BOOKS

BY

ANNA M. GALBRAITH, M.D.

Four Epochs of Woman’s Life

12mo of 260 pages.

3d Edition, Ready Soon

Personal Hygiene and Physical Training for Women

12mo of 393 pages, illustrated

2d Edition

PERSONAL HYGIENE
AND
PHYSICAL TRAINING
FOR WOMEN

BY
ANNA M. GALBRAITH, M.D.

Author of “Hygiene and Physical Culture for Women” and “The Four Epochs of Woman’s Life;” Member of the New York County and State and the American Medical Associations; Fellow of the New York Academy of Medicine; Ex-President of the Alumnæ Association, Woman’s Medical College of Pennsylvania; former Attending Physician, Neurological Department, of the New York Orthopædic Hospital and Dispensary; late Attending Physician and Instructor in Diagnosis and Clinical Medicine at the Woman’s Medical College, New York Infirmary
SECOND EDITION, THOROUGHLY REVISED
PHILADELPHIA AND LONDON
W. B. SAUNDERS COMPANY
1916

Copyright, 1911, by W. B. Saunders Company. Reprinted
April 1913, and October, 1915. Revised,
reprinted, and recopyrighted
November, 1916

Copyright, 1916, by W. B. Saunders Company

PRINTED IN AMERICA

PRESS OF
W. B. SAUNDERS COMPANY
PHILADELPHIA

In Loving Memory

of

HELEN WORTHING WEBSTER, M. D.

Professor of Physiology and Hygiene and Resident Physician at Vassar College
from 1874 to 1881

An untiring worker of charming and inspiring personality,
the living embodiment of all that was womanly,
great hearted, and noble.
This book is affectionately dedicated as a slight tribute of
the esteem in which she was held, and in grateful acknowledgment
of the value of her teachings
By her former pupil
The Author

PREFACE TO THE SECOND EDITION

Since the writing of this book six years ago the entire subject of digestion has been revised by scientific research, and thanks to the same scientists the nutritive value of the various food-stuffs has been ascertained. The importance of this knowledge is so great that educators are now making an endeavor to have the nutritive value of artificial and canned goods placed on their labels; and the New York Board of Health has requested a large Chain of Restaurants to have the nutritive value of foods printed, beside the cost of the various articles, on their bill of fare.

Hence the entire chapter on Digestion and Nutrition has been rewritten. In Chapter I has been given the result of original statistical studies, showing the urgent need for every woman to know and put into practice the principles of personal hygiene.

Dancing has become such a popular form of exercise that a description of the plates giving the dancing steps has been added, together with some simple dancing exercises. For these excellent descriptions the author is indebted to Miss Barbara Blankenhorn, a widely known teacher of music and dancing of Englewood, New Jersey.

The reason that such a comparatively short space was given in this work to “pelvic physiology and hygiene” was that this subject had been treated in extenso, in “The Four Epochs of Woman’s Life.”

Anna M. Galbraith.

New York City,
November, 1916.

PREFACE

The aim of this work has been to present in a clear and concise manner the fundamental physiological laws on which all personal hygiene is based; together with the practical, detailed directions for the proper development of the body and the training of the physical powers to their highest degree of efficiency by means of fresh air, tonic baths, proper food and clothing, gymnastic and outdoor exercise, so that the tissues will be placed in the best possible condition to resist disease.

The spirit of the times demands nothing less than the most perfect development of body and mind of which youth is capable, and maintaining the highest degree of efficiency of the adult worker for the longest possible term of years. The fiat has gone forth from the American Medical Association for the scientific education of the public in the laws of hygiene and sanitation. And the great civic movement inaugurated by that same Association and the Committee of One Hundred on National Health for the establishment of a National Department of Public Health, promises to be crowned with success in the near future. And so it has been deemed superfluous to expound at length what preventive medicine has already accomplished in the short space of fifty years by the eradication of terrible epidemics and many diseases, and what a general knowledge of applied hygiene might reasonably be expected to accomplish in the near future.

It gives the author great pleasure to have this opportunity of expressing her deep indebtedness to Miss Ruth Blankenhorn, Vassar College, A. B., 1909, of Englewood, N. J., a most artistic and graceful dancer who posed for all the illustrations; and to Miss Harriet I. Ballintine, the able director of the Vassar College Gymnasium, who arranged the poses for the very excellent plates illustrating the free exercises and classic dances. Also to the Vassar College Athletic Association for 1908-09 for the especially arranged dances and field sports which they were so extremely kind as to demonstrate for her benefit.

Anna M. Galbraith.

New York City.

CONTENTS

PERSONAL HYGIENE
AND
PHYSICAL TRAINING FOR WOMEN

CHAPTER I
THE WISDOM OF PHYSICAL EFFICIENCY

Physical Efficiency as an Exact Science; Marks for Physical Efficiency; Statistical Study of the Physical Examinations of 160 Young Women; the Physical Status of the Women of To-day; the Reflex Action of the Various Impairments of the Entire Organism.

“Circumstances,” said Napoleon, “I make circumstances.”

Physical efficiency stands for initiative, endurance, success; it is the very keynote of modern life and has become one of the burning questions of the day. West Point and Annapolis have always recognized this, and in order that their graduates should measure up to the highest standard of efficiency a most rigid physical examination was and is demanded as a prerequisite for admission; and during the whole of the four years’ course physical training is systematically carried on so as to insure the most perfect physique possible, with the result that in addition to their great powers of endurance and initiative, is their distinguished carriage and elegance of bearing.

To increase the safety of their passengers the railroad companies were the next to demand these same physical examinations to determine the efficiency of their applicants and employees. Other large corporations followed.

So long as women remained in the home, or were willing and content to accept any small wage that was doled out to them, the public did not seem especially interested in their physical condition. But when women, as a large teaching body or in any other public service, began to demand equal pay for equal work, the situation was materially altered, and in 1914 the English Royal Commission summed up the following conclusions: “Where the character and conditions of work performed by women approach those of the work of men, the pay of the women should approximate that of the men, but in so far as the efficiency of men is higher, the salaries of men should remain higher.” This at once changed the complexion of the matter, and physical efficiency for women became a matter of paramount and equal importance to both employer and employee.

Again, from the standpoint of social science, the physical efficiency of women is demanded because they are the mothers of the race, and on them, equally with the fathers, does the welfare of future generations depend, since it is believed that a child inherits equally from its parents—one-fourth from father and mother each, one-fourth from its grandparents, etc. The states are beginning to seriously take up the framing of laws for eugenic marriages, based on fixed standards of physical efficiency of the contracting parties. And the day is not far distant when women as well as men will have to undergo physical examinations to secure or hold any positions of importance.

Then, too, one of the results of the present terrible European war has been to demonstrate that women possess a large amount of latent powers and endurance which only needed for their development the same general physical training that the state gives her sons. Women are now being employed in these countries in all branches of the civil service, as well as in agriculture and the making of munitions, engaging in a vast number of employments and trades hitherto considered unfit for women, because of the great physical strength and endurance which they demanded.

Physical Efficiency as an Exact Science.—Physical efficiency is growing to be an exact science; it is demonstrable in figures. We have standardized percentage tables for measuring the capacity of the lungs, the strength of the heart and muscles, and, added to these, must be a normal condition of the digestion, kidneys, generative organs, sight, and hearing. If the sum total of these amounted to 100 per cent., that would mean capacity for the greatest possible endurance under strain, and so the most effective worker; for there is a direct relation between the percentage standard of physical efficiency and the output of work, both as to quantity and quality.

Marks for Physical Efficiency.—Sir Francis Galton, the great English scientist, was the first to conceive the idea of assigning marks for physical qualifications. They were as follows: Breathing capacity, strength tests, both to be regarded with reference to the height and weight; quickness of response to a signal, made either to the eye or ear; the sense of sight and hearing, and the color sense.

Realizing the usefulness of these tests in measuring the physical efficiency, Professor Sargent included them in the physical examinations of the Harvard students. The strength tests consist of that for each forearm, of the back and legs, the dip, the pull-up, and the lung capacity. The combination of these seven tests is what is known as the intercollegiate strength test, and is the best means as yet devised for measuring the general muscular strength and the respiratory power.

It is obvious that many of these tests would be needed only by men going into the army or navy, or qualifying for civil engineers or professional athletes, etc. So it was considered best to modify these tests to meet the requirements of physical efficiency for women.

For the large number of measurements of the arms, legs, etc., included in the Sargent system have been substituted the rating of the condition of the heart and circulatory system, including the blood-pressure; lung and chest development; digestive and nervous system; the kidneys and generative organs; the muscular system; tests of endurance; ocular and aural tests; with a final impression of the working efficiency.

This standardized percentage table for physical efficiency of women was worked out and the ratings made with the able assistance of Dr. David Bovaird, Associate Professor of Clinical Medicine, Columbia University, and Dr. George A. Meylan, Associate Professor of Physical Education, Columbia University; and it has seemed to us that this combination of tests is of greater practical value, since the maintenance of physical efficiency depends upon the integrity of all of the organs of the body. These ratings were made to cover the Special Medical Blank for Women,[1] gotten up for the examination of the women candidates of the Presbyterian Board of Foreign Missions.

For many years the various Boards of Foreign Missions, which are the great church corporations, have required that candidates for this work should pass a physical examination similar to that demanded by the life insurance companies, and so similar blanks were sent out to be filled by the local examining physicians; but because of the many breakdowns of the women on the field, and the great detriment to the work and the expense thus entailed, four years ago the Presbyterian Board of Foreign Missions decided to have all of their women candidates re-examined in New York by a woman physician especially appointed by them for this purpose.

The results of these examinations have been most illuminating as to the physical condition of women who call themselves well, to say nothing of what the medical profession in general seem to consider as standards of good health in women who will be obliged to do very hard work under most trying climatic conditions, which all Life Insurance Companies rate as extrahazardous.

The composite picture thus obtained by the statistical study of the physical examinations of these 160 young women is of great value, not only because it is the first of the kind made for the first decade after leaving college; but also because it is very fairly representative of the average physical condition of the great masses of women who are engaged in teaching, social service, secretarial work, etc.; and, further, it demonstrates the striking difference in physique of women who call themselves well, and that of the normal standard of physical efficiency to which most of these women could have attained by proper physical education.

Statistical Study of the Physical Examinations of 160 Candidates.—This study is made from the records of four successive classes of young women coming from all over the United States, city and country, including college and non-college graduates, whose occupations were physicians, teachers, students, nurses, social workers, housewives, etc. All had passed a preliminary physical examination. The average age was twenty-eight years, when woman should be physically at her best.

I. Acute Diseases Since Childhood and Number of Days Lost Through Illness. For Classes of 1913 and 1914 Only, Consisting of 100 Women.[2]

Of the acute illnesses, the following are of the greatest interest because now preventable: Typhoid fever, 12 per cent.; malaria, 6 per cent.; tonsillitis, 6 per cent.

Of the causes for operations, appendicitis leads with 13 per cent.; of these, 9 per cent. were simply for the removal of the appendix; 2 per cent. for the removal of the appendix and diseased right ovary; and 2 per cent. for the removal of the appendix and ovarian cyst. The recovery was not only complete from the operation, but the general health was greatly improved in every respect.

Of the cases of tonsillitis, 4 per cent. were operated on not only with complete recovery, but also with the cure of rheumatism from which these women had previously suffered.

II. Heart and Circulatory System.

III. Lungs and Chest Development.

IV. The Digestive System.

V. The Kidneys.

VI. The Generative Organs and Menstrual Function.

VII. The Nervous System.

VIII. The Muscular System.

IX. Tests of Endurance.

X. General Impression of Working Efficiency.

General Summary.

Ocular Tests

Where the vision was normal, or had been corrected by glasses, this was rated as normal; because of the occupations of these women it was practically so.

The most striking points of weakness in the entire class were the bad postures in sitting and standing, consisting of round shoulders, a stooped position, and flabby muscles, 67 per cent.; a deficiency of one-seventh of the normal chest and lung development, accompanied by a deficiency of one-third of the normal chest expansion, 85 per cent.; weak hearts with weak and rapid pulse, subnormal blood-pressure, and anemia in over 50 per cent.; over 66 per cent. had some form of pelvic trouble which was acting to undermine the whole system.

Aside from tuberculosis, life insurance companies reject applicants who fall more than 20 per cent. below the normal standard of weight, and because of this 16 per cent. would have been rejected. The cause of this great loss of weight was due to malnutrition and overwork, and had it seemed practicable to adhere to Professor Meylan’s wise advice that anyone who fell below 7.5 per cent. in any one series of tests, or below 75 per cent. in the general average, 20 per cent. of the entire class would have been turned down.

It must be taken into consideration that these examinations were made during the first week of June, at the end of a hard year’s work; but, making due allowance for this, the results of these examinations have revealed such a subnormal condition of the vital organs of the body as to be appalling even to those of us who have long been familiar with these subjects. In addition to this was the fact that many unsuspected ailments needing immediate attention by physicians or surgeons were discovered in a class of women who considered themselves well.

The Physical Status of the Women of To-day.—The strong presumption that the above statistics are very fairly representative for the average woman of to-day is strongly borne out by data furnished by the absence on account of illness of the teachers of New York, and by corresponding statistics recently published by the Life Extension Institute of New York City.

Statistics compiled during the year 1913-14 showed that more than 20 per cent. of the teachers of the New York public schools were absent at some time on account of illness, and that these absentees averaged 16½ school days. The data obtainable showed four prevalent ailments: diseases of the respiratory organs, 35 per cent.; acute contagious diseases, 16 per cent.; nervous diseases, 15 per cent.; and digestive disorders, 11 per cent. And on the health of the teachers ultimately depends the efficiency of the entire educational system of the country.

The Life Extension Institute of New York, in its tabulation of 2000 examinations of young men and women clerks between the ages of thirty and thirty-five years, showed only 3 per cent. normal, i. e., free from bodily impairments and from habits of life which were leading to such impairments; and showed 59 per cent. sufficiently impaired to justify their recommendation to the definite care of their family physician. “These statistics were compiled at an age when the human being is supposed to be at the very prime of life. The results prove that the majority of young men and young women in New York City begin to die as soon as they are grown up. Deaths due to degenerative diseases have increased 86 per cent. in the past thirty years; this means an increased death-rate whereby between 100,000 and 200,000 lives are lost every year.”

The Reflex Action of Some of These Various Impairments on the Entire Organism.—In the normal erect position of the body the trunk is given its greatest length, the head is held erect, the shoulders thrown back flat against the ribs, the chest is high, and the abdomen flat. (See Plate III, Senegalese woman.)

In the bad postures noted in 67 per cent. of the entire class, of round shoulders with a stooped position and flabby muscles, we note four distinct and prominent factors in the breaking down of the human organism:

I. The Effect on the Chest and Lung Development and on the Action of the Heart.—In this malposition the upper part of the body is inclined forward, with the result that the chest is flattened to the extent of 1 inch. The restriction which this must mean to the expansion of the lungs is evident; and when it is realized that in the erect position the heart occupies the space between the breast bone and the spine, with practically no space to spare, the resulting interference with the heart’s action is evident.

It is a very serious matter when we have superadded to a deficient chest development a deficient chest expansion. For these are the very women in whom because of their general run-down condition and undeveloped muscles the breathing is very superficial; the apices of the lungs, the favorite site of tuberculosis, and the deeper portions are seldom expanded; and not only does the body suffer from a deficient oxygen supply, but there is an equally defective suction power on the part of the heart, which means a poor circulation and a lowered general nutrition of the whole body.

The main function in metabolism is oxidation, and scarcely a step in the series of chemical changes proceeding within the body is possible in the absence of an abundant supply of oxygen, constantly renewed. Living in close rooms lowers the vitality to an extent little dreamed of by most persons.

II. The Effect on the Abdominal Viscera.—In the normal erect position the abdominal muscles remain taut and afford proper support and pressure to the abdominal viscera and the great splanchnic circulation of large blood-vessels; whereas in the stooped position the muscles of the abdomen, not being properly used, become weakened and sag forward, causing the downward displacement of all of the abdominal viscera, with consequent disturbance of their circulation and function. Many cases of indigestion, congestion of the liver, and constipation can be explained in this way.

III. The Effect on the Circulation of the Spinal Cord.—The circulation of the spinal cord is very largely dependent on the tone of the muscles of the spine; hence the weakness of these muscles interferes with its circulation. In the spinal cord are large nerve-centers which have to do with the control of the arms and legs as well as of the organs of the trunk, so that anything which lowers the tone of these centers depresses the vitality of the organs supplied by them; and this is believed to be the cause of many cases of so-called nervous indigestion.

IV. The Waste of Energy which Results from Faulty Posture.—Weak foot, in its final stage flat-foot, is more common in women than in men because it is not purely a local condition in the arch of the foot, but primarily due to a weakened condition of the leg muscles that support the arch. Weak feet are gradually converted into flat-feet by faulty standing and walking and lack of leg exercises.

Many cases of nervous prostration are to be traced not merely to overwork or worry, but to the waste of energy which results from the faulty posture of the body and with the interference of the circulation in the spinal cord, and the consequent weakness of the nerve power which results. In other words, it is not the load which breaks the bearer down, but the way in which the load is carried.

Good chest and lung development, a strong heart, well-developed and firm muscles are the tripod on which rests physical endurance and resistance to disease. And this was just where the entire class was found to be gravely subnormal.

Physical training consists primarily of heart training; in increasing the breathing capacity; in strengthening and developing the heart and other muscles of the body. As the muscles become stronger the body is held more erect, and this favors, as we have seen, all of its functions.

And it is not generally understood how great is the effect of physical training on the brain and mental activities. With a strong and vigorous action of the heart there is a feeling of courage and general exaltation; whereas with a weak heart and feeble circulation fear and impaired mental activity predominate.

The charge is constantly laid at the door of women that they seldom rise above the mediocre, and have never been leaders in the world of art, literature, the drama, science, or the learned professions; that it is men who have invented devices for the home!

According to statistics, of the 25,000,000 wage earners in the United States, 8,000,000 are women, of whom 1,250,000 are over forty-five years of age and 637,000 under fifteen years of age. From an economic point of view, anything which will raise the working efficiency of one-third of our producing population, whose average wage is now the paltry sum of $6 per week, must be welcomed, because it not only prevents loss of time from work, but also the cost of illness. The study of the above statistics demonstrates the fact that the physical efficiency of women can easily be doubled; that should mean that the average wage should be raised to $12 per week, which would be a vast economic gain to the individual, the home, and to the state.

FOOTNOTES:

[1] See page [330].

[2] Similar records for the classes of 1915 and 1916 were not preserved.

[3] As the physical examinations are made during the time of the Annual Conference, in order to shorten the time as much as possible the Board requested that the tests of endurance be omitted.

CHAPTER II
HYDROTHERAPY

Description of the Skin; Functions of the Skin; the Physiologic Effects of Water, Hot and Cold; the Chief Varieties of Baths; Ablutions; the Tub Bath; the Alcohol Rub; the Cold Dip; Alkaline and Saline Baths; the Rain Douche or Shower Bath; the Hot Foot-bath; the Sitz Bath; Salt Ablution; the Turkish Bath; the Electric-light Bath; Indications for the Use of Turkish Bath, and Contraindications; the Douche; Rationale of the Douche; Contraindications.

The Internal Use of Water; Its Action on the Heart and Blood, on the Digestion; Therapeutic Indications for the Use of Water; Contraindications for Drinking Cold Water.

Enemas; Vaginal Douche; Douching the Ear.

The term hydrotherapy will be used here in its broadest sense, and may be defined as the hygienic and systematic use of water, both externally and internally, for the preservation and restoration of health and the prevention of disease.

The hygienic and therapeutic value of the systematic use of water is just beginning to be appreciated by the medical profession. When this newly acquired knowledge is put to practical use by the great masses of the people, there will be a greatly diminished necessity for the use of drugs. Indeed, water has been pronounced by a high medical authority to be, and probably is, more nearly a panacea for all human ills than any other known agent.

The bath is generally considered merely as a cleansing procedure, whereas this is only one of its beneficial effects. There is, in addition, the stimulation of all the functions and organs of the body obtained through the temperature of the water, and the mechanical stimulation which is obtained by the mode of application.

Again, the skin is not a mere covering for the body, but one of its most important organs, with well-defined functions; so that, in order to obtain a clear understanding of the subject, it is necessary first to consider briefly the functions of the skin; and, secondly, the physiologic action of water.

Description of the Skin.—The skin is a very sensitive and complex organ, and upon the condition of the skin and the vicissitudes to which it is exposed the health of the individual is dependent to a very great degree.

Fig. 1.—Vertical section of skin. sbg, Sebaceous glands; ep, epidermis; h, hair; d, derma (Fox).

The skin is composed of three distinct layers—the epidermis, the corium or true skin, and the subcutaneous connective tissue. The appendages of the skin are the hair, nails, the sebaceous and sweat-glands. This complicated structure is supplied with blood-vessels, lymphatics, and nerves.

The Epidermis.—The outer layer of this is the horny layer; when a blister is formed, its fluid raises the entire epidermis from the true skin. The flat scales forming the horny layer are continually being thrown off; this process of desquamation is increased by the friction of the clothes, of bathing, massage, and so forth, and is as constantly being replaced by new cells from underneath.

The corium, or true skin, is the most important part of the integument. This is a thick, felt-like tissue which is pierced in all directions for the passage of the blood-vessels, lymphatics, sweat-ducts, and nerves, and affords lodgment for the hair follicles and sebaceous glands. The tension of the skin is produced by its muscular structure and elastic network, and is subject to temperature changes. This power of contractility is known as the tone of the skin.

The skin has two kinds of glands, the sebaceous and sweat-glands. The sebaceous glands consist of a gland structure, with a short excretory duct, which opens upon the epidermis or into the hair follicles. These glands secrete an oily substance, which keeps the hair and skin soft and protects them from the sweat.

There exists in the sebaceous glands of the skin an infinite number of vulnerable points for infection, and the greater part of the process of cleanliness is directed toward their protection. If in any part of the skin there is an accumulation of bacilli, their toxins, or excretions, and, at the same point, a collection of sebum, the friction of the clothes, caused by the movements of the body, becomes an active agent in effecting their absorption by the skin. Hence, the scientific basis for the necessity of the daily bath.

In the subcutaneous tissue we find the fat; it is this part of the skin that contributes to the roundness and beauty of the body. It is increased by abundant fatty food, sedentary habits, and freedom from care.

Functions of the Skin.—The skin exercises three distinct functions; first, as an organ of sense; second, as an organ of excretion; and third, as an organ of heat regulation.

Next to sight, the sense of touch is the most important of all the senses. Through this sense the human organism is made conscious of its contact with the outer world. The cutaneous nerve-endings stand guard, as it were, over most of the functions of the human body.

The importance of the action of the skin as an organ of excretion will be better understood from the well-known fact that the skin is one of the most important aids to the kidneys. That the perspiration and the urine are to a certain extent vicarious excretions has been proved.

The blood is the circulating medium which not only serves to convey nutritive materials from the stomach to the tissues, and the excrementitious materials from the tissues to the excretory glands, but also to equalize the body temperature. It conveys the surplus heat from the interior of the body to the surface, where it may be dissipated by conduction, radiation, and evaporation. Nearly nine-tenths of the daily heat-loss takes place through the skin; and of this, one-seventh is due to evaporation, which is enormously increased by perspiration.

The amount of perspiration produced daily is about two pints, or in the neighborhood of 1/64 the body weight. This is double the amount of water thrown off by the lungs. The watery portions of the perspiration are readily evaporated, and the solid constituents are deposited upon the skin. Urea and uric acid, together with more subtle poisons, are found in the sweat.

Animal Heat.—The heat of the body is wholly derived from foods, which, when completely oxidized within the body, produce practically the same amount of heat and energy that would be generated by their combustion outside the body.

But it is essential, in order to keep the body of warm-blooded animals at a constant or normal temperature, that an increase in the heat-production should be accompanied by a corresponding increase in the heat dissipation; the functions are reciprocal, and this equilibrium is regulated and maintained by a special nervous and functional mechanism.

The automatic protective measures against the effects of heat are:

First.—Dilatation of the cutaneous vessels and an acceleration of the circulation through the skin and the subcutaneous tissue. By this means the dissipation of heat is increased; the sweat at the temperature of the blood, deposited upon the surface of the body, evaporates under favorable circumstances, and in this way considerable amounts of heat are abstracted from the body. In consequence of sweating and its evaporation, the blood circulating through the skin is cooled, and returning to the internal organs at a lowered temperature, prevents their overheating.

Second.—Should the action of heat be continued for a greater length of time, a large amount of blood will be retained in the skin in consequence of the loss of tonicity of the cutaneous vessels; the cutaneous circulation will be slowed, and thereby the blood, heated at the surface of the body, is prevented from returning to the internal organs and so overheating them.

Third.—In consequence of the accumulated amount of blood in the skin, a diminished amount of blood will remain in the internal organs; thus their activity, and thereby also the production of heat, will be lessened.

In these processes will be found a safeguard against the excessively rapid penetration of heat to the internal organs, and against the unduly rapid elevation of the body temperature through thermic influences.

As a result of the stimulating influence of cold, there first occurs contraction of the skin and its vessels. This, by restricting the dissipation of heat, brings about perfect compensation if the abstraction of heat be but slight; and but partial compensation, if the abstraction of heat is more marked. In the latter event the body temperature will continue to decline, to a greater or less degree; in the former it will remain constant.

The rôle played by the skin in maintenance of the normal temperature of the body is indispensable.

The normal temperature of the adult human body is 98.6° F. in the mouth, and that of the rectum and vagina is one degree higher.

Fasting, sleep, and short applications of heat all decrease heat-production; during sleep the temperature of the body falls half a degree or more.

Respiration by the skin varies from ½ to 1 per cent. of the total amount of oxygen taken into the body, and a somewhat lower percentage of carbonic acid is thrown off through this channel.

The skin absorbs substances in watery solutions with difficulty, on account of the oil lying upon and in the epidermis; substances dissolved in oil and rubbed in are more rapidly absorbed; absorption takes place rapidly after the skin has been washed with ether, chloroform, or alcohol.

The Physiologic Effects of Water.—These depend on whether the water is taken internally or applied externally. If applied externally, the effects will depend upon the temperature, whether hot, tepid, or cold; also on the manner of application, but, most of all, on the length of time which it is applied and the state of health of the individual.

The temperature of water is classified as very cold, from 32° to 55° F.; as cold, from 55° to 65° F.; cool, from 65° to 80° F.; tepid, 80° to 92° F.; warm, 92° to 98° F.; hot, 98° to 104° F.; very hot, 104° F. and above.

Heat.—A general hot bath produces dilatation of the vessels of the skin and contraction of the vessels of the brain; a general activity of the glands of the skin, both perspiratory and sebaceous. Perspiration may be produced, either to the degree of slight moisture or of profuse sweating, according to the length of time and the intensity of the application made. In a very hot bath the rate of perspiration may be increased from fifty to sixty times the ordinary amount. The most pronounced effect possible may be secured by either the electric light or sun bath.

Loss of fluids from the body has a depressing effect similar to, though somewhat less marked than, that produced by bleeding, so that there is a vital necessity for administering water internally before, during, and after the bath.

Prolonged and repeated perspirations induced by artificial means weaken the skin, and thus lessen its power to resist cold impressions, unless counteracted by frequent cold applications.

The general and usual reactions following the applications of heat are atonic and depressing in character. For the most part, the reactions following cold applications are to be preferred to those following hot ones.

The three great vascular areas of the body are the muscles, the portal system, and the skin. Each of these parts may be regarded as a great reservoir, capable of retaining a large part of the entire amount of blood of the body. When one of these areas is in a state of congestion, the others must be in a comparative state of anemia.

The restorative effects due to the application of heat are due partly to the elimination of fatigue poisons which is thereby encouraged, as well as by the reflex stimulation of the nerve-centers. The good effects are much more decided and lasting, and the exhausting effects neutralized, if the hot application is followed by a short cold one.

The effects of a neutral bath, 92° to 95° F., is sedative, diminishing nervous irritability.

A hot-water bottle or fomentations, placed over the stomach for an hour or two after eating, increase the gastric secretions, and, when placed over the liver, increase the flow of bile.

The Physiologic Effects of Cold.—In suitable cases a short general application of cold is a powerful heart tonic. Cold causes a contraction of the vessels of the skin and of those of the brain, with a dilatation of the internal vessels. There are pallor and coldness of the skin, and an almost instantaneous suspension of perspiration, which is dangerous only when the body is in a state of fatigue.

If the application of cold is long continued, the surface becomes blue, the temperature of the muscles beneath the skin is lowered, thus checking heat-production in these muscles; the circulation is slowed, and the heart’s action is diminished in frequency. There is a goose-flesh appearance of the skin; a sensation of chilliness, trembling, shivering, chattering of the teeth; at first a quickening and then slowing of the pulse, and deep gasping respiration.

When the cold application is considerably prolonged, the tendency to reaction is suppressed. There is an exhaustion of the nerve-centers as well as of the heat-producing powers of the body. Thus, the system gradually loses its power to resist the depressing effects of cold. The repeated chillings of the body increase the length of time required to return to the normal temperature. Applications of water below the temperature of the body always lower the temperature.

Reaction.—If the application of cold is of very short duration, of very low temperature, and given under high pressure, the phenomena of reaction begin immediately on its cessation.

The reaction consists in a dilatation of the surface capillaries, with contraction of the internal vessels; redness of the skin; the skin is smooth, soft, and supple; there is a sensation of warmth, comfort, and well-being; respiration is slower and deeper; there are a fall of the internal temperature and increase of perspiration.

Certain measures to favor reaction should be taken before the bath, such as exposure to the air of a warm room, drinking hot water, and short exercise of a rather vigorous kind.

During the bath the measures which favor reaction are short, sudden applications of cold, friction while in the bath with the hand, and pressure effects in the douche.

After the bath reaction is favored by vigorous rubbing, a thorough drying of the body, warm clothing, warm air of the room, and as vigorous exercise as the strength of the individual will permit.

Conditions which are unfavorable to healthy reaction are: old age, infancy, exhaustion, either temporary or from an excessive loss of sleep, or extreme nervous exhaustion, obesity, rheumatic diathesis, unhealthy or inactive skin, profuse perspiration when accompanied by a state of fatigue, extreme nervous irritability, a very low temperature of the skin, an immediately preceding or impending chill, and extreme aversion to cold applications.

The average temperature of the human nude skin is in the neighborhood of 90° F. The difference between the temperature of the skin and water is the chief element in determining the reaction of the individual. It is evident that water at a temperature of 90° F. would be neutral or indifferent; the difference of intensity of effect is in proportion to the difference of temperature of the water and skin. The duration of the cold procedure is an important element in the production of reaction. It may be laid down as a rule never to give any cold-water application without friction. The physical and psychic state of the individual exerts more or less influence upon his reactive capacity. An anemic, or otherwise depressed individual must be managed with great circumspection, because she bears heat abstraction badly. The hydriatic procedure must always be adapted to the reactive capacity of the bather.

The woman must be thoroughly rubbed after the bath until a good reaction has occurred. Especial attention must be paid to the feet and legs. The bather should first be rubbed with a warm towel or sheet, and then with the bare hands of the attendant, as the warm hand greatly facilitates the reaction. The bather is by no means dry when the skin ceases to feel wet. So long as the skin is soft and spongy, it still contains moisture which has been absorbed by the superficial layers of the epidermis. The absorbed moisture, being left to evaporate after the bath, the individual is liable to become chilly and contract a cold, which is erroneously attributed to the bath itself.

Other injurious effects following imperfect reaction after the cold bath are secondary chills or a continuous chill lasting for several hours. The hands and feet are cold, there is headache, not infrequently diarrhea, and other evidences of internal congestion, such as abdominal or ovarian pain, vertigo, etc.

Reaction may be favored by covering the patient with blankets, surrounding her with hot-water bottles, and giving her hot tea to drink. Exercise should follow the bath. Walking for from twenty minutes to an hour is the most usual form of exercise. Very vigorous exercise for a short time cannot be substituted for moderate exercise for a longer time.

The Tonic Effect of Cold Upon the System.—The effect of cold upon the muscles, when given in the form of a cold bath, douche, or spray, is to augment muscular energy and tone to a very great extent; this increased muscular tonicity is the cause of the slight shivering. The cold douche, if short,—one or two seconds,—and given with a pressure of from 25 to 30 pounds, is a powerful restorative in fatigue resulting from severe muscular effort, but it must be immediately preceded by a short hot bath, and must be followed by vigorous rubbing and wrapping in a hot blanket.

Short cold applications cause elevation of temperature and increased metabolism, while prolonged cold applications cause a fall of temperature and decrease of metabolism.

The tonic effect of cold water is believed to be due to the stimulation of the sympathetic nerve-centers. The sympathetic nervous system controls the blood-vessels, heart, the functions of secretion and excretion; and, indeed, all the vital functions of the body.

The sensation of well-being which accompanies the reaction following a general cold application is largely due to an increased activity of the cerebral circulation. Cold water is a physiologic tonic, and the cold bath, properly employed, increases the vital resistance to pathologic processes.

All applications of water at a temperature low enough to provoke vital resistance are tonic; hence, tonic effects are produced by all temperatures below 90° F., but the most certain and pronounced results are obtained from the douche in every form, which adds mechanical impact to the thermic effects of cold. The most durable tonic effects are produced by the frequent use of very cold and very short baths.

A tepid bath causes a lowering of the body temperature.

The Chief Varieties of Baths.—These, in the order of frequency with which they are used, are: ablutions; tub; foot-tub; sitz; salt sponge; shower; Turkish; horizontal jet; needle; fan douche; Scotch douche; Roman and electric-light baths.

Ablutions or Sponge Baths.—These baths are of universal use. The sponge is one of the dirtiest and most impossible articles of the toilet to clean and to keep clean. It is a collector of dirt and germs, and should be banished from every bath-room and from every house. It is not sufficient that each member of the family should have her own sponge; it is quite possible for the individual to become infected or reinfected from her own sponge. Incidentally, it does not afford sufficient friction, and thus does not favor reaction. In taking ablutions, the application of water may be made with the hand, though it is best made by means of a wash towel. The good effects of the simple ablution will be greatly enhanced by the use of the hat tub, and this especially where there is no bath-tub in the house.

When the bath is taken for the purpose of cleanliness, the water should be warm or hot, and pure Castile soap is one of the best that can be used. If the skin is rough, a good sand soap will be more beneficial. The bath should be completed by dashing cold water over the body with the wash-towel.

The body must be quickly and thoroughly dried by means of a rough bath-towel. After this, the skin may be still further toned up by a good alcohol rub.

If the ablution is taken simply for the tonic effect, it is generally taken on rising in the morning, and the water used is cold. The ablution may be confined to the upper part of the body, that is, the chest and back; and consists in friction with a rough wash-towel, followed by dashing the water over the body; followed by brisk friction with a rough bath-towel. This procedure causes a marked stimulation of the heart and lungs, and is followed by a rise of temperature.

In winter all baths must be taken in a warm room.

There is a decided increase of muscular and mental capacity after the cold ablution, demonstrating the tonic effect it has produced.

The cold ablution may also serve as an introductory to other and more heroic hydriatic procedures. If the reaction is not good, water at a higher temperature should be used, and only small portions of the body should be attacked each day, followed always by brisk friction. As the reaction becomes better, the temperature of the water should be gradually lowered from day to day.

There must be a decided sensation of warmth of the body before proceeding to take any form of cold bath. This may be induced by sipping a cupful of hot water before rising, and then being well covered with the bed-clothes until the body is in a glow. In conditions of anemia or neurasthenia, where the circulation is markedly poor, in addition to drinking the hot water, the bather may stand on hot blankets while taking the cold ablution, and after it be rubbed briskly with hot towels.

Nothing is gained, and a great deal of harm is done, by trying to persevere in the daily cold ablution when it is followed by a pallor of the skin, chilliness, etc.

The Tub Bath.—This is much more refreshing, more salutary, and may be used to produce a much greater variety of effects than the simple ablution. Tub baths may be classified according to the amount of water in the tub as half or full tubs; and again, according to the temperature of the water, as warm, tepid, hot, and cold. The half tub contains about 30 gallons of water.

In a general way it may be said that the half tub of warm water is used for the purpose of cleanliness; the hot baths for breaking up colds, for rheumatism, etc.; the tepid bath to allay nervousness; and the full cold tub, for the tonic morning dip.

For cleansing purposes the so-called half tub, that is, the tub contains a sufficient amount of water to reach above the pelvis when one is seated in the tub, is used. The temperature ranges from 98° to 102° F. Five minutes is as long as the bather should remain in the tub, as all hot baths are more or less exhausting. After an initial immersion in the water, the scrub takes place by means of the Turkish bath-towel, or, better, by the use of the flesh brush. If there is a shower attached, the hot bath should always be followed by a brief cold shower; if not, the cold water should be turned on and dashed over the body by means of the wash-towel. This closes up the pores of the skin, prevents the profuse perspiration from taking place that so often follows a hot bath, and greatly diminishes the susceptibility to taking cold. An alcohol rub completes the procedure. This insures a further toning up of the cutaneous vessels. A small quantity of alcohol is poured into the hand and applied to a limited area of the body. It is well rubbed in with friction until the alcohol has wholly evaporated. Beginning with the arms, the legs, chest, and back are successively gone over.

The hot bath is best taken immediately before retiring, and should not be repeated oftener than twice a week. Retiring to bed at once, the bed acts as the cooling chamber of the Turkish bath. The hot bath is most restful, and, except in rare cases, tends to the production of refreshing sleep.

If the bather has a weak heart, suffers from shortness of breath, or is weak from any cause whatever, she should only take a half tub bath, since it has been learned from experience that when the water covers the entire body, there is increased difficulty in the respiration, and the heart’s action often becomes embarrassed, palpitation of the heart is experienced, with a feeling of impending suffocation. There is sometimes also a feeling of faintness. On getting into the tub, the temperature of the room should never be above 68° to 70° F.

The Full Tub or Immersion Bath.—In this form of bath there is a complete submersion of the body in the water, so that the water reaches the under surface of the chin, the head of the bather resting on a cross strap, being the only portion of the body uncovered by the water.

If the bath is tepid, that is, has a temperature of from 80° to 90° F., great care should be taken to have the chest covered, in order to prevent pulmonary congestion. This is best accomplished by placing a Turkish towel, wrung out of hot water, about the chest and shoulders of the bather just after she enters the tub.

If the bath is hot, from 98° to 104° F., before entering the bath the face and neck are rubbed with cold water, in order to relax the vessels of the brain and so prevent cerebral anemia. Except when the hot bath is given for especial therapeutic purposes, as for rheumatism, cystitis, colic, etc., it should always be followed by a cold application.

The Cold Dip.—For the dip, the tub is filled with water at a temperature of from 65° to 55° F. The duration of the dip varies from two or four seconds to one or two minutes. The bather should wet the face and chest before entering the water. It is best to enter the bath suddenly, as the sensation of cold is thus far less noticeable than when the bath is entered gradually. If the stay in the tub is more than momentary, vigorous rubbing must be kept up during the entire time spent in the tub.

For persons in good health a cold dip on rising in the morning is excellent. It creates an appetite, accelerates the circulation, arouses the nervous system, and produces decided exhilarating effects in those who are strong enough to react after it. When employed for this purpose, the immersion should not be more than from three to fifteen seconds. The bather must rub herself vigorously while in the tub, and follow the bath with brisk toweling and plenty of friction. She should then take moderately active exercise for fifteen to twenty minutes.

For any one just beginning to take the cold dips, the temperature of the water should be just 1 degree below that of the body, and gradually lowered by a drop of 1 degree every morning or two. Or, the dip may be preceded by a preliminary warm bath or warm shower.

The salient point in connection with bathing is not to allow the skin to lose heat too rapidly. To apply this as a warning in the case of cold baths: it has been estimated that the heat loss from the body immersed in cold water at the temperature of 86° F. is double the normal; at 77° F., three times, and at 68° F., five times, the normal.

The daily use of the cold dip for those who are able to react after it is one of the best means of fortifying the system against both acute and chronic diseases.

Contraindications.—The use of the cold dip is contraindicated for young children, the aged, and in run-down conditions of the system; in all cases where the action of the heart is weak, in Bright’s disease, or in any acute or chronic congestion of the kidneys; in all acute inflammations, as inflammation of the bowels, peritonitis, or inflammation of the uterus and ovaries.

Alkaline Baths.—For these baths from 4 to 12 ounces of the carbonate of soda should be used to 30 gallons of water. The water should have a temperature of from 92° to 96° F. This bath is useful in many forms of skin disease, and relieves the itching of jaundice and urticaria.

Saline Baths.—The typical saline bath is the salt-water bath. Sea-water contains in solution from ⅓ to ¼ pound of solids to the gallon of water. The principal ingredients are common salt, magnesium chlorid, and magnesium sulphate. These substances have a decidedly stimulating effect upon the skin and encourage reaction. For an artificial sea-water bath, 8 pounds of sea-salt should be used to 30 gallons of water.

Ordinary coarse salt is purer, contains from 97 to 98 per cent. of the chlorid of sodium, is cleaner, and makes a clearer solution, and it dissolves in about one-third of the time required for sea salt, and can be obtained for about one-third of the cost.

As a cleansing agent, a 5 per cent. brine is equal or superior to soap. Further, the axilla and hairy parts remain clean and sweet for a much longer time than after the use of soap. These brine baths, taken three times a week, are followed by a great improvement in the general health.

The Rain Douche or Shower Bath.—The shower is the most tonic of all the baths that can be taken at home, and no bath-room should be considered complete without it. In this form of douche the water is projected through a perforated disc, falling upon the bather in a number of fine streams. It is necessary for the bather to wear a rubber cap in order to keep the hair dry. In taking the shower bath the bather stands up; the disc is generally placed about 3 feet above the head. The water should be allowed to fall first upon the feet, then the hands, arms, shoulders, back, and, lastly, upon the chest and abdomen. The bather should keep in active motion during the application, flexing the limbs, and rubbing the chest with the hands. At the beginning of the shower the hands should be placed over the chest, in order to protect the precordial region from the impact of the water.

The cold shower should be preceded by some kind of a heating process—either a hot plunge or a hot shower bath. A shower of from 100° to 104° F. may be applied for one to three minutes before the cold application. A cool shower of 75° to 65° F. is an excellent training for persons who are sensitive to cold. The neutral shower, 92° to 97° F., given for three to five minutes, is sedative in its effects.

The cold shower, 60° to 70° F., duration from five to thirty seconds, is useful in phlegmatic neurasthenics and dyspeptics; sedentary people in whom the general metabolic activity is diminished; also in obesity and in all cases after a sweating process. By standing in hot water the bather is much more tolerant of cold.

The neutral shower is one of the most effective measures for the relief of insomnia; especial attention should be given to the back and legs. The action is quicker than that of the neutral immersion bath.

As a hygienic measure, the shower bath offers a most agreeable and rapid means of cleansing the whole surface of the body.

Since the effect of the douche depends on the pressure, it will be readily understood that the hose attached to the faucet of the domestic bath-tub is merely a sprinkler, and not a douche, in the proper sense of the word. Such a procedure can only be tolerated by the most robust. In the upper stories of most city houses the pressure is probably not more than from 3 to 10 pounds; the stream of water from the sprinkler is really only a drizzle; the mechanical effects being so slight, there is no reaction produced; the result is that its use is followed by a feeling of chilliness and depression.

The Hot Foot-bath.—The temperature of this bath should be at the beginning from 102° to 104° F., and the duration from three minutes to half an hour. The pail is nearly filled with water, care being taken that it shall not be so full as to overrun when the feet and legs of the bather are put in. A blanket, closely wrapped about the patient and the pail, should come up above the knees. As the water cools off, hot water should be added.

This form of bath is most commonly used to relieve congestion and inflammation. The dilatation produced in the blood-vessels of the feet and legs relieves congestion of the brain and the organs of the upper half of the body, as well as of the pelvic viscera. It should be taken immediately before retiring.

The Sitz Bath.—The sitz or hip bath requires a tub made for that particular purpose. The back of the tub, which is most commonly made of tin, is cut high, while the front must be sufficiently low for the patient to sit comfortably in it, without undue pressure being made on the under side of the knees.

The tub is half filled with water of the prescribed temperature. It is well to begin with water at a temperature of 102° F., and increase the temperature while the patient is in the tub, making it as hot as is comfortable.

Fig. 2.—Sitz-bath tub made of tin (Ashton).

In giving all hot baths a thermometer must be used, and a word of warning must be given about adding hot water in case of sickness, as well-authenticated cases of paralysis are recorded in which the temperature sense of the patient was lost, and, in adding hot water, it was raised to such a temperature that the legs and feet of the patient were scalded.

During the sitz bath the patient keeps on her stockings and bedroom slippers, and, unless friction is ordered, the entire body, as well as the feet and legs, are enveloped in blankets.

The duration of this bath is from three to ten minutes. This bath is especially useful in restoring the menstrual function when it has been suspended as the result of chill or other causes; also, for relieving hemorrhoids, uterine colic, neuralgia of the ovaries, and inflammation of the bladder.

To prolong the effect of the bath the patient may be put to bed wrapped up in her blankets. In cold weather it is a good precautionary measure to have the bed heated with hot-water bottles, in order to prevent chilling.

Salt Ablution.—As the name indicates, this is a salt-water bath, and the best results are obtained by using a saturated solution, which is in the proportion of 1 pint of salt to 1 gallon of water. Sea-salt is the best, but, if that cannot be obtained, ordinary salt may be used.

If there is no bath-tub in the house an ordinary wash-bowl may be used, but the bath is most effective when taken in the tub. The salt and water are put in a papier-mâché pail, which is placed at the foot of the tub. The chilliness which might be caused by sitting on the cold porcelain is avoided by placing a heavy folded bath-towel on the bottom of the tub. In cold weather the tub should be previously heated by allowing the hot water to run in.

The salt water feels very much colder than plain water at the same temperature. It is well to begin with a temperature of from 90° to 85° F., and gradually lower the temperature until 70° F. is reached.

The water is applied by means of a Turkish wash-towel, accompanied by vigorous friction, beginning with the face and neck, arms, legs, back, and, lastly, the chest and abdomen are gone over. After that, the water is dashed over the entire body, and is followed by a brisk toweling and friction with the hands or hair glove. The salt water should not be washed off, except in those rare cases where it causes a disagreeable sensation; it is then removed by the use of the hot followed by the cold shower, as previously directed.

Indications for Its Use.—It is an excellent nerve tonic in cases of depression with loss of appetite, insomnia, etc., also in anemia and neurasthenia. In this class of cases it is best taken in the afternoon, on rising from the siesta, and just before dressing for dinner. It is especially refreshing in the hot weather.

Its use is contraindicated under the same conditions that other cold baths are, and must never be taken when the bather has a tendency to chilliness.

The various kinds of baths previously described can all be obtained in the home, but the Turkish bath, with its various accessories, can only be taken in a properly equipped bathing establishment.

The Turkish Bath.—This form of bath dates back to the time of the Romans. The essential features of a modern establishment are: dressing-rooms; a warm room, with a temperature of from 110° to 130° F.; a hot room, temperature of 150° to 170° F.; a steam room; a shampoo room; a douche apparatus; a plunge bath, and a cooling room. In many establishments there is only one hot, dry-air room. The air of the room may be heated by steam-coils.

The bather, having disrobed, is enveloped in a sheet, and enters the hot room, where she reclines on a steamer-chair. A towel wrung out of cold water is placed on the forehead and changed as often as it becomes hot. The bather should drink a glass of cold water immediately before or on entering the hot room, and several glasses should be taken at intervals during her stay in this room.

The skin is highly stimulated and profuse perspiration results. The profuse sweating promotes absorption from the alimentary canal, and so is a powerful stimulant to nutrition. It also emphasizes the necessity for copious water-drinking.

Great harm often results from a too prolonged stay in this room. Ordinarily, the bather should leave the room as soon as free perspiration is established; that is, in from fifteen minutes to half an hour.

From this room the bather next enters the Russian bath or steam room. It is very much more agreeable to have very little steam in the room on entering; when the steam is very dense, a feeling of suffocation may occur. Any one with a weak heart should avoid the steam room altogether, as it is apt to cause a sense of great oppression. For the complexion, bronchitis, or laryngitis, it is excellent.

From the hot room the bather goes to the shampoo-room, where, lying upon a marble slab, she is first gone over from head to feet by the wet hands of the attendant. This manipulation removes the layer of cuticle which has been loosened by the free perspiration. These rubbings and strokings are continued until the skin feels smooth and polished.

The bather is next shampooed with soap and water, applied with a bath-brush. This may in turn be followed by a salt rub. After this comes a douche, given with a horizontal jet, at a temperature of 104° to 106° F., followed by a cold douche.

If the bather is a strong woman, she may now enter the cold plunge. The temperature of this should be from 70° to 60° F.; this must only be a quick dip. She is then vigorously rubbed and dried. After this she lies down in the cooling room and has an alcohol rub, which completes the procedure. She should rest here for half an hour at least before dressing. The pulse should be normal and the skin perfectly dry before she dresses and goes out on the street.

In winter, instead of the ordinary alcohol rub which is given, it is much better to have a thorough massage with cocoa-butter or almond oil—the so-called Roman bath. Just following the Turkish bath much of this oil will be absorbed, which is beneficial for thin people, and, in any case, it will lessen the danger of getting chilled on going out into the cold air.

The woman unaccustomed to these baths should under no circumstances go to a Turkish bath without consulting her physician, as great harm might result. The bath should not be taken oftener than twice a week, unless by special orders of the physician. Care must be taken not to overuse them, as frequent and prolonged exposures to the sedative influence of heat is very debilitating. The wise woman will provide her own bathing cap, bath-brush, and straw sandals.

The use of the Turkish bath is indicated in rheumatism, toxemia, chronic dyspepsia, biliousness, obesity, sciatica, and lumbago.

The contraindications to its use are, in Bright’s disease of the kidneys, in most pulmonary affections, in the advanced stages of arteriosclerosis, and in diabetes with emaciation.

The Electric-light Bath.—This is now frequently used instead of the hot-air room of the Turkish bath, and possesses many advantages. A cabinet is lined on three sides with mirrors, on which are arranged 50 or 60 electric-light bulbs; the mirrors multiply the number of lights by reflection. A stool is placed in the cabinet for the patient to sit on, while the head protrudes above the top, which is closed. By means of switches and a proper, grouping of the lamps in wiring, the number of lights, and so the temperature, can be instantly and perfectly controlled. The heat is derived by radiation, so that it is not necessary to have the air confined. In this form of light bath the body is directly exposed to the effects of radiant light and heat.

The incandescent electric-light bath is superior to every other form of heating procedure in which the only object is the preparation for the cold bath. The time required is not more than from three to five minutes. When it is desired to produce profuse perspiration, the patient may remain in from eight to fifteen minutes. A longer stay than this is apt to produce an overstimulation of the nervous system and an excessive elevation of temperature.

The electric-light bath possesses the distinct advantages that, while the body is exposed to a high degree of heat, the air of the room in which the head is, and which one is breathing, may be cool, and unique advantages in the exactness of the dosage as regards time and intensity. It can also be used in a much greater number of diseases than the hot-air room of the Turkish bath.

The finishing treatment on leaving the cabinet is identically the same as that for the ordinary Turkish bath.

Indications for Its Use.—While the electric-light bath is not a complete substitute for sweating produced by exercise, it comes nearer to that than any other heating procedure, and, when followed by some vigorous cold application, it possesses a hygienic value which cannot be overestimated.

It is especially valuable in cardiac disease and diabetes. It stimulates oxidation, and is thus valuable in obesity and the toxemia of chronic dyspepsia; also in malarial cachexia, syphilis, neuritis, neuralgia, sciatica, habit chorea, hysteria, rheumatism, and anemia.

It is superior to all other treatment in chronic rheumatism and all diseases dependent on uric-acid diathesis or diminished metabolism, by the combined action of the elevation of temperature and the vigorous cutaneous activity. The elevated temperature stimulates the oxidation of the proteid wastes and augments vital combustion, while the increased skin activity carries off all waste-products prepared for elimination.

As a prophylactic, this form of bath is especially valuable for all persons leading a sedentary life; it is the best substitute for exercise in the open air, and, where there are no contraindications to its use, should be taken once a week.

In cases of obesity, sweating may be used to reduce the weight; but, in order to obtain the best effects, it must be combined with exercise, and it must be borne in mind, that in obesity there is great danger of overheating the blood, in consequence of the obstacles to heat elimination presented by the thick layers of non-conducting fat. Therefore, these hot applications for the reduction of fat should never be too much prolonged, and the bath should always be finished by vigorous applications of cold. These cold applications have also a tonic effect upon the nervous system, and increase the muscular disposition for exercise, and this is the most rational treatment for obesity.

Loss of Weight.—There are many cases in which metabolism has been so sluggish, allowing an accumulation of imperfectly oxidized matters in the body, that the first active stimulation of the nutritive processes is in disproportion to the increased destructive metabolism. Under these circumstances there is necessarily a decrease in weight. The rubbish must first be removed and old defective structures before new and highly organized tissues can be deposited. A slight loss of weight need, therefore, give rise to no apprehension, but if the loss is considerable, or continues for some time, especially if accompanied by loss of strength or appetite, it is a matter for investigation.

Palpitation of the heart and fulness of the head are an indication that the applications have been too hot or too long continued. Vertigo and fainting are apt to occur when hot applications have been continued too long, but they are quickly relieved by cold applications, especially by cold affusions to the chest and shoulders. Headache may result, either from excessively hot or cold procedures. Deficient reaction is generally the result of a too prolonged application of cold.

On entering the electric-light cabinet, a wet towel wrung out of ice-water is placed around the neck and another around the forehead; or an ice-bag may be placed on the top of the head.

The Douche.—A douche consists of a single or multiple columns of water directed against some portion of the body. The apparatus is complicated, and it is essential that an accurate pressure-gauge and thermometer should be introduced into the circuit of the douche. It can only be properly administered in a hydriatic establishment. In the employment of the douche three factors must be considered—the temperature, pressure, and the mass.

The range of temperature employed varies from 45° to 125° F. The pressure ordinarily employed varies from 10 to 60 pounds. The mass varies according to the effect desired, and may be regulated by means of the finger, placed in the water column near the nozzle.

The douche is applied by means of the rubber hose, which is connected at its proximal end with the water-supply, and at its distal end is attached a nozzle, the average diameter of which varies from 2 inches to ⅜ inch. From these a fine or coarse jet or a fan douche may be produced. The latter is formed by placing the index-finger of the hand holding the nozzle upon the lower border of the outlet, producing an expansion of the otherwise solid jet into a fan-shaped stream.

The mechanical effects of the douche are derived from atmospheric pressure, and this is of more importance in the effects produced than the temperature.

The Scotch douche consists of alternate streams of hot and cold water. The general cold douche is the most powerful of all the tonics; the warm or neutral douche is sedative; the very hot douche is frequently followed by atonic reactions.

Rationale of the Douche.—The douche is a thermic massage. Since the douche is a sorbefacient of pathologic products, the French have availed themselves of its use to aid the body to throw off an excess of uric acid, fatigue toxins, etc.

It has been demonstrated that a rain douche of 50° F., under a pressure of two atmospheres, increases threefold the work that the muscles are capable of doing, while the Scotch douche, oscillating between 98° and 53° F., doubles the working capacity of the muscles. Even tepid douches increase the working capacity of the muscles, while a tub-bath of the same temperature is without decided effect. The pressure under which the douche is given adds a powerful element, which is absent in other hydriatic procedures. The percussion and vibration affect the vasomotor system much more powerfully than any form of still bathing.

The power and action of the heart are greatly improved by the use of the douche, the capacity of the lungs is increased, and the digestion is improved.

Brief douches of from ten to fifteen seconds generally act better than those of longer duration. The general condition of the patient must always be carefully studied, and, like the Turkish bath, the douche should always be taken under the direction of a physician, as they are also capable of doing a great amount of harm as well as good. The best results from the douche are obtained when it is taken following the use of the electric-light bath.

The neutral douche is particularly applicable in cardiac affections and in cases of high arterial tension. The sensation afforded should not be either that of hot or cold, and the duration from one to two minutes. The douche for this purpose should be given with only a slight degree of pressure, and to avoid irritation it should be directed to either side of the spinal column. This is a sedative application.

Contraindications for the Use of the Douche.—In all acute inflammations and in eruptive disorders of the skin. The cold douche is contraindicated in inflammation of the uterus, ovaries, kidneys, stomach, liver, bowels, and bladder, in intestinal catarrh, chronic inflammation of the stomach, and general neuritis. It must also be avoided in rheumatism, arteriosclerosis, cardiac insufficiency, valvular diseases of the heart with deficient compensation, fatty degeneration of the heart, and in cases of extreme nervous irritability.

The Internal Use of Water.—The internal use of water is essential to life. Water constitutes about two-thirds of the body weight; it is found in every tissue and organ of the body; it acts to dilute the foods so that they can be absorbed from the digestive tract; its presence in the blood is essential, both to carry foods to the tissues and to convey the waste matter away from the tissues. Its use in the form of a lavage is even more necessary, to keep clean and free from impurities the mucous membrane lining the 30 feet of the digestive canal and the tubules of the kidneys than is the external use of water to keep the skin in a healthy condition. Its use is also needed to keep the blood-pressure and the heart in a normal condition.

About 4½ pints of water are given off daily in the excreta and exhalations; but, since about one-half of the solid foods taken consist of water, 3 pints of water, taken daily as such, are sufficient to counterbalance the loss.

All water for drinking purposes should be filtered. The best method is to have a filter attached to the pipes of the house-supply, so as to insure filtered water running from all the spigots.

If the water is not filtered, it should be boiled for thirty minutes. The water should be run off in the morning, then poured into a well-kept tea-kettle and boiled. It is then allowed to stand and become partially cooled in covered vessels, when it is poured into large bottles—quarts are the most convenient size; these should be stoppered with corks of absorbent cotton. When cool, the bottles are placed in the refrigerator beside the ice. Water should be boiled every morning for the twenty-four hours. Boiling for this length of time secures the destruction of all the germs of disease, and it is doubly essential on the return to town in the fall, when the house has been closed for some time; also when typhoid fever in the neighborhood indicates the strong possibility of the impurity of the water-supply.

The mistake should not be made of undoing the good that has been done by boiling the water by the addition of ice to the water when it is placed on the table. Furthermore, ice-water is so cold that it retards and interferes with the digestive processes.

In the internal use of water the same marked difference is caused by the different temperatures at which the water is taken, as was seen in the external applications of water; but, while the temperature of the skin is about 90° F., that of the mucous membrane lining the digestive tract is 98.6° F. and above.

The Action of the Internal Use of Water on the Heart and Blood.—Water improves the quality of the blood, both by its direct action on the constituents and by the increased elimination of waste-products. By the increase of the volume of blood, a more energetic contraction of the heart is caused, and the activity of all the glands of the body is increased. There is a greater amount of oxygen absorbed by the lungs; oxidation in the tissues is carried on more perfectly, the result of which is that there is a diminution or absence of the products of incomplete combustion in the body, such as uric acid, the oxalates, etc.

By the increase of the blood-pressure, caused by drinking water in sufficient quantities, the activity of the kidneys is increased, and this not only in the amount of urine passed, but also of the solid constituents, which are the waste-products, removed from the body through the agency of the kidneys.

The Action of Water on the Digestion.—Very little water is absorbed from the stomach; it passes from the stomach to the intestines, where it is absorbed. In order to obtain a thorough cleansing of the stomach, and at the same time not to cause its overdistention, not less than ½ pint of water and not more than 1½ pints should be taken at one time. The water must be taken one hour before meals, in order to insure its removal from the stomach and the proper rest of that organ before food enters it, as it has been found by actual experiment that in a quarter of an hour after water had been taken one-half of the quantity remained in the stomach, but that none remained after the lapse of half an hour. Cold water is more quickly absorbed than warm, and the absorption is hastened by the presence of carbonic acid, while salt of any kind delays its absorption.

The Therapeutic Indications for the Use of Water.—First, the temperature of the water taken must be regulated by the effect desired. Briefly stated, if the water is taken for dyspepsia in any form, whether acute or chronic catarrhal inflammation of the stomach or the intestinal canal, ½ pint of water, just as hot as it can be sipped with a spoon, should be taken three times a day, one hour before each meal.

No water should be taken during the meal, and only one glass, at a temperature of about 60° F., on its completion.

If the water is taken as a diuretic, or, in other words, to increase the activity of the kidneys, the most of the water should be taken in the morning on rising and the remainder about 4 o’clock in the afternoon. Probably the best natural waters for this purpose are the waters of the Vosges, France. The Vittel water, “Grande Source,” acts on the kidneys alone; where the bowels are regular or inclined to be loose, this is the best water to use. If, on the contrary, there is constipation or biliousness, the “Source Salée” should be taken in connection with the first named or alone. The “Source Salée” has a decided action on the liver and is laxative.

In order to obtain a pronounced effect, at least 3 pints of these waters should be taken daily; in some cases more is required. Two glasses may be taken on rising in the morning, with an interval of twenty minutes between; the last glass must be taken one hour before breakfast. The temperature of the water should be 50° F., which is the temperature of the water at the springs and that of the water when placed in bottles in the refrigerator against the ice. In the afternoon the other two glasses may be taken, with the same interval between.

In gastric catarrh, where there is an accumulation of mucus or fermenting matter, with or without nausea and vomiting, hot water alone is useful. In addition to its action in diluting the contents of the stomach and the intestines, and its cleansing and antiseptic effect on their mucous membranes, the reflex effect of very hot water, slowly sipped, is a stimulation of their muscular coats, which furthers the passage of the digested food from the stomach into the intestines. The quantity taken must be from ½ to 1 pint, in order to obtain a thorough cleansing and yet not to cause an overdistention of the stomach.

In acute nephritis, inflammation of the kidneys, small quantities of very cold water, repeated at half-hourly intervals, act as a diuretic. Care must be had, however, not to overtax the stomach and heart by overfilling the system with fluids.

In obesity, water-drinking is essential as a means of dissolving and carrying out of the body the large amount of broken-down material which results from the increased tissue destruction caused by exercise, hot and cold baths, and other means employed to decrease the weight.

For constipation and biliousness two glasses of cold water should be taken before breakfast, with an interval of twenty minutes between, the last glass being taken one hour before breakfast.

Contraindications.—Cold water taken into the stomach produces more marked effects than water applied to an equal area of the skin. The quantity of water taken is a factor as well as the temperature. Cold-water drinking lowers the temperature and slows the pulse, so that drinking cold water must be strictly prohibited when one is in a state of fatigue, whether perspiring or not. Feeble persons should not drink cold water, except in very hot weather, or just before starting out for a brisk walk in the open air, or when about to engage in other exercise. With the air of the room at 70° F., a woman in fair condition, moving about making her toilet, may safely drink cold water slowly, except when there is a feeling of chilliness. In the latter case, the powers of reaction being diminished, chill and internal congestion, often resulting in great injury, may be produced. Cold-water drinking is always prohibited when in a state of fatigue. Ice-water should never be taken. When taken with meals, it greatly retards digestion and may do much harm.

Enemas.—Coloclysters.—Another valuable internal use of water is for emptying the lower bowel, and washing out the large bowel in cases of catarrhal inflammation.

For constipation, in which the object is to unload the bowel as quickly as possible, 1 or 2 pints of water, at a temperature of from 104° to 110° F., is made into a suds by means of Castile or other good soap, and poured into a fountain-syringe. If the enema is being given by an attendant, the patient lies on the right side in the Sims’ position; the under leg is stretched out so that it forms a straight line with the trunk, while the upper leg is sharply flexed at the knee, so that the foot is opposite the knee of the under leg; the right arm is thrown back from under the body.

If the patient is administering the enema to herself, the best position is the knee-chest. In this the patient kneels on the floor, the thighs are held rigid, and while the shoulders are brought to touch the floor, the face is turned to one side. The position can only be taken satisfactorily with the corsets and all tight bands around the waist removed. In this position gravity causes the intestines to fall upward toward the waist, and the water naturally follows this course. In this position the water goes up higher, and is retained longer, than when taken in the other positions. Two pints of the soap-suds are prepared at the proper temperature, and the patient uses as much of this as she feels that she can retain. The water should be retained from five to ten minutes, to get the best results.

For the purpose of washing out the large intestine more water is used, but not more than 2 quarts should be used for this. The position of the patient and the temperature of the water are the same. But for this clyster, instead of adding soap to the water, cooking salt is used, in the proportion of 1 teaspoonful of salt to 1 pint of water.

This lavage of the intestine removes rapidly large masses of decomposing material, swarming with microbes and ptomains and the toxins produced by them. It also increases the activity of the portal circulation.

In cases of chronic constipation there are atony and dilatation of the colon, and the patient always carries about with her an enormous accumulation of fecal matter, and lives in a state of chronic autointoxication. In this class of cases the coloclyster should be administered daily for from two to three weeks; if need be, so long as the patient complains of gaseous distention and fetid flatulence. After the discharge of the warm water, 1 pint of cool water should be introduced, beginning with a temperature of 85° F., and gradually decreasing this from day to day until 70° F. is reached. This water should be retained if possible; it acts as a tonic bath for the colon.

Care should be exercised to avoid the distention of the colon by an excessive amount of water, and, after the colon has been thoroughly cleansed, the amount of water used should be decreased from day to day, until finally only 1 pint is used. Warm water is always relaxing, whereas cold water stimulates and tones up the bowel. If the quantity of water used is small, the cold coloclyster may be used indefinitely without producing constipating effects.

Great care must be used to avoid the introduction of air into the bowel with the water; to this end the water is allowed to run out of the nozzle before its introduction into the rectum. A small-sized nozzle should always be used, and this should be lubricated with vaselin or some other emollient, in order to prevent irritation of the mucous membrane.

Vaginal Irrigations.—To be of any service the vaginal douche should be taken in the horizontal position. It may be taken on the bed, couch, or lying on the floor. When taken on the floor, a heavy rug or steamer blanket should be doubled four times, and two pillows are used: the under one goes up and down for the support of the back, while the second is used for the support of the head. A douche-pan is, of course, indispensable. The agate pans holding 4 quarts of water are the most serviceable. The douche-pan is placed against the lower edge of the under pillow, which is protected by a bath-towel. The woman must throw a heavy shawl or blanket over herself while taking the douche, otherwise there is great danger of becoming chilled, and thus doing actual harm instead of good.

The most common and best form of syringe is the fountain-syringe. This is hung about 6 feet above the bed or floor. It should hold 4 quarts of water; this quantity of water is necessary when the douche is given, as it most commonly is, for pelvic inflammation. On beginning its use, the temperature of the water must be controlled by the sensitiveness of the patient; generally one can use a temperature of at least 112° F., but not always; sometimes one must be content with a beginning temperature as low as 104° F., gradually increasing the temperature by two degrees every few days, until from 114° to 120° F. is reached. The use of a bath thermometer is always essential to test the temperature of the water. The temperature of the douche should never go above 120° F., or actual harm will be done.

On lying down, the lower part of the body rests on the broad strip of the douche-pan, the nates coming over the edge, and the clothing well pushed up, otherwise the water will seep up the back.

The water acts as a hot poultice about the uterus and its adnexa; it is also astringent, and greatly relieves ovarian irritation and congestion. It is highly sedative, and is best used at night just before retiring. In severe cases better results will be obtained by its use twice daily. In that case one douche must be taken in the morning, but in cold weather it must never be taken immediately before going out-of-doors; there must be at least one hour between the time of taking the douche and going out into the cold air. Patients taking hot douches must be warned that the pelvic viscera are much more susceptible of chilling because of these heating procedures, and of the necessity to counteract this tendency by the wearing of woolen abdominal bands, both night and day.

Ordinarily, plain hot water is all that is necessary to use, but if the vaginal discharge is irritating, one teaspoonful of borax may be added to the pint of water; or one teaspoonful of cooking salt; or one-half teaspoonful of the sulphate of zinc.

Douching the Ear.—This procedure is made use of to remove impacted ear-wax or to relieve the pain of earache. A small fountain syringe should be used, hung not more than 3 feet above the head. The water should have a temperature of from 105° to 110° F. The nozzle must be small, and have a very fine opening, and great care must be used in its introduction not to allow the nozzle to enter beyond the external opening of the ear. A pus-basin or small dish may be used to protect the clothing from getting wet. After the procedure is finished, the ear is dried by means of a very fine handkerchief or a little absorbent cotton.

CHAPTER III
THE CARE OF THE SKIN AND ITS APPENDAGES

The Complexion; the Action of the Bath in Health; the Proper Time to Bathe; the Care of Wash-cloths; Cleansing the Face; Protection of the Face; the Use of So-called Cosmetics for the Face; Facial Blemishes, Freckles, Liver Spots, Sallow Complexion, Pimples, Acne, Eczema, Wrinkles, and Their Treatment; the Relation of Diseases of the Skin to Internal Disorders.