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Practical Hydrotherapy

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Seventh-day Adventist Publishing Association · Battle Creek, Mich. · May 13, 1902

FromReview and Herald, Vol. 79, No. 19.

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Practical Hydrotherapy

By GEO. THOMASON, M. D.

Lesson XIII—Fever

GEO. THOMASON, M. D.
(Continued from last week)
THE most natural thing to do to put out a fire is to pour on water. This principle holds good in reference to the vital fires, not, however, to quench them entirely, but to diminish their activity when burning too vigorously, as in the case of fever. There are quite a variety of water applications which may be usefully employed in combating a high temperature, more or less vigorous in character according to the necessities of the case. It should be borne in mind first of all that cold applications in this class of cases are to be made not alone for the reduction of temperature, but for their tonic and exhilarating effect upon the patient. Other symptoms besides the temperature are greatly modified by the cold applications.
As before mentioned, the character of the treatment varies according to the condition of the patient. Vigorous patients, that is, those with good physiques, having an abundance of reserve tissue in the form of fat, and, as a rule, persons in early adult or middle age of life, are best prepared to tolerate vigorous applications of cold. Such a patient with a fever in which the skin is hot and dry, the face flushed, and the temperature sufficiently high, say 103° to 105° or above, may be immersed in a full cold bath. It is in such cases that the famous Brand bath is applicable. This bath consists in immersing the patient in water having a temperature of from 68° to 70°, keeping him in the bath for fifteen minutes, observing the precaution to have the head thoroughly wet in cold water before entering the bath, and keeping a cloth upon the head, frequently wetting it in water at a temperature at least ten or fifteen degrees lower than the temperature of the bath. Vigorous friction should be administered to the patient while in the bath, especially to the extremities. It requires two attendants to administer such a bath, one to apply friction to the upper, the other to the lower, parts of the body. On removal from the bath, the patient is wrapped in a sheet, and again put to bed. This is an extremely vigorous treatment. It has, however, been resorted to in thousands of cases, often being practically the only hydropathic measure employed, and has resulted in the saving of the lives of many thousands of fever patients. It is customary to repeat this bath whenever the temperature of the patient rises above 102½°.
Less heroic measures may, however, be used, and with equally satisfactory results; for example, an excellent substitute for the Brand bath, and one which is applicable in by far a larger percentage of cases, is the so-called graduated bath. This method consists in immersing the patient in a bath at a temperature of 100°, and reducing the temperature at the rate of two degrees every five minutes until a temperature of 85° is reached, and the bath continued at this point until the desired results are secured, as indicated by the reduction of the patient's temperature at least to 101½° or 102°. As the bath becomes cooler, it is necessary to apply friction to relieve the patient from the sensation of chill. Such a bath does not produce any shock to the patient, as does the cold immersion bath; and the results are equally satisfactory, and in many cases superior to more vigorous treatments.
Another very excellent method of combating high temperature, and one which is applicable at all ages of life, is the neutral immersion bath. In health, immersion of the body in water at a temperature of 92° to 95°, even though continued for several hours, does not produce any lowering of temperature; but with patients suffering from fever, the neutral bath is an excellent means of securing a lowering of temperature. The bath may be continued, if desired, for one or two hours, or even longer. It is only necessary to make the patient comfortable in the bath by having him suspended in a hammock in the water or lying upon an air cushion.
It is very essential that friction should be applied during any form of bath previously mentioned, as the friction diminishes the sensation of chill, and thus prevents the tendency toward increased heat production, while at the same time it helps to maintain dilatation of the blood vessels of the skin, thus bringing a larger quantity of blood in close proximity to the cold water, and heat is thereby much more rapidly eliminated from the body.
Temperature may be lowered very successfully by wrapping the patient in a sheet wrung from cold water, applying in addition a single blanket, or more if necessary, to prevent too rapid cooling of the body. Friction may be applied outside the sheet to prevent chill. As soon as the sheet becomes warm, it may be renewed, or cold water may be sprinkled upon it while it is left in position. The wetting of the sheet should be repeated a sufficient number of times to secure the desired reduction in temperature.
In cases where the patients are very susceptible to cold, and in which there is pallor of the skin, tendency to chill, or in which the patients are very weak, the sheet may be wrung from very hot water and placed about them. The sheet, while hot, will relieve the chill and dilate the surface vessels, and by becoming quickly cool, will secure the lowering of temperature. Cooling by evaporation may be hastened by fanning the patient.
Various forms of cold friction are of great value in dealing with this class of cases, and may be applied, alternating with the more vigorous measures. For example, the body may be rubbed with the hand dipped frequently in cold water. The application should be made to first one portion of the body, as, for example, the arms, then proceeding systematically from one part to another. For this purpose, water should be used at a temperature of 55° to 65°. A mitt made of coarse cloth, such as haircloth or alpaca, may be placed upon the hand, and dipped frequently in cold water. This furnishes an excellent means of lowering the temperature.
In addition to being used as alternating treatments, the more mild forms of applications should be used for very young or very old persons, also for feeble patients in which the tendency to chill is marked, or where there is a marked inability to react. In the majority of such cases, it is advisable to give a short hot application of some sort as a preliminary measure; as, for example, fomentations to the spine or abdomen, the graduated bath, the hot sheet, or other means already suggested.
An enema at 65° or 70° three times a day, repeating the injection two or three times at each application, is a most excellent means of reducing temperature.
Cold water drinking is another efficient measure. Fever patients should be given at least half a glass of cold water every half hour. The patient should be urged to drink. To encourage drinking it may be necessary to acidulate the water with lemon or other fruit juice.
The outline here given is merely suggestive. It would be impossible in the space of one article exhaustively to outline suggestions for the entire care of cases of fever. The attention of the reader is called to the suggestion made in the footnote accompanying this article.