Baths of various kinds are the mainstay in the treatment of most cases of this kind. They are used for four purposes: (a) To allay excitement. (b) To relieve pain. (c) To equalize the circulation, and (d) To procure sleep. They succeed when drugs fail.
On the third or fourth day of treatment it is usual to have, especially in very nervous persons, considerable excitement, reflex nervous irritability, not so great, however, as when the drug is suddenly taken away. The violent delirium tremens spoken of by Levenstein I have never seen, save in one case, which I treated according to his method. When delirium occurs at all, it is usually of a low, muttering, harmless kind. For its treatment and that of the severe nervous irritability and restlessness sometimes seen, the hot bath, followed by the cold douche, is an excellent remedy. If the patient is strong I let him remain in it for twenty minutes; if weak, from five to fifteen minutes. A good reaction is had and the quieting powers of the bath enhanced by pouring one or two pails of cold water over the patient’s head and shoulders, or directing upon him for a moment a number of fine jets of cold water, with considerable force. The nozzle should be so arranged that from twenty to forty jets may play at the same time. After this the body should be thoroughly rubbed with a hair glove, until the surface is in a glow, and the patient then be put to bed, where gentle perspiration usually follows, with considerable relief to the pain in the limbs, shivering and sneezing; oftentimes a quiet sleep, lasting from thirty minutes to two hours, follows.
A rapid hot bath, followed by the douche or spray, and that by thorough rubbing, I find an excellent measure in the after-treatment of these cases, it hastening the breaking down of old and stimulating the growth of new tissues, as also the different secretions.
The temperature of the bath should never be below 112° Fahr.
In some neuralgic patients, the cold douche sometimes causes pain afterward. In these cases it should be omitted, the hair glove being used freely in its stead.
Several baths may be given in the course of a day, but I rarely find it necessary to give more than two or three in the worst cases.
The bath, too long continued or too often given, will sometimes greatly weaken the patient. In debilitated subjects and those suffering from pelvic pains I find the hot sitz bath, followed by thorough rubbing and kneading of the whole body, often gives great relief.
For persistent insomnia I find the cold pack a most serviceable agent. The patient is wholly undressed, a sheet is wrung out of cold water, and he is wholly enveloped in it up to the chin. The sheet should be folded under the feet and tucked in evenly and closely about the neck. He is then closely wrapped in from four to six blankets, and in the majority of instances will soon fall asleep, a gentle perspiration breaking out all over him. He may be allowed to remain in this an hour or even two hours.
Excitement and nervousness are calmed by it, the restlessness and pain disappear, and the sufferer often remarks how much good it is doing him.
In removing it, the whole matter should be done rapidly, under cover of a heavy blanket, and the body be thoroughly rubbed with a sponge dipped in whiskey and water.