradic electricity. 
 
 8. Huscular Spasm. — Revulsive compress (1341) to spine. 
 Fomentation (1328) over irritated muscular groups, followed by 
 continuous heating compress (1344), repeating twice daily or as 
 often as neccessary; heating spinal compress (1355). 
 
 9. Hiccough. — See 1523, 14. 
 
 10. Gastric Crises. — Hot and cold trunk pack (1367); revul- 
 sive gastric compress (1341); fomentation (1328) to spine; hot 
 foot bath (1297); hot leg pack (1393); hot immersion (1126) 
 or hot sitz (1311); galvanism to back of neck and epigastrium. 
 
 n. Contraindications. — Cold immersion and other general 
 cold applications. Carefully avoid burning or blistering the patient 
 with hot applications. 
 
 CHRONIC riYELITIS. 
 
 1547 Pathological Indications. 
 
 1. 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), 1 to 6 hours; heating 
 compress to the spine (1355). Later stages, alternate douche or 
 compresses to the spine (1342- ) 
 
SPINAL SCLEROSIS. IO53 
 
 Clinical Indications. 
 
 2. Prickling Sensation in Legs. — Scotch douche (1037), hot 
 fomentations or affusion (96 ) (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. 
 
 SPINAL SCLEROSIS. 
 
 A. Lateral Sclerosis — Posterio=Lateral Sclerosis — Dissemin- 
 
 ated Sclerosis. 
 
 Pathological Indications. 154.S 
 
 1. To Improve Genera! 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 (1200), 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), 1 to 4 hours daily. 
 
 Clinical Indications. 
 
 3. To Relieve Clonic Spasm and Nervous Irritability. — Warm 
 bath (96 to ioo°); 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, 
 
1054 RATIONAL HYDROTHERAPY. 
 
 The patient should be kept in the open air as much as possible. 
 Out-of-door gymnastics are especially useful. 
 
 B. Amyotrophic Lateral Sclerosis. 
 
 i. See (A) i, above. 
 
 2. Prolonged neutral baths (1130), i to 3 hours daily; massage; 
 manual Swedish movements. 
 
 3. Contraindications — Avoid the use of electricity, the cold 
 douche, prolonged hot baths, and general cold baths. 
 
 General Method. — Build up the general health by gentle tonic 
 measures slowly increased in intensity (1625), suppressing the 
 formation of toxic substances and promoting their elimination by 
 a suitable dietary (1026), improvement of digestion and the 
 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 nutri- 
 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 of 
 the disease may be delayed, even when it can not be altogether 
 arrested. 
 
 LOCOMOTOR ATAXIA. 
 
 1549 1. 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 (1423); 
 coloclyster daily (1407). 
 
 3. Improve Nutrition of Cord. — Fomentation (1328) to the 
 spine no°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. IO55 
 
 Clinical Indications. 
 
 4. Ataxic Movements. — Special exercises in small movements 
 of each of the affected muscular groups. 
 
 5. Lightning Pains. — Prolonged warm fan douche to spine 
 (1061), 95° to ioo°, two or three times a day (pressure 2 to 5 lbs.). 
 
 6. Gastric 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 (1037) followed by heating compress (1344). 
 
 8. Rectal Pain. — Very hot anal douche (1087), 115 to 122 , 
 with little pressure. Revulsive sitz (13 11 J). Fomentation (1328) 
 over buttocks. Hot rectal irrigation (1410). 
 
 9. Paresis of Bladder. — Daily irrigation f 1411). Cold plan- 
 tar douche (1083). 
 
 10. Constipation — See 1524. 
 
 11. Trophic Changes — 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. 
 
 General 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 training. 
 
 CEREBRAL APOPLEXY. 
 
 1. During Attack — Rest, head and shoulders raised; cold 1550 
 compress to head (1371); tepid enema (1404); warm extrem- 
 ities by hot-water bags or hot pack. Ice-collar (1316). 
 
 1. After Attack. — Cold mitten friction(1209)twice daily; well- 
 protected wet girdle (1347) 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- 
 
IO56 RATIONAL HYDROTHERAPY. 
 
 ual Swedish movements; carefully graduated exercises; massage; 
 cold or alternate douche (1044) to affected muscles. 
 
 EPILEPSY. 
 
 1551 1. Abstemious, dry, aseptic dietary (1626), chiefly fruits and 
 grains; vigorous out-of-door exercise to the extent of fatigue daily. 
 Prolonged neutral bath (1130) daily; sweating process (642, 
 1233-1255) two or three times a week; graduated cold proced- 
 ures (1625), avoiding prolonged and intense applications. 
 
 2. When Attack Is Threatened Coloclyster (140?) twice 
 
 daily; copious water drinking (1423); neutral pack (1182); ice 
 to head (1314); rest in bed. If aura in hand or foot precedes 
 attack, the seizure may sometimes be averted by placing the part 
 in cold water. 
 
 3. After Attack. — Rest; 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 regimen, a 
 simple abstemious dietary (1626), abundance of outdoor exercise, 
 the daily employment of the prolonged neutral bath (1130); fol- 
 lowed by short, moderately cold applications (1625); copious 
 water drinking (1423); regulation of all the vital functions, avoid- 
 ance of all sources of nervous irritation and exhaustion. 
 
 CHOREA. 
 
 1552 Etiological Indications, 
 
 1. Combat anemia and improve general nutrition by graduated 
 
 tonic applications (1625); copious water drinking (1423); large 
 enema or coloclyster (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 Til 03); wet-sheet pack 
 1.179). 
 
HYSTERIA. IO57 
 
 4. Constipation. — See 1524. 
 
 5. Indigestion — See 1520-1525. 
 
 6. Irregular flovernents. — Neutral pour to spine (1103) 
 daily; prolonged neutral bath (1130); special gymnastics. 
 
 7. Endocarditis Ice-bags over the heart (1314). See 
 
 1576. 
 
 General Method. — Improve the nerve tone by tonic measures 
 
 and careful attention to nutrition. Train the patient to better 
 
 mental and moral control, and combat the choreic movements by 
 
 systematic gymnastic training. 
 
 HYSTERIA. 
 
 Pathological Indications. 1553 
 
 1. Tonic, reconstructive, and sedative measures. Graduated 
 cold applications (1625) are of the first importance; must be 
 carefully managed at first; application twice daily, short, intense. 
 Prolonged neutral bath (1130) in cases due to autointoxication. 
 Out-of-door life; generous aseptic diet (1626); suitable moral 
 and mental surroundings. 
 
 Clinical Indications. 
 
 2. Convulsions — Neutral bath (1130); neutral pack (1182); 
 hot-blanket pack (1197); hot and cold spinal compress or spong- 
 ing (1342); hot enema (1406); hot half-bath (1177) with tepid 
 affusion (1103) to head and spine; heating spinal compress (1355). 
 
 3. Coma. — Alternate compress or sponging to spine (1342); 
 cold mitten friction (1209); hot half bath (1177); cold, or hot 
 and cold, compress to head (1358). 
 
 4. Vomiting — Hot and cold gastric compress (1362); dry 
 diet (1629); rectal feeding; gastric lavage (1401); ice to the 
 epigastrium; (1314) ice pills. 
 
 5. Anorexia. — Ice-bag (1314) over stomach half an hour be- 
 fore meals; alternate compress (1340) to epigastrium, twice daily. 
 Alternate lavage (1401); cold douche (1074) to spine and epi- 
 gastrium (1079). 
 
 6. Cough — Fomentation (1328) to spine; sipping hot water 
 (1429); chest pack (1373). Cold compress to the throat 
 (1381); gargling hot water (1400) several times daily. 
 
 7. Muscular Paralysis — Alternate affusion (1103) or douche 
 (1044); alternate compress (1340); cold affusion (1103); 
 
IO58 RATIONAL HYDROTHERAPY. 
 
 cold douche (1047); massage douche (1066); massage; manual 
 Swedish movements; electricity. 
 
 8. Contractions — Fomentations to affected parts (1328) 
 followed by heating compress (1344). Revulsive douche (1041). 
 
 9. Trembling — Neutral affusion (1103) to spine, 92 to 96 
 15 minutes. 
 
 10. Incontinence of Urine — Percussion douche (1035) to 
 spine; neutral sitz (1312) 15 to 30 minutes. 
 
 11. Retention of Urine — Hot sitz (1311), 5 minutes, followed 
 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); cold percussion douche (1035) to spine; 
 cold rubbing of affected 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 (1344); 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 (1344) 
 during the intervals; Scotch fan douche (1061, 1037); fomenta- 
 tion (1328) followed by affusion (1103) for 5 minutes, 8o° to 85 . 
 
NEURASTHENIA. - IO59 
 
 20. Ana! 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 (1010). 
 
 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- 1554 
 toms due to various etiological influences and connected with vari- 
 ous morbid states. 
 Etiological Indications, 
 
 1. 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 minutes) 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 Discharges by appropriate measures 
 as Menorrhagia (1588), Leucorrhea (1591, 3), Spermatorrhea 
 (1596). 
 
 5. Relieve Reflex Irritation. — If sexual, rectal, prostatic, or 
 urethral irritation, employ revulsive sitz (1311 2), prolonged neu- 
 
1060 RATIONAL HYDROTHERAPY. 
 
 tral sitz (1312), rectal and urethral irrigation, hot foot bath 
 (1297), hot pelvic pack (1390). For ovarian irritation, in 
 addition to above, hot vaginal irrigation (1413), 15 to 20 min. 
 
 6. Irritation of Solar Plexus and Sympathetic Ganglia. — 
 
 Fomentation (1328) over abdomen three times daily; during 
 intervals, heating compress (1344); abdominal supporter. 
 
 Clinical Indications. 
 
 7. Improve General Nerve Tone. — Graduated cold applica- 
 tions (1625). The cold percussion douche (1035) to spine is 
 the most efficient of all measures; general cold douche (1010); 
 very hot douche (1024) (no° for 30 seconds), followed by grad- 
 uated or cold douche (1017). 
 
 8. Indigestion.— See 1520-1525. 
 
 9. Constipation — See 1524. 
 
 10. Intestinal Catarrh. — See 1529. 
 
 n. 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 (1206) to upper spine and occipital region. Revulsive com- 
 press (1341); hot and cold cephalic compress (1358). 
 
 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 (1555). 
 
 16. Sensation of Band around Head. — Hot sponging 
 (1206) or hot compress (1286); alternate sponging (1206) of 
 neck and upper spine; massage to head. 
 
 17. Sensation of Pressure at Vertex. — Hot foot bath 
 
NEURASTHENIA. Io6l 
 
 (1297), cold compress (1318) to head; ice-collar (1316); sleep 
 with head elevated; heat to feet and legs if cold. 
 
 18. Pain in Eyes, Intolerance to Light 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. Backache — Fomentation (1328) to abdomen; wet girdle 
 (1347); abdominal supporter; alternate spinal sponging (1206) 
 or compress (1340); Scotch douche (1037) to spine; revulsive 
 sitz (1311J). 
 
 20. Neuralgia See 1545. 
 
 21. Insomnia — See 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) over 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 (1130) for 1 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 (131 li); neutral pour to spine 
 (1103). 
 
 27. Dreams.— Neutral bath (1130) 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). 
 
I062 RATIONAL HYDROTHERAPY. 
 
 29. Cold Extremities. — Scotch douche (1037) to legs and 
 feet, followed by standing shallow bath (1174); fomentation 
 to abdomen (1328) twice daily, followed by heating compress 
 (1344) during intervals; alternate foot bath (1298); massage to 
 feet and legs; cold friction (1209). 
 
 30. Perspiration when Sleeping. — 1508, 11. 
 
 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- 
 tion, improvement of nutrition, regulation of the bowels and the 
 relief of prominent and distressing symptoms by suitable pallia- 
 tive measures. 
 
 MIGRAINE. 
 1555 Etiological Indications. 
 
 1. Prevent Formation of Uric Acid Avoid use of meats, 
 
 also tea and coffee, etc.; aseptic dietary (1625); out-of-door life. 
 
 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, 
 ioo° 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. IO63 
 
 7. Gastric Disorders — 1519-1527. 
 
 8. To Prevent Attack — Lavage (1401); fruit diet (1627); 
 large coloclyster (1407); water drinking (1423). 
 
 9. To Relieve Hyperesthesia of Lumbar Ganglia. — Abdom- 
 inal fomentation (1328) twice daily; continuous heating compress 
 (1344) during interval. Abdominal supporter. 
 
 General 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 (1554, 3) and other conditions requiring 
 tonic treatment. The causes must be removed, especially auto- 
 intoxication and morbid reflex influences arising from dilatation 
 of the stomach, enteroptosis, and indigestion. 
 
 INFANTILE CONVULSIONS. 
 Etiological Indications, 1556 
 
 1. Regulate diet, withholding meats and all indigestibles. 
 Avoid cow's milk if curds are present in the stools. Daily cold 
 bath, wet-hand rub (1201) or cold towel rub (1213). 
 Pathological Indications. 
 
 2. When due to autointoxication from intestinal irritation, 
 large hot enema (1406). If undigested food is present in the 
 stomach, lavage (1401). For immediate relief, hot-blanket pack 
 (1197); warm bath (95 to 98 ) (1123), 1 to 2 minutes. If not 
 quickly 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. 
 
 1. General. — Scotch douche (1037, 1074) to spine and 1557 
 affected muscles twice daily. Neutral affusion (1103) to spine 
 
 10 minutes daily; neutral bath (1130), 1 hour at bedtime. Cold 
 mitten friction (1209) twice daily following other treatment. 
 Shallow bath 1 to 3 minutes (1174); prolonged neutral bath 
 (1130); massage and passive exercises (1461). 
 
 2. Paresis. — Cold percussion douche to spine (1037, 1074) 
 following warm rain douche (1047). Alternate douche (1044) 
 to affected muscles. Gymnastics; passive exercises and massage 
 of affected parts; sinusoidal or galvanic electricity. 
 
IO64 RATIONAL HYDROTHERAPY. 
 
 MELANCHOLIA 
 
 1558 Pathological Indications. 
 
 1. For Anemia and Malnutrition. — Fomentation (1328) to 
 abdomen followed by cold mitten friction (1209) twice daily; 
 aseptic diet (1626); water drinking (1423); air bath (1470); 
 electric-light bath (1250); sun baths (1254); rest in bed; mas- 
 ~sage; manual Swedish movements; galvanization of cervical and 
 abdominal sympathetic. 
 
 2. For Cerebral Anemia (usually present). — Warm compress 
 (98 to ioo°) to back of neck 15 minutes three times daily. 
 
 3. To Diminish Blood Pressure (usually excessive). — Warm 
 immersion bath (1126), 98 to ioo°, 10 to 20 minutes, twice daily; 
 heating wet-sheet pack (1183); heating trunk pack (1196), 30 
 minutes, twice daily; neutral douche (94 ), pressure 10 to 20 
 pounds, duration 2 to 4 minutes. 
 
 4. For Autointoxication. — See 1559, 4. 
 
 Clinical Indications. 
 
 5. Insomnia. — 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; 1527, 6. 
 
 10. Dry Skin.— See 1609. 
 
 11. Mental and Nervous Irritability — 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 riethod. — 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. 
 
 1559 Pathological Indications. 
 
 1. For Malnutrition. — Graduated tonic baths (1625); gener- 
 ous aseptic diet. See 1558, 1. 
 
TOXIC INSANITIES. IO65 
 
 2. To Increase Blood Pressure. — Hot baths — electric-light 
 (1250), hot immersion (1126), ioo° to 162 , 8 to 15 minutes, hot 
 leg (1299) or sitz bath (1311), 108 to 115 , 8 to 12 minutes, 
 followed by shallow (1174) at 68° to 74 , affusion (1103) at 
 70 to 6o°, or percussion douche at 6o° to 50 , duration 20 to 40 
 seconds; ice-bag over heart for 15 minutes every 2 hours. 
 
 3. To Diminish Cerebral Hyperemia. — Short hot immersion 
 (1126) or shower (1047) followed by douche (1010) at 70 to 
 6o°, 20 to 40 seconds, light pressure; hot (106 to 115 ) leg 
 (1299) or sitz bath (1311); ice-collar (1316); 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 minutes. 
 
 Clinical Indications. 
 
 5. To Relieve or Prevent Exhaustion. — Rest in bed; tonic 
 treatment (1625) twice a day. 
 
 6. For Fever. — Local antiphlogistic measures (698) as may 
 be indicated; neutral bath (1130); cooling pack (1189). 
 
 7. For Insomnia. — See 1564. 
 
 8. For Constipation Cool enema (1405). See 1524. 
 
 9 . Indigestion.— See 1521, 1522. 
 
 io. Contraindications. — Avoid very hot or prolonged cold 
 baths; avoid cold to head when face is pale. 
 
 CONFUSIONAL, PUERPERAL; POST=FEBRI LE, POST= 
 
 OPERATIVE, TOXIC INSANITIES. 
 i. flalnutrition. — Rest; careful tonic treatment (1625). 1560 
 
 2. Autointoxication. — Aseptic dietary (1626); fruit diet 
 (1627) for 3 or 4 days; warm baths, electric-light (1250), 
 sweating pack (1191) 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. — Curettement, hot 
 vaginal irrigation (1413); neutral (1312) or tonic sitz (1309). 
 
 4. Fever. — Absolute rest in bed; prolonged tepid bath (88°. 
 to 92 , 30 to 60 minutes); cooling enemas (1405); cold cepha- 
 lic compress (1371); copious water drinking (1423). 
 
1066 RATIONAL HYDROTHERAPY. 
 
 5. Alcoholism. — Withdraw alcohol at once; withhold food for 
 3 days; nutritive enemas; copious water drinking (1423); neutral 
 coloclyster (1407) daily for a week. 
 
 6. Uremia. — See Acute Nephritis, 1537- 
 
 7. For other Clinical indications, see Simple Mania, 1559. 
 
 8. Contraindications — The same as those of Mania, when 
 conditions coincide. Especially avoid all intensely exciting pro- 
 cedures. 
 
 General 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 cases, 
 the symptoms are those of Melancholia, and the treatment must be 
 modified accordingly. 
 
 GENERAL PARESIS. 
 
 1561 Pathological Indications. 
 
 1. Malnutrition. — Vigorous but graduated tonic measures 
 (1625); rest in bed. See 1558, 1, also Neurasthenia, 1554. 
 
 2. Cerebral Hyperemia. — Continuous ice-cap (1323). See 
 1562, 1. 
 
 3. Disturbed Arterial Tension. — If excessive, see 1558, 3; 
 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 6o°); running footbath 
 (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 tfor 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 (1404) if constipated; dry, aseptic diet (1626) two 
 meals a day, or fruit only at night. 
 
 For palliation, hot and cold cephalic compress (1358) ; avoid 
 sleeping soon after eating, though a short nap is sometimes bene- 
 ficial. 
 
 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 (1250, 1197, 1246, 1126) fol- 
 lowed by cold douche (1010), wet-sheet rub (1216), or shallow 
 (1174) ; copious water drinking (1423) ; enema (1404) or colo- 
 clyster (1407) daily or tri-weekly; out-of-door life; air-bath (1470); 
 aseptic diet. 
 
 7. Periodical Headache, Nervous Headache, Bilious Head- 
 ache, fligraine, 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 (1404); tonic 
 treatment (1625); wet girdle (1347); abdominal supporter if 
 enteroptosis exists. 
 
 8. Rheumatic Headache — Sweating bath, 1499, 12, daily; 
 
1068 RATIONAL HYDROTHERAPY. 
 
 not foot bath (1297) or leg pack (1393), fomentation to painful 
 part for 10 to 15 minutes, followed by heating compress (1344). 
 See Uric Acid Diathesis 1511. 
 
 9. Neurasthenic Headaches See 1554, n-15. 
 
 10. Clavus. — Very hot foot bath (1297), with fomentation 
 over painful point for 10 minutes, repeated every 2 hours; carefully 
 graduated cool baths (1625). Heating compress at night; pro- 
 tect well from cold during the day. 
 
 11. Renal Headache. — Copious water drinking (1423); enema 
 (1404); hot bath (1126, 1250, 1246, 1197); ice-bag over 
 lower sternum, with hot and cold compress to head (1358). See 
 Acute Nephritis (1537); and Chronic Nephritis (1538). 
 
 12. Hepatic Headache, — Aseptic diet (1626); fruit diet 
 (1627); water-drinking (1423); graduated enema (1409); 
 fomentation over liver twice daily, 15 min., heating compress 
 during the intervals. Out-of-door exercise; air-bath (1470); 
 breathing exercises; abdominal massage. For palliation, revul- 
 sive compress to head (1341); hot and cold head compress (1358), 
 with derivative applications to legs (1299, 1393, 1037, 1250); 
 graduated tonic treatment (1625). 
 
 13. Organic Headaches (tumors, inflammation, syphilis, ab- 
 scess, trauma, general paresis). — Very hot and frequently repeated 
 derivative applications 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. See 
 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- 
 
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 16, 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 (1311-J-) ', abdominal supporter; wet girdle (1347); 
 application of sinusoidal electricity to uterus ; central galvanization ; 
 hot and cold head compress (1358); massage of head; static breeze 
 to head. Correct any ovarian or uterine disease present. See Neur- 
 asthenia (155-4). 
 
 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 1563 
 height water at 6o° or less, while two persons rub the patient 
 vigorously. Give special attention to the spine. Ice compress to 
 
 the head and neck (1314). 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 (1187, 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. 
 
IO7O RATIONAL HYDROTHERAPY. 
 
 6. Threatened Cardiac Failure Cold bag over heart 
 
 (1383) for 15 minutes every hour; cold mitten friction (1209) 
 every 2 hours; hot-blanket pack (1197) 10 minutes, followed by 
 cold towel rub (1213). Hot enema (1406) followed by cold 
 enema (1405) j artificial respiration. 
 
 INSOMNIA, 
 1564 Pathological Indications. 
 
 1. To Relieve Cerebral Congestion, — Neutral douche (1031) 
 3 to 5 minutes at bedtime; cold douche (1010); 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 legs; 
 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, 6o° 15 seconds; 
 neutral douche (1031), 3 to 5 minutes; evaporating head-cap 
 (1324); downward stroking of head and neck; galvanization of 
 the cervical sympathetic. 
 
 2. Relieve Irritability of the Cerebral Cell. — Prolonged 
 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 Ganglia. — 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 (a) congestion of the brain; 
 (£) irritability of the cerebral cell, or to (V) 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. 
 
 PRURITIS. 
 
 1. Neutral fan douche (1061), 95 to ioo°, 10 to 15 minutes. 1565 
 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), 1 to 2 minutes, 115 to 122 , followed by cool douche 70 
 30 seconds; prolonged neutral bath (1130), 92 . 
 
 3. Pruritis of Genitals 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, 1250) 1566 
 
 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. 
 
 Etiological Indications. 
 
 3. Avoid taking cold, and when an acute catarrh is contracted, 
 cure as soon as possible. See Acute Catarrh 1566, 1, 2. 
 
10/2 RATIONAL HYDROTHERAPY. 
 
 Pathological Indications. 
 
 4. Increase Activity of the Skin and Tone of Cutaneous 
 Vessels. — Short sweating procedures, especially the electric-light 
 bath (1250) and wet-sheet pack (1179) continued until the sweat- 
 ing stage, followed by short cold applications, — wet-sheet rub 
 (1216), shallow (1174), or cold douche (1010); neutral bath at 
 bedtime (1130), 20 to 30 minutes, 3 times a week; daily cold 
 morning bath; cold towel rub (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 General Nutrition by Correcting Existing 
 Digestive Disorders.— See 1520, 1521, 1523. Out-of-door 
 exercise, especially sun-baths (1254) and swimming. 
 
 6. Relieve Nasal Congestion. — Alternate compresses to the 
 face (1340); alternate sponging or compresses to the cervical 
 spine (1342); running cold foot (1290) bath if extremities are 
 cold; nasal secretions must be removed by antiseptic spray or 
 vaporizer; hypertrophies, 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 — TONSILITIS. 
 
 A. Acute Form. 
 
 1 567 1. 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 (1191 ; 
 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. IO73 
 
 tat: on (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, Clergyman'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. 
 
 LARYNGITIS. 
 
 A. Acute Form. 
 
 See Acute Coryza (1566). 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 the 
 Skin — Graduated cold baths (1625); sweating bath (1197, 
 1246, 1250) 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 worn 
 during the night. 
 
 3. Cough ? — See 1570, 4-7, 
 
1074 RATIONAL HYDROTHERAPY. 
 
 CROUP. 
 
 1569 A. Acute Catarrh of Larynx. 
 
 Hot bath with cold to head; hot water drinking (1429); cold 
 mitten friction (1209) every 3 hours; inhalation of vapor arising 
 from slacking lime; 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 arms very warm. Surgical inter- 
 ference often necessary. 
 
 B. False Croup, Laryngismus Stridulus, Spasmodic 
 Laryngitis. 
 
 Etiological Indications. 
 
 1. Prevent attacks by hardening the skin by daily cold bath 
 (1625). Remove nasal obstruction, hypertrophies, or adenoid 
 vegetations. Antiseptic inhalations. - ■ 
 
 2. Prevent Chilling of Shoulders during sleep, by warm 
 sleeping jacket. Proper clothing. 
 
 Pathological Indications. 
 
 3. Develop Resistance. — Graduated tonic applications 
 (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 sterno-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. 
 
ACUTE AND CHRONIC BRONCHITIS. 1075 
 
 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 (1.191), 1 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. Cough. — 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 Cough, without Expectoration — Sipping very 
 hot water; gargle hot water (1400); steam inhalations (1419); 
 avoid mouth breathing; keep air of room warm (75 ° to 8o°), 
 and moist with steam; carefully avoid exposure of back of neck, 
 chest, or shoulders to drafts, or chill by evaporation during treat- 
 ment. 
 
 6. Cough 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. 
 
 1. Improve General Resistance. — Graduated cold treatment 1571 
 (,1625); aseptic dietary (1626); warm dry climate; outdoor life. 
 
I0;6 RATIONAL HYDROTHERAPY. 
 
 2. Cough. — Chest pack (1373) protected by impervious cov- 
 ering. Copious water drinking (1423), 3 to 6 pints daily, steam 
 inhalation (1419). See 1570. 
 
 3. Ineffective Cough. — Increase expulsive power by rubbing 
 or percussion of the chest with the hand dipped in ice water, or 
 slapping the chest with a cold, wet towel. 
 
 4. Asthma. — Cold fan douche to back of chest (1061), 
 followed by heating chest pack (1373); revulsive compress 
 to chest (1341); Scotch douche to legs (1037); hot foot 
 (1297) or leg bath (1299); hot leg pack (1393); hot enema 
 ^1406) ; if sympathetic is irritable, wet-girdle (1347, 1348, 
 1367); chest pack (1373), well protected. 
 
 5. Emphysema. — Alternate compress or douche to spine 
 (1342); cold mitten friction (1209); cold towel rub (1213); 
 wet-sheet rub (1216); wet girdle covered with flannel only 
 (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 1529. 
 
 PULMONARY CONGESTION. 
 
 1572 1. Active Congestion. — 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 (1318), renewing every fifteen minutes, rubbing surf ace well 
 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 1 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 1 to 2 
 minutes; maintain skin circulation by dry rubbing (1221)' Keep 
 
BRONCHO-PNEUMONIA PLEURISY. I OJJ 
 
 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 
 
 i. Bronchial Irritation. — Steam inhalation (1419), 15 min- 
 utes every hour; fomentation (1328) to chest every 2 hours for 
 15 minutes, followed by heating compress (1373); 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 (1103) 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, 1, 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. — Limit movement of lung by tight bandage to the chest. 
 Very hot fomentation (1328) for 10 minutes over affected side. 
 Revulsive compress (1341). Repeat every 2 hours. During inter- 
 val, apply either cold (1318) or heatin'g 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. 
 
IO78 RATIONAL HYDROTHERAPY. 
 
 B. Chronic Form. 
 
 1. Neutral bath (1130) at night three times a week, of 20 to 30 
 minutes' duration. Graduated cold (1625) daily. Fomentation 
 (1328) to chest three times a day, or revulsive spray (1041), or 
 compress (1341); well-protected heating compress (1344) during 
 the interval. 
 
 2. Aseptic dietary (1626). Gymnastics to expan dchest 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 ASTHilA. 
 
 1575 Neutral bath (1130) at bedtime; wet girdle (1347); copious 
 
 water drinking (1423); 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 gastric disturbance. 
 
 Sweating process when skin is inactive (1250, 1246, 1197, 
 1191) followed by cold bath of appropriate form (1625). 
 
 PERICARDITIS, ENDOCARDITIS. 
 
 1576 1. To Combat Inflammation. — Continuous ice-bag over heart, 
 or precordial compress (1383) at 6o°, 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 Haintain General Vital 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 1 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. IO79 
 
 ORGANIC CARDIAC DISEASE, VALVULAR DISEASE 
 OF THE HEART. 
 
 1. General tonic measures, carefully graduated (1625); mod- 1577 
 erate antiseptic dietary (1626), avoiding hot foods, tea and coffee, 
 alcoholic drinks, condiments, flesh meats, and indigestibles. 
 Pathological Indications. 
 
 2. To Increase Energy of Heart. — Ice-bag over heart (1383) 
 for 15 minutes, gradually increased to 1 hour, twice a day. If 
 limbs are swollen, rest in bed until swelling disappears. Efferves- 
 cent bath (1139) one to three times weekly; massage; leg packs. 
 Special gymnastics (Schott). 
 
 Clinical Indications, 
 
 3. Dyspnea. — Elevate the head and shoulders when patient is 
 lying down; cold compress to chest (1318) and hot pack to legs 
 (1393); change compress every 15 to 20 minutes; at each change, 
 rub the surface of the chest with dry flannel until red. 
 
 4. Pain. — Very hot fomentation (1328) over seat of pain for 
 3 minutes; follow by heating compress (1344) at 6o°, changing 
 every 20 minutes; repeat every two or three hours; revulsive com- 
 press (1341); hot and cold gastric compress (1362). 
 
 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 (1130); copious water 
 drinking (1423); cool 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 (1191) ending with cold friction 
 (1209); leg packs (1393); electric-light bath (1250) or vapor 
 bath (1246) for lower half of body; ice-bag over heart during hot 
 baths; massage; effervescent bath (1139). 
 
 8. To Energize the Heart and Encourage Peripheral Circu- 
 lation Wet-sheet rub (1216); cold towel rub (1213); Scotch 
 
 douche (1037) at 102 , lowering without sudden change to 8o° 
 during first applications. At each succeeding application, a tem- 
 perature i° lower until 65 or 6o° is reached. Cold friction 
 
<* 
 
 IOSO RATIONAL HYDROTHERAPY. 
 
 (1209); fan douche (1061) over chest without pressure at 75 , 
 duration 10 or 15 seconds. 
 
 9. Cardiac Hypertrophy. — Rest in bed; ice-bag over heart 
 for 1 hour three to four times daily; prolonged neutral bath 
 (1130), 92 to 94 , 20 to 60 minutes; neutral pack (1182) 20 to 
 40 minutes; graduated cold baths (1625); heating abdominal 
 compress (1351); gentle massage; centrifugal friction (1224). 
 
 10. Hepatic Congestion and Hypertrophy (Nutmeg Liver). 
 — Alternate compress (1340); alternate douche (1044) with slight 
 pressure; heating compress (1344), covered with flannel only 
 during the night; if pain is present, revulsive compress (1341); 
 treatment for relief of portal congestion. See 1278, 1279- 
 
 11. Pulmonary Hemorrhage. — See Pulmonary Congestion 
 (1572, 2, 3). 
 
 12. Cough. — If acute, 1572, 2; if chronic, chest pack, 'flannel 
 covered (1373); warm covering of arms; heat to legs; intermit- 
 tent precordial compress (1383). 
 
 13. Palpitation. — See 1578, 3. 
 
 14. Angina Pectoris. — Ice-bag to dorsal spine (1372); hot 
 leg pack (1393); short fomentation (30 sees.) over heart, fol- 
 lowed by warm dry compress. 
 
 15. Gastric Catarrh — See 1519. 
 
 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 first stage, 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- 
 
FUNCTIONAL CARDIAC DISEASES. Io8l 
 
 ployment of the same measures necessary for the second stage. 
 The general aim is to energize the heart and lessen its work by 
 increasing the activity of the peripheral heart (1161). 
 
 FUNCTIONAL CARDIAC DISEASES. 
 
 1. Shock, Collapse, Cyanosis. — Hot fomentations (1328) or 1578 
 hot-blanket pack (1197) for 10 to 15 minutes, or hot immersion 
 
 bath (1126) 3 to 6 minutes, followed by cold mitten friction 
 (1209); cold towel rubbing (1213) or wet-sheet rubbing (1216), 
 continued until surface is reddened, applying every 2 to 3 hours, or 
 two to three times daily, as may be necessary; ice-bag over heart, 
 or cold precordial compress (1383), 15 minutes, 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); 
 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, 92 ° 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-sheet rub (1216); shallow bath 78 , one-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 nightwithout impervious covering. 
 
 5. Feeble Heart, without Fatty Degeneration. — Cold pre- 
 cordial compress (1383) 15 minutes daily; increase 5 minutes 
 each day until duration is 30 to 40 minutes. Percussion douche 
 
1082 • RATIONAL HYDROTHERAPY. 
 
 to the spine (1035); vigorous cold friction (1209) to extremities. 
 Avoid prolonged cold applications or prolonged chilling. 
 
 6. Decrease Work Required of the Heart Dilate surface 
 
 vessels and increase their activity by cold mitten friction (1209), 
 cold towel rub (1213), wet-sheet rub (1216), shallow bath, 72°to 
 75°, one-half minute (1174). If necessary, precede the short cold 
 application by a short heating procedure as a fomentation to the 
 spine (1328), vapor (1246), hot immersion (1126), or electric- 
 light bath (1250) for 3 to 5 minutes, or hot sponging (1206). 
 
 7. Remove Toxins. — Lavage (1401); coloclyster (1407); 
 water drinking (1423). 
 
 8. Slow Pulse. — Alternate sponging or compress to spine 
 (1342); hot water drinking (1429); dry friction (1221); mas- 
 sage; carefully graduated cold baths (1625). 
 
 9. Avoid hot baths, or if a warm bath is necessary, make 
 very short (102 to 104 ), and follow with short, cold application. 
 
 CHLOROSIS. 
 1579 Etiological Indications. 
 
 1. Correct Enteroptosis. — Abdominal Supporter; abdom- 
 inal massage; corrective exercises; cold abdominal douche 
 
 (1081); electricity. 
 
 Pathological Indications. 
 
 2. Increase Vital Resistance. — General graduated cold pro- 
 cedures (1625) twice daily. 
 
 3. Combat Autoxintoication. — Aseptic diet (1626); sweating 
 bath to beginning perspiration, electric-light bath (1250) or sun 
 bath (1254) followed by short cold application (1625). 
 
 Clinical Indications. 
 
 4. Low Blood Count. — See Anemia 1580, 1. 
 
 5. Constipation. — See 1524. 
 
 6. Vaso=Motor Spasm. — General Scotch douche (1037); 
 alternate immersion (105 to no°, 30 seconds, 8o° 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-protected heat- 
 
ANEMIA. IO83 
 
 ing compress (1344); Mackintosh-covered wet girdle at night; 
 cool enema (75 to 68°), 1 to 3 pints, daily. 
 
 ANEMIA. 
 Etiological Indications. 1580 
 
 1. Increase Blood=Making Process. — Graduated cold appli- 
 cations (1625). The electric-light bath (1250) is especially 
 valuable as a means of heating before general cold applications 
 (1625); aseptic dietary (1626), substances rich in proteids and 
 fats; rest in bed, if patient is emaciated; out-of-door life; cold air 
 1 aths (1470); sun baths (1254); sea bathing (1147); massage; 
 manual Swedish movements; electricity; oxygen inhalation. 
 static. 
 
 Clinical Indications. 
 
 2. Neuralgia. — See 1545. 
 
 3. Hyperpepsia.— See 1522. 
 
 4. Hypopepsia. — See 1521. 
 
 5. Chronic Gastrointestinal Catarrh.— See 1519, 1529. 
 
 6. Loss of Appetite, — See 1521, 5. 
 
 7. Vomiting.— See 1523, 3. 
 
 8. Constipation, — See 1524. 
 
 9. Enteroptosis. — See 1525. 
 
 10. Gastric Dilatation, — See 1523. 
 
 11. Gastric Ulcer.— 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 ^1050). 
 
 14. Dropsy, — See 1582. 
 
 15. Palpitation of Heart or Aorta. — See 1578, 3, 4. 
 
 16. Metrorrhagia or Menorrhagia. — See 1588. 
 
 17. Chronic Nephritis, — See 1538. 
 
 18. nalarial 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 (1524), 
 is often the principal cause to be combated (1473-1475). 
 
IO84 RATIONAL HYDROTHERAPY. 
 
 PERNICIOUS ANEHIA. 
 
 1581 1. Combat Autointoxication Electric-light bath (1250) 
 
 vapor bath (1246), or hot-blanket pack (1197), 5 minutes, fol- 
 lowed by cold bath (1625) twice a week. Aseptic dietary 
 (1626). 
 
 2. Indigestion. — See Hypopepsia (1521). Aseptic diet 
 (1626). 
 
 3. Promote General Nutrition and Blood Making. — Gradu- 
 ated tonic baths daily (1625); ice-bag over the stomach half an 
 hour before each meal. See Anemia 1580. 
 
 4. Cerebral Anemia. — Rest in bed with foot of bed raised. 
 
 Warm flannel about the neck to promote cerebral circulation. 
 
 Warm compress to back of neck if patient is inclined to faint. 
 
 5. General Method. — The same as for simple Anemia (1580). 
 
 GENERAL DROPSY, ANASARCA, OR MALEOLAR EDEflA. 
 
 1582 1. 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 pro- 
 cedures when due to renal disease (1250, 1191); wet girdle 
 (1347), changing every 2 hours. 
 
 2. Palpitation. — See 1578, 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 trunk 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. 
 
 1583 Pathological Indications. 
 
 1. Enlarged Thyroid. — Ice-bag over gland, continuously, re- 
 moving for five minutes every half-hour; galvanization of cervical 
 and abdominal sympathetic. 
 
 2. Anemia. — Carefully graduated cold wet hand rub (1201), 
 mitten friction (1209), and towel rub (1213). See 1580. 
 
 3. Autointoxication. — Aseptic diet (1626); coloclyster 
 (8o°) daily; neutral bath, 20 to 30 minutes daily (1130); water 
 drinking (1423). 
 
MYXEDEMA — RHEUMATIC GOUT. IO85 
 
 4. Nervous Irritability and Exhaustion. — Rest in bed; care- 
 fully graduated cold baths (1625). 
 
 Clinical Indications. 
 
 5. General Feebleness. — Graduated cold applications (1625). 
 
 6. Emaciation. — Rest; diet rich in fats and proteids (1626) = 
 
 7. Palpitation. — See 1578,3, 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 
 (1362); revulsive compress (1841). See Chronic Gastritis 
 (1520), Hypopepsia (1521), Hyperpepsia (1522). 
 
 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 Hethod. — 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. 
 
 1. General Restorative Measures. — The diet must be specially 1585 
 nourishing and digestible, rich in fats and proteids (1626V See 
 
1086 RATIONAL HYDROTHERAPY. 
 
 Emaciation (1516)- A warm, rather dry, and uniform climtae 
 is most desirable. 
 
 2. Carefully graduated cold applications (1625), preceded by 
 very short hot applications; fomentation (1328) to spine or the 
 electric-light bath (1250) 3 to 5 minutes, and the sun bath 
 (1254), followed by cold mitten friction (1209) are especially 
 suitable; massage; manual Swedish movements; oil rubbing 
 (1232); wet girdle (1347). 
 
 Clinical Indications. 
 
 3. Fever — Prolonged neutral bath (1130) at 92 ; fomenta- 
 tion (1328) to spine followed by cold friction (1209) or towel rub 
 (1213). 
 
 4. Frequent Pulse. — Cold precordial compress (1383) or 
 ice-bag for 15 to 30 minutes three times a day. 
 
 5. Pain in Joints. — Revulsive compresses (1341) followed by 
 cotton poultice (1388); local vapor bath (1249); local electric- 
 light bath (1250). 
 
 6. Neuralgia of Hands. — Hot hand bath (1302) followed by 
 cotton poultice (1388). 
 
 7. Radiating Pains. — Fomentation (1328) to spine three 
 times a day, heating compress (1344) during interval, well pro- 
 tected with mackintosh; revulsive compress (1341) to spine; gal- 
 vanic or sinusoidal electricity to trunk, arms, or legs, as indicated. 
 
 8. Numbness and Tingling of Hands and Feet. — Fomen- 
 tation to spine, hot or alternate sponging of limbs (1204), repeated 
 three times a day; faradic or sinusoidal electricity. 
 
 9. Muscular Cramps. — Fomentation (1328) or hot immer- 
 sion of affected parts two or more times daily; during interval, 
 well-protected heating compress (1344); hot sponging; firm 
 bandaging. Protect patient from chill. 
 
 10. Muscular Atrophy. — Alternate douche (1044), compress 
 (1340) or sponging; massage; massage-douche (1066); sinus- 
 oidal electrical current (1446) applied to affected muscles. 
 
 11. Joint Deformities, — For thickening of synovial membrane 
 or accumulation of fluid in joints or bursas, apply alternate douche 
 (1044); alternate compress (1340); massage-douche (1066); 
 Apply to joint dry flannel bandage or cotton poultice (1388). 
 
 i2. Contraindications. — Cold douche to painful joints; long 
 sweating processes and prolonged general hot applications. 
 
DYSMENORRHEA. IO87 
 
 General Method. — Improve the general health by general 
 tonic measures, especially carefully graduated cold baths (1625), 
 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 1586 
 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 (1525), 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 (1311 2) 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 (1389, 1393); hot-blanket pack 
 (119?); fomentation (1328) over hypogastrium ; hot pelvic 
 pack (1390); revulsive sitz (1311£) j hot rectal irrigation 
 (1410) followed by hot foot bath (1297) if flow is checked; 
 hot douche (99 to 102 ); very hot immersion (^105° to no°) 
 5 to 8 minutes. 
 
 3. When Due to Uterine Disease (beginning with and ac- 
 companying flow). — Hot hip pack (1389) with hot foot bath 
 
1088 RATIONAL HYDROTHERAPY. 
 
 (1297) followed by cold compress to hypogastrium and inner 
 surfaces of thighs for 30 to 40 seconds. For treatment between 
 periods, see 1591- 
 
 4. When Due to Inflammatory Disease of Appendages, — 
 
 Hot enema (1406); hot fomentations (1328); hot pelvic pack 
 (1390); hot-blanket pack (1197). 
 
 General Method. — In addition to the local measures for relief 
 of pain which have been indicated above, it is in most cases nec- 
 essary to combat some general disorder to which the local disease 
 may be more or less directly related. See Anemia (1580), Neuras- 
 thenia (1554), Hysteria (1553). General tonic measures must 
 be employed between the menstrual periods. In chronic ova- 
 nan congestion, apply the hypogastric compress (1318) during 
 the night; administer daily the revulsive sitz (1311 J) or hot 
 pelvic pack (1390), and the very hot vaginal irrigation (1413), 
 115 to 120 , 15 minutes. In cases of deficient development, as 
 in infantile uterus or vasomotor spasm of the uterine vessels, 
 employ the revulsive sitz, alternate genito-urinary douche (1099), 
 tonic sitz (1309), pelvic and general massage, and local galvanic 
 and sinusoidal electrical applications. 
 
 Applications of electricity and surgical measures are often 
 required for permanent relief, but a surprisingly large number of 
 cases are curable without surgery; hence hydriatic measures should 
 be perseveringly tried before resorting to surgical procedures. 
 
 METRORRHAGIA AND MENORRHAGIA. 
 
 1588 1. Hot vaginal irrigation (1413); short hot hip pack (1389); 
 
 hot foot bath (1297), followed by cold compress to hypogastrium 
 (1318) and inner surfaces of thighs. In obstinate cases, cold 
 vaginal irrigation (1413). Moderately prolonged, very cold, 
 shallow sitz (50 to 65 for 5 to 15 minutes) (1308), accompanied 
 by hot foot bath (1297) when other measures fail; hot douche 
 (1024) to lower spine, hypogastrium, inner surfaces of thighs, 
 twice daily during intervals. 
 
 2. Contraindications. — Prolonged hot sitz, hot douche, hot leg, 
 foot, and sitz baths, and in some cases even fomentations and hot 
 vaginal irrigation must be avoided. It is equally necessary to 
 avoid short cold applications to the lower spine, abdomen, thighs 
 and feet, as the reflex effects of such applications increase pelvic 
 and uterine congestion, 
 
/ PELVIC PERITONITIS. • IO89 
 
 General Method. — It is always 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), Uterine Displacement 
 (1619), ovarian or tubal disease (1592), 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 . 
 (1591). 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 sitz (1309); cold pelvic pack (1390, 1); graduated 1589 
 tonic baths (1625) twice daily; short very cold douche to lower 
 spine (1076), hypogastrium and inner surfaces of thighs; pelvic 
 massage daily, and especially when period is due. 
 
 2. Suppressed Menstruation. — 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 periods. Intrauterine applications of the faradic or sinu- 
 soidal electrical current; hot hip pack (1389); warm vaginal irri- 
 gation (1413), 95° to IOO °- 
 
 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, CELLULITIS. 
 
 Etiological Indications. 1590 
 
 1. Surgical and puerperal asepsis; care to avoid exposures 
 at menstrual periods; protection of feet and legs in damp and 
 cold weather; proper clothing. 
 
 Pathological Indications. 
 
 2. Increase Resistance. — Cold mitten friction (1209) or cold 
 towel rub (1213) 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 
 
I O9O RATIONAL HYDROTHERAPY. 
 
 3. Combat Local Inflammation. — Hot hip and leg pack 
 (1389, 1393) 20 minutes every 2 hours; during intervals, cold 
 compress (1318) at 6o° to hypogastrium, pudenda and inner sur- 
 faces of thighs, with heat to feet and legs, or ice-bag over seat of 
 pain, hot bags or fomentations to feet, hips and thighs; hot and 
 cold pelvic compress (1364) with ice-bag over seat of pain; 
 continue 20 to 40 minutes, and repeat when needed; hot vaginal 
 irrigation (1413) (no° to 120 ), one gallon, every 4 hours. 
 
 4. Encourage Resolution, — After acute stage has passed, 
 apply alternate compress (1340) for 30 minutes three times a day; 
 during interval, heating compresses (1344), changing every 2 
 hours, or as soon as well warmed; graduated tonic baths (1625); 
 alternate vaginal irrigation (no°, 8o° to 70 ) ; later, pelvic 
 massage. 
 
 Clinical Indications. 
 
 5. Pain, — Fomentation (1328) or revulsive compress (1341) 
 every 2 to 4 hours, or oftener if necessary. 
 
 6. Constipation, — Large hot enemas (1406) twice a day 
 during acute pain and inflammation; later, graduated cold enema 
 (1409). 
 
 7. Chill. — Anticipate chill by wrapping patient in warm blan- 
 kets with hot bags to trunk and limbs; hot water drinking (1429). 
 
 8. Septic Fever, — Add to local measures, if fever is high, hot- 
 blanket pack (1197) 10 to 15 minutes, followed by sweating wet- 
 sheet pack (1187, 1191) prolonged neutral bath (1130). If 
 suppuration occurs, surgical interference is generally indicated. 
 
 9. Anemia, — See 1580. 
 
 10. Contraindications. — Avoid cold immersions; partial cold 
 applications, such as the cold-mitten friction and the cold-towel 
 rub, must be used instead. 
 
 CHRONIC METRITIS AND PELVIC CONGESTION, 
 
 1591 1. Graduated cold applications (1625); hot vaginal irriga- 
 
 tion (1413), 10 to 15 minutes, twice daily; hot-blanket pack to legs 
 (1393) with cold pelvic pack (1390), continued to sweating 
 stage, followed by cold friction (1209, 1213) or wet-sheet rub 
 (1216). 
 
OVARITIS, SALPINGITIS. I09I 
 
 Clinical Indications. 
 
 2. Pain, — Prolonged neutral sitz bath (1312) 95 to 97 , 
 duration, 15 to 20 minutes. 
 
 3. Leucorrhea. — In addition to the above measures, anti- 
 septic vaginal irrigation, bichloride 1 to 5,000, or permanganate 
 1 to 200. In certain cases, cool irrigation, 75 to 65 , produces 
 better results than hot irrigation. Constipation (1524) and portal 
 congestion (1279) must 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 (1389, 1393); hot and cold 
 pelvic compress (1364) or hot and cold pelvic pack (1370). 
 
 OVARITIS AND SALPINGITIS. 
 A. Acute Form. 
 
 1. Rest in bed; hot vaginal irrigation (1413) twice daily; hot 1592 
 pelvic pack (1390); hot leg pack (1393) or hot foot bath 
 (1297) twice daily, followed by cold friction (1209). If sup- 
 puration of tubes occurs, operation is usually necessary. Dur- 
 ing the first few days, ice-bag over inflamed part, interrupted at 
 intervals of 1 to 3 hours by fomentatation for 15 minutes or hot 
 
 and cold pelvic compress (1364) for 30 minutes; heat to limbs. 
 
 2. Contraindications, — General cold applications, and cold 
 applications to the feet. 
 
 B. Chronic Form. 
 
 1. Rest in bed with hips elevated; neutral bath (1130) 15 to 
 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 (1389, 
 1393) twice daily, with the heating compress during the interval. 
 The circulation of the lower extremities may also be encouraged 
 by a prolonged heating compress applied to each leg separately 
 (1393) 2 or 3 hours once a day. Vigorous cold friction with 
 towel or mitt should be applied to the legs on removal of the 
 pack (1209-1213). Keep the feet and legs warm. 
 
 2. Hot vaginal irrigation twice daily (1413); hot rectal irriga- 
 
1092 RATIONAL HYDROTHERAPY. 
 
 tion (1410) once daily if exudate in pelvis is extensive; sinu- 
 soidal current with very rapid alternations; pelvic massage. 
 
 3. General tonic applications (1625); general massage; manual 
 Swedish movements; Sun Baths (1254); out-of-door exposure with 
 proper protection, carefully avoiding chill; fat and blood-building 
 diet. See Emaciation (1516). 
 
 4. If suppuration is present, drainage. Removal of the dis- 
 eased appendages is sometimes required, but in most cases this 
 may be obviated by the proper application of hydriatic measures 
 at the outset. 
 
 STERILITY IN WOMEN. 
 
 1593 When not due to organic diseases, may often be cured by a 
 course of hydriatic treatment. A course of graduated cold appli- 
 cations (1625) is most efficient. The cold rubbing sitz (1309) 
 is highly useful. Remove catarrhal conditions of uterus and 
 vagina and subinvolution by means of hot vaginal irrigation 
 (1413) followed by tonic sitz (1309). 
 
 PROSTATITIS. 
 
 1594 1. Revulsive sitz bath (1311J); hot rectal irrigation (1410); 
 irrigation of bladder (1411), if bladder does not empty itself. 
 Neutral sitz (1312), 30 to 60 min. Cold mitten friction (1209). 
 
 2. When painful, revulsive sitz (1311*). Fomentation 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 results 
 often follow the use of the following measures: alternate rectal 
 irrigation (1410); shallow cold rubbing sitz (1309) 4 to 8 min.; 
 cold pelvic pack (1390) with hot leg pack (1393); massage 
 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 general 
 cold baths, cold sitz and foot baths, and chilling of feet. Absolute 
 sexual continence is essential. 
 
 ACUTE ORCHITIS. 
 
 1595 Rest in bed. Elevation of scrotum upon a tense broad band 
 of cloth placed about the thighs close to hips. Hot pelvic pack 
 
SPERMATORRHEA — -IMPOTENCE PRIAPISM. IO93 
 
 (1390) or hot hip pack with cold compress over genitals (13(5-1), 
 every 3 hours. During intervals, cold compress at 6o° over 
 perineum, genitals, and hypogastrium, with heat to feet. Tepid 
 enema (1404) twice daily; cold mitten friction (1209) or cold 
 towel rub (1213) twice a day; prolonged neutral bath (1130) 
 or neutral pack (1182) to control temperature if necessary. 
 
 SPERMATORRHEA. 
 
 1. Graduated cold applications (1625) to improve general con- 1596 
 dition. 
 
 Clinical Indications, 
 
 2. General Nervous Irritability. — Prolonged neutral bath 
 (1130) at night. See Neurasthenia (1554). 
 
 3. Irritable Prostate, Irritable Urethra. — Prolonged neutral 
 sitz (1312), 30 to 60 minutes, at bedtime; Scotch douche to 
 perineum (1084) with little pressure; tepid rectal irrigation 
 (1410) at 8o°. 
 
 4. Relaxed Ejaculatory Ducts — Rubbing cold sitz (1309), 
 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 (1626) is essential 
 Condiments must be strictly avoided. Cooling sound (1416), 
 70 , for 5 minutes daily. 
 
 5. Contraindications. — When losses are frequent or parts 
 irritable, avoid cold sitz baths and prolonged hot baths. 
 
 SEXUAL IMPOTENCE. 
 
 Graduated cold baths (1625); cold douche to spine (1074), 1597 
 especially lower part; cold rubbing sitz (1309), beginning at 8o°, 
 lowering temperature 5 daily to 6o°; duration of bath 3 to 8 
 minutes. Patient should be vigorously rubbed to prevent chilling. 
 If urethral irritation is present, short (2 to 4 minutes) revulsive sitz 
 (131H); cooling compress (1395), 5 minutes daily. 
 
 PRIAPISM, 
 
 Immersion bath (1112), ioo° for 1 minute, 90 for 5 minutes; 1598 
 gradually lower temperature to 75 , and continue for 5 minutes; 
 
1094 RATIONAL HYDROTHERAPY. 
 
 lower minimum temperatures i° daily to 6o°; hot douche to 
 lower spine (1074:) and thighs for 30 seconds; follow by general 
 neutral douche (1031) 2 to 3 minutes with considerable pressure 
 (20 to 30 lbs.); prolonged general neutral bath (1130) 30 to 40 
 minutes; spinal affusion (1103) 5 minutes, 98 . 
 
 IRRITABLE RECTUM. 
 
 1599 Pathological Indications. 
 
 1. Increase Vital Resistance. — Graduated tonic baths 
 
 (1625). 
 
 2. Combat Local Inflammation. — Prolonged cool sitz 
 (1308), 75° for 15 minutes; cooling compress (1395) to nates, 
 anus, perineum, and genitals; cleanse rectum after each stool; 
 render fecal matters soft and bowels regular, by diet and other 
 measures. See 1524. Rest in horizontal position; hot rectal 
 irrigation (1410) daily or oftener; prolonged cold anal douche 
 (1087) with little pressure. 
 
 Clinical Indications, 
 
 Pain, — Revulsive compress (1341); ice-bag to anus; fomenta- 
 tion (1328) to nates and perineum; hot hip pack (1389); hot 
 footbath (1297); hot hip and leg pack (1389, 1393); hot va- 
 ginal irrigation (1413). 
 
 Spasm.— Hot sitz (1311); sitting over hot water (1249). 
 
 Constipation. — See 1524. 
 
 Pain in the Back — Scotch douche to back (1037); hot sitz 
 (1311); wet-girdle (1347). 
 
 HEMORRHOIDS. 
 
 1600 1. Portal Congestion.— Running cold foot bath (1296); hot 
 foot (1297) or leg bath (1299); hot leg pack (1393);' 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. 
 
SYPHILIS. IO95 
 
 5. Inflamed Hemorrhoids. — Rest in bed with feet and hips 
 elevated; knee-chest position if necessary; ice-cold compress 
 (1395) pressed firmly against anus; ice suppositories; very shal- 
 low ice-cold sitz. 
 
 6. Pain. — If due to inflammation, short hot fomentation 
 (.1328) followed by cold compress applied to the anus and nates 
 (1395), with hot foot bath (1297) at the same time; repeat 
 fomentation hourly or every two hours; prolonged tepid sitz 
 (1304), temperature 85 to 8o°; hot hip and leg pack (1389, 
 1393), followed by cold compress over nates, perineum, and 
 lumbar region (1395). 
 
 SYPHILIS. 
 
 1. First and Second Stages — Eliminative baths — vapor 1601 
 (1246), electric-light (1250), sweating pack (1191), followed by 
 short cold tonic applications — wet-sheet rub (1216), graduated 
 douche (1017), or cold towel rub (1209); outdoor life; reg- 
 ular habits, aseptic dietary (1626), especially careful avoid- 
 ance of meats, tea and coffee, tobacco, alcoholic drinks, and 
 
 all indigestible and unwholesome foods. 
 
 2. Skin Eruptions. — Prolonged neutral bath (1130). 
 
 3. Syphilitic Cachexia. — Electric-light baths (1250); sun 
 baths (1254); water drinking (1423); wet girdle (1347); cold 
 mitten friction (1209); cold towel rub (1213); rubbing wet sheet 
 (1216). 
 
 4. Anemia Due to Long=Continued Use of Mercury or 
 Iodide of Potash. — Galvanic bath (1457) two or three times 
 a week, and carefully graduated tonic baths (1625) ; water drink- 
 ing (1423). 
 
 5. Nocturnal Pains. — Prolonged neutral douche (1031), 
 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; See 1564. 
 
 7. Syphilitic Ulcers. — General eliminative and tonic measures, 
 sweating bath daily (1250, 1191) followed by short cold appli- 
 cations (1625); prolonged immersion of the affected parts 
 (1107), or antiseptic dressing. 
 
 8. Indolent Ulcers. — Alternate spray to ulcer, with measures 
 indicated above, twice daily for 10 minutes. 
 
IO96 RATIONAL HYDROTHERAPY. 
 
 9. To Induce Absorption of Gummata. — A fruit dietary 
 (1627) for 3 days, prolonged sweating bath (1191) daily, 
 electric-light bath (1250), vapor bath (1246), or sweating wet- 
 sheet .pack followed by a vigorous cold application, 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 patients, also when patient's temperature is 
 elevated. 
 
 General Method. — The important thing to be accomplished in 
 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 eruption. 
 
 INFLAMMATIONS OF THE EYE, 
 
 1602 1. External Inflammations, — Light fomentations (1328) 
 for 15 minutes every 2 hours; frequently renewed cooling (1318) 
 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, 6o°) 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 
 
SKIN DISORDERS. IO97 
 
 drinking (1423); large enema (1404); daily aseptic dietary; 
 C1626) effervescent bath (1139). 
 
 Eruptions. — If dry, not irritable, prolonged neutral bath 1607 
 (1130). If scaly, alkaline bath (1463). If moist and irritable, 
 cool evaporating compress moistened with soda solution, 1 ounce 
 to the gallon; emollient bath (1462). If skin is thickened, as in 
 chronic eczema, hot or alternate spray or compress for 10 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. 
 
109$ RATIONAL HYDROTHERAPY. 
 
 DRUG HABITS. 
 A. Alcoholism. 
 1612 General. — i. Aseptic dietary (1626), especially fruits. 
 
 Meats and flesh foods must be strictly prohibited, also meat 
 juices, broths, and all preparations of flesh. Fomentation (1328) 
 over the stomach twice a day with wet girdle (1347) between 
 applications; short sweating baths, — electric-light bath (1250), 
 sweating pack (1191) followed by wet-sheet rub (1216). Grad- 
 uated cold baths (1625) twice a day. 
 
 2. Insomnia. — Neutral bath at bed-ime, 94 to 96 , 20 to 60 
 min. ; wet girdle at night. See Insomnia (1564). 
 
 3. Vomiting. — Ice pills, ice-bag over stomach, hot and cold 
 gastric compress (1362). See 1519, 3. 
 
 4. Delirium Tremens. — Rest in bed; hot immersion bath 
 (1126) 5 minutes, hot-blanket pack (1197) followed by sweat- 
 ing wet-sheet pack (1187, 1191); neutral bath (1130) 1 to 2 
 hours or longer twice a day; ice-cap (1314, 1371); hot fomen- 
 tations (1328) over stomach and abdomen, every 3 hours for 15 
 minutes; during interval, heating compress (1344) changing every 
 30 to 60 minutes. Copious water drinking (1423); large enema 
 (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 cold 
 douche to spine (1074) and lower sternum. Repeat every hour or 
 two if necessary, until the toxic effects disappear. Gastric lavage 
 (1401), followed by cold or alternate irrigation (1401). 
 
 6. Nephritis. — Usually present in acute alcoholism. See 
 1537. 
 
 7. Gastritis.— See 1519. 
 
 General Method. — The patient must be placed in a proper 
 environment; isolation and confinement may be required. Suit- 
 able mental and moral influences must be brought to bear. 
 
 B. Opium, Cocaine, and Chloral Habits. 
 
 1. Rest in bed. Sweating baths, — electric-light bath (1250), 
 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. IO99 
 
 2. Nervousness, Restlessness, " Indescribable Sensations.* ' 
 
 — Prolonged neutral bath (1130) 92 to 94 , ten minutes; neutral 
 douche (1031), 92 , 2 to 4 minutes. 
 
 3. Cardiac Weakness. — Cold precordial compress (1383) or 
 ice-bag over heart (1314); alternate applications to spine (1342); 
 cold mitten friction (1209); cold towel rub (1213), repeating 
 treatment hourly if necessary. 
 
 4. Vomiting. — Hot and cold trunk pack (1367); ice-bag over 
 stomach and spine; hot leg pack (1393). 
 
 5. Diarrhea. — Hot enema (1406) after each movement; cold 
 abdominal compress (1284, 1318) 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, 20 to 60 minutes (1130); prolonged neu- 
 tral spray (1031) 3 to 5 minutes; heating leg pack (1393); wet 
 girdle (1347); cold 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 (1187, 1191), twice daily; follow with 
 short cold application, as shallow bath (1174), wet-sheet 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. 
 
 1. Discontinue the use of the drug at once. If necessary, 
 employ some harmless cereal substitute. Neutral bath (1130) 
 at bedtime. Fomentation over abdomen (1328); alternate 
 sponging of the spine (1342); cold mitten friction (1209) 
 or cold towel rub (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 application (1625). 
 
IIOO RATIONAL HYDROTHERAPY. 
 
 2. Constipation. — Graduated enema (1409). See 1524. 
 
 3. Diarrhea. — Neutral enema (1404) after each movement; 
 cold abdominal compress (1318) every half-hour. 
 
 4. Nervous Headache. — See 1554, 15. 
 
 5. The diet should consist chiefly of fruits (162?) and liquid 
 foods (1628) for a few days; the patient should be gradually 
 accustomed to a dry dietary (1629). 
 
 APPLICATIONS OF HYDROTHERAPY IN SURGICAL 
 
 CASES. 
 
 1613 Contusions. — Fomentation (1328) three times a day, 10 to 
 15 minutes, with protected heating compress (1344) during the 
 interval; if heat and swelling are great, change the compress every 
 15 minutes; as swelling and heat diminish, renew less frequently. 
 
 1614 Fractures — Apply a fomentation (1328) or a revulsive com- 
 press (1341) for 10 or 15 minutes before application of the 
 permanent dressing. When possible, the revulsive compress 1 should 
 be applied two or three times daily. This will afford the patient 
 much comfort in relief from pain, and will expedite the healing 
 process. Apply massage to portion of the limb which is accessi- 
 ble. In cases of compound fractures which are inoperable, 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 (1126) 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 (1103) 
 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 (1201), 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). 
 
HYDROTHERAPY IN SURGERY. HOI 
 
 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 with cor- 
 rective gymnastics, massage, and electricity, the tonic and ener- 
 gizing effects of hydrotherapy. Administer daily or twice daily, 
 carefully graduated tonic measures (1625), and in addition apply 
 to the back the cold jet (1074), cold percussion douche (1035), 
 or alternate douche (1044). 
 
 Uterine Displacements Retroversion, procidentia, and some 1619 
 
 other forms of uterine displacement require mechanical and surgi- 
 cal treatment in most cases, but hydrotherapy is almost essential 
 for a radical cure. Administer daily vaginal irrigation (no° to 
 1 1 5° when pain is present, 8o° to 70 when pain is not a prominent 
 symptom); tonic sitz (1309); graduated tonic measures (1625). 
 See 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, elec- 
 tric-light bath (1250), vapor bath (1246), 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 (1626), 
 employed for one or two weeks, enormously increase the patient's 
 prospects for a safe and quick recovery, and prevent many of the 
 complications to which this class of patients are especially liable. 
 Tonic hydriatic procedures are equally useful in hastening the 
 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- 
 inal surgeon will recognize. 
 
II02 RATIONAL HYDROTHERAPY. 
 
 Pelvic inflammation following operation should be combated by 
 the measures elsewhere indicated. See 1590. 
 
 The ice-bag renders invaluable service in combating threatened 
 cardiac failure; Apply over the heart for 15 minutes every 2 hours 
 when necessary, but not continuously. The ice-bag to the throat 
 or over the stomach, or applied to the spine opposite, will often 
 check vomiting. Persistent vomiting may be relieved in many 
 cases by gastric lavage, whether following an abdominal operation 
 or in any case after the use of an anesthetic. 
 
 1621 Surgical Shock. — Hot bags and blankets about the patient; 
 hot enema (1406); alternate compress to spine (1342); fomen- 
 tation to spine (1328) immediately followed by cold mitten friction 
 (1209); ice-bag over heart (620) for 15 minutes every 2 or 3 
 hours; hot or alternate irrigation of stomach (1401). 
 
 1622 Anesthesia. — Cold compress (6o° F. ) or ice-bag over heart 
 during operation. Change every 15 minutes, with rubbing 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 contraindicated, as in rectal cases, 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 (S344) 
 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. 
 
ASEPTIC DIETARY. I IO3 
 
 GRADUATED SCHEME FOR TONIC COLD APPLICATIONS. 
 
 1. Wet=Hand Rubbing (1201). — In extremely feeble patients 1625 
 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 
 entire 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 34 . 
 
 2. Cold riitten Friction (1209) — Begin with water at 6o°, 
 dipping once only. Lower the temperature i° or 2 daily to 40 , 
 then gradually increase the number of dips from one to four. 
 
 3. Cold Towel Rub (1213). — Begin at 65 °; 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 65 °. 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 ^ 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 (1174). — Begin at 75 °; lower temperature 
 i° daily to 6o°; duration at first y 2 minute, gradually increas- 
 ing to 3 minutes. 
 
 7. Pail Douche (1103) — Begin at 75 ; lower the tempera- 
 ture 2 daily to 6o°; 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 broths, and all meat preparations are carefully and rigidly 
 excluded because of the presence of tissue wastes, uric acid, crea- 
 
I 1 04 RATIONAL HYDROTHERAPY. 
 
 tin, creatinin, and other toxic substances, together with ptomains, 
 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 the 
 reason that their indigestibility leads to their retention in the stom- 
 ach and colon, and thus encourages fermentative processes. Cau- 
 liflower, tender asparagus roots, green peas, purees of peas, beans, 
 and lentils, excluding the skins of these seeds, are allowable, if 
 not the very best. Eggs in the form of egg-nog, prepared without 
 wine or brandy, slightly boiled or poached eggs, and soft custards, 
 prepared without sugar, are readily taken. In many cases of gas- 
 tric dilatation, eggs must be avoided. Raw, fresh milk is admis- 
 sible in a small proportion of cases only. In the majority of 
 cases, milk is well tolerated only in the form of kumyss, kumy- 
 zoon, buttermilk, cottage cheese, peptonized milk, junket, or in 
 combination with cereals, as in 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 DIETARY. IIO5 
 
 Malt, malt honey (meltose), honey, if sterilized by heating in 
 a double boiler at boiling point for half an hour, malted milk, 
 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 1627 
 is required, fasting, or better still, an exclusive fruit dietary, is the 
 best course. Fruits consist chiefly of water, with a small amount 
 of thoroughly digested starch in the form of fruit sugar or levu- 
 lose, and various acid flavors, and almost nothing requiring the 
 action of the digestive fluids. It is important that the fruit 
 should enter the stomach in the form of a smooth pulp. Fruit 
 swallowed in masses is very difficult of digestion. . Imperfectly 
 ripened apples or pears, and grapes swallowed without separating 
 the seeds are often a source of indigestion, being retained so long in 
 the stomach that fermentation occurs. Fruit skins and seeds 
 should always be rejected. 
 
 When the dietary consists wholly of fruit, food may be taken 
 four times a day, and the patient may be allowed to take as much 
 as he likes. 
 
 A modified fruit dietary is often sufficient. At dinner the 
 patient takes fruits and grains, and perhaps a small amount of nuts 
 or nut preparations, with fruits only for breakfast, and the same 
 for supper, if a third meal is taken. 
 
 Intestinal asepsis may also be promoted by an exclusive dietary 
 of acid buttermilk or kumyss. The patient should take three or 
 four quarts of kumyss in four portions, say at 7 a. m., ii a. m., 
 3 p. m., 7 p. m. Zwieback, or toasted granose flakes or biscuits, 
 may be eaten at the 7 a. m. and 3 p. m. meals. 
 70 
 
II06 RATIONAL HYDROTHERAPY. 
 
 An exclusive diet of fruit or kumyss is usually not required for 
 more than a short period, as two to six days. If greatly pro- 
 longed, the patient will be weakened. 
 
 An aseptic dietary is best for all, sick or well. It is especially 
 demanded in typhoid and all other acute fevers, in the rheumatic 
 or uric acid diathesis, in diabetes, obesity, and other nutritive 
 disorders, in indigestion accompanied by a dilated stomach or a 
 prolapsed stomach, in intestinal catarrh and all cases of bacterial 
 infection of the stomach or intestines, in infectious jaundice, 
 arteriosclerosis, hepatic cirrhosis, all forms of autointoxication, 
 in Bright's disease of the kidneys, malarial cachexia, pulmonary 
 tuberculosis, eczema, and other forms of skin disease, apoplexy, 
 neurasthenia, anemia (Haig has shown that flesh-eating causes 
 anemia in consequence of the uric acid present), especially in per- 
 nicious anemia, and acute infections and inflammatory disorders, 
 visceral inflammations of every description, — acute and chronic, — 
 epilepsy, insanity, hysteria, in diseases of children of all forms, 
 in insomnia, before and after grave surgical operations, in the 
 treatment of the alcohol, morphia, cocaine, and tobacco habits, 
 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 brandied fruits, fried foods, rich pastry, cheese, 
 griddle cakes, ices, ice-cream, tea, coffee, cocoa, beer, and alco- 
 holics of every description. Condiments of every sort must also 
 be interdicted, as mustard, pepper, peppersauce, ginger, cayenne, 
 capsicum, horseradish, chillies, curries, and hot sauces of every sort. 
 
 1628 Liquid Diet. — Fruit juice, malted nuts, almond cream, gluten 
 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, malt 
 honey, malted nuts, nuttolene, nuttose, granola, granuto. 
 
 1630 Dextrinized Cereals. — Well-toasted bread, zwieback, browned 
 or roasted rice, parched wheat or corn (gofio), granose, granola, 
 granuto, toasted wheat flakes. 
 
 1631 Malted or Predigested Foods. — Syrupy extracts of malt, malt 
 honey, malted milk, malted nuts, bromose, granuto. 
 
A BRIEF SUMMARY OF EXPERIMENTAL WORK 
 DONE IN THE HYDRIATIC 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 the 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. Wolfsen, Swartwout, Larson, Lemon, and Selmon, 
 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). 
 
 (#) 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 
 
 1 107 
 
I 1 08 RATIONAL HYDROTHERAPY. 
 
 road. The rectal temperature on starting was 98. 9 . At the close 
 of the ride the rectal temperature was 103. 3 ; increase, 4. 4 . 
 The patient perspired very freely, showing increase of elimina- 
 tion; but notwithstanding, the increase in heat production was suffi- 
 cient to cause an accumulation of heat amounting to 554.4 heat 
 units (i4oX4-4X. 9=554.4). 
 
 (£) F. W. W., aged 25, 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 elimination, 
 heat amounting to 490 heat units (160X3.4X.9 = 489.6). 
 
 (c) L. H. W., a young man aged 30, weight 150 lbs., Oct. 4, 
 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 water, 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 
 less than 162 heat units (150X1.2 X-9 = i62). 
 
 Experiment 2. — Showing that heat production is increased by cold 
 applications of brief duration {page 82). 
 
 L. H. W., a young man aged 30, weight 166 lbs., received a per- 
 cussion douche for thirty seconds, followed immediately by moder- 
 ate exercise. The rectal temperature before the application was 
 99 ; immediately afterward, 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- 
 cumulation occurred in this case to the extent of 90 heat units 
 (i66x.6X-9=89.6). During the first moments following a short 
 cold bath there is an elevation of temperature from diminished 
 heat elimination. 
 
 Experiment 3. — Showing the method of determining the rate of 
 heat elimination by ?neans of the bath-tub calorimeter {page 87 s ). 
 
SUMMARY OF EXPERIMENTAL WORK. I IO9 
 
 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 
 7 1. 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 8/.) 
 
 The conditions being the same as in the preceding experi- 
 ment, the subject, E. 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. 
 
I I 10 RATIONAL HYDROTHERAPY. 
 
 The body temperature had also fallen from 98. 4 to 98 , representing 
 a loss of 59 heat units. Subtracting 59 from 280 we have 221 heat 
 units, representing the amount of heat actually produced by the 
 body during the five minutes. At the ordinary rate, the amount 
 of heat produced during this period would be about 37.5 heat 
 units. There was hence an increase in heat production amounting 
 to 183.5 neat un its, and heat production was excited to the extent 
 of about five times the ordinary rate (221—37.5 = 183.5-7-37.5=: 
 4.89). 
 
 (<5) The young man was then given a hot shower bath for ten 
 minutes, at which time the body temperature was found to be 99 . 
 He was then placed in the calorimeter with the water at 7 6°. At 
 the end of five minutes the temperature of the water was raised to 
 77. 1 °, while the patient's temperature had fallen to 98 , indicating 
 a loss of 440 heat units. 
 
 (<r) On removal from the bath, the patient was wrapped in 
 blankets, and allowed to remain covered until warm, when he was 
 returned to the calorimeter with the water at a temperature of 
 77. 5 . At the end of five minutes the temperature of the water 
 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 temperature 
 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. i°. 
 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= 1.7 X 400 = 680). 
 Of this amount, 403.2 heat units is accounted for in the lowering 
 of body temperature (104.8 — 102 = 2.8°X 160X.9* = 4°3- 2 )- 
 There was thus a temporary increase of heat production during the 
 bath, amounting to 7.4 times the normal, while heat elimination 
 
 * The specific heat of the body k .9 that of water. 
 
Fig. 249 (Exp. 16). Plethysmography Tracing Showing Shrinkage of Blood-vessels in 
 Hand Produced by Ice Applied to Opposite Hand (p. 11 14). 
 Before. After. 
 
 Fig. 250 (Exp. 
 
 17). Sphygmographic Tracing Showing Contraction of Vessels of Arm Produced 
 
 by Applications of Ice to Axilla (p. 1114)- 
 
 ICE APPL/ED 
 NORM/JL Xi 
 
 -jwfxf 
 
 Fig. 251 (Exp. 18). Sphygmographic Tracing of Radial Pulse Showing Contraction of the vessels 
 of the Forearm Resulting from Application of Ice to Bend of Elbow (p. 1114). 
 
 Wto| 
 
 . 
 
 /CE . V V 
 APPLIED 
 
 ^Mli 
 
 
 ¥ II II TIME IN SECONDS 
 
 _n_ru 
 
 
 
 v>l ICE REMOVED ^H 
 
 Fig. 252 (Exp. 19). Plethysmography Tracing Showing Diminution in the Volume of 
 the Forearm Resulting from Application of Ice to Elbow (p. 1114). 
 
SUMMARY OF EXPERIMENTAL WORK. I I I I 
 
 was increased to 18 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 (0)), 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. 
 
 Experiment 6. — Observations respecting the influence of various 
 procedures upon heat elimination by means of d'ArsonvaVs calorim- 
 eter {Fig. 24, page <?p) . 
 
 (a) 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. 
 
 (£) 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. 
 
 (V) 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. 
 
 (d) The same subject was given a cold percussion douche for 
 two minutes (temperature of the water 6o° 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 89.) 
 
 (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. 
 
1 1 12 RATIONAL HYDROTHERAPY. 
 
 (£) After a very cold percussion douche (5 6°) the rate of 
 movement was found to be reduced to 92 feet per minute. 
 
 (V) The same subject was placed in a wet-sheet pack, and 
 removed at the beginning of the heating stage. When placed in 
 the calorimeter, the rate of air movement was found to be 98 feet 
 per minute. 
 
 (d) After a hot blanket pack and while perspiring freely, the 
 same subject produced an air movement of 122 feet per minute. 
 
 (*?) The subject was made to exercise moderately until general 
 perspiration was induced. He was 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 
 (c) 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 8. — Showing the effects of partial cold applications in 
 lowering the surface temperature (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 ten 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 105). 
 
 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. I I I 3 
 
 Experiment 10. — Showing the influence of cold upon perspiration 
 {page 1 OS). 
 
 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 6o° was then dashed upon the leg, with the result 
 that perspiratory activity was instantly suspended. 
 
 
 Experiment ii. — {Page 106.) 
 
 The subject, M. M. M., was a young man aged 35. By means 
 of an asthesiometer thejiormal tactile sensibility of the subject was 
 found to be such as to enable him to recognize the two points of 
 the asthesiometer when separated 2 mm. After immersion for 
 five minutes in water at 6o°, it was necessary to separate the points 
 3.5 mm. to enable the subject to distinguish them. Five minutes' 
 immersion at 40 increased the distance to 6 mm. 
 
 Experiment 12. — Showing the effect of short cold applications upon 
 cardiac activity {page 107). 
 
 {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 
 dozen times, raised the pulse rate to 86. 
 
 {I?) In another subject with normal pulse (66), the cold per- 
 cussion douche at 65 increased the pulse rate to 86. 
 
 Experiment 13. — Showing the increase of arterial tension resulting 
 from cold applications of short duration {page 107). 
 
 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 
 by Gaertner's tonometer (Figs. 239, 240, page 931), of 9.5 cm. of 
 mercury. Upon the application of a douche at 55 , the pulse 
 rate was immediately increased to 90, and the tension to 10 cm. 
 
 Experiment 14. — Showing the effect of prolonged cold applications 
 in slowing the lie art {page 107). 
 
 {a) The subject, a man aged 40, weight 140 lbs., pulse rate 76, 
 was in water at 55 for ten minutes, when the pulse rate was 
 found to be reduced to 50 . The tension was decidedly increased. 
 
I I 14 RATIONAL HYDROTHERAPY. 
 
 Experiment 15. — {Page 107.) 
 
 {b) The subject, E. F. O., a young man aged 26, weight 105 
 lbs., pulse 74, was placed in a shallow bath at 70 for three min- 
 utes. The pulse rate at the close of the bath was 60, with tension 
 greatly increased. This observation was made by the author's 
 colleague, Dr. W. H. Riley, in August, 1895. 
 
 Experiment 16. — Showing that ice held in one hand produces a 
 contraction of the blood-vessels of the opposite hand {page 108). 
 
 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. — Showing that the application of ice to the axilla 
 causes contraction of the arteries of the arm {page 108) I 
 
 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 48) immediately before and after the 
 application of ice to the axilla (Fig. 250 a and b.) 
 
 Experiment 18. — Showing the effect of the application of ice to the 
 bend of the elbow in diminishing the weight of the up stroke in 
 sphygmo graphic tracings obtained from the radial pulse {page 108). 
 
 The subject was a young man aged 26, weight 105 lbs. By 
 Marey'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). 
 
 Experiment 19. — Showing by means of the plethysmograph the effect 
 of the application of ice to the bend of the elbow in diminishing 
 the capacity of the blood-vessels of the hand and forearm {page 
 . 108, Fig. 252). 
 
 Experiment 20. — Showing the effect upon the pulse rate of a pro- 
 longed cold immersion with friction {page 109). 
 
 The subject, J. T. M., a vigorous young man of 32 years, weight 
 170 lbs., with normal pulse rate of 80, was placed in a cold immer- 
 
Fig. 255 (Exp 45 ). MOSSO'S ERGOGRAPH (p. i I23 ). 
 
SUMMARY OF EXPERIMENTAL WORK. I I I 5 ^ 
 
 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 of cold beverages upon the 
 pulse rate and tension (page 109). 
 
 The subject, A. E. 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 Gaertner'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. i°, still 
 nearly 2 F. below the normal rectal temperature. 
 
 (b) 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. 92). 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 for a longer time (see Fig. 26, p. 92). 
 
IIl6 RATIONAL HYDROTHERAPY. 
 
 Experiment 24. — Showing the restorative effects of the cold 
 douche {page 112). 
 
 M. J. N., a man of 21 years, weight 136 lbs., rode, Aug. 26, 
 1900, 35 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 
 shown 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 was then made, and the total strength was 
 found to be increased to 6,555 ^ s -? a & a i n °f 6°° lbs. 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. 
 
 Experiment 25. — Showing diminution of the rate of transmission 
 of impressions over a nerve trunk as the result of a cold 
 application made along the course of the nerve {pages no, 114). 
 
 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 five minutes, the time required was .22 seconds. 
 
 Experiment 26. — Showing the local increase in the blood count 
 resulting from a cold application {pages no, I2i~). 
 
 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, 4,900 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 of 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 123). 
 
 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 
 1 15. 2 heat units (i6oX-8x.9 = n5.2), 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 i?i lessening 
 heat productioft {page 123). 
 
 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 five minutes, the temperature of the bath had risen .3°, 
 showing the absorption of 120 heat units (400 X .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. 
 
I I I 8 RATIONAL HYDROTHERAPY. 
 
 five minutes, 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 production by reflex influence 
 upon the thermic centers. 
 
 Experiment 30. — {Page 126.) 
 
 (a) The subject, S. R. A., a young man aged 26, weighing 128 
 lbs., was first placed in a bath-tub calorimeter with water at a 
 temperature of 82. 4 . The temperature of the water was raised .18° 
 in five minutes. The patient's temperature at the beginning of the 
 bath was 98. 6°, at the end 98. 3 . From this data it appears that 
 400 pounds of water absorbed from the subject 72 heat units, of 
 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 in the meantime fallen 
 .1 of a degree (from 98. 8° ^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 of the application of the cold 
 
 proximal compress to the arm {page 128). 
 
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 bath at 50 . 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. 
 
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SUMMARY OF EXPERIMENTAL WORK. I I 1 9 
 
 Experiment 32. — Showing the effect of cold water in the stomach 
 upon the temperature of the overlying shin (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. i°, 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-bag applied over the heart 
 (page 128). 
 
 The subject, A. C. S., having a normal pulse of 80, and a 
 tonometer reading (Gsertner) of 10 cm. of 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 
 ioo° 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, ioo°. 
 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 . 
 
 (b) The subject, A. J. M., was made to drink seven glasses of 
 weak lemonade at 59 F. The rectal temperature was reduced from 
 ioo° 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. 
 
1 120 RATIONAL HYDROTHERAPY. 
 
 Repeating the same experiment under the same conditions, with 
 the exception that the hand was rubbed vigorously during immer- 
 sion in the water, the normal temperature was regained at the end 
 of ten minutes. 
 
 Experiment $6. — Showing that percussion accompanying a cold 
 application favors reaction (page 134). 
 
 (a) The subject, A. C. S., aged 23, weight 137 lbs., was im- 
 mersed in a bath at 5 6° 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. i°. 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 initial temperature was 
 recovered at the end of ten minutes. 
 
 (V) 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 5 6° 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 5 6° 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. i°. The initial temperature was regained 
 in eighteen minutes. 
 
 (V) 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. i°. 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 
 {page 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 139.) 
 
 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 143). 
 
 {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 1 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 
 7i 
 
1 122 RATIONAL HYDROTHERAPY. 
 
 water at 117 for four and a half minutes, the two points were dis- 
 tinct only at 30 mm. Temperatures of 98 to 95 produced no 
 effect. 
 
 Experiment 42.—- Showing the effect of general hot applications upon 
 the blood pressure and pulse rate {page 1 47). 
 
 The subject, R. R. H., was a young man aged 21, weight 115 
 lbs. Before the experiment, with the subject reclining, the pulse 
 was 92, radial tension 9 cm., as determined by Gaertner's tonom- 
 eter (Figs. 239, 240, page 931). The couch, the subject lying 
 upon it, was pushed into an electric-light cabinet without any ex- 
 ertion on his part. Within a mmute the radial pulse fell to 54, and 
 the tonometer showed a rise of pressure in the peripheral vessels to 
 10 cm. At the end of five minutes, the subject was perspiring 
 moderately. The pulse was then found to be 66, the tonometer 
 reading 8 cm. At the end of 20 minutes the pulse was 92, the 
 tonometer reading 7 cm. The subject was then withdrawn from 
 the cabinet. The pulse rate immediately fell to 86, but some 
 time elapsed before the blood pressure rose to normal. 
 
 Experiment 43. — Showing the effect of heat and cold upon the 
 volume of the tidal air of respiration {page 149). 
 
 (a) The subject, R. A. S., was a young man aged 21, weight 
 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 air 
 was found to be 27 cubic inches. Ten minutes after the bath, the 
 tidal air was 33 cubic inches; 30 minutes after, 37 cubic inches. 
 This experiment shows a loss in the volume of the respired air 
 amounting to 37.5 per cent. 
 
 (£) A wet-sheet rub at a temperature of 40 was administered 
 toa young man, O. R. C, aged 25, weight 142 lbs. The initial 
 volume of tidal air was 28 cubic inches. The volume of tidal air 
 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 
 51 cubic inches, an increase of 55 percent. 
 
Fig. 256 (Exp. 45). Ergogram Obtained by Means of Mosso's Ergograph, Showing 
 Normal Fatigue Curve of a Young Man, R. A. S. Total work, 4.994 kgm. (p. 1123). 
 
 Fig. 257 (Exp. 45). Ergogram Showing Fatigue Curve of R. A. S. after a Spray at 113* 
 for Fifteen Minutes. Total work, 4.432 kgm. (p. 1123). 
 
 Fig. 258 (Exp. 45). Ergogram Showing Fatigue Curve of R. A. S. after a Cold Spray 
 Following a Hut Bath. Total work, 6.094 kgm. (p. 1124)- 
 
SUMMARY OF EXPERIMENTAL WORK. 1 1 23 
 
 (d) E. F. O., a young man aged 25, weight 105 lbs., was given a 
 wet-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 of 
 33/^ P er cent; fifteen minutes later, ^^ cubic inches. The ampli- 
 tude of respiratory movement gradually lessened, until at the end 
 of an hour, when the experiment terminated, the amount 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 main- 
 taining the pack in the neutral stage. 
 
 Experiment 44. — Showing the depressing effects of the general hot 
 bath by its influence up 071 muscular capacity (page 150). 
 
 The subject, W. P. L., was a young man of 21 years, weight 
 140 lbs. His total muscular strength, as shown by the Universal 
 Dynamometer (see Fig. 253), was 6,480 lbs. (Fig. 254). The 
 full immersion bath was administered at 112 , duration 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 of a spray douche at 50 for thirty 
 seconds. His strength was again tested, 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. 
 
 Experiment 45. — Showing the effects upon muscular capacity of a 
 cold bath following a hot immersion bath (page 151). 
 
 (a) The subject, R. A. S., was a young man aged 21, weight 
 140 lbs. The strength of the flexor muscle of the 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 ergogram was 
 obtained (Fig. 257), and the amount of work done was found to 
 
I 1 24 RATIONAL HYDROTHERAPY. 
 
 be 5.235 kgm., showing a loss of .562 kgm., or 11 per cent. A 
 cold spray was then administered at 6o°, duration ten minutes, 
 and the ergogram shown in Fig. 258 was obtained. The amount 
 of work recorded was 6.094 kgm., an immediate increase of more 
 than 16 per cent, and an increase of 15 per cent over the total 
 work recorded at the beginning of the experiment. 
 
 (b) In a similar experiment with the same subject, in which the 
 Universal Dynamometer was used as a means of determining the 
 effects of the applications, the hot bath produced a loss of 915 
 pounds, or 13 per cent of the total strength, while the cold bath 
 produced a gain of 1,267 pounds, or 18 per cent, the subject hav- 
 ing a total muscular capacity at the end of the experiment 5 per 
 cent greater than at the beginning. 
 
 Experiment 46. — Showing the effects upon the body temperature of 
 a general application of heat {page 158). 
 
 (a) The subject, A. C. S., was a young man aged 23, weight 137 
 lbs. A Russian bath was administered at 115 , duration twenty- 
 five minutes. The initial body temperature was, mouth, 98. 6°; 
 rectal, 99. 9 . At the conclusion of the bath, the mouth tempera- 
 ture was 102. 4 and the rectal temperature 102 , an increase of 
 258.9 heat units (137X2. iX- 9 = 25 8. 9). 
 
 (b) An electric-light bath was administered (1891) to a 
 young man aged 22, weight 145 lbs. The subject's tempera- 
 ture was normal at the beginning of the experiment, and was raised 
 by the bath in five and one-half minutes i.6° F. (mouth). The 
 surface temperature was elevated during the same period 2.3 F. 
 
 Experiment 47. — Showing the effects of the hot immersion bath on 
 the body temperature {page 158). 
 
 The subject, W. E. P., was a young man aged 35, weight 120 
 lbs. He was placed in a full bath at 104 for thirty minutes. 
 The initial body temperature was, mouth, 98. 7°; rectal, 99. 6°. At 
 the end of the experiment, the mouth temperature was found to 
 be 102. 3 ; and the rectal temperature, 102. 8°, an increase of 3.2 , 
 representing 345.6 heat units (120X3.2 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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 B 
 
 3 
 
 
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 4 
 
 C/J 
 
 M 
 
 
 
 J 
 
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 E 
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 13 
 
SUMMARY OF EXPERIMENTAL WORK. 112$ 
 
 heat 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 bath 
 at the temperature of the body {page IS 9)- 
 
 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 °; rectal, 101.2 . The subject was placed in an 
 immersion bath at ioo° for one hour. The mouth temperature 
 was then found to be 101.9 ; the rectal, 101.8 . 
 
 Experiment 49. — Showing the effect of 'dry friction upon the surface 
 teinperature {page 166). 
 
 Friction with the dry shampoo brush was administered for thirty 
 minutes to a subject, W. E. P., aged 35, weight 120 lbs. The 
 surface 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 2.7 . 
 
 Experiment 50. — -Showing the effects of a partial cold application in 
 increasing muscular capacity (page 300). 
 
 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 douche at 6o°, the ergogram shown in 
 Fig. 260 was obtained, and the total work recorded was 6.925 kgm., 
 an increase of 30 per cent. 
 
 Experiment 51. — Showing the effect of friction in connection with 
 the cold bath in increasing heat elimination (page 304). 
 
 The subject, E. F. 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 1.08 F. every five 
 
I 1 26 * RATIONAL HYDROTHERAPY. 
 
 minutes. By calculation it appears that the rate of heat elimin- 
 ation was, without friction, 57.6 heat units per minute; with 
 friction, 86.4 heat units, an increase of 50 per cent. 
 
 Experiment 52. — Showing the effects of the cold enema upont he 
 body te?nperature in a normal, healthy person (page 318). 
 
 The subject, L. H. \V\, was a young man aged 30, weight 166 
 lbs. The initial temperature was, mouth 99 ; rectal, 99. 7 . The 
 temperature of the water administered was 70 F., the amount, 8 
 pints. This quantity was introduced in three portions within 57 
 minutes, each succeeding portion being introduced immediately 
 after the discharge 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 axillary temperature at 
 the beginning of the experiment was 97.2°; 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 vessels, 
 producing a movement of blood toward the surface, especially of 
 the upper portion of the body. 
 
 Experiment 53. — Showing the effects of percussion in incr easing 
 the intensity of the reaction from cold (page 3 47). 
 
 (a) The subject, W. P. L., was a young man aged 21, weight 
 140 lbs. The initial surface temperature obtained by placing a 
 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 temperature, 
 determined at the same point, was 94. 6°. The initial tempera- 
 ture was reached at the end of fourteen minutes. (See also 
 experiment 36.) 
 
 {b} The subject, A. G. F., was a young man aged 23, weight 
 132 lbs. The cold compress and the percussion douche were simul- 
 taneously given at 65 ° for five seconds, to opposite and corre- 
 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. 
 
SUMMARY OF EXPERIMENTAL WORK. 1 1 27 
 
 Experiment 54. — Showing the effect of cold applications upon the 
 muscular response to electrical currents (page 438). 
 
 The amount of work done before and after the application was 
 measured by Mosso's ergograph (see Fig. 255, page 11 14), in which 
 a spring resistance was substituted for the weights (this modifica- 
 tion was suggested by Dr. E. Otis). The results obtained are 
 shown in Figs. 261, 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- 
 utes, the ergogram shown in Fig. 263 was obtained, and the 
 amount of work registered was .927 kgm. The capacity for 
 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 energetic con- 
 traction of the muscles. 
 
 The observation was constantly made that the resistance of the 
 skin is increased to a marked degree after a cold application; that 
 is, after the application of cold to the parts while the current is 
 passing there is immediate decrease in the reading of the milliam- 
 peremeter, while an application of heat produces the opposite 
 effect, without any change in the adjustment of the rheostat. 
 
 Experiment 55. — Showing the effect of the general cold douche on 
 the capacity for muscular work (page 438). 
 
 The subject, A. E. L., was a young man aged 26, weight 151 
 lbs. His normal fatigue curve is shown in Fig. 264. After the ad- 
 ministration of a general douche at 6o° 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 
 total work was 11.966 kgm. an increase of 44 per cent. 
 
 Experiment 56. — Showing the effects of heat and cold on the ca- 
 pacity for muscular work (page 438). 
 
 (a) The subject, A. E. L., a young man aged 26, weight 151 
 lbs., gave the normal fatigue curve shown in Fig. 266; total work, 
 6.371 kgm. A general douche at 5 6° 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 112 , 
 duration fifteen min. ) was then administered, and another ergo- 
 gram obtained, shown in Fig. 268. The total amount 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 kgm. After the bath, the fatigue curve shown in 
 Fig. 270 was obtained, showing a notable depression. The amount 
 of work registered was 4.459 kgm., a decrease of 44 per cent. 
 
 Experiment 57. — Showing the effects of very hot applications in 
 producing an initial slowing of the pulse with subsequent in- 
 crease {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. — Showing the effects of the cold and the neutral 
 immersion bath on capacity for muscular work {page 3 '2p). 
 {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 was obtained, and the amount of work registered was 8.642 
 kgm., an increase of 48.5 per cent. 
 
 (b) 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 curve presented in Fig. 273. 
 Total work, 5.789 kgm. 
 
Fig. 264 (Exp. 55). Normal Fatigue Curve of A. E. L. Total work, 8.282 kgm. (p. 1127). 
 
 Fig. 265 (Exp. 55). Fatigue Curve of A. E. L. after a General Douche at 6o° for 
 Three Minutes. Total work, 11.966 kgm. (p. 1127). 
 
SUMMARY OF EXPERIMENTAL WORK. I 1 29 
 
 Experiment 59. — Showing the effects of the cold shallow bath on 
 capacity for muscular work {page S97)- 
 
 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 613). 
 
 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 6o° 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 
 cent. 
 
 Experiment 61. — Showing the effects of oiling the skin upon heat 
 
 elimination by conduction {page 685). 
 
 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 704). 
 {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 X2.1 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. 
 
I I 30 RATIONAL HYDROTHERAPY. 
 
 (b~) The subject, V. P., aged 26 years, weight 130 lbs., was 
 placed in an electric-light bath for twenty-three minutes. At the 
 beginning of the bath the pulse rate was 82; rectal temperature, 
 99. 9 . At the end of the bath, the pulse rate was 134; rectal 
 temperature, 101.4 ; mouth temperature, 102 , an increase of 
 175.5 neat un its (130X1. 5 X- 9 = 175.5). The amount of heat 
 normally produced during the time covered by the experiment is 
 about 165.6 (23X7.2), almost exactly the amount represented by 
 the elevation of temperature. As heat elimination, either by radi- 
 ation or evaporation, is not interfered with during this bath, the 
 increase was probably the result, in part, at least, of augmented 
 heat production. 
 
 (c) P. H., a young man aged 25 years, weight 150 lbs., was 
 given a Turkish bath for one hour at 146 to 15 8°. At the begin- 
 ning of the bath, the pulse was 49; rectal temperature, 98. 9 . 
 At the end of the experiment, the pulse rate was 59; rectal tempera- 
 ture, 100.6 , and respiration increased from 13 to 19 per minute. 
 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 proximal 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. i°. 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. i°. 
 
 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 inner 
 surface was reduced to 90° F. 
 
SUMMARY OF EXPERIMENTAL WORK. I I 3 I 
 
 Experiment 66. — (-Page 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 . 
 
 (e) An ice bag applied to the axilla for thirty minutes reduced 
 the temperature of the hand from 97 to 96 . 
 
 (d) 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 21 beats; the temperature of the external auditory canal, 
 5 ; the mouth, 4. i°; and the rectal temperature, .6°. 
 
I I 32 RATIONAL HYDROTHERAPY. 
 
 Experiment 69. — Showing the rate of heating of the abdominal 
 compress protected with flannel only {page 826). 
 
 Three experiments were made on a subject, a young man, A. 
 E. L., aged 26, weight 151 lbs. The procedure consisted of the 
 application of an ordinary heating abdominal compress, using a 
 linen cloth for the moist layer, covering with flannel, employing 
 different thicknesses in the different experiments. The tempera- 
 ture of the water used was 59 F., the room temperature 77 F. 
 The temperature was taken at the end of the first and second 
 minutes, then every two minutes afterward until the maximum 
 temperature was reached. The results were as follows: — 
 
 (0) Employing one layer of flannel to cover the wet compress, 
 the temperature at the end of the first minute was found to be 
 81. 5 ; the maximum temperature, 86. 5 , was reached at the end of 
 eight minutes. 
 
 (£) With two layers of flannel, the temperature was found at 
 the end of the first minute as in the preceding experiment, 81. 5 °. 
 The maximum temperature of 89. 3 was reached at the end of ten 
 minutes. 
 
 (V) The moist bandage was covered with four thicknesses of 
 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: — 
 
 (#) 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 9 2.1 was reached at the end of twenty minutes. 
 
 (^) With four thicknesses of flannel, the maximum temperature 
 of 93. 6° was reached at the end of twenty minutes. 
 
 (d) With eight thicknesses of flannel, the maximum temperature 
 of 94. 7 was reached at the end of twenty minutes. 
 
Fig. 273. (Exp. 58). Fatigue Curve of A. E. L 
 
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. 
 
 (£) 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 Gsertner's tonometer, rose to 5 cm. 
 
 (7) 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. 
 
1 1 34 RATIONAL HYDROTHERAPY. 
 
 Experiment 73. — Showing the effect of cold-water drinking upon 
 the axillary temperature and the surface temperature as deter- 
 mined at the epigastrium (page 928). 
 
 The subject, A. G. M., was a young man aged 26, weight, 153 
 lbs.; axillary temperature, 97. 7°; mouth, 98. 7 ; rectal, 99. 2 ; surface 
 temperature at the epigastrium, 97 . The patient drank in rapid 
 succession seven glasses of lemonade at 5 8°. A fall in the axillary 
 temperature was noted in five minutes. At the end of twenty 
 minutes, the axillary temperature was 96. i°; mouth, 98 ; rectal, 
 98 ; surface temperature at the epigastrium, 92 . 
 
 The great fall in surface temperature at the epigastrium, after 
 drinking ice-water, may be utilized as a means of locating the 
 stomach and determining its size and contour. The interesting 
 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-water, was first noted by Dr. F, J. Otis 
 (1898), while a medical student, engaged in carrying out experi- 
 mental researches under the direction of the author. 
 
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Fig. 278. — Diagram of the Circulation. 
 
HYDRIATIC MEASURES FOR REGULATING 
 BLOOD PRESSURE. 
 
 THE evident inadequacy of drugs for the correction of 
 abnormal conditions arising from the failure of the 
 blood pressure regulating mechanism of the body, 
 which has been made so clearly evident by the experiments 
 of Romberg, Passler, Crile, and other investigators, has 
 brought prominently before the profession the importance 
 of the physiologic method in dealing with questions pertain- 
 ing to the blood circulation, and particularly as a means of 
 correcting defects of the pressure regulating function. It 
 is not the purpose of this chapter to deal with the whole ques- 
 tion of physiologic therapeutics in relation to blood pressure, 
 but rather to point out those hydriatic measures which are 
 of greatest value in the practical treatment of cases of abnor- 
 mally high or low pressure. 
 
 The subject of blood pressure is a comparatively new one 
 in physiologic therapeutics, for the reason that it is only 
 recently that accurate means for measuring blood pressure 
 have been available. Comparatively little is yet known 
 scientifically concerning the physiologic therapeutics of 
 blood tension; but scientific data is being rapidly ac- 
 cumulated. 
 
 The writer has for many years made a study of blood 
 pressure in connection with hydriatic treatment. The first 
 attempts were made with the sphygmograph, but this was 
 found to be altogether too uncertain an instrument to be of 
 value in the study of blood pressure. Von Basch's instru- 
 ment was obtained, also Oliver's, and Mosso's, and in turn 
 each of the various devices which have been brought for- 
 ward for the determination of blood pressure. 
 
 Gartner's tonometer, Riva-Rocci's sphygmomanometer, 
 
 ii35 
 
1 1 36 RATIONAL HYDROTHERAPY. 
 
 and the various modifications of the latter instrument which 
 have appeared in this country, and finally Erlanger's beauti- 
 ful instrument have made the accurate determination of the 
 blood pressure almost as simple as the taking of the body 
 temperature, and so have rendered possible an exact study 
 of the influence of various hydriatic and other measures 
 upon changes in the conditions of the circulation which 
 formerly could only be guessed at. 
 
 For two years it has been the writer's custom to make a 
 careful determination of blood pressure in the case of every 
 patient received for treatment in the institution of which he 
 has charge. The total number of observations recorded is 
 more than 10,600. It has been found to be an almost univer- 
 sal rule that the second examination shows a lowering of pres- 
 sure in cases in which the blood pressure is above normal. 
 This is the natural result of the change in dietary, and the ap- 
 plication of hydriatic and other physiologic measures, the 
 effect of which is to establish normal conditions and thereby 
 to bring the blood pressure toward the normal standard. 
 
 The value of hydrotherapy as a means of controlling 
 blood pressure, especially in cases of hypotension, is empha- 
 sized by the fact that it is especially adapted to those cases in 
 which digitalis has ceased to produce any beneficial effect. 
 Mercandino, who made a careful study of the effects of the 
 cold bath in typhoid fever, found rise of pressure to be more 
 uniform after the bath than from the use of any drug. Both 
 Passler and Crile found that strychnia improves blood pres- 
 sure only when given in toxic doses (one-tenth grain). 
 Equally large doses of digitalin were required to produce 
 any decided effect. It was also demonstrated by Passler 
 and Crile that the effects of digitalin and strychnia are very 
 temporary, and that when the dose is repeated, there is not 
 only no beneficial effect, but the very opposite. Crile, in 
 fact, in his experimental work, found large doses of strych- 
 nia the most convenient method of producing the symptoms 
 of shock, and regularly employed the drug for that purpose. 
 
 The use of strychnia, or of any other drug, for the pur- 
 pose of raising blood pressure in cases of secondary hypoten- 
 
REGULATING BLOOD PRESSURE. H37, 
 
 sion is a most irrational proceeding, exactly analogous to 
 the application of a goad or whip to an over-worked and ex- 
 hausted animal instead of lightening the load. 
 
 Hydrotherapy affords a thoroughly rational method of 
 either raising or lowering blood tension, as may be indi- 
 cated, and a method which within reasonable limits can be 
 relied upon to accomplish what is expected of it. It is, 
 moreover, a safe method, and one which may be repeated 
 without producing cumulative effects, and without losing 
 its effects, as is the case with every known drug. Crile has 
 shown that the beneficial effects which follow the use of 
 strychnia are very transient, and also that the second dose 
 produced little effect, and the third dose none at all, or even 
 the very opposite of the effect. This, then, is a question of 
 highest importance to the practitioner, and one which will 
 well repay the most careful study. 
 
 First a word with reference to the physiology of blood 
 pressure and pressure regulation. The circulating mechan- 
 ism consists of a pump — the heart; and reservoirs — the ar- 
 terial system, a high pressure reservoir, and the venous sys- 
 tem, a low pressure reservoir. These two reservoirs are 
 connected by small tubes — the arterioles and capillaries. 
 The pressure in the arterial reservoir is due to the fact that 
 the heart is able to pump blood into the reservoir more rap- 
 idly than it escapes through the small openings which con- 
 nect the arterial with the venous reservoirs. The size of the 
 outlet openings is controlled by nerve centers acting upon 
 the muscular walls of the small arteries, whereby they are 
 made to dilate or contract as the needs of the body may 
 require. When the arterioles and capillaries contract, the 
 blood escapes less rapidly, and the pressure rises so long as 
 the heart has energy enough to enable it to respond to the 
 demand made upon it. The limit of pressure rise is reached 
 only when the pressure is such as to force out through the 
 smaller openings the amount of blood needed to supply each 
 one of the great organs or series of organs in the body. 
 General blood pressure may be increased for the purpose of 
 meeting the needs of a single organ, as in cases of brain an- 
 72 
 
1 1 38 RATIONAL HYDROTHERAPY. 
 
 emia, due to compression by a clot, or any other mechani- 
 cal cause. High blood pressure usually exists also in 
 chronic interstitial nephritis, as a compensation for the crip- 
 pled condition of the kidneys, as well as in general arterio- 
 sclerosis. 
 
 The venous reservoir may be regarded as divided into 
 three great reservoirs : the veins of the skin, which are capa- 
 ble of holding two-thirds of the total volume of blood ; the 
 veins of the muscles, which may hold half of the blood ; and the 
 portal system, which has capacity sufficient to hold all the 
 blood of the body. The portal system differs from the other 
 venous systems of the body in the fact that the walls of its 
 vessels are well supplied with muscles. These are under the 
 control of the great splanchnic nerve. The portal system also 
 differs from other venous systems in the fact that it is con- 
 nected with a second venous reservoir, the hepatic veins, 
 through a series of minute channels, the venous capillaries of 
 the liver, so that the blood which passes through the portal 
 circulation traverses two sets of capillaries. One reason for 
 this doubtless is that the portal veins are supplied with mus- 
 cles, so that the blood current may be accelerated. The re- 
 lation of the portal and hepatic reservoirs to the chest cavity 
 is also a marvelously wise arrangement, since each inspira- 
 tory movement acts forcibly as a means of drawing the blood 
 from the hepatic and portal reservoirs toward the heart. 
 
 The several secondary venous reservoirs — the skin, the 
 muscles, and the portal circulation — are directly and indi- 
 rectly connected, and through the action of the vasomoter 
 centers the blood may be accumulated in one or the other of 
 these reservoirs, as may be necessary to meet the needs of 
 the body in conditions of health or disease. The large ca- 
 pacity of these several reservoirs renders it evident that an 
 accumulation of blood in either one must have a very marked 
 effect upon the pressure in the arterial reservoir. That is 
 the filling of the skin reservoir, which is capable of holding 
 two-thirds of all the blood in the body, must have a notable 
 effect in lowering arterial pressure. The filling of the portal 
 reservoir must have a still greater effect in lowering the general 
 
REGULATING BLOOD PRESSURE. II 39 
 
 blood pressure. An accumulation of blood in all the venous 
 reservoirs may bring about such a fall of arterial pressure 
 as to cause death. This is what occurs after division of the 
 cervical cord. The experiments of Crile have shown most 
 conclusively that in shock and .collapse there is excessive 
 accumulation of blood in the portal reservoir. 
 
 The chief factors concerned in blood pressure, as ob- 
 served in health, are : — 
 
 i. The cardiac energy, by which blood is being con- 
 tinually forced into the arterial reservoir. 
 
 2. The vessel tonus, by which the outlets of the reser- 
 voirs are narrowed. 
 
 3. The peripheral heart — the rhythmical activity of the 
 arterioles and capillaries. 
 
 4. The blood volume, whereby the ventricles are distended 
 and stimulated to contraction. 
 
 5. The elasticity of the arterial walls and of the tissues. 
 
 6. The viscosity of the blood. 
 
 These several factors in the causation and regulation of 
 blood pressure may be influenced by hydriatic and other 
 physiologic measures more certainly and safely than by 
 any other means. Physiologic measures have a great advan- 
 tage over all others in that their efficiency increases with use, 
 whereas in the case of drugs a tolerance is rapidly establish- 
 ed, so that a drug, the first doses of which produce very pow- 
 erful effects, soon fails to produce any effect at all, or may 
 even produce effects opposite of those at first produced. A 
 physiologic measure produces the same effect the thousandth 
 time it is applied as the first time, unless of course there has 
 been, in the meantime, such an advance in the disease that 
 the vital mechanism has become so crippled that its power 
 of response is lost. Of all physiologic measures which may 
 be brought to bear in cases requiring the regulation of blood 
 pressure, hydriatic are on the whole the most practical, both 
 because of their effectiveness, and because they are so read- 
 ily and universally available. The physiologic effects of 
 hydriatic applications in relation to blood pressure may be 
 thus briefly stated : — 
 
II4O RATIONAL HYDROTHERAPY. 
 
 HYDRIATIC MEASURES FOR INCREASING CARDIAC 
 ENERGY. 
 
 As a matter of fact, cases are comparatively rare in which 
 
 cardiac stimulation is required. The heart is, as a rule, 
 doing its full duty, and more. The trouble usually is that 
 the heart is working under unfavorable conditions. For ex- 
 ample, when the outlets of the cardiac reservoir, the arter- 
 ioles, are widely dilated through failure of the vasoconstric- 
 tors or over-action of vasodilators, if such an action occurs, 
 the heart may be expending twice the ordinary amount of 
 energy, while the blood pressure still remains at an abnor- 
 mally low point. This is the state of things which exists 
 in shock or collapse. The arterioles leading into the portal 
 reservoir are so widely open that an excessive amount of 
 blood accumulates in the abdominal veins, and pressure in 
 the systemic circulation must necessarily fall, the large 
 amount of blood withdrawn from the circulation leaving the 
 heart without adequate supply- The ventricles are not well 
 filled, and so the heart action becomes inadequate. In other 
 words, there is a large leak in the water main, while at the 
 same time the supply to the pump is diminished and under 
 such conditions, the pressure must fall. 
 
 Under these circumstances it is of very little use to in- 
 crease the speed or power of the pump. The leak must be 
 stopped, and the supply to the pump must be increased. 
 
 Moderate stimulation of the heart, even under such con- 
 ditions, may be beneficial, however, as an aid to the most 
 speedy relief. A convenient and effective means of cardiac 
 stimulation is the cold precordial compress or an ice-bag 
 over the heart. It may be employed, with proper precau- 
 tions, in all cases of cardiac weakness. In cases of sec- 
 ondary low-pressure, however, the cold precordial compress 
 must always be preceded by cold mitten friction, dry hand 
 rubbing, or some other measure whereby the arterioles may 
 be dilated, and thus the peripheral pressure diminished. 
 Cold rubbing to the chest, general cold mitten friction, the 
 cold rubbing sitz bath (75 ° to 65 ° two to five minutes), a 
 
REGULATING BLOOD PRESSURE. II4I 
 
 rubbing shallow bath (87 to 75 ° one to two minutes), alter- 
 nate hot and cold sponging or rubbing of the spine, these are 
 all excellent means of stimulating a flagging heart. The ice- 
 bag over the heart may be employed fifteen to thirty min- 
 utes two or three times a day. Warm applications are de- 
 pressing to the heart, also prolonged hot applications. 
 Short hot applications stimulate the heart, but are very seldom 
 indicated, and must be used with very great care. 
 
 METHODS BY WHICH THE VESSEL TONE MAY BE 
 INCREASED AND DIMINISHED. 
 
 In general, cold baths raise the vessel tonus, while warm 
 baths lower it. Neutral baths have little influence upon 
 blood pressure. When prolonged, neutral baths slightly 
 raise the blood pressure by increasing the volume of blood 
 through the absorption of water, and possibly by the elimi- 
 nation of pressure lowering toxines. Cold mitten friction 
 is one of the very best means of increasing the tone of the 
 vessels. 
 
 Muller found that baths below 92 ° to 104 F. produced 
 first a slight rise of pressure, then a fall, followed later by 
 another rise. Baths at a temperature of 104 F. and up- 
 ward increased the pulse rate and raised pressure. Vapor 
 baths and hot air baths at a temperature of 122 F. and up- 
 ward occasioned a rise in pressure and pulse rate. Water 
 baths at a temperature below that of the body (98. 6° F.) 
 slowed the pulse. Baths at a higher temperature increased 
 the pulse. 
 
 Carl Briick made in 1902 an important study of the effect 
 of cold baths upon blood pressure. His observations 
 showed that immersion baths at a temperature of 46 F. 
 caused a rise in blood pressure within 30 seconds. A bath 
 at 6o° caused a rise of pressure within one minute. A bath 
 at 68° to 73 of less than two minutes duration was quickly 
 followed by a fall in pressure. 
 
 The writer observed a fall of 20 millimeters as the result 
 of an electric light bath administered by means of the hori- 
 zontal cabinet. A rise of 10 millimeters was observed in a 
 
1 142 RATIONAL HYDROTHERAPY. 
 
 healthy subject as a result of swallowing rather rapidly two 
 pints of cold lemonade. 
 
 A rise of five to fifteen millimeters usually follows a cold 
 mitten friction or a cold towel rub. 
 
 A full bath at yo° for four minutes, accompanied by fric- 
 tion, produced a rise of blood pressure amounting to 23 mil- 
 limeters (90-113 millimeters). 
 
 MEASURES WHICH INCREASE THE ACTIVITY OF 
 THE PERIPHERAL HEART. 
 
 The rhythmic activity of the small vessels whereby the 
 blood is moved forward into the veins is an important func- 
 tion to which the term "peripheral heart" has been very 
 properly applied. Its activity may be stimulated by short 
 cold applications, especially when accompanied by rubbing. 
 Prolonged cold applications cause a spastic contraction of 
 the vessels, and this produces venous stasis, which is shown by 
 the mottled blue appearance occasioned by prolonged ex- 
 posure to cold. Short cold applications, on the other hand, 
 both raise the tone of the peripheral vessels and increase 
 their activity. Short and very hot applications produce a 
 similar effect. Prolonged hot applications paralyze the pe- 
 ripheral vessels, producing stasis indicated by a dusky tinge 
 of the skin. 
 
 MEASURES BY WHICH BLOOD VOLUME MAY 
 BE INCREASED. 
 
 The experiments of Crile and others have shown that in 
 cases of acute low pressure (shock or collapse) there is a great 
 accumulation of blood in the portal circulation. In cases of 
 chronic high pressure there is usually a diseased condition of 
 the vessels of the splanchnic area, a condition which may exist 
 when evidence of general arterioscelerosis can not be dis- 
 covered in the radial or other external vessels. Hydriatic 
 measures may render great service in both these classes of 
 cases. 
 
 All vasomotor nerves respond readily to sensory impres- 
 sions. The splanchnic nerve has been shown by Tigerstedt 
 
REGULATING BLOOD PRESSURE. 1 143 
 
 to be more sensitive to reflex influences from sensory im- 
 pressions than any other vasomotor nerve in the body. 
 
 The following are effective means whereby the splanchnic 
 nerve may be stimulated, thus causing contraction of the 
 portal vessels, and increasing the supply of blood to the 
 heart : — 
 
 The cold abdominal compress, to be withdrawn for five 
 minutes every half hour to allow warming of the skin. 
 
 Ice rubbing of the abdominal and dorsal regions for two 
 minutes, preceded by very hot applications for half a minute, 
 repeating the alternations for ten or fifteen minutes. 
 
 The cold sitz bath (75 ° to 65 °) accompanied by vigorous 
 rubbing of the submerged parts; duration eight to twelve 
 minutes. This is a powerful means of increasing the tone 
 of the mesenteric and portal vessels. It should be remem- 
 bered, however, that a short cold sitz bath, one to four min- 
 utes, is quickly followed by reaction, thus increasing the 
 amount of blood in the portal circulation instead of diminish- 
 ing it, hence the duration of the bath must be not less than 
 eight minutes. It may be prolonged to fifteen or twenty in 
 special cases. 
 
 The cold shallow bath, or cold rubbing sitz ; three to five 
 minutes, with vigorous rubbing. 
 
 The wet girdle, without mackintosh, consisting of a towel 
 wrung out of cold water, placed about the trunk and covered 
 with two or three thicknesses of flannel. The wet bandage 
 should be renewed before it is entirely dried. This is an 
 admirable method of acting continuously upon the vessels 
 of the splanchnic area in such a way as to permanently in- 
 crease their tone. The evaporation of the water contained 
 in the moist bandage produces a moderate degree of cool- 
 ing, the influence of which in increasing the tone of the vis- 
 ceral vessels is most excellent. 
 
 Abdominal massage is another excellent means of forc- 
 ing the blood out of the portal vessels into the general circu- 
 lation. 
 
 Another means which the writer has found effective is 
 to slip under a tight bandage placed about the body an empty 
 
1 144 RATIONAL HYDROTHERAPY. 
 
 rubber bag, then to inflate the bag with air which may be 
 pumped in by means of a rubber bulb, or the bag may be dis- 
 tended by placing the end of the tube in the mouth and in- 
 flating it with air from the lungs. Another excellent method 
 is to fill such a bag with cold water. This secures the favor- 
 able effect of three factors, the weight of the water, the dis- 
 tention of the bag, and the low temperature of the water, 
 thus producing both a thermic, a sensory, and a mechanical 
 effect. This application reflexly contracts and mechanically 
 compresses at one and the same time the mesenteric and 
 portal vessels. 
 
 Deep breathing, especially raising the chest, with strong 
 contraction of the abdominal muscles, is a most effective 
 means of emptying the abdominal vessels and forcing the 
 blood which so easily stagnates in the splanchnic area toward 
 the right side of the heart, and thus bringing it back into the 
 general blood current. 
 
 Abdominal supporters of various sorts doubtless owe 
 their efficiency chiefly to the compression of the vessels 
 rather than to the support of prolapsed and pendant viscera. 
 The Priessnitz bandage is doubtless also beneficial in the 
 same way. 
 
 Warm hot baths relax the vessels along with other tis- 
 sues, especially those of the skin, while cold baths contract 
 the vessels and the tissues. 
 
 Landerer has called special attention to the importance 
 of tissue elasticity as a factor in blood pressure. This is a 
 matter of special importance in relation to the skin, the ves- 
 sels of which contain less muscular tissue than do those of 
 other parts. Cold applications to the skin render it firm and 
 dense, and greatly increase its elasticity, thus tending to 
 raise the blood pressure. This is true of all applications to 
 the skin, especially those of two minutes or longer duration. 
 A cold application which leaves the skin firm and smooth 
 will produce this effect. 
 
REGULATING BLOOD PRESSURE. 1 145 
 
 MEASURES BY WHICH BLOOD=VOLUME MAY 
 BE REDUCED. 
 
 Measures of this sort are especially indicated in cases of 
 eclampsia, either present or impending, uremic convulsions, 
 apoplexy with high blood-pressure, or when progressive clot 
 formation is suspected. 
 
 Sweating is one of the most effective means of lowering 
 blood-pressure by reducing the volume of the circulating blood. 
 A large amount of blood is withdrawn from the general circu- 
 lation by the dilatation of the cutaneous vessels, while at the 
 same time the total volume of blood is diminished by the serum 
 poured out by the sweat glands. The hot blanket pack fol- 
 lowed by the sweating wet sheet pack, the vapor bath, the elec- 
 tric light bath, and all sweating procedures are serviceable. 
 
 The moist girdle protected with mackintosh, and heating 
 compresses to the legs are also most useful means for with- 
 drawing a portion of the circulating blood. 
 
 EFFECTS OF BATHS UPON THE VISCOSITY OF 
 THE BLOOD. 
 
 Burton-Opitz has recently called attention to the fact 
 that hot baths lessen the viscosity of the blood while cold 
 baths increase viscosity. A bath at 23 C. (73. 4 F.) low- 
 ered the viscosity coefficient from K 836 to K 760 in fifteen 
 minutes; that is, increased the viscosity of the blood 10 per 
 cent. A bath of 42 to 43. 5 C. (107. 6° to no.3 F.) raised 
 the coefficient from K 1027 to K 1126 in fifteen minutes; 
 that is, diminished the viscosity of the blood 10 per cent, in 
 Ihe time named. 
 
 These interesting facts which have just appeared (The 
 Journal of Experimental Medicine, January 25, 1906) con- 
 firm the results of both experimental and clinical observa- 
 tions in relation to the effects of hot and cold baths upon 
 blood pressure. 
 
 Variations in the viscosity of the blood unquestionably 
 influence blood pressure to a very considerable extent. 
 
 It is generally held that the influence of iodide of potash 
 
1 146 RATIONAL HYDROTHERAPY. 
 
 in reducing blood-pressure is due to the fact that it reduces 
 viscosity of the blood to the possible amount of one-tenth. 
 There is this important difference, however, between the ef- 
 fects of baths in lowering blood-pressure and the effects of 
 iodide of potash : the bath may be repeated an indefinite 
 number of times without any injurious effect upon the body 
 whereas the continuous use of iodide of potash sooner or 
 later results in iodism and various pathological changes more 
 or less grave in character. 
 
 A fact which is highly worthy of note in this connection is 
 that the changes produced in the viscosity of the blood by 
 hot baths and cold baths have the same influence upon blood- 
 pressure as do the vasomotor and other effects produced by 
 hot and cold baths respectively ; that is, the warm bath lowers 
 blood pressure by dilating the surface vessels and inhibiting 
 the vasomotor centers while at the same time lessening the 
 viscosity of the blood and thereby diminishing the effort 
 required to force the blood from the arterial reservoir 
 through the arterioles into the venous system of low pres- 
 sure reservoirs. On the other hand the cold bath raises the 
 blood-pressure not only by stimulating cardiac activity by con- 
 tracting the peripheralvessels and increasing the energy and 
 efficiency of the heart through stimulation of the vasomotor 
 and cardiac centers, but also by increasing the viscosity of the 
 blood and thereby raising peripheral resistance by increasing 
 the work required to drive the blood through the narrowed 
 arterioles. 
 
 The experienced physician will have no difficulty in ap- 
 plying the above facts to all cases of high or low blood pres- 
 sure which come under his supervision. A few additional 
 suggestions respecting the application of hydrotherapy to 
 individual cases or classes of acute and chronic disease may, 
 however, be of service. 
 
 Cases requiring therapeutic regulation of pressure' may 
 be included, in the following classes: Primary low-pressure 
 cases, high-pressure cases, secondary low-pressure cases. 
 
REGULATING BLOOD PRESSURE. II47 
 
 HYDRIATIC MEASURES ADAPTED TO PRIMARY 
 LOW=PRESSURE CASES. 
 
 In acute cases both the heart and the blood vessels 
 may be involved. That is, the heart may be weak and the 
 vasoconstrictors paralyzed. This condition is found in the 
 majority of acute infectious disorders, and is a result of the 
 toxic influence of bacterial poisons upon the heart and ves- 
 sels. This is a reason for the great efficiency of the Brand 
 Bath in typhoid and other acute infectious febrile disorders. 
 The value of the Brand Bath is due far less to its direct in- 
 fluence upon temperature than to its beneficial effect upon 
 the heart and vessels through its influence upon the cardiac 
 and vaso-motor centers. The strong sensory stimulation pro- 
 duced by the contact of cold water with the skin energizes 
 the heart, stimulates the splanchnic nerves, and so con- 
 tracts the vessels of the splanchnic area, thus supplying an 
 increased amount of blood to the heart, whereby it is able 
 to fill the arterial reservoir, while at the same time raising 
 the tone of the peripheral vessels, and increasing the activity 
 of the peripheral heart. The cold bath of Brand, when prop- 
 erly administered, is one of the most efficient of all means of 
 aiding the body in its battles against the invading organisms 
 of infectious febrile diseases, hence its adaptability to all dis- 
 orders of this class, which are almost without exception 
 characterized by low blood-pressure. 
 
 The cold wet sheet pack, the cold rubbing sheet, vigor- 
 ous cold sponging, cold rubbings, and all hydriatic procedures 
 useful as anti-febrile measures, are effective through their 
 favorable influence upon blood-pressure. 
 
 One point should be borne in mind especially in the treat- 
 ment of typhoid fever, namely, in cases of hemorrhage there 
 is likely to be a sudden drop in pressure, although the pres- 
 sure may already be low. If perforation and infection 
 occur, however, there will be a rise in pressure. The sys- 
 tematic observance of blood pressure, as well as of tempera- 
 ture, is a matter of great importance in all febrile and sur- 
 gical cases. It is in fact, only by this means that the condi- 
 
1 148 RATIONAL HYDROTHERAPY. 
 
 tion of the patient can be thoroughly understood and appre- 
 ciated, and the proper indications determined. 
 
 HYDRIATIC MEASURES ADAPTED TO CACHECTIC 
 DISORDERS. 
 
 In nearly all cases of chronic cachexia, in advanced ma- 
 lignant disease, especially cancer of the stomach, and chronic 
 pulmonary tuberculosis, in fact in nearly all chronic wasting 
 disorders, low pressure is present, the result of cardiac weak- 
 ness through malnutrition and through imperfect control of 
 the splanchnic vessels. The writer has often obtained most 
 surprisingly beneficial effects in these cases by the appli- 
 cation of cold rubbings from one to three times daily, gentle 
 massage, the application of the sinusoidal current, especially 
 in the form of a general sinusoidal bath, and daily local appli- 
 cations to the splanchnic area. For this purpose the electrode 
 should be applied to the lower dorsal region and the abdomen. 
 The strength of the current should be such as to cause vigorous 
 and slightly painful contraction of the abdominal muscles. 
 
 THE HYDRIATIC TREATMENT OF CASES OF CHRONIC 
 CARDIOVASCULAR DISEASE— ARTERIOSCLEROSIS. 
 
 The heart and vessels must be considered as one organ, 
 the vessels being simply ramifying branches of the heart ex- 
 tending throughout the body. Those influences which af- 
 fect the heart affect also the vessels. 
 
 From the standpoint of chronic cardio-vascular disease, 
 cases may be divided into three classes : low pressure, high 
 pressure, and secondary low pressure. In low pressure cases 
 the fault is primarily with the heart. The difficulty may be 
 either stenosis or insufficiency of the valves, inflammation or 
 degeneration of the cardiac muscle, or a crippled condition 
 due to pericardial inflammation. The pump is weakened, so 
 that the adequate pressure can not be maintained in the arter- 
 ial reservoir. In high pressure cases the trouble is disorder of 
 the arteries, generally with the small arteries. The case 
 may be one of general arterioscelerosis, easily recognized by 
 examination of the radial pulse, which can be felt rolling under 
 
REGULATING BLOOD PRESSURE. 1 149 
 
 the finger. Recent studies of this subject have shown, how- 
 ever, (von Basch and Huchard) that high pressure exists 
 in many cases in which arteriosclerosis can not be dis- 
 covered by examination of the superficial vessels. Post- 
 mortem examinations have also shown (Hasenfeld and 
 Hirsch) that degenerative changes of the portal circulation 
 are often present in cases of renal disease when no changes 
 can be discovered in vessels which are accessible to the 
 touch. In all these cases high pressure is due to a decrease 
 in size of the outlets of the arterial reservoir, the result of 
 degenerative changes in the vessels of the splanchnic area, — 
 a condition which is becoming more and more common as a 
 result of the sedentary and luxurious habits so increasingly 
 prevalent at the present time. 
 
 Boix has shown conclusively that the use of pepper, mus- 
 tard, and other condiments, as well as various dyspeptic condi- 
 tions, are the most common causes of degenerative changes in 
 the liver, spleen, and other divisions of the splanchnic circula- 
 tion. He also demonstrated the fact that toxins produced by 
 the colon bacillus produce the same effects. 
 
 Metchnikoffs observations likewise point conclusively 
 to bacterial action upon food residues in the colon as a cause 
 of these tissue changes. 
 
 In cases of hypertension the very fact that the pressure is 
 high is evidence that the heart does not require stimulating by 
 drugs or other means. Changes in the vessels are generally 
 of a permanent character, and hence the heart must always 
 have an excess of work to do. Nothing could be more unwise 
 than the frequent or habitual use of drugs which tend to lower 
 tension by lessening the force of the heart. Thousands of 
 lives have been shortened by the use of such drugs, since they 
 necessarily hasten the time at which the heart energy will per- 
 manently fail. It is now generally conceded that the use of 
 amylnitrite and of the nitrites in general, when to any extent 
 prolonged, is a potent cause of secondary low tension. 
 
 High pressure is not in itself a detriment. It is in fact 
 protective. The narrowing and withering of the arterial 
 twigs as the result of the degenerative process threaten the 
 
I 150 RATIONAL HYDROTHERAPY. 
 
 tissues with starvation. The heart works with sufficient 
 energy to maintain the pressure at such a point that an ade- 
 quate supply of blood can be forced through the narrow 
 channels to sustain the integrity of the tissues and their func- 
 tions. The thing to be done then is not to lessen the 
 energy or activity of the heart, but to lessen the resistance 
 against which it works. In other words, the evident indica- 
 tions are: (1) to stop the degenerative process; and (2) to 
 dilate the contracted vessels. The best means for relaxing 
 the contracted vessels are the following: 
 
 (1) Baths of all sorts at a temperature of 92 ° to 98 
 Baths at the lower temperature should be accompanied by 
 rubbing so as to maintain the surface circulation. Baths at 
 the higher temperature should not be greatly prolonged. 
 A duration of fifteen to thirty minutes is about the proper 
 time. At a temperature of 92 the bath may be consider- 
 ably prolonged with advantage, say thirty to forty minutes, 
 or even an hour or tAVO. The shallow bath, and the rubbing 
 sitz bath at 78 ° to 85 ° is a very excellent measure. Dura- 
 tion should be one to three minutes for the shallow bath, or 
 two to four minutes for the sitz bath. The neutral fan 
 douche (92 ° to 96 ), the neutral spray, rain douche, and the 
 needle bath (88° to 96 ), applied for one to three minutes, 
 are measures of value as a means of dilating the peripheral 
 vessels. 
 
 (2) Hot immersion baths, and general hot baths of all 
 sorts should be avoided as dangerous, the first effect of such 
 baths being to raise the pressure, which may produce great 
 injury through the rupture of some weakened vessel in the 
 brain or elsewhere. Partial hot baths, however, may be 
 employed with advantage, particularly hot sponging, hot 
 mitten friction, the short hot foot bath combined with a 
 fomentation to the abdomen or to the spine. 
 
 (3) Cold immersion baths, the general cold shower, or 
 the general cold douche, are measures which should be care- 
 fully avoided. The short cold towel rub, and mitten friction 
 with water at 65 ° to 75 °, may be utilized, if care is taken to 
 avoid chilling the patient. It is well to apply a hot bag to . 
 
REGULATING BLOOD PRESSURE. II5I 
 
 the spine or feet during this application, to insure against 
 chilling. All the above hydriatic applications may be re- 
 peated two or three times a day with advantage. 
 
 (4) The wet girdle, and heating packs to the legs, worn 
 at night, are measures of great value in cases of high blood 
 pressure due to arteriosclerosis. The wet sheet pack, pre- 
 ceded by vigorous friction of the skin, and followed by cold 
 mitten friction, is also a measure of very considerable value. 
 
 (5) The partial electric light bath applied in succession 
 to various parts of the body, and continued until the skin is 
 thoroughly reddened, is one of the most effective of all 
 means for dilating the surface vessels and clearing the tissues 
 of waste products. The cabinet electric light bath may 
 be employed in cases in which the pressure is not high 
 and the vascular changes are still in an incipient state. The 
 arc light bath may be employed in the same way to excellent 
 advantage. The sun bath, used with precaution and re- 
 peated daily until the skin is thoroughly tanned, is one of the 
 most effective means of combatting degenerative changes in 
 I he cutaneous vessels. 
 
 (6) The sinusoidal electric bath, at a temperature of 94° 
 to 88°, also baths at the same temperature combined with 
 faradic and galvanic electric currents are very servicable in 
 this class of cases. 
 
 Moderate hydriatic measures of nearly every sort im- 
 prove metabolism and thus check the degenerative processes 
 of the vessels which give rise to high blood-pressure. 
 
 All measures which improve the blood supply of the skin 
 and maintain a vigorous circulation in the limbs are useful 
 in cases of hypertension, especially in arteriosclerosis. In 
 such cases great care should be taken to keep the extremi- 
 ties warm and to avoid general chilling. Prolonged neutral 
 baths, hot foot baths, the Scotch douche to the legs, and leg 
 packs over night are very useful, but general cold baths, 
 even the morning cold bath must be forbidden in these cases. 
 
 In treating cases of arteriosclerosis, the fact must be 
 borne in mind that the condition of secondary hypotension 
 may have begun although the blood pressure is above nor- 
 
II5 2 RATIONAL HYDROTHERAPY. 
 
 mal. For example, a person who has enjoyed very com- 
 fortable health with a blood pressure of 200 millimeters or 
 more, may begin to show symptoms of secondary hypoten- 
 sion with a blood pressure of 160 millimeters; and the first 
 symptoms of improvement in such a case may be accom- 
 panied by increase of tension rather than diminution through 
 improvement of the cardiac energy. 
 
 Hydrotherapy is an instrument of great power, but it 
 must be used with precision, and every application must be 
 based on an accurate knowledge of the patient's condition, 
 and an appreciation of physiologic principles. 
 
 HYDRIATIC MEASURES ADAPTED TO CASES OF SEC= 
 ONDARY LOW TENSION. 
 
 Every case of high tension due to degenerative changes 
 either in the systemic vessels or in the vessels of the 
 splanchnic area, sooner or later gives place to low pressure, 
 due to exhaustion of cardiac energy. The enormous in- 
 crease of cardiac work required to maintain the pressure in 
 the arterial reservoir when the outlets are greatly reduced 
 in number and capacity, sooner or later wears out the 
 strongest heart. If the patient does not die of apoplexy or 
 of some intercurrent malady, death will come in time from 
 cardiac failure. The treatment of this class of cases must 
 be entirely different from that which is appropriate in cases 
 of primary low pressure, for although the pressure falls, the 
 condition of the vessels remains the same. In primary low 
 pressure the fall of pressure is due to dilatation of the arter- 
 ioles, whereby the outflow from the arterial reservoir is in- 
 creased. In secondary low pressure, the fault is at the other 
 end of the circulatory system, namely, failure of cardiac 
 energy. 
 
 There are two things necessary in these cases. First, to 
 dilate the small vessels so as to diminish the work to be ac- 
 complished by the enfeebled heart, and second, to energize 
 the heart and sometimes to stimulate it so far as this can 
 be safely done. The measures required are, then, a com- 
 bination of those indicated in high pressure due to arterio- 
 
REGULATING BLOOD PRESSURE. .H53 
 
 sclerosis, and those which tend to increase cardiac energy. 
 For the last named purpose one of the most useful measures 
 is the cold precordial compress or ice-bag placed over the 
 heart. But in the employment of this measure care should 
 always be taken to precede the application by a measure of 
 some sort whereby the peripheral vessels may be relaxed, 
 and thus the work of the heart diminished. The reason for 
 this is obvious. If the heart is exhausted because of long con- 
 tinued effort to overcome an abnormal degree of resistance, 
 the employment of a cardiac stimulant of any sort can serve 
 only to still further exhaust it. It is like whipping a horse 
 which is pulling a heavy load. The efforts of the over- 
 worked beast may be increased temporarily, but only at the 
 expense of hastening the moment when the animal will fall 
 completely exhausted. On the other hand, if the load is 
 lightened before the whip is applied, the lessening of the work 
 to be performed, combined with the stimulus of the whip, 
 may carry horse, driver, and load safely over the hill top. 
 
 The best means for relaxing the surface vessels in these 
 cases are short, very hot mitten frictions or hot spongings, 
 short, very hot fomentations to the spine ; dry hand rubbing ; 
 short cold mitten frictions; the hot foot bath accompanied 
 by hot mitten friction or hand rubbing; gentle exercise; 
 resistance movements ; light massage ; a very short electric 
 light bath at a moderate temperature, one to three minutes, 
 with an ice-bag over the heart after the first half minute. 
 
 It is in this particular class of cases that the Nauheim 
 baths are of great service. The temperature of the bath 
 should generally be 88° to 92 °. The moderate stimulation 
 of the thermic nerves energizes the heart. The reaction 
 which follows the cold application, especially when the bam 
 is accompanied by rubbing, as it always should be, relaxes 
 the surface vessels, and so lessens the work of the heart. 
 The systematic use of this bath may greatly prolong the life 
 of a person suffering from secondary low pressure, although 
 of course actual cure is out of the question. 
 
 In personal experience with the baths at Nauheim, the 
 writer observed that patients were not rubbed sufficiently dur- 
 73 
 
1 1 54 RATIONAL HYDROTHERAPY. 
 
 ing the bath. Violent rubbing should be avoided, but gentle 
 rubbing should be almost constant during the entire bath, so 
 as to encourage the cutaneous circulation and thus enable the 
 patient to tolerate a gradually lowered bath temperature 
 whereby the energizing effect upon the heart and vessels is 
 greatly increased. 
 
 Cautions, — The greatest care should be used in these cases 
 to avoid general cold baths, general hot baths, and abdom- 
 inal compression. The patient's life may be easily snuffed 
 out by an injudicious hydriatic application. A severe gen- 
 eral chilling of the surface is about as dangerous in such a 
 case as a bullet wound through the body. 
 
 In cases in which the disorder is due to changes in 
 the vessels of the splanchnic area, either with or without 
 accompanying cardiac or renal disease, measures may be em- 
 ployed which will serve to dilate the portal vessels, thus les- 
 sening the resistance in the vascular system. The measures 
 most useful for this purpose are the following : The pro- 
 tected wet girdle worn at night (care must be taken to wring 
 the towel quite dry, to cover well with mackintosh, and to 
 protect sufficiently to secure quick heating) ; the neutral sitz 
 bath (92 ° to 98 °, duration fifteen to twenty minutes) twice 
 daily; the Scotch douche to the back and abdomen and over 
 the hepatic region. 
 
 When the abdominal muscles are contracted, the applica- 
 tion of the wet girdle may be preceded by a fomentation to 
 the abdominal region for three to five minutes, and the neu- 
 tral sitz bath may be preceded by a hot sitz, temperature 
 102 , for one or two minutes. Care should be taken to keep 
 the colon empty, employing daily, if necessary, the enema or 
 coloclyster at a temperature of 90 to ioo°. The effect of 
 these applications will be to dilate the vessels of the splanchic 
 area. In extreme cases the legs may be utilized as a means 
 of diverting blood from the general circulation by employing 
 moist packs to the legs at night. 
 
 In these cases great care should always be taken to avoid 
 chilling the surface. The patient should be dressed warmly, 
 so as to keep as much blood in the skin as possible, and a flan- 
 
REGULATING BLOOD PRESSURE. 1 1 55 
 
 nel should be worn about the trunk to promote the accumula- 
 tion of blood in the abdomen. 
 
 The employment of hydriatic measures as a means of 
 combating the dangers which arise through changes of blood 
 pressure during surgical operations, especially collapse and 
 shock, can not be over-estimated. The systematic use of the 
 sphygmomanometer before, during, and after surgical oper- 
 ations, should be made the rule in every surgical hospital. 
 It has been the custom of the writer for many years to meas- 
 ure the blood pressure of every patient coming under his 
 care, and more recently the plan of taking blood pressure be- 
 fore the operation, at frequent intervals during the operation, 
 and at stated intervals during the first few days following the 
 operation, especially in grave cases, and in all abdominal 
 cases, has been adopted as a routine practice. Great benefit 
 has been derived from the systematic use of the cold chest 
 compress as a means of maintaining respiratory and cardiac 
 activity during operation, especially when chloroform is em- 
 ployed. After all operations it has for years been the cus- 
 tom of the writer to apply general cold mitten friction and 
 the cold precordial compress as a means of aiding the pa- 
 tient to recover as quickly as possible from the effects of the 
 anesthetic. In cases in which the anesthetic has been pro- 
 longed, a hot enema is administered as a means of raising 
 the blood pressure and aiding the kidneys in the elimination 
 of pressure lowering poisons. 
 
 The value of the practice of taking the blood pressure in 
 connection with every surgical operation was well shown 
 in a case in which, after removal of a large sarcoma from the 
 groin which involved many branches of the crural nerve, the 
 patient's blood pressure was found so low that it could not be 
 registered by the tonometer. Strong compression of the 
 abdomen by placing a rubber bag under a bandage and in- 
 flating it, brought the pressure at once to 75 millimeters. 
 When the air was allowed to escape the pressure at once fell 
 to zero. A second inflation of the bag brought the pressure 
 up to 115 millimeters, where it was held by continuing the 
 abdominal compression during several hours, until the symp- 
 
1 1 56 RATIONAL HYDROTHERAPY. 
 
 toms of shock had disappeared. In this case, cold mitten 
 friction, the ice-bag over the heart, and other means for 
 stimulating the cardiac and vasomotor centers were assidu- 
 ously employed, as in all cases. As a rule, in such cases, 
 the ice-bag is employed continuously for several hours, 
 being removed for five minutes every half hour; and cold 
 mitten frictions, employing water at a temperature of 6o° 
 to 34 , are repeated every hour, and in extreme cases more 
 often. 
 
 The efficiency of the methods described above in lower- 
 ing pressure in cases of extremely high tension might be illus- 
 trated by a very large number of cases. A few will suf- 
 fice. It should be stated that the instrument usually em- 
 ployed has been a modification of the Riva-Rocci type of 
 sphygmomanometer with a 10 centimeter armlet. 
 
 Case I. Patient a lady, age 60, from Georgia, referred 
 by her physician. Examination showed the systolic pressure 
 to be 275 millimeters. Radials palpable and chalky. Great 
 uncertainty of memory. When asked from what State she 
 came, she was obliged to ask a friend, as she could not at 
 the moment recall the name of the State in which she had 
 resided for nine years. This patient's diet had for many 
 years consisted chiefly of flesh food and she had used a large 
 amount of strong coffee. The amount of caffein taken daily 
 according the patient's statements, could not have been less 
 than 20 to 30 grains. In three weeks the blood pressure in 
 this case was reduced to 240 millimeters. 
 
 Case II. Patient a lady, age 48. The patient was of 
 sedentary habits, a writer of marked ability, who had for 
 years made large use of meat and used tea and coffee freely. 
 Albumin was constantly found present in the urine, though 
 not in large amount. On examination, the systolic pressure 
 was found to be 240. At the end of a few months this patient's 
 systolic pressure was found to be 125, diastolic, 90 millimeters. 
 The albumin had entirely disappeared, and the patient's gen- 
 eral condition was very greatly improved. 
 
 Case III. Patient a man, thirty-five years of age. The 
 urine contained a large amount of albumin, and there were 
 
REGULATING BLOOD PRESSURE. I 1 57 
 
 several casts in each field. The patient was very pale, feeble, 
 anemic. Blood-count was 75 per cent, of normal. Systolic 
 pressure 185. At the end of five weeks the blood-pressure was 
 140, and the patient was in every way very greatly improved. 
 
 Case IV. Patient a lady, age 44. Pale, sallow skin. 
 Could take but little exercise without getting out of breath. 
 Slight cardiac hypertrophy. Mitral regurgitant murmur. 
 No history of rheumatism or of acute cardiac disease. 
 Blood pressure, 175 millimeters. At the end of four weeks 
 this patient's systolic pressure was reduced to 125 millimeters; 
 the color of the skin was greatly improved and the general 
 strength increased. 
 
 The writer feels it but just to state that he does not regard 
 hydrotherapy alone as a sufficient means for dealing with ab- 
 normalities of blood tension. Especially is this true of high 
 pressure cases, and cases of secondary low tension. The 
 causes of the tissue changes to which the disturbance of tension 
 is due must be removed. The patient's habits must be made 
 to conform to natural physiologic principles. Flesh meats, 
 tea, coffee, alcohol, and tobacco must be discarded. It is very 
 important that the habitual use of pressure-regulating drugs 
 should be dispensed with. However useful such drugs may 
 be for producing temporary effects, their frequent or constant 
 use is in every case detrimental. The free use of juicy fruits, 
 and of other foods which tend to alkalinize the blood is espe- 
 cially to be recommended. Cane sugar must be avoided, to- 
 gether with spices and condiments of all sorts. The colon 
 should be thoroughly evacuated daily; the patient should live 
 as much as possible in the open air, and should at night sleep 
 on an open balcony or with windows widely opened, unless 
 supplied with a Porte- Air or fresh air tube by which outdoor 
 air may be brought directly to the sleeper. Violent exercise 
 must, of course, be avoided, but as large an amount of mod- 
 erate exercise should be taken as possible without actual 
 fatigue. 
 
BIBLIOGRAPHY. 
 
 With very few exceptions all the following authorities have been 
 consulted in the preparation of this work, and a considerable number 
 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 are 
 referred to in Parts I and II. 
 i. Landois & Stirling. Text-book of Human Physiology, 1891, 
 page 174. 
 
 2. Landois & Stirling. Text-book of Human Physiology, 1891, 
 
 page 113. 
 
 3. Waller, Augustus. Human Physiology, 1891, page 59. 
 
 4. Landois & Stirling. Text-book of Human Physiology, 1891, 
 
 page 228. 
 
 5. Landois & Stirling. Human Physiology, 1891, pages 780-783. 
 
 6. Landois & Stirling. Human Physiology, 1891, page 230. 
 
 7. Waller, Augustus. Human Physiology, pages 280-281. 
 
 8. Schuller. Archiv fur 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'hydrologie medi- 
 
 cale, 1870. 
 
 12. Franck, Francois. Travaux dur laboratoire du professeur Marey. 
 
 Tome 1. 
 
 13. Vinaj & Maggiori. Blatter fur klin. Hydrother., 1893. 
 
 14. Centralblatt fur innere Medicin, 1893, page 1017. 
 
 15. Archiv fur experimentelle Pathologie und Pharmakologie. 
 
 16. Thayer, W. S. Johns Hopkins Hospital Bulletin, 1893. 
 
 17. Strasser, A., and Buxbaum, B. Fortschritte der Hydrotherapie, 
 
 1897. 
 
 18. Landois & Stirling. Human Physiology, 1S91, page 548. 
 
 19. Fleury, Louis. Traite Therapeutique et clinique d' hydrotherapie, 
 
 page 144. 
 
 20. Fleury, page 160. 
 
 1159 
 
Il6o BIBLIOGRAPHY, 
 
 21. Bottey, Fernand. Traite theorique et pratique d'hydrotherapie 
 
 medicale, 1895. 
 
 22. Oliver. London Lancet, 1896. 
 
 23. Beni-Barde. L'Hydrotherapie dans les maladies chronique et les 
 
 maladies nerveuses, 1894. 
 
 24. Maggiori & Vinaj. Blatter fur Klinische Hydrotherapie 1892, 
 
 Vol. II, No. 15; Vol. Ill, No. 7, also page 67. 
 
 25. Henocque, Albert. Annales de la Societe de Biologie, 1887. 
 
 26. Pfluger's Archiv, 1871. Jahrg IV, pages 57-90. 
 
 27. Beni-Barde. Les douches locales en hydrotherapie, Congres 
 
 d'hydrologie, 1889. 
 
 28. Bottey, Fernand. Traite theorique et pratique d'hydrtherapie 
 
 medicale, 1895, page 117. 
 
 29. Bottey, Fernand. Annales de la Societe d'hydrologie medicale, 
 
 1886, page 60. 
 
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 Baginsky. Lehrbuch der Kinder Krankheiten, 1896, page 292. 
 Barra, M. P. L'usage de la glace de la neige et du froid, Aggrege au 
 
 college de Lyon. 
 Barthelemy, T. Etude sur de Dermographisme, Paris. 
 Baruch, Simon. 
 
 The Treatment of Typhoid Fever, Medical Record, Vol. 37, No. 
 12, pages 318, 355. 
 
 Causes and Treatment of the Summer Diarrhea of Infants, Med- 
 ical News, 1890. 
 
 The Status of Water in Modern Medicine, 1890. 
 
 A Plea for the Practical Utilization of Hydrotherapy, Gaillard's 
 Medical Journal, New York, 1890, Vol. 1, pages 24-54. 
 
 Hydrotherapy in Europe, Medical Record, Oct. 11, 1890. 
 
 Hydrotherapy and Mineral Springs (Hare's American System 
 
 of Practical Therapeutics), Phila., 1891. Vol. 1, page 453. 
 
 A Plea for the More Methodical Management of Chronic Dis- 
 eases, Dietetic Gazette, January, February, March, 1892. 
 
 The Uses of Water in Modern Medicine, Geo. G. Davis, Detroit, 
 1892. 
 
 Conditions Indicating Change of Air and Baths in the Summer 
 Diarrhea of Children, Medical News, June 18, 1892. 
 
 Practical Data on the Application of Water in Some Intractable 
 Diseases, Medical Record, Vol. 43, page 5, 1893. 
 
BIBLIOGRAPHY. \ll6l 
 
 Discussion on Therapeutic Reflections, Medical Record, Nov. 4, 
 1893, pages 597, 598, and Vol. 44, No. 19, page 580. 
 
 Diagnostic Bath in Typhoid Fever, N. Y. Med. Jour., Sept. 2, 1893. 
 
 A Plea for Physiological Remedies, Therapeutic Gazette, 1893. 
 
 Logic vs. Sentiment in Therapeutics, Medical Record, Dec. 23, 
 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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 i895. 
 
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 Das Wasser in der Aertztlichen Praxis, Trans, by Dr. Friedrich 
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 The Clinical Aspect of Dyspepsia, Transactions South Carolina 
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 Importance of Precision in the Technique of Hydrotherapy, 
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 Tubbing in Typhoid Fever, Discussion, Medical Record, Nov. 7, 
 
 1896, page 692. 
 
 Riverside Association Hydriatric Department, Medical News, May 
 
 2, 1896, page 500. 
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 Vol. 68, No. 6. 
 The Management of Pneumonia Patients, Medical News, Jan. 2, 
 
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 Recent Advances in Hydrotherapy (Hare's System of Practical 
 
 Therapeutics), Phila., 1897, Vol. 4, pages 17-36. 
 
 Cold Compresses in Pneumonia, Medical News, January, 1897. 
 
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 nik, Fortsch. der Hydrotherapie, Festschrift, Wilhelm Win- 
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 1897, Vol. 9, pages 129-143. 
 
 Lecture on the Practical Application of Hydrotherapy, Philadel- 
 phia International Clinics, 1897. 
 
 Faulty Hydrotherapy, Jour, of the Amer. Med. Assn., May 13,1897. 
 
1 1 62 BIBLIOGRAPHY. 
 
 Discussion of Typhoid Bathing at the County Medical Society, 
 Medical Times, February 1897, P a £ e 56. 
 
 Pneumonia, Editorial, Medical Record, Jan. 9, 1897, page 14. 
 
 Some Desperate Cases of Typhoid Fever Treated with and with- 
 out Baths, Medical Record, Oct. 1, 1898. 
 
 The Principles and Practice of Hydrotherapy, Wm. Wood and 
 Co., 1898. 
 
 Die praktische Anwendung der Wasserheilkunde, Monatschr. f. 
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 U5-I55- 
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BIBLIOGRAPHY. II63 
 
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 H65 
 
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1 1 66 BIBLIOGRAPHY. 
 
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 Landois and Stirling. Text-book of Human Physiology, 1891, pages 
 
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BIBLIOGRAPHY. 
 
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1 1 68 BIBLIOGRAPHY. 
 
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BIBLIOGRAPHY. 
 
 1 169 
 
 Hydrotherapie bei Erkrankungen der Respirationsorgane. Poli- 
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 Die feuchten Einpackungen als antipyretische Procedur. Jahrb. f. 
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 Die Hydrotherapie auf physiologischer und klinischer Grundlage. 
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 On the Action of the Thermal Application to the Skin upon the 
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 1878. 
 
 Die Aufgaben der Hydrotherapie bei der Lungenphthise. Wiener 
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 Die Hydrotherapie. Ziemssen's Handbuch der allgemeinen 
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 1888. 
 
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 74 
 
1 1 70 BIBLIOGRAPHf. 
 
 Die Wasserheilanstalt in Kaltenleutgeben. 2. Auflage, nebst 
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 Infectionskrankheiten und Hydrotherapie. Blatter f. klin. Hydro- 
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 Wochenschr., 1896. 
 
 Kurzer Abriss der Hydrotherapie. Borner's Reichs-Medicinal- 
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 Hydrotherapy in Fevers, Trans, in Modern Medicine and Bac- 
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 Angina diphtheritica und ihre hydrotherapeutische Behandlung. 
 
 Artikel " Hydrotherapie " in Eulenburg's Real-Encyclopadie der 
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 Winternitz, Wilhelm, and Pospischil. Neue Untersuchungen tiber 
 den respiratorischen Gaswechsel unter thermischen und 
 mechanischen Einfliissen. Blatter f. klin. Hydrother., 1893, 
 Heft "1-5. 
 Winternitz, Wilhelm, and Strasser, Alois. Hydrotherapie, Berlin, 
 
 1898. 
 Wratsch. Lyon Medicale, 1883, page 541. 
 
INDEX 
 
 Abdomen, cutaneous hyperesthesia of, 
 
 614. 
 Abdominal bandage, dry, 838. 
 
 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, 1101. 
 
 sympathetic, hyperesthesia of, 266, 
 495, 77i,. 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. 
 Adnexa, 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. 
 
 contraindications, 522. 
 
 to head in typhoid, 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, ion. 
 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, 966. 
 
 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, 
 
 applications, revulsion by, 250-1. 
 applications to spine, 820. 
 ascending douche, 481. 
 bath, Finkley, Galen, Vinaj, and 
 
 Pfliiger on, 312. 
 compress, 196, 816, 817. 
 
 1171 
 
1 1 72 
 
 INDEX. 
 
 Alternate douche, 470-2. 
 
 douche in hypertrophy of pros- 
 tate and vesical paresis, 481. 
 
 foot bath, 758. 
 
 spinal douche, 264. 
 
 sponging, 196, 264, 639. 
 Alternating fan douche, 484. 
 Alveolar inflammation, 778. 
 Amenorrhea, 241, 244, 472, 513, 545, 
 877, 940, 1089. 
 
 caliper douche in, 482. 
 
 cathodic, faradic, or sinusoidal 
 applications in, 942. 
 
 tonic hip pack in, 241. 
 America, hydrotherapy in, 32. 
 Amyloid kidney, 829. 
 
 liver, 618, 829. 
 Amyotrophic lateral sclerosis, 1054. 
 Anal douche, 504. 
 
 douche, cold, in constipation, 
 
 5°4- 
 douche, contraindications, 505. 
 douche in hemorrhoids, 504. 
 douche, very hot, 505. 
 fissure, warm douche in, 481. 
 insufficiency, cold ascending 
 
 douche in, 481. 
 muscle, weakening of, 505. 
 spasm in hysteria, 1059. 
 tenesmus, 769. 
 Analgesic effects, 799, 944. 
 Anasarca, 1084. 
 
 Anatomy, relation of, to hydrother- 
 apy, 53. 
 Ancient use of vaginal irrigation, 29. 
 
 use of water drinking, 24. 
 Anemia, 231, 369, 471, 597, 609, 633, 
 
 637, 646, 661, 718, 723, 753, 828, 
 
 839, 844, 855, 1083. 
 cerebral, 494, 508, 677, 751, 855, 
 
 867. 
 cerebral, in pernicious anemia, 
 
 1084. 
 chronic, 823. 
 
 cold applications in, 218, 443. 
 collateral, 241, 759. 
 of cord, 840. 
 dropsy from, 231. 
 headache due to, 801, 856. 
 in malaria, 990. 
 in melancholia, 1064. 
 methods of combating, 242-3. 
 in neuralgia, 1050. 
 in pelvic peritonitis, 1090. 
 pernicious, 867, 1084. 
 in pulmonary tuberculosis, 1019. 
 of skin, 597, 939. 
 spinal, 495. 
 
 Anemia in syphilis, 1095. 
 
 in typhoid, 987. 
 
 visceral, 243, 244. 
 Anemic headache, 1067. 
 
 insomnia, 829. 
 Anesthesia, 1102. 
 
 in hysteria, 444, 1058. 
 
 of plantar region, 758. 
 
 treatment during, 620, 800, 823, 
 844, 845, 869, 870. 
 Anesthetic effects, 270. 
 Angina pectoris in gout, 1024. 
 Angioneurotic edema, 809. 
 Animal heat, 77-8. 
 Ankylosis, fibrous, 515. 
 Anodal galvanic applications, 94a, 
 
 941. 
 Anodynes, 263. 
 Anorexia, 412, 647, 776. 
 
 in anemia, 1083. 
 
 in gastric dilatation, 1035. 
 
 in hypopepsia, 1032. 
 
 in hysteria, 809, 1057. 
 
 in melancholia, 1064. 
 
 in nervous dyspepsia, 1040. 
 
 in neurasthenia, 1061. 
 
 in typhoid, 986. 
 Anterior poliomyelitis, 810. 
 Antiphlogistic effects, 272, 280, 856. 
 
 effects of articular douche, 513. 
 
 effects of heat, 279. 
 Antipyretic, cold compress as, 306, 
 
 313- 
 
 cold sponge bath as, 307. 
 
 effects, 283, 287, 288. 
 
 effects of enema, 318, 320. 
 
 effects of wet-sheet pack, 284. 
 
 measures, precautions concern- 
 ing, 329, 615. 
 
 methods, 293, 295-342. 
 
 wet sheet as an, 603. 
 Antipyretics, 287. 
 Antipyrine, effect on blood count, 
 
 582. 
 Antispasmodic effects, 270. 
 Antithermic effects, 283, 615. 
 
 measure, cool compress as, 783. 
 
 methods, general principles of, 
 286. 
 Apepsia, 498, 661, 768, 886, 932. 
 
 cold gastric douche in, 510. 
 
 sinusoidal current in, 941. 
 Aphonia, hysterical, 445, 1059. 
 Apoplexy, 445, 553, 560. 
 
 in typhoid, 984. 
 
 of spine, 856. 
 " Apotheraphia," 23. 
 Apparatus, douche, 427. 
 
INDEX. 
 
 ii/3 
 
 Appendicitis, 781, 810, 829, 832, 847, 
 898, 1043. 
 
 in typhoid, 983. 
 Appetite, loss of, 412. 
 Arc light bath, 708, 711. 
 Arm bath, 759. 
 d'Arsonval, 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, Winternitz, 791. 
 Arthritis, 716. 
 
 deformans, 1085. 
 
 in erysipelas, 997. 
 
 in typhoid, 985. 
 Articular douche, 513-14. 
 
 antiphlogistic effects of, 513. 
 
 douche in chronic exudates, 514. 
 
 therapeutic applications of, 514. 
 
 rheumatism, 515, 804, 828, 1006. 
 Ascending douche, 480-1. 
 
 paralysis, acute, 823, 829. 
 Ascites, 457, 618, 829. 
 Asiatic 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, 
 864. 
 
 in 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, 905, 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 intestinal 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, 771, 831, 877. 
 
 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 after, 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, 987. 
 Beer on asphyxia, 779. 
 Bell's 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. 
 Beverley-Robinson, 318. 
 Bigelow on empiricism, 065. 
 
1 174 
 
 INDEX. 
 
 Bile, vomiting of, 850. 
 Bile-ducts, catarrh of, 900. 
 
 in typhoid, 983. 
 Biliary colic, 987, 1044. 
 
 dyspepsia, 457. 
 Bilious headache, 1067. 
 Biliousness, 691, 900, 928. 
 
 in hypopepsia, 1032. 
 Bladder, acute catarrh of, 771. 
 
 acute inflammation of, 847. 
 
 atony of, 480, 484, 500, 503, 513, 
 764, 768, 905, 906, 941. 
 
 blood supply of, 739. 
 
 catarrh of, 245, 771. 
 
 contraction of, 754. 
 
 douche, therapeutic applications 
 of, 905. 
 
 hyperesthesia of, 481. 
 
 inflammation of, 445, 804. 
 
 irrigation of, 903-6. 
 
 irritability of, 481, 495, 501, 771, 
 1046. 
 
 motor insufficiency of, 495-6. 
 
 neuralgia of, 500, 769, 1051. 
 
 painful affections of, 766. 
 
 paralysis of, 905. 
 
 spasm of neck of, 497, 769. 
 
 See Vesical. 
 Blanket pack, hot, 230, 310, 599, 623. 
 
 hot, contraindications, 625. 
 
 hot, method, 623. 
 
 hot, in nephritis, 230. 
 
 hot, physiological effects, 623. 
 
 hot, requisites, 623. 
 
 hot, revulsive effects of, 254. 
 
 hot, therapeutic applications, 624. 
 
 hot, in uremia, 235. 
 Bleeding fibroids, 600. 
 
 from wounds, 777. 
 Blood, alkalinity of, 413, 966, 1023. 
 
 circulation of, 54. 
 
 corpuscles, influence of heat 
 upon, Maurel, 583. 
 
 count in fever, 582. 
 
 effects of cold upon, 120. 
 
 effects of heat upon, 156. 
 
 healing power of, 242. 
 
 movement, means of controlling, 
 
 977- 
 
 movement, procedures which in- 
 crease, 974. 
 
 movement in spinal sclerosis, 1053. 
 
 pressure, 59, 1135. 
 
 pressure, high, headache from, 
 1067. 
 
 pressure increased by very hot 
 douche, 447. 
 
 pressure in mania, 1065. 
 
 Blood pressure in melancholia, 1064. 
 
 vessels, effects of cold upon, 104. 
 Bloody sweat, 66. 
 Bocker on water drinking, 922. 
 Body surface, method of determining, 
 
 316. 
 Boils, 806. 
 
 in diabetes, 1026. 
 
 in typhoid, 987. 
 Bones, dislocation and fracture of, 
 
 800. 
 Bottey, effects of cold douche on 
 
 kidney, 512. 
 Bouchard on autointoxication, 705. 
 
 on graduated bath, 536. 
 
 on perspiration, 606. 
 
 on skin elimination, 578. 
 
 on slowed nutrition, 661. 
 Bougarel on Scotch douche, 466. 
 Bowels, atonic condition, 484, 940. 
 
 chronic inactivity of, 928. 
 Bradycardia, 869. 
 Brain, chronic inflammation of, 552. 
 
 congestion of, 764, 844, 940. 
 
 effects of neutral rain douche on, 
 
 475- 
 passive congestion of, 844. 
 temperature of, 80. 
 and viscera, effect of hot douche 
 
 on, 448. 
 See Cerebral. 
 Brand bath, 520, 569, 598, 602, 617, 
 645, 680. 
 contraindications for, 329, 593. 
 method, 569. 
 
 physiological effects, 571. 
 therapeutic applications, 573. 
 Brand, statistics in typhoid, 585. 
 Breathing, effects on temperature, 
 
 3*4, 315- 
 Bright's disease, 373, 471, 512, 618, 
 676, 691, 1046. 
 
 acute, 624. 
 
 hot bath in, 229. 
 
 in lithemia, 1022. 
 Broken jet, 431. 
 
 Bronchial catarrh in measles, 996. 
 Bronchioles, spasm of, 779, 864. 
 Bronchitis, 466, 616, 828. 
 
 acute, 616, 700, 805, 916, 1075. 
 
 capillary, 521, 544, 1005. 
 
 chronic, 545, 612, 660, 676, 862, 
 863, 1075. 
 
 in croup, 1074. 
 
 in diabetes, 1026. 
 
 in emaciation, 1028. 
 
 in gout, 1024. 
 
 in influenza, 1013. 
 
INDEX. 
 
 "75 
 
 Bronchitis in meningitis, 999. 
 
 in obesity, 1027. 
 
 in typhoid, 983. 
 Broncho-pneumonia, 278, 521, 544, 
 
 _ 844-5, 1077. 
 
 in 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. 
 Burns, 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, functional, 1081. 
 
 diseases, organic, 1079. 
 
 dropsy, 228, 637, 646, 662, 691. 
 
 excitants, 200, 647, 777, 809, 867, 
 870. 
 
 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 nephritis, 1045. 
 
 weakness in cholera morbus, 1043. 
 
 weakness in drug habits, 1099. 
 
 weakness in obesity, 1027. 
 
 weakness in typhoid, 986. 
 
 See Heart. 
 Cardialgia, 864. 
 Catarrh of bile ducts, 900. 
 
 of bladder, 245, 771. 
 
 bronchial, 700, 828, 862. 
 
 bronchial, in measles, 996. 
 
 of cecum, 898. 
 
 duodenal, 499. 
 
 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, 1074. 
 
 nasal, 466, 776, 839, 916, 1071. 
 
 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. 
 
 313. 
 
 compress, physiological effects 
 of, 854. 
 
 compress, therapeutic applica- 
 tions, 855. 
 
Llj6 
 
 INDEX. 
 
 Cephalic douche, 493, 854. 
 
 douche, cold, in typhoid, 493. 
 douche, physiological effects of, 
 
 493. 
 douche, therapeutic applications 
 
 of, 493- 
 Cerebellum, irritation of, 856. 
 Cerebral activity, to excite, 775. 
 anemia, 494, 508, 677, 75 h 855, 867. 
 apoplexy, 1055. 
 congestion, 466, 478, 494, 508, 610, 
 
 622, 660, 661, 749, 754, 756, 764, 
 
 776, 807, 837, 844, 855, 856, 880, 
 
 899, 940. 
 congestion in dengue, 1015. 
 congestion in insomnia, 1070. 
 congestion in meningitis, 999. 
 congestion in pneumonia, 1005. 
 congestion in typhus, 1010. 
 congestion in yellow fever, 1011. 
 douche, 506. 
 douche, physiological effects of, 
 
 507. 
 excitation, tepid douche to head 
 
 in, 494- 
 ganglia, reflex activity of, 610. 
 hyperemia, 501, 502, 612, 844, 855. 
 irritation, 494, 610. 
 rheumatism, 1007. 
 See Brain. 
 Cerebrospinal douche, 507. 
 
 meningitis, 521, 545, 999. 
 Cervico-occipital headache, 1069. 
 typhoid, 587. 
 typhoid, 587. 
 Chapman on cold to spinal cord, 778. 
 
 on hot bag to spine, 812. 
 Charcot on the douche, 436, 937. 
 Charcot's joints in locomotor ataxia. 
 
 1055- 
 Chardin, Sir John, 30. 
 Charrin on the alkalinity of the 
 blood, 966. 
 defense of the organism, 574. 
 Chest compress, half, 861-63. 
 compress, heating, 863. 
 dropsy of, 683. 
 exudates in, 748. 
 ice to, in pneumonia, 787. 
 neutral douche to, in asthma, 
 
 509- 
 pack, 238, 853, 857. 
 pack, hot, 864. 
 pack, hot and cold, 849. 
 pack, method, 857. 
 pack, physiological effects of, 
 
 862. 
 pack, precautions respecting, 864. 
 
 Chest pack, square, 858. 
 
 pack, therapeutic applications. 
 862. 
 
 pack, towel, 860. 
 
 pack, triangular, 859. 
 Chilblains, 471, 632, 1096. 
 Children, convulsions of, 624. 
 
 incontinence in, 495, 1047. 
 
 lavage for, 887. 
 
 nocturnal enuresis of, 768, 1947. 
 
 typhoid in, 647, 987. 
 Chill, 828. 
 
 in dengue, 1015. 
 
 in jaundice, 1044. 
 
 in malaria, 991. 
 
 in pelvic peritonitis, 1090. 
 
 in pulmonary tuberculosis, 1019. 
 
 recurring, in erysipelas, 997. 
 
 in yellow fever, ion. 
 China, wet-sheet pack in, 21. 
 Chinese, affusion used by, 21. 
 
 massage, 675. 
 Chloroform anesthesia, 823, 845, 869. 
 
 collapse, 823. 
 Chloral habit, 1098. 
 
 neutral bath in, 553. 
 Chlorosis, 609, 637, 646, 661, 723, 1082. 
 
 cold douche in, 443, 476: 
 Cholagogic effects, 239. 
 Cholera, 896, 1014. 
 
 infantum, 810, 1040. 
 
 morbus, 624, 810, 1042. 
 Chorea, 560, 610, 809, 1056. 
 
 habit, 718. 
 
 major, 647, 809. 
 Chordee, 908. 
 Circle douche, 482. 
 Circulation of blood, 54. 
 
 effect of cold upon, 107-10, 746. 
 
 effect of heat upon, 96, 146. 
 
 effect of wet-sheet pack on, 611. 
 
 Kiernan on, 741. 
 
 peripheral, 646. 
 
 peripheral, in organic cardiac dis- 
 ease, 1079. 
 
 portal, 740. 
 
 sedatives of, 262. 
 Circulatory reaction, 129, 162, 241. 
 
 by cold friction, 645. 
 
 following Scotch douche, 464. 
 
 by neutral percussion douche. 
 456. 
 
 of percussion douche, 454. 
 Cirrhosis of liver, 1044. 
 
 of liver in diabetes, 1026. 
 Classification of hydriatic effects, 
 191. 
 
 of temperatures, 100. 
 
INDEX. 
 
 1 177 
 
 Clavus, 1068. 
 
 Clergyman's sore throat, 866, 1073. 
 
 Climacteric, Scotch douche in, 465. 
 
 Cocaine habit, 1098. 
 
 Cocainism, 553, 809. 
 
 Coccygodynia, 513, 771, 879. 
 
 Coccyx, neuralgic affections of, 1051. 
 
 Coefficients, physical, 356. 
 
 Coffee habit, 618, 1099. 
 
 in typhoid, 587. 
 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, 
 
 939- 
 in burns, 269. 
 changes produced by, 163. 
 effects of, anesthetic, 270. 
 
 analgesic, 265. 
 depressant, 101. 
 
 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. 
 
 C0 2 elimination, 125. 
 
 circulation, 107-10. 
 
 electrotonus, Hermann, 939. 
 
 excretion, 124. 
 
 heat elimination, 105. 
 
 heat production, 105. 
 
 metabolism, 122. 
 
 muscles, 111-2. 
 
 nervous system, 112-20. 
 
 perspiration, 105. 
 
 respiration, no, in. 
 
 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, 39i, 405, 53i. 
 • Dujardm-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. 
 
 m 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, 428. 
 
 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 
 Schiiller on, 437. 
 Cold friction mitt, 308, 642, 1103. 
 Cold towel rub, 307, 446, 632, 647, 
 1 103. 
 
1 178 
 
 INDEX. 
 
 Colds, 384, 866. 
 
 breaking up, 621. 
 
 in head, 839. 
 
 sweating bath in, 238. 
 Coil, cooling, 787. 
 
 therapeutic applications of. 788. 
 Colic, 266, 510, 807. 
 
 biliary, 1044. 
 
 enema in, 897. 
 
 gastric, 546. 
 
 hepatic or biliary, 266, 897. 
 
 in influenza, 1013. • 
 
 intestinal, 546. 
 
 renal, 266, 546, 1045. 
 
 renal, in lithemia, 1022. 
 
 uterine, 769. 
 Colitis, chronic, 847, 1042. 
 
 pseudo-membranous, 897, 898. 
 Collapse, 197, 209, 521, 522, 600, 621, 
 622, 631, 809, 855, 897. 
 
 in anesthesia, 800, 823. 
 
 cardiac, 603. 
 
 in cardiac disease, 1081. 
 
 in cholera, 624, 1014. 
 
 in cholera infantum, 1040. 
 
 in cholera morbus, 1042. 
 
 in diphtheria, 1001. 
 
 in hemorrhage, 620. 
 
 hot affusion to head in, 494. 
 
 in plague, 1016. 
 
 in tonsillitis, 1001. 
 
 in typhoid, 896. 
 
 in yellow fever, ion. 
 Collateral anemia, 759. 
 
 hyperemia, 241. 
 Coloclyster, 891, 897-9, 9 01 - 
 Colon, atony of, 837, 899. 
 
 dilatation of, 661, 768, 832, 837, 
 
 . 8 99-. 
 
 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, 993. 
 
 in typhoid, 987. 
 
 in typhus, 1010. 
 Compress, 771. 
 
 abdominal cold, Le Drau on, 786. 
 
 abdominal heating, 749, 835-6. 
 
 Compress, abdominal, contraindica- 
 tions and precautions, 836. 
 
 abdominal, sedative effects of, 
 264. 
 
 alternate, 816. 
 
 alternate, therapeutic effects of, 
 817. 
 
 in appendicitis, 781. 
 
 " C0 2 ," 772 . 
 
 carbonic acid gas, 773. 
 
 cardiac: See Cardiac compress. 
 
 cephalic : See Cephalic compress. 
 
 chest : See Chest compress. 
 
 clay, Benjamin Rush on, 771. 
 
 cold : See Cold compress. 
 
 cool, 783, 784. 
 
 cooling : See Cooling compress. 
 
 evaporating, 788, 789. 
 
 gastro-hepatic hot and cold, 846. 
 
 graduated, 317. 
 
 half-chest, 861-2. 
 
 head, 854. 
 
 head, hot and cold, 843. 
 
 heating: See Heating compress. 
 
 hot, 197, 748. 
 
 hot and cold : See Hot and cold 
 compress. 
 
 ice : See Ice compress. 
 
 intestinal, hot and cold, 847. 
 
 irrigating, 789-90. 
 
 joint, 853, 872. 
 
 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, 774. 
 
 precordial : See Precordial or 
 Cardiac compress. 
 
 proximal, 275. 746, 700. 
 
 proximal, useful applications of, 
 791. 
 
 renal, hot and cold, 846. 
 
 revulsive, 818-20. 
 
 roller, 853. 
 
 special forms of, 853. 
 
 spinal, 264, 313, 777, 856. 
 
 therapeutic applications, 775. 
 
 thoracic, 862. 
 
 throat, 853, 865. 
 
 very cold, 772. 
 
 warm, 748. 
 
 warm, and sponging, antispas- 
 modic effect of, 270. 
 Confusional insanity, 1065. 
 Congestion, 451. 
 
 of abdominal viscera, 832. 
 
INDEX. 
 
 1179 
 
 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, 462, 466, 
 
 611, 661, 831. 
 hypostatic, 521. 
 
 of intestines, chronic, 461. 
 
 of kidneys, 808, 832. 
 
 of liver, 445, 457, 461, 511, 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, 936, 940, 944. 
 visceral, 245, 612, 820, 836, 877. 
 visceral, in acute bronchitis, 1075. 
 visceral, in cholera, 1014. 
 visceral, in plague, 1016. 
 visceral, in typhus, 1010. 
 Congestive headache, 855. 
 Conjunctivitis, chronic granular, 809. 
 Constipation, 456, 472, 496, 500, 503, 
 
 qio, 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, 1062. 
 
 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, 83S. 
 
 affusion, 522. 
 
 anal douche, 505. 
 
 Brand bath, 329, 593-94. 
 
 cold bath, 208, 221, 344, 369-73, 
 
 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 pack, 617. 
 cold sitz, 766. 
 cold towel rub, 653. 
 cooling compress, 787. 
 douche, 432. 
 flowing foot bath, 756. 
 
n8o 
 
 INDEX. 
 
 Contraindications, 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. 
 
 percussion, 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. 
 Contusions, 1100. 
 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, 1001. 
 
 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, 853, 872. 
 Couette on the douche, 430. 
 Cough in bronchitis, acute, 1075. 
 
 Cough in bronchitis, chronic, 1076. 
 
 hacking, 884. 
 
 in hysteria, 1057. 
 
 in laryngitis, 1073. 
 
 in measles, 997. 
 
 in pneumonia, 1004. 
 
 in pulmonary tuberculosis, 862, 
 1019, 1020. 
 
 tickling, 884. 
 
 in typhoid, 981. 
 Counterbalancing reaction, 138. 
 Counter-irritation of filiform douche, 
 
 485. 
 Cramp, writer's, 1063. 
 Cramps in cholera, 1015. 
 
 in legs in plague, 1016. 
 
 muscular, in arthritis deformans, 
 1086. 
 
 neutral douche in, 452. 
 Crawford on effect of cold bath, 121. 
 Crises, 385. 
 Croup, 866, 916, 1074. 
 
 in diphtheria, 1003. 
 
 false, 1074. 
 Crural neuralgia, 465, 599. 
 Cullen's use of water, 27. 
 Currie, on physiological effects of 
 cold, 101. 
 
 on effects of temperature, 143. 
 
 on immersion bath, 526. 
 
 method of, in cold full bath, 527. 
 
 on neutral bath, 552. 
 
 principles of, 30. 
 
 on sponge bath, 637. 
 
 statistics by, 530. 
 
 use of warm affusion by, 295. 
 
 use of cold affusion, 519, 522, 532. 
 
 on water drinking, 921. 
 Curiosities of common water, 1723. 
 Curtis on urethritis, 907, 908. 
 Cutaneous affections, 446. 
 
 areas useful for derivative ef- 
 fects, 733. 
 
 circulation, 747. 
 
 congestion, 611. 
 
 disease, 385. 
 
 eruption, 419, 446, 622, 680, 1097. 
 
 hyperesthesia, 479, 560, 680, 707. 
 
 irritation, effects of, 102. 
 
 reflex areas, 117, 118. 
 
 respiration, 67. 
 
 stimulation by electro-chemical 
 bath, 949. 
 
 thermic applications, reflex effect 
 of, 96. 
 Cyanosis, 559, 632, 647, 844. 
 
 areolar, 337, 870. 
 
 in broncho-pneumonia, 1077. 
 
INDEX. 
 
 Il8l 
 
 Cyanosis in cholera, 1014. 
 
 in functional 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, 1010. 
 
 in yellow fever, ion. 
 Delmas on exercise, 351. 
 Dengue, 616, 624, 647, 1015. 
 Depressant, cold a, 101. 
 
 effects of heat, to avoid, 197. 
 
 effects of Scotch douche, 464. 
 Derivative effects, 241, 254. 
 
 effects, cutaneous areas which 
 may be utilized for, 733-51. 
 
 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, 1001. 
 
 in pneumonia, 1004. 
 
 in pulmonary tuberculosis, 1020. 
 
 in rheumatism, acute, 1008. 
 
 in scarlet fever, 994. 
 
 in smallpox, 998. 
 
 summer, 1040. 
 
 in tea and coffee habit, 1100. 
 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, 
 1 106. 
 
 in nephritis, acute, 1045. 
 Dietary, aseptic, 1103. 
 Dietl on nature cure, 925. 
 Dieulafoy, ice-bags in typhoid, 777. 
 Digestion, effect on temperatre, 81. 
 
 improvement in, 530. 
 
 painful, in hyperpepsia, 1033. 
 Digestive viscera, disorders of, 660. 
 Digitalis, 869, 870. 
 
 effect on heart, 205. 
 Dilatation, cardiac, 691. 
 
 of colon, 661, 768, 832, 837, 899. 
 
 gastric, in typhoid fever, 892. 
 
 of stomach, 472, 498, 661, 768, 832, 
 887, 1033. 
 
 of stomach, cold gastric douche 
 in, 510. 
 Diphtheria, 547, 802, 866, 916, 1001. 
 Diphtheritic paralysis, 485. 
 Dislocations, 800, 1100. 
 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, 766. 
 
 alternate, 470. 
 
 alternate, in hypertrophy of pros- 
 tate, 481. 
 
 alternate, physiological effects, 
 470. 
 
 alternate, spinal, 264. 
 
II82 
 
 INDEX. 
 
 Douche, alternate, therapeutic applica- 
 tions, 471, 
 alternate, in vesical paresis, 481. 
 anal : See Anal douche, 
 apparatus, 427. 
 
 articular : See Articular douche, 
 ascending, 480-1. 
 bladder, therapeutic applications, 
 
 90S- 
 
 caliper, 481-2. 
 
 cardiac, 509. 
 
 cautions, respecting its use, 442. 
 
 cephalic : See Cephalic douche. 
 
 cerebral, 506-7. 
 
 cerebrospinal, 507. 
 
 circle, 482. 
 
 cold, 432. 
 
 cold, graduated, 441. 
 
 Couette on, 430. 
 
 contraindications, 432, 445. 
 
 dorsal, 495. 
 
 enteric, 510. 
 
 epigastric : See Epigastric 
 
 douche, 
 effect upon temperature, 430. 
 fan : See Fan douche, 
 filiform: See Filiform douche, 
 fog, 486. 
 
 fog, therapeutic applications, 486. 
 to feet, 462, 501. 
 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, 198. 
 
 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. 
 
 Douche, Scotch : See Scotch douche. 
 
 sedative, 264. 
 
 shoulder, 497. 
 
 simultaneous Scotch, 460. 
 
 splenic, 511. 
 
 spinal, 462. 
 
 spinal, warm, 496. 
 
 spray, cold, 502. 
 
 tepid : See Tepid douche. 
 
 therapeutic applications of, 432. 
 
 thoracic: See Thoracic douche. 
 
 used by Greeks, 22. 
 
 vaginal, 909-12. 
 
 vapor: See Vapor douche. 
 
 visceral, 505. 
 
 visceral, forms of, 506. 
 
 visceral, physiological effects of, 
 505. 
 
 warm, abdominal, 501. 
 
 warm, in anal fissure, 481. 
 
 warm, in irritable rectum, 481. 
 Draper on temperature in bath, 126. 
 Dreams in neurasthenia, 1061. 
 Drinking after laparotomy, Tait, 932. 
 Drinking, water: See Water drink- 
 ing. 
 Dripping sheet, 603, 653, 656, 1103. 
 
 physiological effects, 658. 
 
 therapeutic applications, 659. 
 Dropsy, 457, 471, 544, 560, 618, 718, 
 1083. 
 
 abdominal, 611, 837. 
 
 in anemia, 231, 1083. 
 
 cardiac, 228, 637, 646, 662, 691. 
 
 in cirrhosis of liver, 1044. 
 
 of chest, 683, 818. 
 
 general, 1084. 
 
 hot bath in, 228. 
 
 in nephritis, 230. 
 
 in organic cardiac disease, 1079. 
 
 renal, 637. 
 
 water drinking in, 923. 
 Drowning, 522, 822. 
 Drug habits, 647, 1098. 
 
 habits in emaciation, 1029. 
 
 hypnotic, 833. 
 
 poisoning, 818. 
 Drugs, asphyxia from, 779. 
 Dry abdominal bandage, 838. 
 Dry friction : See Friction, dry. 
 Dry heat, 269. 
 Dry pack, 619. 
 
 contraindications, 621. 
 
 method, 619. 
 
 physiological effects, 620. 
 
 requisites, 619. 
 
 therapeutic applications, 620. 
 Dry protection, 613. 
 
INDEX. 
 
 H83 
 
 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, 882. 
 
 in mumps, 1001. 
 Eclampsia, 624. 
 Eczema, 376, 472. 
 
 in diabetes, 1026. 
 Edema in acute febrile disorders, 
 1018. 
 
 angioneurotic, 809. 
 
 of joints, 471. 
 
 of legs and joints, 471, 1026. 
 
 maleolar, 1084. 
 
 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 2 , 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, 1031. 
 
 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. 
 
1184 
 
 INDEX. 
 
 
 Endocarditis in scarlet fever, 995. 
 
 in smallpox, 998. 
 
 in typhoid, 984. 
 Endometritis, 500. 
 Enema, 891-902. 
 
 in abdominal surgery, 893. 
 
 antipyretic effects of, 318, 320. 
 
 cold, 766, 894-6. 
 
 cold, effects upon the heart, 202. 
 
 cold in fever, Jacques on, 320. 
 
 in constipation, 893. 
 
 De Hahns, Germany, on, 894. 
 
 graduated, 891, 901-2. 
 
 hot, 896-7. 
 
 in constipation, 893. 
 
 in infantile diarrhea, 897. 
 
 in jaundice, 896, 900. 
 
 Kemp, Krull, and Stadelmann on, 
 
 in ovariotomy, 894. 
 
 in pelvic pain, 266. 
 
 in temperature reduction, 894. 
 
 in typhoid, 896. 
 
 warm, Schuller, 899. 
 Energy, nervous, 211. 
 Enteralgia. 46^, 501, ^10, 766, 820, 
 
 829,832,879. 
 
 in neuralgia, 1051. 
 Enteric douche, 510. 
 Enteritis, 600, 661. 
 
 in scarlet fever, 995. 
 Enteroclyster. 891, 897. 
 Entero-colitis in febrile disorders, 1017. 
 Enteroptosis. 456, 484, 496, 500, 503, 
 771, 832, 877, 1037- 
 
 in anemia. 1083. 
 
 in chlorosis. 1082. 
 
 in constipation. 1036. 
 
 and dilatation of stomach, 1034. 
 
 headache due to. 1067. 
 Enuresis, nocturnal. 913. 
 
 nocturnal, of children, 768. 
 Epigastric douche, 239, 498. 
 
 Scotch, 499. 
 
 therapeutic applications, 498. 
 
 very hot, 498. 
 Epigastrium, fomentation to, 239. 803. 
 
 ice-bag to. 240. 
 Epilepsy. 561. 610, 618, 1056. 
 
 in chronic gout. 1024. 
 Epileptic state, 857. 
 Enistaxis, 503, 760. 
 Erethism, sexual, 853. 855. 
 Ergograph, 150, 514. 615. 
 Erotomania, 453, 771. 
 Eructations, gaseous, in chronic gas- 
 tritis, 1031. 
 
 in nervous dyspepsia, 1039. 
 
 Eruptions, 1097. 
 
 cutaneous, 419, 446, 622, 680. 
 
 delayed in measles, 996. 
 
 delayed in scarlet fever, 994. 
 
 delayed in smallpox, 998. 
 Eruptive fevers, 611, 680. 
 Erysipelas, 278, 616, 785, 803, 997. 
 
 typhoid with, 988. 
 Erythema, 680, 789, 1096. 
 
 nodosum, 471. 
 Erythro-melalgia, red neuralgia, 1051. 
 Esophageal veins, 741. 
 Ether spray, 270. 
 Evaporating compress, 788-9. 
 
 sheet, 625-7. 
 
 sheet, cold, 308. 
 
 sheet, hot, 309. 
 
 sheet, physiological effects of, 
 626. 
 
 sheet, therapeutic applications, 626. 
 Evaporation, 626. 
 
 heat elimination by, 290, 315, 317. 
 Excitability of spinal centers, 453. 
 Excitant effects of alternate douche, 
 470. 
 
 of fomentation, 796. 
 
 of hot douche, 447. 
 
 local, 222. 
 
 primary, 194-207. 
 
 of rain douche, 474. 
 
 of Scotch douche, 463. 
 
 secondary. 207. 
 Excretion, 124, 611. 
 Exercise and bathing, 349-50. 
 
 Delmas on. 351. 
 
 effect on temperature, 81. 
 
 with hydrotherapy, 348. 
 Exhaustion, 900. 
 
 alcoholic, 508. 
 
 hot douche in, 450. 
 
 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, Schuller, 604. 
 
 on rate of heating. 826. 
 
 Schiiller's, 95, 103, 114, 610. 
 
 of Schultze, on temperature, 783. 
 
 Strasser's, 123. 
 
 of Vinaj, 95. 
 
 Wertheimer's, 102. 
 Experiments, summary of, 1107. 
 Extractives, Robin on, 576. 
 Extremities, cold, in melancholia, 1064. 
 
 1 
 
INDEX. 
 
 1 185 
 
 Extremities, cold, in nervous dys- 
 pepsia, 1039. 
 cold, in neurasthenia, 1062 
 Exudates, tfh 49A 640, 705, 748, 828, 
 
 chronic, articular douche in, 5*4 
 meningitis with, 597, 705- 
 in pleurisy, 1077. 
 in pneumonia, 1004. 
 rheumatic, 484- 
 Eye, inflammations of, 1090. 
 
 inflammation of, in influenza, 1013. 
 
 S.S 6 77 ,785,8 2 o. 
 
 Eye dfseas 3 e 6 s of, 269,780, 80!, 8o 2 . 
 
 inflammation of, 1096. 
 Face, ache of, 808. 
 Fallopian tubes, diseases of, 77h »47, 
 
 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, 4»3- 
 revulsive, 484. 
 Scotch, 497- 
 tepid thoracic, 499- . 
 therapeutic applications, 483. 
 Farquharson on incontinence, 801. 
 Fasting, effect of, on heat production. 
 
 82. 
 Fat glands, 66. 
 Fauces, inflammation 01, 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- . , . . oQ /r 
 
 Fenwick, on cold in pneumonia, 28O. 
 Fever, go, 335-42, 549, 573^94, 599, 
 602, 646, 676, 776, 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. 
 75 
 
 Fever calorimeters, 88. 
 cases neglected, 349. 
 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, 609, 670. 
 cooling pack in, 603, 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. 
 gastric juice diminished in, 284. 
 in gout, 1023. 
 headache, 1069. 
 heat elimination in, 289, 583- 
 heat production in, 289, 583- 
 hot blanket pack in, 624. 
 hydriatic treatment of, Winter- 
 
 nitz, 592. 
 infectious, 597, 609, 855- 
 in influenza, 1013. 
 in insanity, 1065. 
 intermittent, 599, 609, 620. 
 in jaundice, 1043. 
 low, 868. 
 in malaria, 991. 
 in mania, 1065. 
 
 partial cold applications m, 321. 
 in peritonitis, 1048. 
 in pneumonia, 1005. 
 prolonged, 521. • . 
 
 in 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, 850. 
 sponge bath, 637-9- 
 in tonsillitis, 1002. 
 in typhoid, 982. 
 in typhus, 1010. 
 value of affusion in, 520. 
 water drinking in 320, 920, 921. 
 wet-sheet pack in, 603, 610. 
 wet-sheet rub, 659. 
 Fibroids, 941. 
 
 bleeding, 600. 
 
n86 
 
 INDEX. 
 
 Fidgets in insomnia, 1070. 
 
 in neurasthenia, 1061. 
 Filiform douche, 485. 
 Finkler on alternate bath, 312. 
 Finland, Russian bath in, 699. 
 
 sweating bath in, 719. 
 Finsen on light, 721. 
 
 on smallpox, 171. 
 
 on tuberculosis, 721. 
 Flatulence, 481, 482, 510, 832, 836, 838, 
 850, 1033. 
 
 in hyperpepsia, 1033. 
 Fleming on Turkish bath and water 
 
 drinking, 922. 
 Flesh, reduction of, 598. 
 Fleury, 95, 126. 
 
 reflex relationships, 937. 
 Flint, Austin, 306, 924. 
 Fluxion, 242, 729. 
 
 effects of cold massage douche, 
 490. 
 Fog douche, 486. 
 Fomentations, 612, 791. 
 
 to abdomen, 311. 
 
 analgesic effects, 797-9. 
 
 calorific effects of, 259. 
 
 combined with electric current, 
 
 94 1 - . 
 
 contraindications, 810. 
 
 derivative effects, 798. 
 
 to epigastrium, 239. 
 
 excitant effects, 796. 
 
 over liver, 239. 
 
 method, 792. 
 
 mustard, 814. 
 
 physiological effects, 796. 
 
 requisites, 792. 
 
 to spine, 311, 802. 
 
 therapeutic applications, 798. 
 Fonssagrives, 279. 
 Food, heat value of, 77. 
 
 regurgitations of, 850. 
 Foot, neuralgia of, 758. 
 Foot bath, alternate, 758. 
 
 cold, 753. 
 
 cold, contraindications for, 754. 
 
 cold, physiological effects, 754. 
 
 cold, therapeutic applications, 754. 
 
 flowing, contraindications, 756. 
 
 flowing, therapeutic applications, 
 756. 
 
 hot, 756. 
 
 hot, emmenagogic effects of, 240. 
 
 hot, physiological effects, 757. 
 
 hot, therapeutic applications, 757. 
 
 running, or flowing, 755. 
 
 shallow, 755. 
 Foot douche, 462, 501. 
 
 Foot pack, 853, 880. 
 
 therapeutic applications, 880. 
 Forges on drug asphyxia, 779. 
 Fractures, 800, 1100. 
 Franck, experiments of, 116. 
 Friction areas, Dana, 677. 
 
 bath, cold, 301. 
 
 cold, 197, 203, 259, 446, 632, 633, 
 637, 642-7, 827, 837, 42. 
 
 with cold baths, 950. 
 
 cold, contraindications, 647. 
 
 cold, method, 643. 
 
 cold, physiological effects, 644. 
 
 cold, requisites, 643. 
 
 cold, therapeutic applications, 645. 
 
 cold wet, 308. 
 
 dry, 202, 663-81. 
 
 dry, contraindications, 677. 
 
 dry, method, 644. 
 
 dry, physiological effects, 672. 
 
 dry, therapeutic applications, 674. 
 
 effects of, in cold bath, 126. 
 
 with Mydriatic measures, 950. 
 
 physiological effects, 164-7. 
 
 and reaction, 603. 
 Fruit 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, as a hygienic measure, 531. 
 
 cold, method of, 532. 
 
 cold, method of Currie in, 527. 
 
 cold, physiological effects of, 528 
 
 cold, therapeutic applications of, 
 529. 
 Gsertner, tonometer of, 931. 
 Galen on alternate baths, 312. 
 
 warm bath in fever, 547. 
 Gall-stones, 239, 511, 546, 800, 900, 
 928, 1044. 
 
 in lithemia, 1022. 
 Galvanic current, hydriatic applica- 
 tions combined with, 936, 938, 
 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, 1019. 
 
 senile, 761. 
 
 of skin, Hebra on, 558. 
 Gargling, 883. 
 Gastralgia, 266, 496, 498, 510, 932. 
 
INDEX. 
 
 II87 
 
 Gastralgia in neuralgia, 105 1. 
 
 in rheumatism, acute, 1008. 
 Gastric 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. 
 Gastritis, 498, 820, 886. 
 
 in alcoholism, 1098. 
 
 chronic, 445, 482, 798, 510, 609, 
 660, 661, 810, 833, 837, 889, 1030. 
 
 chronic, in emaciation, 1028. 
 
 in febrile disorders, acute, 1017. 
 Gastro-duodenitis, 499, 510. 
 
 in pneumonia, 1004. 
 Gastro-hepatic compress, hot and 
 
 cold, 846. 
 Gastro-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, atony of, 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, 716, 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, 
 
 320. 
 Hamilton, continuous bath, 761. 
 Hancocke, John, water drinking, 318. 
 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; 
 
 INDEX. 
 
 Head, colds in, 839. 
 
 compress, 854. 
 
 compress, hot and cold, 843. 
 
 fan douche to, in typhoid, 493. 
 
 hot affusion to, 494. 
 
 neuralgia, chronic, and rheu- 
 matic affections of, 839, 1050. 
 
 pack, 839. 
 
 tepid douche to, in cerebral ex- 
 citation, 494. 
 Headache, 638, 640, 828, 944, 1066. 
 
 anemic, 801, 839, 856. 
 
 in cardiac disease, organic, 1079. 
 
 chronic, 502, 839. 
 
 congestive, 502, 855, 1060. 
 
 in enteroptosis, 1038. 
 
 in gout, 1023. 
 
 in hydropathic, 382, 417, 501. 
 
 in influenza, 1013. 
 
 in jaundice, 1043. 
 
 in lithemia, 1022. 
 
 in measles, 996. 
 
 in meningitis, 999. 
 
 in mumps, ion. 
 
 nervous, 844, 1060, 1100. 
 
 in nervous dyspepsia, 1040. 
 
 neurasthenic, 844, 1060. 
 
 periodical, 1067. 
 
 in pneumonia, 1005. 
 
 in smallpox, 998. 
 
 in tea and coffee habit, 1100. 
 
 in typhoid, 981. 
 
 in yellow fever, 1011. 
 Heart, effects of alcohol, on, 205, 587, 
 589. 
 
 deficient compensation, 445. 
 
 effects of cold upon, 202. 
 
 effect of digitalis upon, 205, 869. 
 
 effect of heat upon, 147, 448. 
 
 failure, 588, 603, 800, 863. 868. 
 
 failure in broncho-pneumonia, 
 1077. _ 
 
 failure in cholera, 1015. 
 
 fatty degeneration of, 445. 
 
 functional disease of, 869, 1081. 
 
 hypertrophy of, in organic car- 
 diac disease, 1080. 
 
 palpitation of, 414, 501, 863. 
 
 palpitation of, in anemia, 1083. 
 
 temperature of, 80. 
 
 tonics, hydriatic, 200. 
 
 valvular disease of, 445, 869, 1079. 
 
 weak, in pneumonia, 1004. 
 
 See Cardiac. 
 Heartburn in nervous dyspepsia, 1039. 
 Heat, animal, yy. 
 
 antiphlogistic effects of, 279. 
 
 to avoid depressant effects of, 197. 
 
 Heat, to be avoided after baths, 353. 
 and cold, comparative table of 
 
 effects of, 188. 
 and cold, revulsion by, 247-9. 
 dry, 269. 
 effect upon the blood, 156, 583. 
 
 HC1 production, 158. 
 
 the circulation, 146. 
 
 the heart, 147, 448. 
 
 heat elimination, 145. 
 
 heat production, 158. 
 
 the muscles, 150. 
 
 the liver, 158. 
 
 the nervous system, 153. 
 
 nutrition, 156. 
 
 oxidation, 157. 
 
 protoplasmic activity, 153. 
 
 respiration, 144, 149. 
 
 the skin, 142. 
 
 the stomach, 158. 
 
 tactile sensibility, 145. 
 
 temperature, 158. 
 
 vasoconstrictors, 143. 
 elimination, 86, 626. 
 
 diminished by dryness of 
 skin, 325, 578. 
 effect of cold upon, 105. 
 effect of heat upon, 145. 
 
 by evaporation from skin, 84, 
 290, 315-7. 
 
 in fever, Winternitz, 583. 
 
 to increase, 975. 
 
 to lessen, 977. 
 
 rate of, 326. 
 
 relation of, to antipyretic 
 methods, 289. 
 
 symptoms of decreased, 291. 
 excitant effects of, 194. 
 exhaustion, 1069. 
 functions, control of, 03. 
 hemostatic effects of, 271. 
 organic changes produced by, 
 
 163. 
 physics of, 44. 
 
 physiological effects of, 141. 
 primary effects, 192. 
 production and body tempera- 
 ture, 91. 
 
 causes which decrease, 82, 
 
 977- 
 causes which increase, 81, 
 
 975- 
 effect of cold upon, 105. 
 effect of fasting and sleep 
 
 upon, 82. 
 effect of heat upon, 158. 
 effect of hot and cold air 
 
 upon, 82, 90. 
 
INDEX. 
 
 1 189 
 
 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. 
 
 units, 46. 
 
 units, daily production of, 78. 
 
 use of, in vaginal irrigation, 912. 
 
 value of food, 77. 
 Heating compress, 239, 772. 
 
 abdominal, 749, 835-8. 
 
 abdominal, method, 836. 
 
 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, 828. 
 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 burns, 558, 561. 
 
 on pemphigus, 558, 561. 
 Heggelim on the douche, 446. 
 Helmholtz 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, 198. 271, 600, 1102. 
 
 cold sitz in, 766. 
 
 collapse after, 620. 
 
 following electrolysis, 941. 
 
 gastric, in plague, 1016. 
 
 in gastric ulcer, 1039. 
 
 intestinal, 766, 776, 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, 777, 857. 
 
 renal, in plague, 1016. 
 
 steam in, 919. 
 
 of stomach, 198, 892. 
 
 of urethra, 766. 
 
 uterine, 754, 766, 776, 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, 832, 940. 
 
 congestion in cardiac disease, 
 1080. 
 
 congestion in gastritis, 1031. 
 
 congestion in gout, 1024. 
 
 douche, 239, 510. 
 
 enlargement in malaria, 992. 
 
 headache, 1068. 
 
 inactivity, 244. 
 
 pain, 461, 511, 677, 800. 
 
 sclerosis, 272, 446. 
 
 See Liver. 
 
1 190 
 
 INDEX. 
 
 Hermann, cold in electrotonus, 939. 
 
 Hernia, irreducible, 809. 
 
 Herpes, circinatus, 808. 
 
 Herpes zoster, 815, 1051. 
 
 Herz on heat elimination, 325, 578. 
 
 Hibernation, 98. 
 
 Hiccough in hysteria, 1058. 
 
 in myelitis, acute, 1052. 
 
 in dilatation of stomach, 1035. 
 Hip pack, 853, 873. 
 
 Hippocrates, on cooling compress, 
 780. 
 
 on sun bath, 724. 
 
 on water drinking, 920. 
 
 on the use of water, 22. 
 Horizontal douche, 632. 
 
 jet, 431, 432-46, 495- 
 
 jet, contraindications, 445. 
 
 jet, physiolgical effects, 436. 
 
 jet, therapeutic applications, 440. 
 Horslev, alcohol on the heart, 587. 
 Hot-air bath, 687. 
 
 among Japanese, 693. 
 
 contraindications, 692. 
 
 local, 259, 692. 
 
 local, therapeutic applications, 
 
 693- 
 
 method, 687. 
 
 physiological effects, 690. 
 
 therapeutic applications, 690. 
 
 effect of, upon heat production, 
 82, 90. 
 Hot applications, 748, 749. 
 
 for bruises, 268. 
 
 general principles, 192. 
 
 reflex effects, 154. 
 
 for relief of pain, 265-7. 
 
 for sprains, 268. 
 
 when required, 325. 
 Hot bath, 230, 539. 
 
 in Bright's disease, 229. 
 
 cautions respecting, 228. 
 
 in dropsy, 228. 
 
 in Japan, 541, 543. 
 
 in rheumatism, Laseque, 546. 
 
 short, 209. 
 
 in vaginal discharge, 547. 
 Hot blanket pack: See Blanket pack, 
 
 hot. 
 Hot and cold applications, alternate, 
 161, 747. 
 
 applications to mucous passages, 
 
 913. 
 bath, 312. 
 
 compress, 750, 840, 853. 
 gastro-hepatic, 846. 
 to head, 843. 
 
 Hot compress, heating, or pack, 751, 
 847. 
 
 heating, physiological effects, 
 
 . 848. 
 
 intestinal, 847. 
 
 to lung, 844. 
 
 method, 841. 
 
 pelvic, 847. 
 
 physiological effects, 842. 
 
 renal, 846. 
 
 therapeutic applications, 842. 
 
 and heating pack, 751, 847. 
 
 abdominal, 849. 
 
 chest, 849. 
 
 lumbar, 851. 
 
 pelvic, 852. 
 
 pelvic, method, 852. 
 
 pelvic, therapeutic applica- 
 tions, 852. 
 
 physiological effects, 848. 
 
 spinal, 851. 
 
 trunk, 240, 849. 
 douche, 194, 197, 446. 
 
 effect upon muscular irrita- 
 bility, 438. 
 
 to feet, 462. 
 
 gastric, 282. 
 
 to hypogastrium, 496. 
 
 Lemarchand on, 450. 
 
 lumbar, 199. 
 
 physiological effects, 447. 
 
 in pruritis, 481. 
 
 restorative effects, 450. 
 
 tonic effects, 450. 
 
 therapeutic applications, 449. 
 Hot evaporating sheet, 309. 
 sponge baths, 309. 
 sponging, for pruritis, 234. 
 spots, 69. 
 
 water, antipyretic effects of, 288. 
 water bag, 812, 821. 
 Hydriatic applications combined with 
 galvanic current, 940. 
 applications, therapeutic effects 
 
 of, 190. 
 effects, classification of, 191. 
 effects, general principles, 192. 
 effects, reflex, 936. 
 heart tonics, 200. 
 incompatibilities, 978. 
 institutions, 397. 
 measures, local or partial, 724. 
 measures to reduce temperature. 
 
 293. 
 prescription making, 354, 421, 964. 
 prescriptions, adaptation of, 979. 
 procedures, indications for, 327, 
 
 328, 967. 
 
INDEX. 
 
 II9I 
 
 Hydriatic training, 378. 
 
 treatment, dyspnea under, 416. 
 
 treatment of fevers, Winternitz, 
 592. 
 
 treatment, mortality of pneu- 
 monia under, 286. 
 
 treatment, mortality rate of ty- 
 phoid fever under, 285, 288. 
 Hydriatics, 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, 373. 
 
 general rules, 343. 
 
 history of, 21. 
 
 massages with, 681, 949. 
 
 physiology in relation to, 53. 
 
 as a prophylactic measure, 388. 
 
 in surgical cases, 1100. 
 
 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. 
 Hyperemia, 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. 
 
 Hyperesthesia in hysteria, 1058. 
 
 of lumbar ganglia, 462, 495, 503, 
 
 771, 832, 836, 851. . 
 of lumbar ganglia in migraine, 
 
 Io6 3-. 
 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 vesiculse seminales, 504. 
 Hyperidrosis, 1097. 
 Hyperorexia, 829. 
 
 Hyperpepsia, 282, 445, 466, 510, 751, 
 756, 759, 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. 
 Hypogastric 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, 484. 498, 
 530, 598, 609, 647, 677, 768, 828, 
 
1 192 
 
 INDEX. 
 
 Hypopepsia — continued. 
 
 832, 833, 851, 886, 888, 932, 940, 
 1032. 
 
 in anemia, 1083. 
 
 and apepsia, 1032. 
 
 caliper douche in, 482. 
 
 cold douche in, 443. 
 
 cold gastric douche in, 510. 
 
 in emaciation, 1028. 
 
 in pulmonary tuberculosis, 1020. 
 
 sinusoidal current in, 941. 
 Hypostatic congestion, 521. 
 
 congestion of lungs, 786. 
 Hysterectomy, enema in, 894. 
 Hysteria, 270, 384, 456, 495, 647, 705, 
 718, 808, 809, 857, 1057. 
 
 in dilatation of stomach, 1034. 
 
 in enteroptosis, 1038. 
 
 tepid bath in, 561. 
 
 in typhoid, 9J85. 
 Hysterical anesthesia, cold douche 
 in, 444. 
 
 anorexia, 809. 
 
 aphonia, cold douche in, 445. 
 
 hyperesthesia, cold douche in, 445 . 
 
 paralysis, 445, 485. 
 Ice to chest in pneumonia, Mays, 787. 
 
 cooling tissue by, 773, 774. 
 
 water in fever, Todano, 921. 
 Ice-bag, 244, 268, 275, 773, 776, 778, 
 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, 197, 198. 
 Ice-collar, 198, 275, 779. 
 Ice-compress, 197, 202, 268, 752, 777. 
 
 to spine, 198, 244, 856. 
 Ice-rub, 644. 
 Icterus, chronic, 484. 
 
 neonatorum, 829. 
 
 neutral bath in, 234. 
 
 sweating bath in, 234. 
 Immersion bath, 522, 526, 527. 
 
 alterative effects of, 258. 
 
 cold, 222, 296, 339, 527, 610. 
 calorific effects of, 259. 
 
 contraindications, 531. 
 Currie on, 526. 
 
 hot, 539, 599,. 675. 
 
 contraindications, 548. 
 
 and cold, 312. 
 
 emmenagogic effects of, 241. 
 
 Japanese method, 541. 
 
 revulsive effects of, 253. 
 
 Immersion bath, hot, method, 540. 
 physiological effects, 540. 
 therapeutic applications, 544. 
 
 method, 526. 
 
 physiological effects, 528. 
 
 tepid, 538. 
 
 tepid, physiological effects of, 
 538. 
 
 tepid, therapeutic applications, 
 538. 
 
 therapeutic applications, 529. 
 Immersion treatment of wounds, 761. 
 Impotence, 768, 877, 1093. 
 Incontinence in children, 495. 
 
 nocturnal, in children, 764, 768, 
 1047. 
 
 of urine, 495, 496, 503, 801, 1047. 
 
 of urine in hysteria, 1058. 
 
 Incurable maladies, 381. 
 Indigestion, 622, 723, 807, 828. 
 
 in chorea, 1057. 
 
 chronic, 642. 
 
 in enteroptosis, 1038. 
 
 in hypopepsia, 1032. 
 
 in mania, 1065. 
 
 in melancholia, 1064. 
 
 in neurasthenia, 1060. 
 
 in pernicious anemia, 1084. 
 
 in pulmonarv tuberculosis, 1019. 
 Induration in prostatitis, 1092. 
 Inebriety, cold douche in, 444. 
 Infancy, 339, q87. 
 Infantile convulsions, 547, 1063. 
 
 diarrhea, enema in, 897. 
 
 uterus, 496. 
 Infection of liver, 900. 
 
 local, temperature due to, 522. 
 
 malarial, 512, 661, 990. 
 
 malarial, chronic, 611. 
 
 malarial, chronic, toxemia in, 
 609. 
 
 prevention of, in cholera, 1014. 
 Infectious fevers, 597, 609. 
 
 jaundice, 245, 482, 499, 5 10, 511, 
 624, 705, 800, 829, 837, 900, 928. 
 Infiltration, amyloid, 829. 
 Inflamed hemorrhoids, 268. 
 Inflammation, acute, 246, 680, 779, 784. 
 
 acute, of pelvic viscera, 878. 
 
 acute, precautions required, 246. 
 
 alveolar, 778. 
 
 of bladder, 445, 804, 847. 
 
 of brain, chronic, 552. 
 
 of cecum, 832. 
 
 circum-uterine, 766. 
 
 cold in, 277. 
 
 of cord, chronic, 552. 
 
 of cornea, 802. 
 
INDEX. 
 
 1 193 
 
 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* 
 
 meningeal, 788, 856. 
 
 of muscles, 514, 780, 799. 
 
 non-suppurating, of ovaries and 
 tubes, 878. 
 
 of ovaries, 266, 445, 771, 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, 494, 
 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, 1026. 
 
 electricity in, 949. 
 
 electro-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. 
 Schuller on, 833. 
 spinal pack in, 265. 
 in sunstroke, 1069. 
 in syphilis, 1095. 
 in typhoid, 982. 
 ni typhus, 1010. 
 after withdrawal, in drug habits, 
 
 J ?99. 
 
 Institutions, hydriatic, 397. 
 Intercostal nerves, 852. 
 
 neuralgia, 465, 499, 638, 804. 
 Intermittent fever, 620. 
 
 malarlial fever, 599, 990. 
 Intestinal catarrh, 245, 445, 612, 647, 
 661, 829, 831, 836. 
 
 catarrh, chronic, 462, 482, 798, 
 1 041. 
 
 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, 1 041. 
 
 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. 
 
 gastric, Turck, 889. 
 
 of intestine, physiological effects 
 of, 898. 
 
1 194 
 
 INDEX. 
 
 Irrigation, nasal, 882. 
 
 post-nasal, 883. 
 
 rectal, 881, 902. 
 
 rectal, Reclus on, 896. 
 
 of stomach, 884. 
 
 of throat, 883. 
 
 of urethra, 907. 
 
 uterine, 198. 
 
 of urethra, Daggett on, 904. 
 
 vaginal, 199, 908. 
 
 vaginal, ancient use of, 29. 
 
 vaginal, Max Runge on, 910. 
 Irritability of bladder, 495, 501, 77*- 
 
 neutral ascending douche in, 481. 
 
 of genito-urinary center, 495, 857. 
 
 muscular, effect of heat upon, 150. 
 
 of nerve centers, 610. 
 
 of ovaries, 501. 
 
 of spinal centers, 840. 
 
 of splanchnics, 495, 501. 
 
 urethral, 504. 
 
 of uterus, 501. 
 
 of rectum, 481, 1094. 
 Irritation, cutaneous, effects of, 102. 
 
 of lumbar ganglia of abdominal 
 sympathetic, 501, 836. 
 
 phenomena of, 749. 
 
 of renal plexus, 496. 
 
 of skin. 789. 
 
 spinal, 840, 857. 
 
 of splanchnics, 40s, 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, 546, 1043. 
 Jaborandi, 899. 
 Jacques on cold enema in fever, 320. 
 
 statistics in typhoid, 592. 
 Japanese, hot-air bath among, 693. 
 
 method of hot immersion baths, 
 
 541, 543- 
 Jaundice, 450, 453, 613, 618, 705, 764, 
 
 I097- 
 catarrhal, 618, 837, 1043. 
 catarrhal, in influenza, 1013. 
 in cirrhosis of liver, 1044. 
 enema in, 896, 900. 
 in exophthalmic goiter, 1085. 
 infectious, 245, 482, 499, 510, 511, 
 
 624, 705, 800, 829, 837, 900, 928. 
 itching of, 546, 1043. 
 in pneumonia, 1004. 
 in yellow fever, 1012. 
 Jardet, effect of continuous bath on 
 
 urinary secretion, 558 . 
 
 Jet, broken, 428. 
 
 horizontal: See Horizontal jet. 
 
 steam, 197, 919-20. 
 Joint compress, 853, 872. 
 
 deformities in arthritis deform- 
 ans, 1086. 
 Joints, edema of, 471. 
 
 inflammation of, 775, 815. 
 
 inflammatory process in, in acute 
 rheumatism, 1006. 
 
 injury of, 815. 
 
 neuralgia of, 800. 
 
 pain in, 480, 484, 486, 515, 1006, 
 1086. 
 
 pain and swelling of, in gout, 
 1023. 
 
 painful and swollen, in lithemia, 
 1022. 
 
 prevent damage to, in acute rheu- 
 matism, 1007. 
 
 rheumatic, 480, 680, 693. 
 
 stiffened, 471. 
 
 stiffness of, in chronic rheuma- 
 tism, 1009. 
 
 swelling of, in chronic rheuma- 
 tism, 1009. 
 
 swollen, 519. 
 
 swollen, in dengue, 1015. 
 
 tuberculosis of, 815. 
 Jurgensen, on cold bath, 126. 
 Kaltenleutgeben, 702, 721. 
 Kaposi, use of continuous bath, 558. 
 Kellogg, John H., applicators, hol- 
 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, 533. 
 
 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, 918, 919. 
 
 on cold bath, effect of on blood.. 
 120. 
 
 douche apparatus, 427, 433. 
 
 douche table, 909. 
 
 dynamometer, 413. 
 
 electric cabinet, 711. 
 
 electric-light bath, 177, 219, 231, 
 380, 707, 716. 
 
 on electricity combined with 
 water, 938, 944, 945. 949- 
 
INDEX. 
 
 1 195 
 
 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. 
 Kiernan 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, 
 
 S5i. 
 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, 168-80. 
 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, 1044. 
 
 cirrhosis of, in diabetes, 1026. 
 
 disorders of, 660. 
 
 dyspeptic, 471, 660. 
 
1 196 
 
 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. 
 Loins, 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 douche, 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, 737. 
 
 disorders of, 660. 
 hypostatic congestion of, 786. 
 See Pulmonary. 
 Lymph glands, tuberculosis of, 810, 
 1020. 
 
 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, 
 5ii, 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. 
 Mammae, inflammation of, in mumps, 
 
 1001. 
 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, 
 95i. 
 
 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, 905. 
 Meniere's disease, 810. 
 
INDEX. 
 
 1 197 
 
 Meningeal inflammation, 788. 
 
 inflammation of spine, 856. 
 Meningitis, 552, 560, 600, 776, 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 insufficiency 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. 
 
 sedatives, 263. 
 Muscles, abscess of, in typhoid, 985. 
 
 contractures of, 515. 
 
 effect of cold upon, ill. 
 
 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, 1 05 1. 
 
 chronic, 597, 618, 1052. 
 Myocarditis, 338, 600, 631, 785, 869. 
 
 in erysipelas, 997. 
 
 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, 72,7. 
 
 douche, 198. 
 
 hemorrhage, 883. 
 
 irrigation, 882. 
 
 secretion diminished, 839. 
 Naso-pharyngeal irritation in mea- 
 sles, 996. 
 Nauheim baths, 562. 
 Naumann, 103, 164, 672. 
 
1 198 
 
 INDEX. 
 
 Nausea in gall-stone, 1044. 
 
 in influenza, 1013. 
 
 in migraine, 1062. 
 
 in nephritis, acute, 1045. 
 Neale, 313. 
 
 Neck, pain in back of, 801. 
 Neck compress, 853, 866. 
 
 physiological effects, 866. 
 
 therapeutic applications, 866. 
 Nephritis, 230, 445, 565, 618, 631, 647, 
 705, 718, 808, 1045. 
 
 acute, of scarlet fever, 546. 
 
 in alcoholism, 1098. 
 
 chronic, in anemia, 1083. 
 
 chronic, Bright's disease, 1046. 
 
 in diabetes, 1026. 
 
 in diphtheria and tonsillitis, 1002. 
 
 in febrile disorders, acute, 1018. 
 
 in influenza, 1013. 
 
 in measles, 996. 
 
 in smallpox, 998. 
 
 in scarlet fever, 995. 
 
 in typhoid, 624, 986. 
 Nerve centers, 72. 
 
 centers, irritability of, 610. 
 
 circumflex, paralysis of, 810. 
 
 disorders, sympathetic, 801. 
 
 filaments, absorption of water by, 
 
 279, 55i. 
 tone in incontinence, 1047. 
 tone in neurasthenia, 1060. 
 Nerves, inflammatory affections of, 
 
 799- 
 
 sensibility of, diminished by ab- 
 sorption of water, 279, 551. 
 
 of skin, 67. 
 Vasoconstrictor, influence on, 780. 
 
 vasomotor, 73. 
 Nervous affections, 445, 622. 
 
 asthma, 466, 499, 501, 851, 856, 
 864. 
 
 asthma in enteroptosis, 1038. 
 
 dyspepsia, 609, 886, 1039. 
 
 energy, 211. 
 
 excitability, rain douche in, 478. 
 
 headache, 844, 1067. 
 
 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, 
 
 1053. 
 irritability in melancholia, 1064. 
 system, 455, 555. 
 
 system, effects of cold upon, 112. 
 system, effect of heat upon, 153. 
 system, sympathetic, 611. 
 
 Nervous vomiting, 496, 857. 
 Nervousness, 383. 
 
 in drug habits, 1099. 
 
 wet-sheet pack in, 604. 
 Neuralgia, 450, 457, 484, 485, 500, 618, 
 621, 705, 718, 776, 804, 815, 1050. 
 
 in anemia, 1083. 
 
 of bladder, 500, 769. 
 
 crural, 252, 268, 465, 599. 
 
 in exophthalmic goiter, 1085. 
 
 facial, 252, 705. 
 
 of Fallopian tubes, 771. 
 
 of foot, 758. 
 
 of genito-urinary organs, 770. 
 
 of hands, in arthritis deformans, 
 1086. 
 
 of head, 839. 
 
 intercostal, 252, 465, 499, 638, 804. 
 
 of joints, 800. 
 
 of kidney, 496, 512. 
 
 in lithemia, 1022. 
 
 lumbo-abdominal, 769. 
 
 malarial, 621, 705. 
 
 in neurasthenia, 1061. 
 
 ovarian, 465, 497, 500, 513, 600, 
 766, 769, 879. 
 
 reflex, 801, 1050. 
 
 revulsive Scotch douche in, 252. 
 
 in rheumatism, acute, 1008. 
 
 sciatic, 599, 600. 
 
 of skin, 446. 
 
 of spermatic cord, 513, 771. 
 
 spinal, 456, 480, 515, 613, 705, 829. 
 
 of testicles, 513, 769, 771. 
 
 uterine, 465, 497, 500, 513, 766. 
 
 visceral, in hysteria, 1058. 
 Neuralgic affections of pelvic vis- 
 cera, 879. 
 
 joints, 942. 
 
 pain, 940. 
 Neurasthenia, 258, 369, 384, 450, 456, 
 457, 462, 472, 476, 484, 496, 503, 
 553, 609, 610, 618, 631, 638, 646, 
 647, 661, 677, 680, 705, 718, 723 
 756, 801, 822, 899, 1059. 
 
 cold douche in, 443. 
 
 with cerebral congestion, 508. 
 
 in dilatation of stomach, 1034. 
 
 in enteroptosis, 1038. 
 
 gastric, 503, 598, 686. 
 
 in lithemia, 1022. 
 
 neutral douche in, 453. 
 
 percussion douche in, 455. 
 
 pulmonary douche in, 509. 
 
 in sunstroke, 1069. 
 Neurasthenic headache, 844, 1068. 
 
 symptoms in chronic intestinal 
 catarrh, 1041. 
 
INDEX. 
 
 1 1 99 
 
 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 effects, 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, 27a 
 
 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, 1001. 
 
 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. 
 uccipital sinus, 735. 
 Occupation neuroses, 809, 829. 
 Oil rubbing : See xCubbing, oil. 
 Oils, antiseptic volatile, 882. 
 Old age, cold bath in, 339, 392. 
 
 typhoid in, 647, 987. 
 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, 163. 
 
 headache, 1068. 
 Organism, natural defense of, 574, 
 
 965. 
 Organotherapy, 359. 
 Oscillatory reaction, 347. 
 Osier, statistics in typhoid, 586. 
 
1200 
 
 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, 513, 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, Winternitz, 603. 
 
 dry : See Dry pack. 
 
 foot : See Foot pack. 
 
 half, 622. 
 
 head, 839. 
 
 heating, 610, 824, 837. 
 
 heating compress or, 824. 
 
 heating, hot and cold, 847. 
 
 heating, hot and cold, physio- 
 logical effects of, 848. 
 
 hip, 853, 873. 
 
 hip, tonic, in amenorrhea, 241. 
 
 hot blanket : See Blanket pack, 
 hot. 
 
 hot and cold : See Hot and cold 
 pack. 
 
 leg : See Lee: pack. 
 
 lumbar, hot and cold, 851. 
 
 neutral, 610. 
 
 pelvic : See Pelvic pack. 
 
 shower : See Shower pack. 
 
 spinal: See Spinal pack. 
 
 Pack, sweating : See Sweating pack. 
 
 tonic, 609. 
 
 trunk, cold, diuretic effects, 238. 
 
 trunk, hot and cold, 240, 849. 
 
 wet-sheet : See Wet-sheet pack. 
 Pail douche, 515, 610, 1103. 
 Pail pour, method, 516. 
 
 in Persia, Sir John Chardin on, 
 
 519. 
 
 physiological effects of, 518. 
 
 therapeutic applications of, 519. 
 Pain, 369, 417, 445, 451, 749, 864. 
 
 in abdomen and back in pneu- 
 monia, 1005. 
 
 in abdomen, in cholera infantum, 
 1040. 
 
 in back in irritable rectum, 1094. 
 
 in back and legs in meningitis, 
 999. 
 
 between shoulders in enterop- 
 tosis, 1038. 
 
 in cardiac disease, organic, 1079. 
 
 caused by treatment, 417. 
 
 in chest in pneumonia, 1004. 
 
 chronic, 800. 
 
 in chronic intestinal catarrh, 1041. 
 
 in cirrhosis of liver, 1044. 
 
 in constipation, 1036. 
 
 in dilatation of stomach, 1034. 
 
 in dysentery, acute, 1042. 
 
 in dyspepsia, 499. 
 
 in the eye, 268. 
 
 in eyes in neurasthenia, 1061. 
 
 in the eyeball, 269. 
 
 in gall-stone, 1044. 
 
 in gastric catarrh, acute, 1030. 
 
 in gastric ulcer, 1039. 
 
 in head, back, and legs in in- 
 fluenza, 1012. 
 
 in head in plague, 1016. 
 
 in hemorrhoids, 267, 1095. 
 
 hot applications for the relief of, 
 265-9. . 
 
 in hysteria, 1058. 
 
 in jaundice, 1043. 
 
 in joints, 480, 484, 486, 515. 
 
 in joints in arthritis deformans, 
 1086. 
 
 in joints in lithemia, 1022. 
 
 in joints in rheumatism, acute, 
 1006. 
 
 in legs in myelitis, acute, 1052. 
 
 in legs in typhus, 1010. 
 
 lightning, in locomotor ataxia, 
 457, 480, 489, 496, 512, 814, 857, 
 I055- 
 
 local, in drug habits, 1099. 
 
 local, in locomotor ataxia, 1055. 
 
INDEX. 
 
 I20I 
 
 Pain, local, in scurvy, 1029. 
 
 in loins and legs, in yellow fever, 
 
 ion. 
 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, 105 1. 
 in neuritis, 1049. 
 in neuritis, multiple, 1049. 
 nocturnal, in syphilis, 1095. 
 pelvic, 267, 462, 599, 676, 759, 879, 
 
 Io8 7\ 
 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, 385. 
 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, 501, 863, 986. 
 of heart under treatment, 414. 
 Palsy, Bell's, 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. 
 
 76 
 
 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, 1060. 
 Paresthesias, in arthritis deformans, 
 1086. 
 in drug habits, 1099. 
 Parker, Joseph, j&6. 
 Paroxysms of dyspnea, 856. 
 
 malarial, 990. 
 Partial hydriatic measures, 724. 
 Parturition, 809, 897. 
 Passavant, continuous bath in burns, 
 
 559- 
 Patients, training of, 403. 
 Paulus of iEgina 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, 086. 
 inflammation, 600, 803. 
 pack, 853, 873. 
 
 heating stage, 875. 
 hot, 750, 875, 879. 
 hot and cold, 852, 875. 
 hot and cold, method, 852. 
 hot and cold, therapeutic ap- 
 plications, 852. 
 neutral stage, 875. 
 physiological effects, 876. 
 repeated, 878. 
 sweating stage, 875. 
 
1202 
 
 INDEX. 
 
 Pelvic pack, therapeutic applications, 
 
 877. 
 tonic stage, 874. 
 
 pain, 462, 599, 676, 759, 879, 1087. 
 pain, hot sitz bath in, 267. 
 peritonitis, 847, 878, 1089. 
 sitz, 765. 
 viscera, congestion of, 660, 771, 
 
 852,877,878,896. 
 viscera, inflammation of, 878. 
 viscera, delayed development of, 
 
 496. 
 viscera, muscular spasm in, 852. 
 viscera, irritability of, 771. 
 viscera, neuralgic affections of, 
 
 879. 
 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, 682. 
 
 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, 881. 
 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, 600, 624, 
 754, 78o, 798, 803, 829, S32, 879, 
 1048. 
 
 in acute febrile disorders, 1017. 
 
 pelvic, 847, 878, 1089. 
 Pernicious anemia, 867, 1084, 1106. 
 Persia, pail pour in, 519. 
 Perspiration, Bouchard on, 606. 
 
 and constipation, Rohrig, 598. 
 
 effect of cold upon, 105. 
 
 effect of wet-sheet pack on, 6 1 1 , 6 1 8. 
 
 in neurasthenia, 1062. 
 
 profuse, 450. 
 
 profuse, in rheumatism, 1007. 
 
 profuse, Scotch douche in, 465. 
 Pfluger, 162, 165. 
 
 on alternate bath, 312. 
 Phagocytosis, 966. 
 Pharyngitis, 1072. 
 
 chronic, 884. 
 
 in scarlet fever, 994. 
 Pharynx, 737. 
 
 acute inflammation of, 866, 916. 
 Phlebitis, in acute febrile disorders, 
 1017. 
 
 in acute rheumatism, 1008. 
 
 in typhoid, 621, 984. 
 Phlegmons in typhoid, 987. 
 Photophore, 711. 
 Physical chart, 152. 
 Physical coefficients, 356. 
 Physics of air, 42. 
 
 of heat, 44. 
 
 of water, 38. 
 Physiological effects of abdominal 
 heating compress, 836. 
 
 ablution, 636. 
 
 affusion, 518. 
 
 alternate compress, 816. 
 
 alternate douche, 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, 495. 
 
 douche, 429. 
 
INDEX. 
 
 1203 
 
 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, 848. 
 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, 765. 
 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, 1018. 
 
 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, 
 844. 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, 996. 
 
 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, 809. 
 
 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, 03. 126. 16s. 
 
T204 
 
 INDEX. 
 
 Pospischil, 93, 126, 165, 596. 
 Post-nasal irrigation, 883. 
 
 region, inflammation of, 916. 
 Pott's disease, 1100. 
 Poultice, 771. 
 
 cotton, 279, 853, 872. 
 Pouring bath, 515. 
 
 Precautions respecting antipyretic 
 measures, 329. 
 
 relating to baths, 396. 
 
 special, respecting localized ap- 
 plications, 751. 
 Precordial compress, 202, 299, 867. 
 
 antipyretic effects of, 313. 
 
 contraindications, 871. 
 
 physiological effects, 868. 
 
 therapeutic applications, 868. 
 Pregnancy, 647. 
 
 albuminuria of, 624. 
 
 typhoid with, 988. 
 
 vomiting of, 851. 
 Priapism, 771, 1093. 
 Priessnitz, 35. 
 
 on cold water drinking, 920, 925. 
 
 on elbow bath, 759. 
 
 on wet-sheet pack, 600, 606. 
 
 on use of shower bath, 473. 
 Prillieux, 172. 
 Primary effects of cold, 193. 
 
 effects of heat, 192. 
 
 excitant effects, 194-207. 
 
 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. 
 
 hypertrophy of, 503. 
 
 hypertrophy of, alternate douche 
 in, 481. 
 
 inflammation of, 267, 847, 896, 
 902. 
 
 irritable in lithemia, 1022. 
 
 irritable, in spermatorrhea, 1093. 
 
 painful affections of, 766. 
 Prostatitis, 503, 600, 804, 878, 1092. 
 Prostatorrhea, 503. 
 Protected heating compress, 824. 
 Protective applications, 256. 
 
 Protoplasmic activity, effect of heat 
 
 upon, 153. 
 Proximal compress, 275, 746, 790. 
 compress, useful applications of, 
 791. 
 Pruntis, 450, 453, 554, 1071, 1096. 
 ani, 771. 
 
 ani in gout, 1023. 
 ani, hot douche in, 481. 
 in diabetes, 1026. 
 very hot sponging for, 234. 
 vulva, 771. 
 
 vulva, hot douche in, 481. 
 Psychrophore, 913. 
 Psoriasis, 716. 
 Puerperal fever, 519, 647. 
 
 insanity, 1065. 
 Pulmonary complications in measles, 
 996. 
 congestion, 501, 616, 646, 749, 759, 
 786, 805, 845, 862, 880, 940, 
 1076. 
 congestion, acute, 844. 
 congestion in diabetes, 1026. 
 congestion in typhoid, 984. 
 disease, 376. 
 douche, 508. 
 
 douche, cold, for sedentary neu- 
 rasthenics, 509. 
 hemorrhage, 198, 509, 760, 805, 
 
 844,856,863. 
 hemorrhage in tuberculosis, 1020. 
 
 inflammation, 863. 
 tuberculosis, 646, 862, 1019. 
 tuberculosis, cough in, 862. 
 tuberculosis, night sweats in, 638, 
 
 862, 1020. 
 See Lungs. 
 Pulsation of spleen, 59. 
 Pulse, 60. 
 
 dicrotic, 647. 
 
 frequent, in arthritis deformans, 
 
 1086. 
 slow, in functional cardiac dis- 
 ease, 1082. 
 Purpura, 647, 1029. 
 
 in emaciation, 1029. 
 Pylorus, obstruction of, 887. 
 Pyrosis in dilatation of stomach, 1034. 
 Rabbits, experiments upon, Schiiller, 
 
 _ 604. 
 Rachitis, rickets, 647, 1029. 
 
 in emaciation, 1029. 
 Radiation, of oiled surface, 685. 
 Rain douche, 472. 
 
 cold, combined with Russian bath, 
 
 477- 
 exciting effects of, 474. 
 
INDEX. 
 
 I205 
 
 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 significance of, 346. 
 
 thermic, 135-46, 241. 
 
 tonic, 131, 262. 
 
 vital, 162. 
 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. 
 
 ifritable, 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 ganglia, 610. 
 
 Reflex areas, cutaneous, 117. 
 
 effects of cold, 116. 
 
 effects of cutaneous thermic ap- 
 plications, 96. 
 
 effects of hot applications. 154. 
 
 effects, methods of producing, 
 119. 
 
 irritations, 499, 610. 
 
 neuralgias, 1050. 
 
 relations, 725, 734, 936-8. 
 Reflexes, 73. 
 Relapsing fever, 609. 
 Remier, statistics in scarlet fever, 
 
 586. 
 Remittent fever, 990. 
 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, 1016. 
 
 insufficiency, 244, 472, 496. 
 
 plexus, irritation of, 496. 
 
 vessels, 739, 741, 777. 
 
 See Kidney. 
 Rendu on wet-sheet pack, 602. 
 Resolvent effects, 257. 
 Restin 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. 
 
I206 
 
 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. 
 
 effects, general, 253. 
 
 effects of hot blanket pack, 254. 
 
 effects of hot immersion, 253. 
 
 effects 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. 
 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, 377, 457, 484, 618, 640, 
 661, 691, 705, 716, 719, 720, 723. 
 
 acute, 445, 815. 
 
 articular, 515, 804, 828, 1006. 
 
 chronic, 445, 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, 54^, 
 624, 829, 1025. 
 
 and neurasthenia, 553. 
 
 neutral bath in, Vigoroux, 553. 
 
 in scarlet fever, 995. 
 
 subacute, 624. 
 Rheumatoid influenza, 1013. 
 Rickets, 647, 1029. 
 
 cold bath in, 28. 
 Riess on continuous bath, 539, 558, 559. 
 Robertson, cold bath in alcoholic in- 
 toxication, 534. 
 
 Robin on extractives, 576. 
 
 Rogers on destruction of toxins in 
 
 liver, 576. 
 Rohrig on friction, 164, 672. 
 
 on perspiration and constipation, 
 
 . 598. 
 Rokitansky, 925. 
 Roller compress, 853. 
 Romans, oil rubbing used by, 684. 
 
 Turkish bath among, 694. 
 Romberg on heart failure, 580. 
 
 on peripheral vessels, 579, 588. 
 Roque, toxins in urine of typhoid 
 
 fever, 575. _ 
 Rosenbaum, gastric lavage, 885. 
 Rub, cold towel, 307, 647. 
 
 contraindications, 653. 
 
 method, 648. 
 
 physiological effects, 651. 
 
 requisites, 647. 
 
 therapeutic applications, 652. 
 Rub, wet-sheet : See Wet-sheet rub. 
 Rubbing, oil, 612, 684. 
 
 among natives of Africa, 685. 
 
 method, 684. 
 
 physiological effects, 684. 
 
 in Samoa, 685. 
 
 therapeutic applications, 685. 
 
 used by Romans, 684. 
 Rubbing shallow bath, 203, 645. 
 
 sitz bath, 645. 
 
 sitz bath, cold, 767. 
 
 sitz bath, cold, contraindications, 
 768. 
 
 sitz bath, cold, physiological ef- 
 fects, 767. 
 
 sitz bath, cold, therapeutic appli- 
 cations, 768. 
 Rubbing, wet hand: See Wet hand 
 
 rubbing. 
 Rubbing wet sheet, 203, 660. 
 
 contraindications, 663. 
 Runge, Max, 271. 
 
 vaginal irrigation, 910. 
 Running or flowing foot bath, 755. 
 Rush, Benjamin, clay compress, 771. 
 
 on enema, 894. 
 
 on ice compress, 313. 
 Russian bath, 675, 698. 
 
 cold rain douche with, 477. 
 
 contraindications, 700. 
 
 in Finland, 699. 
 
 therapeutic applications, 700. 
 Saline baths, 955. 
 
 composition of, 955. 
 Salpingitis, 600, 829, 879. 
 
 chronic, 462, 1091. 
 Salt glow, 641. 
 
INDEX. 
 
 1207 
 
 Salt, physiological effects, 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, 471, 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, 1101. 
 
 Scotch douche, 161, 456, 496, 497, 499, 
 675, 7^7, 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. 
 
I208 
 
 INDEX. 
 
 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, 1 08 1 . 
 
 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. 
 Simultaneous douche, Scotch, 460, 461. 
 Sinclair, John, wet-sheet pack used 
 
 by, 29. 
 Sinus, cavernous, 735. 
 
 lateral, 735. 
 
 longitudinal, 734, 735- 
 
 occipital, 735. 
 Sinusoidal, cathodic, and faradic ap- 
 plications in amenorrhea, 942. 
 
 current in apepsia and hypopep- 
 sia, 941. 
 Siphon hot-water bag, 812. 
 
 sack, 849. 
 Sitz bath, 761. 
 
 cold, 762. 
 
 cold, as a derivative measure, 
 764. 
 
 cold, contraindications for, 764, 
 766, 767. 
 
 flowing, 762. 
 
 hot, 599, 769. 
 
 hot, emmenagogic effects of, 240. 
 
 method, 761. 
 
 neutral, 770. 
 
 neutral, physiological effects of, 
 77o. 
 
 Sitz bath, neutral, therapeutic applica- 
 tions, 771. 
 
 physiological effects, 763. 
 
 prolonged cold, 764. 
 
 prolonged cold, physiological ef- 
 fects, 765. 
 
 prolonged cold, therapeutic ap- 
 plications, 765. 
 
 revulsive, 762, 766, 770. 
 
 rubbing, 645. 
 
 rubbing cold, 767. 
 
 rubbing cold, contraindications, 
 768. 
 
 rubbing cold, physiological ef- 
 fects, 767. 
 
 rubbing cold, therapeutic appli- 
 cations, 768. 
 
 therapeutic applications, 763. 
 
 very hot, 769. 
 
 very hot, physiological effects of, 
 769. 
 
 very hot, therapeutic applica- 
 tions, 769. 
 
 Winternitz on, 765. 
 Skin, 62. 
 
 absorption by, 67. 
 
 activity of, in nephritis, 1046. 
 
 anemia of, 597, 939. 
 
 area of, 316, 327. 
 
 in chronic diseases, 224. 
 
 chronic inactivity of, 928. 
 
 diseases, 376, 446, 759- 
 
 disorders, 700, 1096. 
 
 dry, 47 2 , io 97- 
 
 dry, heat elimination diminished 
 by, 325. 
 
 dry, heat elimination of, Herz, 
 578. 
 
 dry, in diabetes, 1027. 
 
 dry, in melancholia, 1064. 
 
 dry, in rheumatism, chronic, 1009. 
 
 effect of cold upon, 104. 
 
 effect of heat upon, 142. 
 
 elimination, Bouchard and Brun- 
 ner and Leyden on, 578. 
 
 eruptions in syphilis, 1095. 
 
 eruptive disorders, 419, 522, 680. 
 
 friction of, and increased elimi- 
 nation, Weyrich, 578. 
 
 gangrene, Hebra on, 558. 
 
 heat loss from, 84. 
 
 hyperemia, 759. 
 
 hyperesthesia of, 442, 446, 453, 
 486, 707. 
 
 inactive, 472, 661, 676, 723. 
 
 inactivity of, chronic, 928. 
 
 irritation of, 789. 
 
 nerves of, 67. 
 
INDEX. 
 
 1209 
 
 Skin, neuralgia of, 446. 
 
 formula to determine area of, 316. 
 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, 777, 856. 
 
 antipyretic effects of, 313. 
 cord in acute myelitis, 1051. 
 anemia of, 840. 
 congestion of, 245. 
 effect of cold upon, Dr. 
 
 Chapman, 778. 
 functional disorders, 705. 
 nutrition of, in locomotor 
 ataxia, 1054. 
 or dorsal douche, 495. 
 
 physiological effects of, 495. 
 therapeutic applications, 495. 
 
 Spinal douche, 462. 
 
 alternate, 264, 
 neutral, 270. 
 warm, 496. 
 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, 829, 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, 508, 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, 511. 
 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. 
 
I2IO 
 
 INDEX. 
 
 Sponge bath, therapeutic applications, 
 636. 
 
 very hot, 638. 
 Sponging, alternate, 196. 
 
 alternate spinal, 264, 639. 
 
 hemostatic effects of, 638. 
 
 hot, 638. 
 
 revulsive, 640. 
 
 very hot, for pruritis, 234. 
 
 and warm compress, anti-spas- 
 modic effects of, 270. 
 Sprains, 268, 640, 677, 754, 758, 800, 
 815, 1100. 
 
 arm, 759. 
 
 hot applications for, 268. 
 Spray, 479. 
 
 advantages over shower, 480. 
 
 douche, cold, 502. 
 
 ether, 106, 197, 270. 
 
 horizontal, 479. 
 
 hot, 479. 
 
 less exciting than full jet, 480. 
 
 Lister's, 920. 
 
 neutral, in ataxic pains, 480. 
 
 revulsive, 480. 
 Square chest pack, 858. 
 Stadelmann on enema, 898. 
 Statistics in scarlet fever, Remier and 
 Schill, 586. 
 
 in typhoid, Brand, 585. 
 Jacquez, 592. 
 Osier, 586. 
 
 in typhus, Currie, 530. 
 Steam inhalation, 915. 
 
 jet, 197, 919- 
 
 jet in hemorrhage, Kiliani and 
 Snegirjow, 919. 
 Sterility, 768, 1092. 
 Stimulant effects of heat, 142. 
 Stolz, 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, 1031. 
 
 painful affections of, very hot 
 gastric douche in, 510. 
 
 prolapse of, 832. 
 
 Stomach, sensory disturbance of, 850. 
 
 ulcer of, chronic, 499, 778. 
 
 See Gastric. 
 Stomach-tube, 884. 
 
 contraindications, 890. 
 Stools in chronic intestinal catarrh, 
 1041. 
 
 in cholera infantum, 1040. 
 Storoscheff on cold douche, 437. 
 Strain, 754, 800. 
 
 Strangulated hemorrhoids, 771. 
 Strasser on effects of cold bath, 971. 
 
 experiments of, 123. 
 
 experiments on rate of heating 
 of compress, 826. 
 
 on wet-sheet pack, 600. 
 Strychnia, 210, 869. 
 Stupor, 647. 
 St. Vitus's dance, neutral douche in, 
 
 453- 
 Subinvolution of uterus, 245, 500, 
 
 503, 513. 
 Submucous fibroids, 941. 
 Sudorific effects, 223. 
 Suffocation in diphtheria and tonsil- 
 litis, 1003. 
 Sugar in sweat, 66. 
 
 in urine, 413. 
 Sulphur bath, 956. 
 Summary of effects of cold, 181. 
 
 of effects of heat, 185. 
 Sun bath, 196, 722. 
 
 Diogenes and Plutarch on, 723. 
 
 Hippocrates and Pliny on, 724. 
 
 physiological effects, 723. 
 
 precautions, 724. 
 
 therapeutic applications, 723. 
 Sunburn, 169. 
 Sunstroke, 1069. 
 
 with pallor, 404, 751. 
 
 Paulus of TEgma, and Winter- 
 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 hydro- 
 therapy in, 1 100. 
 
 fever, 1102. 
 
 shock, 1 102. 
 Swartz, Dr., on effects of hot bath, in 
 Japan, 543. 
 
INDEX. 
 
 I2II 
 
 Sweat, 63, 66. 
 
 See Perspiration. 
 Sweating bath, 225. 
 
 circumscribed, 236. 
 
 in colds, 238. 
 
 contraindications, 236, 237, 335. 
 
 elimination by, 235, 236. 
 
 expectorant effects, 237. 
 
 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, 
 
 237- 
 
 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. 
 Table of areas of transferred pain, 
 
 945- 
 classification of hydriatic effects, 
 
 191. 
 classification of temperatures, 
 
 100. 
 of comparative effects of heat and 
 
 cold, 188. 
 Tachycardia, 869. 
 
 in functional cardiac disease, 
 
 1081. 
 in rheumatism, 1008. 
 
 Tactile sense, effect of heat upon, 145. 
 Tarnier, 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. 
 
1212 
 
 INDEX. 
 
 Tepid sponge bath, 639. 
 
 thoracic douche, fan, 499. 
 Testicles, inflammation of, 481, 1001. 
 
 neuralgia of, 513, 769, 77*- 
 Tetany, 610, 705, 718, 809. 
 Thayer on effect of cold bath on cor- 
 puscles, 582. 
 on leucocytosis, 971. 
 Therapeutic applications, ablution, 
 636. 
 applications, alternate, to spine, 
 
 822. 
 bath, Brand, 573. 
 continuous, 558. 
 effervescent, 565. 
 electric-light, 717. 
 foot, cold, 754. 
 foot, flowing, 756. 
 foot, hot, 757. 
 full, cold, 529. 
 graduated, 537. 
 hot air, 690. 
 hot air ?< local, 693. 
 immersion, hot, 544. 
 immersion, tepid, 538. 
 mud, 569. 
 neutral, 552. 
 outdoor, 960. 
 Russian, 700. 
 sea, 568. 
 shallow, 597. 
 site, cold, 763. 
 sitz, cold rubbing, 768. 
 sitz, neutral, 771. 
 sitz, prolonged cold, 765. 
 sitz, very hot, 769. 
 sun, 723. 
 surge, 567. 
 Turkish, 697. 
 vapor, 704. 
 vapor, local, 706. 
 coloclyster, 899. 
 compress, 771. 
 
 abdominal heating, 836. 
 alternate, 817. 
 cephalic, 855. 
 cold, 784. 
 evaporating, 789. 
 heating, 828. 
 hot and cold, 842. 
 neck, 866. 
 neutral, 814. 
 perineal, 881. 
 precordial, 868. 
 revulsive, 820. 
 cooling coil, 788. 
 douche, 432. 
 
 alternate, 471. 
 
 Therapeutic applications — continued, 
 douche, articular, 514. 
 
 bladder, 905. 
 
 cephalic, 493. 
 
 dorsal or spinal, 495. 
 
 epigastric, 498. 
 
 fan, 483. 
 
 filiform, 485. 
 
 fog, 486. 
 
 hot, 449. 
 
 hypogastric, 500. 
 
 massage, 489. 
 .neutral, 452. 
 
 percussion, 455. 
 
 perineal, 503. 
 
 rain, 476. 
 
 revulsive, 468. 
 
 Scotch, 464. 
 dripping sheet, 659. 
 dry shampooing, 683. 
 effects of hydriatic applications, 
 
 190. 
 evaporating sheet, 626. 
 fomentations, 798. 
 friction, 674. 
 friction, cold, 645. 
 gastric lavage, 88". 
 horizontal jet, 440. 
 irrigation of bladder, 905. 
 pack, chest, 862. 
 
 cooling, 616. 
 
 dry, 620. 
 
 foot, 880. 
 
 hot-blanket, 624. 
 
 leg, 880. 
 
 pelvic, 877. 
 
 pelvic, hot and cold, 852. 
 
 shower, cold, 617. 
 
 spinal, 840. 
 
 sweating, 618. 
 
 wet-sheet, 609. 
 pail pour, 519. 
 percussion, 682. 
 plunge, cold, 525. 
 oil rubbing, 685. 
 towel rubbing, cold, 652. 
 wet-hand rubbing, 630. 
 wet-sheet rub, 659. 
 salt glow, 642. 
 water drinking, 923. 
 wet girdle, 831. 
 Therapeutic significance of reaction. 
 
 346. 
 Thermes on leucocytosis, 971. 
 Thermic applications, cutaneous, re- 
 flex effects of, 96. 
 fever, 1069. 
 functions, 92. 
 
INDEX. 
 
 1213 
 
 Thermic reaction, 135-40. 
 Thermo-electric bath, 948. 
 Thermo-electrical effects of cold, 129. 
 Thermogenesis, lessened, 624. 
 Thermometer, 50. 
 
 temperature test without, 49. 
 Thermometry, 48. 
 Thermophore, 813, 849, 850. 
 Thirst in diabetes, 1026. 
 Thompson, experiments on dogs, 783. 
 Thoracentesis, 774. 
 Thoracic compress, 862. 
 
 douche, 497. 
 
 douche, physiological effects of, 
 408. 
 
 douche, tepid fan, 499. 
 Threadworms, 898. 
 Throat, catarrh of, 376. 
 
 compress, 853, 865. 
 
 fomentations to, 802. 
 
 irrigation of, 883. 
 
 rawness of, 884. 
 
 sore, 866. 
 
 sore, clergyman's, 866. 
 Tic, 809. 
 Tissue cooling by ice, 773, 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, 458. 
 463- 
 
 pack, 609. 
 
 pack, hip, in amenorrhea, 241. 
 
 reaction, 131, 262. 
 
 stage of pelvic pack, 874. 
 
 stage of wet-sheet pack, 606. 
 Tonics, medicinal, 210. 
 Tonometer of Gsertner, 931. 
 Tonsillitis, 802, 1001, 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, 
 896. 
 
 Toxemia, chronic, 609, 618, 624, 646, 
 705. 
 chronic, cold douche in, 443. 
 in chronic dyspepsia, 609, 700, 
 . 7i8. 
 
 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, 970. 
 procedures to encourage elimina- 
 tion of, 970. 
 tissue, elimination of, 607. 
 in urine in typhoid fever, Roque 
 and Wile, 575. 
 Training for cold douche, 441. 
 hydriatic, 378. 
 of neurasthenics, 457. 
 of patients, 403. 
 Traumatic arthritis, 640. 
 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, 209. 
 Trunk pack, cold, 238, 622. 
 
 pack, hot and cold, 240, 849. 
 Tubercular pleurisy, 1078. 
 Tuberculosis, 339, 609. 646, 818. 
 in emaciation, 1028. 
 Finsen of Copenhagen on, 721. 
 of joints, 815. 
 
 of lymph glands, 810, 1020. 
 pulmonary, 646, 862, 1019. 
 
1214 
 
 INDEX. 
 
 Tuberculosis, pulmonary, cough in, 
 862. 
 
 pulmonary, night sweats in, 638, 
 862, 1020. 
 
 typhoid with, 988. 
 Tumefaction of face in smallpox, 998. 
 Turck on gastric lavage, 886, 889. 
 Turkish bath, 694, 718. 
 
 among Romans, 694. 
 
 contraindications, 698. . 
 
 method, 694. 
 
 physiological effects, 696. 
 
 therapeutic applications, 697. 
 
 and water drinking. Fleming, 922. 
 Tympanitis of typhoid, 803, 982. 
 
 in chronic gastritis, 10.31. 
 
 in pneumonia, 1004. 
 Typhoid, 621, 631. 
 
 in the aged, 647, 987. 
 
 ataxic cases of, 777. 
 
 Bouchard on, 964. 
 
 in children, 647. 
 
 coffee in, 587. 
 
 cold cephalic douche in, 493. 
 
 collapse in, 896. 
 
 delirium of, 610. 
 
 in diabetics, 647. 
 
 enema in, 896. 
 
 fever, 547, 616, 617, 637, 777, 784, 
 786, 809, 818, 846, 894, 979. 
 
 fever, gastric dilatation in, 892. 
 
 fever, under hydriatic treatment, 
 288. 
 
 fever, mortality rate under hydri- 
 atic treatment, 285. 
 
 fever, tepid bath in, 539. 
 
 fever, toxins in urine of, 575, 587. 
 
 ice bags in, Dieulafoy, 777. 
 
 in infants, 987. 
 
 in influenza, 1013. 
 
 nephritis in, 624. 
 
 with puerperal fever, 988. 
 
 skin elimination in, Leyden, 578. 
 
 state in acute febrile disorders, 
 1019. 
 
 state in plague, 1016. 
 
 statistics in, 585, 586, 302. 
 
 tea in, 587. 
 
 tympanitis of, 803, 982. 
 Typho-malarial fever, 621, 989. 
 Typhus, 616, 809. 
 
 cold bath in, Surgeon Mc Gregor, 
 
 : 532. 
 
 fever, 610, 1010. 
 
 fever, Currie's statistics with 
 
 cold bath in, 530. 
 and scarlet fever, cold affusion 
 
 in, Currie, 522. 
 
 Ulcer, chronic, 759. 
 
 gastric, 466, 465, 510, 810, 888. 
 gastric, chronic, 499, 778. 
 gastric, in emaciation, 1028. 
 of leg, chronic, 472. 
 rectal, 267, 707, 778, 915. 
 rectal, very hot anal douche in, 
 
 505. . 
 
 syphilitic, 1095. 
 Ulceration of cornea, 802. 
 
 intestinal, in typhoid, 983. 
 Umschlag, 849. 
 
 Untoward effects of cold applica- 
 tions, 217. 
 
 effects of hydrotherapy, 382. 
 
 effects of sedative applications, 
 263. 
 Urea, increase under treatment, 413. 
 Uremia, hot blanket pack in, 235. 
 
 in insanity, 1066. 
 Uremic coma, 624. 
 Urethra, acute catarrh of, 771. 
 
 hemorrhage of, 766. 
 
 irrigation of, 907. 
 
 irrigation, Daggett of Buffalo, 
 904. 
 
 irritable, in spermatorrhea, 1093. 
 
 tenesmus in, 881. 
 Urethral irritability, 504. 
 Urethritis, 878. 
 
 chronic, 503, 907. 
 
 Curtis on, 907, 908. 
 Uric acid diathesis, 598, 705, 719, 
 1021. 
 
 acid in migraine, 1062. 
 Urinary incontinence, 495, 503, 764, 
 768, 801, 1047. 
 
 incontinence in hysteria, 1058. 
 
 retention, 495, 497, 768. 
 
 secretion, scanty, 503. 
 Urine, observations on effect of con- 
 tinuous neutral bath on, Jar- 
 det, 558. 
 
 scanty, in cholera, 1014. 
 
 scanty, in gout, 1024. 
 
 scanty, in typhoid, 986. 
 
 suppression of, 807. 
 
 suppression of, in renal colic, 
 1045. 
 
 toxicity of, in typhoid, Chan- 
 temesse, 587. 
 
 of typhoid fever, toxins in, 575. 
 Urticaria, 450, 554, 638. 
 
 in acute rheumatism, 1008. 
 Uterine colic, 769. 
 
 congestion, 852, 881, 936, 940, 
 944. 
 
 disease with dysmenorrhea, 1087. 
 
INDEX. 
 
 1215 
 
 Uterine disorders, 677, 764. 
 
 displacement, 503, 513, 768, 1101. 
 
 headache, 1069. 
 
 hemorrhage, 754, 77&, 857, 878. 
 
 irrigation, 198. 
 
 neuralgia, 465, 497, 500, 513, 766. 
 
 pain, 500, 897. 
 
 prolapse, 877. 
 
 prolapse, cold douche in, 481. 
 
 vegetations, 941. 
 Uterus, 739. 
 
 elctrolysis to, 944. 
 
 hyperesthesia of, 852. 
 
 infantile, 496. 
 
 inflammation of, 445, 503, 804, 
 
 . 8 47- 
 
 inflammation of chronic, 500. 
 
 inflammation, subacute, 771. 
 
 irregular contractions of, 897. 
 
 irritability of, 501. 
 
 neuralgia of, 497, 500, 1051. 
 
 subinvolution of, 245, 503, 513, 
 768. 
 
 tenesmus in, 881. 
 Uvula, elongated, 917. 
 Vaginal discharge, bloody, 548. 
 
 discharge, hot bath in, Tarnier, 
 
 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, 73. 
 
 centers, stimulation of, 832. 
 
 disturbance, 272, 675, 801. 
 
 effects of hot douche, 447. 
 
 nerves, 73. 
 
 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, 501, 771, 
 852. 
 
 irritation in incontinence, 1047. 
 
 paresis, alternate douche in, 481. 
 
 tenesmus, 500, 504, 513, 771, 852, 
 881. 
 
 See Bladder. 
 Vesiculae 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. 
 congestion in plague, 1016. 
 douche, 505. 
 douche, forms 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. 
 
I2l6 
 
 INDEX. 
 
 Vomiting in dropsy, 1084. 
 in drug habits, 1098. 
 
 in erysipelas, 997. 
 fecal, 889. 
 
 in gall-stone, 1044. 
 
 in gastric catarrh, acute, 1030. 
 
 in gastric dilatation, 1034. 
 
 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, 1001. 
 
 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, 1010. 
 
 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, Schiiller on, 8C9. 
 Wasting disease, 646. 
 Water absorption, sensibility of 
 nerves diminished by, 279, 551. 
 
 analgesic effects of, combined 
 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 effects 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, 929. 
 
 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, 920. 
 in " fever of Bender," Sir John 
 
 Chardin, 921. 
 free, when to avoid, 932. 
 Hippocrates on, 920. 
 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. 
 Weil's 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, 1103. 
 contraindications, 633. 
 method, 627. 
 
 physiological effects, 630. 
 therapeutic applications, 630. 
 Wet-sheet pack, 600. 
 
 alterative effects of, 258. 
 antipyretic effects of, 284, 603. 
 in China, 21. 
 contraindications, 613. 
 cooling, 304. 
 cooling stage, 606. 
 effects of, 611. 
 eliminative effects of, 604. 
 heating effects of, 604. 
 Kussmaul on, 602. 
 Lucas, 600. 
 method, 600. 
 
INDEX. 
 
 I2iy 
 
 Wet-sheet 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. 
 
 Winternitz on, 284, 600. 
 Wet-sheet rub, 203, 610, 653, 660, 837, 
 1 103. 
 
 contraindications, 663. 
 
 method, 653. 
 
 physiological effects, 658. 
 
 requisites, 653. 
 
 salt, 661. 
 
 therapeutic applications, 659. 
 Wet-towel rub, 307. 
 Weyrich, 166. 
 
 on friction, 578, 673. 
 Whooping-cough, 647, 866, 102 1. 
 Wile, toxins in urine of typhoid 
 
 fever, 575. 
 Wilson, J. C, 285. 
 
 Winternitz, 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. 
 Winternitz, 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 leucocytosis, 971. 
 
 on prolonged cold sitz, 765. 
 
 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, 777. 
 
 inflamed, 775. 
 
 painful, 268. 
 Wright, Dr., 519. 
 Writer's cramp, 456, 1063. 
 Yellow fever, 616, 624, 647, ion. 
 Ziemssen, 303. 
 
WAY 2 1906 
 

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