This section is from the "A Practical Treatise On Materia Medica And Therapeutics" book, by Roberts Bartholow. Also available from Amazon: A Practical Treatise On Materia Medica And Therapeutics
Cold baths are of equal utility in scarlatina. In mild and uncomplicated cases of this disease, no remedies are required, and simple sponging of the body, followed by inunctions of oil, is all that is required. When, however, the temperature rises to 104°, 105°, 106° Fahr., and higher, and there is delirium or stupor, the rash being dark and indistinct, and the urine scanty, the cold wet-pack will often render most signal service. The rash will reappear and become vividly red; the pulse, respiration, and temperature, will decline. The cold wet-pack to the neck, and frequent gargling of the throat with warm water, relieve the sore-throat, and are really more effective than the caustic applications so commonly resorted to. When the urine becomes scanty and highly albuminous, hot fomentations to the lumbar region, with or without addition of medicaments, are often very serviceable. The vapor-bath, or the warm wet-packing, by determining free diaphoresis, relieves the brain when convulsions are threatened, or have actually occurred, from uraemia.
Other eruptive diseases, measles, small-pox, cerebrospinal meningitis, are advantageously treated in the same way.
Constitutional syphilis is very much ameliorated, and the cure by specific treatment hastened, by a course of Turkish baths, or wet-packing. Three baths should be taken each week. If the wet-packing be used, the patient should remain in it until free diaphoresis is produced.
The wet-packing is very efficacious in acute rheumatism, but the prejudices of the patient, and of the patient's friends, often interfere to prevent its use. If there be much pain and soreness, the front of the body may be packed, and the inflamed joints may be separately swathed, but, whenever practicable, the packing should include the whole body. A vapor-bath is often very serviceable. A vinegar vapor-bath has been used, it is said, with great advantage. This application may be readily made in the following way: Some bricks are previously heated; the bedclothes are elevated above the patient by hoops transversely placed; and vinegar is poured over the heated bricks, which have been laid under the bedclothes. The perspiration which follows these baths should be wiped off, the skin quickly sponged with tepid water, and then dried with a soft towel. Great relief is experienced from these applications; the joints are less tender, the fever declines, and the acid perspirations are diminished. Chronic rheumatism, if chiefly muscular, and if changes have not occurred in the joints, which are simply stiff, and chronic gout, are much benefited by the Turkish bath.
In acute cerebral congestion, the cold douche may be applied to the head, while the feet are immersed in warm water. A piece of ice, held against the nape of the neck, acts powerfully in the same way. The alternate application of ice and hot water is often more effective than ice alone. The author has seen these alternate applications of ice and hot water have an excellent effect in the stupor of opium narcosis, of uraemia, and in carbonic-acid poisoning, occurring under various conditions.
In inflammatory affections of the meninges, and in meningeal haemorrhage, a bag or bladder of pounded ice has the sanction of universal use. The author believes that these applications are often made without due discrimination in cerebral haemorrhage and other allied states. When the face is pale, the surface cool, and the circulation depressed, cold applications to the head are harmful. Ice to the head, and frictions of the surface with ice, are very serviceable in sunstroke or thermic fever, when the surface is hot, the pupils contracted, and the pulse full and bounding. The cold wet-packing gives great relief under the same circumstances, but, when the symptoms of depression exist, these cold applications are hazardous. Usually, however, in thermic fever, the range of temperature is very high, and the most important indication is to abstract the heat, which can be best accomplished by application of ice or the cold wet-pack, or the cold bath. The results of the practice are in accordance with this theory, for these applications have been most successful in restoring patients in imminent danger of death. When, in delirium tremens, the head is hot, the conjunctivae injected, the face flushed, and the pulse strong, an ice-bag to the head, or cold affusion, or a mild douche, will assist in quieting the patient, and favor the production of sleep; but these measures will do mischief when considerable depression of the bodily powers exists, and they are of doubtful utility in any case affording evidences of atheroma of the cerebral arteries, or of cardiac disease. Cold affusion to the head and spine, and cold baths, are among the most important means of relief in chorea. Wakefulness in children and adults may be often overcome, and quiet sleep insured, by a tepid bath taken just before retiring; but, when the head is hot, the eyes brilliant, and the circulation active, cold should be applied to the head, while the body is immersed in the tepid bath.
The shower-bath, the douche, and cold affusion, were formerly much used to calm the violence of acute mania and maniacal delirium. The great depression of the powers of life which the douche and the shower-bath have caused in some cases, and the fatal results which have occurred during their administration, have led to their disuse by many alienist physicians. By others, they are held to be extremely serviceable in appropriate cases. Bucknill and Tuke advise the occasional use of the shower-bath in the excitement of intercurrent mania and monomania, and a daily shower-bath in melancholia. They advise, further, that the shower-bath should, in the first-named group of cases, be used no longer than three minutes, and in melancholia from fifteen to thirty seconds, the patient being dried while standing in a pan of hot water. The same authors prescribe a warm bath of thirty minutes, at 95° Fahr., for the excitement and sleeplessness of various forms of insanity, and they affirm that its "tranquillizing effect is often wonderful." The simultaneous use of cold affusion to the head and the warm bath has been warmly advocated by M. Brierre de Boismont, and is decidedly approved by Bucknill and Tuke, who advise that the duration of the bath should not exceed one hour. The wet-pack is an exceedingly valuable remedy in the excitement of acute mania, but this measure should not be allowed to degenerate into a means of restraint merely. It should be applied in the mode already described, and the patient should continue in it until free diaphoresis is established.
In infantile convulsions great benefit is derived from the general warm bath combined with cold affusion, or an ice-bag, to the head. Hysterical convulsions are quickly relieved in the same way, and the hysterical state is much improved by a daily shower-bath.
Water, cold and warm, in the state of vapor, as ice, has been largely applied in the treatment of tetanus and hydrophobia, but without good results beyond the merest temporary assuagement of the patient's sufferings.
Lesions of the spinal meninges and of the cord, corresponding pathologically to those of the brain, are remediable by similar means as respects hydrotherapy. The author has seen remarkable improvement follow a hot douche to the spine in a case of paraplegia of syphilitic origin. Erb reports remarkable curative results from the use of the "rubbing wet-pack" in chronic myelitis. He advises the use of merely tepid water, and opposes the application of the extremes of temperature, whether hot or cold. The backache so common in women, and frequently due to anaemia of the cord, may be much relieved by a sponge dipped in hot water and passed over the spine. The hot douche to the spine is often more decidedly serviceable in these distressing cases.
Alterations of sensibility, analgesia, anaesthesia, hyperalgesia, hyperaesthesia, are often relieved by hydrotherapy—by the wet-pack, by ice, by local hot and cold affusion. Neuralgic affections, especially sciatica, are benefited greatly by the wet-pack. Paralyzed parts that have become cold and that waste, and that are undergoing other nutritive changes, are improved in condition by douches, by wet-packing, and other methods of the water-cure.
In inflammatory affections within the chest, wet-packing is very useful. As a rule, a hot wet-pack gives more relief than a cold one, but the feelings of the patient are a proper guide. In acute pleuritis a cold wet-pack applied to the side unquestionably diminishes the pain, and no doubt relieves the inflammation. In pneumonia remarkable results have been obtained by the cold bath, as well as by topical applications to the chest. Jürgensen has especially done much to establish this practice on a sure basis, and Dr. Thomas J. Mays, of Philadelphia, has published statistical evidence of a most favorable character. The mode of procedure is the same as in hyperpyrexia and in fevers. The patient is immersed in tepid water, and cold water is added to reduce the temperature of the bath to 60° Fahr. The stay in the water is determined by the effect on the body heat, the condition of the heart, and the respiration. The reduction of the febrile heat is coincident with a decline in the local inflammation. When the organs within the chest are inflamed, it is good practice to wrap the whole chest tightly in a pack to limit the motion of the chest-walls. The method of proceeding is as follows: Wring out in cold or hot water a large towel, fold it and place over the affected side or part; have in readiness a bandage or long towel sufficient to encircle the chest, and confine the wet-pack by pinning as tightly as possible around the chest the bandage or towel. Spongiopiline is an excellent material for making these hot or cold applications. The same expedients—the application of cold and the tight bandage—are of great utility in pulmonary haemorrhage, but a more decided effect, by means of ice-bags to the chest and back, may be procured in this condition of things.