NONE of us bathe merely for external cleanliness and the benefits derived therefrom. If that were true, junior would not have to be reprimanded for swimming in the old pond long before the trees are green, and Atlantic City and Palm Beach would be unknown. Bathing, like eating, can be a pure sensuous delight. The contact of the skin with water, whether in a tub, under a shower, in a pool, a river or the ocean is an almost unparalleled pleasure. But the pleasure is not due only to the touch of the water on the skin, but to the far reaching effects it has on the internal system effects which vary with the temperature of the water, the mode of application and the length of contact with the water. It is these effects that have made water one of the principal therapeutic remedies known to man.
The use of water goes back far beyond the historic period and is lost in the folklore and legends of primitive mankind. Primitive man soon learned to dip injured limbs into cooling streams. He worshipped the waters that gave life and health, and to bathe in waters of the Ganges, the Nile and other waters, became a religious ritual. Even the Greeks combined religion with bathing, as witness the natural springs dedicated to the god Heracles and the warm baths of the Cilician nymphs. Nor must we forget that Achilles was bathed in the waters of the Styx to give him immortality. And the ceaseless search for the fountain of youth is one of the instinctive quests which form the background of modern water therapy of hydro-therapy.
Despite the ceremonial cleansings, however, the ancients never forgot the healing qualities of water. Hippocrates, the father of physiotherapy, discarded many of the drugs that were handed down from the Egyptians and treated his patients with proper diet, fresh air, change of climate, purgation, massage and hydrotherapy. And the sumptuous baths of the Romans, which we described before, are an additional witness of this fact.
The Romans passed their knowledge of the beneficial effects of bathing to the Arabians who took it to Spain and to Northern Africa. And during the Middle Ages the science of water therapy received its chief impetus from the Arabian physicians who advocated baths for fevers. We are apt to think that the folk who lived in the Middle Ages were an unclean, unscientific lot. In truth, this is an exaggeration. Not only did the physicians prescribe baths, but there were bathkeepers who enrolled themselves in guilds and erected bath houses all over Europe. And the knowledge of the beneficial effects of water was passed on and enlarged upon in the Renaissance and modern times.
Oddly enough, truly scientific therapy of modern times was inaugurated in 1830 by a crude and powerful Silesian peasant with no medical training, one Vincent Priessnitz. He sprained his wrist and crushed his thumb one day and healed it by immersion in cold water. Some time later a cart passed over our hero’s body and broke his ribs. When he heard the gloomy remarks of his physicians, he tore his bandages off and applied cold, wet compresses to his ribs and pressed his abdomen against his window sill, breathing deeply. So salutory was his treatment that he established a hydropathic institute at Graefenberg. Almost at once proceedings were started against him since he was not a doctor, but the Austrian government intervened and before long physicians from all countries flocked to him to learn the procedure of douche, plunge, dripping sheet, dry heat pack, wet sheet pack, foot bath, sitz bath, warm and tepid bath.
Shortly afterwards, in Germany, a series of experimental researches were undertaken with the object of ascertaining more exactly the effect of bathing at varied temperatures, its influence on the circulatory system and the nervous systems and on metabolism in general. Subsequently, a large number of clinical and experimental studies along the same lines were con-ducted by workers in different countries.
It is to be regretted that hydrotherapy in the United States has been too frequently controlled by faddists. For this reason prejudice sometimes exists against water treatment. However, the subject found a scientific advocate in Dr. Simon Baruch, who had a chair at Columbia University where he taught five hundred students that water has a place in the Materia Medica as a stimulant, sedative, tonic, diuretic, diaphoretic, emetic, purgative, promoter of metabolism, antipyretic, hypnotic, antiseptic and even local anaesthetic.
The World War taught us the value of hydrotherapy more than any other factor of recent date. Not only was it used extensively during the War, but in both this country and in Europe hydrotherapy has been well established in veteran hospitals and in hospitals for the mentally unstable. Indeed, hydrotherapy is now considered indispensable although, to be sure, no system of medicine can be entirely built on water. There is still much to be learned in the field of hydro-therapeutics, especially since we have so many new scientific weapons on hand. It is safe to predict, however, that its beneficial effects will be more and more recognized both in the hospital and in the home as research progresses.
Broadly speaking, hydrotherapy is used to modify the condition of the body by utilizing ordinary water on the skin as a vehicle of heat or cold or force. Its peculiar physical characteristics make it an ideal instrument for bringing about such modification. In the first place, it is a perfect vehicle of heat and cold. In the second place, its application can be localized or spread over the entire body, and with varying degrees of force. And thirdly, according to its temperature it ranges from a solid, through a liquid, to a vapor all of which states have a marked therapeutic importance.
The effects of the application of water on the skin are both chemical and physical. As a chemical, water is a detergent or cleansing agent, as we have already learned. From a physical standpoint the effects of water are twofold local, that is, confined to the skin; and internal, through the media of the nervous and circulatory systems. According to its temperature and force, water may be a tonic, a stimulant or a sedative. Its thermal effect is by far more important than its mechanical effect of force. Generally speaking, water of a temperature cooler or hotter than skin temperature is stimulating, the colder to a greater degree. The neutral bath, on the other hand, that is, a bath which approximates the skin temperature, has a soothing sedative effect.
It is obvious, since any change wrought in an organism by the external application of water is effected through the skin, nervous system and blood vessels, that the mechanism of these three organs is of great importance and that the effect of the various types of baths cannot be fully appreciated without some knowledge of the structure of the skin, particularly in relation to the nervous and circulatory systems. In our review of the hygiene of the skin, we described the structure of the skin as well as its several functions, so that there is no need to repeat here, except to point out that the sensory function of the skin is of special importance. The skin is richly supplied with nerves, it will be recalled, and since it is sensitive it not only serves as a warning against harmful external forces, but controls other functions. This sensitiveness is therefore of utmost importance in the effect of varied temperature baths on the organism.
Moreover, from the previous description of the skin and its functions, one might reasonably surmise, particularly from the heat-regulating and excretory functions, that the temperature of the skin varies. This is indeed the case while the internal temperature remains about the same in a normal healthy individual, the temperature of the skin is modified by the weather condition, exercise, amount of perspiration, clothing and many other factors. It varies, too, in different parts of the body of the same individual. Since the skin is the organ with which water comes in direct contact in hydrotherapy, the skin temperature plays an important role in this type of treatment. Indeed, the neutral bath is maintained as near the skin temperature as possible and even in the application of hot and cold baths of all types, it is always taken into consideration, sometimes a preliminary wetting of the skin being given to avoid shock to the nervous system. It is not necessary for us to describe in detail the variations in skin temperature. Suffice to say that generally the skin temperature is a few degrees less than body temperature and that it has a tendency to rise after exercise, eating and in warmer atmospheres. The best way to judge is by the feel of the water on the skin.
As we have said, the blood supply of the skin is derived from branches of a subcutaneous, arterial network which is distributed to the sweat glands, hair follicles and fat. Other branches unite in a network which lies immediately under the sub-papillary network and which gives off arterioles or small arteries and capillaries to the papillae. From the capillaries, the blood supply passes into a subcapillary network of veins and from thence to the connecting and main skin veins. The blood vessels of the skin are capable of contracting and dilating independently of the heart and this can be brought about by appropriate stimulation. Moreover, as we also explained,the blood vessels are in close relation to the nerve endings and are therefore affected by their stimulation. Now much of the effect of hydrotherapeutic measures is due to the stimulus of temperature and of the pressure or force of water on these skin nerve endings.
Cold water and warm water in contact with the skin stimulate the cold and heat receptors respectively. By receptors are meant nerve cells that receive the stimuli. The receptors, in turn, reflexively affect remote tissues, producing various functional changes in the tissue. The greater the difference between the temperature of the water and the temperature of the skin, the more intense is the thermic stimulation. Furthermore, mechanical stimulation produced by the impact of the water in showers, in douches and in sea-bathing or by friction, active exercise, etc., in conjunction with baths, influences considerably the effect of the water.
The types of baths are many. Water may be applied therapeutically in the form of plain, artificially medicated or naturally mineralized water. It may be in the form of a full or partial immersion in a tub, spray or douche, with or without massage and manipulation. Water vapor may also be utilized locally or generally.
While the immersion of the whole body in a tub bath brings all the parts under the influence of the temperature of the water, a general effect is also produced by a partial submersion as the action of the water is not confined to the submerged parts. The same holds true for spray and douche, which produce an additional stimulation from the impact of the particles of water.
Baths according to temperature vary from very cold baths through neutral, lukewarm to very hot baths. Heat and cold are, of course, relative terms and are therefore not particularly scientific. For this reason many authorities prefer to use the number of degrees rather than the terms hot and cold. For our purpose, however, it will be sufficient to designate the baths as hot, cold and neutral.
Full immersion baths of any temperature are taken in a tub which contains about forty to fifty gallons of water. If you have a feeling of oppression or a headache from the water, regardless of temperature, take the precaution of wrapping your head in a towel wrung out in cold water.
The mechanical action of water depends upon the pressure of the water on the parts immersed and the resistance offered by different parts of the circulatory system. The veins and capillaries are most affected and the great vessels the least, since their walls are under greater pressure. The smaller arteries, however, are also under influence of the external stimulation. The net result of the water pressure is to increase the circulation and the work of the heart. In regard to the abdomen, the result would be to decrease splanchnic stasis impacted feces in the last end of the colon. The pressure on the thorax favors expiration at the expense of inspiration, which is hindered by the failure of the diaphragm to make its full expiration.
On the whole it may be said that where all factors tend in the same direction, the pressure of the water increases the work of the heart, lessens abdominal stasis and decreases inspiration.
The thermal effect naturally varies with the temperature in the bath and will be treated subsequently when we describe the various types of baths.