External

Cold baths are used for the subsequent exhilarating effects, which may be increased by brisk rubbing with a rough towel. Persons in whom a feeling of warmth does not immediately follow a cold bath should not use it. The constant daily use of a cold bath probably diminishes the liability to catch cold. Cold baths are said to arrest attacks of laryngismus stridulus. They have been largely used to reduce the temperature in fever, especially typhoid fever. The first effect of putting the patient in the cold water is to cause, reflexly from the stimulation of the skin by the cold, an increased production of heat; for this reason and because of the cessation of radiation, the rectal temperature at first rises a little, but soon, owing to the direct abstraction of heat, and to the diminished production of heat which quickly sets in, it falls rapidly, and continues to do so after the patient is taken out. The temperature of a bath for a patient with typhoid fever should be between 68° and 58° F. 200 and 14.4° C.; he should be lowered into it by a sheet, and remain in ten minutes, unless before that time he shows signs of collapse; he is then lifted back to bed, where a blanket is thrown loosely over him. If this treatment is adopted, the bath ought to be given whenever the axillary temperature is 103° F. 39.40 C. Sometimes the patient is placed in a bath at a temperature of 10° F. 5.5° C below his own, and the water is cooled by putting in cold water or ice, till it has fallen to about 68° F. 200 C, when he is taken out. Brisk rubbing of the whole body should be carried out during the bath and the feet kept warm. Cold baths are no longer used in the treatment of typhoid fever with the notion that they reduce temperature. They are useful for the stimulation of the nervous system which they may possibly bring about to some degree and for the marked diuresis which they produce thus, supposedly, favoring the elimination of toxins in the urine. Often, instead of having a bath, he is sponged with cold water as he lies in bed; this saves trouble, but both sponging and a cold pack (which consists of a sheet four folds thick, wrung out in cold water and wrapped round the naked body for five or ten minutes) are inferior to a bath. Pneumonia is often treated by the application of cold, generally by means of ice poultices applied to the chest. To make an ice poultice, put on a piece of rubber tissue a layer of wood wool, then one of powdered ice sprinkled with a little salt, turn over the edge of the rubber tissue - which has been left wide enough - so as to cover in the poultice, and seal the edges with a little chloroform or turpentine. Put the poultice in a flannel bag, and bind it on the body when desired, with lint between it and the skin. The term " poultice " is hardly a proper one to designate this method of applying cold. See definition of poultice on p. 36. The immediate action of very cold baths is far the best treatment for any sudden hyperpyrexia.

* Unless otherwise stated, the word action will in this book always be taken to mean physiological action, or action in health.

Cold is applied locally either by cold water in Leiter's coils or by ice bags, in a number of conditions, with the object of arresting inflammation. Thus ice bags are put on the head in meningitis, or concussion, and on the knee-joint for acute synovitis, etc. According to most authorities, cold contracts not only the vessels of the skin to which it is applied, but by reflex action those of the organs underneath it. This explains the application of an ice bag to the chest to arrest pulmonary haemorrhage. Cold locally applied is, therefore, haemostatic.

Warm baths, as they liquefy the fatty secretions, are more cleansing than cold. Hot baths, like any other application of heat, soothe pain; hence they are useful for rheumatoid arthritis and colic, whether renal, biliary or intestinal. By bringing blood to the skin and lessening the amount in the internal organs, they relieve muscular spasm, such as we find in spasmodic stricture of the urethra, colic, laryngismus stridulus, other forms of laryngeal spasm, and infantile convulsions. In the same way they are of service in weariness from muscular or cerebral activity, and are useful in many inflammatory affections; as, for example, a cold in the head. A warm bath immediately before going to bed may sometimes cure insomnia. The practice in asylums for the insane is to give a hot bath (104° F.; 40° C.) as a remedy for sleeplessness. The subsequent increased perspiration makes hot baths and hot packs of great value in the various forms of nephritis and in uraemia. Great care must be taken, after a hot bath which has been given to induce sweating, to see that the patient is kept warm by being wrapped quickly in a hot blanket and put into a warm bed; if not, the cutaneous vessels soon contract, and there is no diaphoresis. A local hot bath has the same effects, but to a less degree. A hot foot-bath is often used for a cold in the head, or for amenorrhoea. Sponging with hot water will, by the vascular dilatation and sweating it causes, reduce the temperature slightly in fever.

A cold bath is one the temperature of which is below 70° F. 21° C., one between 88° and 980 F. 31.1° and 36.6° C is properly speaking indifferent, but it is often called a warm bath. A tepid bath is intermediate between warm and cold. Anything above 980 F. 36.6° C. is a hot bath. Few people can bear a temperature much over 102° F. 38.9° C.

Internal

The chief therapeutic use of water is to wash out the tissues, especially the kidneys, and to keep the urine diluted. Some persons who are liable to the formation of gravel or urinary calculi can, by drinking plenty of pure water, prevent their formation, for the minute collection of crystals which are the beginning of all calculi, are washed out of the ordinary system before they have time to grow to any size, and if they are composed of uric acid, the copious drinking of water diminishes the liability of their formation, for it decreases the amount of uric acid excreted. The liability to the formation of gall-stones may also be kept in check by the drinking of plenty of water, since then the bile becomes less concentrated and flows more quickly. When large quantities of water are drunk it should be pure dis-tilled water, and should be taken between meals. A glass of cold water taken on rising in the morning will with some persons cause the bowels to be opened. Warm water is an emetic*