Baths (water,)

Baths, water, i.e., immersion of the body for a longer or shorter period in prepared water, are one of the most common and at the same time very important hydrotherapeutic procedures. They are performed in specially adapted containers, usually in the well-known bathtubs, much less frequently in pools of various sizes, and if necessary even in a tub, trough, etc. Water baths can be subdivided: 1) By size—into general, or full baths, when the entire body is immersed up to the neck (for an adult 200-300 liters of water are required, and for a child only 50-100 liters), and into local, or partial baths, for some part of the body, namely: half, or waist baths, when the bathtub is filled only halfway; sitting, or more precisely, hip baths, when the entire pelvis with the lower abdomen and upper thighs is immersed (approx. 25-50 liters); then hand, foot (8-15 liters), occipital baths, etc.; 2) By temperature—into baths with indifferent temperature (34-35°), into baths with lower temperature—cool and cold (the latter below 20°)—and with higher temperature—warm and hot (the latter above 40°); 3) By duration—into short baths (1-5 min.), of ordinary duration (15-30 min.), prolonged (for hours) and continuous (for whole days); 4) By composition—into simple baths (of fresh water only), medicinal baths (with the addition of various gases, salts, aromatic substances, etc.) and finally 'combined' baths, when the action of water is combined with the effect of some other physical therapeutic factor (e.g., hydroelectric baths, etc.). The effect of baths on the organism is determined by the same factors as in other water treatment procedures, namely: thermal, mechanical and sometimes chemical irritation (see Hydrotherapy); but since when using baths a much larger mass of water comes into contact with the body and usually for a longer time, therefore a more significant effect occurs both on the skin and on the entire organism in general, especially on heat exchange, blood distribution, the nervous system; finally, the effect of hydrostatic pressure (on blood circulation and respiration) is more evident here. Due to the fact that each of the above-mentioned factors can vary within wide limits and that all of them can be combined with each other in the most diverse ways, the effect of different kinds of baths can be very different. A. Simple water baths (and namely general ones) are used most often. Of these, general baths with indifferent temperature do not cause direct irritation of the skin and have no noticeable effect on heat exchange, the nervous system, or internal organs, but they are by no means indifferent to the organism. First of all, they cleanse the skin from various external contamination and from various secretions, help remove dead layers of the epidermis, and at the same time excellently stimulate the activity of the skin, which has a very significant influence on all life processes of both healthy and sick organisms. Therefore, they are used for hygienic and preventive purposes, and since no expenditure of energy, no compensatory efforts are required from the organism, they can be prescribed not only to children, the elderly, and generally weak subjects, but even to most patients (the more severe patients should, however, be given a mild stimulant before the bath and have a stronger one ready). Then, such baths, especially somewhat warmer (by 1-2°), more prolonged (30 minutes or more) and used repeatedly, are a good sedative and are indicated for various nervous diseases with signs of excitement, for various painful sensations, hyperesthesias, skin itching. Due to the effect on the superficial layers of the skin (cleansing, softening, disinfecting) and improvement of blood circulation in it, they are beneficial for a number of skin ailments, especially for widespread inflammatory dermatoses. Furthermore, due to the beneficial effect on the renal parenchyma as well as to the enhancement of the vicarious function of the skin, they are used in nephritis, nephrosis, etc. Recently, these baths have also been recommended for various diseases of the lungs (emphysema, chronic bronchitis, bronchial asthma). The same baths, but with gradually decreasing temperature (approximately by 5-10°), are prescribed for infectious diseases, especially those with high temperature, clouded consciousness, with a decline in cardiovascular activity (e.g., in severe forms of typhoid fever); during the bath itself, the patient is usually rubbed slightly, and sometimes his head is poured with colder water. Finally, continuous baths, especially in the form of the so-called 'Hebra's water bed' (baths with special devices for convenient lying of the patient, for lowering him into the bath and taking him out, for constant changing of water, for maintaining its temperature at 35-37°), are used for widespread skin lesions accompanied by severe pain, ulceration, suppuration (e.g., in pemphigus, burns, bedsores, in extensive infected wounds, etc.; then, in deep operations on the rectum, in cases of excitement in mental patients, in severe forms of joint rheumatism). General hot baths cause sharp hyperemia of the skin, strongly excite the cardiovascular and nervous systems, increase blood pressure, limit heat loss, increase metabolism, first non-nitrogenous, and then nitrogenous, and finally cause sweating. They should be short-term, since fairly soon fatigue, general weakness, shortness of breath, palpitations, dizziness appear. These adverse side effects, once they appear, then quickly intensify unless the baths are discontinued. Wetting the head and face with cold, and in some cases hot water, reduces these symptoms (it is done both before starting the bath and during it). After hot baths, sufficient rest (at least 20-30 minutes) is necessary, and in addition, if it is desirable to maintain sweating, then wrapping in warm blankets and drinking hot liquids is required, and if, on the contrary, it is necessary to stop sweating and refresh the patient, then some cool procedure (pouring, shower, half-bath) is necessary. Hot baths are most often used as a diaphoretic and metabolism-enhancing agent for the usual indications (e.g., kidney diseases, especially with edema, chronic poisoning, various rheumatic lesions, especially of joints, gout, etc.); much less frequently—in some infectious diseases, especially in childhood, in the algid period of cholera, as well as in some skin lesions (e.g., prurigo, psoriasis); finally (very rarely), as a stimulant (immersion in water at 40-50°, but only for a few seconds). In general, in Europe hot baths are not often used, while in Japan such baths (with temperature 40-45° and even higher, but usually only for 2-5 minutes, rarely more, and repeated every 1-2 days, or even daily) are a very common folk remedy and are used for the purpose of refreshing, strengthening and even hardening. Contraindications to hot baths are diseases of the cardiovascular system, especially those with clear weakening of it, high blood pressure, tendency to bleeding, tuberculosis of the lungs, severe weakness and general exhaustion. General cold baths, used even less frequently, are also a strong stimulant for the nervous system and general metabolism, but, in contrast to hot ones, cause more or less significant heat loss. They should also be short-term (only 1-3 minutes, rarely more and often less), since they require a large expenditure of energy from the organism, and should never be carried to the appearance of 'secondary chills'. On the contrary, with properly performed and well-dosed cold baths, the initial sensation of cold, chilliness quickly passes and is replaced by a pleasant feeling of warmth, heating, which is greatly helped by intensified movements, rubbing; in addition, a feeling of freshness, vigor appears, general well-being improves, and work capacity increases. Therefore, cold baths are usually used as a general stimulating and tonic agent, as a metabolism-enhancing agent, especially in the treatment of obesity, as a hardening agent, as a cooling agent after the use of various heat procedures and in some infectious diseases, especially if there is very high temperature and significant depression of the nervous system. Cold baths are prescribed to stronger, well-nourished people, not too irritable and more or less accustomed to cold; absolute contraindications for them are the same as for hot baths, and in addition—lesions of the renal parenchyma, most so-called 'rheumatic or cold' diseases, as well as painful and spasmodic phenomena. Local baths have a lesser effect on the organism in general, but they can be made more intense both in temperature and in time. Thanks to this, with their help one can achieve a stronger effect directly at the place of application, and at the same time a more pronounced reflex effect on certain specific organs.

The most important of the local baths are sitz baths, which are made in vessels of special shape (a truncated cone, with the base turned upward and cut obliquely from this edge); they usually have devices for quickly filling the bath first with hot water, then with cold water, for emptying, for passing a strong and wide stream of one or the other temperature, and finally for simultaneous action with small streams under pressure on the back and on the perineum. The patient sits in these baths, bending the legs at the hip and knee joints and bending the calves over the front, lower edge; at the same time, the back is reclined against the higher backrest, and the bent arms rest on special supports on the sides of the bath. The water should reach the level of the navel, and the other parts of the body, not immersed in water, are covered with blankets, while the feet are sometimes immersed in a tub with warm water. Sitz baths are used for diseases of the intestine, especially its lower sections, the entire urinary system, and also the skin and soft parts of this same area. In this case, cold but short baths (20-10° and 3-5 min.) in the final result cause increased blood flow and excite the nervous and muscular apparatuses, and therefore are indicated for atony of the bladder, intestine, for scanty menstruation, sexual weakness; warm baths (approx. 35° and 20-30 min.) cause moderate hyperemia of the above-mentioned organs and tissues and therefore have a calming effect on pains and spasms of various origins and a resolving effect on various inflammatory processes; finally, hot baths (at 40-42° and 10-15 min. and more) act even more strongly in the same direction, but intensify menstruation and can even cause abortion.-II. Foot and hand baths can be performed in a tub, basin, etc., but it is better to have specially adapted bathtubs where the temperature of the water can be quickly changed as desired, and also the latter can be passed at a higher speed ('flowing baths'). These baths are used either cold-at 20° and below, but short-lived-3-5 min. and less (then they are usually accompanied by rubbings both during the bath itself and after), or hot-at 40° and above, but longer-lasting-10-15 min. and more, or finally, variable: first for 1-2 min. hot water (40-42°) and then for 7/8-3/4 min. cold water (15-10°); the temperature is changed in this way several times during 5-10 min. In this case, they always try to achieve clear reddening of the skin and a feeling of warmth. Thus, the action of these baths is determined, mainly, by temperature irritation, but sometimes mechanical (rubbings) and less often even chemical (addition of salt, mustard) are added to this. These baths are used, on the one hand, for purely local action on the limb (hot-for various residual inflammatory processes: scars, infiltrates of soft parts, stiffness and swelling of joints; and cold and partly variable-for varicose veins, chilblains, vasomotor disorders) and, on the other hand, for action on more distant organs (cold and variable foot baths-for rushes of blood to the head, for insomnia, for stagnation in the pelvis; hand baths, usually hot-for attacks of cardiac and bronchial asthma, for pulmonary edema, for pains in the heart).-III. Recently, local hot baths with gradually increasing temperature (according to Hauffe) have come into use. Their technique is as follows: one or another limb (it is better to start with the upper one) is immersed in a bathtub with water at 37°; the patient sits or even lies down and is well covered with blankets; the temperature during the first 10-15 min. is gradually raised to 40-45 and even 47° (exactly until clear sweating appears), and then maintained at the same level for another 20 minutes, but if the face becomes pale or blue, if the general condition worsens, if the pulse weakens and quickens or breathing becomes more frequent-the bath must be stopped immediately; after this, the patient is wrapped in a blanket and laid in bed for about 30 minutes, where he gradually cools down. These baths are done once a day, first daily, then less often, and in total 15-20 times. According to Hauffe, this leads to dilation not only of peripheral vessels but also of deeper ones (whereas with the action of sharp temperatures the latter constrict), thanks to which the baths not only do not burden the heart, but on the contrary stimulate it, facilitate its work. The indications for them are, in general, the same as for general and local hot baths, and in addition, diseases of the cardiovascular system, such as: heart neuroses, weakening of its activity, arteriosclerosis, especially high blood pressure and attacks of angina pectoris. Medicinal baths, i.e. baths with the addition of various substances to ordinary fresh water, differ from ordinary water baths in their action, since these substances can, on the one hand, change the physical and other properties of the medium into which the patient is immersed, and on the other hand, exert on the body a special action inherent to them.- I. Of gas baths, i.e. with the addition of gases, artificial carbonic baths are of particular importance for hydrotherapy. They are prepared a) by passing CO₂ from a cylinder with compressed gas into water already poured into the bath, through dense rubber tubes with small holes placed at its bottom; b) by forming CO₂ directly in the bath itself, for which soda is dissolved in it in an amount of about 3/4-1 kg, and then the same amount of unrefined hydrochloric or sulfuric acid, strongly diluted, is added to it, passing it through the same tubes, or dense but well-dissolving patented cakes of various composition are placed at the bottom of the bath; c) by preliminary saturation of water, often cold, under pressure of 1.5-2 atm. in special apparatuses-columns (mixer). The latter method gives the best saturation of water with CO₂, closest to natural (more uniform, stronger, more closely bound) and giving rapid formation of numerous small bubbles on the body of the patient immersed in the bath (for more details on the mechanism of action, method of application, indications and contraindications see Balneotherapy). After carbonic baths come oxygen baths, the method of preparation of which is generally the same as for CO₂ baths, but the chemical composition of the means for preparing them is different (here Sodium perborate and Magnesium superoxydatum or Potassium hypermanganicum are most often used). O₂ baths are usually made at 35-30° with a duration of 10-20 min., daily, in total 20-25 baths in succession. Their action differs from that of CO₂ baths in that, firstly, there is no such strong saturation with gas, and therefore no such abundant formation of its bubbles, and secondly, that O₂ does not irritate the skin as much as CO₂ and, entering the body, acts on it in a completely different way. In general, O₂ baths beneficially influence the circulation, slightly excite and regulate cardiac activity, tone the vessels, but more weakly than CO₂ baths, while blood pressure rather lowers, and on the nervous system they produce not an exciting but a distinctly calming action; in addition, they improve the function of the skin and increase diuresis. The main indications for them are as follows: various diseases of the cardiovascular system, with not sharp phenomena of weakening of cardiac activity or with weakening of the tone of peripheral vessels; some nervous diseases with phenomena of irritation, as well as nervous palpitations, Basedow's disease, climacteric disorders; some infectious diseases, especially those where the cardiovascular system is severely affected, or already in the period of recovery. Sometimes air-water, or 'pearl baths' are used, where air is forcibly blown into the baths in one way or another, but in small streams (balloon with compressed air or air-pressure pump). Their action, in general, resembles that of O₂ baths, but is noticeably weaker. They are used mainly for nervous, irritable patients.- II. Baths with the addition of various salts also have great practical significance. Of such baths, saline baths are most often used, i.e. with the addition of 3-9 and even 15-18 kg of ordinary unrefined or sea salt, and sometimes Strasbourg or Kreuznach salt, etc. (the latter are expensive); sometimes for this purpose 2-3 liters of strong brine (with a content of solids up to 30-40%) or simply sea water are taken; sometimes to these baths with brine or from sea water an additional 4-6 kg of salt is added. The technique is quite simple: temperature 33-35°, sometimes higher, to be applied daily, duration 20-30 min.; the entire course of treatment 20-30 baths. The action of such baths approaches the action of more or less strong brine baths. They are used most often for various joint diseases, mainly of a rheumatic nature; then, for gout, scrofula, especially in childhood, where they often have an excellent strengthening effect. Sometimes to the baths, instead of salt, soda (about 1/2 kg) or potash (100-500 g) is added, but in pure form these soda baths are rarely used (only for some skin diseases to soften and remove the epidermis), and much more often-in mixed form-in the form of saline-alkaline baths.

The technique and indications are the same as for salt baths. Finally, sulfur baths, iron baths, sublimate baths, iodine baths, thymol baths and many others are used, for the preparation of which various patented preparations or specific medicinal substances are used. The effect of these baths is based on the properties of the added substances. At present, they are rarely used and then almost exclusively for certain skin diseases. III. Aromatic baths. Baths with the addition of a decoction of various fragrant herbs, for example, chamomile, mint or mixtures of them, for example, Species aromatica (1-2 kg to be infused in a bucket of water, and after half an hour the decoction is poured into the bath, or the entire mixture is placed in a linen bag and lowered into the bath in this form). Much more often, pine extract is used, a simple decoction of young pine branches and cones, or a special powder, the main component of which is Oleum pini; previous preparations, for example, fluinol, pinofluol, are much more expensive but without special advantages. The technique of such baths: temperature 34-37°, 15-20 minutes, daily. With their somewhat irritating effect on the skin and pleasant odor, they enhance the soothing effect of warm baths; perhaps the psychological influence also plays a major role here. Aromatic baths are readily prescribed for symptoms of nervous system fatigue, for its excessive irritability, as well as for various rheumatic and neuralgic diseases. IV. Finally, baths with the addition of various substances are used, some that moderate skin irritation, others that act specifically on it, and still others that simply do or do not irritate it. The first group includes baths with a decoction of bran, especially almond bran (from 1/2 to 1 1/2 kg), starch (2-3 kg), malt, glue, etc.; the second group includes tin baths (10-15 g), a decoction of oak bark (1-1 1/2 kg), alum, tar, soap, etc., and finally, the third group includes baths with the addition of turpentine (20-30 g in the form of an emulsion), formic alcohol (200-300 g), various patented substances, but most often with the addition of mustard (for a bath, 100-250 g is taken; crushed into powder, it is mixed beforehand with warm water until a clear odor appears and then is added directly to the bath or placed in a bag and lowered into it). Or 200 g of mustard alcohol, or 2 g of mustard oil, previously dissolved in alcohol. These baths, quite commonly used by the people, are rarely prescribed by physicians, only for certain special skin diseases. The exceptions are: 1) mustard baths, which are readily prescribed both in the form of local, hand or foot baths, to obtain a rapid and strong counter-irritant effect, and in the form of general baths, especially for certain infectious diseases, especially in childhood, and 2) some of the patented baths, for example, transcutaneous baths, which allegedly give good results in persistent, prolonged cases of joint lesions, similar neuralgias, etc. Combined baths include: I. Kinetic-therapeutic baths, in which the patient is made to perform certain movements in water with a temperature slightly above indifferent, depending on the disease. Their application is based on the fact that in water movements can be performed much more easily, provided they are slow, since on the one hand the weight of the body is significantly reduced here, and on the other hand painful sensations and spasmodic phenomena are also reduced. They are usually prescribed for chronic sciatica, but can also be usefully applied to a number of other movement disorders. II. Wave baths, when the water in the bath is set in motion by some mechanism to resemble sea or river waves. Here not only the usual temperature irritation is enhanced, but also significant mechanical irritation is added to it, which is why an exciting and metabolism-enhancing effect is obtained even at an indifferent temperature. III. Hydro-electric baths, i.e., baths through which an electric current is passed, but in such a way that it also passes through the patient in the bath. They are usually bipolar, with one pole in the form of one or several large electrodes, preferably carbon, placed at the foot end of the bath, and the other similar one behind the patient's back, or the entire bath is divided into two equal parts by a rubber partition with a cutout, so that when the patient lies down, the current can pass from one half to the other only through him (finally, there are four- and even five-chamber baths). The current used is galvanic, faradic, and much less frequently sinusoidal (due to its unfavorable, often dangerous side effects). The strength of the current for the first type of baths is 50-100 and even 200 µA, at a usual voltage of about 60-70 V; for the second type, usually according to the patient's condition - until a slight tingling sensation appears (usually around 10-15 µA), and for the third type - not more than 30-40 µA at 30 V. Their duration is 10-15 minutes, rarely longer, temperature about 35°; frequency every other day or daily, for a total of 20-30 baths. The effect of these baths is complex, with the electric current playing a significantly predominant role, while water is mainly a convenient electrode that fits tightly over a large surface of the body; sometimes salt or other substances are added to the bath, and then the effect of the bath can become even more complex (for example, tannin-tannic baths). In general, such baths act mainly on the cardiovascular system: they increase the amount of blood ejected by the heart per unit of time, slow down the pulse and sometimes regulate it noticeably; blood pressure with alternating current baths increases, while with direct current it decreases; in addition, they have a beneficial effect on the nervous system, with the first type having more of an exciting effect and the second type a calming effect. That is why these baths are a good vasomotor remedy for various conditions of weakened cardiac activity, for its irregularity, and for the most varied painful sensations in the heart area (constriction, beating, stopping) both in organic and purely nervous conditions. Then, they are used for certain diseases of the central nervous system of a functional nature, as well as for certain forms of neuralgia; finally, they are also used for rheumatic and gouty joint and muscle lesions (especially with the addition of strongly irritating substances).

I. Gorbachev.

Baths for children. Baths are widely used in children for both hygienic and therapeutic purposes (the bath should be faience, enameled, or zinc, by no means wooden, with a capacity for an infant of no less than 18-20 liters). The first bath is given immediately after the umbilical cord is tied. However, as to whether the newborn should be bathed before the umbilical cord falls off, doctors have not reached a consensus. It can be considered proven that bathing does not significantly affect the time of umbilical cord detachment (Zaitsev, Schweitzer, Berend, Racz, Keller), but a number of authors note that in bathed children, infection of the navel is observed somewhat more frequently. Until the navel is completely healed, the child can only be bathed in well-boiled water. In maternity institutions with experienced but overworked staff, it is better not to bathe (Jaschke). Subsequently, hygienic baths at 35°, and during the first days (especially in very weak children) at 36-37°, lasting from 5 to 10 minutes, are given daily. The soap should be neutral, without irritating additives (egg, Marseille). The time for bathing - morning or evening, it doesn't matter, but it should not be changed, as the bath determines the child's customary daily routine. In the bath, the child is supported by the left forearm of the person bathing, while the right hand continuously rinses and slightly rubs the child's skin. After the bath, the child is rinsed with water 1° cooler than the bath temperature. In the second half of the year, the bath temperature can be reduced to 34-33°. After the first year, bathing is usually done less frequently, but a daily bath, only cooler, at 31-32°, is very beneficial. Weak children who cool down significantly and do not nurse well after the bath are bathed less frequently (2-3 times a week) and the duration of the bath is reduced. Contraindications for hygienic baths are excessive weakness of the child, extensive inflammatory processes on the skin, especially weeping ones, and, in exceptional cases, in neurotics, an insurmountable fear of baths. For therapeutic purposes, indifferent, cool, hot, and medicinal baths are used. Indifferent baths at 34-35°, especially longer ones (up to 20-30 minutes), have a calming effect and are prescribed for spasmodic conditions (paralysis) and excitement (insomnia). Cool baths are used as an antipyretic for various infectious diseases. They are contraindicated in children under one year of age, with cardiac weakness, and extensive lung lesions. The room temperature should not be below 18°, and the linen is slightly warmed. The child is placed in a bath at 35-33° and, gradually adding cold water from the feet, the water is cooled to 32-30°, while the child's skin is continuously rubbed by hand; the duration of the bath is 5-10 minutes. After the bath, the child is well covered. Such baths are prescribed 1-2 times a day. Hot baths are prepared at 35-36° and, gradually adding hot water, are brought to 38-40° and 41°; a cloth soaked in cold water is placed on the child's head; the duration of the bath is 5-15 minutes. It is necessary to constantly monitor the pulse and breathing; if the child tolerates the bath poorly - the pulse weakens, cyanosis appears - the bath is discontinued. Hot baths have a stimulating and diverting effect and are prescribed for threatening collapse (Shlosman), for meningitis, for nephritis, in cases of a significant decrease in urine output, for severe nutritional disorders and scleroderma. They are especially widely used recently for bronchopneumonia and capillary bronchitis (Feer, Marfan, Koplik), often to enhance the effect - in the form of hot mustard baths (50-100 g of mustard per bath). After the bath - chest compresses or warm drinks. Some authors recommended hot baths for gonorrhea in girls. Hot baths should be used with great caution in very weakened children and with weakened cardiac activity (stimulants before or after the bath). Of the medicinal baths, besides mustard baths, the most commonly used are: 1) salt baths (100 g of sea or table salt per 10 liters of water), which have a tonic effect and are prescribed, mainly, for rickets; the course of treatment (Medovikov) is 20 baths, 2 times a week (in children with delicate skin, it is useful, to avoid irritating itching, to subsequently rinse with fresh water 2° cooler than the bath temperature); 2) baths with the addition of starch or wheat bran (200-600 g per bath), which have a soothing and softening effect on the skin, are used for hyperkeratosis, chronic urticaria, strophulus 'e. Baths with the addition of tannin (20-30 g) or, better, a decoction of oak bark (50-60 g per 1 liter of water; the decoction is added to the bath) have a more energetic astringent effect; they are especially useful for weeping inflammatory processes on the skin; 3) sulfur baths (wooden bath); Sol. Vlemingkx from 15 cubic cm per bath for infants, up to 30 cubic cm for older children per 50-80 liters of water; duration of bath 5-10 minutes; they are used for itchy, non-weeping skin rashes; 4) astringent and disinfecting baths with the addition of potassium permanganate (0.03-0.06 g per 1 liter of water) for pyoderma, furunculosis; as sitz baths for gonorrheal vulvovaginitis; with prolonged use, they cause yellowing of the skin.

p. Lunts.