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BATHING. 



BATHING. 



10JO 



investigation of the state of the mucous membranes of the chest and 

 intestinal canal should be made, as it will certainly prove hurtful 

 where chronic inflammation of these organs exists. If tubercles are 

 suspected to exist in the lungs, cold bathing should be dispensed with. 

 Though cold bathing is very useful in a tendency to scrofulous diseases, 

 it is very hurtful when these are really developed, though tepid and 

 warm bathing are allowable. 



Where the increased irritability shows itself in the mental functions 

 or in the muscular system, as in hypochondriasis or hysteria, cold 

 bathing is very useful ; and especially in the hypochondriasis of literary 

 persons, accompanied with a disposition to indigestion, and a dry harsh 

 skin. In actual indigestion, especially if complicated with sub-acute 

 inflammation of the mucous membrane of the stomach or intestines, 

 cold bathing is very injurious. 



In cases of torpor and loss of power, cold bathing is of much service ; 

 in a relaxed state of the skin, subject to debilitating perspirations, it is 

 often the most effectual remedy ; in weakness of the limbs, or of any 

 member, and after sprains or paralysis, the local cold bath is very 

 useful. The astringent as well as tonic effect of the cold bath is 

 employed to prevent the prolapsus or descent of different parts : hence, 

 in a t ndency to hernia (or even when it has occurred, ice laid upon 

 the tumour, and frequently renewed, has restored the bowel to its 

 place, or at least warded off the inflammation till other means could be 

 tried) ; in loss of power of the sphincter muscles, or of the contractile 

 power of the bladder, pumping cold water on the back is very useful ; 

 but it should be used only for a minute at a time. In chronic hiemo- 

 rrhages, cold applied locally or generally has a good effect. 



The cold bath, like every other powerful agent, when improperly 

 used, is capable of producing much mischief; in some states of the 

 system it niust be carefully avoided. In infancy and very advanced 

 age it is less admissible than at other times, and even quite improper if 

 the debility be great. It is inadmissible during, or immediately before, 

 certain conditions of the female system ; also when there is congestion 

 of blood in the veins or internal organs : hence it is not suited to 

 chlorosis. In any organic affection of the heart, or aneurism, it is 

 altogether improper. 



Of the cold shower-bath and douche we shall only observe here, 

 that their effects are more speedy, and extend more to the internal 

 organs : consequently they are only to be used for a very short time, 

 whenever recourse is had to them. A glow of the surface is sooner 

 felt after the shower than the common bath ; and as soon as this is 

 perceived the person should withdraw himself from the stream. If 

 the douche falls upon the head, it produces almost instantaneous and 

 most powerful effects. If its use be prolonged, it quickly lowers, then 

 destroys the sensibility, induces faintings, and places the patient in 

 the most imminent danger. Medical superintendence is therefore 

 required through every stage of its employment. 



When the body is surrounded by media of a temperature in some 

 cases Inwer, and in some higher than its own, it receives caloric, instead 

 i>f p.uting with it. The difference of density and humidity is the 

 cause of its receiving it from some media which are of a lower tempera- 

 ture than its own, as well as from most which are higher. This 

 depends upon the capacity for caloric, and the conducting power of 

 the surrounding medium. Thus, dry air at 70" Fahr. will impart heat 

 to the body, while water at 92 will abstract it, though water at 96 

 may impart heat. The tepid bath, therefore, being so close upon the 

 limit of abstracting or imparting heat, cannot exercise a very powerful 

 effect upon the function of the development of animal heat ; neither 

 does it much affect the circulation, which it rather retards than 

 quickens ; but its influence is mostly confined to the skin, which it 

 cleanses, softens, and renders more fit to execute its duties. The 

 cases in which the tepid bath is to be preferred to that of a different 

 temperature, are those of a febrile character joined to an irritability of 

 the skill, which is generally dry and harsh ; some cutaneous diseases, 

 where, by friction, the scales are removed and a new surface presented ; 

 and, lastly, as preparatory to the cold bath in delicate persons, or for 

 those whose peculiarities of system render them unable to bear a warm 

 bath of a high temperature. It is of much us,e in the form of tepid 

 sponging of the surface in the advanced stage of fevers, and in con- 

 valescence from acute diseases. In this case vinegar is often added to 

 the water with increased good effect. The natural tepid waters of 

 Buxton furnish a most valuable bath for persons suffering from gout 

 or rheumatism. 



The primary effect of the application to the surface of the body of 

 water of a temperature varying from 93 to 98, is, in consequence of 

 the communication of warmth, the same as that of dry heat, namely, 

 a stimulating, enlivening, and expanding effect. Hence there is a 

 quickening of the circulation and respiration, as well as the direction 

 of a greater quantity of fluid to the surface, manifested by the swelling 

 and, redness of the part. There results also a freer and more lively 

 action of the muscular system, and increased sensibility and activity 

 of the nervo<is system. Diminished exhalation from the skin takes 

 place, while a greatly increased absorption occurs : the exhalation from 

 the lungs, however, is increased. An increased quantity of heat is 

 thus introduced into the system, felt first in the superficial, but after- 

 wards in the most internal parts of the body. 



The secondary or ultimate effect is somewhat different. The in- 

 creased action of the arteries gradually subsides, the pulse becomes 



ARTS AND SCI. DIV. VOL. I. 



fuller and slower, and the greatest quantity of the blood lodges in the 

 veins, particularly in the great venous centres, such as the vena porta 

 and the liver, which it stimulates to increased secretion of bile. Cor- 

 responding changes occur in all the other organs ; and if the applica- 

 tion of the warmth be continued for a longer time, the increased 

 energy and elasticity of the muscles disappear, and a sense of fatigue, 

 with atony, and a tendency to sleep, succeeds. 



The final result of the action and re-action is an augmented secretion 

 from the skin, and a corresponding diminution of urine, and of the 

 secretion from the mucous surfaces. 



The warm bath may be employed to effect two opposite ends, to 

 stimulate or calm and soothe. It accomplishes the first when its 

 temperature is high (98), and its use is confined to five or ten minutes ; 

 the second when it is about 93, and continued for three-quarters of an 

 hour, or an hour. Employed in this laat way, Marcard found that it 

 always diminished the velocity of the circulation, and that the longer 

 the bath was continued the slower the . pulse became ; also, that the 

 more the pulse deviated from a state of health, the more it is diminished 

 by the warm bath. The bath may even be prolonged till it induce 

 fainting and other consequences of a depressed circulation. Short of 

 actual fainting it may be beneficially employed to produce great 

 relaxation of the muscular system, so as to enable dislocations or 

 hernias to be more easily reduced. The state of relaxation bordering 

 upon fainting is very favourable to the process of absorption ; it may, 

 therefore, be advantageously employed in dropsy arising from weakness 

 of the absorbents. As the warm bath has generally the effect of 

 equalising the circulation, and relieving internalcongestion, it is much 

 resorted to as a remedy in spasmodic and convulsive diseases ; but 

 here the utmost caution and discrimination are necessary. If the 

 spasmodic actions result from an inflammatory state of any of the 

 nervous centres, more harm than good will be done by a bath. The 

 inflammatory condition must first be removed or greatly lessened by 

 bleeding, purgatives, and other appropriate means, before the bath can 

 be safely used. These cautious do not so strictly apply to the con- 

 vulsive excitement which often precedes the eruption of small-pox, or 

 even measles, which is often greatly relieved by the warm bath, which 

 may also be repeated during the early stages of the eruption. (See 

 Marcard, ' Uber die Bader,' Hanover, 1793 ; or Duncan's ' Med. Comm." 

 2nd Decade, part x. p. 153.) The convulsions of infants during teeth- 

 ing are almost invariably attempted to be removed by the warm bath, 

 but in many instances more harm than good is done. The condition of 

 the brain must be carefully inqxiired into by the medical attendant, 

 and the state of the gums investigated, before this measure should be 

 had recourse to. If there be congestion of blood in the brain, this 

 must be removed before any good can result from a bath, and after its 

 removal the convulsive actions will generally subside. The same good 

 effect will follow free scarification of the gums, if a tooth be preparing 

 to protrude. [ANTISPASMODICS.] Even when the bath is properly 

 applied, the good which might be derived from it is often frustrated 

 by inattention or ignorance. The bath is prepared at random, and the 

 temperature is never sufficiently regarded. If above 96, it cannot fail 

 to be injurious. 



During the existence of all active inflammation, at whatever age, the 

 warm bath may be pronounced an unfit measure ; and even after the 

 acuteness may have been reduced by active antiphlogistic means, the 

 warm bath is a doubtful remedy, if we except a very few cases. Of 

 these, inflammation of the peritonaeum is the best marked exception ; 

 but even here the bath is a very secondary means towards lowering the 

 action of the system, though it may assist the flow of blood from leech- 

 bites, and may be continued till a tendency to faint show itself. 



In acute rheumatism, after venesection, the warm bath may perhaps 

 be employed, if we can ensure its being followed by copious perspira- 

 tion. For this purpose the patient should have the bath close to his 

 bed, remain in it for half or three-quarters of an hour, be well rubbed 

 with warm flannel cloths, replaced in bed between warm blankets, take 

 diaphoretic medicines, and drink bland warm fluids, such as gruel or 

 weak tea, and maintain the perspiration for twenty-four or forty-eight 

 hours. 



In a disposition to gout or rheumatism the warm bath is more 

 proper than when a paroxysm of these diseases occurs. In such cases 

 the natural warm baths are preferable : those of the Queen's Bath, or 

 Cross Bath, at Bath, the temperature of which is from 94 to 96, arc 

 well calculated for such cases. 



In few chronic inflammatory diseases are warm baths allowable, 

 if we except some of those of the digestive organs, especially sub-acute 

 inflammation of the mucous membrane of the stomach and intestines. 

 Indigestion is often the most common symptom accompanying this 

 state, and it is almost always benefited by a course of warm or tepid 

 bathing. 



The other states to which warm bathing is unsuited are great gene- 

 ral torpor, but especially of the skin ; also when there is a tendency 

 to profuse secretion from the skin; when there is great plethora or 

 fulness of the vascular system, especially of the veins ; in tendency to 

 active haemorrhage ; in aneurism, or any disease of the heart ; also in 

 cases of a tendency to apoplexy : lastly, in extreme atony, or excessive 

 irritability of the nervous system. In the very extreme cases of de- 

 rangement of the nervous system, the warm bath is unfit ; in more 

 moderate derangements of it, a more applicable or useful remedy 



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