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The good effects of this system of treatment can easily be nullified in the hands of unskilled and unintelligent operators; furthermore, each patient is a law unto himself and demands close study by the physicians and the bath attendant. Subjective symptoms cannot be entirely ignored, and sometimes too strict adherence to a definite prescription may do more harm than good, and the bath attendant must learn by experience to recognize any error in the prescription. On the other hand, however, due care must be taken that the patient does not lead physician and operator astray by misleading statements to their own detriment.
The rationale of treatment in cases ranging from the mildest form of neurasthenia to the gravest form of melancholia generally resolves itself into a question of suitable diet and its proper assimilation. I am well within the mark when I say that 80 per cent. of the mental and neurasthenic admissions to the Homewood, present, in addition to their many symptoms, an emaciated appearance, and a body weight much below par.
Any method of treatment that will improve assimilation in these neurotic and mental patients is a valuable adjunct to our armamentarium.
In hydrotherapy, scientifically applied, we have, without doubt, an aid to general treatment that will materially assist us in the recovery of our patients.
Time does not permit me to go extensively into the action of water on the various functions and organs of the body, but let me point out a few facts that can be easily demonstrated with the proper apparatus. (A) On the Circulation : Baruch says:
“ The circulatory system forms the great highway upon which the products for the maintenance and growth of the organism are conveyed, and by which the products of waste and repair incident to the performance of all functions are eliminated. It, therefore, follows that
, any agent which is capable of exercising the slightest influence upon an apparatus which is destined for these important tasks, must be capable of exercising in disease an analogous influence upon the organs and their functions, which come under the domain of its influence."
These are some of the effects of water so applied :-
(B) On the Composition of Blood.—After cold there is an increase of red and white blood corpuscles and haemoglobin.
After hot air and steam baths a diminution followed by moderate increase in robust people.
(C) On Respiration.—The greatest irritation of the respiratory centre is produced by a cold application on chest and abdomen, then follow deeper respirations and an increased oxygen consumption, and a freer carbon dioxide elimination.
It must be noted, however, that after cold applications, respiration is affected by the extent to which reaction ensues; if the latter is good, then respiration becomes much deeper, and more air is inspired into the lungs.
If mechanical influences be added to thermic, as in douches, the effect upon the respiratory centre is much more enhanced.
(D) On Muscular System.—The fatigue curve is much increased by cold, that is, the working capacity is much improved.
Warm baths, unaccompanied by mechanical effect, lower the working capacity. Combined with mechanical effect warm baths increase working capacity, but not to the same extent as cold, or alternating hot and cold.
(E) On Tissue Change.—The influence of hydriatic procedures on circulation, respiration, composition of the blood, and muscular action has been stated. If these effects are far-reaching in health, how much more marked must they be in disease. The quantity and quality of the blood in various organs and parts of the body are improved and controlled, and since functional activity is the chief agency in producing tissue change, and this activity is dependent upon the blood supply in the organs, we may, by influencing the latter, readily exercise a powerful effect upon the former. That thermic and mechanical irritation applied by means of water upon the cutaneous surface arouses cell activity and effects tissue change is a fact that is based upon substantial experimental data.
Accepting these conclusions as correct, as they are attested to by practical demonstration, we are then in possession of an important agent with which to treat successfully many forms of mental and nervous diseases met with, not only by the specialist, but by the general practitioner.
Our plan of treatment, to be more specific, has been as follows:
Neurasthenia.In all bath treatment it is a fundamental principle that reaction must follow the application of cold water.
Equally as important is it that no procedure should be prescribed which will in any way frighten a patient, or cause that patient to lose confidence in a method which is new to the large majority of them, therefore, in the treatment of neurasthenia, I make it a practice to employ the milder measures at first, and gradually work up to the highest degree of hydrotherapeutic treatment. For example: the patient is only sent to the bath three times a week for the first week, and if their reactive capacity is fair, and they have grown accustomed to the procedures as ordered, they are sent daily.
A general prescription reads as follows:
Fan and jet douche to entire body, 90° to 80°—10 lbs—1 minute.
Lower minimum temperature 2 degrees and increase pressure 2 lbs each treatment until a temperature of 60° and a pressure of 30 lbs is reached.
The above prescription is suitable for a female; male patients can be treated more actively, beginning with lower temperatures and higher pressures.
After the patient has become accustomed to the jet douche, the Scotch douche (alternating hot and cold) may be used with good results.
Usually a walk in the open air, to the point of fatigue, is ordered to follow the bath.
Melancholia.—The same treatment as outlined above. If it is impossible to place the patient in a hot box, owing to some mental phase, I would suggest as a substitute the circular douche at 102° or 104° for two minutes before reducing to 90°, as it is important that the body be well warmed before any cold is applied.
In the melancholic, the Scotch douche, used freely all over the body, markedly stimulates the circulation and imparts a sense of well-being, substituting the depression; and also considerably lessens the lethargy, inclining the patient to greater activity. As the treatment progresses, day by day, the periods of euphorbia lengthen, and the depression decreases until finally normal mental health is restored.
Following the bath a vigorous towelling is indicated, more particularly in cases where reaction is not marked. . This is usually required in the early stages of treatment in the majority of cases.
In case of any difficulty with the patient refusing the douches, the nurse steps into the bath and manipulates the patient, at the same time reassuring him.
DEMENTIA PRAECOX. (a) Hebephrenic Type.—Some good has been obtained in these cases by the use of stimulating baths of various kinds. The patient should go to the bath daily, and the treatment should be the same as in neurasthenia and melancholia, and gradually be increased in strength. Circular, rain, jet and Scotch douches are indicated with lowering of minimum temperature, and increase of pressure each day until the highest point of efficiency is reached. (b) Catatonic Type.—As above. Results not so encouraging.
MANIC DEPRESSIVE INSANITIES. (a) Manic Type.-Control excitement by continuous bath, 100°-one-half to six hours, according to condition.
Hot or cold packs (cold preferred) continued until excitement subsides. If patient falls asleep, leave him in the pack until he wakens, in the meantime keep him well covered with additional blankets. On removing patient from the pack, a half bath, 80° or 85°, should be quickly given with active friction, to restore tone of dilated blood vessels, and then return patient to bed.
Pack repeated two or three times a day if necessary.
Exhaustion Psychoses, or Exhaustion Following Acute Disease.—Half bath, or drip sheet, or affusions night and morningtemperature 80° to 85°, duration 3 to 5 minutes, followed by a vigorous towelling, and patient returned to bed, and in serious cases the temperature may be reduced to 70° or even 60°.
Let not the fear of cold water deter anyone from resorting to cold affusions in these desperate cases. They
. are the hydriatic substitute for digitalis and alcohol.” fully endorse this statement, as I have recently treated a serious case of exhaustion and collapse in this way, and I can assure you that the result has been most gratifying. Alcoholism—Prescription (daily) :
Hot-air box, 140°—185°—10 minutes.
Morphinism—Cocainism.—For the unpleasant symptoms of pain and restlessness during and following the reduction of the drug, I know of nothing better than full tub bath, temperature 102°, gradually increased to 110°, duration 15 minutes, at least; may use this twice daily.
In our year's experience with general hydrotherapy our most excellent results have been obtained in neurasthenics, melancholics, exhaustion psychoses, manic depressive insanity, and alcoholics. In the other psychoses only fair results have been obtained.
Incidentally it has been found that the use of the perineal douche, temperature 85°, pressure 25 lbs., 2 minutes, patient sitting or standing over it, has been useful in chronic constipation. This is only of recent date, but, so far, results are good. The jet douche-same pressure and temperature—applied to the abdomen is also useful in torpor of the bowel. Sitz bath in sexual neurasthenia-warm gradually reduced to cold-five to ten min'utes.
Much of the success of hydrotherapy at the Homewood is due to my first assistant, Dr. E. C. Barnes, who has been untiring in his efforts to place the treatment on a practical basis. In this he has been materially aided by the intelligent co-operation of the nursing staff. By means of lectures and practical demonstrations the nurses have been instructed in the physiology and anatomy of the skin, and the various organs and functions of the body that are affected by hydriatic procedures, the effects of the various kinds of baths and the indications for their use, but above all, they have been taught to be exact in all procedures, and have now learned to fully appreciate the necessity of this by the gratifying results that have been obtained.
A SMALL meningocele may resemble a sebaceous cyst. The previous history is important in the diagnosis. A meningocele of this character is present “as long as the patient can remember?' and remains about the same size; a cyst begins as a small nodule later on in life and increases in size.
PERSISTENT furunculosis and allied suppurating skin lesions appear to yield in a large percentage of cases to Wright's vaccine treatment. Stack vaccines are usually suitable to such cases. The internal administration of yeast, calcium sulphide, etc., affords only occasional help.- American Journal of Surgery.