CHAPTER IV.

THE USES OF BATHS.

We do not propose to enter at all fully into the question of the place which baths ought to occupy as remedies for disease; but we shall merely indicate some of the chief conditions for which bathing might reasonably be expected to be of service. It has been generally claimed for baths that they cure everything; and, in fact, the many unfounded assertions as to the remedial powers of hot and cold water, which have been made by professed hydropathists and others, have done much to bring these very useful agents into disrepute.

It proved very puzzling to the acute mind of the author of the ‘Bubbles from the Brunnens,’ that the baths and waters which he encountered in his travels seemed capable of curing everything; and it was difficult to understand how patients whose conditions were in no way similar should apparently derive equal benefit from precisely the same treatment; and perhaps we shall not be wrong in assuming that the very healthy mode of life which is pursued by visitors to baths has much to do with the good results of treatment.

The most common purpose for which baths are used is the cleansing of the skin, and the importance of this, of course, cannot be over-estimated. When we speak of a clean skin we mean a skin with clean pores as well as a clean surface. The indolent and luxurious man, whose skin is spotlessly clean, but whose sense of the proprieties is such that he never indulges in a good vulgar sweat, has not, in reality, so healthy and clean a skin as the navvy, whose myriad sweat-ducts are constantly being flushed by the hardness of his work; but whose skin surface, possibly, is soiled with the various grimy particles with which his labour has brought him in contact. A clean skin is an impossibility without perspiration; and if the necessary perspiration be not brought about by the ordinary business of life, it is advisable to encourage it by artificial means. Hence bathing is more necessary to the man of sedentary occupation than to one who knows the daily luxury of physical exertion. For the purposes of cleansing, the bath should be warm, the skin should be well soaped, and a subsequent thorough friction with a rough towel should be indulged in. This process has the effect of removing the outer layer of the cuticle, of softening the secretion lying in the mouths of the sweat-ducts, and by the action of the heat dilating the blood-vessels of the skin and encouraging perspiration. Its utility and its comfort are so well known that there is no necessity for making any formal remarks thereupon.

Perhaps there is no better form of exercise than that to be found in a good swimming bath, always provided that an open river or the sea is not at hand. The swimmer exercises every muscle in his body; and, if swimming be vigorously kept up, there is nothing which more speedily induces fatigue. For an athlete in training a daily swim ought to be a part of his course of exercise. We wish there were more swimming baths in London than there are. Such as exist are all overcrowded in the summer, and in many of them the ventilation is not of the best. To take violent exercise in a close, badly-ventilated room must be wrong, and we would advise no one to patronise a bath which smells in the least degree stuffy. Swimming should be practised not more than once a day, and about midway between two meals. The bather, at the commencement of his course, should not remain more than five minutes in the water; and if his bath be not followed by a healthy glow, he will recognise that even that is too much for him. The time of the bath may be gradually extended.

The cold bath in the morning is a luxury of which most of us know the value. It cleanses, stimulates, and braces; and, if used in moderation, conduces to health. A word of caution is necessary to those who use their “morning tub” too heroically. The best criterion as to the advisability of continuing its use is the readiness and completeness of the reaction; and, if there is any feeling of chilliness, languor, or want of appetite, with an inability to eat breakfast, it is as well to ask whether, possibly, the cold bath had better be moderated. Persons who suffer from rheumatic pains, or sciatica, or neuralgia, ought also to be careful about continuing a practice which may be too severe for them. It is always easy to add a small quantity of warm water to the bath. There can be no doubt that a daily bath is absolutely necessary for the health of children who are tender-skinned and too young to attend to their personal cleanliness.

There are certain diseases in which cold bathing is of acknowledged service:--

Foremost among these is _fever_, and it is not too much to say that many lives have been saved by the timely use of the cold bath. The use of it, however, requires great judgment and knowledge, and it is not applicable to every case, and is not without danger. In this country its use is restricted almost entirely to those cases in which the fever runs a very severe course, in which the bodily temperature rises above 105° Fahr., and the patient attains what is technically known as a condition of hyperpyrexia. The use of cold baths in fevers has been known from time immemorial, although it has only attracted the attention of modern physicians during the last ten or fifteen years. The usual method of employing this treatment is to immerse the patient in a bath of about 90° Fahr., or 95° Fahr., and by means of removal of hot water and its renewal by cold, gradually, in about 20 minutes, to reduce the temperature to 60° Fahr. In this way the temperature of the patient may be reduced as much as four or five degrees, and his sufferings are usually very much diminished. Cold bathing cannot be said to _cure_ the fever, but it prevents some of its worst results, and may enable the patient to pass through a trying ordeal unscathed. All forms of fever may, occasionally, be treated with cold baths; but this method of treatment in no case shortens the course of the fever.

Cold bathing is of considerable use in some nervous affections, such as hysteria, St. Vitus’s dance, and spasmodic croup. These affections often, if not always, depend upon a depressed condition of health, and a cold bath of short duration (before a fire in winter), and followed by a brisk rubbing, is a very efficient means for their relief.

Rickets is benefited by cold bathing; but for the relief of this and other conditions of weakness the greatest moderation must be observed.

Cold water is sometimes of use when locally applied, and seems to act as a wholesome stimulant to parts which have become stiffened by want of use, such as strained and sprained joints. In some skin diseases benefit will be derived by the use of cold water. This is particularly the case in itching of the skin or _Prurigo_, and _Acne_.

Warm baths are far more generally useful in diseases than cold baths. For the removal of the thickenings around joints, which have been caused by gout or rheumatism or “rheumatic gout,” bathing in tepid or hot water is justly considered as a powerful means of alleviation, and as a valuable accessory to treatment by diet and regimen. The hot water of Bath and the tepid water of Buxton have long enjoyed a great reputation for gout and rheumatic gout, and there are many baths on the Continent, which have a reputation, equally high, in the treatment of these affections, such as _Teplitz_, _Gastein_, _Wiesbaden_, and _Wildbad_. The treatment of gout by bathing is usually aided by the internal administration of mineral water, but into this question we are unable to enter, notwithstanding its great importance.

For exudations round joints, which have arisen from causes other than gout and rheumatism, warm bathing is of very great service, as well as in relieving the stiffness and thickenings which sometimes occur as the result of severe wounds.

For _paralysis_ warm bathing is often of great use, provided the cause of the paralysis be a removable one. Formerly, the principal method of treating cases of lead paralysis occurring in the cider counties of the West of England, was the sending of the patient to the warm springs at Bath, and the results were generally very good. There are many forms of paralysis which could not be benefited by treatment with hot water or anything else; but it is impossible, in an elementary treatise, to enter into a question requiring a high degree of medical knowledge for its proper appreciation.

For neuralgia, sciatica, lumbago, and many forms of muscular rheumatism, hot bathing may be employed with advantage.

For Bright’s disease of the kidneys, warm baths, vapour baths, and Turkish baths, are all employed with benefit.

An occasional Turkish or hot bath is a very great aid to the well-being of dwellers in cities who get an insufficiency of air and exercise, since it produces an activity of the skin which can only be brought about by such means or by violent exertion.

A common cold may sometimes be cured by means of a Turkish bath. To bring about this result, however, the treatment must be applied in the very earliest stages of the disease, when the slight tension in the head, or a trifling feeling of chilliness, is warning the patient of his coming trouble, and before the running of the eyes and nose has thoroughly set in. A Turkish bath in this very earliest stage of a cold will sometimes cut the disease short, but such a result is, unfortunately, by no means invariable.

Warm baths, as aiding the action of the skin, have been regarded as of some value, when combined with proper diet and regimen, in the treatment of diabetes.

In diseases of the skin warm bathing is occasionally of service. For _psoriasis_ a soaking in hot water has the effect of removing the scales from the body, but it has probably no real curative influence on the disease. In acne, chloasma, and diseases which are fostered by a want of attention to cleanliness, warm bathing is of great service, especially when aided by a liberal supply of soap and the rigorous use of the flesh-brush and rough towel.

Although we are all ready, perhaps too ready, to recognise the great value of water applied externally, we are not always so quick at recognising the evil effects of an excessive use of baths.

Professor Hebra, of Vienna, one of the greatest authorities living on the diseases of the skin, speaks in very decided tones of the occasional harmful action which water exerts upon the skin. “It is,” he says, “almost universally believed that the frequent use of vapour and shower baths, frequent bathing in warm or cold water, frequent washing and scrubbing, are healthful operations which can never do any harm.

“Against this opinion I must enter my decided protest. On the one hand, we know that there are millions of human beings who have never bathed in warm or cold water all their lives long, who, at the utmost, give their hands and face a superficial rinse once a week, and nevertheless enjoy up to old age a state of health which may well be envied. On the other hand, none can prove by statistics that the frequent use of the various kinds of baths protect people from sickness, or that washing in cold water strengthens the body against catarrh and rheumatism and catching cold. So long as bathings are accompanied by a feeling of comfort, and are not followed by any eruptions on the skin, they may, no doubt, be allowed as a pastime, an amusement, an aquatic sport; but whenever the skin thus repeatedly irritated begins to react--as soon as itching, more or less severe, follows; as soon as persistent redness or wheals, or pimples or watery heads make their appearance--it is high time to leave off bathing and washing if we do not wish to produce diseases of the skin, which often take months and years before they disappear, and give the patient unspeakable misery.”

Simple baths do not irritate the skin so much as when combined with shampooing and wet packing and shower-baths, or when a vapour bath is made more efficient by friction and by the various manipulations of the Turkish or Russian bath. The result of such attacks upon the skin are seldom long to wait for. Sooner or later a continual redness appears, followed by burning or itching; then come pimples, boils, and pustules; and though in past times these eruptions were regarded as critical and beneficial we must now look on them in their true light, as simply the injurious results of the action of water.

Hebra has used the warm bath with success in alleviating the pain and misery arising from extensive burns of the skin, and he has also used it for some of the more troublesome of the scaly and itching diseases of the skin. Although he seems more alive than most authors to the evil effects produced by the irritation of water in cases which are unsuited for it, he has, on the other hand, surpassed every one in the extensive and continuous use of warm water. He says, “I began with two hours, then advanced to days, and at last extended the duration of the warm bath from one to nine months. I find that people can eat, drink, and sleep just as well in a continuous warm bath as out of it; that nutrition, respiration, and excretion go on as before.”

Hebra asserts that in the external use of water it is a matter of small moment whether we apply the water hot or cold to the part; that the water soon approximates in temperature to that of the part to which it is applied; and that in this matter the wishes and inclinations of the patient need alone be consulted. With regard to _salt baths_, we may remind the reader that they may be used either cold or hot, and that they may thus be used in almost all those cases (some skin diseases excepted) in which baths of hot or cold water are found useful. When salt is added to the water, the stimulating effect upon the skin is increased, and the bath may be considered by so much the more powerful. Sea water, natural salt waters, and even crystals of sea-salt, or common salt added to ordinary water, have so firm a place among popular remedies that it is almost superfluous to make any formal remarks upon them.

It is perhaps in the treatment of scrofulous affections that sea bathing and salt water have their greatest reputation. The sea-bathing infirmary at Margate is too well known, and its work too highly valued to need any words of approbation from the author of this Primer. It is probable that the inhalation of sea-air has more to do with the successful treatment of scrofula than the bathing in sea water, although we have no wish to cast a doubt upon the efficacy in the treatment of such diseases of a systematic stimulation of the skin.

Dr. Jacob of Cudowa, in Silesia, has made a series of experiments on the power of stimulating the skin which is possessed by various kinds of baths. He has proved that mud and bran baths of the same consistence produce the same alterations in the circulation, which are to be regarded as the real expression of the amount of skin-stimulation. It has been ascertained also that mud baths retain the heat of the bather more effectually than simple water baths. A carbonic acid bath is said to have the greatest stimulating action on the skin; a saline bath the next greatest, and mud and pure water follow next. A carbonic acid bath is also said to have the greatest power of causing general stimulation and excitement. As to the cooling effect of these varieties of baths, Dr. Jacob has noted that a water bath of an hour’s duration, and of a temperature of 91·4°, lowers the bodily temperature of a healthy man about ·9°; the mud bath of same duration and temperature 1·5°; the salt bath 2°, and the carbonic acid bath about 2·6°.

_Sulphur baths_ in former times enjoyed a very great reputation in the treatment of skin diseases, gout, rheumatism, and the effects of metallic poisons, especially lead and mercury. There is, however, probably nothing peculiarly beneficial in the sulphur, and the good effect of these baths is due more to the heat of the water than to anything else. Many of the sulphur springs may rightly be regarded as salt waters also, and they have a great power of skin-stimulation, a power which adds immensely to their therapeutic efficacy. The bather in sulphur water is constantly inhaling the vapour of sulphuretted hydrogen, and this fact may have not a little to do with the good effects of the water. A course of bathing at a sulphur spring is generally combined with the internal administration of the water, and it is consequently a very difficult problem to determine whether the internal or external administration of the water has the greater effect in producing the desired cure.

Steel baths, or baths containing iron, have fallen almost entirely into disuse, and any effect which was formerly attributed to the chalybeate water is now with more probability ascribed to the water and its temperature. The change in this respect is scarcely greater than that which has taken place at Carlsbad, where purgative waters, formerly used chiefly for bathing, are now almost exclusively employed for drinking.

The author of the ‘Bubbles from the Brunnens’ thus describes his feelings while taking a steel bath at Langen Schwalbach, some forty years ago:--

“As soon as the patient was ready to enter his bath, the first thing which crossed his naked mind, as he stood shivering on the brink, was a disinclination to dip even his foot into a mixture which looked about as thick as a horse-pond, and about the colour of mulligatawny soup. However, having come as far as Langen Schwalbach, there was nothing to say but ‘_en avant_,’ and so, descending the steps, I got into stuff so deeply coloured with the red oxide of iron that the body, when a couple of inches below the surface, was invisible. The temperature of the water felt neither hot nor cold, but I was no sooner immersed in it than I felt that it was evidently of a strengthening, bracing nature, and I could almost have fancied myself with a set of hides in a tan-pit. The half-hour which every day I was sentenced to spend in this red decoction, was by far the longest in the twenty-four hours, and I was always very glad when my chronometer, which I regularly hung on a nail before my eyes, pointed permission to me to extricate myself from the mess. While the body was floating, hardly knowing whether to sink or swim, I found it was very difficult for the mind to enjoy any sort of recreation, or to reflect for two minutes on any one subject; and as, half shivering, I lay watching the minute-hand of my dial, it appeared the slowest traveller in existence.”

In the delightful book from which the above quotation is taken, no mention is made of the disease, if any, for the relief of which the author underwent the unpleasant ordeal of the iron bath. The reader, however, will have no difficulty in surmising that the good he derived at Langen Schwalbach was due more to the change of air and scene and occupation than to the disagreeable bathing process to which he submitted daily. There is, or has been, a great deal of superstition in medicine, and the public have, or used to have, a surprising amount of faith in nasty medicines. In old dispensatories will be found the records of prescriptions into the composition of which there entered hideous and nameless abominations, and we are very much inclined to think that the lingering belief in steel baths, sulphur baths, and mud baths is but the remnant of a dying faith in nasty prescriptions, and the necessity of doing penance.