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THE PEI^CIPLES AND PRACTICE

OF

HYDROTHERAPY

A GUIDE TO

THE APPLICATION OF WATER IN DISEASE

FOR STUDENTS AND PRACTITIONERS OF MEDICINE



SIMON BAEUCH, M.D.

VISITING PHYSICIAN TO THIS J. HOOD WRIGHT MEMORIAL (FORMERLY MANHATTAN GENERAL) HOSPI-
TAL; CONSULTING PHYSICIAN TO THE MONTEFIORK HOME FOR CHRONIC INVALIDS; MEM-
BER OF THE NEW YORK ACADEMY OF MEDICINE; FORMERLY GYNjECOLOGIST TO
THE NORTHEASTERN DISPENSARY ; PHYSICIAN FOR EYE, EAR, AND
THROAT TO THE NORTHWESTERN DISPENSARY OF NEW YORK
city; PHYSICIAN AND SURGEON TO THE NEW YORK JU-
VENILE ASYLUM, AND CHIEF OF THE MEDICAL
STAFF OF THE MONTKFIORE HOME FOR
CHRONIC INVALIDS



WITH NUMEROUS ILLUSTRATIONS



N K \y ^' () 1{ K

WILLIAM WOOD AND COMPANY

1898



1®%



" Therapeutics developed by empiricism or clinical experi-
ence alone cannot rest upon a secure foundation. Experi-
ments made upon the loiver animals or upon healthy human
beings are the only rational scientific groundwork for the
treatment of disease.^' — Horatio C. Wood.



Copyright, 1898, by
WILLIAM WOOD & COMPANY.



PREFACE.



Differing from all other works on hydrotherapy, this book is
written by a general practitioner for the guidance of his colleagues.

The following pages represent the observations of the author, who
has labored in every branch of medicine, and who has gathered these
data from a private and hospital practice extending over a third of a
century, and more recently from special institution practice. The lat-
ter, extending over a period of seven years and furnishing the recorded
details of over one hundred thousand hydriatic treatments, may be
confidently offered as a trustworthy guide in the hydrotherapy of
chronic diseases, while the former is regarded by the author as equally
trustworthy as a guide in the management of acute diseases.

It is not the purpose of the author to write a panegyric upon
Hydrotherapy, but to discuss water as a remedial agent precisely as
medicinal remedies are discussed in the text-books on therapeutics.

The first part of the book deals with the physical properties of
water and its mode of action in health; the laboratory experiments
upon which the latter is based being freely discussed. The second
part is devoted to the practice of hydrotherapy. The various meth-
ods of applying water in disease are minutely described and illus-
trated, the rationale of each procedure is discussed, and its special
therapeutic indications are outlined.

Having mastered the technical details, the reader is introduced to
the practical application of hydrotherapy in acute and chronic diseases,
in order to familiarize him with the flexibility of this potent remedial
agent. The clinical histories which are added to this part of the book
are specially commended to the attention of the reader, inasmuch as
they illustrate pratically how different hydriatric procedures may be
adapted to varying conditions of the patient and his malady. That
hydrotherapy differs materially in this respect from medicinal therapy
will be made evident by a careful reading of these histories. Every
statement of the author will be found supported not only by his per-
sonal observations, but also by the published testimony of acknowledged
authorities in clinical medicine. The opinions of specialists in hydro-
therapy have been avoided as far as possible, because these are often
charged with unwarranted enthusiasm for their favorite remedy.

The author has adopted this judicial and dispassionate course, be-



iV PREFACE.

cause he desires to disarm prejudice and to disseminate a more exact
knowledge of the application of water in disease among medical men,
many of whom appear to entertain vague ideas on the subject.

That hydrotherapy is an effective agent in acute diseases is begin-
ning to be recognized by reason of the success attending it in typhoid
fever. But the fallacious idea still prevails that chronic diseases must
be sent away from home in order to obtain good results from hydro-
therapy. While it is true that the treatment in institutions offers the
best prospect in chronic cases, the reason lies not so much in the facili-
ties offered by them as in the experience and consequent skill acquired
by physicians from the large clientele of such institutions. A consid-
erable proportion of the most prevalent chronic diseases does not require
institution treatment; nevertheless, they demand a careful adjustment
of temperature, duration, and technique to each individual case. Such
knowledge may be as readily acquired by the practitioner as is that of
any other department of therapeutics.

Having mastered the technique and mode of action of hydriatric pro-
cedures, the educated physician will discover that he may often obtain
as good results from the simplest methods as from those requiring more
technical skill.

To afford this information in a concise and practical form is the
object of this work ; the author, himself a general practitioner, believes
that he appreciates the needs of his colleagues.

The chapter on the hydriatric prescription is devoted to an exposi-
tion of the prevalent fallacy that water is so simple and innocuous a
remedy that it may be applied with less regard for precision than the
physician is wont to exercise in prescribing medicinal remedies. The
author has endeavored to inculcate by striking examples the importance
of exactness in prescribing and executing hydriatric procedures.

The concluding chapter points out the lessons derived from the his-
tory of hydrotherapy. It aims to show the need of instruction in.
hydrotherapy in our medical schools, in order that this valuable rem-
edy may be wrested from the laymen and empirics, who have stolen it
from medical men, and who alienate the latter by perverting it for their
mercenary ends.

The addition of hydrotherapy to the curriculum of our medical
schools, as is done in the universities of Vienna and Heidelberg, would
arm the young practitioner with a much-neglected weapon, whose power
is amply demonstrated in these pages.

The author would ask the earnest attention of teachers of clinical
medicine to the concluding chapter of the book.

New York, 51 West Seventieth Street,
July 10th, 1898.



CONTENTS.



Introduction. Definitions,



CHAPTER I.



The Physiological Effects of "Water,
Anatomy and Physiology of the Skin,



Function of the Skin,



Physical Properties of Water,



CHAPTER II.



CHAPTER III.



CHAPTER IV.



Rationale of Action of Water in Health,

Effect of Hydriatic Applications upon the Distribution of Blood,
Effect of Hydriatic Applications upon the Composition of the Blood,
Conclusions, ...........

Influence of Hydriatic Applications upon the Respiration, .
Influence of Hydriatic Applications upon the Muscular System, .
Influence of Hydriatic Procedures on Temperature,



CHAPTER V.



The Practice of Hydrotherapy,

Ablution,

Half-Bath,

Affusion,

Sheet Bath,

Cold Rub,

Wet Pack,

Wet Compress,

Precordial Compress,



CHAPTER VI.



PAOB
1



18



27



29
30

48
60
61
63

77



81

83



92
101
101
112
129



The Full Bath, 132

The Cold Full Bath, 136

Therapeutic Indication of the Cold Full Bath 154

Fevers 155

Reason for the Therapeutic Supremacy of the Cold Bath in Infectious Fevers, 168

Objections Urged against the Brand Metliod, 170

Contraindications to the Bath, 188



VI CONTENTS.



CHAPTER VII.

FAQX

The Warm Full Bath, 193

The Continuous or Hammock Bath, 200

Localized Continuous Baths, 207

CHAPTER VIII.
The Douche, .... " 211

CHAPTER IX.
The Hip Bath, .221

CHAPTER X.

Irrigation, 226

Lavage, 236

Enteroclysis, 239

Irrigation of the Urethra and Bladder without the Catheter, . . . 248
Vaginal Irrigation, 251

CHAPTER XI.

Methods of Cooling and Heating Internal Parts, 254

Steam as a Therapeutic Agent, 257

Steam as a Styptic, 258

CHAPTER XII.

The Internal Use of Water, 261

Therapeutic Indications, . . . 265

CHAPTER XIII.

Practical Application of Hydrotherapy in Acute and Chronic Diseases, . 267
Typhoid Fever, 268

CHAPTER XIV.

The Exanthemata 278

Measles, 278

Scarlatina, 281

CHAPTER XV.

Pneumonia, 286

Pneumonia of Children, 289

Pneumonia of Adults, 293

CHAPTER XVI.
Entero-Colitis, „ . . . 304

CHAPTER XVIL
Asiatic Cholera, 310



CONTENTS. Vll

CHAPTER XVIII.

PAGE

Insolation 317

CHAPTER XIX.
The Hot-Air Bath 325

CHAPTER XX.

Hydrotherapeutic Apparatus for Hospitals, Asylums, and Other Institu-
tions 331

CHAPTER XXI.

Chronic Diseases, 341

Anaemia and Chlorosis, 341

CHAPTER XXII.
Phthisis, 347

CHAPTER XXIII.
Malarial Diseases, 359

CHAPTER XXIV.

Neurasthenia, 365

Neuralgia, 380

Hysteria 386

CHAPTER XXV.
Chronic Rheumatism and Gout, 393

CHAPTER XXVI.
The Hydriatric Prescription, 404

CHAPTER XXVII.

Historical Epitome, 416

Hydrotherapy in Germany, . 417

" Italy, 419

" " France 420

« " England 421

" " America, 423

Conclusion, 424

Necessity for Instruction in Hydrotherapy, 426



THE

PRINCIPLES AND PRACTICE OF HYDROTHERAPY.



I^TRODUOTIOK

HYDROTHERAPY.

Definition. — Hydrotherapy, as its derivation from udwp, water, and
Otpa-s'ju}, to heal, indicates, may be defined as the method of applying
water in disease. Some physicians have endeavored to restrict the
term to the remedial use of cold water alone, and this is not an un-
common error. An excellent medical dictionary, now in considerable
use, defines hydrotherapeutics to be the application of cold water to
disease. If those who are familiar with the derivation of the term
commit so serious an error, it is not surprising that erroneous views of
the application of water in disease are general among the profession
and lay people. The idea probably originated with the hydropaths,
who claim Priessuitz, the apostle of cold water, as their leader. This
empiric has doubtless given a strong impetus to the popularization of
cold water in disease. Indeed, his life and labors form a remarkable
chapter in the history of this subject, and will be referred to more
fully in another part of this work.

It will surely inure to the progress and development of hydro-
therapy, i.e., the scientific application of water in disease, if this false
conception of its being a cold-water treatment be removed from the
minds of the profession and the people. There seems to exist in the
human mind a strong feeling of repulsion against cold baths, wet
packs, and other hydriatric procedures. The former conjure up in the
mind of the timid practitioner vague apprehensions of shock and heart
failure; the latter remind him of damp sheets bearing rheumatism
and colds in their train. The reader who shall follow these pages
will find in them ample illustrations of the untenability and the
absurdity of such views.

Hydrotherapy includes the application of water in any form from
the solid and fluid to vapior ; from ice to steam, internally and exter-
nally. The recently discovered styptic action of steam, the well-known
1



2 THE PRINCIPLES AND PRACTICE OF HYDROTHERAPY.

aseptic effects of hot water in surgery ; its resorbent use in gynaecology
and surgery ; its application in gastric, rheumatic, and intestinal troubles
and in meningitis; its value in gastric catarrh, render hot water as im-
portant a hydriatric agent as is cold water.

Hydrotherapy does not, however, include the use of mineral waters
when these depend upon their mineral constituents for therapeutic
efficacy (which, by the way, is rarely the case). While these mineral
waters are quite as valuable as is plain water in all the procedures of
hydrotherapy, if they possess the proper temperature, etc., the mineral
constituents do not often add to the effects produced, inasmuch as the
latter are the result of the judicious adaptation of the mechanical and
thermic influence of water alone.

A clear conception of this subject is important at the outset. It
may, therefore, be stated that hydrotlieraxjy depends upon the me-
chanical and thermic action of water in disease, irrespective of the
source from which it may be obtained. Balneology depends upon the
chemical and diluent action of mineral waters, the effects of which are
greatly modified by and depend almost entirely upon the source from
which they are derived.

Hydropathy is a method of practice adopted by certain empirics
who base their results chiefly upon the effect of cold water. Other
terms, referring to the subject in general, are the adjectives hydriatric
and hydriatic. Hydriatric is derived from udwp, water, and larpia,
medical treatment ; it is a short and equally expressive substitute for
the adjective hydrotherapeutic. We may correctly speak of hydriatric
procedures or hydriatric institutions, but the term cannot be applied
to water applications made in physiological experiments.

Hydriatic is an adjective in common use, qualifying nouns con-
nected with the use of water in medicine or for other purposes. Its
correct derivation I have been unable to obtain. It may obviously be
applied to procedures as hydriatic measures, or applications in health,
but its use is incorrect when applied to institutions, etc. This word
should be banished altogether when referring to the remedial applica-
tion of water. The word hydriatric is more expressive and clearly in-
dicates that water is used for remedial purposes. It is proper to use
it in connection with measures, procedures, or prescriptions, but it
would obviously be tautology to use it in connection with treatment.



CHAPTER I.

THE PHYSIOLOGICAL EFFECTS OF WATER

As a basis for the proper understanding of the uses and effects of
water in diseased conditions, it is important to study and thoroughly
master its action in health. Wilhelm Winternitz, of Vienna, has
made the expansion of hydrotherapy into a branch of scientific thera-
peutics the mission of his life. To his initiative may be traced al-
most all the advances that have been made in this important subject.
Twenty years ago he endeavored to impress upon the medical pro-
fession the idea that methodical and physiological observation must be
utilized as the basis of hydrotherapy. Deviating from the prevalent
comments resorted to in balneological writings, he banished such ex-
pressions as "enhancement of activity of functions," "favorable
changes in the gastric and pulmonary nerves, " " agreeable stimulation
of the circulation," "improvement of the blood." For these he pro-
posed to substitute actiial demonstrations by experimental processes
of the effect of water in health and disease. Thus a grand impetus
was given to the subject, an impetus whose influence will be long dis-
cernible. Indeed, no writer in this field of therapeutics can add much
to the thorough and masterly presentation of the scientific side of this
subject. We may, however, amplify the observations of Winternitz,
and add confirmation by experiments and clinical results of the claims
he has set forth for the remedial value of water. Differing from all
writers who have preceded him, and from many who have followed
him, the writings of Winternitz are not panegyrics upon the unfailing
virtues of this remedial agent, but rather ingenious, at times classical,
demonstrations, often mingled with confessions of defects in our knowl-
edge, and strivings to amplify the latter by pointing them out in the
clearest manner.

Since the chief, though not by any means all, effects of hydro-
therapy concern the thermic and mechanical action of water upon the
cutaneous surfaces of the body, it becomes necessary to study, 1, the
anatomical construction and physiology of the skin, from a hydriatric
standjjoint; and, 2, the physical properties of water which render it
capable of producing these effects.



THE PRINCIPLES AND PRACTICE OF HYDROTHERAPY.



Anatomy and Physiology of the Skin.

Although an intimate knowledge of this subject is important to the
hydrotherapist, it is not my purpose to enter into so minute and de-
tailed an account of the anatomy of the skin as would be required for
the purposes of dermatology, hi connection tvith hydrotherapy it is
only necessary to study briefly the anatomical structure of the skin for
purposes of furthering a correct understanding of its functions. Those
portions of the skin which contain the blood and nerve supplies will,
therefore, interest us most. Their distribution over enormous areas
and their interdependence, direct and indirect, with almost every
organ in the human body, lend to the subject of the nerves and blood-
vessels of the skin paramount import to the student of hydrotherapy.

It appears to the author that a more careful and elaborate discus-
sion of these structures than is usually accorded to them in the works
on hydrotherapy would be of practical value.

The e])iclermis is so constructed anatomically that it serves as a
protecting layer to the more delicate and sensitive structures lying
immediately beneath it.

The c%itis vera consists of the white fibrous and yellow elastic con-
necting tissue, forming bundles which, in the upper layers, are so
thickly and closely aggregated that they appear like felt. This con-
tains the papillae, whose number is enormous. In the deeper layer,
the stratum reticularis, the elastic fibres form a network which, by
its disposition, lends itself to the special functions of the skin in the
various parts of the body, and by its structure admits the blood
vessels and nerves, which lend to the skin the most important functions
connected with hydrotherapy. The muscular fibres of the skin are of
the involuntary variety. They are regarded as a whole by Unna, who
gives them the appellation of oblique tensors of the cutis, the real
origin and ending of which are in the elastic tissue, and through the
latter in the entire skin. The tension of the skin produced by this
muscular structure and elastic netivork, is really subject to and produced
by temperature changes. This may be observed very readily in the
dartos of the scrotum. In the latter, medium tension is produced by
a medium temperature, relaxation by a higher temperature, while a
lower temperature produces contraction, which is evidenced by its
being drawn up. In hairy parts this contraction produces the well-
known cutis anserina. This anatomical construction, by reason of
which the cutaneous muscles are surrounded in their entire extent by
a woof of elastic fibres which are connected with each other and with
the tendinous formations existing in the skin, renders it plain that a



THE PHYSIOLOGICAL EFFECTS OF WATER. 5

shortening or tension of the muscular fibres always simultaneously
contracts the elastic apparatus which is woven around their entire ex-
tent. This exjjlalns the vital imjjort of the contractility of the shin when
exerted iipon the small blood-vessels contained in it. Inasmuch as the
condition of tension of the skin may thus be readily varied in the most
direct manner by reason of the universal presence of the elastic fibres,
and inasmuch as muscular coats are either absent in the vessels of the
skin or are feebly developed, these structures really perform the func-
tion of an inhibitory apparatus which distributes uniformly pressure
and motion, and enables the oblique muscular fibres tvhich are embedded
in the skin to regulate the secretion and circulation, the movement of
lymph, and consequently the nutrition. The functional interdependence
of the muscular and elastic fibres in the skin, which has long been
recognized, is evidenced here by the fact that those parts which, like
the palms of the hands, the soles of the feet, the nose, show the
smallest quantity of muscular fibres also possess the smallest elastic
fibres. Both of these parts appear simultaneously in the first six or
seven months of foetal life (Unna).

It is evident that a recognition of the contractility with which the
elastic and muscular apparatus of the skin is endowed furnishes the
hydrotherapist a clew to most of the functions of the skin.

Blood- Vessels. — The papilla? contained in the upper layer of the
cutis show fine capillary loops, or blood-vessels, which rise perpen-
dicularly to the near vicinity of the epidermis, nourishing it and
furthering exchange of gases and secretion of the aqueous portions of
the perspiration. These capillary loops consist of an arterial and a
venous portion, which combine a short distance below the point of the
papilla", and which ri;n either straight or form loops, as they may be
filled with blood or compressed by the papillae. The loop may be so
filled with blood that it may double and fold over in spiral windings
until it occupies almost the entire space of the papilla. Tltis capacity
for increasing or diminisliing the size of the capillary loopjs furnishes an
important agency by u'hich hydrotherapy may affect the circulation.
The Vjlood-vessels of the skin differ greatly with the locality and func-
tions of the part. They run either in perpendicular or in radiating
loops to the surface, as in the palms of the hands, ending in a circular
arrangement of the numerous branches, or they are drawn into a flat
arrangement by the densely contracted bundles of elastic fibres. The
horizontal branching of these jjartly oblique and partly perpendicular
vessel loops is found chiefly in two regions : at the border and between
the true cutis and the subcutaneous tissue, or between the border of
the former and the papillary body. The terminal branches of the
capillaries which lie beneath the capillary body consist of numerous



6 THE PRINCIPLES AND PRACTICE OF HYDROTHERAPY.

tubules, forming a wide-meshed arterial network, whose long axis
adapts itself to the direction of the folds of the epidermis. From this
arises for each vessel papilla a rolled-up arterial capillary which is
looped in order to form the more winding venous capillary. All
the venous capillaries of the papillary body unite in a dense, narrow-
meshed capillary network on a line with the arterial capillaries j from
these the larger veins issue which pass through the cutis in the same
direction as the arteries. All the vessels of the papillary tract,
as also the larger branches which pass through the skin, consist of
only an endothelial tube, to which are added a very insignificant media
and adventitia in the vicinity of the subcutaneous tissue. Hence
their character is chiefly capillary. The arteries are narrow, the veins
relatively very wide, a difference which increases with the thickness
of the epidermis (Unua) .

The papillary blood tract enters the deeper layer of the cutis vera
at several points, and supplies the follicles, glands, and oblique mus-
cular fibres. Beneath the papillary layer is found an area the extent
of which corresponds with the thickness of the cutis, and which is not
well supplied with blood-vessels.

The fibrous layers of the corium have no capillaries, but at the
border lines between the corium and the subcutaneous tissue the most
abundant supply of blood-vessels is met. From the minute arterial
trunks separate branches are seen to arise and pass to the whole
papilla, surroimding the latter with a capillary loop. Every sebace-
ous gland, also, has a delicate capillary network, which forms a com-
plete plexus where these canals are in close proximity. Branches
from this plexus, forming delicate though dense capillary networks,
also are seen within the small fat flaps. In the capillaries permeating
the skin the elastic coat is absent, being supplied by the elastic fibres
of the skin itself. Meissner* says that these elastic fibres form a
frame strvicture around the vessels ; they oppose the action of the vaso-
motors, and separate the vasodilators,' whose power is much less.
They also protect the vessels against pressure from the surrounding
structures. When the coats of the cutaneous vessels become rigid, the
elastic fibres disappear, even before atheromatous thickening is notice-
able. A section under the microscope would thus enable us to detect
changes in the vessels due to senile degeneration and alcoholism.

With the exception of the isolated branches supplying the whole
papillae, the horizontal distribution of the vascular branches may be
said to keep chiefly within the two border lines of the cutis vera. The
form of distribution of vessels in the adult depends upon the develop-



Online LibrarySimon BaruchThe Principles and practice of hydrotherapy : a guide to the application of water in disease for students and practitioners of medicine → online text (page 1 of 47)