Part 8
Water applications are made to the ear by means of fomentations, compresses, the douche, or the spray. Compresses and fomentations are useful in inflammations of the structures of the ear, including abscesses which often form in the walls of the external canal. Alternate hot and cold applications are useful in causing the absorption of inflammatory deposits, and thus restoring the hearing. The douche, administered with the fountain syringe, is a valuable means of removing foreign bodies and insects. The warm douche has proved very serviceable in restoring the hearing by removing hardened ear-wax. In administering the douche, the head should be inclined over a basin, while the stream of water is allowed to issue from the nozzle held close to the external opening of the ear. Violent syringing of the ear should never be practiced, as it may occasion irreparable injury.
NOSE BATH.
This bath is administered either by drawing water into the nose while the mouth is closed, or by injecting it by means of a fountain syringe. Great care should always be exercised to apply the water gently, as a forcible application will cause pain and irritation. Injection should never be practiced with a piston syringe, as there is liability of forcing the water into the Eustachian canals and producing deafness. The temperature of the water should be warm or tepid for most applications.
Much benefit may be derived by the proper use of this bath in case of acute or chronic catarrh. The addition of a slight portion of salt to the water does no harm, and a slightly saline fluid is sometimes less unpleasant than pure water, probably because it is more nearly like the mucous secretion of the nasal mucous membrane. Drawing cold water into the nose is sometimes recommended for hemorrhage from the nose; but it is of doubtful utility, because the application cannot be continuous, and transient applications of cold water are always followed by an afflux of blood to the part so exposed. There are better remedies for nose-bleed.
COMPRESSES.
The compress is a wet cloth or bandage applied to a part. The object may be to cool the part under treatment, or to retain heat. The compress may be used with equal success for either purpose. When the part is to be cooled, a compress composed of several folds should be wet in cool, cold, or iced water, as required, and placed upon the part after being wrung so it will not drip. It should be changed as often as _every five minutes_. This is often neglected to the injury of the patient. A very cold compress may be prepared by placing snow or pounded ice between the folds of the compress. This will not need renewal so frequently; but its effects must be carefully watched, as injury may be done by neglect. In applying cold to such delicate parts as the eye, a very thin compress is better. It should be renewed once in five minutes, at least.
When accumulated warmth is required, a thick compress is applied, being wrung out of tepid water, and covered with a dry cloth to exclude the air. Soft, dry flannel is an excellent covering. Rubber or oiled silk may be employed when the compress is not to be retained more than a few hours; but if it is to be worn continuously, they will be injurious, as they are impervious to air and thus interfere with the function of the skin. The effects of a compress thus applied are identical with those of the poultice, and the application is a much more cleanly one.
Compresses are applicable in all cases in which poultices are commonly used. They may replace the old-fashioned plasters with profit and comfort to the wearer. The wet-sheet pack, half pack chest pack and wrapper, leg pack, and wet girdle are all large compresses.
When applied continuously in the same place for a long time, the compress occasions a considerable eruption of the skin, and sometimes boils and carbuncles. There is no particular advantage in these eruptions, and they sometimes do much harm by producing a great degree of general irritation. The notion that they purify the system, though a very popular one, has really a very slight foundation. The discharge is largely made up of elements which would be of great utility if retained in the system, and the amount of foul matter eliminated in this way is certainly infinitesimal compared with the amount thrown off by a few inches of healthy skin. The skin can always do more and better work when healthy than when diseased. The eruptions are no doubt due to debility of the skin, produced by a too long continuance of the very abnormal conditions supplied by the compress. Yet, strange as it may appear, there are those claiming to be physicians who directly aim to produce inflamed and irritated surfaces by the continuation of the compress for months and even years.
The _wet head cap_ is a compress made to fit the head. It should consist of several thicknesses of cotton or linen cloth, so as to retain moisture for some time. It is a good temporary appliance in diseases of the scalp, and for headache; but it should never be worn continuously for the purpose of relieving congestion, as it will have an effect just the opposite of that desired. In eczema of the scalp it may be worn until the disease is cured, being frequently rewetted. It is an excellent means of preventing sun-stroke and other effects of heat when worn beneath the hat in summer; but even for this purpose its use should be temporary, the cap being worn only during the hotter portion of the day.
FOMENTATIONS.
The fomentation is a local application analogous to such general appliances as the hot pack, vapor bath, and hot-air bath. It consists in the application of a cloth wet in hot water. It may be considered as a hot compress. Fold a soft _flannel_ cloth twice, so that it will be of three or four thicknesses. Lay it in a basin, pour boiling water upon it, and wring it dry by folding it in a dry towel. Or, if only one end of the cloth is wet, it may be wrung by folding the dry portion outside of the wet; in wringing, the whole will become equally wet. Apply it to the patient as hot as it can be borne. The second application can usually be made much hotter than the first. Frequently dipping the hands in cold water will enable the attendant to wring the cloth much hotter than he would otherwise be able to do. The most convenient way is to heat the cloths in a steamer; by this means they are made as hot as boiling water, and yet they are more easily handled, not being saturated with water. When no hot water is at hand, a fomentation may, in an emergency, be quickly prepared by wetting the flannel in cool water, wringing it as dry as desired, folding it between the leaves of a newspaper, and laying it upon the top of the stove, or holding it smoothly against the side. The paper prevents the cloth from becoming soiled, the water protects the paper from burning, and the steam generated quickly heats the cloth to boiling heat. For a long fomentation, the heat may be made continuous by applying over the wet cloth a hot brick or slab of soapstone.
The hot cloths should be re-applied once in five minutes. Two cloths should be employed, so that the second may be applied the moment the first is removed. To retain the heat, a dry flannel, rubber, or oilcloth should be placed over the fomentation. The application may be continued from ten minutes to half an hour, or longer in special cases. This appliance is very powerful, and should not be employed to excess. Alternate hot and cold fomentations are frequently more efficient than the continuous fomentation. Hot applications should always be followed by a cool or tepid compress for four or five minutes, at least.
The uses of the fomentation are very numerous. It is indicated whenever there is local pain without excessive heat, or evidences of acute inflammation. Local congestions, neuralgia, toothache, pleurisy, pleurodynia, and most local pains vanish beneath its potent influence as if by magic. For indigestion, colic, constipation, torpid liver, dysmenorrhea, and rheumatic pains, it is a remedy of great power, and is used with almost uniform success. In relieving sick headache by application to the head, neck, and stomach, its efficiency is unrivaled.
When applied to the head for some time without intermission, it will often occasion faintness; hence, a cooler application should be made after the use of the hot cloths for fifteen or twenty minutes.
If the applications must be continued for a long time, it is well in most cases to apply them at a temperature slightly lower than when they are to be used for only a few minutes.
This remedy may well replace the blisters, plasters, cataplasms, scarifications, rubefacients, and other irritating measures so long used for relieving pain, local congestions, and inflammations.
REFRIGERANT APPLICATIONS.
A freezing mixture which will reduce the temperature to 4° is made by mixing equal parts of salt and pounded ice. The ice and salt should be stirred together very quickly and applied at once to the part to be frozen. Two parts of dry snow and one of salt make an equally good mixture. Freezing is more conveniently performed by the rapid evaporation of ether or rhigoline.
Freezing is a useful process in numerous cases. By its use, excrescences—as warts, wens, and polypi—fibrous tumors, and even malignant tumors, as cancer, may be successfully removed. Small cancers may sometimes be cured by repeated and long-continued freezing. Their growth may certainly be impeded by this means. Felons, if treated early in their course, may be cured by two or three freezings.
For freezing a felon, place the finger in a mixture ice and salt, or surround it with cotton, saturate the cotton with ether or rhigoline, and blow it very strongly with a pair of bellows. This is a very good method when an apparatus for producing a fine spray is not at hand. The latter instrument facilitates the freezing very much if used with the bellows.
No harm results from repeated freezing if proper care is used in thawing the frozen parts. They should be kept immersed in cool water, or covered with cloths kept cool by frequent wetting with cold water, until the natural feeling is restored.
The application of ice is found extremely serviceable in many inflammatory diseases, and in some nervous affections. In inflammation of the brain, the ice cap is of inestimable value. Ice applied to the spine will check the convulsive spasms of chorea and hysteria when other remedies fail. In putrid sore throat, or malignant diphtheria, ice is a sovereign remedy. It should be applied to the neck externally, and held in small bits in the mouth. Small bits swallowed will sometimes relieve the pains of gastralgia.
Rubber bags are very convenient for applying ice or iced water; but their place can be very well supplied by dried bladders filled with pounded ice. The ice cap is a double head cap stuffed with pounded ice.
Some physicians recommend the application of ice to the spine in cases of congestive chill and paralysis, and in inflammation of the stomach, kidneys, uterus, and other internal organs. The real worth of such applications in these cases has yet to be determined by careful and repeated observations. We would not recommend an unskillful person to attempt to relieve a violent ague chill by rubbing ice on the patient’s back, and we have some fears that a very skillful operator would hardly succeed to his entire satisfaction and that of the patient.
The snow bath, applied by rubbing the part vigorously with snow, is a useful application for restoring the circulation to frosted parts. In cases of extreme chilling or absolute freezing, there is perhaps no better remedy. Powdered ice may be used when snow cannot be readily procured.
MISCELLANEOUS BATHS, ETC.
VAPOR BATH.
This bath can be readily and successfully administered with such conveniences as every family possess. Place the patient in a cane-seat chair, having first taken the precaution to spread over the seat a dry towel. Surround the patient and the chair first with a woolen blanket, and then with two or three thick comfortables, drawing the blankets close around his neck, and allowing them to trail upon the floor so as to exclude the air as perfectly as possible. Now place under the chair a large pan or pail containing two or three quarts of boiling water. Let the blankets fall quickly so as to retain the rising vapor. After a minute or two, raise the blankets a little at one side and carefully place in the vessel a very hot brick or stone, dropping the blankets again as soon as possible avoid the admission of cold air. Before the first brick or stone has cooled, add another, and so continue until the patient perspires freely. The amount of perspiration must be judged by the face and forehead, as much of the moisture on the skin beneath the blankets is condensed steam. Should the bath become at any time too hot, a little air may be admitted by raising the bottom of the blankets a little, being careful to avoid chilling the patient in so doing. The bath should seldom be continued more than half an hour, and fifteen to twenty minutes will usually accomplish all that is desired by the bath. If too long continued, it induces faintness. A too high temperature will be indicated by a strongly accelerated pulse, throbbing of the temples, flushed face, and headache. The head should be kept cool by a compress wet in cool water and often changed. The temperature of the bath should be from 100° to 115°. Unpleasant effects are sometimes produced at 120°.
After this bath, apply the tepid spray, rubbing wet-sheet, pail douche, or full bath. No time should be allowed to elapse after the blankets are removed before the concluding bath is applied, as the patient will chill. He should not be allowed to become chilly by exposure to cool air before the application of the spray, douche, or other bath, which should be followed by vigorous rubbing.
For “breaking up a cold,” relieving rheumatism, soreness of the muscles from overexertion, and relaxing stiffened joints, this is a valuable agent. It may also be used to advantage in chronic diseases in which there is torpidity of the skin; but great care must be exercised to avoid excessive use, as too frequent repetitions of the bath produce debility.
This is a milder application than the hot-air bath, unless employed at a high temperature, 120° or more, when it becomes more severe.
In institutions where the bath is in daily requisition, a permanent arrangement for giving the bath is usually employed. It sometimes consists of a box in which the patient sits upon a stool, his head being allowed to remain outside by a suitable opening. A wet towel is placed around the neck to prevent the steam from rising about the head. Others prefer a box or small room large enough to admit the whole person, the whole body being subjected to the warm vapor. An opening guarded by a curtain is made in one side to allow the bather to inhale cool air if he should wish to do so, and to give the attendant access to the patient without chilling him by the admission of a large quantity of cold air. As in the simpler form of vapor bath, the head should be kept constantly cool by a cool wet compress often re-applied. Patients troubled with “rush of blood to the head,” should be further protected by a large cool compress placed around the neck and the upper part of the chest.
Steam may be generated for these larger baths by boiling water in the box with a spirit-lamp or a gas-burner, or it may be conducted into the box by a rubber tube connected with a tight boiler.
RUSSIAN BATH.
This is essentially the same in effect as the vapor bath. It consists of a room filled with vapor, and so arranged that by transferring the patient from one point to another the heat may be gradually increased. It has no advantages not afforded by the simpler vapor bath. It is now much used in the larger cities. Probably as much harm as good results from the indiscriminate and reckless manner in which it is employed. Patients have been known to die in the bath of apoplexy induced by the excessive heat. It is followed by shampooing and cooling baths of various sorts.
HOT-AIR BATH.
In administering this bath, prepare the patient precisely as directed for the vapor bath. Instead of placing under the chair a vessel of hot water, place a large alcohol lamp or a small dish containing a few ounces of alcohol. When all is ready, light the lamp or alcohol, and carefully exclude the air. It is hardly necessary to suggest the propriety of putting the lamp in such a position as to insure safety from fire. If alcohol is used in an open dish, it is important to wipe the outside of the vessel quite free from any trace of the fluid, as otherwise it might be communicated to the floor or carpet. Also avoid spilling any portion in putting it in place, for the same reason. It is a very good precaution to place the dish containing the burning alcohol in a plate or shallow vessel containing a little water.
This bath should be conducted in the same manner as the vapor bath. A temperature of 140° to 160° is not at all disagreeable to the patient. At 170° or 180° the same effects are produced as in the vapor bath at 120°. The bath should be followed by cooling baths as directed for the vapor bath.
This is a very valuable remedy for the same class of diseases for which the vapor bath is recommended. It is of very great service in cases of dropsy, Bright’s disease with poisoning from retained urea, and all cases in which a vigorous elimination by the skin is desired. It should not be continued longer than the vapor bath, and much harm may result from its too frequent employment. Like the vapor bath, this may be conducted in a suitable box with an opening for the head.
TURKISH BATH.
This is entirely analogous to the hot-air bath, though on a much more elaborate plan. The patient is gradually conducted from a temperature of 120° to that of 160° or even much more than 200°. The bath is concluded by shampooing, rubbing, cooling baths, and gradual cooling in a room maintained at a temperature of 70°.
The uses of this bath are the same as those of the hot-air bath. It has no advantages over it of very great importance, and is much more liable to produce injury by prolonged and frequent application. It generally occupies an hour, and by those who resort to it as a luxury, as did the ancient Romans, it is often prolonged to several hours.
The long-continued application of excessive heat to the body is a very unnatural process. It tends to produce permanent relaxation and debility of the cutaneous tissues, and the manner in which this bath is administered in Turkish bath establishments is productive of great harm. It is often presented to invalids as almost a panacea; and is given alike to the strong and vigorous, and the weak and debilitated.
The bath is certainly good in its place, but it is decidedly bad when abused. Many consider the hot-air bath greatly preferable since it obviates the necessity of inhaling superheated air, the effects of which upon the lungs are said to be injurious. The hot-air bath is doubtless safer.
ELECTRIC BATH.
Electricity may be more efficiently applied in connection with water than by itself. Water is a better conductor of electricity than the dry skin, and hence facilitates its communication to the body. The ordinary method of applying electricity is by attaching one pole of the battery to a metallic plate, placed in contact with some part of the body, while the circuit is completed by the application to the patient of a moist sponge connected with the other pole. The operator often holds one pole in his hand and applies the other hand, moistened, to the part to be treated. He is in this way enabled to judge very accurately of the strength of the current applied. The metallic plate is frequently placed at the feet of the patient, sometimes in a foot bath. The sponge may be applied to various parts of the body while the patient is in a sitz bath. For a general application of electricity the full bath is most convenient.
This bath is applicable to a very large variety of conditions. To describe them all would be to give nearly all the uses of electricity as a remedial agent, which does not come within the scope of this work. The electric full bath has been strongly recommended for the removal of mineral poisons from the body. Just how efficacious it is in this respect, we cannot confidently affirm. Probably its value has been somewhat exaggerated. Only the primary or galvanic current could be of any service in this direction.
Electricity is generally acknowledged to be a powerful remedial agent; but its use requires costly apparatus and much skill in application. It is necessary that the operator should not only understand the nature of diseases and the proper methods of applying electricity in treating them, but he must also thoroughly understand the general laws of electricity. The electric bath is as badly abused by quacks and charlatans as the Turkish bath. It should not be employed by unskillful persons; and for this and other reasons given, it is not well adapted to home use.
ELECTRO-VAPOR BATH.
This is a combination of the electric and the vapor bath, the electricity being applied to the body by means of the sponge, and metallic plates covered with moistened cloths. It is a valuable appliance if carefully used; but, like all effective modes of treatment, it is very liable to excessive use, which becomes abuse. It has been very highly lauded by certain specialists, and doubtless its value has been unstintedly exaggerated. It is perhaps not well proven that its effects are greatly superior to the effects of the vapor bath and electric bath administered separately; and the latter mode would be more convenient, though consuming a little more time.
DRY RUBBING-SHEET.
Cover the patient with a soft, dry sheet in the same manner as directed for applying the wet sheet in the rubbing wet-sheet bath. Then rub lightly but briskly upon the outside of the sheet with the flat hand. Do not rub _with_ the sheet, but over it. Continue the rubbing ten or fifteen minutes, going over the whole body several times, and not neglecting the arms, the hands, and the feet. This application may be administered daily with profit to nearly all patients. It should always follow any form of general bath in which water is employed, as a means of drying the body. It promotes activity of the skin, and equalizes the circulation.
DRY HAND-RUBBING.