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.