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.