We see, therefore, that in douches we have a weapon of great power for good or ill, and the results achieved will be exactly proportional to the judgment displayed in meeting individual requirements in the matter of their temperature, duration, and pressure.
The space at our disposal forbids entering into great detail, and a few general principles are all that can be enunciated. Thus, while extreme pressures are permissible in selected cases, they are contra-indicated when dealing with regions the seat of pain. In such instances we should always begin with mild measures, viz., a tepid fan or spray douche (80° to 92° F.) of low (4 to 8 pounds) pressure. These later may be replaced by a hot (104° to 110° F.) broken jet, or rain douche, of 10 to 15 pounds pressure, and by such graduated procedures pain will often be relieved.
For the relief of stiffness and swelling alternating jets or sprays are most suitable, the hot and cold douches being each of fifteen to thirty seconds duration. The more remote the extremes of temperature, and the more abrupt the transition from hot to cold, the greater the excitant effect.
Simultaneous massage greatly reinforces the stimulating and absorbing action of douches, which latter also may in various ways be advantageously combined with other local procedures, viz., local vapour, hot air, and electric light baths.
Treatment by Hyperæmia
Enhanced oxidation and destruction of nitrogen-containing waste and toxins being one of the primary indications in the treatment of all so-called auto-toxic states, it is not surprising that hot air baths—both luminous and non-luminous types—are so extensively employed in gout, either for their curative or prophylactic action.
For the practical details of their administration I must refer the reader to special works on the subject, contenting myself with a brief reference to their therapeutic indications. While all gouty subjects at some period of their life-history may be eligible for hot air baths, their use is contra-indicated in pyrexia. Nor are they appropriate if the case is complicated by any irritable skin condition, or in the graver forms of glycosuria. They are unsuitable, too, if there are any evidences of hyper-thyroidism, from which the gouty, no more than others, are immune.
Again, in cardiac dilatation they must be exhibited with great caution, and where extreme, are of course impermissible, as also in the later stages of chronic nephritis. On the other hand, they are eminently suitable for the treatment of fibrositis in gouty persons, especially of obese type, nor does the presence of glycosuria in such association constitute a bar to their use.
Moreover, as a prophylactic measure, they are extremely well adapted to those victims of gout who lead sedentary lives, as to a limited extent they counteract the evil effects of muscular inactivity. Here also, by the judicious use of graduated after-applications of cold or hypothermal grade, the undue sensitiveness of the skin in these subjects is reduced, and their liability to so-called “liver chills” diminished.
In conclusion, it is the proper blending of their eliminative and prophylactic qualities, according to individual needs, that constitutes the key to rational treatment by hyperæmia. These same postulates are applicable also to the various peat, mud, and fango baths, whose action in essence depends on the varying degree of hyperæmia they produce, and to which, in all probability, their well-established efficacy in gouty affections is attributable. That there are other valuable accessory methods of treatment—electrical, hydro-electric, etc.—in vogue at spas, I am perfectly aware, but the number of special works available for reference on this point relieves me of the necessity of alluding to them in detail.