REFERENCE BOOKS

"The Practice of Medicine," Osler.

"Essentials of Medicine," Emerson.
"Measurement of Intelligence," Terman.

"Invalid Occupations," Tracy.

"Occupation Therapy," Dunton.

"Book of Indoor and Outdoor Games," Kingsland.

"Indian Basket Weaving," Navajo School of Indian Basketry.

"The Mind that Found Itself," Beers.

"The Education of Self," Dubois.

"The Influence of the Mind on the Body," Dubois.
"Heredity in Relation to Eugenics," Davenport.
"What Men Live By," Cabot.

Hydrotherapy

CHAPTER XIII

HYDROTHERAPY

the treatment of disease by means of water is very largely employed as a therapeutic measure in nervous and mental diseases. Water has long been valued as a nerve stimulant, sedative and general tonic. It is given internally, and applied externally in many forms, baths, sprays, ablutions, affusions, packs and douches. It is applied at temperatures ranging from hot to cold, and under pressure. The application of water which is of the same temperature as the skin (about 90° F.) produces no effect. It must be several degrees colder or warmer to produce a therapeutic action, and this is directly dependent upon the difference in temperature.

When first applied to the surface of the body, cold produces a blanching of the skin. This is a reflex action, - the sensory nerves of cold are stimulated, the impulse is conducted to the vasomotor centre where it in turn stimulates the vasoconstrictor nerves which contract the muscles in the walls of the arteries, thereby diminishing their size and decreasing the amount of blood in the capillaries. This raises the blood pressure, makes the heart beat stronger and increases the amount of blood in the deeper structures. The respirations at first are gasping, but soon become more prolonged and deeper. When the cold is removed the blood vessels dilate and quickly fill with blood (vasodilatation) an action which takes place when the inhibitory control of the vasoconstrictor nerves is diminished. The skin becomes red and glowing, and there is a pleasurable sensation of warmth, which induces calmness and a feeling of wellbeing. This is termed the reaction, and is evidence that

active circulation has been restored. The degree of cold and the duration of its application must be determined by the ability of the patient to react. Some persons cannot react, and general treatments should not be given. When there is prolonged shivering, chattering of the teeth, cyanosis of the lips, and a weak, thin pulse, the treatment is not well taken, and heat and friction must be applied at once to bring about a reaction, for a dangerous congestion of the viscera may result.

Heat is one of the most powerful stimulants, but it may become a depressant if its action is too much prolonged. When applied to the skin the first effect is a constriction of the cutaneous vessels and a diminished supply of blood in the capillaries, but this is rapidly followed by vasodilatation with reddening of the skin and a lowering of the blood pressure, a condition which persists as long as the heat is applied. It also has valuable sedative action. The dilatation of the cutaneous vessels diminishes the supply of blood in the brain and other organs and deep structures, nervous and muscular energy are decreased, and a feeling of languor is produced. When its application is prolonged, the excretory glands of the skin are stimulated, perspiration is induced, the body temperature is elevated, the heart action becomes more rapid and the respirations are increased. If the treatment is too long continued collapse may follow.

Water under pressure is applied by means of hose and nozzle, and the effect of the forcible impact against the muscles and tissues is similar to that of massage. Water applied in this manner is a strong stimulant, an eliminative and a sedative.

Douche treatment. Many hospitals have a department of hydrotherapy under the direct supervision of nurses who have received special training in this branch of therapy. It usually consists of a dressing-room in which are located the hot air and electric light cabinets, a wet room which is equipped with a control table, shower and sitz baths, and a quiet room provided with cots or tables where the after

treatments and massage may be given. From the control table the operator regulates the temperature and the pressure of the water, and also the form in which it is applied. Some of the more common forms are: Jet douche, in which a small stream is directed under pressure; circular douche, in which the water strikes at an angle and the patient turns slowly around; the Scotch douche, in which hot and cold water are alternately applied; the rain douche, in which the stream is directed from above; and the fan douche produced by placing the finger over the outlet of the nozzle.

The form of treatment and the duration are usually prescribed by the physician. Before the treatment begins the pulse and blood pressure, both systolic and diastolic, are taken and recorded on the hydriatic chart. The patient is then undressed and placed in the cabinet to become thoroughly warmed; ice compresses are applied to the head, water is given freely to drink and the pulse is taken frequently. After about five minutes, or when perspiration begins, the patient is removed, wrapped in a sheet and quickly placed in position for the douche treatment. This usually consists of:

Circular douche (C. D.) 2 minutes 105° F. to 90° F. at 20 pounds. Jet douche (J. D.) 1 minute 100° F. to 80° F. at 20 pounds. Scotch douche (S. D.) 20 seconds 105° F. to 80° F. at 20 pounds. douche (F. D.) 10 seconds 65° F.

Fan

The minimum temperatures are reduced one degree or more daily until 60° F. to 55° F. has been reached. The pressure may be started at ten pounds and increased gradually to twenty pounds or until the maximum which the patient can stand has been reached.

The patient is dried, using rough towels and friction, wrapped in a sheet or blanket, and allowed to rest. The pulse and blood pressure are again taken and recorded. The reaction is also recorded on the chart.

Ablution is one of the simplest forms in which water may be applied. Have ready a rubber sheet, two bath blankets, towels and basin of water at a temperature of 50° to 60° F.

Remove the bedclothes and cover the patient with a bath blanket; slip the rubber sheet covered with a bath blanket under the patient, to protect the bed; remove the gown; expose a part of the body, and apply the water from the hollow of the hand, or by means of a bath mit; rub vigorously for one or two minutes, applying more water as needed, and dry with a coarse towel. Repeat this procedure until the whole body has been gone over systematically. This treatment is given for insomnia, and will usually bring about quiet, restful sleep.

Affusion. The patient sits or stands in a bath tub. A sheet is placed around the body under the arms, and water at a temperature of 50° to 60° F. is poured from a pitcher for fifteen to twenty seconds. The patient is then rubbed with coarse towels until reaction is obtained.

This treatment may also be given to a patient in bed. The upper covers are removed and the patient covered with a blanket and the gown removed. The mattress is protected with a large rubber sheet of sufficient length to form a drain at the foot, or two smaller rubber sheets may be used by overlapping their edges. The side edges of the sheet are rolled to prevent the water from draining on to the floor, and the edges of the lower end are rolled to form a drain through which the water will flow into a pail or foot tub placed at the foot of the bed. A sheet folded lengthwise, dipped in water 50° to 60° F., is then slipped under and folded about the patient. The head of the bed is elevated and water at a temperature of 50° to 60° F. is then poured over the patient from a pitcher, beginning at the left ankle going up the side to the shoulder, across the chest and down the right side. Friction may be given over the sheet and more water applied. The patient may be dried at once with coarse towels, or may be covered with a bath blanket and allowed to remain in the sheet for ten minutes.

Baths may be given locally, full tub, half tub or continuously. For a cold bath or plunge the tub should be filled two thirds with water at 60° F. The patient is im