BAT 



35 



BAT 



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 func- 

 tion 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 pre- 

 ferred to that of a different temperature, are those of a febrile 

 character joined to an irritability of the skin, which is gene- 

 rally 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 per- 

 sons, or for those whose peculiarities of system render them 

 unable to bear a warm bath of a high temperature. It is of 

 much use in the form of tepid sponging of the surface in the 

 advanced stage of fevers, and in convalescence from acute 

 diseases. In this case vinegar is often added to the water 

 with increased good effect. 



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, viz., a stimulating, enlivening, and 

 expanding effect. Hence there is a quickening of the cir- 

 culation 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 nervous system. Diminished 

 exhalation from the skin takes place, while a greatly in- 

 creased 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 afterwards in the most internal parts of the body. 



The secondary or ultimate effect is somewhat different. 

 The increased action of the arteries gradually subsides, the 

 pulse becomes 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. Corresponding 

 changes occur in all the other organs ; and if the application 

 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 aug- 

 mented secretion from the skin, and a corresponding diminu- 

 tion 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 con- 

 fined to five or ten minutes ; the second when it is about 

 93 J , and continued for three-quarters of an hour, or an hour. 

 Employed in this last way, Marcard found that it always 

 diminished the velocity of the circulation, and that the 

 longer the bath was continued the slower the pulse be- 

 came ; 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 disloca- 

 tions or hernias to be more easily reduced. The state of re- 

 laxation 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 equalizing the 

 circulation, and relieving internal congestion, it is much re- 

 sorted 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 

 iiy a bath. The inflammatory condition must first be 

 removed or greatly lessened by bleeding, purgatives, and 

 otht'r appropriate means, before the bath can be safely used. 

 These cautions do not so strictly apply to the convulsive ex- 

 citement which often precedes the eruption of small-pox, or 

 even measles, which is often greatly relieved by the warm 

 batli, which may also be repeated during the early stages of 

 the eruption. (See Marcard, Uber die Bader, Hanover, 



1 793, or Duncan's Med. Comm. 2nd Decade, part x. p. 1 53.) 

 The convulsions of infants during teething are almost in- 

 variably attempted to be removed by the warm bath, but in 

 many instances more harm than good i.- done. The con- 

 dition of the brain must be carefully inquired 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 ils 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. [See ANTISPASMODICS.] Even 

 when the bath is properly applied, the good which might be 

 derived from it is often frustrated by inattention or igno- 

 rance. The bath is prepared at random, and the tempera- 

 ture is never sufficiently regarded. If above 96 it cannot 

 fail to be injurious. 



During the existence of all active inflammation, at what- 

 ever age, the warm bath may be pronounced an unfit mea- 

 sure ; 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, inflam- 

 mation 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 til! a 

 tendency to faint show itself. 



In acute rheumatism, after venesection, the warm bath 

 may perhaps be employed, if we can ensure its being fol- 

 lowed by copious perspiration. 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, are well calculated for such cases. 



In few chronic inflammatory diseases are warm baths al- 

 lowable, 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 general 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 exces- 

 sive irritability of the nervous system. In the very extreme 

 cases of derangement of the nervous system the warm bath 

 is unfit ; in more moderate derangements of it, a more ap- 

 plicable or useful remedy cannot be found. In cases of ner- 

 vous exhaustion from intense literary employment, or 

 official or parliamentary duties, the warm bath is of great 

 service, more particularly when, in addition to the warm 

 bath, the cold douche is employed, directed upon the head 

 for a few seconds, while the patient is in the bath. In the 

 milder cases of mania it has been found of great use. 



In cases of contractions of the joints from rheumatic or 

 gouty inflammation, the warm bath, or, what is better, the 

 local vapour bath, is of service in restoring the flexibility of 

 the limb. 



It may be briefly stated that the warm bath is much 

 more serviceable when there is a tendency to disease, con- 

 stitutional or accidental, or in convalescence, than in any 

 other circumstances. It is therefore rather to be considered 

 as a preventive than remedial measure. But its value in 

 this point of view is very great ; and it is to be regretted 

 that it is not sufficiently appreciated and used. It is ex- 

 ceedingly beneficial as a means of allaying the irritation of 

 the vascular system, which occurs in young persons dis- 

 posed to consumption, when the disease is beginning slowly 

 to impair the integrity and hcalthfulness of the lungs or 

 other important organs. To prevent the development of 

 the morbid deposit in the lungs is of infinite impnrt:m<-r : 

 and this will be best accomplished by keeping up a < 

 Vigorous action of thy skin. The bath must b<; pcrso\ered 



F '2 



