Part 5
=Ignorance.=—The greatest bane of all has been the ignorance of those who have professed to be qualified to administer water as a remedy understandingly. Priessnitz himself was an ignorant peasant. He was innocent of either anatomical or surgical knowledge. His slight acquaintance with physiology was gathered by cursory observations of patients. Of the effects of water he knew more, studying them with a good degree of acuteness. His lamentable want of knowledge allowed him to fall into many errors. It is related of him that he treated hopeless cases of solid anchylosis of joints just as though they were mere cases of stiffness from rheumatism. Cases of hopeless organic disease, he pronounced curable and submitted to long but unavailing treatment, not knowing the real nature of the disease. A young lady died of what he supposed an internal abscess. No abscess was found, upon which he remarked that “she had too short a neck for long life.”
It could be no wonder, then, that the disciples of such a master should be sadly lacking in many of those qualifications essential for a successful physician, no matter what the remedies employed. The most lamentable feature of the matter is that the same ignorance has continued to be, with few exceptions, characteristic of those who have employed water as a remedy; this has been especially disastrous because a man with the native shrewdness and acuteness of perception of Priessnitz has rarely appeared in the ranks of hydropathists.
=A Popular Error.=—It is a grievous popular error that any one can apply water as skillfully as the most experienced physician, and that its successful use requires no knowledge of the structure and functions of the human body. No doubt this has grown out of another error, perhaps quite as common; viz., that water is so simple a remedy that it will do no harm if it does no good. Such notions have frequently led to most disastrous results. Water, as already shown, is one of the most powerful remedies. And while it is, undoubtedly, far safer in the hands of the uneducated than blisters, purgatives, diuretics, and such agents as opium, chloral, alcohol, and most other drugs, yet it certainly requires careful usage, and the more scientific knowledge the user possesses, the more skillfully will he be able to apply it. It is, furthermore, true that a great majority of ordinary diseases are commonly so void of danger under careful nursing and hygienic management that the application of water is a simple matter which any intelligent mother can perform successfully. A case is related by good authority of a person who fell in apoplexy an hour after taking an excessively hot bath. Another patient became a paralytic from the same cause. Water is a remedy which cannot be safely used by one who has not informed himself of its effects, and of the proper modes of application.
=Absurd Claims.=—Sensible people have been rightfully disgusted with the claims which have been made by certain pretentious ones for the use of water. One declares that the bath will dissolve out of the body mineral substances which have been taken into it. Another claims to have been able, by the application of fomentations to a rheumatic knee, to extract in regular order the ointments which had previously been successively applied. Numerous other claims equally preposterous might be related, if it were necessary. They have all tended to excite a feeling of contempt for a means of treating disease which is really worthy of the highest estimation.
=Neglect of Other Remedies.=—As has been previously remarked, many seem to have forgotten that water is not the only remedy for disease, and not only attempt to cure every disease by its application, but use it to the exclusion of all other remedies. In nearly all cases, sunlight, pure air, rest, exercise, proper food, and other hygienic agencies are quite as important as water. Electricity, too, is a remedy which should not be ignored; and skillful surgery is absolutely indispensable in not a small number of cases. Even drugs are sometimes useful auxiliaries, though, doubtless, infinitely more harm has resulted from the employment of drugs in conjunction with water treatment than from their omission.
_Rational Hydropathy_ leaves room for every other remedy of value. It does not regard water as a specific nor as a panacea, but only as one of the most valuable of numerous excellent remedies. It discards the erroneous and harmful practices of empirics and ignorant charlatans, whether they concern water or other agents, and gives to the aqueous element only its due share of importance.
APPLICATIONS OF WATER.
The indications which are to be met in the treatment of disease are chiefly those enumerated below; and how admirably they are met by applications of water may be easily demonstrated by following the directions given.
=1. Equalization of Circulation.=—Disease cannot exist without some disturbance of the circulation. In perfect health each part receives its due share of blood. One of the first indications in disease, then, is to balance the circulation. If an organ contains too much blood, the application of cold water to the part will occasion contraction of the minute vessels of the part, and thus the amount of blood is lessened, as explained more at length in considering the physiological effects of water.
Or, the part may be relieved by the application of warm water in some form to adjacent or remote parts of the body, by which means the surplus blood will be drawn to other parts, thus relieving the suffering organ. Again, if an organ contains too little blood, the opposite course must be pursued. Warm or hot applications are made to the part, while cold applications may be made to other parts if necessary. Very often the two remedies may be advantageously combined, since one part cannot contain too much blood without some other part or parts being deprived of the due proportion, and _vice versa_; so that while a cold application is needed at one part, the opposite is required at another.
=2. Regulation of Temperature.=—As the condition of the bodily temperature is closely associated with that of the circulation, the two are usually controlled by the same remedies applied in the same manner. A part which contains too much blood has usually, also, too high a degree of heat. The cold application relieves both. If the entire surface of the body is involved, the application must be as extensive as necessary to affect the whole. In general fevers, the admirable adaptation of water to this end is well exhibited. When the temperature of the body rises above 100°, or even above 98°, a cooling bath should be resorted to. It may consist of a simple sponging with water, scarcely below the bodily temperature, an affusion with tepid water, a full bath of a tepid, temperate, or cold temperature, or some other form of cooling application according to the degree of cooling effect desired. Any temperature below 98° will be cooling. In general, it is better to employ a bath only a few degrees below the bodily temperature, as its application will not be followed by an increase of heat, called reaction, which follows a brief application of a cool bath. To obtain the proper cooling effects of a cool or cold bath, it must be continued for some time, from ten minutes to half an hour, at least. The same remark applies also to the application of cool baths for the purpose of equalizing the circulation.
=3. Removal of Pain.=—Pain is usually dependent upon disturbance of the circulation, being caused by the pressure of overfilled vessels upon the nerves in a confined space. Pain may be relieved by either hot or cold applications. The first object should be to remove the surplus blood, by local cold applications, and remote hot ones. If this plan is not successful, relief will be obtained by a hot local application, which operates by relaxing the surrounding tissues, so that the nerve fibers are relieved from pressure, as well as by quickening the local circulation, and so relieving congestion. The latter method is usually most quickly successful; but it is not so radically curative as the former. Pain dependent on passive congestion will be best relieved by the method next described.
=4. To Excite Activity.=—Many organs often become torpid or inactive, as the skin and liver, especially. Sometimes the blood-vessels of an organ become relaxed and inactive, passive congestion resulting. No remedy will so readily induce a return of activity to the affected parts as alternate hot and cold applications, continued for some minutes, fifteen to thirty or more. This is one of the best applications for the relief of old pains.
=5. Removal of Obstructions.=—A very large class of diseases are attributable to obstruction in various organs, caused by the reception of foreign matters into the system, and the accumulation of the natural waste of the tissues. The warm bath, to remove, external obstructions, and the internal use of water as a solvent for internal sources of obstruction, are the remedies which will achieve success in nearly all cases. Offending substances in the stomach are readily removed by the water emetic; and hardened accumulations in the large intestine are removed with equal facility by means of the enema.
=6. Dilution of the Blood.=—In fevers, cholera, and other diseases, the blood often becomes abnormally thickened, dark, and viscid, circulating with difficulty, and not imparting due nourishment to the tissues. Nothing but water can remedy this difficulty. It may be got into the blood by absorption from the skin, if the mucous membrane of the stomach will not absorb it.
=7. Influence on the Nervous System.=—Finally, it is often important to affect certain organs through their nervous centers. Water, properly applied, will accomplish this also. A fomentation applied to the abdomen will often remove headache, and is an excellent remedy for general nervousness, seeming to affect the whole system, just as does galvanic electricity when applied to the same locality, doubtless through the large nervous ganglia located in that region.
Some physicians claim to have obtained peculiar results by the application of heat or cold to the spine. It is said, for example, that cold applied to any portion of the spine will produce an increased circulation in the portion of the body supplied with organic nerves from the part. Hot applications to the spine are said to produce a contrary effect upon corresponding organs. Perhaps there should be still further observations upon this subject before any attempt is made to establish a definite law. It is well known that applications of ice to the spine is an excellent remedy for chorea, and several other nervous diseases.
For general nervous irritability, or nervousness, the _warm_ full bath may be applied with uniform success. Neither hot nor cold applications are generally useful in such cases.
=Temperature of Baths.=—The thermometer is the only accurate measure of temperature; hence the importance of its use in the administration of baths. Yet the thermometer may be abused. A given temperature may seem warm to one individual and tepid or cool to another. The same difference of sensation will occur in the same individual on different occasions. What seems cool to-day will be thought warm to-morrow. The susceptibility of the body to sensations of heat and cold largely depends upon its condition and the temperature of surrounding objects. In consequence of this physiological fact, it is improper to attempt, as some have done, to fix certain exact temperatures at which baths must be given to all persons under all conditions.
For convenience and perspicuity, the temperatures of baths have been divided into six grades, as given in the following table by Forbes; all who attempt to use the bath according to the directions should carefully learn and preserve the distinctions here made:—
1. Cold Bath, 33° to 60° F. 2. Cool, 60° „ 75° 3. Temperate, 75° „ 85° 4. Tepid, 85° „ 92° 5. Warm, 92° „ 98° 6. Hot, 98° „ 112°
The vapor bath ranges from 98° to 120°; the hot-air or Turkish bath from 100° to 160°, or even higher, though not usefully so.
A bath of any temperature above the natural heat of the body, 98°, is a hot bath. At 32°, water becomes ice; a bath is very rarely given at this temperature, and then the application should be made to only a small surface. Water at 32°, and even ice and snow, may be usefully employed as topical remedies in local diseases. It will rarely be necessary to employ a full bath at a lower temperature than 65°, which will usually seem very cold to the patient. A temperature from 85° to 95° is the most generally useful for baths which involve a considerable portion of the body, though of course higher temperatures are employed in local applications.
=How to Determine the Temperature of a Bath without a Thermometer.=—It is often necessary to administer a bath when a thermometer cannot be obtained. In such cases it is customary to test the temperature by placing the hand in the water. This is an unreliable method, however; for the hand becomes, by usage, so obtuse to heat that water which would seem only warm to it would be painfully hot to the body of the patient. To avoid this source of error, it is only necessary to plunge the arm to the elbow into the water, by which means its real temperature will be determined. Water which causes redness of the skin is hot; when it feels simply comfortable, with no special sensation of either heat or cold, it is warm. Slightly cooler than this, it is tepid. When it causes the appearance of goose-flesh, it may be for practical purposes called cool, a still lower degree being cold.
_Another Method._—The method about to be described is somewhat more accurate than the preceding, and may be found convenient for facilitating the preparation of a bath of proper quantity as well as temperature, a matter which though simple enough is often quite annoying to inexperienced persons. It is a fact of common knowledge that water boils at 212° F. Boiling water, then, is always of this temperature. Well and spring water, and the water of cisterns in winter, does not vary greatly from 53°. The temperature of well and spring water changes very slightly with the seasons. By combining in proper quantities water of these known temperatures, any required temperature may be produced. Not having seen this method suggested before, we have prepared the following table, which may perhaps be used to advantage in the absence of a thermometer; we advise all to obtain and use a thermometer, however, when it is possible to do so:—
Tem. 53°. Tem. 212°. 2 qts. added to 1 qt. equals 3 qts. at 106° 2½ „ „ 1 „ „ 3½ „ 98° 3 „ „ 1 „ „ 4 „ 93° 4 „ „ 1 „ „ 5 „ 85° 5 „ „ 1 „ „ 6 „ 80° 6 „ „ 1 „ „ 7 „ 76° 8 „ „ 1 „ „ 9 „ 71°
When larger quantities are needed, it is only necessary to multiply each of the combining quantities by the same number. For instance, if a gallon and a half of water is needed for a foot bath at 106°, pour into a pail or bath-tub four quarts of fresh well water and then add two quarts of boiling water. If four gallons of water are wanted for a sitz bath at 93° (a very common temperature), pour into the bath-tub three gallons of fresh well or spring water, and add one gallon of boiling water. Thus any required quantity can be obtained at the temperatures given. The cold water should be placed in the vessel first, and there should be no delay in adding the hot water, as it would rapidly lose its heat, and thus make a larger quantity necessary. Determinate measurement is not essential. The cold and hot water may be added alternately in proper proportions, being measured by the same vessel until the requisite quantity is prepared.
RULES FOR BATHING.
The following general rules should be carefully studied and thoroughly understood by any one who expects to employ the bath. Much injury to health and most of the discredit cast upon the use of water as a remedy have arisen from a disregard of some of them:—
1. A full bath should never be taken within two or three hours after a meal.
2. Such local baths as fomentations, compresses, foot baths, and even sitz baths, may be taken an hour or two after a meal; indeed, compresses and fomentations may be applied almost immediately after a light meal, without injury.
3. Employ the thermometer to determine the temperature of every bath when possible to do so; if not, employ the other methods described.
4. The temperature of the room during a bath should be 70° to 85°. Invalids require a warmer room than persons in health. Thorough ventilation is an important matter; but draughts must be carefully prevented, by screens of netting placed before openings into the room when necessary.
5. Never apply either very cold or excessively hot treatment to aged or feeble patients. Cold is especially dangerous.
6. Hot baths are rarely useful in health. The warm bath answers all the requirements of cleanliness.
7. Never take a cold bath when exhausted or chilly. A German emperor lost his life by taking a cool bath after a fatiguing march. Alexander came near losing his life in the same manner. Many have been rendered cripples for life by so doing. No harm will result from a cool bath if the body is simply warm, even though it may be in a state of perspiration. Contrary to the common opinion, a considerable degree of heat is the best possible preparation for a cold bath. The Finlanders rush out of their hot ovens—sweat-houses—and roll in the snow, without injury.
8. Cold baths should not be administered during the period of menstruation in females. At such times, little bathing of any kind is advisable with the exception of a warm or tepid sponge bath, or such treatment as may be advised by a physician.
9. Bath attendants should carefully avoid giving “shocks” to nervous people or to those inclined to apoplexy or affected with heart disease. Shocks are unpleasant and unnecessary for any one.
10. Never apply to the head such treatment as will cause shock, as the sudden cold douche, shower, or spray bath.
11. A light hand bath every morning will be none too frequent to preserve scrupulous bodily cleanliness. More than a week should never be allowed to elapse without a bath with warm water and soap.
12. The best time for treatment—especially cool treatment—is about three hours after breakfast.
13. Always employ for bathing purposes the purest water attainable. Soft water is greatly preferable to hard on many accounts.
14. Those not strong and vigorous should avoid drinking freely of cold water just previous to a bath.
15. The head should always be wet before any bath; and the feet should be warmed—if not already warm—by a hot foot bath, if necessary.
16. In applying a bath to sick persons, it should always be made of a temperature agreeable to the feelings.
17. One very important element in the success of a bath is the dexterity of the attendant. The patient should be inspired with confidence both in the bath and in the skill of the attendant. The mind has much to do with the effect of a bath.
18. In general baths, the patient, unless feeble, will derive benefit by assisting himself as much as possible.
19. Patients should receive due attention during a bath, so that they may not feel that they are forgotten. Nervous patients often become very apprehensive on this account. It is also important, in most cases, that a reasonable degree of quietude should be maintained.
20. When any unusual or unexpected symptoms appear during a bath, the patient should be removed at once.
21. In case symptoms of faintness appear, as is sometimes the case in feeble patients, during a hot bath, apply cold water to the head and face, give cool water to drink, lower the temperature of the bath by adding cool water, and place the patient as nearly as possible in a horizontal position.
22. The temperature of a warm or hot bath should always be decreased just before its termination as a precaution against taking cold.
23. In health, a cool or cold bath should be very brief, lasting not more than one or two minutes. A tepid bath should last not more than ten or fifteen minutes. A warm bath may be continued thirty or forty minutes, or even longer, but nothing could be more absurd than the custom prevailing in some places of prolonging the bath to great length. At Pfeffers and Leuck, in Switzerland, many persons spend the whole day in the water, taking their meals on floating tables, and occupying their time in reading, playing chess, and other games. Some remain in the water as many as sixteen hours out of the twenty-four. Of course, certain baths may be advantageously prolonged in cases of disease; but no intelligent physician will now recommend the antiquated practice which we sometimes see represented by a patient seated in a tub, with an open book in hand.
24. It is of extreme importance that the patient should be carefully dried after any bath. A large sheet is much better for this purpose than a towel. An old linen or cotton sheet is preferable to a new one, being softer. Full directions are given under the heading, “Dry Rubbing-Sheet.”
25. A patient should never be left chilly after a bath. Rub until warm.
26. It is equally important that the body should not be left in a state of perspiration, for it will soon become chilly.
27. Patients who are able to do so should exercise a little both before and immediately after a bath to insure thorough reaction.
28. An hour’s rest soon after a bath will add to its beneficial effects. It is best to go to bed and cover warm.
29. If a bath is followed by headache and fever, there has been something wrong, either in the kind of bath administered, or in the manner of giving it.
30. Very cold and very hot baths are seldom required. The barbarous practices of half a century ago are now obsolete, or should be, if they are not quite discontinued as yet. No good resulted from them which cannot be attained by milder means, and much harm was occasioned which is avoided by the use of less extreme temperatures.
31. Patients should not be allowed to become dependent on any special form of bath, as an after-dinner fomentation to aid digestion, the abdominal bandage, or any other appliance. Destroy such a habit if it has been formed.
32. Order, cleanliness, dispatch, and a delicate sense of propriety are items which every bath attendant should keep constantly in mind, and which will often contribute in no small degree to success in the use of this agent.
33. Never employ a bath without a definite and legitimate purpose in view. It is somewhat customary, in many institutions where water is employed, to apply it in a routine way. Many baths are prescribed for the sake of producing variety, or pleasing the patient. A faithful and scientific physician will carefully adapt his remedies to the condition of his patient, and will observe the results. It seems to be a prevalent error that it makes little difference how water is applied, provided the patient is only wet. Warm, hot, tepid, temperate, cool, and cold baths are used indiscriminately.