Aucust 31, 1899] NATURE 419 
variations from hour to hour or day to day; and also to } raising it. The chemical constituents of the water in 
measure the varying calibre of the arteries in the extrem- | the case of the saline and sulphur baths also exert 
ities. We are thus ableto form a fairly accurate estimate | an influence, augmenting the fall in pressure result- 
é ing from warm baths. The percussion 
of water impinging sharply on the 
skin, as in the needle bath, tends to 
raise the blood pressure. Massage to: 
the limbs and body causes a fall in 
pressure, provided the abdomen be 
not massaged too vigorously; deep: 
pressure and manipulation of this part 
is followed by a marked rise in pres- 
sure owing to the dispersal of blood 
from the capacious veins of the viscera 
into the general circulation. In the 
Aix and Vichy douches massage 1s 
combined with warm douching. 
In the former bath, massage is 
administered under a simple douche 
conveyed by a flexible pipe passing 
over the shoulder of the attendant and 
playing between his hands, the patient 
being in the sitting posture. The 
result on the blood pressure is to 
produce a fall, the massage and heat 
acting in the same direction. In the 
Vichy douche, however, the patient 
lies in the recumbent position, and is 
massaged under a needle spray fall- 
ing from a bracket suspended over the 
table. Owing to the position adopted, 
massage of the abdomen is more freely 
performed, and this, combined with the 
= ae ‘ ag es ; ‘ Be tonic effect of the percussion of the 
— —_— : = needle spray, produces as a net result 
Greaves.) (Harrogate. a rise in pressure. 
Fic. 5 —The Aix douche. The above considerations as to the 
mode by which tissue change is 
of the conditions of the circulation, and from these observ- | stimulated and nutrition modified by agents brought 
ations to infer the completeness or otherwise of the | to bear on the circulatory system, serve to explain 
nutritional processes on which depend the well-being of | certain more remote effects experienced as the result 
the individual. In different morbid 
conditions the blood pressure may de- 
viate considerably from the normal, 
the vaso-motor mechanism be im- 
paired, and the free interchange of 
blood plasma and tissue fluid be 
defective, to the detriment of the or- 
ganism. Experiment has shown that 
the blood pressure is markedly affected 
by baths, some procedures having the 
effect of raising it and some the re- 
verse. The effect, though at first 
temporary, 1s cumulative, so that a 
permanent modification of pressure 
may be obtained, from which it fol- 
lows that an intelligent use of bathing 
as a therapeutic agent can so act on 
the circulatory system as to regulate 
the blood pressure, restore the normal 
mobility of the vessels, promote the 
interchange of tissue fluid, and pro- 
foundly medify nutrition. By means 
of these new methods we can watch 
closely the changes occurring under 
treatment, and can adjust the latter 
to the requirements of any particular 
case with a delicate nicety. 
A few instances may be given of esi é a 3 
the effect of various baths on the  [Greaves.] : ; (Harrogate. 
blood pressure. Heat in all forms, Fic. 6.—The Vichy douche. 
whether dry as in the Turkish bath 
and superheated air baths, or moist as in the Rus- | of baths. To enter into these in detail is impos- 
sian bath, or the simple immersion bath, lowers the | sible within the limits of an article of this description: 
pressure. Cold, on the other hand, has the effect of | suffice it to mention one bath only. The Aix douche 
NOW U5g 7 MOL. Co] 
