Heat Treatment

Heat treatment, thermotherapy, a method of applying mostly high temperatures, associated with various physical media. Beginning in ancient times, the application of heat for therapeutic purposes only received scientific justification in the 18th century and became widely used. Physical media for heat treatment include: water, steam, mud, clay, sand, etc. In heat procedures, there is usually a combination of various irritations, of which the thermal factor predominates. Depending on the nature of the heat used, there are: a) Wet heat—hot local water baths, steam baths and showers, warming compresses, fomentations, etc., b) Dry heat—dry-air and electric-light baths, local and general (polysol), hot water bottles, thermophores, hair dryers, bags with hot sand, and a number of apparatuses (solux, spectrosol, projector, etc.) in which the predominant rays of the spectrum are thermal. Deep tissue heating is possible by diathermy (see).-A steam bath is a wooden box at the bottom of which narrow metal tubes with many holes are placed. Steam is supplied to these tubes, penetrating into the box through the holes. Winteritz proposed a steam bath in which slowly flowing hot water heated the air to 50° in the tubes. The general steam bath starts at 37-40°, bringing it up to 50°. The duration of the bath is from 10 to 20 minutes. The number of sessions is 15-20 baths every 1 or 2 days. Steam bath—a jet of steam directed at the patient at weak pressure; usually used at a distance of 1 meter from the patient for 10-15 to 30-40 minutes. Dry-air bath—the most common model of the Lindemann type for the arm, leg, and shoulder. A waist and leg bath of the Lindemann type is used. The principle of the apparatus is that city electric current, passing through electric heating devices (a plate that does not conduct electric current, on which a certain length of nichrome wire is wound), heats them. This source of heat warms the air in the cavity of the box. Inside the apparatus there is a grid covered with asbestos cloth, on which the organs needing treatment are placed. Depending on the organ to be treated, the shapes of the wooden boxes vary. The Turnauer apparatus, built on the same principle, in form approximates the local light bath and is more convenient for treating the shoulder and joints with limited mobility. The usual temperature is 80-90°. The duration of the procedure is from 15 to 30 minutes or more. In their simplicity and accessibility, heat procedures take first place, not yielding in therapeutic effect to many other therapeutic factors. Heat has analgesic and antispasmodic effects. The application of heat causes vasodilation, increased blood flow to the periphery, i.e., improvement of disturbed blood supply, cellular infiltration and serous impregnation of tissues. The latter probably also accounts for the pain-relieving effect of heat. Heat has a resorptive effect and possesses bactericidal influence. Both wet and dry heat act on the body surface and cause hyperemia, predominantly in the skin and subcutaneous tissue. The deep effect of heat (except diathermy) with its local application is limited to reflex vasodilation. Heat procedures with prolonged action can affect deeper located organs through heated blood. The strength and degree of hyperemia depend on the temperature, duration of the procedure, and physical properties of the medium. Heat with moderate action relaxes the skin and vessel musculature. More intense thermal irritation acts similarly to cold, i.e., it causes skin anemia, and then its hyperemia due to the paralytic state of the vessels and their dilation. The general body temperature can rise by 2-3^e. The organ that perceives thermal irritations is the skin, which has a correlation with all internal organs. The general effect of heat procedures consists of the influence on heat exchange (body temperature), metabolism, the cardiovascular system, and to a lesser extent on other systems and organs of the human body. As a result of these procedures, a number of physiological changes are observed in the body in the sense of intensification of combustion processes, perspiration, more energetic excretion of urea, sodium chloride, uric acid, various poisons and toxins. Blood pressure under the influence of general heat procedures decreases. Pulse and respiration become more frequent. The absorption of O and excretion of CO₂ increases. The secretory activity of the glands increases, oxidation processes occur faster and more completely. The results of heat procedures are not always yet explainable.-The indications for heat treatment are very extensive. Heat in various forms is used in almost all diseases, especially in inflammatory processes, for resorption, removal through the general bloodstream and skin of pathological products. Joint diseases (polyarthritis rheum, urica), traumatic joint injuries, etc., diseases of tendons and sheaths, bursitis, myositis, neuralgias, neuritis usually respond well to treatment with dry-air baths and diathermy. In the field of otorhinolaryngology (frontitis, sinusitis, otitis, etc.), heat is usually used in the form of radiant energy (solux, etc.). In gynecological practice in inflammatory processes—diathermy, mud tampons and baths. In bronchial asthma, dry pleurisy and some serous conditions—solux lamp, light-heat baths and diathermy. For pains due to adhesions and scars after operations, water procedures at 36-37°, hot water bottles, diathermy are used. Warm baths (35°) are used in local circulatory disorders. Diseases of the urinary organs (nephritis, pyelitis, prostatitis, epididymitis, vesiculitis) are indicated for heat water treatment. Nephritis in the acute stage, gonorrheal epididymitis in the subacute state are indicated for treatment with diathermy. Thus, for each disease, the choice of type of heat treatment must be individualized.

E. Pasytkov. Heat treatment in gynecological diseases is applied very frequently. Along with its application in inflammatory processes, heat treatment is also successfully used for prophylactic purposes in the preoperative period. By reducing inflammatory formations around tumors, heat treatment thus serves as a preparatory phase for surgical intervention. Heat treatment, on the other hand, serves as a prevention of postoperative complications. The success of heat treatment, like any treatment, depends on a number of factors: the general condition of the body, the stage of the pathological process, its etiology, and the nature of the action of the chosen procedure. With stereotyped application, heat treatment often does not give the effect that it could give with its proper application. In the therapy of gynecological diseases, hot local baths (Hauffe baths), douches, irrigations according to Snegirev with water temperature approaching hot, etc., are used among heat procedures. Among the means related to so-called dry heat, local and general electric light baths, Sollux lamp, spotlight, Lindemann belt, spectrozol, etc., are applied; among simpler means, bags with hot sand, thermophor or metal hot water bottles applied to the lower abdomen, compresses (the latter can be heated by electricity), fan, with the help of which hot air can be applied to the outer surface of the abdomen or the vaginal mucosa, are used. This type of therapy should also include mud therapy and endermia (see respective words). Among hydrotherapeutic procedures in gynecological practice, sitz baths with water temperature of 37-40° for 15 minutes, hot douches (10-15 liters) with temperature up to 45-50° (caution with skin coverings), abdominal douching for 1-5 minutes are used. All these procedures are indicated in cases of chronic inflammatory diseases of the parametrium and peritoneum with the presence of dense exudate, with disorders of the ovarian-uterine cycle (amenorrhea, oligomenorrhea). Heat treatment is contraindicated in patients with a tendency to exacerbations and suffering from meno- and metrorrhagias. Baths according to Hauffe deserve wider application. It has long been noted that the effect on the skin of the legs leads to certain changes in the circulation of the pelvic organs; due to this, it is possible to influence the circulation in the pelvic organs even in cases when direct effect from the vagina or outer abdominal coverings is impossible. When using Hauffe baths, the patient's legs are immersed in a bath with water at 37°, into which hot water is gradually added for 8-10 minutes with the temperature being raised to 45-47°, the rest of the body is covered with warm clothing (fufayka, etc.). Usually by this time, and sometimes earlier, sweating appears with the preceding feeling of pleasant warmth. The duration of the session is 15-20 minutes. After the bath, the patient is wrapped up for 15 minutes. The course of treatment consists of 15-20 baths. Georgievskaya somewhat modified the Hauffe baths; she wraps the upper part of the trunk and legs in a warm fufayka, subjecting the pelvic area to the effect of gradual increase in water temperature. According to the data of a number of authors (Nielsen, Georgievskaya, Preysman), Hauffe baths are indicated for chronic inflammatory diseases of the pelvic organs (metro-, endo- and parametritis, periadnexitis), for amenorrhea, for insufficient cardiac function, when mud therapy and sometimes endermia cannot be applied. They are not indicated for bleeding, for stagnant phenomena in the small pelvis. Hauffe baths can be performed in any setting. The advantage of these procedures lies in the partial application of irritations and their gradual increase. For the treatment of diseases of the female genital sphere, sulfur, carbonic, saline-alkaline, etc. baths are indicated. Resorts: Sochi-Matsesta, Sergievskie mineral waters, Dzhalal-Abad, etc. (see respective words). Among artificial light sources giving heat rays, in the treatment of diseases of the female genital sphere, Minin's lamp is used, especially for diseases of external organs (vulvitis, pruritus vulvae et ani, for tenderness of the external abdominal coverings). Most often, Minin's reflector with a blue lamp is used, but it can be used with red and colorless ones. Distance 15-20 cm from the affected area. Session 15-20 minutes. Local light baths with 6, 8, 12 incandescent bulbs. The bath is placed on the pelvic area, covered with a blanket from above. Session 20-30 minutes. The heat of the heated dry air enclosed in the cavity of the bath acts. Indicated for metro-endometritis, perisalpingo-oophoritis, parametritis, adhesions of the parametrium, etc. It is recommended for diseases of the genital sphere in combination with ischialgic pains. Before using these baths, it is necessary to examine the condition of the heart. These baths are not indicated for acute processes and for bleeding. General light bath of the Kellogg type is used less frequently in gynecological practice. Indicated for metabolic disorders. Sollux lamp is used with red and blue filter and without filter. As studies by a number of authors (Zholtova, Preysman, etc.) have shown, Sollux with a red filter, differing from endermia in its physical properties, is very close to it in its therapeutic effect. Congestive hyperemia occurs some time after the session. Leukocytosis, both local and general, slowly but steadily increases. Being a kind of irritant therapy (Reiztherapie), Sollux affects the vegetative-endocrine system. Sollux with a red filter should be used as a separate procedure, especially in patients prone to exacerbations. Red Sollux should also be rationally applied for prophylactic purposes before surgical intervention, in order to soften adhesions, create some mobility of the tumor to be removed. Processes with a tendency to bleeding are contraindications for the use of red Sollux due to its hyperemizing effect. Good results are obtained with Sollux in combination with iontophoresis. Session with Sollux lamp - 20 minutes every day or every other day depending on the condition of the process. Sollux with a blue filter, as observations by a number of authors (Zholtova, Preysman, etc.) have shown, has a weak hyperemizing effect. Regarding leukocytosis, it acts like Sollux with a red filter. For diseases of the female genital sphere, Sollux with a blue filter can only be used in subacute cases, and due to its analgesic property - in combination with other physical therapy procedures. Sollux with a blue filter is applied after surgery on the scar area as an analgesic. The modification of Sollux of the extragenital type proposed by Yagunov deserves attention, especially indicated for diseases of the external genital organs. Among artificial light sources with heat rays, the spotlight deserves application. In front of the apparatus there are grooves for inserting red and blue filters. Most often, the spotlight is used with other procedures in the treatment of chronic diseases of the female genital sphere. Dense parametric exudates respond particularly well to spotlight treatment. Heliotherapy (see) has also found wide application in the treatment of diseases of the female genital sphere. It is indicated for metro-endometritis, periadnexitis; sometimes dense inflammatory formations literally 'melt' after several sessions (12-15-18) of heliotherapy. Menses are in no case a contraindication to taking sun baths (Snegirev). The duration of the session should be dosed depending on the time of year, weather conditions, and the effect of the sun's rays themselves. In the absence of contraindications from internal organs (heart, lungs), general sun baths are recommended; if such are present, local sun baths are recommended. Covering the abdomen with black cloth, as some recommend, is not necessary.