HYDROTHERAPY
Description of the Skin; Functions of the Skin; the Physiologic
Effects of Water, Hot and Cold; the Chief Varieties of Baths;
Ablutions; the Tub Bath; the Alcohol Rub; the Cold Dip; Alkaline
and Saline Baths; the Rain Douche or Shower Bath; the Hot
Foot-bath; the Sitz Bath; Salt Ablution; the Turkish Bath; the
Electric-light Bath; Indications for the Use of Turkish Bath,
and Contraindications; the Douche; Rationale of the Douche;
Contraindications.
The Internal Use of Water; Its Action on the Heart and Blood,
on the Digestion; Therapeutic Indications for the Use of Water;
Contraindications for Drinking Cold Water.
Enemas; Vaginal Douche; Douching the Ear.
The term hydrotherapy will be used here in its broadest sense, and
may be defined as the hygienic and systematic use of water, both
externally and internally, for the preservation and restoration of
health and the prevention of disease.
The hygienic and therapeutic value of the systematic use of water is
just beginning to be appreciated by the medical profession. When this
newly acquired knowledge is put to practical use by the great masses
of the people, there will be a greatly diminished necessity for the
use of drugs. Indeed, water has been pronounced by a high medical
authority to be, and probably is, more nearly a panacea for all human
ills than any other known agent.
The bath is generally considered merely as a cleansing procedure,
whereas this is only one of its beneficial effects. There is, in
addition, the stimulation of all the functions and organs of the body
obtained through the temperature of the water, and the mechanical
stimulation which is obtained by the mode of application.
Again, the skin is not a mere covering for the body, but one of its
most important organs, with well-defined functions; so that, in order
to obtain a clear understanding of the subject, it is necessary first
to consider briefly the functions of the skin; and, secondly, the
physiologic action of water.
=Description of the Skin.=—The skin is a very sensitive and complex
organ, and upon the condition of the skin and the vicissitudes to
which it is exposed the health of the individual is dependent to a
very great degree.
[Illustration: Fig. 1.—Vertical section of skin. _sbg_, Sebaceous
glands; _ep_, epidermis; _h_, hair; _d_, derma (Fox).]
The skin is composed of three distinct layers—the epidermis, the
corium or true skin, and the subcutaneous connective tissue.
The appendages of the skin are the hair, nails, the sebaceous
and sweat-glands. This complicated structure is supplied with
blood-vessels, lymphatics, and nerves.
_The Epidermis._—The outer layer of this is the horny layer; when a
blister is formed, its fluid raises the entire epidermis from the
true skin. The flat scales forming the horny layer are continually
being thrown off; this process of desquamation is increased by the
friction of the clothes, of bathing, massage, and so forth, and is as
constantly being replaced by new cells from underneath.
The _corium_, or true skin, is the most important part of the
integument. This is a thick, felt-like tissue which is pierced in
all directions for the passage of the blood-vessels, lymphatics,
sweat-ducts, and nerves, and affords lodgment for the hair follicles
and sebaceous glands. The tension of the skin is produced by its
muscular structure and elastic network, and is subject to temperature
changes. This power of contractility is known as the tone of the skin.
The skin has two kinds of glands, the sebaceous and sweat-glands. The
sebaceous glands consist of a gland structure, with a short excretory
duct, which opens upon the epidermis or into the hair follicles.
These glands secrete an oily substance, which keeps the hair and skin
soft and protects them from the sweat.
There exists in the sebaceous glands of the skin an infinite number
of vulnerable points for infection, and the greater part of the
process of cleanliness is directed toward their protection. If in any
part of the skin there is an accumulation of bacilli, their toxins,
or excretions, and, at the same point, a collection of sebum, the
friction of the clothes, caused by the movements of the body, becomes
an active agent in effecting their absorption by the skin. Hence, the
scientific basis for the necessity of the daily bath.
In the _subcutaneous tissue_ we find the fat; it is this part of the
skin that contributes to the roundness and beauty of the body. It is
increased by abundant fatty food, sedentary habits, and freedom from
care.
=Functions of the Skin.=—The skin exercises three distinct functions;
first, as an organ of sense; second, as an organ of excretion; and
third, as an organ of heat regulation.
Next to sight, the sense of touch is the most important of all the
senses. Through this sense the human organism is made conscious of
its contact with the outer world. The cutaneous nerve-endings stand
guard, as it were, over most of the functions of the human body.
The importance of the action of the skin as an organ of excretion
will be better understood from the well-known fact that the skin is
one of the most important aids to the kidneys. That the perspiration
and the urine are to a certain extent vicarious excretions has been
proved.
The blood is the circulating medium which not only serves to convey
nutritive materials from the stomach to the tissues, and the
excrementitious materials from the tissues to the excretory glands,
but also to equalize the body temperature. It conveys the surplus
heat from the interior of the body to the surface, where it may
be dissipated by conduction, radiation, and evaporation. Nearly
nine-tenths of the daily heat-loss takes place through the skin;
and of this, one-seventh is due to evaporation, which is enormously
increased by perspiration.
The amount of perspiration produced daily is about two pints, or
in the neighborhood of 1/64 the body weight. This is double the
amount of water thrown off by the lungs. The watery portions of the
perspiration are readily evaporated, and the solid constituents are
deposited upon the skin. Urea and uric acid, together with more
subtle poisons, are found in the sweat.
_Animal Heat._—The heat of the body is wholly derived from foods,
which, when completely oxidized within the body, produce practically
the same amount of heat and energy that would be generated by their
combustion outside the body.
But it is essential, in order to keep the body of warm-blooded
animals at a constant or normal temperature, that an increase in the
heat-production should be accompanied by a corresponding increase
in the heat dissipation; the functions are reciprocal, and this
equilibrium is regulated and maintained by a special nervous and
functional mechanism.
The automatic protective measures against the effects of heat are:
_First._—Dilatation of the cutaneous vessels and an acceleration
of the circulation through the skin and the subcutaneous tissue.
By this means the dissipation of heat is increased; the sweat at
the temperature of the blood, deposited upon the surface of the
body, evaporates under favorable circumstances, and in this way
considerable amounts of heat are abstracted from the body. In
consequence of sweating and its evaporation, the blood circulating
through the skin is cooled, and returning to the internal organs at a
lowered temperature, prevents their overheating.
_Second._—Should the action of heat be continued for a greater length
of time, a large amount of blood will be retained in the skin in
consequence of the loss of tonicity of the cutaneous vessels; the
cutaneous circulation will be slowed, and thereby the blood, heated
at the surface of the body, is prevented from returning to the
internal organs and so overheating them.
_Third._—In consequence of the accumulated amount of blood in the
skin, a diminished amount of blood will remain in the internal
organs; thus their activity, and thereby also the production of heat,
will be lessened.
In these processes will be found a safeguard against the excessively
rapid penetration of heat to the internal organs, and against the
unduly rapid elevation of the body temperature through thermic
influences.
As a result of the stimulating influence of cold, there first occurs
contraction of the skin and its vessels. This, by restricting the
dissipation of heat, brings about perfect compensation if the
abstraction of heat be but slight; and but partial compensation, if
the abstraction of heat is more marked. In the latter event the body
temperature will continue to decline, to a greater or less degree; in
the former it will remain constant.
The rôle played by the skin in maintenance of the normal temperature
of the body is indispensable.
The normal temperature of the adult human body is 98.6° F. in the
mouth, and that of the rectum and vagina is one degree higher.
Fasting, sleep, and short applications of heat all decrease
heat-production; during sleep the temperature of the body falls half
a degree or more.
Respiration by the skin varies from ½ to 1 per cent. of the total
amount of oxygen taken into the body, and a somewhat lower percentage
of carbonic acid is thrown off through this channel.
The skin absorbs substances in watery solutions with difficulty,
on account of the oil lying upon and in the epidermis; substances
dissolved in oil and rubbed in are more rapidly absorbed; absorption
takes place rapidly after the skin has been washed with ether,
chloroform, or alcohol.
=The Physiologic Effects of Water.=—These depend on whether the water
is taken internally or applied externally. If applied externally,
the effects will depend upon the temperature, whether hot, tepid, or
cold; also on the manner of application, but, most of all, on the
length of time which it is applied and the state of health of the
individual.
The temperature of water is classified as very cold, from 32° to 55°
F.; as cold, from 55° to 65° F.; cool, from 65° to 80° F.; tepid, 80°
to 92° F.; warm, 92° to 98° F.; hot, 98° to 104° F.; very hot, 104°
F. and above.
_Heat._—A general hot bath produces dilatation of the vessels of
the skin and contraction of the vessels of the brain; a general
activity of the glands of the skin, both perspiratory and sebaceous.
Perspiration may be produced, either to the degree of slight moisture
or of profuse sweating, according to the length of time and the
intensity of the application made. In a very hot bath the rate of
perspiration may be increased from fifty to sixty times the ordinary
amount. The most pronounced effect possible may be secured by either
the electric light or sun bath.
Loss of fluids from the body has a depressing effect similar to,
though somewhat less marked than, that produced by bleeding, so that
there is a vital necessity for administering water internally before,
during, and after the bath.
Prolonged and repeated perspirations induced by artificial
means weaken the skin, and thus lessen its power to resist cold
impressions, unless counteracted by frequent cold applications.
The general and usual reactions following the applications of heat
are atonic and depressing in character. For the most part, the
reactions following cold applications are to be preferred to those
following hot ones.
The three great vascular areas of the body are the muscles, the
portal system, and the skin. Each of these parts may be regarded as
a great reservoir, capable of retaining a large part of the entire
amount of blood of the body. When one of these areas is in a state of
congestion, the others must be in a comparative state of anemia.
The restorative effects due to the application of heat are due partly
to the elimination of fatigue poisons which is thereby encouraged,
as well as by the reflex stimulation of the nerve-centers. The good
effects are much more decided and lasting, and the exhausting effects
neutralized, if the hot application is followed by a short cold one.
The effects of a neutral bath, 92° to 95° F., is sedative,
diminishing nervous irritability.
A hot-water bottle or fomentations, placed over the stomach for an
hour or two after eating, increase the gastric secretions, and, when
placed over the liver, increase the flow of bile.
=The Physiologic Effects of Cold.=—In suitable cases a short
general application of cold is a powerful heart tonic. Cold causes
a contraction of the vessels of the skin and of those of the brain,
with a dilatation of the internal vessels. There are pallor and
coldness of the skin, and an almost instantaneous suspension of
perspiration, which is dangerous only when the body is in a state of
fatigue.
If the application of cold is long continued, the surface becomes
blue, the temperature of the muscles beneath the skin is lowered,
thus checking heat-production in these muscles; the circulation is
slowed, and the heart’s action is diminished in frequency. There is
a goose-flesh appearance of the skin; a sensation of chilliness,
trembling, shivering, chattering of the teeth; at first a quickening
and then slowing of the pulse, and deep gasping respiration.
When the cold application is considerably prolonged, the tendency to
reaction is suppressed. There is an exhaustion of the nerve-centers
as well as of the heat-producing powers of the body. Thus, the
system gradually loses its power to resist the depressing effects of
cold. The repeated chillings of the body increase the length of time
required to return to the normal temperature. Applications of water
below the temperature of the body always lower the temperature.
_Reaction._—If the application of cold is of very short duration, of
very low temperature, and given under high pressure, the phenomena of
reaction begin immediately on its cessation.
The reaction consists in a dilatation of the surface capillaries,
with contraction of the internal vessels; redness of the skin; the
skin is smooth, soft, and supple; there is a sensation of warmth,
comfort, and well-being; respiration is slower and deeper; there are
a fall of the internal temperature and increase of perspiration.
Certain measures to favor reaction should be taken before the bath,
such as exposure to the air of a warm room, drinking hot water, and
short exercise of a rather vigorous kind.
During the bath the measures which favor reaction are short, sudden
applications of cold, friction while in the bath with the hand, and
pressure effects in the douche.
After the bath reaction is favored by vigorous rubbing, a thorough
drying of the body, warm clothing, warm air of the room, and as
vigorous exercise as the strength of the individual will permit.
Conditions which are unfavorable to healthy reaction are: old age,
infancy, exhaustion, either temporary or from an excessive loss of
sleep, or extreme nervous exhaustion, obesity, rheumatic diathesis,
unhealthy or inactive skin, profuse perspiration when accompanied
by a state of fatigue, extreme nervous irritability, a very low
temperature of the skin, an immediately preceding or impending chill,
and extreme aversion to cold applications.
The average temperature of the human nude skin is in the neighborhood
of 90° F. The difference between the temperature of the skin and
water is the chief element in determining the reaction of the
individual. It is evident that water at a temperature of 90° F. would
be neutral or indifferent; the difference of intensity of effect
is in proportion to the difference of temperature of the water and
skin. The duration of the cold procedure is an important element in
the production of reaction. It may be laid down as a rule never to
give any cold-water application without friction. The physical and
psychic state of the individual exerts more or less influence upon
his reactive capacity. An anemic, or otherwise depressed individual
must be managed with great circumspection, because she bears heat
abstraction badly. The hydriatic procedure must always be adapted to
the reactive capacity of the bather.
The woman must be thoroughly rubbed after the bath until a good
reaction has occurred. Especial attention must be paid to the feet
and legs. The bather should first be rubbed with a warm towel or
sheet, and then with the bare hands of the attendant, as the warm
hand greatly facilitates the reaction. The bather is by no means dry
when the skin ceases to feel wet. So long as the skin is soft and
spongy, it still contains moisture which has been absorbed by the
superficial layers of the epidermis. The absorbed moisture, being
left to evaporate after the bath, the individual is liable to become
chilly and contract a cold, which is erroneously attributed to the
bath itself.
Other injurious effects following imperfect reaction after the
cold bath are secondary chills or a continuous chill lasting for
several hours. The hands and feet are cold, there is headache, not
infrequently diarrhea, and other evidences of internal congestion,
such as abdominal or ovarian pain, vertigo, etc.
Reaction may be favored by covering the patient with blankets,
surrounding her with hot-water bottles, and giving her hot tea to
drink. Exercise should follow the bath. Walking for from twenty
minutes to an hour is the most usual form of exercise. Very vigorous
exercise for a short time cannot be substituted for moderate exercise
for a longer time.
_The Tonic Effect of Cold Upon the System._—The effect of cold upon
the muscles, when given in the form of a cold bath, douche, or spray,
is to augment muscular energy and tone to a very great extent; this
increased muscular tonicity is the cause of the slight shivering. The
cold douche, if short,—one or two seconds,—and given with a pressure
of from 25 to 30 pounds, is a powerful restorative in fatigue
resulting from severe muscular effort, but it must be immediately
preceded by a short hot bath, and must be followed by vigorous
rubbing and wrapping in a hot blanket.
Short cold applications cause elevation of temperature and increased
metabolism, while prolonged cold applications cause a fall of
temperature and decrease of metabolism.
The tonic effect of cold water is believed to be due to the
stimulation of the sympathetic nerve-centers. The sympathetic nervous
system controls the blood-vessels, heart, the functions of secretion
and excretion; and, indeed, all the vital functions of the body.
The sensation of well-being which accompanies the reaction following
a general cold application is largely due to an increased activity
of the cerebral circulation. Cold water is a physiologic tonic, and
the cold bath, properly employed, increases the vital resistance to
pathologic processes.
All applications of water at a temperature low enough to provoke
vital resistance are tonic; hence, tonic effects are produced by
all temperatures below 90° F., but the most certain and pronounced
results are obtained from the douche in every form, which adds
mechanical impact to the thermic effects of cold. The most durable
tonic effects are produced by the frequent use of very cold and very
short baths.
A tepid bath causes a lowering of the body temperature.
=The Chief Varieties of Baths.=—These, in the order of frequency
with which they are used, are: ablutions; tub; foot-tub; sitz; salt
sponge; shower; Turkish; horizontal jet; needle; fan douche; Scotch
douche; Roman and electric-light baths.
=Ablutions or Sponge Baths.=—These baths are of universal use. The
sponge is one of the dirtiest and most impossible articles of the
toilet to clean and to keep clean. It is a collector of dirt and
germs, and should be banished from every bath-room and from every
house. It is not sufficient that each member of the family should
have her own sponge; it is quite possible for the individual to
become infected or reinfected from her own sponge. Incidentally,
it does not afford sufficient friction, and thus does not favor
reaction. In taking ablutions, the application of water may be made
with the hand, though it is best made by means of a wash towel. The
good effects of the simple ablution will be greatly enhanced by the
use of the hat tub, and this especially where there is no bath-tub in
the house.
When the bath is taken for the purpose of cleanliness, the water
should be warm or hot, and pure Castile soap is one of the best that
can be used. If the skin is rough, a good sand soap will be more
beneficial. The bath should be completed by dashing cold water over
the body with the wash-towel.
The body must be quickly and thoroughly dried by means of a rough
bath-towel. After this, the skin may be still further toned up by a
good alcohol rub.
If the ablution is taken simply for the tonic effect, it is generally
taken on rising in the morning, and the water used is cold. The
ablution may be confined to the upper part of the body, that is, the
chest and back; and consists in friction with a rough wash-towel,
followed by dashing the water over the body; followed by brisk
friction with a rough bath-towel. This procedure causes a marked
stimulation of the heart and lungs, and is followed by a rise of
temperature.
In winter all baths must be taken in a warm room.
There is a decided increase of muscular and mental capacity after the
cold ablution, demonstrating the tonic effect it has produced.
The cold ablution may also serve as an introductory to other and more
heroic hydriatic procedures. If the reaction is not good, water at
a higher temperature should be used, and only small portions of the
body should be attacked each day, followed always by brisk friction.
As the reaction becomes better, the temperature of the water should
be gradually lowered from day to day.
There must be a decided sensation of warmth of the body before
proceeding to take any form of cold bath. This may be induced
by sipping a cupful of hot water before rising, and then being
well covered with the bed-clothes until the body is in a glow. In
conditions of anemia or neurasthenia, where the circulation is
markedly poor, in addition to drinking the hot water, the bather may
stand on hot blankets while taking the cold ablution, and after it be
rubbed briskly with hot towels.
Nothing is gained, and a great deal of harm is done, by trying to
persevere in the daily cold ablution when it is followed by a pallor
of the skin, chilliness, etc.
=The Tub Bath.=—This is much more refreshing, more salutary, and may
be used to produce a much greater variety of effects than the simple
ablution. Tub baths may be classified according to the amount of
water in the tub as half or full tubs; and again, according to the
temperature of the water, as warm, tepid, hot, and cold. The half tub
contains about 30 gallons of water.
In a general way it may be said that the half tub of warm water is
used for the purpose of cleanliness; the hot baths for breaking up
colds, for rheumatism, etc.; the tepid bath to allay nervousness; and
the full cold tub, for the tonic morning dip.
For cleansing purposes the so-called half tub, that is, the tub
contains a sufficient amount of water to reach above the pelvis when
one is seated in the tub, is used. The temperature ranges from 98° to
102° F. Five minutes is as long as the bather should remain in the
tub, as all hot baths are more or less exhausting. After an initial
immersion in the water, the scrub takes place by means of the Turkish
bath-towel, or, better, by the use of the flesh brush. If there is a
shower attached, the hot bath should always be followed by a brief
cold shower; if not, the cold water should be turned on and dashed
over the body by means of the wash-towel. This closes up the pores of
the skin, prevents the profuse perspiration from taking place that so
often follows a hot bath, and greatly diminishes the susceptibility
to taking cold. An alcohol rub completes the procedure. This insures
a further toning up of the cutaneous vessels. A small quantity of
alcohol is poured into the hand and applied to a limited area of the
body. It is well rubbed in with friction until the alcohol has wholly
evaporated. Beginning with the arms, the legs, chest, and back are
successively gone over.
The hot bath is best taken immediately before retiring, and should
not be repeated oftener than twice a week. Retiring to bed at once,
the bed acts as the cooling chamber of the Turkish bath. The hot bath
is most restful, and, except in rare cases, tends to the production
of refreshing sleep.
If the bather has a weak heart, suffers from shortness of breath,
or is weak from any cause whatever, she should only take a half
tub bath, since it has been learned from experience that when the
water covers the entire body, there is increased difficulty in the
respiration, and the heart’s action often becomes embarrassed,
palpitation of the heart is experienced, with a feeling of impending
suffocation. There is sometimes also a feeling of faintness. On
getting into the tub, the temperature of the room should never be
above 68° to 70° F.
_The Full Tub or Immersion Bath._—In this form of bath there is a
complete submersion of the body in the water, so that the water
reaches the under surface of the chin, the head of the bather resting
on a cross strap, being the only portion of the body uncovered by the
water.
If the bath is tepid, that is, has a temperature of from 80° to 90°
F., great care should be taken to have the chest covered, in order to
prevent pulmonary congestion. This is best accomplished by placing a
Turkish towel, wrung out of hot water, about the chest and shoulders
of the bather just after she enters the tub.
If the bath is hot, from 98° to 104° F., before entering the bath
the face and neck are rubbed with cold water, in order to relax the
vessels of the brain and so prevent cerebral anemia. Except when
the hot bath is given for especial therapeutic purposes, as for
rheumatism, cystitis, colic, etc., it should always be followed by a
cold application.
=The Cold Dip.=—For the dip, the tub is filled with water at a
temperature of from 65° to 55° F. The duration of the dip varies from
two or four seconds to one or two minutes. The bather should wet the
face and chest before entering the water. It is best to enter the
bath suddenly, as the sensation of cold is thus far less noticeable
than when the bath is entered gradually. If the stay in the tub is
more than momentary, vigorous rubbing must be kept up during the
entire time spent in the tub.
For persons in good health a cold dip on rising in the morning is
excellent. It creates an appetite, accelerates the circulation,
arouses the nervous system, and produces decided exhilarating
effects in those who are strong enough to react after it. When
employed for this purpose, the immersion should not be more than from
three to fifteen seconds. The bather must rub herself vigorously
while in the tub, and follow the bath with brisk toweling and plenty
of friction. She should then take moderately active exercise for
fifteen to twenty minutes.
For any one just beginning to take the cold dips, the temperature
of the water should be just 1 degree below that of the body, and
gradually lowered by a drop of 1 degree every morning or two. Or, the
dip may be preceded by a preliminary warm bath or warm shower.
The salient point in connection with bathing is not to allow the skin
to lose heat too rapidly. To apply this as a warning in the case of
cold baths: it has been estimated that the heat loss from the body
immersed in cold water at the temperature of 86° F. is double the
normal; at 77° F., three times, and at 68° F., five times, the normal.
The daily use of the cold dip for those who are able to react after
it is one of the best means of fortifying the system against both
acute and chronic diseases.
_Contraindications._—The use of the cold dip is contraindicated for
young children, the aged, and in run-down conditions of the system;
in all cases where the action of the heart is weak, in Bright’s
disease, or in any acute or chronic congestion of the kidneys; in all
acute inflammations, as inflammation of the bowels, peritonitis, or
inflammation of the uterus and ovaries.
=Alkaline Baths.=—For these baths from 4 to 12 ounces of the
carbonate of soda should be used to 30 gallons of water. The water
should have a temperature of from 92° to 96° F. This bath is useful
in many forms of skin disease, and relieves the itching of jaundice
and urticaria.
=Saline Baths.=—The typical saline bath is the salt-water bath.
Sea-water contains in solution from ⅓ to ¼ pound of solids to the
gallon of water. The principal ingredients are common salt, magnesium
chlorid, and magnesium sulphate. These substances have a decidedly
stimulating effect upon the skin and encourage reaction. For an
artificial sea-water bath, 8 pounds of sea-salt should be used to 30
gallons of water.
Ordinary coarse salt is purer, contains from 97 to 98 per cent. of
the chlorid of sodium, is cleaner, and makes a clearer solution, and
it dissolves in about one-third of the time required for sea salt,
and can be obtained for about one-third of the cost.
As a cleansing agent, a 5 per cent. brine is equal or superior to
soap. Further, the axilla and hairy parts remain clean and sweet for
a much longer time than after the use of soap. These brine baths,
taken three times a week, are followed by a great improvement in the
general health.
=The Rain Douche or Shower Bath.=—The shower is the most tonic of
all the baths that can be taken at home, and no bath-room should be
considered complete without it. In this form of douche the water
is projected through a perforated disc, falling upon the bather in
a number of fine streams. It is necessary for the bather to wear a
rubber cap in order to keep the hair dry. In taking the shower bath
the bather stands up; the disc is generally placed about 3 feet above
the head. The water should be allowed to fall first upon the feet,
then the hands, arms, shoulders, back, and, lastly, upon the chest
and abdomen. The bather should keep in active motion during the
application, flexing the limbs, and rubbing the chest with the hands.
At the beginning of the shower the hands should be placed over the
chest, in order to protect the precordial region from the impact of
the water.
The cold shower should be preceded by some kind of a heating
process—either a hot plunge or a hot shower bath. A shower of from
100° to 104° F. may be applied for one to three minutes before the
cold application. A cool shower of 75° to 65° F. is an excellent
training for persons who are sensitive to cold. The neutral shower,
92° to 97° F., given for three to five minutes, is sedative in its
effects.
The cold shower, 60° to 70° F., duration from five to thirty seconds,
is useful in phlegmatic neurasthenics and dyspeptics; sedentary
people in whom the general metabolic activity is diminished; also in
obesity and in all cases after a sweating process. By standing in hot
water the bather is much more tolerant of cold.
The neutral shower is one of the most effective measures for the
relief of insomnia; especial attention should be given to the back
and legs. The action is quicker than that of the neutral immersion
bath.
As a hygienic measure, the shower bath offers a most agreeable and
rapid means of cleansing the whole surface of the body.
Since the effect of the douche depends on the pressure, it will
be readily understood that the hose attached to the faucet of the
domestic bath-tub is merely a sprinkler, and not a douche, in the
proper sense of the word. Such a procedure can only be tolerated
by the most robust. In the upper stories of most city houses the
pressure is probably not more than from 3 to 10 pounds; the stream
of water from the sprinkler is really only a drizzle; the mechanical
effects being so slight, there is no reaction produced; the result is
that its use is followed by a feeling of chilliness and depression.
=The Hot Foot-bath.=—The temperature of this bath should be at the
beginning from 102° to 104° F., and the duration from three minutes
to half an hour. The pail is nearly filled with water, care being
taken that it shall not be so full as to overrun when the feet and
legs of the bather are put in. A blanket, closely wrapped about the
patient and the pail, should come up above the knees. As the water
cools off, hot water should be added.
This form of bath is most commonly used to relieve congestion and
inflammation. The dilatation produced in the blood-vessels of the
feet and legs relieves congestion of the brain and the organs of the
upper half of the body, as well as of the pelvic viscera. It should
be taken immediately before retiring.
=The Sitz Bath.=—The sitz or hip bath requires a tub made for that
particular purpose. The back of the tub, which is most commonly made
of tin, is cut high, while the front must be sufficiently low for the
patient to sit comfortably in it, without undue pressure being made
on the under side of the knees.
The tub is half filled with water of the prescribed temperature. It
is well to begin with water at a temperature of 102° F., and increase
the temperature while the patient is in the tub, making it as hot as
is comfortable.
[Illustration: Fig. 2.—Sitz-bath tub made of tin (Ashton).]
In giving all hot baths a thermometer must be used, and a word of
warning must be given about adding hot water in case of sickness,
as well-authenticated cases of paralysis are recorded in which the
temperature sense of the patient was lost, and, in adding hot water,
it was raised to such a temperature that the legs and feet of the
patient were scalded.
During the sitz bath the patient keeps on her stockings and bedroom
slippers, and, unless friction is ordered, the entire body, as well
as the feet and legs, are enveloped in blankets.
The duration of this bath is from three to ten minutes. This bath
is especially useful in restoring the menstrual function when it has
been suspended as the result of chill or other causes; also, for
relieving hemorrhoids, uterine colic, neuralgia of the ovaries, and
inflammation of the bladder.
To prolong the effect of the bath the patient may be put to
bed wrapped up in her blankets. In cold weather it is a good
precautionary measure to have the bed heated with hot-water bottles,
in order to prevent chilling.
=Salt Ablution.=—As the name indicates, this is a salt-water bath,
and the best results are obtained by using a saturated solution,
which is in the proportion of 1 pint of salt to 1 gallon of water.
Sea-salt is the best, but, if that cannot be obtained, ordinary salt
may be used.
If there is no bath-tub in the house an ordinary wash-bowl may be
used, but the bath is most effective when taken in the tub. The salt
and water are put in a papier-mâché pail, which is placed at the foot
of the tub. The chilliness which might be caused by sitting on the
cold porcelain is avoided by placing a heavy folded bath-towel on
the bottom of the tub. In cold weather the tub should be previously
heated by allowing the hot water to run in.
The salt water feels very much colder than plain water at the same
temperature. It is well to begin with a temperature of from 90° to
85° F., and gradually lower the temperature until 70° F. is reached.
The water is applied by means of a Turkish wash-towel, accompanied
by vigorous friction, beginning with the face and neck, arms, legs,
back, and, lastly, the chest and abdomen are gone over. After that,
the water is dashed over the entire body, and is followed by a brisk
toweling and friction with the hands or hair glove. The salt water
should not be washed off, except in those rare cases where it causes
a disagreeable sensation; it is then removed by the use of the hot
followed by the cold shower, as previously directed.
_Indications for Its Use._—It is an excellent nerve tonic in cases
of depression with loss of appetite, insomnia, etc., also in anemia
and neurasthenia. In this class of cases it is best taken in the
afternoon, on rising from the siesta, and just before dressing for
dinner. It is especially refreshing in the hot weather.
Its use is contraindicated under the same conditions that other cold
baths are, and must never be taken when the bather has a tendency to
chilliness.
The various kinds of baths previously described can all be obtained
in the home, but the Turkish bath, with its various accessories, can
only be taken in a properly equipped bathing establishment.
=The Turkish Bath.=—This form of bath dates back to the time of
the Romans. The essential features of a modern establishment are:
dressing-rooms; a warm room, with a temperature of from 110° to 130°
F.; a hot room, temperature of 150° to 170° F.; a steam room; a
shampoo room; a douche apparatus; a plunge bath, and a cooling room.
In many establishments there is only one hot, dry-air room. The air
of the room may be heated by steam-coils.
The bather, having disrobed, is enveloped in a sheet, and enters
the hot room, where she reclines on a steamer-chair. A towel wrung
out of cold water is placed on the forehead and changed as often
as it becomes hot. The bather should drink a glass of cold water
immediately before or on entering the hot room, and several glasses
should be taken at intervals during her stay in this room.
The skin is highly stimulated and profuse perspiration results. The
profuse sweating promotes absorption from the alimentary canal, and
so is a powerful stimulant to nutrition. It also emphasizes the
necessity for copious water-drinking.
Great harm often results from a too prolonged stay in this room.
Ordinarily, the bather should leave the room as soon as free
perspiration is established; that is, in from fifteen minutes to half
an hour.
From this room the bather next enters the Russian bath or steam
room. It is very much more agreeable to have very little steam
in the room on entering; when the steam is very dense, a feeling
of suffocation may occur. Any one with a weak heart should avoid
the steam room altogether, as it is apt to cause a sense of great
oppression. For the complexion, bronchitis, or laryngitis, it is
excellent.
From the hot room the bather goes to the shampoo-room, where, lying
upon a marble slab, she is first gone over from head to feet by the
wet hands of the attendant. This manipulation removes the layer of
cuticle which has been loosened by the free perspiration. These
rubbings and strokings are continued until the skin feels smooth and
polished.
The bather is next shampooed with soap and water, applied with a
bath-brush. This may in turn be followed by a salt rub. After this
comes a douche, given with a horizontal jet, at a temperature of 104°
to 106° F., followed by a cold douche.
If the bather is a strong woman, she may now enter the cold plunge.
The temperature of this should be from 70° to 60° F.; this must only
be a quick dip. She is then vigorously rubbed and dried. After this
she lies down in the cooling room and has an alcohol rub, which
completes the procedure. She should rest here for half an hour at
least before dressing. The pulse should be normal and the skin
perfectly dry before she dresses and goes out on the street.
In winter, instead of the ordinary alcohol rub which is given, it is
much better to have a thorough massage with cocoa-butter or almond
oil—the so-called Roman bath. Just following the Turkish bath much of
this oil will be absorbed, which is beneficial for thin people, and,
in any case, it will lessen the danger of getting chilled on going
out into the cold air.
The woman unaccustomed to these baths should under no circumstances
go to a Turkish bath without consulting her physician, as great harm
might result. The bath should not be taken oftener than twice a week,
unless by special orders of the physician. Care must be taken not
to overuse them, as frequent and prolonged exposures to the sedative
influence of heat is very debilitating. The wise woman will provide
her own bathing cap, bath-brush, and straw sandals.
The use of the Turkish bath is indicated in rheumatism, toxemia,
chronic dyspepsia, biliousness, obesity, sciatica, and lumbago.
The contraindications to its use are, in Bright’s disease of the
kidneys, in most pulmonary affections, in the advanced stages of
arteriosclerosis, and in diabetes with emaciation.
=The Electric-light Bath.=—This is now frequently used instead of the
hot-air room of the Turkish bath, and possesses many advantages. A
cabinet is lined on three sides with mirrors, on which are arranged
50 or 60 electric-light bulbs; the mirrors multiply the number of
lights by reflection. A stool is placed in the cabinet for the
patient to sit on, while the head protrudes above the top, which is
closed. By means of switches and a proper, grouping of the lamps
in wiring, the number of lights, and so the temperature, can be
instantly and perfectly controlled. The heat is derived by radiation,
so that it is not necessary to have the air confined. In this form
of light bath the body is directly exposed to the effects of radiant
light and heat.
The incandescent electric-light bath is superior to every other form
of heating procedure in which the only object is the preparation for
the cold bath. The time required is not more than from three to five
minutes. When it is desired to produce profuse perspiration, the
patient may remain in from eight to fifteen minutes. A longer stay
than this is apt to produce an overstimulation of the nervous system
and an excessive elevation of temperature.
The electric-light bath possesses the distinct advantages that, while
the body is exposed to a high degree of heat, the air of the room
in which the head is, and which one is breathing, may be cool, and
unique advantages in the exactness of the dosage as regards time and
intensity. It can also be used in a much greater number of diseases
than the hot-air room of the Turkish bath.
The finishing treatment on leaving the cabinet is identically the
same as that for the ordinary Turkish bath.
_Indications for Its Use._—While the electric-light bath is not a
complete substitute for sweating produced by exercise, it comes
nearer to that than any other heating procedure, and, when followed
by some vigorous cold application, it possesses a hygienic value
which cannot be overestimated.
It is especially valuable in cardiac disease and diabetes. It
stimulates oxidation, and is thus valuable in obesity and the toxemia
of chronic dyspepsia; also in malarial cachexia, syphilis, neuritis,
neuralgia, sciatica, habit chorea, hysteria, rheumatism, and anemia.
It is superior to all other treatment in chronic rheumatism and all
diseases dependent on uric-acid diathesis or diminished metabolism,
by the combined action of the elevation of temperature and the
vigorous cutaneous activity. The elevated temperature stimulates the
oxidation of the proteid wastes and augments vital combustion, while
the increased skin activity carries off all waste-products prepared
for elimination.
As a prophylactic, this form of bath is especially valuable for all
persons leading a sedentary life; it is the best substitute for
exercise in the open air, and, where there are no contraindications
to its use, should be taken once a week.
In cases of obesity, sweating may be used to reduce the weight;
but, in order to obtain the best effects, it must be combined with
exercise, and it must be borne in mind, that in obesity there
is great danger of overheating the blood, in consequence of the
obstacles to heat elimination presented by the thick layers of
non-conducting fat. Therefore, these hot applications for the
reduction of fat should never be too much prolonged, and the bath
should always be finished by vigorous applications of cold. These
cold applications have also a tonic effect upon the nervous system,
and increase the muscular disposition for exercise, and this is the
most rational treatment for obesity.
_Loss of Weight._—There are many cases in which metabolism has
been so sluggish, allowing an accumulation of imperfectly oxidized
matters in the body, that the first active stimulation of the
nutritive processes is in disproportion to the increased destructive
metabolism. Under these circumstances there is necessarily a
decrease in weight. The rubbish must first be removed and old
defective structures before new and highly organized tissues can be
deposited. A slight loss of weight need, therefore, give rise to no
apprehension, but if the loss is considerable, or continues for some
time, especially if accompanied by loss of strength or appetite, it
is a matter for investigation.
Palpitation of the heart and fulness of the head are an indication
that the applications have been too hot or too long continued.
Vertigo and fainting are apt to occur when hot applications have
been continued too long, but they are quickly relieved by cold
applications, especially by cold affusions to the chest and
shoulders. Headache may result, either from excessively hot or cold
procedures. Deficient reaction is generally the result of a too
prolonged application of cold.
On entering the electric-light cabinet, a wet towel wrung out of
ice-water is placed around the neck and another around the forehead;
or an ice-bag may be placed on the top of the head.
=The Douche.=—A douche consists of a single or multiple columns of
water directed against some portion of the body. The apparatus is
complicated, and it is essential that an accurate pressure-gauge and
thermometer should be introduced into the circuit of the douche. It
can only be properly administered in a hydriatic establishment. In
the employment of the douche three factors must be considered—the
temperature, pressure, and the mass.
The range of temperature employed varies from 45° to 125° F. The
pressure ordinarily employed varies from 10 to 60 pounds. The mass
varies according to the effect desired, and may be regulated by means
of the finger, placed in the water column near the nozzle.
The douche is applied by means of the rubber hose, which is connected
at its proximal end with the water-supply, and at its distal end
is attached a nozzle, the average diameter of which varies from 2
inches to ⅜ inch. From these a fine or coarse jet or a fan douche
may be produced. The latter is formed by placing the index-finger
of the hand holding the nozzle upon the lower border of the outlet,
producing an expansion of the otherwise solid jet into a fan-shaped
stream.
The mechanical effects of the douche are derived from atmospheric
pressure, and this is of more importance in the effects produced than
the temperature.
The Scotch douche consists of alternate streams of hot and cold
water. The general cold douche is the most powerful of all the
tonics; the warm or neutral douche is sedative; the very hot douche
is frequently followed by atonic reactions.
_Rationale of the Douche._—The douche is a thermic massage. Since
the douche is a sorbefacient of pathologic products, the French have
availed themselves of its use to aid the body to throw off an excess
of uric acid, fatigue toxins, etc.
It has been demonstrated that a rain douche of 50° F., under a
pressure of two atmospheres, increases threefold the work that the
muscles are capable of doing, while the Scotch douche, oscillating
between 98° and 53° F., doubles the working capacity of the muscles.
Even tepid douches increase the working capacity of the muscles,
while a tub-bath of the same temperature is without decided effect.
The pressure under which the douche is given adds a powerful element,
which is absent in other hydriatic procedures. The percussion and
vibration affect the vasomotor system much more powerfully than any
form of still bathing.
The power and action of the heart are greatly improved by the use of
the douche, the capacity of the lungs is increased, and the digestion
is improved.
Brief douches of from ten to fifteen seconds generally act better
than those of longer duration. The general condition of the patient
must always be carefully studied, and, like the Turkish bath, the
douche should always be taken under the direction of a physician,
as they are also capable of doing a great amount of harm as well as
good. The best results from the douche are obtained when it is taken
following the use of the electric-light bath.
The neutral douche is particularly applicable in cardiac affections
and in cases of high arterial tension. The sensation afforded should
not be either that of hot or cold, and the duration from one to
two minutes. The douche for this purpose should be given with only
a slight degree of pressure, and to avoid irritation it should be
directed to either side of the spinal column. This is a sedative
application.
_Contraindications for the Use of the Douche._—In all acute
inflammations and in eruptive disorders of the skin. The cold douche
is contraindicated in inflammation of the uterus, ovaries, kidneys,
stomach, liver, bowels, and bladder, in intestinal catarrh, chronic
inflammation of the stomach, and general neuritis. It must also be
avoided in rheumatism, arteriosclerosis, cardiac insufficiency,
valvular diseases of the heart with deficient compensation,
fatty degeneration of the heart, and in cases of extreme nervous
irritability.
=The Internal Use of Water.=—The internal use of water is essential
to life. Water constitutes about two-thirds of the body weight; it
is found in every tissue and organ of the body; it acts to dilute
the foods so that they can be absorbed from the digestive tract;
its presence in the blood is essential, both to carry foods to the
tissues and to convey the waste matter away from the tissues. Its
use in the form of a lavage is even more necessary, to keep clean
and free from impurities the mucous membrane lining the 30 feet
of the digestive canal and the tubules of the kidneys than is the
external use of water to keep the skin in a healthy condition. Its
use is also needed to keep the blood-pressure and the heart in a
normal condition.
About 4½ pints of water are given off daily in the excreta and
exhalations; but, since about one-half of the solid foods taken
consist of water, 3 pints of water, taken daily as such, are
sufficient to counterbalance the loss.
All water for drinking purposes should be filtered. The best method
is to have a filter attached to the pipes of the house-supply, so as
to insure filtered water running from all the spigots.
If the water is not filtered, it should be boiled for thirty minutes.
The water should be run off in the morning, then poured into a
well-kept tea-kettle and boiled. It is then allowed to stand and
become partially cooled in covered vessels, when it is poured into
large bottles—quarts are the most convenient size; these should be
stoppered with corks of absorbent cotton. When cool, the bottles are
placed in the refrigerator beside the ice. Water should be boiled
every morning for the twenty-four hours. Boiling for this length
of time secures the destruction of all the germs of disease, and
it is doubly essential on the return to town in the fall, when the
house has been closed for some time; also when typhoid fever in the
neighborhood indicates the strong possibility of the impurity of the
water-supply.
The mistake should not be made of undoing the good that has been
done by boiling the water by the addition of ice to the water when
it is placed on the table. Furthermore, ice-water is so cold that it
retards and interferes with the digestive processes.
In the internal use of water the same marked difference is caused by
the different temperatures at which the water is taken, as was seen
in the external applications of water; but, while the temperature
of the skin is about 90° F., that of the mucous membrane lining the
digestive tract is 98.6° F. and above.
_The Action of the Internal Use of Water on the Heart and
Blood._—Water improves the quality of the blood, both by its direct
action on the constituents and by the increased elimination of
waste-products. By the increase of the volume of blood, a more
energetic contraction of the heart is caused, and the activity of all
the glands of the body is increased. There is a greater amount of
oxygen absorbed by the lungs; oxidation in the tissues is carried on
more perfectly, the result of which is that there is a diminution or
absence of the products of incomplete combustion in the body, such as
uric acid, the oxalates, etc.
By the increase of the blood-pressure, caused by drinking water in
sufficient quantities, the activity of the kidneys is increased, and
this not only in the amount of urine passed, but also of the solid
constituents, which are the waste-products, removed from the body
through the agency of the kidneys.
_The Action of Water on the Digestion._—Very little water is absorbed
from the stomach; it passes from the stomach to the intestines,
where it is absorbed. In order to obtain a thorough cleansing of
the stomach, and at the same time not to cause its overdistention,
not less than ½ pint of water and not more than 1½ pints should be
taken at one time. The water must be taken one hour before meals,
in order to insure its removal from the stomach and the proper rest
of that organ before food enters it, as it has been found by actual
experiment that in a quarter of an hour after water had been taken
one-half of the quantity remained in the stomach, but that none
remained after the lapse of half an hour. Cold water is more quickly
absorbed than warm, and the absorption is hastened by the presence of
carbonic acid, while salt of any kind delays its absorption.
_The Therapeutic Indications for the Use of Water._—First, the
temperature of the water taken must be regulated by the effect
desired. Briefly stated, if the water is taken for dyspepsia in any
form, whether acute or chronic catarrhal inflammation of the stomach
or the intestinal canal, ½ pint of water, just as hot as it can be
sipped with a spoon, should be taken three times a day, one hour
before each meal.
No water should be taken during the meal, and only one glass, at a
temperature of about 60° F., on its completion.
If the water is taken as a diuretic, or, in other words, to increase
the activity of the kidneys, the most of the water should be taken
in the morning on rising and the remainder about 4 o’clock in the
afternoon. Probably the best natural waters for this purpose are the
waters of the Vosges, France. The Vittel water, “Grande Source,” acts
on the kidneys alone; where the bowels are regular or inclined to be
loose, this is the best water to use. If, on the contrary, there is
constipation or biliousness, the “Source Salée” should be taken in
connection with the first named or alone. The “Source Salée” has a
decided action on the liver and is laxative.
In order to obtain a pronounced effect, at least 3 pints of these
waters should be taken daily; in some cases more is required. Two
glasses may be taken on rising in the morning, with an interval of
twenty minutes between; the last glass must be taken one hour before
breakfast. The temperature of the water should be 50° F., which is
the temperature of the water at the springs and that of the water
when placed in bottles in the refrigerator against the ice. In the
afternoon the other two glasses may be taken, with the same interval
between.
In gastric catarrh, where there is an accumulation of mucus or
fermenting matter, with or without nausea and vomiting, hot water
alone is useful. In addition to its action in diluting the contents
of the stomach and the intestines, and its cleansing and antiseptic
effect on their mucous membranes, the reflex effect of very hot
water, slowly sipped, is a stimulation of their muscular coats,
which furthers the passage of the digested food from the stomach into
the intestines. The quantity taken must be from ½ to 1 pint, in order
to obtain a thorough cleansing and yet not to cause an overdistention
of the stomach.
In acute nephritis, inflammation of the kidneys, small quantities
of very cold water, repeated at half-hourly intervals, act as a
diuretic. Care must be had, however, not to overtax the stomach and
heart by overfilling the system with fluids.
In obesity, water-drinking is essential as a means of dissolving and
carrying out of the body the large amount of broken-down material
which results from the increased tissue destruction caused by
exercise, hot and cold baths, and other means employed to decrease
the weight.
For constipation and biliousness two glasses of cold water should be
taken before breakfast, with an interval of twenty minutes between,
the last glass being taken one hour before breakfast.
_Contraindications._—Cold water taken into the stomach produces more
marked effects than water applied to an equal area of the skin. The
quantity of water taken is a factor as well as the temperature.
Cold-water drinking lowers the temperature and slows the pulse, so
that drinking cold water must be strictly prohibited when one is in
a state of fatigue, whether perspiring or not. Feeble persons should
not drink cold water, except in very hot weather, or just before
starting out for a brisk walk in the open air, or when about to
engage in other exercise. With the air of the room at 70° F., a woman
in fair condition, moving about making her toilet, may safely drink
cold water slowly, except when there is a feeling of chilliness.
In the latter case, the powers of reaction being diminished, chill
and internal congestion, often resulting in great injury, may be
produced. Cold-water drinking is always prohibited when in a state of
fatigue. Ice-water should never be taken. When taken with meals, it
greatly retards digestion and may do much harm.
=Enemas.=—=Coloclysters.=—Another valuable internal use of water is
for emptying the lower bowel, and washing out the large bowel in
cases of catarrhal inflammation.
For constipation, in which the object is to unload the bowel as
quickly as possible, 1 or 2 pints of water, at a temperature of from
104° to 110° F., is made into a suds by means of Castile or other
good soap, and poured into a fountain-syringe. If the enema is being
given by an attendant, the patient lies on the right side in the
Sims’ position; the under leg is stretched out so that it forms a
straight line with the trunk, while the upper leg is sharply flexed
at the knee, so that the foot is opposite the knee of the under leg;
the right arm is thrown back from under the body.
If the patient is administering the enema to herself, the best
position is the knee-chest. In this the patient kneels on the floor,
the thighs are held rigid, and while the shoulders are brought to
touch the floor, the face is turned to one side. The position can
only be taken satisfactorily with the corsets and all tight bands
around the waist removed. In this position gravity causes the
intestines to fall upward toward the waist, and the water naturally
follows this course. In this position the water goes up higher, and
is retained longer, than when taken in the other positions. Two pints
of the soap-suds are prepared at the proper temperature, and the
patient uses as much of this as she feels that she can retain. The
water should be retained from five to ten minutes, to get the best
results.
For the purpose of washing out the large intestine more water is
used, but not more than 2 quarts should be used for this. The
position of the patient and the temperature of the water are the
same. But for this clyster, instead of adding soap to the water,
cooking salt is used, in the proportion of 1 teaspoonful of salt to 1
pint of water.
This lavage of the intestine removes rapidly large masses of
decomposing material, swarming with microbes and ptomains and the
toxins produced by them. It also increases the activity of the portal
circulation.
In cases of chronic constipation there are atony and dilatation of
the colon, and the patient always carries about with her an enormous
accumulation of fecal matter, and lives in a state of chronic
autointoxication. In this class of cases the coloclyster should be
administered daily for from two to three weeks; if need be, so long
as the patient complains of gaseous distention and fetid flatulence.
After the discharge of the warm water, 1 pint of cool water should
be introduced, beginning with a temperature of 85° F., and gradually
decreasing this from day to day until 70° F. is reached. This water
should be retained if possible; it acts as a tonic bath for the colon.
Care should be exercised to avoid the distention of the colon by an
excessive amount of water, and, after the colon has been thoroughly
cleansed, the amount of water used should be decreased from day
to day, until finally only 1 pint is used. Warm water is always
relaxing, whereas cold water stimulates and tones up the bowel. If
the quantity of water used is small, the cold coloclyster may be used
indefinitely without producing constipating effects.
Great care must be used to avoid the introduction of air into the
bowel with the water; to this end the water is allowed to run out of
the nozzle before its introduction into the rectum. A small-sized
nozzle should always be used, and this should be lubricated with
vaselin or some other emollient, in order to prevent irritation of
the mucous membrane.
=Vaginal Irrigations.=—To be of any service the vaginal douche should
be taken in the horizontal position. It may be taken on the bed,
couch, or lying on the floor. When taken on the floor, a heavy rug
or steamer blanket should be doubled four times, and two pillows are
used: the under one goes up and down for the support of the back,
while the second is used for the support of the head. A douche-pan
is, of course, indispensable. The agate pans holding 4 quarts of
water are the most serviceable. The douche-pan is placed against the
lower edge of the under pillow, which is protected by a bath-towel.
The woman must throw a heavy shawl or blanket over herself while
taking the douche, otherwise there is great danger of becoming
chilled, and thus doing actual harm instead of good.
The most common and best form of syringe is the fountain-syringe.
This is hung about 6 feet above the bed or floor. It should hold
4 quarts of water; this quantity of water is necessary when the
douche is given, as it most commonly is, for pelvic inflammation. On
beginning its use, the temperature of the water must be controlled by
the sensitiveness of the patient; generally one can use a temperature
of at least 112° F., but not always; sometimes one must be content
with a beginning temperature as low as 104° F., gradually increasing
the temperature by two degrees every few days, until from 114° to
120° F. is reached. The use of a bath thermometer is always essential
to test the temperature of the water. The temperature of the douche
should never go above 120° F., or actual harm will be done.
On lying down, the lower part of the body rests on the broad strip of
the douche-pan, the nates coming over the edge, and the clothing well
pushed up, otherwise the water will seep up the back.
The water acts as a hot poultice about the uterus and its adnexa;
it is also astringent, and greatly relieves ovarian irritation and
congestion. It is highly sedative, and is best used at night just
before retiring. In severe cases better results will be obtained
by its use twice daily. In that case one douche must be taken in
the morning, but in cold weather it must never be taken immediately
before going out-of-doors; there must be at least one hour between
the time of taking the douche and going out into the cold air.
Patients taking hot douches must be warned that the pelvic viscera
are much more susceptible of chilling because of these heating
procedures, and of the necessity to counteract this tendency by the
wearing of woolen abdominal bands, both night and day.
Ordinarily, plain hot water is all that is necessary to use, but if
the vaginal discharge is irritating, one teaspoonful of borax may be
added to the pint of water; or one teaspoonful of cooking salt; or
one-half teaspoonful of the sulphate of zinc.
=Douching the Ear.=—This procedure is made use of to remove impacted
ear-wax or to relieve the pain of earache. A small fountain syringe
should be used, hung not more than 3 feet above the head. The water
should have a temperature of from 105° to 110° F. The nozzle must be
small, and have a very fine opening, and great care must be used in
its introduction not to allow the nozzle to enter beyond the external
opening of the ear. A pus-basin or small dish may be used to protect
the clothing from getting wet. After the procedure is finished,
the ear is dried by means of a very fine handkerchief or a little
absorbent cotton.