I! \ I 



34 



B A 'I 



of croup, when ill other remedie* hare failed, cold affusion 

 has sometimes restored the functions of life to new action. 



The cooling or refrigerating effect of cold bathing is mot 

 desired in diseases where the animal heat rises above the 

 proper standard, a* in fevers, both continued and eruptive, 

 especially scarlet fever; also in tome local inflammations, 

 particularly of the brain. For the principle* which should 

 regulate our practice in this application we must refer to Dr. 

 1 other writers, only remarking that in the hot and 

 restless stage of scarlet fever, when the heat is steadily above 

 the natural standard, the skin hot and dry. and neither sleep 

 iv >r perspiration can be procured, a plunge into cold water 

 will be followed by both, to the relief and often recovery of 

 the patient. (See Bateman On Cutanrou* Dittattt, edit. 



, ;> l-^ii.) In applying cold locally, as in inflammation 

 I' the brain, one rule is of the utmost importance to be ob- 



I, viz., that the application of the cold shall be continu- 



t he re fore a second set of cold cloths or bags of ice should 

 be applied before the former has become warm. This plan, 

 especially pursued during the night, along with judicious 

 internal treatment, will save many children from perishing 

 under the most insidious and fatal disease of childhood 

 water in the brain. 



The cases already mentioned are mostly acute diseases, 

 where the cold nffusion is employed to avert an imminent 

 but temporary danger. It is generally in chronic diseases 

 that the cold bath is employed for a length of time, and 

 in these it is chietly the secondary effect, the glow or reao- 

 ti in, which is desired. The rules to be observed in order to 

 obtain this effect are founded upon the strength, which is 

 generally inferred from the age, of the individual. The de- 

 gree of reaction is, for the mot part, dependent upon the cold- 

 ness of the water and the length of time the person remains 

 in the bath. Very cold water, in which the person remains 

 but a short time, will, in general, produce a greater degree 

 of re-action than a more moderate temperature in which he 

 remains longer. But here everything depends upon the 

 general power of the individual, the state of the system, 

 especially of the skin at the moment of immersion, and the 

 natnrc of the bath, according as it is fresh or salt water, and 

 also the season of the year. As the immersion of infants and 

 young children in tub's of water must be considered AS bath- 

 ing, we deem it necessary here to explain the principles 

 upon which the temperature of the bath for them should be 

 regulated, especially during winter. The experiments of 

 Dr. Edwards (see Edwards On the lnfhun<x of Physical 

 Agents on Life, London, 1832) have proved that ' the power 

 of producing heat in warm-blooded animals is at its minimum 

 at birth, and increase* saccesMvely to adult age: It is clear, 

 therefore, that water of a higher temperature than what feels 

 cool to the hand of the nurse should be used, particularly in 

 winter, when the power of regaining a proper degree of heat 

 s necessarily less. The attempt to harden children by ex- 

 posure to too great a degree of cold is of the most injurious 

 nature : it either produces acute disease of the lungs, which 

 arc then very sensible to external impressions, or disease 

 of the digestive organs, leading to disease of the mesenteric 

 glands, scrofula, water in the brain, or, if they sur\i\e ;i 

 few years, to early consumption. Delicate and feeble per- 

 sons of all ages require a higher temperature of the bath, 

 and a shorter stay in it than others. If the re-action 

 does not speedily take place, means must be employed to 

 ensure its so doing, or the use of the cold bath must be 

 abandoned. A tepid or temperate bath may be used in the 

 early treatment of feeble persons, and the cold bath gradu- 

 ally substituted for it, or a glass of wine, or, what is far 

 preferable, strong coffee or chocolate may lie taken before 

 entering the bath. Where the arrangements are such as to 

 admit of it, a brief stay in a warm bath before going into the 



has a good effect. Nor, in general, is danger to lie ap- 

 prehended from such a proceeding. Thou;:h in most oases 

 moderate exercise is advantageous before bathing, unless 

 the person has an opportunity of springing out of bed into 

 the bath, still he should never think of undressing and 

 going into the water when fatigued, or when the skin is 

 covered with perspiration. It is a good rule to wet the head 

 before taking the plunge. For a person in good health, 

 early in the morning is the best time to bathe ; for one more 

 delicate, from two to three noun after breakfast is preferable ; 

 but no one should bathe immediately after a full meal, par- 

 ticularly if there be a tendency of blood to the head, and a 

 disposition to apoplexy. 

 Exercise while in the bath, such as friction of the limb* 



nd chest, or swimming, is advisable, but not even this can 

 prevent evil continence* if the hathcrremain too long in the 

 water. To cay nothing of the risk of cramps and convul- 

 sive action of the respiratory muscles, from the blood being 

 pent up in the large internal vessels, which may occur while 

 the person is in the water, the foundation may be hud for 

 future internal disease if the blood do not soon revisit the 

 surface, either from the natural powers of re action or from 

 friction with coarse dry cloths. Friction should follow the 

 use of the bath in most instances, except where the bath has 

 been in the sea, in which case the salt particles, if all 

 to remain in contact with the skin, stimulate it mure. 



The oases of disease for which cold bathing is a valuable 

 remedy are, morbidly increased irritability and sensibility, 

 accompanied with general debility. If the sensibility be 

 extremely high, it is best to begin with the tepid or 

 bath, and pass gradually to the cold. Where there is a 

 tendency to colds and rheumatism, the cold bath it an ex- 

 cellent preventive ; for this purpose it should be used con- 

 tinually throughout the year, and the chest should be sponged 

 with cold water, or vinegar and water may be substituted in 

 winter, when there are not facilities for using the complete 

 bath. Before beginning this practice, careful investigation 

 of the state of the mucous membranes of the chest and in- 

 testinal 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 Imthiog is very 

 useful in a tendency to scrofulous diseases, it is \ery hurt- 

 ful 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 hvpochondriasis 

 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 inflam- 

 mation of the mucous membrane of the stomach or intes- 

 tines, cold bathing is very injurious. 



In case* of torpor and loss of power, cold battling is of 

 much service; in a relaxed state of the skin, subject to de- 

 bilitating 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 tendency to hernia (or even when it has 

 occurred, ice laid upon the tumor, and frequently reii. 

 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 | 

 of the bladder, pumping cold water on the back is 

 useful ; but it should be used only for a minute at a time. 

 In chronic haemorrhages, cold applied locally or generally 

 has a good effect. 



The cold bath, like every other powerful agent, when im- 

 properly used, is capable of producing much mis. -hid '; in 

 some states of the system it must be carefully avoided. In 

 infancy and very advanced age it is less admissible than al 

 other times, and even quite improper if the debility be ;_ 

 It is inadmissible during, or immediately before, certain 

 conditions of the female system; also when there is i 

 tion of blood in the veins or internal organs: hem. 

 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 ni" 

 the internal organs: consequently they arc only to he used 

 for a very short time, whenever recourse is had to them. 

 A glow of the surface is sooner felt afler 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 in- 

 stantaneous and most powerful effects. If its use be pro- 

 longed, it quickly lowers, then destroys, the sensibility, 

 induce- famlings, and places the patient in the most immi- 

 nent danger. \\> died --upcnnteiideiice is therefore required 

 every stage of its employment 



\Vhen the body is surrounded by media of a temperature 

 in some cases lower, and in some higher than its own, it re- 

 ceives caloric, instead of parting with it. The difference of 

 density and humidity is the cause of its receiving it from 

 some media which are of a lower temperature than its own. 



