In this number we give entire Dr. Jackson’s Lecture on Diptheria, which constitutes No. 5, of the series of Health Tracts, for sale by F. Wilson Hurd & Co., Dansville, N. Y. We also give No. 3, of the same series, entitled, How to Take Baths, by Miss Dr. Austin. J. W.
Diphtheria:
ITS CAUSES, TREATMENT, AND CURE.
BY JAMES C. JACKSON, M. D.
The word “diphtheria” is derived from two Greek words, signifying a membrane. The name was given by M. Bretonneau to a class of diseases which are characterized by a tendency to the formation of false membranes, and affect the mucous membranes and sometimes the skin. It is not a contagious, nor an infectious disease, but only epidemic.
The causes that produce it are of two classes:
First, The Predisposing, or those which operate to fit the organism to take on such abnormal conditions as are indicated by the disease.
Second, The Proximate, or those which immediately operate to produce these conditions.
The predisposing causes are to be found in the general habits of life common to the people of our country. Till attention is called to it, thinking persons are not aware how uniformly and strikingly similar the habits of all children are. As for instance, in the2sphere of dietetics, almost all children eat the same kinds of food, prepared in nearly the same ways.
Culinary preparations, at the beginning of the autumnal season, and so on through the winter and spring, partake largely of oleaginous materials. Butter is one of these, and is used largely; fat pork is another, and lard another. So also, sugar, or syrup is used largely, and so, as a condiment, is common salt. Now, with grains, vegetables and fruits as a base for our food, with butter and lard intermixed, and flesh-meats, as staple articles of diet, together with narcotic beverages, in more or less use, the condition of the blood, of the fleshy tissues, and of the nervous systems of children are such as greatly to predispose them, under circumstances unfavorable to health, to take on diseases of the mucous membrane. Add to these predisposing influences those which grow out of confinement in school-rooms, where the occupants are compelled for hours to sit upon benches and study, while the air which they breathe is quite impure, or, if not so, is of such a temperature that the stratum in which their feet are bathed, is from five to ten degrees lower than that which envelops their heads, and you have another predisposing cause to the production of this disease. To this add another in dress, and you have efficient causes enough to predispose the bodies of such persons to take on the disease.
Consider with me now the proximate causes. These may be regarded in the main as two;
First, Sudden and great changes in the degree of temperature of the atmosphere.
Second, Suppression thereby of the circulation of the blood on the external surface of the body, and the forcing of it thereby violently upon the internal skin, or, as it is called, the mucous membrane, thus inducing severe congestion at the throat, in the case of such persons, as by the operation of the predisposing causes before alluded to, have had their vital resistance weakened, and so are specially fitted to take on such congestion. Under the general habits of living, common to our adult and child population, therefore,3and the imperfect action of the inherent forces of the living organism, in the department of the circulation of the skin, together with the sudden changes of temperature common to our climate, in the autumnal, winter, and spring seasons of the year, are to be found the efficient causes for the existence of this disease.
It is a curious fact which statistics most certainly show, that of adult persons or children who take the disease, females, as compared with males, in the best ratio, rank as two to three, and in the worst ratio they rank as three to four. Thus, under the most favorable view, two-thirds of the persons attacked are females, and under the most unfavorable view, three-fourths are females. It is easy to account for this from two simple considerations:
First, In the case of adult females, women eat nearly as much carbonaceous material for food, as men, yet they live so as to get very much less pure, and very much more impure air than men. As a consequence, their blood becomes less perfectly aerated, or oxygenated, as it is termed. From want of aeration, it becomes foul, its constituents being made up largely of materials which have been separated from the solid tissue, and received into the blood with a view of being passed through the various eliminatory departments, which are the lungs, the bowels, the kidneys, and the skin. Not being carried off as they should be, they become acrid and poisonous. When under sudden changes of the temperature, therefore, the blood is forced from the capillary blood vessels of the skin back upon the capillary vessels of the mucous membrane, the impurities in the blood become a source of irritation and inflammation.
In the case of children, the dress of girls may account for the preponderance in numbers of those who take the disease. Has your attention ever been directed to the unhealthy way in which, for the most part, parents dress their girls, especially during the colder seasons of the year? A boy has thick covering for his feet and legs in the shape of high-topped boots, with thick soles, and woolen stockings, and a pair of4pantaloons coming over his boots down to the ankle. A girl has a pair of calf-skin bootees, with stockings, a pair of pantalettes coming a little below the knees, together with a short skirt, which serves no other purpose in the world, save to hide her nakedness, but that of so arranging the lower portion of her body as to bathe it continually in air, which, if of low temperature, must necessarily produce constant and uninterrupted chilliness of the surface. As an illustration of the truth of this view, one has but to carry an umbrella over his head when currents of cold air exist, to find how much sooner, with the umbrella, the upper part of the body becomes chilled, than if he did not have it. Now, thus to chill the lower extremities from want of proper clothing, and by means of the ill adaptation of such clothing as the girl wears, is to force the circulation to the upper portions of the body, and, when the temperature is cold, to drive the blood from the external surface of the upper extremities to their internal surfaces, thus producing the congestions which are termed diptheritic.
What, then, is Diptheria? It is a disease of the mucous membrane of the throat and air passages, caused by their sudden inflammation. So far it is like croup, and simulates common influenza, as this is often seen in its incipient stages. The points of difference between these diseases and Diptheria are frequently noticeable in their incipient stages, but become more obvious in their advanced stages, through the more complicated conditions in Diptheria, than in croup, influenza or scarlet fever. Persons taken with croup, nine times out of ten show like symptoms; so they do in cases of influenza and scarlet fever. In croup, especially may the disease be said to be local, scarcely dependent upon any general derangement of the organism. Children may be, to all appearance, very healthy, and almost instantaneously show croupy symptoms. Influenza is almost always preceded by headache. In scarlet fever, a child, as a condition precedent to any exhibition of difficulty of the throat, in a majority of instances, shows disturbed condition of digestion. I have never seen one taken down with5scarlet fever, who, as a condition precedent to its unmistakable manifestation, did not show more or less irritation of the digestive organs, for some time previous. The complications of Diptheria are as numerous and as variable as the persons attacked by it, and they differ very much by reason of the temperament, age, special condition of sex at the time of being taken down, &c. I have seen persons, both children and adults, attacked with Diptheria, exhibit some or other of the following symptoms: Very sudden vertigo, with blindness; very sudden nausea, with vomiting; very sudden ringing in the ears, with deafness; excessive palpitation of the heart with great faintness; the most violent neuralgic pains in the lower portions of the legs, especially in the heels; sudden and unconquerable desire for stool, with diarrheic flow; violent pain in the bladder, with great difficulty of making water: irregular, painful and sudden menstruation; chills, as severe as those in the chilled state of fever and ague; great mental irritability, producing mental excitement without cause, in some cases indicating great fearfulness, in others, an audacity unusual, amounting, in a few instances, to temporary aberration of mind, in other cases exhibiting immoderate and excessive laughter; very difficult and painful respiration, in some cases amounting in severity to the worst cases of asthma,—in all such instances, however, these varied symptoms last but a little while, and pass away, to be followed by peculiar conditions of inflammation of the throat and air passages, now known to be unmistakable exhibitions of Diptheria. No such varied introductory exhibition of morbid conditions has it been my lot to witness in connection with any other disease. For the most part, the symptoms of any disease are, with slight modifications, the same in all persons. Scarlet fever, croup, bilious colic, fever and ague, typhoid fever, whooping cough, yellow fever, acute dyspepsia, inflammatory rheumatism, inflammation of the bowels, dysentery, and so on, show so nearly, in all persons, the same morbid conditions, as to enable physicians of any experience, to determine, almost instantly, when brought within the range of observa-6tion, what the matter is with the person or persons affected.
But so far as my experience has gone, the introductory stages of Diphtheria are quite likely to be different in different persons. Thus, out of the great number of adults whom I have treated, I might specify the following. A German hired girl, at work in my family, was taken with sudden blindness and vertigo, and fell to the floor. In thirty minutes the symptoms of Diphtheria were unmistakable. A German hired man, who had not been sick in ten years, to my great dis-service, upon splitting wood, and stooping over to pick up a stick, was taken with such violent congestion of the lungs as with great difficulty to breathe. In half an hour Diphtheria was most manifest. A gentleman sustaining intimate business relations to me, and a member of my family, was taken all of a sudden with violent coughing. In a very little time the diphtheritic symptoms were in full exhibition. A woman cleaning house for me, was taken with violent pains in her heels, and in a little while showed particular affection of the throat.
Children whom I have treated, have been attacked with a great variety of morbid conditions; some complaining of darting, sharp pains in the eyes, some of ringing in the ears, some of pains in the bowels, others of chills running up and down their backbones, pains in their legs, and so on.
My treatment of this disease began years ago. At the outset I had in my own mind no very clear explanation to offer of the causes of the disease, and therefore I could not satisfy myself as to its nature. I, however, saw the unsuccessful results of the course then pursued by physicians of the Allopathic school, and in view of their want of success, pursued a course of treatment converse to theirs. They seemed desirous to produce relief by increased action of the mucous tissue of the stomach and bowels. Some of them, therefore, gave emetics, but most of them gave cathartics. As most of their patients died, I saw no use in pursuing that course, so I turned my attention to the external skin, and sought to produce changes in the7circulation of that structure, hoping thereby to produce the desired end. I know of but few men who have treated so many cases of Diphtheria as my associates at Our Home, and myself. We have never yet lost a case. We have been the means of saving many persons who were considered to be in advanced stages of the disease, and many more, who, having taken the disease, passed under our care in its incipient stages, and were saved, though they were members of families wherein from two to five persons had previously died under the drug-medicating plan of treatment.
Our success has been so great, while as yet our plan of treatment has been so simple, as really to introduce a decided change in the medical practice in this particular disease, in this locality. I do not know of a physician of any school in this town, who has not practically abandoned the administration of cathartics in cases of Diphtheria, and with such modifications of our plan of treatment as his own individuality would naturally prompt him to make, adopted, in fact, our method. The result has been that, whereas great numbers of persons four years ago died of the disease in this town, and whose deaths caused a real panic among the people, the disease has come no more to be feared than any other morbid condition of body common to our people. Owing to our residence here, and as the result of our teachings on the subject of health, or to some silent influence affecting the views of the people of this town, there is much more care given to the conditions of living of children, especially in the cold seasons of the year, than formerly. This, of itself, in my judgment, is a very great security, for it stands to reason that if one can manage the predisposing causes, he need not fear the proximate causes of disease. The best course to be pursued in any family, or in any community, in respect to this fearful scourge, is that of prevention, and to look well after the general habits of life is greatly to add to the securities against its appearance.
There is one feature connected with its exhibition and progress to which I feel bound to call public attention. It is its greater prevalence in families which8are hereditarily scrofulous, and thereby predisposed to diseases of the throat and air passages of the lungs, than in families not thus affected. I have been able by personal advice, and personal examination in this direction, to forewarn parents of the liabilities under which they themselves and their children rested. A scrofulous child, permitted to eat pork, and if a girl, to dress and live as do most children in our society, is predisposed to take on diseases of the air-passages, and when diptheritic conditions of these exist, is as sure almost to die as he or she is to be attacked. Nothing, under such circumstances, saves the child, but the possession on its part of great vitality, and a medical administration marked by great judiciousness and care. The public does not know it, but it is none the less a fact, that scrofula has come to be a household disease in the United States. I can pick out a scrofulous man or woman or child just as far as I can see them. Such persons, more likely than not, are high livers, eat gross and high-seasoned foods, and in great quantities, and are therefore liable to take on inflammatory diseases, and to have these located in or about the throat and air-passages.
To live so as to be able to avoid disease is a very great attainment. That it can be done, and to such degree as to lessen, in a very large measure, the number of persons who are likely to suffer from diptheritic inflammation, is as certain in my own mind, as is the existence of the law of gravitation. There is no need, in the first place, of our children, nor of ourselves, having this disease, and in the second place, if, by reason of some carelessness on our part, in the way of simple, uncomplicated exposure, we find ourselves or our children attacked with it, there is no more need of our or their dying with it, than from a common cold in the nose. Two things we only want to know; one is, how to live so as to keep our bodies in the best possible relations to life; and second, if from causes that are unhealthful we become sick, and Diptheria is the form of our sickness, to know how to treat it in view of the causes that have produced it.
My method of treatment has been as follows: When9I repeat that out of the hundreds of cases which have come under my professional handling, I have never yet lost a case, I leave the public to estimate the value of the suggestions I now offer:
In all cases, no matter whether the subjects are children or adults, I have uniformly, as the first thing to be done, given a hot bath. Its temperature and duration were regulated by the age, sex, and vitality of the patient, the bath ranging from ninety-eight to one hundred and ten degrees, the person sitting in it from five to thirty minutes, always, however, until profuse sweating was produced. The bath I choose to make in such a way as to render it feasible to be given by any private family. Hence, it has been my practice to give a sitz-bath, for which purpose any wash-tub will answer by putting a block under the backside so as to tip it forward a little, and filling it as full of water as possible without having it run over when the patient sits down in it, and taking a common keeler, or pail, if the former cannot be had, and fill it up partly full of warm water, for the purpose of immersing the feet, setting it down in front of the sitz-bath. I then place the patient in a sitting posture and wrap a heavy blanket round him in front, bringing it across his shoulders in the rear, and tucking it smoothly down. Then I bind his head in the shape of a wreath or band with a towel wet in cold water, and let him sit till perspiration is induced. If the patient is a child, quite small, the arrangements must be made to suit size and age. In many instances an attendant is directed to kneel down, and lifting up one side of the blanket, dip his or her hand in water and rub the upper portion of the chest of the person. If sweating is not readily induced, some of the water is dipped out, and hotter water poured in until as high temperature is raised as the patient can bear. I have never had a case where the primary symptoms were not mitigated, in some measure, as soon as increased action of the circulation by the skin was manifest.
Upon taking the person out, my uniform practice has been to pack him. This, as most of my readers will know, consists of spreading upon a bed two or three10woolen blankets, or a woolen blanket and comfortable, the woolen blanket at the top, and over these one or two linen sheets wet in cool water, and left so wet as simply not to drip, and upon coming out, having him lie down and be enveloped in this wet sheet from head to foot, with additional cloths laid over the chest, and coming up close round the throat, these being cold or hot, as my own judgment, derived from the sensations of the patient, might dictate. In this envelopment, just taken out of a hot bath, he feels very pleasant bodily sensations. The effect upon the nervous system is decidedly sedative, so much so, as, in a majority of instances, to induce sleep. If sleep is induced, I allow the nap to continue undisturbed, even though it be prolonged for three, four, or five hours. If the person does not go to sleep, I generally permit the pack to continue from forty-five minutes to an hour and a half, as the patient’s sensations may indicate.
During the period that the patient is in the bath, and while being put in the pack, the room is kept thoroughly warm, but upon being wrapped up in the wet sheet, the windows are opened, and thorough ventilation and lowering of temperature is secured, so that he may be sure to have the coldest air that can be given to him.
When ready to come out of the pack, the windows are shut, the temperature of the room raised, and when well warmed, the envelopments are thrown off, the patient lying upon the bed, an attendant proceeds to rub him with dry towels, until all moisture is removed from the body, and then rubs with the dry hand over the entire body until the skin is dry and velvety.
I then wrap the patient’s throat and chest in wet bandages. These are made so as to fit the parts well, and are covered by dry ones of the same shape as the wet. Thus enveloped, the patient is placed in bed, with a wet cap upon his head, and hot flat-irons, or a jug of hot water, or hot dry woolen blankets at the feet. An attendant is placed in charge of the room, which,11if very much exposed to light, is shaded, and perfect quiet, if possible, thereafter is insured.
It gives me pleasure to say that, whether in my own Cure, or at the houses of private families, I have never found this treatment to fail in mitigating the severities of the attack, no matter in what form it has appeared.
The course pursued afterward has been nearly as follows, qualified somewhat, as I have before said, with reference to the age, sex, and vital power of the subject:
First, having induced, I have sought to keep up thorough circulation on the entire surface.
Second, to insure it in plentiful degree at the extremities, my object being two-fold—to relieve the overburdened internal blood-vessels, and especially those of the mucous membrane; and second, to relieve the blood-vessels of the lungs, throat, and head. To do this, frequent application of warm cloths, wet or dry, to the extremities, or rubbing them with the dry warm hand has been practiced.
Next, freedom from mental anxiety, to as perfect a degree as possible, and to this end no visitors in the room, and no change of attendants, except such as was originally provided for. The practice of having half a dozen different persons have charge of a patient suffering from diphtheritic inflammation, is productive of such mental disturbance as, in many instances, to amount to anxiety of mind, and directly tends to, and not unfrequently produces cerebral congestion. From the family, therefore, two or three persons must be chosen to have the entire care of the case, until all danger is past, and no other members of the family must, on any pretence whatever, enter the room, unless desired to be seen by the patient.
Next, comes the giving of food. Whether infant, child, or adult, male or female, I never allow a particle of food to be given, until I am sure that nature has reacted sufficiently to establish healthful circulation, and quite natural conditions of the nervous system. In some instances, I have made my patients go three days, in others four days, without taking a particle of food, permitting them, however, in the meanwhile, to12drink freely of soft water. Until one tries it, he is not aware how well a person, whose organism is under inflammatory conditions, will find hunger assuaged by the free use of soft water taken internally. When the collective symptoms indicate such change as to relieve the patient from all danger, food may be given; but this should be of a fluid form, and should not be of a carbonaceous character.
Connected with the treatment, the furnishment of pure air is of prime importance. The disease is essentially one derived from imperfect aeration of blood, with imperfect elimination of waste matter. If, then, the treatment can be of such a nature as to set the eliminative organs, especially the skin, which is the structure generally at fault, at work, and thus secure the thorough removal of waste materials from the blood, and the solid tissues, while at the same time, the blood is properly aerated, there can be no failure of recovery to the subject. I have no doubt that one of the best things that could be done, in the treatment of this disease, were it readily practicable, would be the inhalation of oxygen gas. In default, however, of means to do this, the next best thing, as a curative, is to secure the free use of pure atmospheric air, which, by the way, would be, if freely used, a great preventive. I take it upon me, therefore, always to secure thorough ventilation, even though I have to knock a pane of glass out of the room where the sick person lies, or punch a hole through the wall so as to let the air in. The attempt, on the part of doctors and nurses, to have sick persons do well under their treatment in the absence of pure air, is characterized by such folly as to make one wonder why it is so persistently pursued.
There are some other points connected with the treatment of Diphtheria, to which it may be well for me to allude. One is, that many persons who are killed by the disease, die from suffocation, this resulting from the formation of what the doctors call a “false membrane” in the air passages. This false membrane is formed out of thick mucus, secreted from the mucous glands, and almost immediately13thereupon forms into a thick imperfectly organized membraneous shape, filling up the cavities of the air tubes, and thus rendering it impossible for the patients to breathe. The method of treatment which I have pursued has had the effect, while increasing the flow, to render the expectoration of the mucus perfectly within the control of the patient, and it has been wonderful to myself and to others to observe the quantities that have been thus secreted and coughed up, in the course of twelve hours. Some of my patients have raised a quart, others half a gallon; one man in the course of forty-eight hours not less than six quarts of this slippery-elmish substance, and lost nine pounds in weight. The man’s tissues must have been as foul as corruption itself. No other treatment that I have ever been made acquainted with, has seemed to produce this effect, which I consider of great importance.
Another consideration worthy of attention, is the danger of relapse. It has been my practice, therefore, to keep my patients free from physical or mental fatigue for some days, and some of them for weeks, after all danger seems to have passed away. For, many of them, upon convalescence, show nearly the same conditions that persons do who have been taken with congestive chills, or with typhoid fever and recovered. There can be no doubt that in many instances of diphtheritic attack, the cerebral disturbance is very great, the brain and lungs, and sometimes the liver and bowels being excessively congested, and that by the rapidity with which these organs have been relieved by the determination of blood to the surface, has recovery to the patient been insured.
Thus, have I tried, in common phrase, so that the most unlearned or unlettered person may understand me, to mark out the views which I cherish, and the course I pursue in the treatment of Diptheria.
Besides the cases treated personally by myself and associates, Miss Dr. Austin and myself have received hundreds of letters from persons, who, having followed our directions in the main, have succeeded in the recovery of their patients. Some of these patients14have been men, others women, others children, and, with slight modifications, they all tell the same story as to the results produced. Whenever my method of treatment has been taken in the early stages, and has been the only treatment pursued, it has been successful. To apply it to scrofulous children in the more advanced stages of the disease, and especially where these have been previously drugged, is to render the probability of success much less than it would otherwise be. But early attention to it, and a persistent following of it, I am satisfied will save a great majority of children who may be so unfortunate as to be attacked. It is far better so to bring up children as to reduce their liabilities to so low a point as practically to amount to nothing, than it is to rear them in such a way as to have them greatly exposed to take disease, and when taken sick, almost sure to die.
How to Take Baths.
BY MISS HARRIET N. AUSTIN, M. D.
To many persons the descriptions and explanations below may seem unnecessarily minute, but they will not, I think, to him who has had much experience in giving instructions for home-treatment. He who has seen persons attempt to take Sitz-Baths in wash-bowls, to take Half-Baths without undressing, to give a Dripping-Sheet by wetting one corner of the sheet in cold water, or to give hot fomentations with a small linen towel, or a bit of flannel as large as his two hands, has learned how crude are the notions of the people in regard to the whole matter of water treatment. A vast deal of injury has been done in this method of treatment, as well by the bungling use of appliances, which, if skillfully used, would have been entirely proper, as by the use of such as were wholly unsuited to the person to whom they were administered.
We do not give heroic treatment. We do not believe15in it. Our baths are all mild, and given at not very frequent intervals. The first thing to be done when a bath is to be given is to prepare the room, making it of a comfortable temperature. The second is to prepare the bath, using soft water, and making it of the right temperature, as indicated by a thermometer. Persons sometimes ask us to explain what we mean by certain temperatures, so that they can get along without a thermometer. This is impossible. The terms hot, cold, warm, tepid are so indefinite, and convey so different impressions to different persons, as to be entirely unreliable in giving directions. What is hot to one person is cold to another, in the morbid states through which sick persons pass. And the sensations of healthy persons are so variable that they cannot be relied upon to temper baths by the touch, for those with whom a slight change is of consequence. Of course the line where cold passes into tepid, or tepid into warm, is inappreciable, but in general terms I should consider a bath of 75° Fahrenheit cold, at 85° tepid, at 95° warm, and at 105° hot. The idea that the hotter a person is, the colder should be his bath, is productive of great mischief. The true rule is exactly the reverse of this. That is, a person in a high fever should have his bath at a higher temperature than if he had no fever; for what, in the latter case, would be a pleasant temperature to him, might be shockingly cold in the former. So, while in such conditions a bath at 90° would subdue the fever, one at 75° would be likely to produce violent reaction, and in half an hour the fever would be higher than before.
Having the bath ready, the next thing is to get the patient ready. One who is suffering from acute disease may often, when feeling nervous, and restless, and exhausted, be greatly refreshed and soothed by the administration of a bath. But persons who are16taking a course of treatment for chronic ailments, or those who simply bathe for cleanliness, should never take their baths when tired. Baths are always most beneficial in their effects when taken with the body at its highest point of vigor. Hence, as a rule, ten or eleven o’clock in the day is the best hour for bathing. When this is impracticable, the hours of rising or retiring are unobjectionable. No bath should be taken immediately after or before a meal. Care should be taken to have the feet warm on coming for a bath. In cases where they are habitually cold and cannot be warmed by exercise, it is often well to take a warm foot-bath for a few minutes before a general bath or pack. Next, the patient lays aside all his clothing, and wets his forehead and top of the head, in the bath or cool water; and if the bath is continued beyond a few minutes, like a Sitz-Bath, a wet towel or cap should be kept on the head. If the bath is to be reduced, as we very frequently do, as reducing a half or Sitz-Bath from 90° to 85° or 80°, the patient rises out of the water while the attendant pours in cold water. Soap should never be used except for persons who bathe very seldom, or who are very dirty. When a person comes from any general bath, that is, having the whole surface bathed, he should be instantly enveloped in his wiping-sheet, and himself and the attendant should fall to rubbing vigorously. Sheets should be made specially for bathing purposes. A common cotton bed sheet will answer for wiping; for a sheet of some kind must be used, towels after a general bath being entirely unfit, and crash towels quite out of the question. But for packing or dripping sheets, use linen, and have the sheet not longer than to reach from the person’s head to his heels. The fabric may be coarse and heavy, but must be soft and smooth.
As soon as the skin is thoroughly dried after a bath, the sheet is removed, and the rubbing continued briskly and gently over the whole surface, with the dry hands, for four or five minutes. A healthy person can do his own rubbing, but the invalid is greatly benefited by having an assistant. And every thing that this person has to do in administering the treatment, should be17done with energy and expedition, not leaving the patient in a shivering, uncomfortable state for even the shortest length of time.
After getting through with the bath, immediate means must be taken to establish thorough and permanent reaction. If the person has a good degree of strength, he may go out well dressed for a brisk walk, or to split wood, or fodder the cattle, or do anything which will keep him stirring. But in the case of very delicate persons, it is often better, particularly if the weather is inclement, to go to bed, well covered up, with a cool cloth on the head, and a warm blanket at the feet, if needful, and lie for an hour or two, till the circulation becomes entirely quiet. And sometimes comparatively strong persons do well to follow this course, and get up and take their exercise afterward. If a person uses these means, and still grows chilly thirty or sixty minutes after his bath, or if after an hour or two he feels an unusual languor or exhaustion, his bath has done him harm instead of good.
GENERAL BATHS.
The Half-Bath, so called because about half the person is immersed in water, is taken in a tub about four and a half feet long, twenty-six inches broad toward the widest end, and gradually tapering till it is no more than fifteen inches broad toward the other end, and eleven or twelve inches high. At least, this is a convenient size and shape. Ours are made with staves and hoops, and sit on wooden horses about twenty inches high, with a hole stopped with a plug in the bottom, at the small end. The bath is prepared at the right temperature, about six inches deep; the patient wets his head and steps into it, sitting down in the broad end of the tub, with his feet extended toward the narrow end. To have it done just right, there should be two attendants, one to rub the patient’s legs, and the other to rub his back and arms, while he rubs the front part of his body. The rubbing should be done lightly and briskly, dipping the water up on to the body with the hands very frequently. The18common time to continue the bath is for two minutes, though to gain a particular end it is often continued much longer.
In an institution where all the apparatus is at hand, this is one of the most convenient, pleasant, and efficient forms of bath.
The PLUNGE is taken in a tub four or five feet deep, nearly filled with water, and so narrow that the person can place a hand on each side of the tub, leap in, crouch down till the water rises to his chin, and then leap out. This is a very pleasant, and, if taken cold, a very exhilarating form of bath. When arranged, as we have it at Our Home, so that the temperature of the water can be raised to about 75° or 80°, it is one of the best baths which a robust, healthy person can take for cleanliness, daily or tri-weekly.
The DRIPPING-SHEET will, perhaps, be found to be more practicable for invalids in families, than any other form of bath. It requires but little water, can be taken on the nicest carpet, and if mild in its temperature, produces very mild reactions. An oil-cloth should be spread on the floor or carpet, and the sheet put in a pail half full of water. The patient stands in the middle of the cloth, and the attendant raises the sheet by two of the corners and throws it around him, so as to completely envelop him from his neck to his feet, and immediately falls to rubbing him vigorously with both hands, over the sheet. If desired, the sheet can be partly relieved of the water by squeezing through the hand, as it is raised from the pail. It is common to apply the sheet twice; first in front, lapping it behind, rubbing one minute, then removing, dipping in the water again, and putting around from behind, and rubbing another minute. A very feeble person can take this bath sitting on a stool, if need be; but in that case there should be two persons to rub outside the sheet. Or a strong person can take it alone, as he can reach nearly every part of his person to rub, and can wash his back by drawing the sheet across it. It is an excellent bath.
The PAIL-DOUCHE should be taken in a room where a portion of the floor is lower than the main part, and19from which the water is carried off by a drain. From one to six pails full of water may be used. The person stands on the depressed floor, and the attendant, standing four or five feet away, takes up a pail and dashes the water with considerable force, at three or four dashes, over him, letting it strike near the upper part of the body, and so run down and cover him; the recipient meantime turning slowly round, so as to receive the water on all parts of the body. This is a very pleasant bath, if not taken below 80°, and entirely unobjectionable to be used daily for cleanliness by persons in health.
The Towel-Washing has no advantages over the dripping-sheet, except in instances where it is used simply for cleanliness and is more convenient, or where the person is too feeble to sit up. One who is very feeble may be bathed in this way without fatigue or exertion. The nurse uncovers an arm, or a leg, or a small portion of the body at a time, partially wrings a soft towel out of tepid water, and washes the part quickly and gently, wipes with a soft towel, rubs with the warm, dry hand, covers again, and so proceeds till the whole surface is washed. Or, if this is too much at one time, the operation may be suspended an hour or two. Patients who are feverish are often greatly soothed and comforted by having the back bathed in this way several times in a day, or even by having the face, hands, and feet bathed. Water may be used more freely by spreading a dry sheet or blanket under the patient to protect his bed. If the patient is able to get up for his bath, the dripping sheet should be used instead of a towel.