Cold sponging, as recommended by Ringer in his excellent work on Therapeutics, is exceedingly useful in laryngismus stridulus. It should be used two or three times a day whatever be the weather. If the child be hoarse, it should not be allowed to go out, but if there is no hoarseness, the fresh air, even if cold, will be advantageous. To arrest a paroxysm cold water should be dashed over the child.

Ringer also recommends it for a catch in the breath occurring in young children during the night, awaking them from sleep.

By abstracting heat, cold baths are useful in fever in several ways. By reducing the temperature they tend to lessen the amount of tissue-change which is already excessive, and they thus tend to husband the patient's strength, as well as to reduce the alterations of the tissues, such as fatty degeneration of the heart, which occur in consequence of a high temperature. By lessening the temperature also, they diminish the rapidity of the pulse, and by thus prolonging the cardiac diastole give more opportunity for the nutrition of the muscular walls of the heart.

A high temperature, if it is remittent, is better supported than a lower temperature which is continuous, and therefore Liebermeister, to whom we in a great measure owe the recent introduction of cold baths as a therapeutic measure, uses them with the object of increasing and prolonging the remissions in temperature which usually occur spontaneously in febrile diseases - producing a condition of ' relative apyrexia.'

There are several ways of employing cold baths to reduce temperature. One is that of cold affusion, in which the patient is put into a tub and four or five gallons of cold water thrown over him. Another is to place the patient in a bath at about 90° F. and gradually reduce the temperature, by the addition of cold water, to 80°, 70°, or even 60° F. The patient is kept in this from ten to twenty minutes, according to his strength and the height of the temperature. As the temperature continues to fall for some time after the removal of the patient from the water, the bath should not be continued so long as to lower it to the full extent required while he is in the bath, lest collapse occur afterwards.

Instead of the bath being gradually cooled down, it may be used at once at a temperature between 60° and 90° according to the condition of the patient, and if the temperature be very high, the water must be cooled still more by means of ice, and its action aided by ice given by the mouth and rubbed or laid upon the surface of the body. This treatment may be adopted even although pneumonia be present, if the patient's life is threatened by an excessive rise in temperature. When the temperature rises again the bath should be repeated.

Cold Pack. - The pack is a less efficient means of abstracting heat from the body, but it is useful in causing a different distribution of blood in the body. It is therefore sometimes very useful in lessening delirium and producing quietness and sleep. In employing it, a wet sheet is wrung well out of cold water and wrapped tightly around the patient; over this are wrapped one to three blankets. A little heat is abstracted at first by the cold of the sheet, but this is very little, and indeed it is asserted by some that cold packs, instead of abstracting heat, prevent its escape. The skin soon becomes warm, and frequently profuse perspiration is produced. A certain amount of heat is lost, though perhaps not very much, by the evaporation through the blankets. It is probable, however, that the production of heat is to a certain extent lessened, at least in restless patients, by their movements being mechanically restrained by the sheet, and also by the blood being withdrawn from the internal organs and muscles to the skin. As the pack restrains the movements in a most complete way and with a force against which it is in vain to struggle, while at the same time it is comfortable and soothing, it frequently induces sleep when narcotics have been useless.

Cold sponging is sometimes a very useful means of abstracting heat in cases of fever, where the patient is weak and the temperature, though perhaps not going above 104° or 105° F., tends rapidly to regain its former height after cooling, and where it seems inadvisable to subject the patient to the frequent movement in and out of bed required in cold baths. The loss of heat consequent on cold sponging is due partly to the application of the cold water, but it is due chiefly to the evaporation which takes place from the surface of the body. Consequently sponging with tepid or even with hot water will also reduce temperature.

Cold Douches.1 - In this form of bath a stream of water having considerable force is directed against a part of the body.

1 For a short and concise account of the various appliances used in hydro-therapeutics, vide Paper on 'Rational Hydro-therapeutics,' by G. L. Pardington, M.D., Practitioner, Jan. 1884.

The stream may either he unbroken, and to this the name douche is usually restricted, or it may be broken up by delivery through a rose into a number of minute streams, so as to form a shower or rain bath. If the douche is large (one or two inches in diameter) it causes a great amount of shock and sometimes does much harm. Usually a stream of a quarter of an inch in diameter is quite sufficient for all purposes. Douches are chiefly applied to the spine, spleen, liver, joints, anus, and vagina. The spinal douche usually consists of a single stream, and may either be allowed to fall vertically upon the spine, the body being more or less inclined, or it may be delivered from a horizontal pipe with the body in an upright position. It is useful as a stimulant in melancholia, cerebral anaemia, and general debility. To avoid too great depression it is better to apply hot and cold water alternately, unless it is used immediately after a hot application such as a spinal pack. Douches to the head are useful in alcoholic coma. Douches to the liver and spleen have been found useful in chronic congestion and enlargement of these organs. The douche applied to stiffened joints appears sometimes to be of considerable service.

The ascending douche is usually delivered through a rose, so as to form a shower, and it is directed against the perineum while the patient is in a sitting position. It is useful in haemorrhoids and pruritus ani, and when used at a regular hour daily, first tepid and then cold, it is useful in constipation.

The vaginal douche is used by the patient lying on her back with her knees drawn up and with the pipe in the vagina. It is useful in vaginal leucorrhoea and cervical catarrh, and in chronic subinvolution and hyperplasia the hot douche at 105°, F. to 110° F. twice a day for several minutes is of much service.