Part 3
_Effect of Cold upon the Pulse._—The experiments of Drs. Currie, Bell, and others, show conclusively that the cold bath has the uniform effect of diminishing the frequency of the heart’s action from ten to twenty beats in a minute below the usual standard. Upon the first application of cold, there is a slight increase in the rate of pulsation; but this soon subsides, and is succeeded by a marked diminution. The ultimate effect is the same, whether the application is made at its maximum degree of severity or not; but if the application is first warm, being gradually reduced in temperature, the result is reached without the occurrence of the unpleasant shock, or feeling of chilliness, which attends the sudden application of cold, especially in persons of delicate nervous sensibilities. The amount and after duration of the diminished rate of pulsation depends upon the temperature and duration of the bath. In health, it does not commonly extend beyond a few hours at most.
_Effect of Cold upon Temperature._—It was also shown by the same experimenters that the temperature of the body is reduced proportionately with the action of the heart. The natural temperature, as shown by a thermometer placed in the axilla, is 98° F. During and after a cold bath, the thermometer applied to the same part, indicates from one-half a degree to five or six, or even more, degrees, diminution of temperature. In some cases the temperature continues to fall after the bath. The real temperature is lessened even though the skin may glow, and may seem to possess increased warmth. Cold and heat are, within certain limits, wholly relative terms to the nerves of sensibility. What is warm at one time may be cold at another, though the temperature remains the same. The same temperature may be warm to one hand and cool to the other. Temperature can only be _accurately_ determined by the thermometer.
_Rationale of Effects of the Cold Bath._—The manner in which the cold bath produces the sedative effects noted, is apparently simple. When applied locally, to a single organ or part, it diminishes the circulation in the part by occasioning contraction of the muscular coats of the _arterioles_, or small arteries. Their caliber being thus lessened, they of course allow the passage of less blood, and the circulation in the part is diminished. There are, then, three causes for the decrease of heat; viz.,—
1. A portion of the heat of any part is brought to it by the blood; the supply of blood being lessened, the heat is diminished;
2. Heat is produced by vital or chemical changes which occur in the capillaries or their immediate vicinity. These depend chiefly upon the supply of oxygen, which, again, is largely regulated by the blood supply; and it being lessened with the blood, the amount of heat _produced_ is diminished.
3. The water in contact with the part, being of a lower temperature, abstracts heat from it as it would from any other body of a higher temperature than itself.
When the application of cold water is more general, being made to the whole body, or to a considerable portion of it, the same effects are produced on a larger scale. A large proportion of the small arteries of the body, being brought under the influence of cold, are made to contract, thus directly lessening the circulation, and so diminishing, also, the production of heat. Through the sympathetic system, the same effect produced upon the small arteries is produced also upon the heart, lessening the rapidity of its contractions. Again, it has been satisfactorily shown that the action of the heart is largely controlled by the action of the small arteries; so that we have abundant explanation of the decrease in the rate of pulsation. Finally, we have a cold fluid in contact with a large portion of the body, abstracting heat by conduction, as well as lessening its production.
Thus we see that water, when applied at a proper temperature, is one of the most powerful means of depressing the vital activities of the body, diminishing circulation and animal heat as will no other agent. The several modes for applying it are considered in another portion of this work.
_The Hot Bath._—We shall include under this head applications of a temperature above 98° F., the mean temperature of the body. As with the cold bath, the effects differ greatly according as the application is brief or prolonged. Local and general applications also differ in their effects.
A brief local application causes an increase in the circulation of a part which very closely resembles, perhaps is identical with, active congestion. The small arteries are distended, and the vital activities and heat of the part are increased. The several effects seem to be little different from those resulting from the application of a mild sinapism. The action of the vital instincts is defensive in both cases.
When applied to special organs, special effects are produced. For instance, a hot fomentation applied to the head for a few minutes will usually produce drowsiness by diversion of a portion of the blood supply of the brain to the skull and scalp. Prolonged applications produce a more or less permanent relaxation of the blood-vessels, and consequent congestion.
A hot bath applied to the whole body, or a large portion of it, produces an acceleration of the pulse and an increase of animal heat proportionate to the temperature of the bath. A bath at 106° to 108° F. will increase the pulse from the normal standard to one hundred or one hundred and twenty beats in a minute, in a short time. A bath four or five degrees hotter has been known to increase the pulse to more than one hundred and fifty beats in a minute.
When a hot bath is prolonged, the face becomes flushed, and the whole skin very red; the head aches; sight is sometimes dimmed; ringing in the ears, faintness, a stinging pain in the skin, and intense desire to urinate are symptoms which are often present. Copious perspiration and intense congestion of the skin are constant effects. The cutaneous congestion, from relaxation of the blood-vessels, is apt to continue to exist after the bath, if it is greatly prolonged, to the serious injury of the subject.
The effects of the vapor bath are essentially the same as those described, though a somewhat higher degree of heat is tolerated without injury. In the hot-air bath, a still higher heat is borne with impunity.
_Rationale of Effects of the Hot Bath._—It scarcely need be repeated that all of the effects noticed, as well as those of all other baths, are chiefly the results of modifications of vital action occasioned by the agent employed. The application of heat to the body occasions relaxation of the muscular coats of the small arteries, and increased action of those vessels. No doubt this is for the purpose of bringing moisture to the surface to protect the tissues against the unnatural heat. As is the case with cold baths, the causes which modify the heat are three; viz.,—
1. The increased quantity of blood circulating through the part brings to it an increased amount of heat;
2. Increased vital and chemical action increases the production of heat;
3. The body absorbs heat from the surrounding medium as any other colder object would do.
In the general application of hot water or vapor, effects similar to its local effects are produced upon the whole surface of the body, involving, also, to a considerable extent, the deeper structures. The pulse is accelerated because the small arteries are distended and more active, creating a demand for a greater quantity of blood, requiring an increase in the heart’s action. It is also quite probable that the action of the heart is somewhat quickened as the result of the influence of heat upon the pneumogastric nerve which controls it.
The cerebral symptoms, faintness, etc., which occur when heat is applied in excess, are the result of the diversion of so large a proportion of the blood into the superficial vessels. A prolonged hot foot bath or leg bath will often produce faintness.
There are few agents which will so rapidly produce such powerfully excitant and stimulant effects as the hot bath. The painful and undesirable results occasioned by its incautious use are evidences of its power.
_The Warm Bath._—In this connection we apply the term warm to baths of a temperature between 85° and 98° F., though baths of a temperature between 85° and 92° would be more accurately termed tepid, which term is applied to baths of that temperature elsewhere than in this immediate connection.
The warm bath never exceeds the temperature of the body, and is usually below it. Its effect is uniformly to diminish the frequency of the pulse and of respiration, and to decrease animal heat. Its effects are the same as those of the cool or cold bath, in this respect, but they differ in several other particulars. Unlike the cold bath, the warm bath is not accompanied by an unpleasant shock, or chill, and, hence, is not followed by reaction. It promotes the action of the skin in a very marked degree, increasing both perspiration and absorption. When continued for an hour or two, the weight is appreciably increased by the absorption of water. Its general effects are very mild and soothing, often inclining the patient to sleep.
This bath seems to produce its effects not so much by exciting the vital energies to abnormal action or resistance, as by supplying the most favorable conditions for the performance of the natural and usual functions. This is doubtless on account of its close approximation to the temperature of the body. In this respect, if this supposition be true, it differs from baths of a temperature either much above or greatly below the normal temperature of the body.
The warm vapor bath produces effects quite analogous to those of the warm water bath. Its effect upon the processes of perspiration and absorption is a little more marked, even with the same degree of temperature. The results differ somewhat, according as the whole body is enveloped, so that the warm vapor is taken into the lungs, or the head excluded. A more equable effect is produced by including the whole body in the bath, and no harm can result if the temperature is not raised above that of the body, as it should not be, in the _warm_ bath.
=Sympathetic Effects.=—There is scarcely room for doubt that many of the effects of the various kinds of water applications are wholly of a sympathetic character. All portions of the body are intimately associated together by a system of nerves called the sympathetic system, from their peculiar function. Certain portions, as the skin and mucous membrane, are particularly related. The large number of sensitive nerves which connect the skin with the brain, bring it in peculiarly close relations to that organ, and give additional potency to any agent applied to so extensive a surface. The well-known fact that burns of the skin are often the occasion of fatal ulceration of the mucous membrane of the intestines sufficiently attests the intimate relation between these two tissues; while the effects upon the skin of mental emotions, as of shame and of fear, are conclusive evidence of the peculiar closeness of relation between the cerebral and cutaneous organs. The condition of the mind has much to do with the effect of a bath.
=Modes of Administration.=—There are numerous modes of administering baths of all temperatures, each of which produces some modification of the general effect of the given temperature. For example, such baths as the douche, the spray, and the shower bath, are much more cooling in their effects than a full bath at the same temperature; since, in the latter case, nearly the whole body would be submerged in a medium of equable temperature, while in the case of the spray, etc., the body would be additionally cooled by the rapid evaporation taking place upon its surface. Many other peculiar effects are obtained by particular modes of administration, which will be described in their proper place.
HISTORY OF WATER CURE.
The utility of water as an agent in the treatment of disease is not a modern discovery, as the pretensions of some aspirants for notoriety have led many to believe. A very cursory glance at the history of various ancient nations furnishes sufficient evidence that the use of the bath as a curative agent was of very remote origin. The works of the oldest medical authors contain numerous references to the bath, recommendations of its use in cases of disease, and testimonials of its good effects when properly employed. As this is a matter of some interest to many of those who employ and advocate the use of water as a remedial agent, as well as to those who are investigating its merits, we shall devote a little space to a sketch of the use and estimation of the bath by various nations and tribes—civilized and barbarous—and regular and irregular physicians, from the remote ages of antiquity down to modern times. For several of the facts presented we are indebted to a valuable work by Dr. Bell, long out of print and now somewhat rare.
=The Bath in Egypt.=—That bathing was practiced to a considerable extent by the Egyptians at a very early period, is evinced by both sacred and profane history. It was through obedience to this custom that Moses was discovered among the rushes by Pharaoh’s daughter as she went down to the river side to bathe. Pictures discovered in ancient Egyptian tombs represent persons preparing for the bath. We have no expression of the estimate which was placed upon the bath as a remedial agent; but it is hardly possible to believe that an agent held in such high esteem as a preventive of disease should not be valued as a useful remedy.
=Bathing among the Jews.=—The code of laws prepared by Moses, under divine instruction, for the government of the Hebrew nation after its departure from Egypt, made bathing a prominent feature. The connection of the bath with the treatment of leprosy would naturally lead to the conclusion that it was employed for its curative effects.
=Persian Baths.=—The ancient Persians held the bath in such high esteem that they erected magnificent public structures devoted to bathing. The baths of Darius are spoken of as especially remarkable.
=The Bath among the Greeks.=—The cold bath was employed among the Greeks. Lycurgus, the famous Spartan legislator, prescribed its daily use for all his subjects, not excepting the tendered infants. In later times, the warm bath was introduced, and stately buildings were erected for the accommodation of bathers.
The learned Greek, Hippocrates, the father of medical literature, and a very acute observer of disease and the effects of various agents upon the body, highly recommended the use of water in many diseases, describing with great care the proper mode of administering a simple bath. He laid great stress upon the careful and skillful use of the bath, asserting that, when improperly applied, it, “instead of doing good, may rather prove injurious.” His directions for the employment of the bath were very discreet. He very wisely remarks that those patients whose symptoms are such as would be benefited by bathing should be bathed, even though some of the requisite conveniences may be wanting; while those whose symptoms do not indicate the need of this remedy, should not employ it, though all the necessary appliances are at hand. He made great use of water as a beverage in treating disease.
=Roman Baths.=—The Romans excelled all other nations in the sumptuousness of their bathing arrangements. Their public baths were among their greatest works of architecture, and were supplied with every convenience for increasing the utility and luxury of the bath. Kings and emperors vied with each other in perfecting and enlarging these sanitary institutions. Accommodations were provided, in some cases, for nearly 20,000 bathers employing the baths simultaneously; and at one time the number of public baths in Rome was nearly one thousand. Even Nero, whose name has come down to us covered with infamy, has the credit of doing at least one good act in erecting a magnificent public bath, though even the detergent effects of such an act can hardly cleanse his character of the many foul blots by which it is rendered odious.
Celsus and Galen, two noted Latin physicians, extolled the bath as an invaluable remedy, almost two thousand years ago. The latter pronounced the bath to be one of the essential features of a system of perfect cure which he termed _apotheraphia_, exercise and friction being the other essentials. If the regular physicians of half a century ago had followed the practice of Galen, as described in his works, they would have refreshed their languishing fever patients with cold water as a beverage instead of leaving them to be consumed by the pent-up fires which parched their lips, disorganized their blood, and finally ended their sufferings with their lives. Celsus was proud to boast of employing the bath more frequently and systematically than others had done before his time.
The Emperor Augustus was cured, by the bath, of a disease which had baffled all other remedies.
=Testimony of Arabian Physicians.= — Although the Arabians are at the present day looked upon, and justly, as a horde of wandering wild-men, a thousand years ago their physicians were among the most learned of the age; and they were as sensible as learned, we judge, for they were most enthusiastic advocates of the efficiency of the bath. Rhazes, one of the most eminent of them, describes a plan of treating small-pox and measles which would scarcely be modified by the most zealous advocate of water treatment at the present day. Avicenna and Meshnes, with others, may be mentioned as holding similar views.
The bath was much used in pestilences by this nation, and was largely employed in Constantinople in the fifteenth century.
=Modern Bathing Customs.=—Three centuries ago, public vapor baths were very numerous in Paris, being connected with barber shops, as are many baths in this country at the present time. According to Dr. Bell, Paris can still boast of a great number of bathing establishments. He states that in the baths connected with the city hospitals nearly 130,000 thousand baths were administered in a single year to out-door patients. Doubtless those treated in the hospitals were duly washed and steamed as well. This is certainly a very marked contrast with what we see in the hospitals in this country at the present day. Notwithstanding the advances in many other particulars of hospital management, the cuticles of patients are sadly neglected. In some of our largest hospitals, the filthiness of many patients is so great that close proximity to them is absolutely intolerable. Half a dozen of them, placed in a warm room, speedily impart to the air a fetor unequaled by anything but the effluvia arising from a neglected pig-sty. Such neglect is inexcusable.
The Germans of olden time were very fond of bathing, according to their historical records, and during the Middle Ages, when plagued by the leprosy, the national faith in the virtues of the bath was manifested by making it a religious duty. It is related of Charlemagne that he used to hold his court in a huge warm bath. Modern Teutons seem less partial to the bath, having transferred their fondness from _aqua pura_ to lager beer.
Although the bath was very freely used in England while the island was occupied by the Romans, who erected commodious baths like those in Rome, the wholesome practice is now sadly neglected by the English people, if we may credit their own writers.
It is a curious fact that the bath seems to be quite generally neglected by the most civilized races, while it is almost universally employed by those less advanced nations, the Russians, Turks, Finlanders, and the inhabitants of Persia, Egypt, Barbary, and Hindostan. The Finlanders make great use of the sweating bath. To nearly every house is attached a small sweat-house, where they subject themselves to a temperature of more than 160° F., often emerging at once into an atmosphere much below freezing, with apparent impunity. The Turkish and Russian baths, similar to which are those in use in Egypt and India, are elsewhere described.
The North American Indians employ the bath for many diseases. They have original and peculiar ways of administering both water and vapor baths. The most common bath among them is the vapor, followed by a plunge into a neighboring stream. They generate the steam by pouring water upon hot stones while they are inclosed in a small, close hut made of mud or skins. The native Mexicans secure a hot-air bath by confining themselves in a brick sweat-house which is heated by a furnace outside. These savages seem to have the most implicit confidence in the efficacy of the bath, always employing it when ill, and with excellent success.
=Modern Medical Use of Water.=—In the early part of the eighteenth century, a Sicilian named Fra Bernado acquired the title of “coldwater doctor” from his exclusive use of cold water in treating the sick.
At the very beginning of the eighteenth century, Floyer published a history of bathing which contains accounts of many remarkable cures effected by means of the bath, which he recommended as a most efficient cure for numerous diseases.
A Mr. Hancock, a clergyman, published, in 1722, a tract entitled, “Common Water the Best Cure of Fevers.” Another writer, in a work entitled, “The Curiosities of Common Water,” published in 1723, speaks of water as an “excellent remedy which will perform cures with very little trouble, and without any charge,” and “may be truly styled, an universal remedy.” Both French and German writers were zealously advocating the use of water as a remedy for many diseases at this same period. Many of the French surgeons had also discovered the immense utility of water in surgery, receiving their first lessons of instruction from an ignorant and superstitious miller, who used water in conjunction with charms.
In the latter part of the last century, Drs. Jackson and Currie each published reports of cases of fever in which they had found the use of the bath a remedy of remarkable efficacy. Dr. Currie obtained many followers for a time, but no very deep impression was made upon the public mind, though his cases were authentic, and were very ably reported.
About the end of the first quarter of the present century, a native of Græfenberg, Prussia, by the name of Priessnitz, met with an accident by which three of his ribs were broken. He treated himself by applications of cold water, and then tried the same remedy upon others in similar cases. His success encouraged him to make further experiments, and though an ignorant peasant, his natural acuteness enabled him to devise various means for applying water to the body, and to suit the application to different diseases. His increasing success attracted numerous patients, and his fame became, in a few years, worldwide. Many of his methods were very rude, and his ignorance of medical science often led him into errors; but he succeeded in restoring to health hundreds of patients whose maladies had been pronounced incurable.