Diaphoretic Therapy

DIAPHORETIC THERAPY, a therapeutic method used since ancient times in a wide variety of diseases, having the purpose of inducing increased sweating. The latter can be achieved by various methods—the action of pharmacological substances, physical agents, etc. Among medicinal agents, the most important for diaphoretic therapy are pilocarpine and salicylates. However, even in therapeutic doses (0.01), pilocarpine leads, along with increased sweating, to a whole series of unpleasant side effects (palpitations, abdominal pain, visual disturbances), which severely limits its field of application. As for salicylates, their diaphoretic effect is especially pronounced in febrile diseases. Diaphoretic therapy is much more frequently used in the form of water and thermal procedures—hot general and local baths, dry-air and general light baths, sand baths, dry wraps, and the like. All these methods of diaphoretic therapy are based on increased heat production or limited heat loss, which leads to an increase in body temperature and an increase in sweating. Under such conditions, it would be incorrect to regard the effect of diaphoretic therapy merely as the result of the increased excretion of metabolic products with sweat. Investigations of the processes occurring in the organism under the influence of diaphoretic therapy reveal complex changes in the composition of the blood, exhaled air, and vegetative shifts of a biphasic nature: one during the diaphoretic treatment and the opposite ones after the procedure. As for the field of application of diaphoretic therapy, the most extensive has long been the group of infectious diseases. However, the question of whether diaphoretic therapy promotes an abortive course of the infectious process remains controversial to this day. On the contrary, there is every reason to assume that diaphoretic therapy (e.g., antipyretics or hot baths) produces a purely symptomatic antipyretic effect without influencing the course of the disease process, in particular the production of antibodies. On the other hand, the tendency toward vasopressor paresis in a number of infections (influenza, pneumonia, diphtheria) requires extreme caution in the use of diaphoretic therapy (see below—contraindications). Significantly more valuable and indicative are the results of diaphoretic therapy in water retention and the retention of various toxic substances in the organism—in obese, renal, and partly cardiac patients, in bronchiectasis, gout, and rheumatism (non-acute). In these cases, a single diaphoretic procedure can facilitate the removal of up to 2 liters of fluid from the organism containing 2–3 grams of sodium chloride and urea. The action of diaphoretic therapy is not limited, however, to sweating. Diaphoretic therapy also entails an increase in the general basal metabolism—a circumstance of extreme importance in the treatment of obesity. The resorptive action of diaphoretic therapy is especially successful when combined with low water intake—the so-called Schroth cure (Schroth-Kur). Diaphoretic therapy also finds application in chronic intoxications (mercury, lead), in neuralgia and chronic arthritis, and in gout. The prescription of diaphoretic therapy, especially intensive therapy, requires considerable caution in view of its sharp cardiovascular action. Contraindications for diaphoretic therapy should thus be considered cases with cardiac and vascular weakness, severe and persistent hypertension, acute nephritis, and overt uremic states, among others.